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.
{"title":"Approach to Pneumonia in Immunocompetent Patients","authors":"Spandana Veeravalli, Safiya Soullane","doi":"10.26443/mjm.v19i1.511","DOIUrl":"https://doi.org/10.26443/mjm.v19i1.511","url":null,"abstract":"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.","PeriodicalId":18292,"journal":{"name":"McGill Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45666941","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}
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.
{"title":"Effectiveness of Home-Based Cardiac Rehabilitation and Its Importance During COVID-19","authors":"Hannah Pollock, Anna Garnett","doi":"10.26443/mjm.v19i1.857","DOIUrl":"https://doi.org/10.26443/mjm.v19i1.857","url":null,"abstract":"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.","PeriodicalId":18292,"journal":{"name":"McGill Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45975081","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}
25% of elderly adults fall every year. As most of disease entities seen in Geriatrics, falls are often multifactorial. A systematic approach is therefore key to identify causes and address them. This review summarizes the main causes of falls in the geriatric population, an approach for work-up, and key aspects for its management and prevention.
{"title":"Approach to: Fall in the elderly population","authors":"Melanie Leung","doi":"10.26443/mjm.v19i1.313","DOIUrl":"https://doi.org/10.26443/mjm.v19i1.313","url":null,"abstract":"25% of elderly adults fall every year. As most of disease entities seen in Geriatrics, falls are often multifactorial. A systematic approach is therefore key to identify causes and address them. This review summarizes the main causes of falls in the geriatric population, an approach for work-up, and key aspects for its management and prevention.","PeriodicalId":18292,"journal":{"name":"McGill Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47419145","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 work is licensed under a Creative Commons BY-NC-SA 4.0 International License. AB S T R AC T Fighting for a Hand to Hold by Dr. Samir Shaheen-Hussain is a heartbreaking and compelling read depicting the history of injustices, terror and trauma inflicted upon Indigenous children by the Canadian medical system. As an emergency pediatrician at the McGill University Health Centre and associate professor at McGill University, Dr. ShaheenHussain weaves his clinical experiences and long-standing advocacy efforts alongside archival research to shed insight on medical colonialism. This piece is structured in two parts: a book review followed by a personal reflection. It is accompanied by a podcast interview with Dr. ShaheenHussain in which he discusses his social justice work, his book, and advocacy advice for students in healthcare. This book review highlights the importance of Fighting for a Hand to Hold as a seminal piece of literature for all healthcare professionals and trainees across Canada. In the personal reflection, the author considers their own experiences with race and racism as a person of colour, settler Canadian, and medical student. This reflection concludes by advocating formore emphasis on Indigenous health in Canadian medical education and practice.
本作品获得知识共享BY-NC-SA 4.0国际许可。Samir Shaheen Hussain博士的《AB S T R AC T Fighting for a Hand to Hold》是一本令人心碎且引人入胜的读物，讲述了加拿大医疗系统对土著儿童造成的不公正、恐怖和创伤的历史。作为麦吉尔大学健康中心的急诊儿科医生和麦吉尔大学的副教授，ShaheenHussain博士将他的临床经验和长期倡导工作与档案研究结合起来，以深入了解医学殖民主义。这篇文章分为两部分：一部分是书评，另一部分是个人反思。伴随着对ShaheenHussain博士的播客采访，他在采访中讨论了自己的社会正义工作、他的书以及为医疗保健学生提供的倡导建议。这篇书评强调了《为抓住一只手而战》的重要性，它是加拿大所有医疗专业人员和受训人员的一篇开创性文献。在个人反思中，作者考虑了他们作为有色人种、加拿大移民和医学生的种族和种族主义经历。这一反思最后主张在加拿大医学教育和实践中更加重视土著健康。
{"title":"A Medical Student's Perspective on \"Fighting for a Hand to Hold\"","authors":"S. J. Wang","doi":"10.26443/MJM.V19I1.830","DOIUrl":"https://doi.org/10.26443/MJM.V19I1.830","url":null,"abstract":"This work is licensed under a Creative Commons BY-NC-SA 4.0 International License. AB S T R AC T Fighting for a Hand to Hold by Dr. Samir Shaheen-Hussain is a heartbreaking and compelling read depicting the history of injustices, terror and trauma inflicted upon Indigenous children by the Canadian medical system. As an emergency pediatrician at the McGill University Health Centre and associate professor at McGill University, Dr. ShaheenHussain weaves his clinical experiences and long-standing advocacy efforts alongside archival research to shed insight on medical colonialism. This piece is structured in two parts: a book review followed by a personal reflection. It is accompanied by a podcast interview with Dr. ShaheenHussain in which he discusses his social justice work, his book, and advocacy advice for students in healthcare. This book review highlights the importance of Fighting for a Hand to Hold as a seminal piece of literature for all healthcare professionals and trainees across Canada. In the personal reflection, the author considers their own experiences with race and racism as a person of colour, settler Canadian, and medical student. This reflection concludes by advocating formore emphasis on Indigenous health in Canadian medical education and practice.","PeriodicalId":18292,"journal":{"name":"McGill Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43592517","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}
Semsi Kocabas, E. Bilgic, A. Gorgy, Jason M. Harley
Artificial intelligence (AI) has gained momentum in the last decade in various professional domains, but its usage remains scarce in the field of medicine. Available AI-enhanced devices are not integrated in a consistent fashion throughout Canadian health facilities, and current medical practitioners and students are not well prepared for AI’s impact on their careers. Undergraduate medical students lack fundamental knowledge of AI in medicine, from its impact on patient care and its potential as an adjunct decision-making tool, to the general fundamentals of how AI-enhanced devices work. Currently, postgraduates don’t have access to AI-enhanced devices; this could potentially limit their understanding of how these devices might affect their future clinical practice. Canadian medical universities can play a critical role in familiarizing students with these new devices. Incorporating new topics into the already heavily charged medical curricula may be challenging, but students could make use of extracurricular activities to learn the concept of AI and strengthen interdisciplinary collaboration. Educational institutions would also need to propose policies for the safe and ethical use of devices in classrooms or internships. However, they might require guidance to draft new policies targeting AI in medical education. Canadian medical associations could take the lead to draft AI policies in healthcare to guide the equal and safe implementation of AI-enhanced devices across the Canadian medical community. Our paper will explore the work that has been done related to AI-specific policies in healthcare, focusing on Canada, and provide key points that could be used to organize future policies.
{"title":"Deconstructing Canada’s efforts to integrate artificial intelligence in medicine and medical education","authors":"Semsi Kocabas, E. Bilgic, A. Gorgy, Jason M. Harley","doi":"10.26443/MJM.V19I1.871","DOIUrl":"https://doi.org/10.26443/MJM.V19I1.871","url":null,"abstract":"Artificial intelligence (AI) has gained momentum in the last decade in various professional domains, but its usage remains scarce in the field of medicine. Available AI-enhanced devices are not integrated in a consistent fashion throughout Canadian health facilities, and current medical practitioners and students are not well prepared for AI’s impact on their careers. Undergraduate medical students lack fundamental knowledge of AI in medicine, from its impact on patient care and its potential as an adjunct decision-making tool, to the general fundamentals of how AI-enhanced devices work. Currently, postgraduates don’t have access to AI-enhanced devices; this could potentially limit their understanding of how these devices might affect their future clinical practice. Canadian medical universities can play a critical role in familiarizing students with these new devices. Incorporating new topics into the already heavily charged medical curricula may be challenging, but students could make use of extracurricular activities to learn the concept of AI and strengthen interdisciplinary collaboration. Educational institutions would also need to propose policies for the safe and ethical use of devices in classrooms or internships. However, they might require guidance to draft new policies targeting AI in medical education. Canadian medical associations could take the lead to draft AI policies in healthcare to guide the equal and safe implementation of AI-enhanced devices across the Canadian medical community. Our paper will explore the work that has been done related to AI-specific policies in healthcare, focusing on Canada, and provide key points that could be used to organize future policies.","PeriodicalId":18292,"journal":{"name":"McGill Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46155263","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}
Hyponatremia is a common laboratory finding in numerous patients. It is defined as a serum sodium concentration <135 mmol/L and represents an excess of water in the extracellular compartment. The severity of this electrolyte abnormality ranges from asymptomatic to seizures, coma and death as a consequence of cerebral swelling. There are multiple medical conditions, medications and disease states that can cause hyponatremia. This article summarizes the important pathophysiological pathways involved in the development of hyponatremia, describes an approach to common causes and reviews the initial steps in management.
{"title":"Approach to Hyponatremia","authors":"Kaylie Schachter","doi":"10.26443/MJM.V19I1.833","DOIUrl":"https://doi.org/10.26443/MJM.V19I1.833","url":null,"abstract":"Hyponatremia is a common laboratory finding in numerous patients. It is defined as a serum sodium concentration <135 mmol/L and represents an excess of water in the extracellular compartment. The severity of this electrolyte abnormality ranges from asymptomatic to seizures, coma and death as a consequence of cerebral swelling. There are multiple medical conditions, medications and disease states that can cause hyponatremia. This article summarizes the important pathophysiological pathways involved in the development of hyponatremia, describes an approach to common causes and reviews the initial steps in management.","PeriodicalId":18292,"journal":{"name":"McGill Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42439291","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":"8e Symposium étudiant de neurologie, 22 au 29 mai 2021 | 8th edition Student Neurosymposium, May 22 to 29, 2021","authors":"","doi":"10.26443/mjm.v19i1.902","DOIUrl":"https://doi.org/10.26443/mjm.v19i1.902","url":null,"abstract":"<jats:p>n/a</jats:p>","PeriodicalId":18292,"journal":{"name":"McGill Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47968481","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}
Between 50 and 80% of adults will experience lower back pain during their life(1). This condition is responsible for a significant portion of emergency room and primary care consultations and it creates a significant burden on the healthcare services and costs. Even if lower back pain causes a significant impact on the quality of life of the patients most causes are benign. This article presents a systematic approach to identifying the cause of lower back pain, summarizes the indications for further workup and presents current evidence for the management of this condition.
{"title":"Approach to: Lower back pain","authors":"Philippe Moisan","doi":"10.26443/MJM.V19I1.827","DOIUrl":"https://doi.org/10.26443/MJM.V19I1.827","url":null,"abstract":"Between 50 and 80% of adults will experience lower back pain during their life(1). This condition is responsible for a significant portion of emergency room and primary care consultations and it creates a significant burden on the healthcare services and costs. Even if lower back pain causes a significant impact on the quality of life of the patients most causes are benign. This article presents a systematic approach to identifying the cause of lower back pain, summarizes the indications for further workup and presents current evidence for the management of this condition.","PeriodicalId":18292,"journal":{"name":"McGill Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48026950","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":"Rosalind and Morris Goodman Cancer Research Centre Annual Symposium | May 6-7, 2021","authors":"","doi":"10.26443/mjm.v19i1.896","DOIUrl":"https://doi.org/10.26443/mjm.v19i1.896","url":null,"abstract":"<jats:p>n/a</jats:p>","PeriodicalId":18292,"journal":{"name":"McGill Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46589608","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}
Uma Anand Raje, Tyler M. Saumur, Fernanda Pesce de Souza, S. Mathur, T. Janaudis-Ferreira
Background:Exercise training programs must be described in detail to facilitate replication and implementation. This study aimed to evaluate the quality of exercise training program description in randomized controlled trials (RCTs) involving solid organ transplant (SOT) recipients. Methods: We evaluated 21 RCTs reporting on exercise interventions in SOT recipients that were included in a recent systematic review/meta-analysis conducted by the research team. This previous review investigated the effects of exercise training (versus no training) in adult SOT recipients. Several databases (MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials) were searched from inception to May 2019. Three reviewers independently rated the exercise programs for SOT using the Consensus on Exercise Reporting Template (CERT). Results: Mean score of the CERT was 6/19. None of the RCTs described all items of the CERT. Items of crucial importance, such as adherence, whether the exercise was done individually or in a group, whether there were home program or non-exercise components, and the type and number of adverse events, were either not mentioned or not described in detail. Conclusion: RCTs in exercise in SOT recipients did not satisfactorily report their exercise protocols, which can lead to difficulties in replication by researchers and implementation by clinicians.
{"title":"Quality of the reporting of exercise interventions in solid organ transplant recipients: a systematic review","authors":"Uma Anand Raje, Tyler M. Saumur, Fernanda Pesce de Souza, S. Mathur, T. Janaudis-Ferreira","doi":"10.26443/MJM.V19I1.219","DOIUrl":"https://doi.org/10.26443/MJM.V19I1.219","url":null,"abstract":"Background:Exercise training programs must be described in detail to facilitate replication and implementation. This study aimed to evaluate the quality of exercise training program description in randomized controlled trials (RCTs) involving solid organ transplant (SOT) recipients. \u0000Methods: We evaluated 21 RCTs reporting on exercise interventions in SOT recipients that were included in a recent systematic review/meta-analysis conducted by the research team. This previous review investigated the effects of exercise training (versus no training) in adult SOT recipients. Several databases (MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled Trials) were searched from inception to May 2019. Three reviewers independently rated the exercise programs for SOT using the Consensus on Exercise Reporting Template (CERT). \u0000Results: Mean score of the CERT was 6/19. None of the RCTs described all items of the CERT. Items of crucial importance, such as adherence, whether the exercise was done individually or in a group, whether there were home program or non-exercise components, and the type and number of adverse events, were either not mentioned or not described in detail.\u0000Conclusion: RCTs in exercise in SOT recipients did not satisfactorily report their exercise protocols, which can lead to difficulties in replication by researchers and implementation by clinicians.","PeriodicalId":18292,"journal":{"name":"McGill Journal of Medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47414958","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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