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Differential impacts of perceived social support on alcohol and cannabis use in young adults: lessons from the COVID-19 pandemic 感知到的社会支持对年轻人使用酒精和大麻的不同影响:来自COVID-19大流行的教训
Q4 Medicine Pub Date : 2023-02-28 DOI: 10.33137/utmj.v100i1.38056
Michelle Blumberg, Lindsay Lo, Geoffrey Harrison, Alison Dodwell, Samantha Irwin, Mary Olmstead
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.
冠状病毒(COVID-19)封锁为研究社会环境变化如何影响心理健康和福祉提供了一个独特的机会。我们通过评估COVID-19限制期间感知的社会支持如何改变新成年人群的酒精和大麻使用情况来解决这一问题,新成年人群易受物质使用不良后果的影响。加拿大和美国的463名年轻人完成了三个回顾性时间点的在线问卷调查:冠状病毒前、封锁和放松限制。评估了社会人口因素、感知社会支持和物质使用情况。总体而言,在封锁期间,酒精的使用减少了,而大麻的使用增加了。有趣的是,在封锁期间,社会支持对酒精使用有负面预测,对大麻使用有积极预测。这些发现表明,新成年人群使用酒精和大麻的动机存在差异。重要的是,当限制放松时,这些变化并没有持续下去,这表明新生成年人对COVID-19限制对物质使用的影响表现出弹性。
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引用次数: 0
Recurrent Neck Abscess in a Child: Is Fourth Branchial Arch Anomaly More Common than We Think? 儿童复发性颈部脓肿:第四支弓异常比我们想象的更常见吗?
IF 0.7 Q4 Medicine Pub Date : 2023-02-28 DOI: 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.
鳃裂弓异常是儿童头颈部先天性病变的第二大常见原因。我们讨论一例复发性颈部脓肿在一个年幼的孩子,最终导致第三/第四鳃裂异常诊断。我们的目的是分享我们的经验,在处理这个病人,并回顾文献集中在表现,诊断检查和治疗的第三/第四支弓异常。
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引用次数: 0
Health literacy awareness among Canadian surgeons 加拿大外科医生的健康素养意识
IF 0.7 Q4 Medicine Pub Date : 2023-02-28 DOI: 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.
充分的健康素养对于医疗保健系统的导航至关重要,并且在围手术期护理和结果中起着重要作用。关于外科医生对健康素养、临床意义和普遍支持措施的认识的了解很少。本研究评估了加拿大外科医生对患者健康素养的看法以及他们对可用支持资源的了解。我们进行了一项横断面研究,使用电子调查分发给学术机构的外科医生。收集的数据包括社会人口统计学、卫生素养知识和围绕使用支持性措施的实践。来自加拿大四所学术机构(多伦多大学、麦克马斯特大学、阿尔伯塔大学和卡尔加里大学)的35名外科医生完成了这项调查,他们来自不同的外科专业,包括普通外科、整形外科和整形外科。大约74%的外科医生报告熟悉“健康素养”的概念,但他们使用总体印象来估计患者的健康素养水平。外科医生的看法是,精通健康知识的患者占其实践的50%或更少。然而,衡量患者健康素养的辅助工具的知识是可变的。熟悉健康知识的外科医生花费更多时间(>15分钟)咨询患者(38%,p=0.02),使用10年级或更低水平的语言(92%,p=0.04)。常见的支持措施包括使用简单的非医学术语(97%,n=34)、重复(83%,n=29)和绘制图片/图表(83%,n=29)。本研究强调了外科医生健康素养意识的重要性,以及提高意识如何指导患者与外科医生的互动并提高护理质量。
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引用次数: 0
Left brachial plexopathy after prone positioning with COVID-19: a case series 俯卧位合并COVID-19后左臂丛病:病例系列
IF 0.7 Q4 Medicine Pub Date : 2023-02-28 DOI: 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.
俯卧位是一种被证明可以降低急性呼吸窘迫综合征机械通气患者死亡率的策略,已在COVID-19大流行中使用。然而,这并非没有复杂性。气压创伤、压疮、呼吸机相关肺炎和周围神经损伤都与俯卧位的并发症有关。也有一些报道,在长期机械通气和俯卧位的患者中发生臂丛病。包括体重指数、危重程度和次优长时间体位在内的患者特征都被认为是可能的影响因素,尽管关于滚动患者的行为及其如何导致损伤的讨论较少。我们描述了3例左臂丛神经损伤的患者谁一贯滚动他们的左侧。患者表现为孤立的左上肢无力,影像学检查未发现任何结构性病因。电诊断研究随后证实了每个病例的左臂丛病。我们认为,俯卧患者的行为可能会导致损伤。这一观察结果尚未在文献中提出,并且具有临床相关性,因为在移动这些个体时可能需要更多的关注和细致的护理。
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引用次数: 0
Management of Alzheimer’s disease in the next ten years 阿尔茨海默病在未来十年的管理
IF 0.7 Q4 Medicine Pub Date : 2023-02-28 DOI: 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.
自从临床神经科学成立以来,科学上的突破增强了我们对某些病理如何损害神经系统功能的认识。由于人口老龄化,阿尔茨海默病(Alzheimer’s disease, AD)是现代临床神经科学中一个永恒的挑战,这使得个体对阿尔茨海默病的易感性越来越高。在全球范围内,阿尔茨海默氏症是最常见的痴呆症形式,从1990年到2016年,全球痴呆症患者人数增加了一倍多,这就需要迅速开发有效的干预措施,阻止或延缓疾病进展。这篇叙述性综述建议进一步研究单克隆抗体治疗早期AD患者的有效性,并利用几种实验室工具来了解AD的复杂病因。在未来的十年里,希望本文的建议能够成为现实,促进临床神经科学的进一步发展,开发出延缓甚至逆转目前预后较差的AD临床表现的治疗方法。
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引用次数: 0
A coagulopathic conundrum of COVID-19 COVID-19的凝血障碍难题
IF 0.7 Q4 Medicine Pub Date : 2023-02-28 DOI: 10.33137/utmj.v100i1.39018
Peter Iskander, Jiayi Zheng, Sumbal Zaidi, Anthony Iskander
We present a case of an elderly male who presented to the hospital with a worsening cough and shortness of breath. Previous outpatient COVID-19 polymerase chain reaction test was negative, and the patient’s symptoms failed to improve despite one-week course of antibiotics. He presented to the hospital a few days later with worsening symptoms and a positive COVID-19 polymerase chain reaction test at this time. Patient was febrile, tachycardic, hypertensive, and was admitted to the intensive care unit due to desaturation on room air ultimately leading to intubation. CBC with differential showed evidence of thrombocytopenia, elevated INR/D-Dimer/fibrin split products/inflammatory markers, as well as decreased fibrinogen. He was treated for COVID-19 pneumonia and given platelets/cryoprecipitate/Vit K for suspected diffuse intravascular coagulation.
我们提出的情况下,一个老年男性谁提出了恶化的咳嗽和呼吸急促的医院。既往门诊COVID-19聚合酶链反应检测阴性,患者使用抗生素一周后症状仍未好转。几天后,他来到医院,症状恶化,此时COVID-19聚合酶链反应检测呈阳性。患者发热、心动过速、高血压,因室内空气不饱和最终导致插管而住进重症监护病房。有差异的CBC表现为血小板减少,INR/ d -二聚体/纤维蛋白分裂产物/炎症标志物升高,以及纤维蛋白原降低。他接受了COVID-19肺炎治疗,并因怀疑弥漫性血管内凝血给予血小板/冷沉淀/Vit K。
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引用次数: 1
Principles of resource allocation and triage during COVID-19 COVID-19期间的资源分配和分流原则
IF 0.7 Q4 Medicine Pub Date : 2023-02-28 DOI: 10.33137/utmj.v100i1.40353
H. Ajzenberg, S. Oczkowski
The COVID-19 pandemic confronted Canadians with the fact that our health care systems may not always have enough to go around. Critical care resources, specifically, were stretched far beyond the limits of what was thought possible. In the spring of 2021, the exponential growth of patients with COVID-19 brought Ontario’s ICUs frighteningly near the breaking point. When a health system’s resources are overwhelmed by the demands placed upon them, allocation of scarce resources is typically performed by triage — a formalized system to determine who receives critical care resources and who does not. In this commentary, we will explain the rationale for the use of a formal triage protocol during times of resource scarcity; review the ethical foundations of an approach to resource allocation; outline the process of triage protocol development in Ontario during the COVID-19 pandemic, and highlight some lessons learned for the future.
COVID-19大流行使加拿大人面临这样一个事实,即我们的医疗保健系统可能并不总是足够的。特别是重症监护资源的使用远远超出了人们的想象。2021年春天,COVID-19患者的指数级增长使安大略省的重症监护病房可怕地接近了临界点。当卫生系统的资源被施加在它们身上的需求所压倒时,通常通过分诊来分配稀缺资源,这是一种确定谁接受重症监护资源而谁不接受的正式系统。在这篇评论中,我们将解释在资源稀缺时期使用正式分类协议的基本原理;审查资源分配方法的道德基础;概述了2019冠状病毒病大流行期间安大略省分诊方案的制定过程,并强调了为未来吸取的一些经验教训。
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引用次数: 0
Debiasing and Educational Interventions in Medical Diagnosis: A Systematic Review 医学诊断中的消除偏见和教育干预:系统综述
IF 0.7 Q4 Medicine Pub Date : 2022-09-14 DOI: 10.1101/2022.09.12.22279750
A. Tung, M. 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 that 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.
背景:认知偏差的普遍性及其对诊断错误的贡献已在最近的研究中得到证实。消除偏见的干预措施或教育举措是减少认知偏见的影响和流行的关键,有助于预防诊断错误。本综述的目的是:1)描述为减少诊断相关认知偏差而实施的常见去偏策略;2)报告所针对的认知偏差;3)确定这些干预措施对诊断准确性的有效性。方法:于2022年4月25日在MEDLINE、EMBASE、Healthstar和PsycInfo中进行检索。如果研究提出了旨在提高诊断准确性的去偏干预措施,则纳入研究。使用Rayyan审查软件进行筛选。使用JBI关键评估工具进行质量评估。提取、质量评价和分析记录在Excel中。结果:检索结果为2232项研究。最终分析纳入了17项研究。确定了三种主要的消除偏见干预措施:工具使用、偏见教育和消除偏见策略教育。所有干预类型报告的结果好坏参半。常见的偏见包括确认、可用性和搜索满意偏见。结论:虽然确定的所有三种主要的去偏干预措施在提高诊断准确性方面都表现出一定的有效性,但纳入的研究报告了实施后的混合结果。此外,没有研究检查临床环境中的决策,也没有研究报告长期随访。未来的研究应该着眼于确定为什么一些干预措施表现出低有效性,使高有效性的条件,以及在小插曲之外的环境和主治医生之间的有效性。
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引用次数: 0
Differential Impacts of Perceived Social Support on Alcohol and Cannabis Use in Young Adults: Lessons from the COVID-19 Pandemic 感知到的社会支持对年轻人酒精和大麻使用的不同影响:来自COVID-19大流行的教训
IF 0.7 Q4 Medicine Pub Date : 2022-08-06 DOI: 10.1101/2022.08.04.22278446
Michelle Blumberg, Lindsay A. Lo, Geoffrey Harrison, Alison Dodwell, Samantha Irwin, M. Olmstead
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 time points: 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.
冠状病毒(COVID-19)封锁为研究社会环境变化如何影响心理健康和福祉提供了一个独特的机会。我们通过评估COVID-19限制期间感知的社会支持如何改变新成年人群的酒精和大麻使用情况来解决这一问题,新成年人群易受物质使用不良后果的影响。加拿大和美国的463名年轻人完成了三个回顾性时间点的在线问卷调查:冠状病毒前、封锁和放松限制。评估了社会人口因素、感知社会支持和物质使用情况。总体而言,在封锁期间,酒精的使用减少了,而大麻的使用增加了。有趣的是,在封锁期间,社会支持对酒精使用有负面预测,对大麻使用有积极预测。这些发现表明,新成年人群使用酒精和大麻的动机存在差异。重要的是,当限制放松时,这些变化并没有持续下去,这表明新生成年人对COVID-19限制对物质使用的影响表现出弹性。
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引用次数: 0
Preface from the Editors 编者序
IF 0.7 Q4 Medicine Pub Date : 2017-01-11 DOI: 10.14361/9783839430132-prf
Ahmadi Mousa
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引用次数: 0
期刊
University of Toronto Medical Journal
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