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Diabetes CDE Preparation Course Level 2 Certificate Program This three-day program builds on the information learned in Level 1. Pharmacists will be provided with information to prepare them to write the Canadian Diabetes Educator Certification Board's CDECB ; , Certified Diabetes Educator Examination to obtain the Certified Diabetes Educator CDE ; designation. A variety of educational formats will be used to provide participants with a review of practical information on the management of diabetes, with special emphasis on education theory and processes critical to patient education. After successfully completing the program, pharmacists are able to provide diabetes-related specialized pharmacy patient care services. Prerequisite: Diabetes Patient Care Level 1 Certificate Program. Availability: Fall Winter 2007 Toronto Asthma and COPD Patient Care CAE CRE Preparation Course This multi-day program prepares pharmacists to write the Canadian Network for Asthma Care examinations and become credentialled as a Certified Asthma Educator CAE ; or Certified Respiratory Educator CRE ; . A number of teaching strategies, such as didactic sessions, device workshops, interactions with standardized patients and case discussions, are included to accommodate participants with varied learning styles. The following topics are covered: pathophysiology, diagnosis, asthma triggers and prevention, treatment guidelines, devices, asthma action plan, patient education learning styles and teaching methods ; and community resources. Availability : Fall Winter 2007 Toronto, for instance, lasix im.
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Extracolonic malignancies associated with HNPCC include gastric, small bowel, hepatobiliary, endometrial, ovarian, ureteral and renal tumors. By far, endometrial carcinoma is the most common of the extracolonic malignancies, presenting in at least one member in 50% of the pedigrees.12 Genetics HNPCC patients develop polyps at the same rate as the general population. Once these polyps develop, however, defective DNA repair ensues and mismatches accumulate. Thus, it takes only 3 to 5 years to develop carcinoma from polyps in HNPCC patients. HNPCC can be considered a disease of tumor progression, whereas, as addressed earlier, FAP can be thought of as a disease of tumor initiation.10 Four mutations have been identified in HNPCC. They occur in genes involved in the repair of various DNA mismatches that occur with replication. In turn, they are named DNA mismatch repair genes. The four genes are hMSH2 chromosome 2p16 hMLH1 3p21 hPMS1 2q31 ; and hPMS2 7q11 ; . Ninety percent of HNPCC gene mutations are mutations of hMSH2 and hMLH1.7 Testing First, the DNA of the tumor itself is tested for evidence of microsatellite instability, which are repeating base sequences of unknown function. If found, the phenotype is termed RER + replication error positive ; . The test costs approximately $350.12 About 80% of HNPCC tumors are RER positive.2 If the tumor is RER + , one then proceeds to gene testing of the affected individual. Commercial testing is available only for hMSH2 and hMLH1 mutations. Both protein truncation assays and gene sequencing are available. These tests carry a 50%95% sensitivity and cost about $750 - $2600.12 Genetic tests are positive in up to 70% of HNPCC families.7 Again, one must discover a mutation in the affected individual before testing other family members. Screening Screening recommendations include annual colonoscopy, starting at age 20. Flexible sigmoidoscopy is not acceptable, due to the proximal location of the tumors.8 Other recommendations include transvaginal ultrasound and endometrial aspiration annually, starting at ages 25-35 years.7 Urine cytology and CA125 levels can be added as useful, inexpensive screening tools. If an at-risk individual is found to be mutation positive, the above guidelines are followed. There is controversy as to whether the mutation positive individual should undergo prophylactic colectomy, or colectomy when polyps become present. A mutation negative at-risk family member could possibly begin colonoscopic screening at a later age, with screening intervals lengthened. At present, there are no strict guidelines as to screening recommendations based on genetic testing.
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