Pub Date : 2020-05-01DOI: 10.21203/rs.3.rs-25430/v1
P. Fenwick, Alyson Colborne, O. Theou, L. Cahill
Keywords: medical education, nutrition, medical students, physicians, undergraduate, lifestyle medicineBackground: Physicians are relied upon as knowledgeable sources of nutrition information; however, many report low nutrition knowledge.Objective: The present study assessed first and second-year medical students’ perceptions of nutrition education within the medical curriculum, in terms of their attitudes, learned body of knowledge, and satisfaction.Methods: An online questionnaire was administered to Dalhousie University medical students completing their first or second year (N=125). Mann-Whitney U tests compared the responses of first-year to second-year students, as well as those with and without previous nutrition education.Results: 97.6% of respondents agreed that nutritional counselling can positively influence patient outcomes, with 91.2% agreeing that physicians play a key role in nutritional counselling. Compared to second-year students, first-year students had greater self-perceived knowledge of basic nutrition concepts (p<0.001) and nutrition in the treatment of disease (p=0.005), as did students with previous nutrition education compared to those without (p=0.019 and 0.018 respectively). Satisfaction was <30% agreement, with first-year students more satisfied with their nutrition education than second-year students (p<0.05).Conclusion: First and second-year medical students regard nutrition as an important component of medical practice that can positively impact patient outcomes. However, low satisfaction with their nutrition education suggests that additional nutrition curriculum would better prepare them for future practice.
{"title":"Medical students’ perceptions of nutrition in medical education and future practice","authors":"P. Fenwick, Alyson Colborne, O. Theou, L. Cahill","doi":"10.21203/rs.3.rs-25430/v1","DOIUrl":"https://doi.org/10.21203/rs.3.rs-25430/v1","url":null,"abstract":"Keywords: medical education, nutrition, medical students, physicians, undergraduate, lifestyle medicineBackground: Physicians are relied upon as knowledgeable sources of nutrition information; however, many report low nutrition knowledge.Objective: The present study assessed first and second-year medical students’ perceptions of nutrition education within the medical curriculum, in terms of their attitudes, learned body of knowledge, and satisfaction.Methods: An online questionnaire was administered to Dalhousie University medical students completing their first or second year (N=125). Mann-Whitney U tests compared the responses of first-year to second-year students, as well as those with and without previous nutrition education.Results: 97.6% of respondents agreed that nutritional counselling can positively influence patient outcomes, with 91.2% agreeing that physicians play a key role in nutritional counselling. Compared to second-year students, first-year students had greater self-perceived knowledge of basic nutrition concepts (p<0.001) and nutrition in the treatment of disease (p=0.005), as did students with previous nutrition education compared to those without (p=0.019 and 0.018 respectively). Satisfaction was <30% agreement, with first-year students more satisfied with their nutrition education than second-year students (p<0.05).Conclusion: First and second-year medical students regard nutrition as an important component of medical practice that can positively impact patient outcomes. However, low satisfaction with their nutrition education suggests that additional nutrition curriculum would better prepare them for future practice.","PeriodicalId":293977,"journal":{"name":"Dalhousie Medical Journal","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123340474","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}
Pub Date : 2019-12-16DOI: 10.15273/dmj.vol46no1.9833
Athena Milios
Anorexia Nervosa (AN) is a serious psychiatric disorder, characterized by restriction of energy intake, low body weight, intense fear of weight gain, and a disturbance in body weight self-perception. Severe and Enduring AN (SE-AN) is a long-lasting (typically 5-7 or more years and marked by several unsuccessful treatment attempts) form of AN. Traditional treatments, centering on weight restoration and core eating pathology, may be part of the reason rates of treatment dropout are high and long-term outcomes are poor, particularly in SE-AN. For SE-AN patients, who have a past marked by failed traditional treatment attempts, multidimensional treatments, addressing motivation to change and maladaptive traits, may improve a range of patient outcomes outside of eating-related symptoms, such as quality of life and interpersonal functioning.The objective of this narrative review is to briefly examine motivation-related factors (e.g., hope and readiness to change), experiential avoidance, perfectionism, and obsessive-compulsiveness, and the impact of treatment approaches incorporating these individual characteristics on various patient outcomes. In conclusion, a holistic, multidimensional, person-centred recovery approach that accounts for (a) illness severity/ chronicity, (b) individual traits, and (c) motivational factors (with a secondary focus on weight gain/eating pathology), could improve quality of life outcomes, particularly in SE-AN. Additionally, integrating patient perspectives, insights, and values into developing/testing novel person-centred interventions is paramount in order to holistically address the underlying biopsychosocial causes and perpetuating factors of AN, and to better understand the trajectory of chronicity.
{"title":"Holistically addressing motivation and maladaptive traits in anorexia nervosa: Impact on prognosis and treatment outcomes","authors":"Athena Milios","doi":"10.15273/dmj.vol46no1.9833","DOIUrl":"https://doi.org/10.15273/dmj.vol46no1.9833","url":null,"abstract":"Anorexia Nervosa (AN) is a serious psychiatric disorder, characterized by restriction of energy intake, low body weight, intense fear of weight gain, and a disturbance in body weight self-perception. Severe and Enduring AN (SE-AN) is a long-lasting (typically 5-7 or more years and marked by several unsuccessful treatment attempts) form of AN. Traditional treatments, centering on weight restoration and core eating pathology, may be part of the reason rates of treatment dropout are high and long-term outcomes are poor, particularly in SE-AN. For SE-AN patients, who have a past marked by failed traditional treatment attempts, multidimensional treatments, addressing motivation to change and maladaptive traits, may improve a range of patient outcomes outside of eating-related symptoms, such as quality of life and interpersonal functioning.The objective of this narrative review is to briefly examine motivation-related factors (e.g., hope and readiness to change), experiential avoidance, perfectionism, and obsessive-compulsiveness, and the impact of treatment approaches incorporating these individual characteristics on various patient outcomes. In conclusion, a holistic, multidimensional, person-centred recovery approach that accounts for (a) illness severity/ chronicity, (b) individual traits, and (c) motivational factors (with a secondary focus on weight gain/eating pathology), could improve quality of life outcomes, particularly in SE-AN. Additionally, integrating patient perspectives, insights, and values into developing/testing novel person-centred interventions is paramount in order to holistically address the underlying biopsychosocial causes and perpetuating factors of AN, and to better understand the trajectory of chronicity.","PeriodicalId":293977,"journal":{"name":"Dalhousie Medical Journal","volume":"215 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117059733","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}
Pub Date : 2019-12-16DOI: 10.15273/dmj.vol46no1.9831
I. Macdonald, J. Blacklaws
Over 100 years ago Sir William Osler made a list of ten readings that should be at the bedside of every medical student reflecting Osler’s broad and prolific reading habits. Time has continued to flow since Osler’s reading list was proposed and thus, its place in current day medical education warrants reflection. Fundamental questions in this respect include: do medical students still read in the same capacity as their century-old counterparts? If so, how widely does Osler’s original reading list apply to current medical students? Finally, what works would today’s medical students recommend having at the bedside? Students representing the classes of 2016 to 2020 were surveyed at Dalhousie Medical School, constituting one of the largest student efforts in the literature to date to provide per- spectives on Osler’s bedside reading list as well as consensus towards an updated library.This study highlights the considerable disconnect between Osler’s original bedside list and reading tendencies of current medical students. Dalhousie medical students predominantly read and are influenced largely by works pertaining to the medical field and physicians, as opposed to the broad selections set forth by Osler.Although this may reflect the changing medical field or the immersive nature of current training, it also urges reflection as to the value Osler saw in his original bedside library and whether these lessons may be lost on future generations of physicians.
100多年前，威廉·奥斯勒爵士(Sir William Osler)列出了十本应放在每个医学院学生床边的读物，这反映了奥斯勒广泛而多产的阅读习惯。自从奥斯勒的阅读清单被提出以来，时间一直在流逝，因此，它在当今医学教育中的地位值得反思。这方面的基本问题包括:医学院学生的阅读能力和他们的百年前辈一样吗?如果是这样的话，奥斯勒最初的阅读清单在医科学生中适用的范围有多大?最后，今天的医科学生会建议在床边使用什么方法?达尔豪斯医学院(Dalhousie Medical School)对2016年至2020年的学生进行了调查，这是迄今为止最大的学生文献调查之一，旨在提供奥斯勒床边阅读清单的观点，以及对更新图书馆的共识。这项研究突出了奥斯勒最初的床边清单与当前医科学生的阅读倾向之间的相当大的脱节。达尔豪斯医学院的学生主要阅读并受到与医学领域和医生有关的作品的影响，而不是奥斯勒所提出的广泛选择。虽然这可能反映了医学领域的变化或当前培训的沉浸性，但它也促使人们反思奥斯勒在他最初的床边图书馆中看到的价值，以及这些教训是否会在未来几代医生身上丢失。
{"title":"Osler’s bedside library: Updated essentials from medical students","authors":"I. Macdonald, J. Blacklaws","doi":"10.15273/dmj.vol46no1.9831","DOIUrl":"https://doi.org/10.15273/dmj.vol46no1.9831","url":null,"abstract":"Over 100 years ago Sir William Osler made a list of ten readings that should be at the bedside of every medical student reflecting Osler’s broad and prolific reading habits. Time has continued to flow since Osler’s reading list was proposed and thus, its place in current day medical education warrants reflection. Fundamental questions in this respect include: do medical students still read in the same capacity as their century-old counterparts? If so, how widely does Osler’s original reading list apply to current medical students? Finally, what works would today’s medical students recommend having at the bedside? Students representing the classes of 2016 to 2020 were surveyed at Dalhousie Medical School, constituting one of the largest student efforts in the literature to date to provide per- spectives on Osler’s bedside reading list as well as consensus towards an updated library.This study highlights the considerable disconnect between Osler’s original bedside list and reading tendencies of current medical students. Dalhousie medical students predominantly read and are influenced largely by works pertaining to the medical field and physicians, as opposed to the broad selections set forth by Osler.Although this may reflect the changing medical field or the immersive nature of current training, it also urges reflection as to the value Osler saw in his original bedside library and whether these lessons may be lost on future generations of physicians.","PeriodicalId":293977,"journal":{"name":"Dalhousie Medical Journal","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121723762","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}
Pub Date : 2019-12-16DOI: 10.15273/DMJ.VOL46NO1.9826
F. Lee
{"title":"The Dalhousie Medical Students’ Society","authors":"F. Lee","doi":"10.15273/DMJ.VOL46NO1.9826","DOIUrl":"https://doi.org/10.15273/DMJ.VOL46NO1.9826","url":null,"abstract":"","PeriodicalId":293977,"journal":{"name":"Dalhousie Medical Journal","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125350925","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}
Pub Date : 2019-12-16DOI: 10.15273/dmj.vol46no1.9834
S. L. Joice, J. Coolen, Catherine Craig
Objective: Interprofessional education (IPE) occurs when two or more professions learn about, from and with each other to improve the quality of care. In Canada, the increasing need for IPE has been acknowledged on a national level.The objective of this project was to assess the implementation and evaluation of an interprofessional simulation curriculum in Obstetrics and Gynaecology (Ob/ Gyn) clerkship. Methods: Three obstetrical emergency simulations were presented to small interprofessional groups of undergraduate students (103): medicine (80), nursing (14), respiratory therapy (1), and paramedicine (8) between September 9, 2016 to August 8, 2017. A paper-based evaluation form was completed by all students.The purpose was to use this evaluation form to conduct a quality assurance review following the completion of the first year of this new interprofessional simulation program. Results: Ninety-nine percent of students indicated the session would benefit their clinical performance; 97.1% found the debriefing exercise helpful; 93% indicated the session was appropriate to their level of training; 98.1% felt it provided valuable team skills training; 92.2% indicated it helped them understand the roles of other health professionals; 96.1% indicated it helped improve collaborative leadership; and 87.1% noted a better understanding of the unique skillset of other health professionals.All students felt they were in a safe learning environment. Conclusion:To our knowledge, this is the first simulation program in Ob/Gyn clerkship in Canada designed to promote IPE amongst the four learner groups described above. Interprofessional simulation in Ob/Gyn Clerkship is valuable and well received by students from all health professional programs involved. It improves communication, role clarification, and collaboration.
{"title":"Introduction and evaluation of an interprofessional undergraduate simulation program in obstetrics and gynaecology - getting started and lessons learned","authors":"S. L. Joice, J. Coolen, Catherine Craig","doi":"10.15273/dmj.vol46no1.9834","DOIUrl":"https://doi.org/10.15273/dmj.vol46no1.9834","url":null,"abstract":"Objective: Interprofessional education (IPE) occurs when two or more professions learn about, from and with each other to improve the quality of care. In Canada, the increasing need for IPE has been acknowledged on a national level.The objective of this project was to assess the implementation and evaluation of an interprofessional simulation curriculum in Obstetrics and Gynaecology (Ob/ Gyn) clerkship. Methods: Three obstetrical emergency simulations were presented to small interprofessional groups of undergraduate students (103): medicine (80), nursing (14), respiratory therapy (1), and paramedicine (8) between September 9, 2016 to August 8, 2017. A paper-based evaluation form was completed by all students.The purpose was to use this evaluation form to conduct a quality assurance review following the completion of the first year of this new interprofessional simulation program. Results: Ninety-nine percent of students indicated the session would benefit their clinical performance; 97.1% found the debriefing exercise helpful; 93% indicated the session was appropriate to their level of training; 98.1% felt it provided valuable team skills training; 92.2% indicated it helped them understand the roles of other health professionals; 96.1% indicated it helped improve collaborative leadership; and 87.1% noted a better understanding of the unique skillset of other health professionals.All students felt they were in a safe learning environment. Conclusion:To our knowledge, this is the first simulation program in Ob/Gyn clerkship in Canada designed to promote IPE amongst the four learner groups described above. Interprofessional simulation in Ob/Gyn Clerkship is valuable and well received by students from all health professional programs involved. It improves communication, role clarification, and collaboration.","PeriodicalId":293977,"journal":{"name":"Dalhousie Medical Journal","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125986365","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}
Pub Date : 2019-12-16DOI: 10.15273/dmj.vol46no1.9835
Clarissa Brisseau, C. LeBlanc
The importance of skills learned through extracurricular activities to medical education, including both athletics and the arts, is undeniable. In this reflective article we draw parallels between the skills learned through the practice of karate, specifically sparring, and those required to perform a patient-centered medical interview in the Emergency Department.Although a collaborative style is traditionally used for both undertakings,there are often good reasons to vary the timing and approach.A high level of situational awareness is necessary to perform either of these tasks effectively.
{"title":"Timing: A key concept for both karateka (空手家) and emergency physicians","authors":"Clarissa Brisseau, C. LeBlanc","doi":"10.15273/dmj.vol46no1.9835","DOIUrl":"https://doi.org/10.15273/dmj.vol46no1.9835","url":null,"abstract":"The importance of skills learned through extracurricular activities to medical education, including both athletics and the arts, is undeniable. In this reflective article we draw parallels between the skills learned through the practice of karate, specifically sparring, and those required to perform a patient-centered medical interview in the Emergency Department.Although a collaborative style is traditionally used for both undertakings,there are often good reasons to vary the timing and approach.A high level of situational awareness is necessary to perform either of these tasks effectively.","PeriodicalId":293977,"journal":{"name":"Dalhousie Medical Journal","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115516011","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}
Pub Date : 2019-12-16DOI: 10.15273/dmj.vol46no1.9836
M. J. Wong
.
．
{"title":"Amazing Grace: A history of the Grace Maternity Hospital in Halifax","authors":"M. J. Wong","doi":"10.15273/dmj.vol46no1.9836","DOIUrl":"https://doi.org/10.15273/dmj.vol46no1.9836","url":null,"abstract":"<jats:p>.</jats:p>","PeriodicalId":293977,"journal":{"name":"Dalhousie Medical Journal","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132561469","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}
Pub Date : 2019-12-16DOI: 10.15273/dmj.vol46no1.9830
K. Macmillan, A. Keddy, J. Furlong
Introduction: Primary open-angle glaucoma (POAG) is characterized by the loss of retinal ganglion cells secondary to optic neuropathy; increased intraocular pressure (IOP) may or may not be present. Many treatment options focus on decreasing IOP measurements to attempt to prevent progression of glaucoma. Our literature review addressed a relatively common question; if cannabis is effective for treating elevated IOP in patients with glaucoma. Objective: To evaluate the current evidence for the use of cannabis for reducing IOP in glaucoma. Methods: PubMed, Embase, and the Cochrane Database were searched along with references drawn from full text articles published before January 2018 for the best available evidence that met the inclusion criteria.Three authors independently evaluated and selected the articles that represented the best available evidence.The selected articles were chosen based on study methodology and the type of cannabis used for the treatment of glaucoma. Randomized Control Trials were preferred, although lacking. No studies directly compared cannabis to the current standard of care medications for lowering IOP. Results: Five randomized controlled trials were included as best available evidence although they used different routes of administration. All studies included compared cannabis to placebo. The studies evaluated showed a range of IOP lowering effects and side effects.Topical administration has shown conflicting results for the treatment of glaucoma.Conclusion:The many forms of cannabinoid administration have demonstrated variable levels of effectiveness. The variability of the studies indicates the need for more research. Specifically, larger sample sizes, and comparison of standardized cannabis to current standards of care instead of placebo are strongly encouraged.
{"title":"Cannabis and glaucoma: A literature review","authors":"K. Macmillan, A. Keddy, J. Furlong","doi":"10.15273/dmj.vol46no1.9830","DOIUrl":"https://doi.org/10.15273/dmj.vol46no1.9830","url":null,"abstract":"Introduction: Primary open-angle glaucoma (POAG) is characterized by the loss of retinal ganglion cells secondary to optic neuropathy; increased intraocular pressure (IOP) may or may not be present. Many treatment options focus on decreasing IOP measurements to attempt to prevent progression of glaucoma. Our literature review addressed a relatively common question; if cannabis is effective for treating elevated IOP in patients with glaucoma. Objective: To evaluate the current evidence for the use of cannabis for reducing IOP in glaucoma. Methods: PubMed, Embase, and the Cochrane Database were searched along with references drawn from full text articles published before January 2018 for the best available evidence that met the inclusion criteria.Three authors independently evaluated and selected the articles that represented the best available evidence.The selected articles were chosen based on study methodology and the type of cannabis used for the treatment of glaucoma. Randomized Control Trials were preferred, although lacking. No studies directly compared cannabis to the current standard of care medications for lowering IOP. Results: Five randomized controlled trials were included as best available evidence although they used different routes of administration. All studies included compared cannabis to placebo. The studies evaluated showed a range of IOP lowering effects and side effects.Topical administration has shown conflicting results for the treatment of glaucoma.Conclusion:The many forms of cannabinoid administration have demonstrated variable levels of effectiveness. The variability of the studies indicates the need for more research. Specifically, larger sample sizes, and comparison of standardized cannabis to current standards of care instead of placebo are strongly encouraged.","PeriodicalId":293977,"journal":{"name":"Dalhousie Medical Journal","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131702502","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}
Pub Date : 2019-12-16DOI: 10.15273/dmj.vol46no1.9827
L. Mahmoud, Hannah Ng, Jade Roberts
Purpose:Tiotropium (SPIRIVA®) is used in the treatment of moderate to severe chronic obstructive pulmonary disease (COPD) in patients with persistent dyspnea despite using a short acting bronchodilator (SABD).This paper explores the role of tiotropium in the treatment of mild COPD. Methods:The Cochrane Library, EMBASE, Pubmed, and Clinicaltrials.gov were searched on February 2018.We included randomized controlled trials (RCTs) that evaluated tiotropium in patients with mild COPD.Three authors assessed studies for eligibility. Outcomes included symptoms, quality of life, exercise duration, lung function, COPD exacerbations and hospitalizations, and serious adverse events. Results: Three RCTs were selected as the best available evidence. Based on the results of the main trial, quality of life and symptoms were improved with tiotropium as compared to placebo with a difference between groups at 24 months to be 1.2 (95% CI: 0.5 to 1.9; p=0.0011) using the COPD Assessment test (CAT) score. Frequency of acute exacerbations of COPD (AECOPD) requiring hospitalization was reduced by 10.3% (28.9% with tiotropium vs 39.2% with placebo) in patients receiving tiotropium. One RCT reported no statistically significant difference in exercise duration (27 ± 27 secs) in the tiotropium group vs 50 ± 21 secs in the placebo group; (p=0.4153). Oropharyngeal discomfort was more common with tiotropium (number needed to harm of 12) compared to placebo. Conclusions: Evidence suggests that tiotropium may reduce COPD exacerbations and hospitalizations and improve quality of life in patients with mild COPD.There is an increased risk of oropharyngeal discomfort with tiotropium.
{"title":"Tiotropium (SPIRIVA®) in mild COPD: Is it worth it?","authors":"L. Mahmoud, Hannah Ng, Jade Roberts","doi":"10.15273/dmj.vol46no1.9827","DOIUrl":"https://doi.org/10.15273/dmj.vol46no1.9827","url":null,"abstract":"Purpose:Tiotropium (SPIRIVA®) is used in the treatment of moderate to severe chronic obstructive pulmonary disease (COPD) in patients with persistent dyspnea despite using a short acting bronchodilator (SABD).This paper explores the role of tiotropium in the treatment of mild COPD. Methods:The Cochrane Library, EMBASE, Pubmed, and Clinicaltrials.gov were searched on February 2018.We included randomized controlled trials (RCTs) that evaluated tiotropium in patients with mild COPD.Three authors assessed studies for eligibility. Outcomes included symptoms, quality of life, exercise duration, lung function, COPD exacerbations and hospitalizations, and serious adverse events. Results: Three RCTs were selected as the best available evidence. Based on the results of the main trial, quality of life and symptoms were improved with tiotropium as compared to placebo with a difference between groups at 24 months to be 1.2 (95% CI: 0.5 to 1.9; p=0.0011) using the COPD Assessment test (CAT) score. Frequency of acute exacerbations of COPD (AECOPD) requiring hospitalization was reduced by 10.3% (28.9% with tiotropium vs 39.2% with placebo) in patients receiving tiotropium. One RCT reported no statistically significant difference in exercise duration (27 ± 27 secs) in the tiotropium group vs 50 ± 21 secs in the placebo group; (p=0.4153). Oropharyngeal discomfort was more common with tiotropium (number needed to harm of 12) compared to placebo. Conclusions: Evidence suggests that tiotropium may reduce COPD exacerbations and hospitalizations and improve quality of life in patients with mild COPD.There is an increased risk of oropharyngeal discomfort with tiotropium.","PeriodicalId":293977,"journal":{"name":"Dalhousie Medical Journal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129743372","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}
Pub Date : 2019-12-16DOI: 10.15273/dmj.vol46no1.9832
A. Riahi
.
．
{"title":"Psoriasis: Advocating for psychosocial support","authors":"A. Riahi","doi":"10.15273/dmj.vol46no1.9832","DOIUrl":"https://doi.org/10.15273/dmj.vol46no1.9832","url":null,"abstract":"<jats:p>.</jats:p>","PeriodicalId":293977,"journal":{"name":"Dalhousie Medical Journal","volume":"23 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122127012","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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