McGill Journal of Medicine

Approach to: Ptosis

Nikhil Patil — 2024-10-03

Question

A 75-year-old male presents to the ophthalmology service with a drooping left upper eyelid. Upon further questioning, he states that he feels his visual acuity has deteriorated in the left eye, but only in the dark. On testing his best corrected visual acuity is 20/25 in the right eye and 20/30 in the left eye. His pupils are equal, round, and reactive to light and accommodation. His intraocular pressures are 14mmHg bilaterally. His past medical history is significant for type 2 diabetes mellitus, hypertension, hypercholesterolemia, and obesity. He states that his dropping eyelid does not get better or worse during the day and he first noticed his drooping eyelid this morning. He also states that he has been experiencing some horizontal diplopia since this morning. Your clinical examination reveals no significant ocular misalignment, but the patient is unable to fully adduct, infraduct, or supraduct his left eye. His margin to reflex distance 1 is 2mm and his levator function is markedly decreased. His ESR and CRP are within normal limits. He is scheduled for a follow-up visit in 6 weeks at which point his symptoms have almost completely resolved.

Third Nerve palsy
Myasthenia gravis
Congenital ptosis
Horner syndrome
Aponeurotic ptosis

Answer

A) Given his history and clinical examination, this patient likely has a third cranial nerve palsy. Furthermore, given no pupillary involvement and systemic risk factors (obesity, diabetes mellitus, hypertension, hypercholesterolemia), an ischemic third nerve palsy is favoured. Typically, ischemic third nerve palsies are self-resolving and the patient can be scheduled for follow-up in 4-6 weeks. Pupil involvement or a lack of improvement at follow-up are indications for head imaging (CT angiography) to rule out an aneurysm or other compressive causes. In this case, since the ptosis does not worsen as the day goes on and improve after rest, myasthenia gravis is unlikely. Additionally, this autoimmune condition would present at an earlier age than 75. Similarly, congenital ptosis would present in the first years of life. Horner syndrome would include miosis and facial anhidrosis alongside the ptosis. Aponeurotic ptosis is a possible diagnosis, however, is less likely given this presentation with an inability to fully adduct, infraduct, or supraduct his left eye.

Approach to: Venous Thromboembolism

Salima Ramdani — 2022-10-06

Venous thromboembolisms can manifest as a spectrum of diseases and complications, such as deep vein thrombosis (DVT) and pulmonary embolism (PE), as a consequence of hypercoagulability, endothelial damage and/or venous stasis. DVT can present as localized pain or heaviness, unilateral edema, dilatation of superficial nonvaricose veins, a palpable cord or Homans’s sign. Symptoms of PE include acute or worsening shortness of breath and pleuritic chest pain while physical examination may be remarkable for tachycardia and tachypnea. However, given their non-specificity, using these signs and symptoms alone allows for poor differentiation between VTE and other entities. This review will focus on a multi-step diagnostic tree allowing for evidence-based interpretation of tests following a determined pre-test probability (PTP), as per Thrombosis Canada recommendations and ASH clinical guidelines. An introduction to VTE in Pediatrics and pregnancy will also be discussed.

Approach to: Bleeding

Ryan Antel — 2022-10-12

This article presents a basic approach to the bleeding patient and is intended for medical students in their pre-clinical and clerkship years. Easy bruising and abnormal bleeding are relatively common symptoms, and may present as excessive bleeding post-injury, epistaxis, menorrhagia, prolonged bleeding after surgery or spontaneous bleeding. Identification and appropriate medical management of abnormal bleeding and bruising can decrease associated morbidity and mortality.

Approach to: Adrenal mass

Erica Bitektine — 2024-01-23

Adrenal masses are a common incidental finding in imaging. Although most are benign, they should be thoroughly investigated to rule out malignancy and hormone hypersecretion. This article provides an approach to evaluating these adrenal masses, delving into the various differential diagnoses and special management considerations.

Approach to: Concussion in the Adult Athlete

Laurence Désilets-Barnabé — 2022-10-23

Concussions are common in the athlete population. They occur after a trauma to the head and can lead to a loss of consciousness. Patients suffering from a concussion commonly present with confusion, amnesia and a headache in the context of a recent head trauma. The approach to this pathology consists in making a clinical diagnosis, ruling out life-threatening complications such as fractures and intracranial hemorrhages and educating the patient on a safe recovery and return-to play. Patients that do not have worrisome symptoms can be discharged home with a responsible adult that has been informed of when to seek medical care in case of a complication. After a short rest period they should be advised to resume gradually their cognitive and physical activity. After a minimal period of 10 days and in the absence of symptoms, the patients can undergo a progressive return to play plan.

Approach to: Headache

Benjamin Rehany — 2022-10-23

Headaches are one of the most common reasons for visiting a family physician. The estimated lifetime prevalence of a headache is about 66%. (1) They pose a significant burden on the patient’s quality of life, and in fact contribute to about 20% of work absences. (2) Fortunately, most cases are benign. The following article presents an approach to headaches, differentiating between benign and worrisome causes and management.

Approach to: Elevated Intraocular Pressure

Nikhil Patil — 2023-08-13

N/A ("Approach to" article type)

Approach to: rotator cuff pathology

Courtenay Wood — 2022-12-06

Shoulder pain is a common problem and the third most common musculoskeletal symptom for which patients seek medical care. Rotator cuff tendinosis is a frequent cause of this pain and can be diagnosed clinically with a careful history and physical exam. Treatment consists of a trial of pain management and physiotherapy and imaging modalities are often not required. However, imaging can be highly valuable for other pathologies. This article guides the reader through key elements to include in a history and physical exam of the shoulder, and how and when to select an appropriate imaging modality.

MJM MedTalks (S01E01): A Conversation with Dr. Samir Shaheen-Hussain

Susan Joanne Wang — 2023-05-05

McGill Journal of Medicine (MJM) MedTalks is a Podcast series where members of the McGill Faculty of Medicine and Health Sciences are interviewed on topics related to career, research, advocacy and more. The aim of MedTalks is to open a space where faculty members can share information and advice for trainees in healthcare and medical sciences. In this episode, McGill medical student Susan Wang interviews Dr. Samir Shaheen-Hussain about his new book, “Fighting for a Hand to Hold* Confronting Medical Colonialism Against Indigenous Children in Canada”. The conversation is divided into three parts: 1) personal questions about Dr. Shaheen-Hussain’s work in social justice, 2) questions regarding the book, in particular on aspects of anti-indigenous systematic racism and its interplay in Canada’s current healthcare system, and 3) advocacy and burnout-related advice for medical trainees. This podcast interview is also accompanied by a book review and reflection, titled “A Medical Student’s Perspective on Fighting for a Hand to Hold”, available at mjmmed.com. The show notes include a transcript of the podcast, time stamps, and resources and references. This podcast is produced and edited by MJM’s social media team, Tom Lee, Saman Arfaie and Susan Wang and transcribed by S. Wang.

Let’s Talk LMCC (S01E03): Legal, Ethical and Organizational Aspects of Medicine - Consent, Truth Telling and Negligence

Amanda Sears — 2023-11-01

Welcome to the McGill Journal of Medicine (MJM) Let’s Talk LMCC Review. This podcast series was created to aid medical students studying for the Canadian Medical Council (MCC)’s licensing exam. Each episode is created based on specific LMCC objectives and is divided into two sections. In Section 1 we provide an overview of the topic with the help of experts in the field, followed by Section 2 where we review LMCC styled questions to help consolidate knowledge. In this episode, we welcome our expert advisor, Dr. Carolyn Ells, a recently retired Associate Professor in the Department of Medicine at McGill, based at the Biomedical Ethics Unit, to speak on LMCC Objectives 121-1 Consent, 121-2 Truth Telling, and 121-3 Negligence. This episode was written by MJM Podcast Team members Amanda Sears and Esther Kang and Dr. Carolyn Ells.

MJM MedTalks (S02E03): Beyond the Hype - GLP-1 Agonists Redefining Glycemic Control

Susan Joanne Wang — 2024-06-10

McGill Journal of Medicine (MJM) MedTalks is a Podcast series where members of the medical and health science communities from McGill and beyond are interviewed on topics related to career, research, advocacy and more. The aim of MedTalks is to open a space where experienced professionals and researchers can share information and advice for trainees in healthcare and medical sciences. In this episode, Susan Wang, MJM Podcast Team Co-Lead and first year Internal Medicine Resident at McGill University interviews guest-experts and endocrinologists Dr. Michael Tsoukas, Assistant Professor in the Department of Medicine at McGill University, and Dr. Vanessa Tardio, Assistant Professor in the Department of Medicine and Program Director of the Endocrinology and Metabolism Residency Training Program at McGill University. This conversation covers GLP-1 agonists, what they are, their uses, the media hype, new and exciting research, and some advice for trainees. The show notes include a glossary of terms, links to publications referenced in the episode, and a full transcript of our conversation.

MJM MedTalks (S02E02): To Boldly Exercise, Where No One’s Exercised Before

Khiran Arumugam — 2024-01-24

McGill Journal of Medicine (MJM) MedTalks is a Podcast series where members of the medical and health science communities from McGill and beyond are interviewed on topics related to career, research, advocacy and more. The aim of MedTalks is to open a space where experienced professionals and researchers can share information and advice for trainees in healthcare and medical sciences. In this episode, McGill MSc Candidate and MJM Podcast member, Khiran Arumugan, interviews guest-expert Dr. Leigh Gabel, assistant professor at the Faculty of Kinesiology at the University of Calgary and a member of the McCaig Institute for Bone and Joint Health, on her research on musculoskeletal health in space. This conversation covers bone and musculoskeletal health, imaging tools and biomarkers used to evaluate bone health, the TBone study and some its results, Dr Gabel’s path to academia and some advice for trainees. The show notes include a glossary of terms, links to publications referenced in the episode, and a full transcript of Khiran Arumugam’s conversation with Dr. Gabel.

MJM MedTalks (S01E02): A Conversation with Dr. Shirin Enger

Nadia Blostein — 2022-10-28

Podcast Links:

Spotify

Anchor

McGill Journal of Medicine (MJM) MedTalks is a Podcast series where members of the McGill Faculty of Medicine and Health Sciences are interviewed on topics related to career, research, advocacy and more. The aim of MedTalks is to open a space where faculty members can share information and advice for trainees in healthcare and medical sciences. In this episode, MSc candidate and MJM Podcast Team member Nadia Blostein interviews Dr. Shirin A. Enger, medical physicist and Associate Professor at the Gerald Bronfman Department of Oncology & Medical Physics Unit. This interview focuses on the interdisciplinary and translational nature of medical physics research, the workflow of radiotherapy, and concludes with a list of open-source initiatives that Dr Enger’s group has participated in, including the McMed Hacks Series on Machine Learning and Medical Imaging. The show notes include a transcript of the podcast, a more detailed content overview, glossary of important terms and resources and references. This episode was recorded and edited by MJM Podcast Team member Nadia Blostein with input from the entire MJM Podcast Team and transcribed by Susan Wang.

Let’s Talk LMCC (S01E01): Glucose Abnormalities

Meryem Talbo — 2023-05-05

Welcome to the McGill Journal of Medicine (MJM) LMCC review. This podcast series was created to aid medical students studying for the Canadian Medical Council (MCC)’s licensing exam. Each episode is created based on specific LMCC objectives and is divided into 2 parts. In part one we provide an overview of the topic with the help of experts in the field, followed by Part 2 where we review LMCC styled questions to help consolidate knowledge. In this episode, we welcome our expert advisor, Dr. Alice Cheng, Endocrinologist and Associate Professor at the University of Toronto to speak on LMCC Objective 37-1* Glucose Abnormalities. This episode was written by Meryem Talbo and Dr. Alice Cheng, edited by Esther Kang, Katherine Lan and Susan Wang. Please see our website www.mjmmed.com for more information, including a link to show notes.

MJM MedTalks (S01E03): A Conversation with Dr. Ahmad Haidar

Khiran Arumugam — 2023-05-05

McGill Journal of Medicine (MJM) MedTalks is a podcast series where members of the McGill Faculty of Medicine and Health Sciences are interviewed on topics related to career, research, advocacy and more. The aim of MedTalks is to open a space where faculty members can share information and advice for trainees in healthcare and medical sciences. In this episode, MJM Podcast Team members, McGill medical student Dylan Langburt and MSc candidate Khiran Arumugam interviews Dr. Ahmad Haidar about his work in the Artificial Pancreas Lab. Dr. Haidar is an assistant professor from the department of Biomedical Engineering, Faculty of Medicine and Health Sciences here at McGill. He leads an interdisciplinary research program that applies feedback control theory and mathematical modeling to diabetes, psychological, and clinical problems. Since 2011, Dr. Haidar’s research aim has been to develop and clinically test novel artificial pancreas systems with the use of Bayesian modeling and isotope tracers to study the pharmacokinetics and pharmacodynamics of dual-hormones (insulin and pramlintide). He is the first to develop the dosing algorithm of the artificial pancreas system. This interview will potentially cover concepts such as the artificial pancreas, diagnosis and treatment systems, automated delivery systems, diabetes (Type 1), biomedical devices, glucose-isotope tracers, glucose physiology metabolism, etc. Today’s conversation is divided into three parts: 1) Questions regarding the history from the discovery to the evolution of insulin; 2) Questions focusing on specific objectives in Dr. Haidar’s lab; 3) General advice for medical/research students. The show notes include a transcript of the podcast, a more detailed content overview, glossary of important terms and resources and references. This podcast is produced and edited by MJM’s social media team members Dylan and Khiran with input from the entire MJM Podcast Team. Please see our website www.mjmmed.com for more information, including a link to show notes.

Let’s Talk LMCC (S01E04): Legal, Ethical and Organizational Aspects of Medicine - Confidentiality and Legal Systems

Sarah Grech — 2023-11-01

Welcome to the McGill Journal of Medicine (MJM) Let’s Talk LMCC Review. This podcast series was created to aid medical students studying for the Canadian Medical Council (MCC)’s licensing exam. Each episode is created based on specific LMCC objectives and is divided into two sections. In Section 1 we provide an overview of the topic with the help of experts in the field, followed by Section 2 where we review LMCC styled questions to help consolidate knowledge. In this episode, we welcome our expert advisor, Prof. Lara Khoury, an Associate Professor in the McGil Faculty of Law and Associate Member of McGill’s Institute for Health & Social Policy and Biomedical Ethics Unit, to speak on LMCC Objectives 121-4 Confidentiality and 121-5 Legal Systems. This episode was written by MJM Podcast Team members, Esther Kang, Sarah Grech, and Professor Lara Khoury.

MJM MedTalks (S02E04+05): Building Healthcare: How Architecture Influences Medicine

Renée-Claude Bider — 2024-09-02

The McGill Journal of Medicine (MJM) Podcast Series, MJM MedTalks, interviews members of the medical and health sciences community from McGill, and beyond to gain insights into their careers, research, advocacy, and more. This series aims to enhance knowledge sharing between experts and trainees in the medical field. In this episode, Renée-Claude Bider, a Master’s student in medical physics and Podcast Associate at the McGill Journal of Medicine, interviews Prof. Annmarie Adams, who is jointly appointed in McGill University's School of Architecture and the Department of Social Studies of Medicine. Dr. Annmarie Adams trained as an architect and architectural historian at UC Berkeley. Her research focuses on how medicine, gender, and architecture intersect. In the first part of their conversation, Bider and Prof. Adams discuss the history of hospital architecture, starting in the late 1800s and focusing on Montreal and Canadian institutions, including the Royal Victoria Hospital, Montreal Neurological Institute, Montreal General Hospital, The McGill University Health Centre (Montreal, Canada), Sick Kids (Toronto, Canada) and McMaster Children’s Hospital (Hamilton, Canada). In the second part of their conversation, Bider and Prof. Adams discuss the architecture of specialized healthcare spaces, such as long-term care homes, birthing suites, palliative care, and cancer centers. They end their conversation by discussing Prof. Adams' ongoing research into the life of influential physician Maude Abbott and advice for trainees in the medical field. A glossary of terms, a content overview, a list of relevant links and research articles, supplementary images from Prof. Adams’ collection, and a transcript of the interview are included in the show notes for this episode.

MJM MedTalks (S01E04 & S01E05): A Conversation with Dr. John Hughes

Masha Samuel — 2023-07-03

The McGill Journal of Medicine (MJM) MedTalks podcast aims to share knowledge and advice with trainees in medicine and the health sciences through interviews with members of the medical community at McGill University and beyond on their careers, research, advocacy, and more. In this episode, Masha (Maryia) Samuel, MJM podcast team member and MSc student in Experimental Medicine interviews Dr. John Hughes, family physician and Assistant Professor at the McGill University Faculty of Medicine. In the first part of the interview, they discuss Dr. Hughes’ early training, his work on an Advanced Crew Medical System, and his involvement in space medicine. In the second part of the interview, they discuss the development of an electronic health record and Dr. Hughes' vision for the future of patient-doctor medical encounters. The episode is rounded off by Dr. Hughes’ advice for medical trainees and junior researchers. The show notes include a glossary of terms, links to publications, images, and videos referenced in the episode, and a transcript of Dr. Hughes and Masha Samuel’s conversation.

MJM MedTalks (S02E01): DIY Automated Insulin Delivery

Meryem K. Talbo — 2023-09-05

McGill Journal of Medicine (MJM) MedTalks is a Podcast series where members of the medical and health science communities from McGill are interviewed on topics related to career, research, advocacy and more. In season 2, we are opening up the conversation to members of the academic community beyond McGill University. The aim of MedTalks is to open a space where experienced professionals and researchers can share information and advice for trainees in healthcare and medical sciences. In this episode, McGill doctoral candidate and MJM Editor and Podcast member, Meryem Talbo, interviews four guest-experts on the topic of do-it-yourself (DIY) automated insulin delivery (AID) systems for people living with type 1 diabetes, with the aim of demystifying this novel and promising technology. The panel includes Kate Farnsworth, a patient-advocate and founder of an online DIY AID community of over 30,000 people; Dr. Ilana Halpern, an endocrinologist at Sunnybrook Health Sciences Centre in Toronto, with over 10 years of experience in the field; Dr. Maha Lebbar, an endocrinologist/diabetologist and current M.Sc. candidate at the University of Montreal with special interests in new technologies for type 1 diabetes; and Dr. Zekai Wu, a physician and current postdoctoral fellow at the Institut de recherches cliniques de Montréal (IRCM) and McGill University, who introduced the DIY AID system into China and is currently working on new type 1 diabetes technologies. This conversation covers the development of DIY AID technologies, their availability and accessibility to people living with type 1 diabetes, as well as the legality and regulatory frameworks that underlie their use. The show notes include a glossary of terms, links to publications, images, and videos referenced in the episode, and a transcript of Meryem Talbo’s conversation with the guest panel.

Title: Let’s Talk LMCC (S01E02): Diabetes Mellitus

Susan Wang — 2023-05-05

Welcome to the McGill Journal of Medicine (MJM) LMCC review. This podcast series was created to aid medical students studying for the Canadian Medical Council’s licensing exam. Each episode is created based on specific LMCC objectives and is divided into 2 parts. In part one we provide an overview of the topic with the help of experts in the field, followed by Part 2 where we review LMCC styled questions to help consolidate knowledge. In this episode, we welcome our expert advisor, Dr. Alice Cheng, Endocrinologist and Associate Professor at the University of Toronto to speak on LMCC Objective 37-2* Diabetes Mellitus. This episode was written by Susan Wang & Dr. Alice Cheng, edited by Esther Kang, Meryem Talbo and Katherine Lan. Please see our website www.mjmmed.com for more information, including a link to show notes.

Let's Talk LMCC (S01E05): 37-2 Antihyperglycemic Agents

Meryem K. Talbo — 2024-09-02

Welcome to the McGill Journal of Medicine (MJM) LMCC review. This podcast series was created to aid medical students studying for the Canadian Medical Council (MCC)’s licensing exam. Each episode is created based on specific LMCC objectives and is divided into 2 parts. In part one we provide an overview of the topic with the help of experts in the field, followed by Part 2 where we review LMCC styled questions to help consolidate knowledge. In this episode, we welcome our expert advisor, Dr. Tricia Peters, Endocrinologist and Associate Professor in the Faculty of Medicine and Health Sciences at McGill University to complete our series on LMCC Objective 37-2: Diabetes Mellitus by speaking about antihyperglycemic agents. This episode was written by Susan Wang, Meryem Talbo and Dr. Tricia Peters, with feedback from the entire MJM Podcast Team.

Family Medicine Symposium (FMGSS) 2023

Family Medicine Graduate Student Society at McGill University — 2023-06-16

Goodman Cancer Institute Research Symposium

Goodman Cancer Institute — 2022-12-01

HBHL Symposium 2023

Healthy Brain Healthy Lives, McGill University — 2023-05-04

Infographics derived from the Nursing master's thesis work

Ingram School of Nursing — 2023-07-27

Healthy Brains Healthy Lives 2024 Symposium

Healthy Brains Healthy Lives (HBHL) — 2024-06-03

Experimental Medicine Biomedical Graduate Conference (AMBGC)

Experimental Medicine Graduate Students' Society (EMGSS) — 2023-03-24

Ontario Student Medical Education Research Conference (OSMERC) 2024

Ontario Medical Students Association (OMSA) — 2024-04-10

Artificial Intelligence and Data Mining in Health Research (AI/MDRS)

The Cardiometabolic Health and Obesity Research Network (rrCMDO) — 2022-11-29

Ontario Student Medical Education Research Conference (OSMERC)

Ontario Medical Student Association — 2023-04-26

The 6th Annual Integrative Psychiatry Conference

Graduate Student Association of Psychiatry (GSAP) — 2023-07-12

The CMDO Network's Health Research and AI symposium

Cardiometabolic Health, Diabetes and obesity Research Network — 2023-12-13

n/a

Second Postgraduate Nutrition Student Academic Exchange

University of Glasgow, University of the West Indies, McGill University — 2022-10-18

Evolving a conceptual framework and developing a new questionnaire for usability evaluation of blended learning programs in health professions education

Anish Arora — 2022-12-06

Background: Blended learning programs (BLPs) have been widely adopted across health professions education (HPE). To bolster their impact on learning outcomes, the usability of BLPs should be rigorously evaluated. However, there is a lack of reliable and validated tools to appraise this dimension of BLPs within HPE. The purpose of this investigation was to evolve a conceptual framework for usability evaluation in order to initially develop the Blended Learning Usability Evaluation – Questionnaire (BLUE-Q).

Methods: After the completion of a scoping review, we conducted a qualitative descriptive study with seven purposefully selected international experts in usability and learning program evaluation. Individual interviews were conducted via videoconferencing, transcribed verbatim, and analyzed through thematic analysis.

Results: Three themes were identified: (1) Consolidation of the multifaceted ISO definition of usability in BLPs within HPE; (2) Different facets of usability can assess different aspects of BLPs; (3) Quantitative and qualitative data are needed to assess the multifaceted nature of usability. The first theme adds nuance to a previously established HPE-focused usability framework, and introduces two new dimensions: ‘pedagogical usability’ and ‘learner motivation.’ The latter two provide guidance on structuring BLP evaluations within HPE. From this followed the development of the BLUE-Q, a new questionnaire that includes 55 Likert scale items and 6 open-ended questions.

Conclusions: Usability is an important dimension of BLPs and must be examined to improve the quality of these interventions in HPE. As such, we developed a new questionnaire, solidly grounded in theory and the expertise of international scholars, currently under validation.

SARS-CoV-2 Epitope Presentation by Class II HLA Genotypes Common in North American Populations: A Proposed Computational Approach for Vaccine Efficacy Evaluation

Laura Leclair — 2022-10-06

Background: Human Leukocyte Antigen (HLA) gene polymorphisms between ethnic groups have been shown to play a role in the heterogeneity of response to SARS-CoV-2, in terms of COVID-19 disease severity and susceptibility, in addition to socioeconomic factors. It was predicted that this finding may extend to vaccine responsiveness.

Purpose: To the best of our knowledge, this study was the first that aimed to predict and evaluate the effectiveness of four COVID-19 vaccines across North American ethnic groups, in terms of their ability to trigger CD4+ T cell help, based on class II HLA allele frequencies.

Methods: Various databases including the Immune Epitope Database (IEDB) were used in this computational approach. The number of peptide-HLA high-affinity pairs between the most common HLA II haplotypes and SARS-CoV-2 peptides in various vaccine types were retrieved and compared between ethnicities. From this, the efficiency of antigen presentation to CD4+ T cells was evaluated, a crucial component in the context of vaccination for cellular immunity and support in antibody generation.

Results: Multiple discrepancies in vaccine effectiveness for ethnic minorities relative to the Caucasian group, overrepresented in vaccine clinical trials, were highlighted. Recommendations were issued in terms of which vaccine types could be most effective for particular ethnicities.

Conclusion: There exists a genetic basis for differential responses to vaccines among ethnic groups in North America. However, given the multifactorial nature of vaccine responsiveness and limitations of computational methods, this study offers future research directions to undertake before the findings can be transferred to clinical and public health settings.

Access to Immunoglobulin Treatment for CIDP Patients During the COVID-19 Pandemic

Vincent Brissette — 2023-08-25

Background:

Immunoglobulin supplies are limited; their access for patients diagnosed with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) may have been difficult during the COVID-19 pandemic.

Methods:

A retrospective cross-sectional study was conducted with CIDP patients (n=16, 68.8% female, mean age 60.4±11.3) recruited from three Montreal tertiary care institutions. Inclusion criteria were patients over 18 years old who were receiving immunoglobulin treatment as of March 1^st, 2020. Patients were asked to complete a questionnaire inquiring about changes in their immunoglobulin treatment during the pandemic and about their quality of life. Their charts were reviewed by an independent investigator. We used weighted chi-squared statistical tests and Cramer’s V correlation ratios to measure associations with treatment change.

Results:

Eighteen months after the pandemic started, 50% of patients were receiving the same treatment, 25% were receiving immunoglobulin treatment at a different frequency, 6.3% were receiving a different dose, 12.5% were receiving a different dose and frequency, and 6.3% were receiving a different treatment. Reasons associated with treatment change were worsening of neurological condition (18.8%; Cramer’s V=0.480; p-value=0.055), improvement of neurological condition (25%; Cramer’s V=0.577; p-value=0.021) and reduced availability of treatment (6.3%; Cramer’s V=0.258; p-value=0.302). There were no significant correlations between lower quality of life (p-value=0.323) or lower Rasch-built Overall Disability Scale score (p-value=0.574) and treatment change.

Conclusion:

Difficulty accessing immunoglobulin treatment was infrequent and not significantly associated with treatment change for CIDP patients during the COVID-19 pandemic. A larger multicentre study across multiple sites might identify other treatment access problems resulting from the pandemic.

Teaching Medical Students to Suture: Evaluation of a Modern Medical School Curriculum

Chantell Cleversey — 2022-11-08

Background: Medical students are traditionally introduced to suturing in a simulated environment using animal products or synthetic materials. However, there is little evidence to support this pedagogy. Our study explored whether a modern suturing curriculum adequately prepares medical students and examined student preference for learning suturing skills.

Methods: Suturing performance was recorded and assessed by expert raters. Students also completed a survey that inquired about self-perceived knowledge and confidence in suturing, and preferred pedagogical methods.

Results: The majority (79%) of students that completed our suturing curriculum demonstrated competence in basic suturing techniques. There was no correlation between objective abilities and self-perceived knowledge or confidence. Students reported being significantly more confident suturing anesthetized patients and in simulated environments. Students reported a desire for earlier introduction to suturing and more frequent simulation training.

Conclusion: A modern medical school suturing curriculum, comprising online modules and in-person simulation-based learning, adequately develops basic suturing techniques.

Major Perioperative Complications of Benign Gynecologic Procedures at a University-Affiliated Hospital

Andrée-Anne Busque — 2022-10-23

Background: With the increasing use of minimally invasive techniques for gynecologic procedures, women are at a low risk for peri-operative complications. The purpose of this study was to determine the incidence of and risk factors for major intra or postoperative complications among women undergoing benign gynecologic surgeries.

Methods: We conducted a retrospective observational study of all women who underwent benign gynecologic surgery in 2016-2017 at a University-Affiliated community hospital. Pregnant women, malignancy cases, and hysteroscopic or minor vulvar procedures were excluded. Primary outcome was composite intraoperative and/or 30-day postoperative complications requiring medical or surgical management. Logistic regression identified significant patient, peri-operative and surgeon risk factors associated with complications.

Results: Of 975 patients included, 53 patients experienced major intra or postoperative complications (5.4%). Mean age was 47.7 ± 13.8 years. Mean BMI was 27.1 ± 5.8 kg/m². Prior abdominal surgery (laparotomy or laparoscopy) (adjusted odds ratio [OR]= 2.01, 95%CI 1.05-3.83) and emergency surgery (adjusted OR= 19.54, 95%CI 2.99-127.54) were significantly associated with major complications. Surgeon volume of 1-2 operative days per month (adjusted OR=0.30, 95%CI 0.10 - 0.87) and age 40-64 years (adjusted OR=0.24, 95%CI 0.11- 0.56) had a protective effect on the risk of major complications.

Conclusions: Among patients in our sample, 5.4% experienced major complications from a benign gynecologic surgery. Complications from benign gynecologic surgery are rare, even in the absence of robotic equipment. Center-specific data and a discussion of the increased morbidity associated with with prior abdominal surgery and emergency surgery should be considered for pre-operative patient counselling.

Children’s health-related experiences in India: A scoping review

Yi Wen Wang — 2023-11-25

Background & Objectives: The perspectives of children have becoming increasingly emphasized in healthcare research and practice in order to facilitate children’s inclusion, participation, and decision-making in matters related to their health. In India, however, little is known about children’s views regarding their health despite the various health challenges and ethical concerns they may face, such as poverty, malnutrition, and gender inequalities. The aim of this scoping review is to explore children’s health-related experiences from their own perspectives in India from 2000 to 2020.

Methods: Five online databases were searched. Three independent reviewers screened articles for inclusion. Included texts were analyzed using thematic synthesis, which involved extracting and descriptively coding data, categorizing/grouping codes by similar topics, and comparing and contrasting topics to generate descriptive themes. The scoping review was reported using the PRISMA-ScR checklist.

Results: Fifty-two articles were included, and five descriptive themes were identified. The articles typically overlapped in themes, which related to children’s health-related experiences (n=38), emotions (n=19), and knowledge (n=15); the impact of illness on children’s lives (n=41); and children’s ability to communicate their needs (n=12).

Interpretation & Conclusions: We identified the need to tailor research designs to better elicit children’s perspectives and provide comprehensive health education for children and families in India. This scoping review helped to highlight gaps in healthcare policy, practice, and research, providing a starting point for more focused investigation into children’s health-related experiences in India.

Reflections on medical education: An innovative near-peer led initiative using online media to teach the neurological exam

Aliya Szpindel — 2023-01-05

The move to virtual learning due to the COVID-19 pandemic has resulted in fewer opportunities for medical students to participate in bedside teaching and encounter patients presenting with characteristic clinical findings of various neurological disorders. We describe an interactive, peer-taught learning-session on Zoom teleconference wherein upper-year students developed learning cases using online videoclips of neurological examinations and corresponding findings. A post-session survey revealed an overwhelmingly positive response, especially regarding the sessions’ case-based and peer-taught structure. Overall, considering the dual benefits of peer-teaching, and the opportunity to see a wide range of findings from the videos, this initiative may be a valuable supplemental learning activity for existing undergraduate neurology rotations.

Healthcare in Her Shoes

Brooke Richards — 2022-10-11

Subjects within the realm of a woman’s reproductive health have been greatly debated for decades and the controversy that surrounds them does not appear to be dissipating any time soon. Thousands of articles are published annually on the topics of abortion, female sterilization, their associated ethical dilemmas, and the disparities that women face in the healthcare system. Although we have made great strides in creating an equitable healthcare system, there are still changes to be made. I would argue that women face a disproportional degree of stigmatization, bias, and unethical policy when it comes to their reproductive healthcare, and my aim is to highlight some realistic examples of what this may look like. Broadcasting these issues and encouraging others to think about them allows disparities to be more greatly recognized and thus better able to be dismantled.

Non-invasive prenatal testing (NIPT): a call for change in reporting practices

Samuel Wilson — 2024-01-30

The use of non-invasive prenatal testing (NIPT) technology has revolutionized the practice of prenatal screening. The assay’s validity and reliability have been demonstrated in both low- and high-risk pregnancies. Despite its excellent screening parameters, its reliability is often overestimated due to confusing and incorrect terminology that appears in private NIPT reports. Herein, we provide a brief explanation of the potential implications at two different levels: patient and provider. We conclude with a call to redesign the way information is presented on NIPT reports to avoid stressing patients, enhance transparency in clinical counselling, and perhaps most critically, to prevent medical decisions that may not be warranted solely based on the NIPT results.

Advance Care Directives : A Herzl Clinic Quality Improvement Project

Dalia Eladas — 2023-02-09

Background: Advance Care Planning has benefits for patients and is often optimal when done in the primary care setting. Unfortunately, it does not occur frequently or routinely. The goal of this project was to understand the challenges and barriers that residents at a Family Medicine training site face in initiating and discussing Advance Care Directives.

Methods: An online survey was conducted among 50 Family Medicine residents at the Herzl clinic. Participants were asked about their experience, their comfort level, and their challenges with Advance Care Planning discussions.

A focus group with 12 Family Medicine residents further probed, through open-ended questions, the specific challenges they have faced during Advance Care Planning and ideas to address them.

Results: The online survey and focus group identified that most residents perceived a lack of time, inadequate training, and poor uptake of available tools as barriers to have Advance Care Planning discussions in a community setting. Residents also felt that patients were inadequately prepared for these discussions. For improvement, most residents suggested to increase the variety of teaching modalities, to dedicate time for these discussions and to prioritize in-person discussions.

Conclusion: The residents in Family Medicine face many challenges and barriers to having Advance Care Directives discussions with their patients but were able to provide avenues for improvement.

Advance Care Directives: A Herzl Clinic Quality Improvement Project on Patients' perspectives

Fanny Hersson-Edery — 2023-11-28

Background: Advance Care Planning (ACP) has benefits for patients and is often optimal when done in the primary care setting. Despite the development of multiple resources and tools to support ACP discussions at our Family Medicine Teaching Clinic, the initiation and documentation of Advance Care Directives (ACD) in patients’ medical files were low and resident physicians had perceived that patients were unwilling or unprepared for ACP discussions. The goal of this project was to understand the challenges and barriers that patients and their caregivers face in initiating and discussing ACD with their primary care team.

Methods:

An online survey was conducted among 78 patients who are part of the Home Care program at the Herzl clinic. Participants were asked about the value placed on ACP and their preferences on various aspects surrounding the initiation of ACD discussions.

Results:

25 of 78 possible responses were received. This included survey responses from 6 patients, 13 caregivers, 4 family members and 2 physicians. Our results show that patients and their caregivers value Advance Care Planning discussions (>80%). Additionally, they endorse multiple benefits of ACP for themselves, their care teams and families. Patients and caregivers prefer that medical professionals initiate and facilitate the discussions (70-80%) and are open to receive educational material to prepare for these discussions (68%).

Conclusion: Patients in a frail population are willing and open to discuss advance care planning with their primary care team. Family Medicine teaching clinics can support patients’ desire to engage in ACP by providing access to education material and initiating these discussions.

A Case of Organizing Pneumonia Following Azacitidine Treatment for Myelodysplastic Syndrome

Kelly Ann Hutchinson — 2023-05-10

Organizing pneumonia (OP) is a lung pathology mainly affecting distal lung structures. Its etiology is often unknown, in which case it is termed cryptogenic organizing pneumonia (COP). Of those cases of OP with an identified cause, the usual culprits include infections, medications, and radiation therapy. In this report, we present the case of a 73-year-old female on azacitidine –a pyrimidine analogue– used for treatment of myelodysplastic syndrome (MDS). The patient presented with fever, productive cough, and pleuritic chest pain. A CT of the chest, a bronchoalveolar lavage and a transthoracic biopsy were performed, and findings were consistent with OP, thought to be induced by azacitidine. The patient was treated with prednisone and subsequently showed significant improvement. Although rare, this case underlines the importance of considering OP in the context of non-resolving pulmonary infiltrates, particularly when there is a potentially relevant exposure, such as azacitidine.

Methadone Maintenance Therapy after Aneurysmal Subarachnoid Hemorrhage: A Case Report

Austin Smith — 2023-03-24

There is limited information on the effects of continued methadone maintenance therapy following aneurysmal subarachnoid hemorrhage (aSAH). However, with the increasing incidence of opioid use disorder (OUD) in the US, there is a need to define best practices for the management of pain and prevention of acute withdrawal syndrome in patients with pre-existing OUD who develop aSAH. In this case report, we describe the use of MMT in a patient with aSAH and discuss important considerations, including sedation or confusion that might mimic acute neurologic changes seen in cerebral vasospasm or delayed cerebral ischemia, cardiac complications related to QTc prolongation, and liver or kidney interactions associated with aSAH routine treatment. Our patient recovered from her aSAH without any adverse events and, with increased monitoring and collaborative team-based care, including input from those with expertise in OMD or aSAH, we believe MMT can be safely continued in most aSAH patients.