Pub Date : 2023-07-31DOI: 10.33137/utmj.v100i2.39000
W. E. Wong, J. Saniasiaya, Abdul Ghani Fauzah, A. Ibrahim, T. L. Loh, A. Zakaria
Leiomyoma of the nasal cavity constitutes less than 1% of all leiomyoma cases and is known to occur predominantly among the adult female population. Traditionally, intranasal Leiomyoma presents with nasal obstruction and epistaxis. Herein, we report a case of solid-pattern Leiomyoma arising from the right inferior turbinate, presenting exclusively as unresolved sphenopalatine neuralgia symptoms. Endoscopic excision of the tumour successfully alleviates the patient’s symptoms, requiring no further management. An extensive literature search revealed that intranasal Leiomyoma could be successfully managed by endoscopic excision with no recurrence. We highlight the importance of intranasal endoscopic examination in all patients with persistent neuropathic pain of the head and neck.
{"title":"Nasal leiomyoma presenting as sphenopalatine neuralgia: a case report and literature review","authors":"W. E. Wong, J. Saniasiaya, Abdul Ghani Fauzah, A. Ibrahim, T. L. Loh, A. Zakaria","doi":"10.33137/utmj.v100i2.39000","DOIUrl":"https://doi.org/10.33137/utmj.v100i2.39000","url":null,"abstract":"Leiomyoma of the nasal cavity constitutes less than 1% of all leiomyoma cases and is known to occur predominantly among the adult female population. Traditionally, intranasal Leiomyoma presents with nasal obstruction and epistaxis. Herein, we report a case of solid-pattern Leiomyoma arising from the right inferior turbinate, presenting exclusively as unresolved sphenopalatine neuralgia symptoms. Endoscopic excision of the tumour successfully alleviates the patient’s symptoms, requiring no further management. An extensive literature search revealed that intranasal Leiomyoma could be successfully managed by endoscopic excision with no recurrence. We highlight the importance of intranasal endoscopic examination in all patients with persistent neuropathic pain of the head and neck.","PeriodicalId":41298,"journal":{"name":"University of Toronto Medical Journal","volume":"58 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78254796","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 : 2023-02-28DOI: 10.33137/utmj.v100i1.40352
Chijindu Ukagwu, Seth Gray
Patient-centered care and evidence-based medicine are mantras that form the foundation of modern healthcare practice. Yet, most of the tools for designing healthcare solutions, including randomized control trials, quality improvement initiatives, and even qualitative research, are often better adapted to providing an evidence-based foundation for practice at the expense of patient, family, and healthcare worker needs. These approaches tend to focus on improving outcomes and processes (Grys, 2022). Stakeholders — particularly patients, but also staff – are objects being scrutinized by “experts” under the scientific or medical gaze, filtering out what the “expert” deems as irrelevant (O’Callaghan, 2022). However, outcomes and processes are not sufficient if they do not prioritize human voice, dignity, and participation. Design thinking provides a complementary approach to evidence-based medicine by engaging the person in experimenting, prototyping, giving feedback, and redesigning healthcare solutions centered around the needs of humans (Razzouk & Shute, 2012). This article describes the process of design thinking as an approach to the creation of human-centered solutions and makes reference to the implementation of the design thinking process in the intensive care unit (ICU) of SickKids, an academic paediatric hospital in Ontario.
{"title":"Applying the principles of Design Thinking to the Intensive Care Environment","authors":"Chijindu Ukagwu, Seth Gray","doi":"10.33137/utmj.v100i1.40352","DOIUrl":"https://doi.org/10.33137/utmj.v100i1.40352","url":null,"abstract":"Patient-centered care and evidence-based medicine are mantras that form the foundation of modern healthcare practice. Yet, most of the tools for designing healthcare solutions, including randomized control trials, quality improvement initiatives, and even qualitative research, are often better adapted to providing an evidence-based foundation for practice at the expense of patient, family, and healthcare worker needs. These approaches tend to focus on improving outcomes and processes (Grys, 2022). Stakeholders — particularly patients, but also staff – are objects being scrutinized by “experts” under the scientific or medical gaze, filtering out what the “expert” deems as irrelevant (O’Callaghan, 2022). However, outcomes and processes are not sufficient if they do not prioritize human voice, dignity, and participation. Design thinking provides a complementary approach to evidence-based medicine by engaging the person in experimenting, prototyping, giving feedback, and redesigning healthcare solutions centered around the needs of humans (Razzouk & Shute, 2012). This article describes the process of design thinking as an approach to the creation of human-centered solutions and makes reference to the implementation of the design thinking process in the intensive care unit (ICU) of SickKids, an academic paediatric hospital in Ontario.","PeriodicalId":41298,"journal":{"name":"University of Toronto Medical Journal","volume":"16 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2023-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75634113","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 : 2023-02-28DOI: 10.33137/utmj.v100i1.39215
Cliff Lindeman, M. Filion, Doug Klein, M. Stickland, N. Drummond, J. Spence
Background: Physical activity (PA) is an important contributor to the health of Canadians. However, the extent that PA is included in family medicine residents' education is largely unknown. This study surveyed curriculum experts in Canadian family medicine residency programs to understand what residents learn about PA and to what extent this varies across programs. Methods: Seventeen family medicine residency program websites were reviewed for information pertaining to their PA curriculum. Additionally, curriculum experts were asked to complete a survey to better understand the extent that PA curriculum is included in their programs. Results: Most (82.4%) of the eligible programs responded to the survey; of which, the majority (92.9%) indicated that residents learn that physical inactivity is a risk factor for chronic conditions, to incorporate into patient care plans, and to recommended PA as prevention for chronic diseases. However, half (50.0%) of the programs stated that they believe residents will be sufficiently prepared to incorporate PA in the care they provide patients, less than half (42.9%) teach PA guidelines, and few (21.4%) teach about PA referral to an allied health care provider or community program. Conclusions: The instruction about PA that family physicians receive in Canadian residency programs varied depending on the program. A standard to ensure residents are sufficiently and competently prepared to recommend and advise physical activity as treatment and prevention is needed. Additional studies are needed to understand the opinions and teachings of preceptors who may have an influence over the residency training of Canadian family physicians.
{"title":"Canadian family medicine residency program survey of physical activity curriculum content","authors":"Cliff Lindeman, M. Filion, Doug Klein, M. Stickland, N. Drummond, J. Spence","doi":"10.33137/utmj.v100i1.39215","DOIUrl":"https://doi.org/10.33137/utmj.v100i1.39215","url":null,"abstract":"Background: Physical activity (PA) is an important contributor to the health of Canadians. However, the extent that PA is included in family medicine residents' education is largely unknown. This study surveyed curriculum experts in Canadian family medicine residency programs to understand what residents learn about PA and to what extent this varies across programs.\u0000Methods: Seventeen family medicine residency program websites were reviewed for information pertaining to their PA curriculum. Additionally, curriculum experts were asked to complete a survey to better understand the extent that PA curriculum is included in their programs.\u0000Results: Most (82.4%) of the eligible programs responded to the survey; of which, the majority (92.9%) indicated that residents learn that physical inactivity is a risk factor for chronic conditions, to incorporate into patient care plans, and to recommended PA as prevention for chronic diseases. However, half (50.0%) of the programs stated that they believe residents will be sufficiently prepared to incorporate PA in the care they provide patients, less than half (42.9%) teach PA guidelines, and few (21.4%) teach about PA referral to an allied health care provider or community program.\u0000Conclusions: The instruction about PA that family physicians receive in Canadian residency programs varied depending on the program. A standard to ensure residents are sufficiently and competently prepared to recommend and advise physical activity as treatment and prevention is needed. Additional studies are needed to understand the opinions and teachings of preceptors who may have an influence over the residency training of Canadian family physicians.","PeriodicalId":41298,"journal":{"name":"University of Toronto Medical Journal","volume":"1 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2023-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75119879","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 : 2023-02-28DOI: 10.33137/utmj.v100i1.38689
Dario Ferri, Clara Moore, K. Mun, Anna Chen, Debra Katzman, J. Nyhof-Young
Background: Evidence-based medicine (EBM) allows physicians to integrate evidence, clinical experience, and patient values into clinical decision making and thus has been readily incorporated into medical education; however, there is limited research capturing the perceptions of both student and educator in their experiences in engaging with an EBM-based research curriculum. Assessing the perceptions of both these key stakeholders represents an important area of research as it can help to inform EBM curriculum integration and evaluation efforts. Methods: This qualitative study utilizes a constructivist framework to assess the thoughts, beliefs, and feelings of students and tutors interacting with a 2-year EBM-based research curriculum. Students completed semi-structured interviews and tutors completed online surveys to explore their perceptions and experiences. Interview transcripts and survey responses were analysed using conventional descriptive content analysis to create a set of recommendations for EBM curriculum development. Results: 13 students and 20 tutors participated, and four major themes were identified. Students noted EBM education was most effective when opportunities existed to apply research skills, complete practical research experience, engage actively in learning, and integrate clinical and research concepts. Tutors found the curriculum to be effective but noted it was challenging to accommodate for the diversity of student knowledge and interest in research. Conclusion: This study provides a general set of recommendations for the design, implementation, and refinement of EBM-based research curricula to facilitate student learning through focusing on 1) research consumption, 2) emphasizing application, 3) emphasizing interactivity, 4) curriculum integration, and 5) catering towards student heterogeneity.
{"title":"Student and educator perceptions of an evidence-based medicine research curriculum: recommendations for research curriculum development","authors":"Dario Ferri, Clara Moore, K. Mun, Anna Chen, Debra Katzman, J. Nyhof-Young","doi":"10.33137/utmj.v100i1.38689","DOIUrl":"https://doi.org/10.33137/utmj.v100i1.38689","url":null,"abstract":"Background: Evidence-based medicine (EBM) allows physicians to integrate evidence, clinical experience, and patient values into clinical decision making and thus has been readily incorporated into medical education; however, there is limited research capturing the perceptions of both student and educator in their experiences in engaging with an EBM-based research curriculum. Assessing the perceptions of both these key stakeholders represents an important area of research as it can help to inform EBM curriculum integration and evaluation efforts. \u0000Methods: This qualitative study utilizes a constructivist framework to assess the thoughts, beliefs, and feelings of students and tutors interacting with a 2-year EBM-based research curriculum. Students completed semi-structured interviews and tutors completed online surveys to explore their perceptions and experiences. Interview transcripts and survey responses were analysed using conventional descriptive content analysis to create a set of recommendations for EBM curriculum development. \u0000Results: 13 students and 20 tutors participated, and four major themes were identified. Students noted EBM education was most effective when opportunities existed to apply research skills, complete practical research experience, engage actively in learning, and integrate clinical and research concepts. Tutors found the curriculum to be effective but noted it was challenging to accommodate for the diversity of student knowledge and interest in research. \u0000Conclusion: This study provides a general set of recommendations for the design, implementation, and refinement of EBM-based research curricula to facilitate student learning through focusing on 1) research consumption, 2) emphasizing application, 3) emphasizing interactivity, 4) curriculum integration, and 5) catering towards student heterogeneity.","PeriodicalId":41298,"journal":{"name":"University of Toronto Medical Journal","volume":"31 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2023-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80368217","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 : 2023-02-28DOI: 10.33137/utmj.v100i1.38937
Arthur Tung, Michael Melchiorre
Background: The prevalence of cognitive bias and its contribution to diagnostic errors has been documented in recent research. Debiasing interventions or educational initiatives are key in reducing the effects and prevalence of cognitive biases, contributing to the prevention of diagnostic errors. The objectives of this review were to 1) characterize common debiasing strategies implemented to reduce diagnosis-related cognitive biases, 2) report the cognitive biases targeted, and 3) determine the effectiveness of these interventions on diagnostic accuracy. Methods: Searches were conducted on April 25, 2022, in MEDLINE, EMBASE, Healthstar, and PsycInfo. Studies were included if they presented a debiasing intervention which aimed to improve diagnostic accuracy. The Rayyan review software was used for screening. Quality assessments were conducted using the JBI Critical Appraisal Tools. Extraction, quality assessment and analysis were recorded in Excel. Results: Searches resulted in 2232 studies. 17 studies were included in the final analysis. Three major debiasing interventions were identified: tool use, education of biases, and education of debiasing strategies. All intervention types reported mixed results. Common biases targeted include confirmation, availability, and search satisfying bias. Conclusion: While all three major debiasing interventions identified demonstrate some effectiveness in improving diagnostic accuracy, included studies reported mixed results when implemented. Furthermore, no studies examined decision-making in a clinical setting, and no studies reported long-term follow-up. Future research should look to identify why some interventions demonstrate low effectiveness, the conditions which enable high effectiveness, and effectiveness in environments beyond vignettes and among attending physicians. PROSPERO registration number: CRD42022331128
{"title":"Debiasing and Educational Interventions in Medical Diagnosis: A Systematic Review","authors":"Arthur Tung, Michael Melchiorre","doi":"10.33137/utmj.v100i1.38937","DOIUrl":"https://doi.org/10.33137/utmj.v100i1.38937","url":null,"abstract":"Background: The prevalence of cognitive bias and its contribution to diagnostic errors has been documented in recent research. Debiasing interventions or educational initiatives are key in reducing the effects and prevalence of cognitive biases, contributing to the prevention of diagnostic errors. The objectives of this review were to 1) characterize common debiasing strategies implemented to reduce diagnosis-related cognitive biases, 2) report the cognitive biases targeted, and 3) determine the effectiveness of these interventions on diagnostic accuracy. Methods: Searches were conducted on April 25, 2022, in MEDLINE, EMBASE, Healthstar, and PsycInfo. Studies were included if they presented a debiasing intervention which aimed to improve diagnostic accuracy. The Rayyan review software was used for screening. Quality assessments were conducted using the JBI Critical Appraisal Tools. Extraction, quality assessment and analysis were recorded in Excel. Results: Searches resulted in 2232 studies. 17 studies were included in the final analysis. Three major debiasing interventions were identified: tool use, education of biases, and education of debiasing strategies. All intervention types reported mixed results. Common biases targeted include confirmation, availability, and search satisfying bias. Conclusion: While all three major debiasing interventions identified demonstrate some effectiveness in improving diagnostic accuracy, included studies reported mixed results when implemented. Furthermore, no studies examined decision-making in a clinical setting, and no studies reported long-term follow-up. Future research should look to identify why some interventions demonstrate low effectiveness, the conditions which enable high effectiveness, and effectiveness in environments beyond vignettes and among attending physicians. PROSPERO registration number: CRD42022331128","PeriodicalId":41298,"journal":{"name":"University of Toronto Medical Journal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135782419","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}
Coronavirus (COVID-19) lockdowns provided a unique opportunity to examine how changes in the social environment impact mental health and wellbeing. We addressed this issue by assessing how perceived social support across COVID-19 restrictions alters alcohol and cannabis use in emerging adults, a population vulnerable to adverse outcomes of substance use. Four hundred sixty-three young adults in Canada and the United States completed online questionnaires for three retrospective timepoints: Pre-Covid, Lockdown and Eased Restrictions. Sociodemographic factors, perceived social support, and substance use were assessed. Overall, alcohol use decreased while cannabis use increased during Lockdown. Interestingly, social support negatively predicted alcohol use and positively predicted cannabis use during Lockdown. These findings suggest a difference in motives underlying alcohol and cannabis use in emerging adults. Importantly, these changes were not sustained when restrictions eased, suggesting that emerging adults exhibit resiliency to the impacts of COVID-19 restrictions on substance use.
{"title":"Differential impacts of perceived social support on alcohol and cannabis use in young adults: lessons from the COVID-19 pandemic","authors":"Michelle Blumberg, Lindsay Lo, Geoffrey Harrison, Alison Dodwell, Samantha Irwin, Mary Olmstead","doi":"10.33137/utmj.v100i1.38056","DOIUrl":"https://doi.org/10.33137/utmj.v100i1.38056","url":null,"abstract":"Coronavirus (COVID-19) lockdowns provided a unique opportunity to examine how changes in the social environment impact mental health and wellbeing. We addressed this issue by assessing how perceived social support across COVID-19 restrictions alters alcohol and cannabis use in emerging adults, a population vulnerable to adverse outcomes of substance use. Four hundred sixty-three young adults in Canada and the United States completed online questionnaires for three retrospective timepoints: Pre-Covid, Lockdown and Eased Restrictions. Sociodemographic factors, perceived social support, and substance use were assessed. Overall, alcohol use decreased while cannabis use increased during Lockdown. Interestingly, social support negatively predicted alcohol use and positively predicted cannabis use during Lockdown. These findings suggest a difference in motives underlying alcohol and cannabis use in emerging adults. Importantly, these changes were not sustained when restrictions eased, suggesting that emerging adults exhibit resiliency to the impacts of COVID-19 restrictions on substance use.","PeriodicalId":41298,"journal":{"name":"University of Toronto Medical Journal","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135782420","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 : 2023-02-28DOI: 10.33137/utmj.v100i1.39079
Jo-Lynn Jean D’Oliveiro, J. Saniasiaya, J. Kulasegarah
Branchial arch anomalies are the second most common cause of congenital lesions of the head and neck in children. We discuss a case of recurrent neck abscess in a young child, which eventually led to a third/fourth branchial cleft anomaly diagnosis. We aim to share our experience in the management of this patient along with a review of literature focusing on the presentation, diagnostic workup and treatment of third/fourth branchial arch anomaly.
{"title":"Recurrent Neck Abscess in a Child: Is Fourth Branchial Arch Anomaly More Common than We Think?","authors":"Jo-Lynn Jean D’Oliveiro, J. Saniasiaya, J. Kulasegarah","doi":"10.33137/utmj.v100i1.39079","DOIUrl":"https://doi.org/10.33137/utmj.v100i1.39079","url":null,"abstract":"Branchial arch anomalies are the second most common cause of congenital lesions of the head and neck in children. We discuss a case of recurrent neck abscess in a young child, which eventually led to a third/fourth branchial cleft anomaly diagnosis. We aim to share our experience in the management of this patient along with a review of literature focusing on the presentation, diagnostic workup and treatment of third/fourth branchial arch anomaly.","PeriodicalId":41298,"journal":{"name":"University of Toronto Medical Journal","volume":"26 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2023-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84798166","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 : 2023-02-28DOI: 10.33137/utmj.v100i1.39410
J. D’Abbondanza, M. Roy, Karen Okrainec, Christine S Novak, H. V. von Schroeder, D. Urbach, S. Mccabe
Adequate health literacy is essential to navigate the healthcare system and has a major role in peri-operative care and outcomes. Minimal information exists regarding surgeons’ understanding of health literacy, clinical implications, and awareness of universal measures of support. This study assessed Canadian surgeons’ perceptions of patients’ health literacy and their knowledge of available supportive resources. We conducted a cross-sectional study using an electronic survey distributed to surgeons at academic institutions. Data collected included sociodemographics, health literacy knowledge, and practice surrounding the use of supportive measures. Across four Canadian academic institutions (University of Toronto, McMaster University, University of Alberta, and University of Calgary), 35 surgeons from various surgical specialties, including general, plastic, and orthopedic surgery, completed the survey. Approximately 74% of surgeons reported familiarity with the concept “health literacy”, but they used general impressions to estimate their patients’ health literacy levels. Surgeons’ perceptions were that patients who had proficient health literacy represented 50% or less of their practice. However, knowledge of supportive tools for measuring patient health literacy was variable. Surgeons familiar with health literacy spent significantly more time (>15 minutes) counselling patients (38%, p=0.02) and used language at a 10th grade level or less (92%, p=0.04). Common supportive measures included using simple, non-medical terms (97%, n=34), repetition (83%, n=29), and drawing pictures/diagrams (83%, n=29). This study highlights the importance of surgeon awareness of health literacy and how improved awareness may guide patient-surgeon interactions and improve the quality of care.
{"title":"Health literacy awareness among Canadian surgeons","authors":"J. D’Abbondanza, M. Roy, Karen Okrainec, Christine S Novak, H. V. von Schroeder, D. Urbach, S. Mccabe","doi":"10.33137/utmj.v100i1.39410","DOIUrl":"https://doi.org/10.33137/utmj.v100i1.39410","url":null,"abstract":"Adequate health literacy is essential to navigate the healthcare system and has a major role in peri-operative care and outcomes. Minimal information exists regarding surgeons’ understanding of health literacy, clinical implications, and awareness of universal measures of support. This study assessed Canadian surgeons’ perceptions of patients’ health literacy and their knowledge of available supportive resources. We conducted a cross-sectional study using an electronic survey distributed to surgeons at academic institutions. Data collected included sociodemographics, health literacy knowledge, and practice surrounding the use of supportive measures. Across four Canadian academic institutions (University of Toronto, McMaster University, University of Alberta, and University of Calgary), 35 surgeons from various surgical specialties, including general, plastic, and orthopedic surgery, completed the survey. Approximately 74% of surgeons reported familiarity with the concept “health literacy”, but they used general impressions to estimate their patients’ health literacy levels. Surgeons’ perceptions were that patients who had proficient health literacy represented 50% or less of their practice. However, knowledge of supportive tools for measuring patient health literacy was variable. Surgeons familiar with health literacy spent significantly more time (>15 minutes) counselling patients (38%, p=0.02) and used language at a 10th grade level or less (92%, p=0.04). Common supportive measures included using simple, non-medical terms (97%, n=34), repetition (83%, n=29), and drawing pictures/diagrams (83%, n=29). This study highlights the importance of surgeon awareness of health literacy and how improved awareness may guide patient-surgeon interactions and improve the quality of care.","PeriodicalId":41298,"journal":{"name":"University of Toronto Medical Journal","volume":"31 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2023-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85442560","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 : 2023-02-28DOI: 10.33137/utmj.v100i1.38865
M. Wunder, Dana Seslija, N. Liem
Prone positioning is a strategy shown to reduce mortality in patients who are mechanically ventilated for acute respiratory distress syndrome and has been used in the COVID-19 pandemic. It is not, however, without complications. Barotrauma, pressure sores, ventilator associated pneumonia and peripheral nerve injuries have all been implicated as complications of prone positioning. There have also been several reports of brachial plexopathy in patients who have undergone prolonged mechanical ventilation with prone positioning. Patient characteristics including body weight index, degree of critical illness, and suboptimal prolonged positioning have all been suggested as possible contributing factors, although, there has been less discussion concerning the action of rolling patients, and how it may contribute to the development of injuries. We describe 3 cases of left brachial plexus injury in patients who were consistently rolled on their left sides. Patients presented with isolated left upper extremity weakness without any structural etiology found on imaging. Electrodiagnostic studies subsequently confirmed a left brachial plexopathy in each of the cases. We suggest that the action of proning patients may contribute to injury. This observation has not yet been suggested in the literature, and carries clinical relevance, as greater attention and meticulous care may need to be employed when moving these individuals.
{"title":"Left brachial plexopathy after prone positioning with COVID-19: a case series","authors":"M. Wunder, Dana Seslija, N. Liem","doi":"10.33137/utmj.v100i1.38865","DOIUrl":"https://doi.org/10.33137/utmj.v100i1.38865","url":null,"abstract":"Prone positioning is a strategy shown to reduce mortality in patients who are mechanically ventilated for acute respiratory distress syndrome and has been used in the COVID-19 pandemic. It is not, however, without complications. Barotrauma, pressure sores, ventilator associated pneumonia and peripheral nerve injuries have all been implicated as complications of prone positioning. There have also been several reports of brachial plexopathy in patients who have undergone prolonged mechanical ventilation with prone positioning. Patient characteristics including body weight index, degree of critical illness, and suboptimal prolonged positioning have all been suggested as possible contributing factors, although, there has been less discussion concerning the action of rolling patients, and how it may contribute to the development of injuries. We describe 3 cases of left brachial plexus injury in patients who were consistently rolled on their left sides. Patients presented with isolated left upper extremity weakness without any structural etiology found on imaging. Electrodiagnostic studies subsequently confirmed a left brachial plexopathy in each of the cases. We suggest that the action of proning patients may contribute to injury. This observation has not yet been suggested in the literature, and carries clinical relevance, as greater attention and meticulous care may need to be employed when moving these individuals.","PeriodicalId":41298,"journal":{"name":"University of Toronto Medical Journal","volume":"2 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2023-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80754922","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 : 2023-02-28DOI: 10.33137/utmj.v100i1.39014
Immanuel Sani
Since the inception of clinical neuroscience, scientific breakthroughs have enhanced our knowledge of how certain pathologies impair the function of the nervous system. Alzheimer’s disease (AD) is a perpetual challenge in modern clinical neuroscience due to the ageing population, which makes individuals increasingly susceptible to AD. On a global scale, AD is the most common form of dementia and the number of people living with dementia worldwide has more than doubled from 1990 to 2016, which warrants prompt development of effective interventions that may halt or delay disease progression. This narrative review recommends further investigation into the effectiveness of monoclonal antibody treatment in patients with early AD and the utilisation of several laboratory tools to understand the complex aetiology of AD. In the next ten years, it is hoped that the recommendations in this article may come to fruition and facilitate further advancements in clinical neuroscience to develop therapies that delay the onset and even reverse the clinical manifestation of AD that currently has a poor prognosis.
{"title":"Management of Alzheimer’s disease in the next ten years","authors":"Immanuel Sani","doi":"10.33137/utmj.v100i1.39014","DOIUrl":"https://doi.org/10.33137/utmj.v100i1.39014","url":null,"abstract":"Since the inception of clinical neuroscience, scientific breakthroughs have enhanced our knowledge of how certain pathologies impair the function of the nervous system. Alzheimer’s disease (AD) is a perpetual challenge in modern clinical neuroscience due to the ageing population, which makes individuals increasingly susceptible to AD. On a global scale, AD is the most common form of dementia and the number of people living with dementia worldwide has more than doubled from 1990 to 2016, which warrants prompt development of effective interventions that may halt or delay disease progression. This narrative review recommends further investigation into the effectiveness of monoclonal antibody treatment in patients with early AD and the utilisation of several laboratory tools to understand the complex aetiology of AD. In the next ten years, it is hoped that the recommendations in this article may come to fruition and facilitate further advancements in clinical neuroscience to develop therapies that delay the onset and even reverse the clinical manifestation of AD that currently has a poor prognosis.","PeriodicalId":41298,"journal":{"name":"University of Toronto Medical Journal","volume":"119 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2023-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75685675","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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