Session descriptions

Session Descriptions


Amputee SIG


Osseointegration: an update of the situation around Canada.
Moderators: Dr Ariane Rajotte-Martel, Dr Amanda Mayo


Stroke SIG


VR and Stroke
Speaker: Hillel Finestone

Virtual Reality Demonstration
Speaker: Bill Dai (CEO/VNovus)

Stroke and CBD facilitated discussion
Speaker: Jennifer Yao


Outcomes and challenges of nerve transfers in tetraplegics

Description:
The presentation will discuss the minimal data available on outcomes of nerve transfers in tetraplegics and highlight some of the limitations. Considerations for timing of surgery and staged surgery will be discussed. This session will be of value to physicians and allied health who treat tetraplegics. Information will help them answer questions from their patients regarding nerve transfer suitability.

Learning Objectives

  1. Counsel tetraplegic patients on potential functional improvements post nerve transfer
  2. Counsel patients on limitations of nerve transfer in tetraplegics
  3. Identify tetraplegics most likely to benefit from a nerve transfer

Speaker: Dr. Gerald Wolff


MedicoLegal SIG Ottawa


Goals

  1. To update colleagues on the jurisdictional variations
  2. To review interesting characteristics specific to the IME Report
  3. To bring up to date the use of today’s technology in IME work
  4. To identify a new Chair for ML SIG

Learning Objectives

  1. Who is a MedicoLegal Expert
  2. What can you Charge (a changing environment)
  3. Where can you practice (i.e. must you have a License to conduct IME’s)
  4. Use of Video in IME’s (saving time and travel)
  5. The Rebuttal Report (what to look for)
  6. The Independent MedicoLegal Report: Format and Style>

Speaker:E. Lyle Gross, MD, FRCPC, FRACP (NZ)
LyleGrossMD@grcvirtual.com


Pain SIG – CAPMR 2019

Symposium Moderator: Dr. Dinesh Kumbhare/Dr. Nimish Mittal

Symposium Title: “Herbal Cannabis in Chronic Pain Management – How do we deliver high-quality clinical care with low-quality evidence?”

Symposium Abstract: The lack of convincing high-quality evidence and well-known side effects of herbal cannabis for chronic pain has not dissuaded patients from accessing this plant. The recent legalization of cannabis for recreational use has obviated the need for physician authorization. Herbal cannabis for chronic pain management, when undertaken with little or no guidance/knowledge of product composition, pharmacology, or dose titration may increase the risk of treatment failure and harm for patients. Despite the limited evidence for efficacy pain remains the primary reason for initiating cannabis. In this context, a measured and thoughtful approach may help guide patients to the appropriate use of cannabis and in some instances provide benefit with minimal harm in patients who have failed other treatment modalities in chronic pain.
The symposium will provide the attendees with a brief overview of cannabis pharmacology as it relates to pain medicine, the extant evidence that exists for the use of cannabis and cannabinoids in pain medicine and outline the considerations of potential harm and adverse effects of cannabis use including its effect on driving and potential for cognitive impairment. Attendees will participate in practical case-based learning to explore practical tips for medical cannabis use in appropriate situations while promoting harm reduction.

Speaker 1: Dr. Amol Deshpande (1310-1330)

Speaker 1 Abstract: While there is still much debate about the indications and quality of evidence for cannabis and cannabinoids in pain medicine, the reality is that pain patients are actively using cannabis to manage symptoms. This talk will briefly review the pharmacology and evidence of cannabis while highlighting some common practical tips for instructing patients on the use of cannabis while minimize harm.

Speaker 1 Learning Objectives:

At the end of this presentation, participants will be able to:

  1. Describe the pharmacology of cannabinoids as it relates to pain
  2. Be aware of the evidence that exists for the use of cannabis and cannabinoids in pain medicine

Speaker 2: Dr. Andrea Furlan (1330 -1350)

Speaker 2 Abstract: Driving a motor vehicle is a complex task that requires attention, concentration, sensory, motor and cognitive functions. Cannabis impacts some cognitive and psychomotor skills such as learning, balance, coordination, tracking ability, memory, perception (visual, auditory, sensory and time), motor impulsivity and attention in a dose-dependent manner. At high doses, cannabis may cause hallucinations. Cannabis also causes euphoria, relaxation and facilitation of social interactions. Self-awareness of the effects of cannabis is maintained. Frequent users do not develop tolerance to the effects of cannabis. An estimated 12.3% of the adult Canadian population reported using cannabis at least once in the past 12 months, and approximately 3% use cannabis daily for medical purposes, recreational enjoyment or both.  A recent survey among young Canadians (age 18-34) showed that 23% would not plan for alternative travel arrangements (e.g. designated driver or taxi) after using cannabis , and 30% said they either drove after smoking cannabis or had been in an automobile driven by someone who had recently smoked cannabis. Detection of impairment by cannabis is not possible based on measures of Δ9-tetrahydrocannabinol (THC), 11-hydroxy-THC (11-OH-THC), or 11-nor-9-carboxy-THC (THCCOOH) in body fluids such as blood, urine, or saliva, as these levels do not correlate well with levels of sensory, motor and cognitive impairment required for driving.
Currently, detecting driving impairment includes the application of the Standardized Field Sobriety Test, which has been validated for impairments related to alcohol but not to cannabis. Roadside saliva tests using the Drager DrugTest 5000 has been legalized since the summer 2018 but many police officers are reluctant about its ability to demonstrate impairment or just recent use.

Speaker 2 Learning Objectives:

At the end of this presentation, participants will be able to:

  1. Describe the effects of THC and CBD on psychomotor function that are relevant to driving and working in safe-sensitive jobs
  2. Inform their clients about how to self-assess for impaired driving due to cannabis products

Speaker 3: Dr. Nimish Mittal (1350-1410)

Title: Practical tips for good prescribing of herbal cannabis using problem-based learning

Speaker 3 Abstract: This problem-based learning interactive session will provide practical tips on the medical use of cannabis in chronic pain management.

Speaker 3 Learning Objectives:

At the end of this presentation, participants will be able to:

  1. Identify modes of administration and dosing strategies for herbal cannabis in chronic pain conditions
  2. Illustrate titration tactics and monitoring to minimize adverse events while promoting harm reduction