Pub Date : 2023-02-28DOI: 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.
{"title":"Principles of resource allocation and triage during COVID-19","authors":"H. Ajzenberg, S. Oczkowski","doi":"10.33137/utmj.v100i1.40353","DOIUrl":"https://doi.org/10.33137/utmj.v100i1.40353","url":null,"abstract":"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.","PeriodicalId":41298,"journal":{"name":"University of Toronto Medical Journal","volume":"112 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2023-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81809835","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.v100i1.39018
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。
{"title":"A coagulopathic conundrum of COVID-19","authors":"Peter Iskander, Jiayi Zheng, Sumbal Zaidi, Anthony Iskander","doi":"10.33137/utmj.v100i1.39018","DOIUrl":"https://doi.org/10.33137/utmj.v100i1.39018","url":null,"abstract":"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.","PeriodicalId":41298,"journal":{"name":"University of Toronto Medical Journal","volume":"33 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2023-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85755237","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 : 2022-09-14DOI: 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.
{"title":"Debiasing and Educational Interventions in Medical Diagnosis: A Systematic Review","authors":"A. Tung, M. Melchiorre","doi":"10.1101/2022.09.12.22279750","DOIUrl":"https://doi.org/10.1101/2022.09.12.22279750","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 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.","PeriodicalId":41298,"journal":{"name":"University of Toronto Medical Journal","volume":"4 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2022-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82271567","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 : 2022-08-06DOI: 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.
{"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 A. Lo, Geoffrey Harrison, Alison Dodwell, Samantha Irwin, M. Olmstead","doi":"10.1101/2022.08.04.22278446","DOIUrl":"https://doi.org/10.1101/2022.08.04.22278446","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 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.","PeriodicalId":41298,"journal":{"name":"University of Toronto Medical Journal","volume":"16 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2022-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82873190","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 : 2017-01-11DOI: 10.14361/9783839430132-prf
Ahmadi Mousa
{"title":"Preface from the Editors","authors":"Ahmadi Mousa","doi":"10.14361/9783839430132-prf","DOIUrl":"https://doi.org/10.14361/9783839430132-prf","url":null,"abstract":"","PeriodicalId":41298,"journal":{"name":"University of Toronto Medical Journal","volume":"103 1","pages":"5"},"PeriodicalIF":0.7,"publicationDate":"2017-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77847230","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 : 2013-03-31DOI: 10.1146/annurev.pm.2.010907.100001
I. Mukovozov, K. Zaslavsky
{"title":"Preface from the Editors","authors":"I. Mukovozov, K. Zaslavsky","doi":"10.1146/annurev.pm.2.010907.100001","DOIUrl":"https://doi.org/10.1146/annurev.pm.2.010907.100001","url":null,"abstract":"","PeriodicalId":41298,"journal":{"name":"University of Toronto Medical Journal","volume":"42 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2013-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73861226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Osteoporosis – Breaking the ‘Silence’","authors":"E. Brecher","doi":"10.5015/UTMJ.V88I1.1285","DOIUrl":"https://doi.org/10.5015/UTMJ.V88I1.1285","url":null,"abstract":"","PeriodicalId":41298,"journal":{"name":"University of Toronto Medical Journal","volume":"35 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2010-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73675846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Defining the Scope of the Manager Role in Medicine","authors":"N. Tan","doi":"10.5015/UTMJ.V88I1.1241","DOIUrl":"https://doi.org/10.5015/UTMJ.V88I1.1241","url":null,"abstract":"","PeriodicalId":41298,"journal":{"name":"University of Toronto Medical Journal","volume":"158 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2010-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86185774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A Talk to Senior Medical Students","authors":"A. Fisher","doi":"10.5015/UTMJ.V88I1.1314","DOIUrl":"https://doi.org/10.5015/UTMJ.V88I1.1314","url":null,"abstract":"","PeriodicalId":41298,"journal":{"name":"University of Toronto Medical Journal","volume":"06 1","pages":"51-52"},"PeriodicalIF":0.7,"publicationDate":"2010-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86104349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Television and the World of Medical Dramas: What Really matters?","authors":"W. Kwong, Mitchell Chow","doi":"10.5015/UTMJ.V88I1.1278","DOIUrl":"https://doi.org/10.5015/UTMJ.V88I1.1278","url":null,"abstract":"","PeriodicalId":41298,"journal":{"name":"University of Toronto Medical Journal","volume":"2 1","pages":"13-14"},"PeriodicalIF":0.7,"publicationDate":"2010-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72681911","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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