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May 1, 2015 | Original Research 

Wii Fit™ Age in Older Adults Undergoing Total Hip Arthroplasty: A Preliminary Study

D. Paluzzi, S. Lalonde, G. Wood

ABSTRACT:

Background: Wii Fit has potential applications in rehabilitative and preventative medicine; however, the prognostic value of the Wii Fit Age (WFA) parameter has not been explored. WFA is derived from the player’s weight, height, age, and balance scores. This study assesses changes in WFA in total hip arthroplasty (THA) patients as a gross estimate of hip function.

Methods: THA participants were aged ≥50 undergoing THA with no experience using Wii Fit. The control group met identical criteria without hip pathology. Both groups were assessed at 3 temporally spaced sessions. Each session consisted of a baseline Wii Fit Age (WFA1) assessment, followed by 3 Wii Fit Exercises (Soccer Heading, Penguin Slide, HulaHoop) and then a post-exercise Wii Fit Age assessment (WFA2). Past medical history and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) were completed.

Results: Seventeen participants were recruited for the study (8 THA group and 9 control). Five THA participants were lost to follow-up by Session 3. WFA1 decreased across sessions for both THA and control groups, but the decrease was not significant. WFA2 was consistently lower than WFA1 for both groups. There were no significant inter-sessional differences in WFA1 or WFA2 for either group. Multiple regression analysis revealed WOMAC scores were never a significant predictor of WFA for either group at any time. There were no significant differences in Soccer Heading or Penguin Slide scores between or within groups. Scores for Super Hula-Hoop were significantly higher in the control group in Session 1 (p=0.042) but not in Sessions 2 or 3 (p=0.792; p=0.105).

Conclusion: This pilot study does not support the use of Wii Fit Age nor any of the undertaken exercises as definitive prognostic tools. Further research with larger cohorts is needed.

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May 1, 2015 | Original Research 

Dose Escalation for Prostate Cancer: Quality Assurance at a Regional Cancer Centre

R.F. Stephens, D. Gopaul, S. Xu, B. Hill, A. Costa

ABSTRACT:

Purpose:To evaluate the freedom from biochemical failure (FFF) and acute toxicity for patients with prostate cancer treated with curative intent radiotherapy (RT) at Grand River Regional Cancer Centre (GRRCC) from 2007 to 2012 inclusive.

Methods and Materials: A retrospective review of electronic patient charts at GRRCC was conducted, and 246 prostate cancer patients receiving curative intent radiotherapy between the years 2007 and 2012 were identified. The median follow-up was 24 months (2007-2012). Contingency tables, logistic regression, and actuarial analysis were used to compare the incidence of biochemical failure (BF = prostate specific antigen [PSA] of nadir + 2 ng/ml) and the incidence of combined gastrointestinal (GI) and genitourinary (GU) acute toxicity symptoms ≥ Radiation Therapy Oncology Group (RTOG) grade 2 in low-dose (<78 Gy) and high-dose (78 Gy) groups.

Results: Contingency tables showed that there was no significant association between dose group and acute toxicity symptoms ≥ RTOG grade 2, but there was a significant association between dose and biochemical failure (P = 0.03), with 11.5% in the <78 Gy group and 4.2% of patients in the 78 Gy group experiencing BF. Logistic regression supported these conclusions: the 78 Gy group had reduced odds of experiencing BF (P = 0.04); the patients in the <78 Gy group had 5.8 greater odds of experiencing BF compared to the 78 Gy group. Actuarial analysis for the rate of BF revealed a nonsignificant difference between the <78 Gy and 78 Gy groups.

Conclusion: There has been a gradual adoption of dose-escalated RT for the treatment of prostate cancer patients at GRRCC from the years 2007-2012 inclusive. Analysis of biochemical failure rates and rates of toxicity suggests a moderate improvement in biochemical failure corresponding to dose escalation, without any increase in the incidence of acute GU or GI toxicity

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May 1, 2015 | Clinical Review 

Lung Cancer Screening: A Clinical Review

R. Shergill, S.A. Kennedy, D. Chetan, S.B. Nair

ABSTRACT:

Lung cancer is a predominant cause of cancer-related morbidity and mortality. Early detection of lung cancer can result in much better outcomes. Thus, there is widespread demand for the development of a screening program to identify lung cancer in chronic smokers. Clinical trials and meta-analyses were compared in order to evaluate the
utility of screening interventions. Initial trials using chest radiography and sputum cytology screening did not reveal a significant improvement in mortality outcomes.

The National Lung Screening Trial (NLST) was the first to demonstrate a significant reduction in the relative risk of death among subjects who were screened with low-dose computed tomography (CT) compared to chest radiographs alone (RR 0.8, 95% CI 0.70 to 0.92). The NLST has sparked significant interest because it showed the potential benefit of a useful screening program that could be implemented on a large-scale. With a common goal towards reducing lung cancer-related mortality, clinical trials further exploring CT screening have started globally. The results of these trials, along with further studies, are necessary to determine which patient subgroups will benefit most from
screening with low-dose CT.

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May 1, 2015 | Clinical Review 

Transplant Therapy for Parkinson's Disease: Triumphs and Challenges in Clinical Research

L. Dolomount

ABSTRACT:

Parkinson’s disease (PD) is a progressive neurodegenerative disorder resulting from the depletion of dopaminergic neurons of the midbrain. The dopamine precursor levodopa (L-Dopa) is often prescribed as the first line of treatment to alleviate symptoms. Extended L-Dopa therapy is associated with significant side effects that impact quality of life. The search for a treatment that targets the etiology of PD has lead to clinical trials of cell transplant therapy aimed at regenerating a functional dopaminergic midbrain. The appropriate cell type to use for PD transplant therapy is under investigation. The optimal cell type will have a minimal risk of tumorogenicity and will not require the use of
immunosuppressive agents, while having the potential to show significant benefits in motor functioning and quality of life. Clinical trials have shown cell transplant therapy to be a safe intervention that can be tolerated well by patients. Sham-surgery clinical trials demonstrate a significant placebo effect and show a need for more double-blind controlled clinical trials in this field.

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May 1, 2015 | Commentary 

Piliriqatigiingniq: Working Together to Stop Tuberculosis in Northern Canada

A. Bresnahan

Every clinical story has a social story. It is Christmas, and I am visiting friends and family in my hometown, an Inuit community on the north coast of Labrador. Packing my computer into my favourite gift, a sewn sealskin case, I explain that I am heading up to the school to write about tuberculosis (TB). “There’s lots of TB here”, one of my friends shares, and she’s right. In 2009, Nunatsiavut experienced its third TB outbreak of the decade, with incidence rates peaking at 550 new cases per 100,000 people...

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May 1, 2015 | Commentary 

Tipping the Scale: Reframing Maternal Obesity as Obesity Commentary

Claire F. Woodworth BSc, BA, MA

In June 2014, the American College of Obstetricians and Gynecologists published a Committee Opinion for physicians on the ethical treatment of obese women.1 The six-page document directs physicians to care for obese women according to the basic
concepts of ethical medical treatment such as respect for autonomy, nonmaleficence, beneficence, and justice. Because all patients should be treated with compassion and without bias, it is interesting that the American College is compelled to remind physicians of the guiding principles of ethical medical treatment in the case of obese women...

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May 1, 2015 | Commentary 

Lessons Learned from the Lucky Iron Fish Project

Christopher Charles PhD

I moved to a fishing and farming village in rural Cambodia in the summer of 2008. I was supposed to stay for three months; I ended up staying for six and a half years.

After finishing up my undergrad training I received a government grant to support a research project of my choosing somewhere in the developing world. My funding allowed me to partner with a local nongovernmental organization that was already established in the region. Although the majority of their work focused on water and sanitation, the links to anemia and poor nutrition (intestinal parasites picked up as a result of open defecation in fields can lead iron deficiency) were evident to all. And so, I was brought on board to investigate just how problematic anemia truly was in these communities.

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May 1, 2015 | Case Report 

The “Atypical Sore Throat” – a Pediatric Case of Lemierre’s Syndrome

Hannah Geddie

Suppurative jugular thrombophlebitis otherwise known as Lemierre’s syndrome is a life-threatening diagnosis. Previously referred to as “the forgotten disease”, the syndrome manifests with such common symptoms as fever, sore throat, and lymphadenopathy. For this reason, it is often misdiagnosed.

Lemierre’s syndrome was first characterized by Dr. Andre Lemierre in 1936 with his report of 20 cases published in the Lancet. The disease typically begins with an oropharyngeal infection and subsequently develops into septic thrombophlebitis...

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May 1, 2015 | Clincal Quiz 

Internal Medicine: Diagnostic and Management Considerations

Aashish Kalani BHSc

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May 1, 2015 | Clincal Quiz 

Dermatology: What’s Your Diagnosis?

Seema Agarwal CPA, CA, Nisha Mistry MD, FRCPC

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May 1, 2015 | Book Review 

How We Do Harm, A Doctor Breaks Ranks About Being Sick in America

Jason Kinnin

How We Do Harm: A Doctor Breaks Rank About Being Sick in America
by Otis Webb Brawley, M.D., with Paul Goldberg. St. Martin’s Griffith; US, October 2012.

This book is a non-fictional piece written by Otis Webb Brawley, who is the chief medical officer and vice president of the American Cancer Society. In this book, Otis Webb Brawley revisits his past cases, experiences, and memories, from since he was a child up until the present day. He does this in order to point out the many faults in the American health care system. Specifically, he wants to make the point that sometimes doctors “Do Harm” rather than good, whether this is intentional or not. The problems that he brings into focus relate to the care that unlucky citizens without health insurance are forced to receive as well as the corruption of several doctors who take advantage of those patients who have health insurance. Additionally, he proposes some examples of ways to try to repair the broken health care system.​

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