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Navigating long wait times for rheumatological health issues and suggestions for further investigations 导航风湿病健康问题的漫长等待时间和进一步调查的建议
IF 0.7 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-07-31 DOI: 10.33137/utmj.v100i2.39276
John-Peter Bonello, Claire Sethuram
Canada continues to struggle with wait times for patients transitioning from primary to specialized care. Since 2019, wait times for speciality consultation and time to specialty treatment have increased significantly throughout Canada, with Ontario ranking third overall among the provinces for the longest wait times. In addition to Ontario having the largest population among the provinces, musculoskeletal (MSK) based issues make up approximately 30% of all primary care reasons for visits and ranks among the longest wait times by specialty. Thus, a large proportion of patients seeking MSK based health care in Ontario are experiencing significant delays. This commentary discusses the burden of wait times for MSK patients requiring specialized care and offers a guide on how to assess, interpret, and possibly challenge the current care model. Essentially, this commentary suggests further studies be conducted through a qualitative lens to gather and assess information about patients’ perspectives on access, feasibility, and patient-provider alignment of care. Through this subjective lens, a better understanding may be gained regarding how patients interact with the current model of care for MSK health, and this knowledge can be applied in creating patient-education resources, guiding continuing medical education, and most importantly, increasing awareness for prominent systemic impacts such as wait times.
加拿大继续与病人从初级护理过渡到专科护理的等待时间作斗争。自2019年以来,加拿大各地的专科咨询和专科治疗等待时间大幅增加,安大略省在等待时间最长的省份中排名第三。除了安大略省在各省中拥有最多的人口外,基于肌肉骨骼(MSK)的问题约占所有初级保健就诊原因的30%,并且按专科排名等待时间最长。因此,在安大略省寻求基于MSK的医疗保健的大部分患者都经历了严重的延误。这篇评论讨论了需要专门护理的MSK患者的等待时间负担,并提供了如何评估、解释和可能挑战当前护理模式的指南。从本质上讲,这篇评论建议通过定性的视角进行进一步的研究,以收集和评估有关患者对护理的可及性、可行性和患者-提供者一致性的看法的信息。通过这种主观视角,可以更好地了解患者如何与当前的MSK健康护理模式相互作用,并且可以将这些知识应用于创建患者教育资源,指导继续医学教育,最重要的是,提高对等候时间等突出系统影响的认识。
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引用次数: 0
A unique case report of sigmoid colon cancer metastasising to the breasts, ovaries and stomach in pregnancy 乙状结肠癌在妊娠期转移到乳房、卵巢和胃的独特病例报告
IF 0.7 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-07-31 DOI: 10.33137/utmj.v100i2.37765
Victoria Phooi Khei Tan, W. Teng, Fong Juen Kiew, N. Azizan, F. Hayati
Colorectal cancer in pregnancy is an infrequent phenomenon. It is estimated to occur in 1 in 13,000 pregnancies, with 80% representing rectal cancer. We report a rare case of a young pregnant female presenting with primary sigmoid colon adenocarcinoma metastasizing to the breast, ovaries, and stomach. Diagnosing colorectal malignancy in pregnancy is challenging, given the similarities in symptoms. Cancer in pregnancy may take on a more malignant course with rapid progression. Physicians must recognise the potential of this deadly disease lurking undetected in patients of this vulnerable population.
妊娠期结直肠癌是一种罕见的现象。据估计,每13000次怀孕中就有1次发生这种情况,其中80%代表直肠癌。我们报告一个罕见的年轻怀孕女性的原发性乙状结肠腺癌转移到乳房,卵巢和胃。鉴于症状的相似性,诊断妊娠期结直肠恶性肿瘤是具有挑战性的。妊娠期的癌症可能发展迅速,恶性程度更高。医生必须认识到这种致命疾病潜伏在这一脆弱人群中未被发现的可能性。
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引用次数: 0
Infusing artificial intelligence into hemophilia care: taking the next step 将人工智能注入血友病护理:迈出下一步
IF 0.7 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-07-31 DOI: 10.33137/utmj.v100i2.41464
Pascal Tyrrell
The field of healthcare has witnessed remarkable advancements in recent years, particularly in the care and management of persons with hemophilia. With the advent of artificial intelligence (AI) and the growing importance of ultrasonography in medicine, the future of hemophilia care holds great promise. These developments not only improve the delivery of healthcare but also empower patients, leading to better outcomes and enhanced quality of life. In this article, I will explore the recent developments in hemophilia care, the impact of AI on healthcare delivery, and the significance of ultrasonography in digital health for persons with hemophilia.
近年来,卫生保健领域取得了显著进展,特别是在血友病患者的护理和管理方面。随着人工智能(AI)的出现以及超声检查在医学中的重要性日益提高,血友病护理的未来前景广阔。这些发展不仅改善了医疗保健的提供,而且还赋予患者权力,从而带来更好的结果和更高的生活质量。在这篇文章中,我将探讨血友病护理的最新发展,人工智能对医疗服务的影响,以及超声检查在血友病患者数字健康中的意义。
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引用次数: 0
Clinic furniture arrangements leading to patient self-reported blood pressure discrepancy: a rare case of total occlusion of left subclavian artery 诊所家具安排导致患者自报血压差异:一例罕见的左锁骨下动脉完全闭塞
IF 0.7 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-07-31 DOI: 10.33137/utmj.v100i2.37887
Mohd Azzahi Mohamed Kamel, I. A. Ismail, Jazlan Jamaluddin, M. F. Hamdan
Subclavian artery occlusion is an uncommon condition affecting approximately 2% of the general population. Only 8.7% of patients with total occlusion of subclavian artery are asymptomatic. It has the potential to cause significant morbidity as it could contribute to the ischemic complications affecting the upper extremities, brain, and heart. We present a case of asymptomatic total occlusion of left subclavian artery which was found following investigations for discrepancy in blood pressure readings from the patient’s right and left arm. The difference was noted due to the clinic’s furniture arrangement. The patient was treated with stent insertion via percutaneous transluminal angioplasty. After three years of follow ups, she remains asymptomatic and free of cardiovascular-related complications.
锁骨下动脉闭塞是一种罕见的疾病,约占总人口的2%。锁骨下动脉完全闭塞的患者只有8.7%无症状。它有可能引起显著的发病率,因为它可能导致影响上肢、脑和心脏的缺血性并发症。我们提出一个病例无症状的完全闭塞的左锁骨下动脉,这是发现在调查后的血压读数差异从病人的右臂和左臂。这种差异是由诊所的家具安排引起的。患者通过经皮腔内血管成形术接受支架置入治疗。经过三年的随访,她仍然无症状,没有心血管相关并发症。
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引用次数: 0
Introduction of a Patient as Teacher Program into family medicine residency: an exploratory pilot study 在家庭医学住院医师中引入病人为教师计划:一项探索性试点研究
IF 0.7 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-07-31 DOI: 10.33137/utmj.v100i2.40384
Muna Alkhaifi, Emily Peircell, Stephanie Mooney, Adam Clayton, J. Simpson
Background: Family medicine residents should be prepared to address the psychosocial issues that breast cancer survivors may experience. Objectives: Our study aimed to implement a patient-centred approach model into the family medicine residency program and evaluate the impact of such a program on residents. Methods: An interactive virtual session (75 minutes), was integrated into the academic half-day of the family medicine residency program at St. Michael’s Hospital. The session was led by a cancer survivor and her partner. They discussed how illness has impacted their lives and reflect on their experiences with the health care system.  The session was facilitated by a trained facilitator in health care. A qualitative approach was used to evaluate the impact of this program. Two focus groups for residents was conducted to evaluate the delivery mode, recommendations and impact of the proposed program. The focus group discussions were recorded, transcribed and thematically analyzed. Results: This program has had positive influences on residents by improving therapeutic relationships and enhancing the residents' understanding of the experience of illness. This program allowed residents to appreciate the importance of understating patients’ perspectives and values. Additionally, adding the partner perspective to the program was appreciated and valued by residents. Conclusions: Based on the school’s specific curriculum, this program can be integrated into the residents’ academic activities. This can improve important competencies for family medicine residents including confidence in communication and increased empathy. Family medicine residency programs wishing to enhance such humanism skills by family physicians might consider this model.
背景:家庭医学住院医师应该准备好解决乳腺癌幸存者可能遇到的社会心理问题。目的:本研究旨在将以患者为中心的方法模型引入家庭医学住院医师计划,并评估该计划对住院医师的影响。方法:在St. Michael 's Hospital的家庭医学住院医师半天的学术课程中加入一个互动式的虚拟会议(75分钟)。会议由一位癌症幸存者和她的伴侣主持。他们讨论了疾病如何影响他们的生活,并反思了他们在医疗保健系统中的经历。会议由一位在保健方面受过训练的调解人主持。采用定性方法评估该项目的影响。针对居民进行了两个焦点小组,以评估拟议计划的交付模式、建议和影响。对焦点小组讨论进行了记录、转录和专题分析。结果:本项目对住院医师产生了积极的影响,改善了治疗关系,提高了住院医师对疾病体验的理解。这个项目让住院医生认识到低估病人的观点和价值观的重要性。此外,在项目中加入合作伙伴的视角也受到了居民的赞赏和重视。结论:根据学校的具体课程设置,该项目可以融入到住客的学术活动中。这可以提高家庭医学住院医师的重要能力,包括沟通的信心和增加的同理心。希望提高家庭医生人文主义技能的家庭医学住院医师项目可以考虑这种模式。
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引用次数: 0
The knowledge-informed development of inhaled aerosol vaccine strategies 以知识为基础开发吸入气溶胶疫苗策略
IF 0.7 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-07-31 DOI: 10.33137/utmj.v100i2.41463
Z. Xing, F. Smaill
Respiratory infectious diseases including tuberculosis (TB), influenza, and COVID-19 account for significant morbidity and mortality worldwide. However, like most of the other human vaccines, the current-generation vaccines against these respiratory infections are administered parenterally via injection into the skin or muscle. As such, most of these human vaccines remain suboptimal in protection (Lavelle et al, 2022). This calls for developing next-generation vaccine strategies which are expected to perform above and beyond the current-generation vaccines.
包括结核病、流感和COVID-19在内的呼吸道传染病是全球发病率和死亡率很高的疾病。然而,与大多数其他人类疫苗一样,目前针对这些呼吸道感染的疫苗是通过皮肤或肌肉注射的非肠外注射。因此,大多数人用疫苗在保护方面仍处于次优水平(Lavelle等,2022年)。这就要求制定下一代疫苗战略,预期其性能将超越当前这一代疫苗。
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引用次数: 0
Dietary intake and vascular disease: you are what you eat 饮食摄入与血管疾病:你吃什么就是什么
IF 0.7 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-07-31 DOI: 10.33137/utmj.v100i2.41466
D. Wan, S. Anand
Peripheral artery disease (PAD) typically refers to atherosclerotic vascular disease, primarily affecting the arteries of the lower extremities. Despite being one of the three major manifestations of atherosclerosis (the others being coronary artery disease and cerebrovascular disease), PAD remains under-appreciated, under-recognized and under-treated. Contemporary estimates suggest that the global prevalence of PAD approaches up to 236 million patients affected and these numbers are expected to rise with an aging demographic.
外周动脉疾病(PAD)通常是指动脉粥样硬化性血管疾病,主要影响下肢动脉。尽管是动脉粥样硬化的三种主要表现之一(另外两种是冠状动脉疾病和脑血管疾病),但PAD仍然没有得到充分的重视、认识和治疗。目前的估计表明,全球PAD患病率接近2.36亿患者,预计这些数字将随着人口老龄化而上升。
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引用次数: 0
The emerging role of wearables in cardiac care 可穿戴设备在心脏护理中的新兴作用
IF 0.7 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-07-31 DOI: 10.33137/utmj.v100i2.41461
Sophie Sigfstead, Christopher Cheung
In recent years the consumer wearable technology market has experienced remarkable growth, offering consumers an increasing variety of health-related metrics, which include heart rate and electrocardiogram (ECG) data. This development has prompted significant investigation into the role of these devices in cardiac care, revealing numerous advantages and possibilities for innovation. Specifically, wearables have demonstrated value in diagnosing cardiac conditions, assisting with personalized disease management, improving health outcomes, and providing continual monitoring. Current limitations are related to issues such as inaccessibility and device inaccuracy, both of which are significant concerns, due to their impacts on patient well-being and appropriate health resource utilization. Despite these issues, wearables remain an incredibly promising frontier in cardiac care, capable of driving innovation in multiple aspects of cardiovascular practice. This article aims to provide an overview of the current technology available, its demonstrated benefits and limitations, and its future advancement opportunities.
近年来,消费者可穿戴技术市场经历了显著的增长,为消费者提供了越来越多的健康相关指标,包括心率和心电图(ECG)数据。这一发展促进了对这些设备在心脏护理中的作用的重大调查,揭示了许多创新的优势和可能性。具体来说,可穿戴设备在诊断心脏病、协助个性化疾病管理、改善健康状况和提供持续监测方面已经证明了其价值。目前的限制与诸如难以接近和设备不准确等问题有关,这两个问题都是值得关注的问题,因为它们影响到患者的福祉和适当的卫生资源利用。尽管存在这些问题,可穿戴设备仍然是心脏护理领域一个非常有前途的前沿领域,能够在心血管实践的多个方面推动创新。本文旨在概述当前可用的技术,其已证明的优点和局限性,以及其未来的发展机会。
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引用次数: 0
Survey of the degree of burnout in state hospitals among Durban and Pietermaritzburg anaesthetists in KwaZulu Natal, South Africa. 南非夸祖鲁-纳塔尔省德班和彼得马里茨堡公立医院麻醉师职业倦怠程度调查
IF 0.7 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-07-31 DOI: 10.33137/utmj.v100i2.39202
Leana Allie, K. Govender
Background: The most widely accepted model that defines the syndrome of burnout is Maslach Multidimensional Theory of Burnout. According to the theory burnout has three dimensions: emotional exhaustion (EE), depersonalisation (DP), and reduced personal accomplishment (PA). The primary aim of this study is to describe the degree of burnout experienced by anaesthetists working in the eThekwini Hospital Complex and Pietermaritzburg Metropolitan state hospitals in KwaZulu Natal in South Africa. Methods: The Maslach Burnout Inventory a well‐tested instrument with high reliability and validity was used as a measure of burnout with three subscales of emotional exhaustion, depersonalisation, and personal accomplishment. Results: Of the 160 anaesthetic care givers available, 139 completed the questionnaires giving a response rate of 86.8%. Burnout occurred in all participants that is medical officers (general medical doctors with a diploma in anaesthetics), registrars (general medical doctors with a diploma in anaesthetics or residents training and specializing in anaesthesiology) and consultants (specialists anaesthesiologists with a diploma and a fellowship in anaesthesiology). The prevalence of burnout was 17.9%. Of the total number of participants, greater proportion of anaesthetic care givers were female aged 31 to 40 years and that a substantial percentage had 4 to 8 years’ experience in anaesthesiology. The dimensional scores when considered individually showed that 42% of anaesthetists experienced high levels of emotional exhaustion, 38% reported high levels of depersonalisation and the lack of personal achievements was observed in more than 50% of the practising anaesthetists. Conclusion:. High levels of burnout were noted among anaesthetists in Kwazulu Natal. An association was noted between quality of sleep and emotional exhaustion and depersonalization. This information could be of value to the department of anaesthesiology as they are in position to implement interventions that promote participants well-being. Anaesthesiology practices should evaluate the balance between the demands they place on anaesthetic care providers and the resources provided to sustain an engaged, productive, and satisfied anaesthetic workforce. If the multiple stressors that lead to burnout are not addressed the department of anaesthesiology will be plagued by burnout.  
背景:最被广泛接受的倦怠综合症定义模型是马斯拉奇的多维倦怠理论。根据该理论,职业倦怠有三个维度:情绪耗竭(EE)、人格解体(DP)和个人成就感降低(PA)。本研究的主要目的是描述在南非夸祖鲁-纳塔尔省的eThekwini医院和Pietermaritzburg大都会州立医院工作的麻醉师的职业倦怠程度。方法:采用马斯拉克职业倦怠量表(一种经过检验的高信度和效度的量表)作为职业倦怠的测量工具,量表包括情绪耗竭、人格解体和个人成就感三个分量表。结果:160名麻醉护理人员中,有139名完成了问卷调查,问卷回复率为86.8%。医务人员(拥有麻醉学文凭的普通医生)、登记员(拥有麻醉学文凭的普通医生或接受过麻醉学培训的住院医生)和顾问(拥有麻醉学文凭和研究金的麻醉学专家)等所有参与者都出现了职业倦怠。倦怠的患病率为17.9%。在所有参与者中,较大比例的麻醉护理人员是年龄在31至40岁之间的女性,并且有相当大比例的人有4至8年的麻醉经验。当单独考虑维度得分时,42%的麻醉师经历了高度的情绪衰竭,38%的麻醉师报告了高度的人格解体,超过50%的执业麻醉师缺乏个人成就。结论:。在夸祖鲁-纳塔尔省的麻醉师中发现了高度的倦怠。睡眠质量与情绪衰竭和人格解体之间存在关联。这些信息可能对麻醉科有价值,因为他们有能力实施干预措施,促进参与者的健康。麻醉实践应评估他们对麻醉护理提供者的需求与所提供的资源之间的平衡,以维持一支敬业、高效和满意的麻醉工作队伍。如果导致倦怠的多重压力源没有得到解决,麻醉科将受到倦怠的困扰。
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引用次数: 0
Entrepreneurial vision will define health/medical innovation at the University of Toronto over the next decade 企业家的眼光将在未来十年定义多伦多大学的健康/医疗创新
IF 0.7 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-07-31 DOI: 10.33137/utmj.v100i2.41462
P. Santerre
If I had been invited to write this article two decades ago, here at the University of Toronto, my definition of innovation for the University of Toronto would have been very similar to what the University aspired to for the previous 50 years, back to 1950. The vision at that time was to generate knowledge creation by training students via the process of curiosity-driven discovery. This prepared them for a singular career path in research by cultivating their direction towards academia within the post-doctoral pathway. In that mindset, discovery was only shared with the public through peer reviewed publications, housed within the ivory towers of universities, far out of reach from the entrepreneurs of the day. The role of the Canadian University was to impact academia. If society benefited from innovative discoveries, it would happen by random osmosis, as it was most certainly not a deliberate mandate of universities to prepare the entrepreneurial minds of scientific translation to in turn deliver the fruits of discoveries for society’s benefit. Rather, that task would be relegated to the established medical and pharmaceutical industry. However, dramatic shifts have occurred in our fields of health sciences and medical care over the last two decades. These have turned the ivory towers of medical science in Canada onto their side.
如果二十年前我被邀请在多伦多大学写这篇文章,我对多伦多大学创新的定义将与多伦多大学在1950年的50年里所追求的创新非常相似。当时的愿景是通过好奇心驱动的发现过程来训练学生,从而产生知识创造。通过培养他们在博士后道路上的学术方向,这为他们在研究领域的单一职业道路做好了准备。在这种心态下,发现只能通过同行评议的出版物与公众分享,这些出版物被封存在大学的象牙塔里,与当今的企业家相距甚远。加拿大大学的作用是影响学术界。如果社会从创新发现中受益,这将是随机渗透的结果,因为培养科学翻译的企业家思想,反过来将发现的成果传递给社会,这肯定不是大学的刻意授权。相反,这项任务将交给现有的医疗和制药行业。然而,在过去的二十年里,我们的健康科学和医疗保健领域发生了巨大的变化。这使得加拿大医学科学的象牙塔站到了他们这一边。
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引用次数: 0
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University of Toronto Medical Journal
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