McGill Journal of Medicine

Knowledge-sharing to enhance global health equity

Breagh Cheng, Salma Chaudhry, Brianna Cheng — Tue, 19 Apr 2022 00:00:00 -0400

Knowledge produced by specialized professionals can be shared to promote public understanding and decision-making. During the COVID-19 pandemic, the application, translation, and dissemination of specialized knowledge has informed global policy responses and contributed to new vaccine technologies that protect against disease. However, the pandemic has also highlighted the potential impacts that ineffective knowledge dissemination and misinformation can have on health outcomes, which can further deepen health inequities between groups. Preliminary considerations are suggested for ways to foster a culture of knowledge sharing aimed at promoting global health equity.

A reflection on the role of anatomists in modern medical education: confronting meaning and mortality in the gross anatomy laboratory

Adam MR Groh — Tue, 19 Apr 2022 00:00:00 -0400

Modes of anatomical instruction (especially the need to dissect cadavers) have been contested for generations. The present narrative provides an opportunity to re-approach this age-old debate and contemplate the state of anatomical sciences education through a narrative reflection of an encounter with a donor in the cadaveric anatomy laboratory.

Promoting Self-Care Among Youth with Type 1 Diabetes Mellitus

Laura Pinkham — Sun, 03 Jul 2022 00:00:00 -0400

Each year, diabetes camps provide fun, stimulating, and safe experiences to approximately 20,000 children across North America. At camp, children and teenagers living with diabetes connect with one another in an inclusive and welcoming environment, designed to meet their social, emotional, and medical needs. Campers enjoy a memorable summer experience, where they are also empowered to become more autonomous in managing their diabetes.

Camp Carowanis is a specialized camp for children with Type 1 diabetes in Sainte-Agathe-des-Monts, Quebec. A multidisciplinary team of allied healthcare professionals join youth on-site to encourage and facilitate campers’ acquisition of disease management strategies. The site also serves as an undergraduate medical education elective in pediatric endocrinology for clerkship students at McGill University.

In this article, Laura Pinkham, a medical student at McGill University who completed an elective at Camp Carowanis, shares her observations on the opportunities for promoting self-care among children with type 1 diabetes at camp.

Implication of COVID-19 on Post-Secondary Students’ Mental Health: A Review

Carly Sillcox — Tue, 19 Apr 2022 00:00:00 -0400

Introduction: Nearing two years into the current pandemic, COVID-19 is recognized worldwide for its devastating physical effects, with mandatory restrictions implemented to prevent the transmission of SARS-CoV-2. However, the world is only beginning to understand the pandemic’s mental and social side effects. As such, current research on consequential mental health from COVID-19 is still novel, and there is much more to be learned concerning the long-term psychological effects and damage from the pandemic.

Discussion: The combination of online learning and social isolation due to COVID-19 has affected post-secondary students across North America as it relates to their overall well-being and mental health. Researchers have aimed to examine the psychological impact on students’ mental health, primarily through cross-sectional studies and self-reported surveys.

Conclusion: Studies have determined that COVID-19 has increased mental health symptoms such as depression, anxiety, PTSD, as well as increased feelings of isolation, loneliness, and fatigue. Furthermore, drinking and substance use, poor sleeping patterns, and screen time have risen as a result of the ongoing pandemic.

Relevance: These findings call for post-secondary institutions, health care providers, and governments to prioritize the mental health of future generations while providing support and intervention programs. Future research should focus on further investigating COVID-19’s long-term effects on the mental health of post-secondary students and exploring prevention methods.

Prevention of Hamstring Injuries in Male Soccer Athletes

Arya Teymourlouei — Tue, 21 Jun 2022 00:00:00 -0400

Abstract

Background: One of the most frequently injured muscle groups in soccer is the hamstring group. Soccer players have high rates of hamstring injury (HSI) due to frequent sprinting, changes in direction and similar high-risk activities. Such movements put immense stress on the hamstrings which can lead to injury. Over the last decade, at least four different HSI prevention programs and techniques have been explored in research. The purpose of this review is to assess the effectiveness of these methods.

Methods: Studies in this review were collected using multiple database searches of PubMed. A total of six studies were selected, all either randomized controlled trials (RCTs) or cluster-RCTs. The selected trials were from various soccer leagues in Denmark, Japan, the Netherlands, and the United States.

Results: The most prevalently studied method is the Nordic hamstring exercise (NHE). Studies that utilized the NHE, either as a stand-alone or within a program, reduced the risk of HSI by 15-71%. In addition, effective programs were characterized by progressively increasing the difficulty of exercises and high compliance rates.

Conclusion: Studies that utilized the NHE showed effectiveness in the prevention of hamstring injuries in male soccer athletes. Based on the limited research available, it is unclear whether adding other exercises to prevention programs further reduces injury risk. More research is needed to explore new and existing prevention methods in a variety of populations and regions.

An Avant-garde Approach to Life: Reviewing the Current Applications of 3D Bioprinting

Iqra Nawaz, Yashfa Nawaz, Eisha Nawaz — Thu, 23 Jun 2022 00:00:00 -0400

Introduction: The promise of bioprinting tissue constructs that could potentially serve the same function in the human body as native tissues has taken the world of regenerative medicine by storm. The current review describes system-wide clinical applications of three-dimensional (3D) bioprinting and aims to address ethical and social considerations, while also discussing the scope of this technology in the near future.

Discussion: 3D bioprinting is believed to present new approaches to conventional treatment, offering the advantage of customization and on-time availability. It facilitates simultaneous deposition of appropriate bioinks and biomaterials onto scaffolds which can then be employed to develop tissue fabricates that can potentially mimic native tissues in both structure and functionality. It has been extensively employed to regenerate viable tissue constructs of skin, bone, cartilage, vasculature, myocardial tissue and heart valves, nervous tissue, lung and tracheal tissue, liver, pancreatic, and corneal tissue.

Conclusion: To obviate the current restrictions associated with this technology, it is imperative to understand where we currently stand in terms of current clinical applications of 3D bioprinting. This technology is anticipated to contribute significantly to the fields of tissue engineering and regenerative medicine (TERM), where it can be employed to fabricate functional tissues that can simulate their counterparts in the human body.

Relevance: The increasing disparity between organ demand and supply as well as the shortcomings associated with antiquated approaches to treatment call for utilizing 3D bioprinting to develop viable tissue constructs.

Congenital Cytomegalovirus Infection: Transmission, Diagnosis and Treatment.

Muhammad Romail Manan, Hamna Manan — Tue, 19 Apr 2022 00:00:00 -0400

Introduction: Cytomegalovirus (CMV) is a linear, dsDNA virus that is regarded as the prototype of the Betaherpesvirinae subfamily of viruses. It has an established endemic status in certain locations around the globe, and is also reported to be the most prevalently occurring congenital infection in humans. Furthermore, Cytomegalovirus is notorious for being a persistent lifelong pathogen that poses a threat of reactivation as well.

Discussion: Congenital cytomegalovirus infection causes numerous ophthalmologic, and neurologic sequelae, and is also known for being the principal reason behind sensorineural hearing loss of non-genetic etiology in neonates. These symptoms, if present, may give rise to a premonition of congenital Cytomegalovirus disease, and so, a diagnosis can be established through serology, radiology, and PCR of salivary, urinary, or dried blood spot samples. Timely administration of ganciclovir or valganciclovir has proven to be effective in managing symptomatic cases of congenital CMV.

Conclusion: A well-timed delivery of pharmacological and non-pharmacological interventions is necessary to achieve healthy developmental outcomes for the neonate. Moreover, there is still a need to study the role of antiviral therapy in silent cases since asymptomatic patients are at a risk of developing long-term clinical sequelae as well.

Relevance: An estimated 60-90% of women of child-bearing age get infected with Cytomegalovirus, and Congenital CMV disease is reported in 0.2-2.4% of all live births. Therefore, in order to develop effective screening and management protocols, it is vital to educate healthcare professionals regarding the various aspects of this congenital infection.

Exercise-Induced Pulmonary Hypertension: How to Define, Diagnose, and Treat At-Risk Patients

Brandon Shokoples, Kevin Comeau — Tue, 19 Apr 2022 00:00:00 -0400

Introduction Pulmonary hypertension is a devastating disease with a rapid progression of symptoms leading to high patient mortality. It is characterized by high blood pressure in the pulmonary vasculature and poor pulmonary perfusion, resulting in patient fatigue, dyspnea, and syncope, especially upon physical exertion. A sub-clinical form of pulmonary hypertension also exists which is referred to as exercise induced pulmonary hypertension, where patients display normal resting hemodynamic properties but abnormal pulmonary responses to exercise.

Discussion Recent evidence suggests early intervention and treatment of pulmonary hypertension can improve patient outcomes. However, there is a lack of clinical evidence supporting effective treatments for exercise induced pulmonary hypertension (EIPH), arguably the earliest stage of pulmonary hypertension. This is due in part to the removal of EIPH from official guidelines such as the European Respiratory Society in 2008. EIPH was removed from clinical guidelines due to a lack of consensus on the definition and standardized testing procedures for diagnosing EIPH. Emerging evidence suggests that exercise testing following a standardized protocol of stress echocardiography or right heart catheterization of patients may allow for the classification of EIPH as a mean pulmonary artery pressure/cardiac output slope > 3 mmHg/L/min, and/or mean pulmonary artery pressure > 30 mmHg with a pulmonary vascular resistance > 3 Wood Units.

Conclusion Providing evidence for a consensus definition of EIPH, along with a validated, standardized testing procedure, will hopefully foster the progression of research on EIPH and further the development of treatments and improve patient outcomes for people with pulmonary hypertension.

The Interplay Between COVID-19 and Cardiovascular Disease

Brandon Shokoples, Dr. Nathanne S. Ferreira, Kevin Comeau — Tue, 19 Apr 2022 00:00:00 -0400

Introduction: The emergence of the global COVID-19 pandemic caused by the severe acute respiratory syndrome coronavirus, SARS-CoV-2, has created a substantial burden on healthcare systems worldwide. The systemic impacts of COVID-19 infection are severe and broad in their implications, and the cardiovascular system is no exception. Discussion: Patients with a history of cardiovascular disease are at an increased risk for hospitalization and mortality, and COVID-19 infection has now been demonstrated to initiate acute, but serious, episodes of cardiovascular events such as stroke. Considering the rapid spread of COVID-19 across the globe and the inability of healthcare systems to address and adequately respond to the pandemic, therein lies an increased need for understanding the interplay between COVID-19 infection and cardiovascular disease. SARS-CoV-2 relies on binding the angiotensin-converting enzyme-2 (ACE2) receptor to infect host cells, with ACE2 representing a critical regulator of blood pressure homeostasis and proper cardiovascular functioning. Conclusion: Identifying the exact role of ACE2 in COVID-19 infection will have major implications for understanding the disease; therefore, here we have reviewed ACE2’s involvement in the pathogenesis of COVID-19 infection and the resulting end-organ damage. In addition, we have summarized how COVID-19 affects cardiovascular physiology, and how COVID-19 infection can manifest in acute cardiovascular events. Finally, we examine why patients with cardiovascular disease are at an increased risk of succumbing to COVID-19 and what the long-term cardiovascular implications of COVID-19 infection could mean. Relevance: This paper discusses the cardiovascular consequences of the global COVID-19 pandemic.

Interpreting the Effects of the COVID-19 Pandemic: Bridging Psychological and Sociological Perspectives

Ege Gungor Onal — Sun, 03 Jul 2022 00:00:00 -0400

Recently, sociologists and psychologists have been investigating the implications of the COVID-19 pandemic, yet much of the social science literature regarding COVID-19 remains partial towards either the sociological or psychological perspective. To mitigate the effects of stigma and guilt, a holistic perspective that integrates sociological and psychological viewpoints needs development.

The purpose of this article is to synthesize evidence on the social and psychological implications of the COVID-19 pandemic. In this context, the author focuses on two key themes, stigma and guilt. The concept of guilt is emphasized by the psychological literature, while, on the other hand, the concept of stigma exists both in sociology and psychology, but tends towards sociological interpretations given its historical origin. Overall, the presence of stigma and excessive guilt are associated with decreased social compliance and increased mortality due to the COVID-19 pandemic.

The author argues that social practices that focus on inclusiveness and preparedness towards mitigating the effects of stigma and guilt—while also complying with public health measures—are crucial for social compliance and increasing societal well-being.

Effects of Visual, Auditory, and Combined Cues on Human Movement and Brain Regions Involved in Perception Action

Kedar K. V. Mate — Tue, 05 Jul 2022 00:00:00 -0400

Background: Sensory stimuli such as visual and auditory cues are important to perceive our surroundings accurately. The effects of visual, auditory, or combined cues to modulate human movements such as walking are well-reported in the neuroscience literature. To date, no comprehensive report has summarized these findings.

Objective: The primary aim of this narrative review is to synthesize the literature on the interaction of visual, auditory, and combined cues of movement, as well as to present specific brain regions involved in perception-action.

Methods: A comprehensive review of the literature of published scientific work was conducted using PubMed and Google Scholar. Only English language articles that reported on visual, auditory, or combined cues and human movements were selected. Literature that included biofeedback was excluded.

Results: The literature suggests that visual and auditory cues have the potential to induce deviation in human movements. The posterior superior temporal sulcus and mirror neuron networks are shown to be critical in multimodal sensory integration.

Conclusion: This review presents some important theoretical models and outlines the brain regions involved in sensorimotor synchronization in human movement. Individual visual, auditory, or combined cues may have the potential to develop therapeutic interventions in the rehabilitation of movement disorders.

Epistemic and ethical considerations in the direct-to-consumer health and ancestry genetic testing process

Katherine Huerne — Tue, 19 Apr 2022 00:00:00 -0400

Background: Direct-to-consumer genetic testing (DTC-GT) is a popular and fast-growing field within the healthcare industry. Consumers often pursue DTC-GT without a clear understanding of its epistemic and medical limitations. This report will present the current state of DTC-GT technology, and highlight the ethical, legal and social issues of DTC-GT.

Methods: Quantitative methods such as systematic reviews were used to evaluate the field of DTC-GT. Experimental data was taken from randomized control trials and case studies of 23andMe. Qualitative methods such as newspaper articles and surveys were also used. Relevant policies and regulatory information were analyzed in the context of 23andMe. Broader ethical issues are analyzed from the social disability model and feminist ethics frameworks.

Results: Several aspects of direct-to-consumer genetic testing are outlined: (i) regulatory and legal distinctions of DTC-GT that separate its use from conventional genetic testing, (ii) epistemic issues of the genetic testing process within the direct-to-consumer context, and (iii) ethical considerations of DTC-GT in regard to genetic health and genetic ancestry.

Conclusion: This report does not take a position for or against the use of DTC-GT; rather, it highlights the key ethical issues often missed in the DTC-GT process. There is no perfect method for understanding genetic health and race. DTC-GT offer consumers the ease and power of taking genetic data ‘in their own hands’, at the cost of exacerbating geneticization and race essentialism. Until further work is done to address the epistemic, regulatory and legal issues, ethical implications of DTC-GT usage will continue to exist.

Approach To: Delirium

Alfiya Mukharyamova — Tue, 19 Apr 2022 00:00:00 -0400

Delirium is a common and serious geriatric syndrome with core features of acute onset and inattention. It is often underdiagnosed and is associated with many adverse outcomes, such as prolonged hospitalization, institutionalization, functional impairment and death. This review summarizes an approach to the recognition, work-up, management and prevention of delirium.

Approach to Gynecological Adnexal Masses

Laurie-Rose Dubé — Tue, 19 Apr 2022 00:00:00 -0400

Gynecological pelvic masses are a common occurrence in women of all ages. The differential diagnosis is extensive and includes masses of all anatomical components of the female reproductive tract. This simple and refined approach leads the reader through the process of narrowing said differential. A thorough history and physical examination are essential steps that can hint to the appropriate investigations such as reproductive hormone levels, serum cancer biomarkers and imaging. Emphasis is put on ultrasound findings, helping differentiate not only diagnoses, but also the benign or malignant character of the mass. It also highlights the Risk of Malignancy Index I, commonly used in clinical practice to assess the risk of malignancy of a mass. Beyond the initial approach, some diagnoses and their management are discussed, from the very common functional cyst to the worrisome ovarian neoplasm, and mentioning more peculiar findings like tubo-ovarian abscess and leiomyoma.

Approach to Ischemic Stroke

Meaghan Wunder — Tue, 19 Apr 2022 00:00:00 -0400

An approach to managing acute ischemic stroke includes recognition, investigations, treatment, and secondary prevention. Firstly, facial drooping, limb weakness and slurred speech are some common signs that should raise the suspicion for stroke. Upon presentation, investigations, including the national institute of health stroke scale and a CT head, should be done to rule out intracranial hemorrhage and diagnose an ischemic stroke. The treatment principles for an acute ischemic stroke focus on removing or dissolving the occlusion to maintain or reinstate perfusion of the brain. Finally, patients suffering ischemic stroke should be admitted to the acute stroke unit and monitored for complications. Basic medical management of comorbidities should also be considered to prevent subsequent ischemic episodes. This article will explain each of these processes in more detail to help develop a basic approach to the management of an acute ischemic stroke.

Approach to Acute Kidney Injury

Sophy Mo — Tue, 19 Apr 2022 00:00:00 -0400

Acute kidney injury is defined as an abrupt decline in kidney function, which manifests as an increase in serum creatinine level or a decrease in urine output within a short period of time. It is a commonly encountered entity in the clinical setting and necessitates a systematic diagnostic approach. Acute kidney injury etiologies are classified as either prerenal, intrinsic renal, or postrenal. This article presents the key elements of history taking, physical examination, and laboratory investigations when assessing a patient for acute kidney injury to properly classify its etiology. The use of imaging modalities is also discussed. Common etiologies of acute kidney injury in each category are highlighted. Lastly, this article provides a brief overview of management principles for acute kidney injury with a particular emphasis on indications for initiation of dialysis.

Approach to Hyperkalemia

Caroline Najjar — Wed, 29 Jun 2022 00:00:00 -0400

Hyperkalemia is one of the most common electrolytic disorders encountered in clinical practice. Serum potassium concentration is tightly regulated by cellular transfer via insulin, catecholamines, and acid-base equilibrium and secondarily by the kidney via aldosterone and renal flow. Severe hyperkalemia can result in dangerous and potentially life-threatening manifestations, mainly cardiac in nature. It is therefore crucial for physicians to be able to identify the causes of hyperkalemia and provide appropriate treatment. This approach article provides an overview of potassium homeostasis, diagnostic strategies, and treatment guidelines for patients with mild, moderate, and severe hyperkalemia.

Approach to Hemoptysis

Magdalena Peeva — Thu, 16 Jun 2022 00:00:00 -0400

Hemoptysis is the expectoration of blood from the lower airway. A study in the United Kingdom showed that the annual incidence of hemoptysis in primary care is 0.1%. Between 5 and 15% of patients presenting with hemoptysis have a life-threatening hemoptysis

Approach to hemoptysis can be particularly perplexing for medical students considering the extensive list of differential diagnosis. It is important for physicians to be able to recognize and manage life-threatening hemoptysis as it is associated with high morbidity and mortality if untreated. Understanding when to further investigate patients at risk of lung cancer can help detect the disease at an earlier stage.

This article begins with a brief introduction to life-threatening and nonlife-threatening hemoptysis and provides a detailed discussion of its management including diagnostic approaches followed by appropriate imaging modalities, laboratory findings, and clinical management. The target audience of this article are medical students at their preclinical or clinical phase.

Approach to Strabismus

Arjan S Dhoot, Michael J Wan — Tue, 19 Apr 2022 00:00:00 -0400

Strabismus is characterized by a misalignment of the eyes. A thorough history and physical examination should be performed by clinicians when strabismus is suspected. The Hirschberg, cover, cover-uncover, and alternate prism cover tests are commonly used to identify and diagnose strabismus. Strabismus usually requires a referral to an ophthalmologist. Treatment of strabismus involves eye patches, cycloplegic drops, prescription glasses, and surgery. Strabismus can result in vision loss due to amblyopia and may also cause double vision, psychosocial concerns, and impaired depth perception.

An Approach to Pneumonia in Immunocompetent Patients

Spandana Veeravalli, Safiya Soullane — Tue, 19 Apr 2022 00:00:00 -0400

Pneumonia is a leading cause of morbidity. Pneumonia is defined as a lung inflammation of infectious etiology. It can be subcategorized into Community Acquired Pneumonia, Hospital Acquired Pneumonia and Ventilator Acquired Pneumonia. Validated scores including the CRB-65, CURB-65 and PSI can guide decision-making between inpatient and outpatient management of pneumonia. While mild presentations can be managed through empiric treatment alone, more acute cases require identification of the infectious agent, initiation of empiric therapy, and subsequent de-escalation of treatment to the identified pathogen. This article aims to provide a framework for junior trainees to diagnose and manage pneumonia.

An Approach to the Management of Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia.

David Bouhadana, Iman Sadri — Tue, 19 Apr 2022 00:00:00 -0400

Benign prostatic hyperplasia (BPH) is a condition that affects up to 50% of men over the age of 50; the condition’s prevalence increases with age, particularly after the age of 40. BPH can lead to lower urinary tract symptoms (LUTS) which can have a significant negative impact on health-related quality of life (HRQoL). Men presenting with a gradual onset of LUTS are often suspected to have BPH. However, the clinician must recognize that LUTS possess many different aetiologies. This article aims to provide medical students with a stepwise approach to the diagnosis and management of LUTS that are secondary to BPH. The outlined approach describes the differential diagnoses, required investigations, and management-related details for LUTS that are secondary to BPH. This approach is based off of relevant Canadian, American, and European urological association guidelines.

Approach to Hypercalcemia

Sophy Mo — Tue, 19 Apr 2022 00:00:00 -0400

Hypercalcemia is a presentation commonly encountered in the clinical setting. Due to its vast differential diagnosis, a systematic approach is necessary when approaching patients with hypercalcemia. This article presents a simple, yet thorough approach to help clinicians determine the etiology of their patients' hypercalcemia. The main components of history taking, physical examination, and laboratory investigations for patients with hypercalcemia are highlighted. Emphasis is put on the importance of determining whether the hypercalcemia is associated with elevated or inappropriately normal parathyroid hormone (PTH) levels or not. The main etiologies of PTH-dependent hypercalcemia and PTH-independent hypercalcemia are explored. Primary hyperparathyroidism and hypercalcemia secondary to malignancy are highlighted as together, they make up 90% of hypercalcemia cases. A presentation of the management principles of hypercalcemia is also provided.

Approach to Shock

Janet Chan — Tue, 19 Apr 2022 00:00:00 -0400

Shock is a life-threatening pathophysiologic state referring to inadequate organ perfusion, which can progress to end-organ dysfunction and eventually, multiple organ failure and death. The diagnosis of shock is clinical, necessitating good understanding of the underlying etiology, pathophysiology, as well as the clinical, biochemical, and hemodynamic manifestations of the various presentations of shock. This article describes an approach to shock, highlighting the important initial actions, pertinent clinical findings, and the four main types of shock, and offers an overview of the inotropes and vasopressors used in the intensive care setting. A case study and additional figures are included to supplement the presented concepts.

Approach to Acid Base Abnormalities

Tharaniya Vallipuram — Tue, 05 Jul 2022 00:00:00 -0400

This Approach To article provides an overview on acid-base imbalance, with a particular focus on metabolic acidosis. It provides a general step-wise approach on how to determine what acid-base imbalance is occurring and some of the potential underlying causes for each.

Effectiveness of Home-Based Cardiac Rehabilitation and Its Importance During COVID-19

Hannah Pollock, Anna Garnett — Tue, 19 Apr 2022 00:00:00 -0400

Cardiac rehabilitation is a secondary prevention and disease-management opportunity for individuals living with cardiovascular disease. The COVID-19 pandemic has caused postponements and cancellations for many health services, including 41% of cardiac rehabilitation programs in Canada. Cardiac rehabilitation effectively reduces the risk of mortality, morbidity, and hospitalizations in cardiac clients. Without access, individuals face challenges to improve their health, which places them at risk of adverse outcomes. This paper argues that transitioning to home-based cardiac rehabilitation programs during the pandemic is a reasonable strategy to meet the ongoing rehabilitation needs of cardiac patients. Home-based cardiac rehabilitation programs utilize limited hospital or clinic visits because the majority of exercise is performed at home through regular communication with a case manager. Programs utilize a variety of resources, including technology, to regularly monitor, educate, and counsel clients. The programs’ flexibility and convenience overcome many multi-level barriers which normally impede participants from accessing services. These programs have proven to be equally effective, if not more effective than centre-based programs, at improving mortality, cardiac events, exercise capacity and modifiable risk factors. Home-based programs are a valid alternative to support and protect a vulnerable population, especially those at high risk if diagnosed with COVID-19. Transitioning to a home-based platform may be a challenge, but the Canadian Cardiovascular Society has provided practical approaches to support programs. Adapting current plans and developing new ones, utilizing appropriate resources, having a conservative exercise program, monitoring clients, emphasizing education, being flexible, and enhancing safety are key steps for a successful transition.

Rethinking Modern Hospital Architecture Through COVID-19

Jeffrey KiHyun Park — Tue, 19 Apr 2022 00:00:00 -0400

Lately, the premier ateliers of contemporary architecture -- such as Herzog & de Meuron, or the Office of Metropolitan Architecture -- are showing increasing interest in hospital design, once the realm of highly specialized architectural firms. This trend towards reevaluating hospital design and architecture is most opportune, as the COVID-19 pandemic urges us all to rethink the ways in which our healthcare institutions can be better designed. This commentary is a discussion on the emerging issues of contemporary hospital architecture, especially as reinforced by the pandemic. For instance, while hospital architecture today focuses on individualized care, providing each patient with hotel-like rooms, the pandemic has reminded us of the issue of capacity and inequality in these limited and costly spaces. To what extent should hospitals be centralized or decentralized? Specialized or despecialized? This commentary discusses how COVID-19 has provided insight into some of contemporary hospital architecture’s greatest problems; specifically, it argues that the hospital of the future must exist on a more decentralized platform, both physically and digitally, and be more flexible in function.

Engaging Pre-Clerkship and Clerkship Students as Medical Scribes in The Emergency Department

Tue, 19 Apr 2022 00:00:00 -0400

The Emergency Department (ED) is a highly stressful and fast-paced environment in which doctors are challenged to efficiently adapt and recall knowledge to make safe patient-care decisions. A literature search was conducted to assess the evidence supporting the benefits of exclusively hiring pre-clerkship and clerkship medical students as medical scribes in the emergency department. Several databases were used to collect a total of (insert#) articles and studies to explore and summarize the benefits of its implementation. These include, but are not limited to, increasing medical student exposure to the specialty of emergency medicine, enhancing their clinical skills, and assisting students to pay-down their medical school-related debt. Furthermore, appointing medical students as scribes is mutually beneficial to the ED by helping to cut down the lengthy wait times for patients and reduce the significantly high rates of emergency physician burnout. We conclude that hiring medical students as scribes in the ED is a potentially beneficial practice that merits further consideration and analysis.

Social Media and Mental Health

Andrea Carboni Jiménez, Monica Vaillancourt, Patricia Zhu, Quinta Seon — Tue, 19 Apr 2022 00:00:00 -0400

There are seemingly opposing findings on social media’s effect on mental well-being. Some studies report no detrimental effects, others no association and others even positive or buffering effects. However, social media has rapidly evolved in a short span of time and so has people’s use of the platforms. Collecting an accurate measure of social media use and other methodological challenges particularly affect data in this area. In this commentary, we discuss two longitudinal studies to elaborate these contracting findings on social media and mental health.

COVID-19, Social Media, and Policy: Suggestions for Canada’s Health Messaging Response

Parham Elmi — Tue, 19 Apr 2022 00:00:00 -0400

COVID-19 has impacted the lives of many Canadians physically, emotionally, and financially. This commentary focuses on suggestions on how to use social media platforms to target Canadians to promote public COVID-19 related health messaging. Policy strategies that limit the use of algorithms for social media in an effort to eliminate opinion silos and provide users with a more well-rounded view of current events are explored.

Rewarding progress: Effective learning strategies through a variable ratio incentive-based approach in medical education

Abanoub Aziz Rizk, Nicolas Mourad, Marina Saad, Emanuel Aziz Rizk, Meena Saad — Tue, 19 Apr 2022 00:00:00 -0400

Medical students are faced with many unprecedented challenges, one of which is the large amount of material they are required to learn and retain. While effective learning strategies have been thoroughly researched, stress levels amongst medical students remain very high due to perceived failure to retain material, suggesting that novel methods of implementing such existing strategies are required. Aside from stress levels, additional challenges in medical education include the incorporation of inconsistent testing methods and the challenge of accommodating different learning styles and preferences. A more evidence-based approach that aims to cover many learning styles at once may be desirable. The aim of this commentary is to present some of the current learning and teaching strategies utilized within medical education across the world and to promote a novel supplementary approach to medical education involving a variable ratio incentive-based system of active recall and spaced repetition. This system aims to reward small achievements throughout the semester and complements formal structured examinations in order to motivate students. While this model has yet to be tested, we hope to motivate medical faculty to pilot a program with these evidence-based strategies in mind.

How should we present the epidemic curve for COVID-19?

Jean-Paul R. Soucy, Sarah A. Buchan, Kevin A. Brown — Tue, 19 Apr 2022 00:00:00 -0400

Epidemic curves are used by decision makers and the public to infer the trajectory of the COVID-19 pandemic and to understand the appropriateness of response measures. Symptom onset date is commonly used to date incident cases on the epidemic curve in public health reports and dashboards; however, third-party trackers date cases by the date they were publicly reported by the public health authority. These two curves create very different impressions of epidemic progression. On April 1, 2020, the epidemic curve based on public reporting date for Ontario, Canada showed an accelerating epidemic, whereas the curve based on a proxy variable for symptom onset date showed a rapidly declining epidemic. This illusory downward trend is a feature of epidemic curves anchored using date variables earlier in time than the date a case was publicly reported, such as the symptom onset date. Delays between the onset of symptoms and the detection of a case by the public health authority mean that recent days will always have incomplete case data, creating a downward bias. Public reporting date is not subject to this bias and can be used to visualize real-time epidemic curves meant to inform the public and decision makers.

18th Annual EBOSS Research Day on March 18th, 2022

Epidemiology, Biostatistics and Occupational Health Student Society (EBOSS) — Fri, 18 Mar 2022 00:00:00 -0400

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McGill Summer Research Bursary Program

McGill Summer Research Bursary Program — Sat, 24 Sep 2022 00:00:00 -0400

5th Annual Integrative Psychiatry Conference

McGill Graduate Student Association of Psychiatry (GSAP) — Tue, 06 Sep 2022 00:00:00 -0400

Abstracts from NeuroSymposium 2021

NeuroSymposium — Tue, 19 Apr 2022 00:00:00 -0400

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22nd Annual McGill Biomedical Graduate Conference (AMBGC)

Experimental Medicine Graduate Students' Society (EMGSS) — Wed, 20 Apr 2022 00:00:00 -0400

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2021 Mental Health Conference | June 4th, 2021

McGill Graduate Student Association of Psychiatry (GSAP) — Tue, 19 Apr 2022 00:00:00 -0400

N/A

Abstracts from NeuroSymposium 2022

NeuroSymposium — Mon, 12 Sep 2022 00:00:00 -0400

N/A

7th Annual McGill Family Medicine Research Symposium, May 12-13, 2022

Family Medicine Graduate Student Society (FMGSS) — Fri, 13 May 2022 00:00:00 -0400

n/a

Thrombolytic Administration for Acute Ischemic Stroke

Tue, 19 Apr 2022 00:00:00 -0400

Background: The therapeutic benefit of tissue plasminogen activator (tPA) for acute ischemic stroke is provenbut extremely time-dependent. Current guidelines recommend a <60 minute door-to-needle time. We identify here factors affecting door-to-needle time of tPA administration for acute ischemic stroke.

Methods: We conducted a retrospective chart review of an emergency department from 2010 to 2013. Inclusion criteria were discharge diagnosis of acute ischemic stroke and tPA administration within 4.5 hours of onset. Exclusion criteria were non-ischemic strokes (transient ischemic attacks, subarachnoid hemorrhage, intracerebral hemorrhage) or those given tPA >4.5 hours. We used a linear regression model to quantify factor influence and compared tPA administration benchmark times to target benchmark times (median + quartiles).

Results: Among the 71 ischemic stroke patients included, 38 (54%) received tPA within ≤ 60 minutes. Female sex was associated with a door-to-needle time delay of 13.97 minutes (95% CI 3.412 to 27.111). Median benchmark times did not show evidence of delay in any benchmark in comparison with target benchmark times.

Conclusion: Female sex was associated with increased door-to-needle time. Further investigation of these areas may enable optimized workflow, decreased door-to-needle times, and improved patient outcomes.

Sonoist: An Innovative Peer Ultrasound Learning Initiative on Canadian Teaching Hospital Wards

Laura Yan, Kacper Niburski, Linda Snell — Tue, 19 Apr 2022 00:00:00 -0400

Background: Students usually learn point-of-care ultrasound (PoCUS) on standardized patients, thus lacking opportunities to correlate their ultrasound findings with clinical abnormalities. Sonoist is a student-led initiative aimed at improving ultrasound training with peer-teaching and real patients. We describe here a pilot project of Sonoist, its implementation and evaluation.

Methods: Sonoist was developed by Independent-Practitioner-certified medical students who teach their peers how to scan patients with abnormal clinical findings, then correlating their ultrasound findings with the physical examination. From May 2019 to February 2020, seven sessions were held, with a sessional average of 3 participants and 3 patients scanned. We collected survey data on ultrasound knowledge, participants’ perceived self-improvement, and general comments. Results were grouped by prior ultrasound training (novice n=8, experienced n=12) and year of study (1-4).

Results: 20/23 completed the survey. An increase in ultrasound skill was perceived by 100% of novices and 66.7% of experienced learners. Knowledge about clinical indications for PoCUS improved in 80% of novice and 81% of experienced students; sonographic knowledge improved in 69% of novices and 81.3% of experienced learners. All novices and 91.7% of experienced learners reported that learning ultrasound was useful for correlating with physical exam and clinical diagnosis. All novices and 83% of experienced students preferred peer-to-peer teaching.

Conclusion: Peer-to-peer PoCUS teaching improved medical students’ sonographic and clinical knowledge, and is perceived as useful by students. A combination of early clinical exposure and a less stressful environment from peer teaching may contribute to these results.

Can an Emergency Surgery Scheduling Software Improve Residents’ Time Management and Quality of Life?

James Lee, Ahmed Aoude, Becher Alhalabi, Ayden Watt, Lucie Lessard — Tue, 19 Apr 2022 00:00:00 -0400

Background: Operating room efficiency is invaluable. Particularly in public health systems, where resources are limited and patient loads are high, efficient systems underpin the continued delivery of high quality care. In addition to impacting patients, the implementation of efficient healthcare tools has the potential to improve staff quality of life. In the face of growing surgical resident attrition and healthcare worker burnout, developments in standard practice, such as the implementation of the 80-hour work week, are necessary to improve quality of life.

Materials and methods: A new online scheduling software (ORNET.CA) was created, installed, and piloted in a Level I Trauma Center after instructing users (physicians and nurses) on its use. A 20-item survey was then distributed to all users to assess the effect implementation of the software had on their quality of life.

Results: ORnet was shown to improve communication between hospital staff and physicians, reduce workflow interruptions, and improve the quality of the working environment. The survey showed that 60% of residents and 50% of attending staff believed that ORNET.CA improved their quality of life.

Conclusions: We present data from a novel emergency operating room scheduling system that allowed surgical residents and attending physicians to better plan their on-call shifts. Staff (resident and physician) reported survey results suggest that implementation of this system resulted in an improved quality of life and a decrease in stress and anxiety levels.

Distal Radial Artery Ligation for Dialysis Access Steal Syndrome

David Fung, Yaasin Abdulrehman — Tue, 19 Apr 2022 00:00:00 -0400

Renal replacement therapy is the definitive treatment for end stage renal disease apart from transplant. Steal syndrome, which can lead to distal limb ischemia, is a rare but serious complication in patients who undergo hemodialysis with an arteriovenous fistula. We present a case of a 48-year-old female with limited options for dialysis access who presented with symptoms of steal syndrome. Given the need to keep her current fistula, we opted to treat her with distal radial artery ligation. This case report summarizes the various surgical techniques available for treating dialysis access-associated steal syndrome and why distal radial artery ligation should be considered a viable management strategy, especially in the context of our patient.

Depression and Anxiety as Important Aggravating Factors of Pain in Morton’s Neuroma

Golale Modarresi, Shirin Modarresi — Tue, 19 Apr 2022 00:00:00 -0400

This report represents a case of Morton’s Neuroma with episodic severe sharp pain. Initially, the patient was prescribed Naproxen 500 mg twice per day, anti-inflammatory topical cream, as well as massage. In a follow up visit, the patient was still experiencing frequent episodic sharp pain. In detailed patient interview, it was revealed that she has depression and anxiety and suffers from social isolation, which was concurrent with episodes of severe pain. Therefore, she was referred to a psychologist and a community support group and started practicing body relaxation techniques such as guided imagery and breathing exercises. The new treatment strategy had a major impact on improving her symptoms. This report aims to illustrate that depression and anxiety can be one of the main aggravating factors in episodic pain in Morton’s neuroma and removing psychosocial contributors of pain has the potential to decrease the need for more invasive interventions.

Applied Theatre and Drama in Undergraduate Medical Education: A Scoping Review

Bronte Johnston, Hartley Jafine — Wed, 06 Jul 2022 00:00:00 -0400

Background: Thematic arts have been integrated throughout various undergraduate medical education programs to improve students’ clinical skills, knowledge, and behaviours to be clinically competent physicians. Applied theatre and drama use theatrical performances and exercises respectively to guide education. Several medical schools across Canada and the United States have incorporated applied theatre and drama within their curriculums, but there is currently no compilation of these initiatives.

Methods: Using Arksey and O’Malley’s methodological framework for scoping reviews, the two authors searched journal databases for articles pertaining to theatre/drama activities being used in undergraduate medical education in Canada and the United States; search terms revolved around applied theatre and undergraduate medical education. Twenty articles were read in full, 14 were included in this review. The articles were subjected to content analysis to understand how these studies connected with the CanMEDS framework to understand the impacts and merits of applied theatre and drama in undergraduate medical education.

Results: Content analyses generated three parent-categories of how theatre and drama can help medical students improve their communication skills, creative medical learning, and aid their professional development. These three categories touched upon all seven aspects of the CanMEDS framework, indicating the values of drama being included in medical education.

Conclusion: This scoping review illustrates the intersections of thematic arts in undergraduate medical education by highlighting how applied theatre or drama activities connect to the entire CanMEDS framework. This review provides insights to current theatre and drama initiatives to aid medical faculty with their undergraduate medical curricula developments.

The Effect of Perceived Weight Gain on Hormonal Contraception Choice for Women: A Review

Dr. Roberts, Madelin Skinner, Arie To, Diane Cho — Tue, 05 Jul 2022 00:00:00 -0400

Abstract

Background: Hormonal contraception plays a pivotal role in protecting against unintended pregnancies and has been developed to provide options that best fit women's lifestyles. However, negative perceptions can alter women's attitudes, which can prohibit the usage of hormonal contraception. This review aimed to collect information surrounding perceptions of hormonal contraception side effects, specifically weight gain and women's contraceptive choice.

Methods: 703 articles were found through searching three electronic databases; EBSCO, PubMed, and Web of Science, in addition to Google Scholar. Articles were included if they were published between 2009-2020, could be translated to English, included any form of hormonal contraception, and reported perceived weight gain. A total of 39 articles met the inclusion criteria and are included in the review.

Results: Within those articles, there were six overarching themes: (1) negative perception of weight gain, (2) fear of weight gain, (3) contraception decision based on obesity concerns, (4) avoidance and discontinuation of method due to concerns of weight gain, (5) limited contraceptive knowledge, and (6) lack of counseling. It was found that negative perceptions of weight gain influence women’s hormonal contraception perception and attitude.

Conclusion: Negative perceptions are derived from experience, misconception, and lack of knowledge, leading to fear, avoidance, or discontinuation. Understanding women's perceived weight gain and perception towards contraceptives can help assess its effect on women's choice of contraception. This information can aid health care professionals in educating and discussing methods that would best fit women and improve hormonal contraception adherence.

The Impact of COVID-19 Pandemic and Associated Restrictions on Skin Cancer Diagnosis and Treatment in the Western World

Solomon Bendayan, Dr. François Lagacé, Dr. Elena Netchiporou, Dr. Ivan Litvinov — Tue, 21 Jun 2022 00:00:00 -0400

No abstract for letter to editor as per author guidlines.