In this Issue
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Congratulations |
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The CAGP Board of Directors
would like to congratulate
Dr. David Conn for his recent promotion to Full
Professor at the University of Toronto
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IN SHORT |
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Ontario Members: Long-Term Care Home Act - Implementation
Update #1
English |
French
Update #2
English |
French
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Opportunities for Geriatric Psychiatrists |
Do you have a career opportunity in the field of Geriatric
Mental Health that you would like to advertise with our
members? We invite you to send your job opportunity to us
for distribution amongst members of the Canadian Academy of
Geriatric Psychiatry. Note: position must be comprised of at
least 50% of geriatric psychiatry
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Volunteer
Opportunity |
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volunteer opportunities throughout the year. If you are
interested in getting involved or want to find more send an
email to info@cagp.ca
indicating your interest in one or more of the following
areas. Education, Communication (Websites, E-newsletter,
etc), membership, Annual Scientific meeting and /or the
Board of Directors. |
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Board of
Directors
2009 - 2010 |
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Dr. Kiran Rabheru,
President
Dr. Melissa Andrew, Vice President & Education Chair
Dr. Martha L Donnelly, Past President & Nominations
Chair
Dr. Marlene Smart, Treasurer / Secretary
Dr. Mark Rapoport, ASM Co-Chair
Dr. Rene Desautels, Sponsorship & ASM Co-Chair
Dr. Cathy Braidek, Membership Chair
Dr. Stuart Sanders, Communications Chair
Dr. Keri-Leigh Cassidy, Fundraising Chair
Dr. Karen Saperson, Director
Dr. Stephane Tanguay, Director
Dr. Dallas Seitz, Director
Dr. David Conn, CCSMH |
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Ask A Question
CAGP
website is being updated on a regular basis. A new feature is
the members only Discussion Forum providing members the opportunity to
ask questions of each other or those they consider experts. We
encourage all members to begin using this Discussion Forum — think of it
as a
Geriatric Psychiatry
Q&A. To view or post a question in the Discussion Forum, enter
your login information to access the Members-only section and then click
on 'Discussion Forum'.
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Dear Member
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Summer is fast approaching and with it many
of us will be seeing our first Residents on their 6 month rotations. On
the one hand it means more work, on the other it’s the result of being
recognised as a Subspecialty by the college of Physicians and surgeons,
just one of many accomplishments of the CAGP in the past year. This
means as you will notice in this newsletter the CPA also now accepts us
as a subspecialty. Our influence hasn’t stopped there. After the
publishing of the “Depression Among Seniors in Residential Care” paper
by the Canadian Institute for Health Information, where did the media
come to obtain a reaction? CAGP member and past president, Dr.
Marie-France Rivard. Dr Rivard spoke to various Media and the news was
presented on the CTV evening News, CanWest Media the Toronto Globe and
Mail, Canadian Press and she was also interviewed by Radio Canada
International.
The fact that CAGP is gaining importance on the national stage is
evidenced by the fact that we are being approached for linking with
other organisations via our website. The link with the Canadian Journal
of Geriatrics continues, closer working relationships with the Canadian
Geriatrics Society are developing, we have been approached by the
National Initiative for the care of the Elderly and now have direct
links from our webpage to theirs and the same is true for Seniors Canada
and their WebPages on Elder abuse. If you haven’t done so recently,
check out the links page which is slowly growing. You will note quite a
few links from this newsletter to sites we feel may be of interest. If
you know of others not listed that you think should be added, please
forward them to us for consideration. The idea is for the webpage to be
a useful resource to all members.
On that note, as always we welcome any news, updates of interest to
members at any time for inclusion in the Newsletter, please feel free to
send it in!
Lastly, an important reminder; September may seem a long way away but it
will soon be here (likely heralded in Calgary by the first snowfall of
the fall) and with September comes the CAGP Annual Scientific meeting,
this year in Toronto, planning for which is discussed in this newsletter
by Dr Mark Rapoport. Mark it in your calendars!
So, until then, on behalf of the board, make sure you have a wonderful
summer.
Dr. Stuart Sanders, Communications Chair
Associate Professor, Department of Psychiatry, University of Calgary
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CAGP News |
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REGIONAL
UPDATE: Alberta
It’s Not The Same OLD Geriatric Division in Calgary
Submitted by Dr. Suparna Madan
Division Head & Program Medical Director
Clinical Assistant Professor, University of Calgary
Geriatric Mental Health
Greetings from Calgary. Although our enthusiasm for older adults
remains strong, changes to staffing, programming and residency
rotation requirements over the past year means it’s NOT the same
OLD geriatric division.
New Recruits: There are currently 15 psychiatrists (about
9 full-time) practicing geriatric psychiatry in Calgary and we
hope to recruit one or two additional psychiatrists in the
upcoming year.
New Rotations: From November 2010 to October 2011, we
will be training one international geriatric psychiatry fellow.
This will be our second fellow since 2003-2004. From July 2010
to June 2011 we anticipate seven PGY II or III residents
completing their mandatory six month rotation and two senior
residents completing electives. The mandatory rotation will
encompass exposure to inpatients, consultations and community
outreach. Didactic teaching is included as part of the
residents’ academic half-day and residents regularly participate
in our divisional journal club and mini-review updates to
interdisciplinary staff and psychiatrists.
New Tests: With access to a PET scanner, we now have
another avenue to assess atypical patient presentations.
New Publications: Dr. Suparna Madan was invited to
contribute a chapter on ‘Therapeutic Approaches and
De-Escalation Techniques’ published in December 2009 in book
entitled “Rights, Risk and Restraint-Free Care of Older People:
Person-Centred Approaches in Health and Social Care” (edited by
Rhidian Hughes).
New Connections: From June 14-20, 2009, Alberta Health
Services hosted an International Collaborative Study Tour on
health system integration with Dr. Guus Schrijvers, Professor in
Public Health at UMC Utrecht University, The Netherlands, and
approximately 40 delegates from Europe. The primary focus was on
seniors and integration topics included the organization of the
health system in Canada and Alberta, emergency services, primary
care networks, remote service provision, Health Link Alberta and
Dr. Madan presented information on seniors mental health
services in Alberta.
New Programs: The Geriatric Mental Health Day Treatment
Services program opened as a pilot program on April Fools’ Day
2008. This program currently consists of two psychiatrists and 3
clinicians and is slowly finding a niche by helping us manage
complex patients in the community. In the last year, we also
added the Substance Abuse in Later Life (SAILL) program to our
division’s programs and addictions service delivery is an area
we hope to expand in the upcoming years.
Need for New Growth: With the growth of Calgary’s
population and the aging baby boomers, we’re in desperate need
of more inpatient beds to add to our 25 acute care inpatient
beds and 20 sub-acute beds. Currently, the majority of geriatric
mental health patients are being treated on medical-surgical
wards or adult psychiatric units across the city.
Our service delivery would also be greatly enhanced by the
addition of a mental health long-term care unit and a
dementia-delirium stabilization unit.
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CAGP Annual Scientific Meeting: From Prevention to Palliation
In collaboration with the University of Toronto Division of
Geriatric Psychiatry
Dr. Mark Rapoport, ASM Co-Chair
Associate Professor, Department of Psychiatry, University of
Toronto
September 22, 2010 at the Westin Harbour Castle, Toronto, ON
The CAGP board is pleased this year to partner with the Division
of Geriatric Psychiatry at the University of Toronto in order to
assemble a lively and interactive program focusing on aspects of
geriatric mental health from prevention to palliation. The
Division of Geriatric Psychiatry has historically presented
yearly CME events geared towards family practitioners, nurses,
occupational therapists, social workers and other allied health
workers. With this year’s partnership, we combine the academic
presentations of the CAGP with practical clinical presentations.
The topics this year have been requested by attendees at several
recent CAGP meetings, and we know that you find our speakers’
approaches interesting and informative.
Susan Mitchell is an Associate Professor of Medicine at Harvard
Medical School, and she will be providing the keynote address on
the topic of palliative approaches in dementia. Nathan Herrmann,
Professor of Psychiatry at University of Toronto will be giving
a plenary presentation about side effects of antipsychotics in
the elderly. The final plenary presentation will be an
interactive discussion of behavioral approaches to the treatment
of behavioral and psychological symptoms in dementia, by Rob
Madan, Assistant Professor of Psychiatry at the University of
Toronto.
We had an unprecedented number of applications for workshop
presentations this year, and have chosen an excellent group of
diverse workshops that will appeal to attendees of the various
backgrounds. Workshop topics include a palliative approach to
behavioral and psychological symptoms in dementia, sexuality in
dementia, cognitive behavioral approaches for patients with
schizophrenia, and ethical issues in seniors’ outreach.
Following up on last year’s theme of treatment-resistance, we
have an update on approaches to treatment resistant depression
in the elderly including transcranial magnetic stimulation. For
non-psychiatrists, we have a workshop update on geriatric
psychopharmacology including antidepressants, cholinesterase
inhibitors and anticholinergic drugs. Finally, an exciting
workshop will focus on education and the path towards geriatric
psychiatry finally becoming a subspecialty.
We encourage you to join us in downtown Toronto on Wed Sept 22,
2010 at the Westin Harbour Castle for this collaborative CME and
Scientific update on geriatric psychiatry.
ASM Committee:
Dr. Mark Rapoport, Associate Professor, University of
Toronto, ASM Co-Chair, CAGP
Dr. Rene Desautels, Associate Professor, McGill University,
ASM Co-Chair, CAGP
Dr. Kiran Rabheru, Associate Professor, University of Ottawa
& British Columbia, President, CAGP
Dr. Zahinoor Ismail, Assistant Professor, University of
Toronto
Dr. Benoit Mulsant, Professor & Vice-Chair, University of
Toronto
For more information please visit
www.cagp.ca
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CPA Voting Status
The Canadian Academy of Geriatric Psychiatry has recently gained
voting status on the CPA Board of Directors. A motion was put
forward at the CPA's spring board meeting to provide three
academies (geriatric, child and adolescent, and forensics)
voting rights at the meeting, and was unanimously accepted. CAGP
President, Dr. Kiran Rabheru, will be attending the CPA board
meetings in future, representing the CAGP and its members.
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CAGP Sponsorship at CGS Annual Meeting (April 15-17, 2010)
The Canadian Geriatrics Society Annual Meeting was held this
past April in Ottawa and following on from last year's goal of
strengthening ties with like-minded organizations the Academy
sponsored speaker, Dr. Caroline Gosselin, at the meeting. This
arrangement was reciprocated through CGS sponsorship of Dr.
Colin Powell at the 2009 CAGP Annual Scientific Meeting in
Montreal. We are pleased to support our partners and look
forward to continuing these links in the future.
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The Canadian Journal of
Geriatrics: Update
Dr. Mark Rapoport
Associate Editor, Canadian Journal of Geriatrics
The Canadian Journal of Geriatrics is currently in a state of
transition. The Canadian Geriatrics Society (CGS) did not own
the journal or its name, and the former publishers have ceased
operations. At the recent CGS annual meeting, members reaffirmed
their commitment (including financial support) for a
peer-reviewed publication. The journal will continue to be
produced but will be transformed into an online open-access
publication. Its name will be changed and a number of
operational details have to be worked through, but we anticipate
resuming publication without much delay in the Summer or Early
Fall 2010. Generally, authors of accepted papers in online open
access publications are charged a fee to cover the costs of
production. They can be substantial ($1,300 plus). We (myself,
David Hogan and Ken Madden, the editorial team of the journal)
are proposing to have these charges waived for members of the
CAGP for the next two years, but have to confirm this with the
CGS council. We will keep you posted as more information becomes
available.
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Other News |
International Psychogeriatric Association 2010 International
Meeting
26-29 September ● Santiago de Compostela, Spain
Poster Submission Deadline – 16 July 2010
Early Registration Deadline – 16 July 2010
Similar to its recent collaboration with CAGP at the 2009
International Congress, IPA is working with local organizations
to develop its next meeting.
The International Psychogeriatric Association (IPA), Sociedad
Española (SEPG) and Associação Portuguesa de Gerontopsiquiatria
(APG) have collaborated to develop a fully international program
in Santiago de Compostela, Spain for the IPA 2010 International
Meeting.
The meeting will take place at the University of Santiago de
Compostela which has a history dating back to 1495. The meeting
venue is just one of the many places of historical significance
throughout the city which has been designated as a UNESCO World
Heritage Site. As the final destination of the medieval
pilgrimage known as the Camino de Santiago (Way of Saint James),
Santiago has been attracting visitors for hundreds of years. Its
winding streets, unique architecture, culture, and cuisine make
it an excellent setting for the 2010 International Meeting which
will explore the themes of Diversity, Collaboration and Dignity.
Poster Submissions
Do you have new research to share? Submit your abstract for the
IPA 2010 International Meeting! To be considered, you must
submit your poster abstract on or before 16 July. Please note
that poster submissions received between 12 May and 16 July will
not be listed in the on-site final program but will be included
in a special addendum that will be distributed to all delegates.
The recommend length for submissions is 500-750 words. Poster
presenters are required register for and attend the meeting.
Please go to the meeting website at
www.ipa2010spain.com
and follow the link to IPA’s abstract system. If you have
questions, please contact,
info@ipa-online.org.
Scientific Program Details
Visit the meeting website at
www.ipa2010spain.com
for the most up-to-date information on confirmed symposia, the
meeting schedule and two unique pre-meeting workshops:
- Long-Term Care Symposium - Friday, 24 September
Chairs: Wendy Moyle, Australia and Arantza Pérez,
Spain
- Neuroimaging in Dementia Workshop - Saturday, 25
September
Chairs: John T. O’Brien, United Kingdom and Leonardo
Pantoni, Italy
We hope to see you in Santiago!
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Study on “Depression Among
Seniors in Residential Care”
Published by Canadian Institute
for Health Information. (www.cihi.ca)
Dr. Marie-France Rivard
Geriatric Psychiatrist Clinical Director, Royal Ottawa Hospital
This is a large scale study of 50,000 seniors living in 550
residential care facilities (such as Long Term Care Homes,
Nursing Homes or Personal Care Homes) living in 5 Canadian
jurisdictions (Nova Scotia, Ontario, Manitoba, Saskatchewan and
the Yukon), using the Resident Assessment Instrument Minimum
Data Set (RAI MDS) Version 2.0 which includes Clinical
Assessment Protocols on a wide range of health issues including
cognition and mental health (CAPs). This instrument has been
validated in a number of countries worldwide, including Canada.
While not perfect, the RAI MDS 2.0 provides us with the
opportunity to better document the extent of mental health
symptoms and problems of seniors living in these facilities in
Canada at this time. While most of us are well aware that
depressive symptoms and diagnosable depressive disorders are
common in this population, we have been suspecting for some time
that the prevalence of depression may be increasing in this
clinical sector where residents are admitted at a more advanced
age and in more frail condition than previously. This study also
begins to demonstrate the poor outcomes associated with
un-diagnosed depression and gives some insight into the fact
that depression can be treated successfully even in those who
are very old and are in LTC Homes, usually for multiple, complex
mental health, medical and social problems.
The main findings of the study are that 44% of residents in LTC
Homes have either a diagnosis of depression (26%) or have 3 or
more symptoms of depression (18%) without a documented
diagnosis. Interestingly, 17% of residents, while they had a
diagnosis of depression had no depressive symptoms and we can
infer that, in this group, the depression was treated
successfully. Nine percent (9%) had a diagnosis of depression
and still had symptoms. The group with a diagnosis and symptoms
of depression had the highest use of antidepressants (80%) along
with those with diagnosis and no symptom (78%). However, less
than 40% of those with symptoms of depression but no diagnosis
were taking antidepressants and this includes the use of
Trazodone at bedtime! Consistent with the literature, the
proportion of seniors with a diagnosis of depression decreased
after age 65 but the proportion with depressive symptoms and no
diagnosis increased from 17% among those age 65 to 74 to 20% of
those over age 95. This suggests that with advancing age, it is
less likely that depressive symptoms will be recognized and
diagnosed but the prevalence of depression itself is not
necessarily decreasing.
Residents with symptoms of depression (whether they had a
diagnosis or not) had more clinical instability and weight loss.
They were also less self sufficient, had more communication
problems and more likely to have had a fall in the last month.
They were much more likely to have withdrawn from activities of
interest and have conflict with staff as well as severe
aggressive behavior. On measures of quality of life, residents
with symptoms of depression experienced more sleep disturbances
and more pain (daily or severe excruciating pain). On all the
above measures, the group with a diagnosis of depression but no
symptom was almost identical to the group with no symptom and no
diagnosis of depression. This suggests that seniors with
successfully treated depressive disorders have no more physical
instability, pain or aggressive behavior than those without a
diagnosis of depression. As we look at better addressing the
problem of violence in the workplace, this finding is important
for the staffs who work in these facilities.
Finally, only a small proportion of residents with symptoms of
depression received an evaluation by a licensed mental health
professional (less than 10% of those with a diagnosis of
depression and less than 5 % of those with symptoms and no
diagnosis). Again, this will not be a surprise to us as there
are still too few facilities who have access to mental health
professionals such as those working in Geriatric Mental Health
Outreach services. However, the results of this study can help
us advocate for more Mental Health Outreach services to the more
than 200,000 seniors who live in Long Term Care, Nursing or
Personal care homes in Canada.
Have a look at the study. It is worthwhile reading. We should
encourage our colleagues at CIHI in their work. For those of us
who sometimes wonder whether it is worth the huge effort and
investment of time to use the RAI while there are many other
clinical priorities, I would like to say: “lets use the data to
advocate for those clinical priorities to be adequately
addressed by planners and funders!” Therefore, I am grateful
that CIHI is providing this analysis of the data. I am also told
that there is more to come so, stay tuned!
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Working together to improve
care: the GERI collaboration
(Geriatric Education and
Recruitment Initiative)
Dr. Chris Frank
Associate Professor, Queen’s University
Past President, Canadian Geriatrics Society
Background
At the Canadian Geriatrics Society annual meeting in 2007,
representatives from a variety of disciplines got together to
discuss the “Future of Geriatrics”. Geriatric psychiatry was
represented at that meeting. One of the recommendations arising
was that a coalition be established to improve the image of
aging and thereby help increase interest (or at least decrease
bias against) fields which focus on older people.
A collaboration of professional organizations involved in health
care of seniors has been forged and recently had our first
face-to-face meeting in Toronto. We chose the name GERI
collaboration (Geriatric Education and Recruitment Initiative)
to reflect our interest in using education to improve the image
of aging and to assist in recruitment to geriatric fields.
Martha Donnelly, who brings her expertise in geriatric
psychiatry and family medicine Care of the Elderly to the
collaboration, has ably represented CAGP.
The following organizations have committed to participate in the
GERI collaborative and have members providing “sweat equity” in
our activities.
Canadian Coalition for Seniors’ Mental Health (CCSMH)
Canadian Gerontological Nurses Association
Canadian Geriatrics Society
Canadian Academy of Geriatric Psychiatry
Canadian Association of Retired People (CARP)
Long term care Medical Directors Association of Canada
Canadian Association on Gerontology
National Initiative for Care of the Elderly
Canadian Pensioners Concerned
Canadian Physiotherapy Association
Our overall goal is that there will be an adequate number of
healthcare providers with the right skills to meet the needs of
older adults. To do this we obviously need to increase
recruitment to our fields.
GERI will work with the following target groups to meet our
goals:
- Policy makers and
politicians
- Deans and / or leadership
in training / education programs
- Practicing clinicians and
academics
- Students and trainees
In addition we are lucky to
have two seniors’ advocacy groups involved that bring the
seniors’ perspective and strengths to the effort. As we know,
the political force of seniors can be huge and has not been
fully harnessed by health professionals.
This collaboration is the first time interdisciplinary
organizations have worked together to address the human resource
issues in geriatric care; despite our similar interests, there
has been little collaboration in advocacy and education in the
past. Given the current push to interdisciplinary education and
the importance of interdisciplinary care in geriatrics, our
collaboration is timely.
The face-to-face meeting May13-14th was funded by CIHR and was a
great opportunity to discuss our current activities but more
importantly to make a work plan for the next year. Our current
activities include:
- A Human Health Resources
funded project entitled: Improving Health Human Resources
for Canada’s Aging Population: Recruiting Students to the
Field of Aging. This $73 000 project helped develop
interdisciplinary geriatric interest groups (GIG’s) at 4
health science centres across the country. Martha Donnelly
has played a key role in this project.
- Development of proposals
to collaborate with corporations to use positive images of
aging in advertising
- Development of a campaign
to raise money from organizations’ membership to support
AFRAN project (geriatric capacity-building in sub-Saharan
Africa).
- Promotion of respective
organizations’ core competencies for education at
undergraduate and postgraduate levels
- Applications for business
funding for Geriatric Interest Groups modeled on family
medicine experience
- Collaboration with CARP to
develop an award for advertising the promotes positive
images of aging
Our activities for the next
year will build on this work and will entail 3 main projects:
- Working to decrease
barriers to training in Care of the Elderly family medicine
programs
- Developing partnerships
with companies to fund activities such as GIG’s (Geriatric
Interest Groups) that promote the positive aspects of caring
for older patients
- Development of an
interdisciplinary Knowledge Institute and promote
interdisciplinary geriatric education
We also plan to work with the
CCSMH in their application to partner with the anti-stigma
campaign of the Mental Health Commission as their work overlaps
with ours given the role of stigma in affecting career choice in
health professionals. A smaller project will be to develop
resources for using medical humanities to interest students and
residents in geriatric care.
We have much to do and limited funding from inside and outside
our organizations. However, member organizations are committed
to the goals of the project and are providing time and energy to
the projects. If you are interested in working with Martha
Donnelly and others in these activities please contact me at
frankc@providencecare.ca.
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New Resources at NICE
The National Initiative for the Care of the Elderly (NICE) is
pleased to announce the following resources, of interest to
students, instructors and practitioners in the field of aging.
Core Competencies in Geriatric and Gerontological Care
Core competencies in geriatric medicine, geriatric
psychiatry and interprofessional approaches to geriatric and
gerontological care are now available on the
NICE website (in English and French),
Academic Supervision and Professional Mentorship Database
Locate potential academic supervisors or professional
mentors in the field of aging by searching our
online database.
Career and Educational Resources
Visit the NICE Students Facebook page for an online
directory to career and educational resources in the field of
aging, and learn about other student events and opportunities.
Search for "National Initiative for the Care of the Elderly
Students" on Facebook, or
click here
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Elder Abuse Information and
Resources
Elder abuse is an all too common problem and one we frequently
come across in our practices. The following
link will take you to a very valuable site that contains
useful information, brochures available for printing and
research articles, etc. There is a very useful PDF brochure on
recognising abuse that will be valuable for anyone working with
at risk seniors. I think you might find it useful and worth
keeping as a link on your computers!
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Call For |
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Call for Poster Presentation
The CAGP is now accepting abstracts for poster presentations for the annual
scientific meeting on September 22, 2010 in Toronto, Ontario themed “From
Prevention to Palliation.” Topics should be timely and relevant to geriatric
psychiatry.
There will be 30 Minutes of protected time for poster presentations and
dialogue. An Award of $500 will be presented at the meeting for the best poster.
Deadline for poster abstracts is July 30, 2010. For more information and a
submission form visit
the ASM page
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Upcoming Events |
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