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.
{"title":"Approach to: rotator cuff pathology","authors":"Courtenay Wood","doi":"10.26443/mjm.v21i1.957","DOIUrl":"https://doi.org/10.26443/mjm.v21i1.957","url":null,"abstract":"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.","PeriodicalId":18292,"journal":{"name":"McGill Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48817886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anisha Arora, Charo Rodríguez, Tamara Carver, Laura Rojas-Rozo, T. Schuster
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.
{"title":"Evolving a conceptual framework and developing a new questionnaire for usability evaluation of blended learning programs in health professions education","authors":"Anisha Arora, Charo Rodríguez, Tamara Carver, Laura Rojas-Rozo, T. Schuster","doi":"10.26443/mjm.v21i1.961","DOIUrl":"https://doi.org/10.26443/mjm.v21i1.961","url":null,"abstract":"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).\u0000Methods: 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.\u0000Results: 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.\u0000Conclusions: 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.","PeriodicalId":18292,"journal":{"name":"McGill Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48974489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Goodman Cancer Institute Research Symposium","authors":"Goodman Cancer Institute","doi":"10.26443/mjm.v21i1.1034","DOIUrl":"https://doi.org/10.26443/mjm.v21i1.1034","url":null,"abstract":"","PeriodicalId":18292,"journal":{"name":"McGill Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44516825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Artificial Intelligence and Data Mining in Health Research (AI/MDRS)","authors":"","doi":"10.26443/mjm.v21i1.1033","DOIUrl":"https://doi.org/10.26443/mjm.v21i1.1033","url":null,"abstract":"","PeriodicalId":18292,"journal":{"name":"McGill Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43881662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Andrée-Anne Busque, É. Belzile, J. Rodrigues, Maryse Larouche
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.
{"title":"Major Perioperative Complications of Benign Gynecologic Procedures at a University-Affiliated Hospital","authors":"Andrée-Anne Busque, É. Belzile, J. Rodrigues, Maryse Larouche","doi":"10.26443/mjm.v21i1.960","DOIUrl":"https://doi.org/10.26443/mjm.v21i1.960","url":null,"abstract":"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.\u0000Methods: 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.\u0000Results: 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.\u0000Conclusions: 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.","PeriodicalId":18292,"journal":{"name":"McGill Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48106442","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"Concussion in the Adult Athlete","authors":"Laurence Désilets-Barnabé, Philippe Moisan","doi":"10.26443/mjm.v21i1.945","DOIUrl":"https://doi.org/10.26443/mjm.v21i1.945","url":null,"abstract":"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.","PeriodicalId":18292,"journal":{"name":"McGill Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45950709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"Approach to: Bleeding","authors":"Ryan Antel","doi":"10.26443/mjm.v21i1.953","DOIUrl":"https://doi.org/10.26443/mjm.v21i1.953","url":null,"abstract":"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.","PeriodicalId":18292,"journal":{"name":"McGill Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43764341","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"Healthcare in Her Shoes","authors":"B. Richards","doi":"10.26443/mjm.v21i1.968","DOIUrl":"https://doi.org/10.26443/mjm.v21i1.968","url":null,"abstract":"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.","PeriodicalId":18292,"journal":{"name":"McGill Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49340046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"Approach to: Venous Thromboembolism","authors":"S. Ramdani","doi":"10.26443/mjm.v21i1.851","DOIUrl":"https://doi.org/10.26443/mjm.v21i1.851","url":null,"abstract":"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.","PeriodicalId":18292,"journal":{"name":"McGill Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44658164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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