The textbook, CanMEDS Physician Health Guide: A Practical Handbook for Physician Health and Well-being, recently published by The Royal College of Physicians and Surgeons of Canada sheds light on the depth and scope of the CanMEDS competencies and how they relate to the personal health and the well-being of the medical doctor. This text is the latest addition to a growing library of College publications which serve as professional development resources pertaining to the CanMEDS roles. This particular text has developed a conceptual framework of physician health and evaluates and proposes concise strategies to address personal health issues that any medical student, resident or attending may encounter throughout his career.
{"title":"CanMEDS Physician Health Guide: A Practical Handbook for Physician Health and Well-being","authors":"Kenneth Vandewark","doi":"10.5015/UTMJ.V87I3.1262","DOIUrl":"https://doi.org/10.5015/UTMJ.V87I3.1262","url":null,"abstract":"The textbook, CanMEDS Physician Health Guide: A Practical Handbook for Physician Health and Well-being, recently published by The Royal College of Physicians and Surgeons of Canada sheds light on the depth and scope of the CanMEDS competencies and how they relate to the personal health and the well-being of the medical doctor. This text is the latest addition to a growing library of College publications which serve as professional development resources pertaining to the CanMEDS roles. This particular text has developed a conceptual framework of physician health and evaluates and proposes concise strategies to address personal health issues that any medical student, resident or attending may encounter throughout his career.","PeriodicalId":41298,"journal":{"name":"University of Toronto Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2010-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80540256","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":"Is that lung cancer I smell in your breath","authors":"T. Yung","doi":"10.5015/UTMJ.V87I3.1244","DOIUrl":"https://doi.org/10.5015/UTMJ.V87I3.1244","url":null,"abstract":"","PeriodicalId":41298,"journal":{"name":"University of Toronto Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2010-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88327170","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}
Vision impairment is one of the leading causes of morbidity in the elderly population. Major causes of vision loss include presbyopia, cataract, age-related macular degeneration, glaucoma, and diabetic retinopathy. A vision screening program has the potential to identify millions of adults at risk for vision loss and vision-related co-morbidities. Previous guidelines in the 1990s recommended routine visual acuity screening by primary care physicians. However, subsequently published data have demonstrated a lack of effectiveness in quality-of-life outcomes with current screening strategies, likely due to the low sensitivity of the screening tests. Until further studies establish the accuracy of any vision test in predicting visual function, routine vision screening in the elderly in the primary care setting is not warranted. The introduction of other vision tests into the screening protocol, including low contrast VA assessment, stereoptic testing, and visual field testing, warrants further investigation and cost-benefit evaluation.
{"title":"Vision Screening in the Elderly: Current Literature and Recommendations","authors":"Y. Chen, Mary Thomas","doi":"10.5015/UTMJ.V87I3.1237","DOIUrl":"https://doi.org/10.5015/UTMJ.V87I3.1237","url":null,"abstract":"Vision impairment is one of the leading causes of morbidity in the elderly population. Major causes of vision loss include presbyopia, cataract, age-related macular degeneration, glaucoma, and diabetic retinopathy. A vision screening program has the potential to identify millions of adults at risk for vision loss and vision-related co-morbidities. Previous guidelines in the 1990s recommended routine visual acuity screening by primary care physicians. However, subsequently published data have demonstrated a lack of effectiveness in quality-of-life outcomes with current screening strategies, likely due to the low sensitivity of the screening tests. Until further studies establish the accuracy of any vision test in predicting visual function, routine vision screening in the elderly in the primary care setting is not warranted. The introduction of other vision tests into the screening protocol, including low contrast VA assessment, stereoptic testing, and visual field testing, warrants further investigation and cost-benefit evaluation.","PeriodicalId":41298,"journal":{"name":"University of Toronto Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2010-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72717798","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}
Thyroid cancer is the most common endocrinological malignancy worldwide and its incidence is increasing faster than for any other cancer. The majority of this increase has been in well differentiated thyroid carcinoma (WDTC) which comprises 90% of all thyroid malignancies. Recent advances in the diagnosis, surgical treatment, and long-term monitoring have enhanced the detection of primary and recurrent disease, as well as treatment modalities. These developments have prompted institutions to revise their guidelines on the management of thyroid disorders. In the diagnosis of thyroid nodules, recommendations have been made regarding initial evaluation, use of TSH and radionuclide studies, clinical and ultrasound criteria for fine-needle aspiration biopsy (FNAB), and the interpretation of FNAB results. Thyroidectomy (removal of gross thyroid tissue) and lymph node dissection have been established as efficacious initial therapies to reduce disease recurrence although the extent of surgical resection is hotly debated. Following surgical therapy, appropriate use of radioactive iodine (RAI) therapy to destroy microscopic disease is discussed, including its controversial use in low-risk patients. Guidelines for long-term management include recommendations on the use of TSH suppression therapy, surveillance of recurrent disease using ultrasound and serum thyroglobulin, and the treatment of recurrent/metastatic disease. Here, we review the recent developments and recommendations in the management of WDTC.
{"title":"Thyroid Cancer: Latest Approaches to Canada's Fastest Growing Cancer","authors":"A. Vaisman, Steven Orlov, J. Yip, D. Orlov","doi":"10.5015/UTMJ.V87I3.1234","DOIUrl":"https://doi.org/10.5015/UTMJ.V87I3.1234","url":null,"abstract":"Thyroid cancer is the most common endocrinological malignancy worldwide and its incidence is increasing faster than for any other cancer. The majority of this increase has been in well differentiated thyroid carcinoma (WDTC) which comprises 90% of all thyroid malignancies. Recent advances in the diagnosis, surgical treatment, and long-term monitoring have enhanced the detection of primary and recurrent disease, as well as treatment modalities. These developments have prompted institutions to revise their guidelines on the management of thyroid disorders. In the diagnosis of thyroid nodules, recommendations have been made regarding initial evaluation, use of TSH and radionuclide studies, clinical and ultrasound criteria for fine-needle aspiration biopsy (FNAB), and the interpretation of FNAB results. Thyroidectomy (removal of gross thyroid tissue) and lymph node dissection have been established as efficacious initial therapies to reduce disease recurrence although the extent of surgical resection is hotly debated. Following surgical therapy, appropriate use of radioactive iodine (RAI) therapy to destroy microscopic disease is discussed, including its controversial use in low-risk patients. Guidelines for long-term management include recommendations on the use of TSH suppression therapy, surveillance of recurrent disease using ultrasound and serum thyroglobulin, and the treatment of recurrent/metastatic disease. Here, we review the recent developments and recommendations in the management of WDTC.","PeriodicalId":41298,"journal":{"name":"University of Toronto Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2010-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87556131","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}
A 56-year-old woman presented to her family physician with a 2-month history of dizziness, palpitations, dyspnea on exertion,and episodic chest discomfort. Initial investigations revealed amild pancytopenia. Two days later, she presented to emergencywith a low-grade fever (37.8oC), left-sided chest discomfort, andweakness. She denied any infectious or bleeding symptoms andhad no significant past medical history, including no medications. On examination, the patient had no lymphadenopathy, andher cardiac, respiratory, and abdominal examinations were unre-markable, with no hepatosplenomegaly. Her investigationsrevealed a pancytopenia (see Table 1). On the basis of her neu -tropenia and low-grade fever, she was admitted for intravenousantibiotics and work-up of her pancytopenia.In hospital, her pancytopenia persisted; her counts reached anadir of hemoglobin (Hgb) 46 g/L, platelets (Plt) 16 X 10
一名56岁女性向家庭医生就诊，有2个月的头晕、心悸、用力时呼吸困难和间歇性胸部不适病史。初步调查显示轻度全血细胞减少症。两天后，患者出现低烧(37.8℃)、左侧胸部不适和虚弱。她否认有任何感染或出血症状，没有明显的既往病史，包括没有服用药物。检查时，患者无淋巴结病变，心脏、呼吸和腹部检查无明显异常，无肝脾肿大。她的检查显示有全血细胞减少症(见表1)。根据她的新肌减少症和低烧，她被静脉注射抗生素并检查了她的全血细胞减少症。在医院里，她的全血细胞减少症持续存在;血红蛋白(Hgb) 46 g/L，血小板(Plt) 16 X 10
{"title":"Acute Panmyelosis with Myelofibrosis: An Unusual Cause of Pancytopenia","authors":"E. Tseng, F. Moid, J. Blondal, Jerry M Maniate","doi":"10.5015/UTMJ.V87I3.1235","DOIUrl":"https://doi.org/10.5015/UTMJ.V87I3.1235","url":null,"abstract":"A 56-year-old woman presented to her family physician with a 2-month history of dizziness, palpitations, dyspnea on exertion,and episodic chest discomfort. Initial investigations revealed amild pancytopenia. Two days later, she presented to emergencywith a low-grade fever (37.8oC), left-sided chest discomfort, andweakness. She denied any infectious or bleeding symptoms andhad no significant past medical history, including no medications. On examination, the patient had no lymphadenopathy, andher cardiac, respiratory, and abdominal examinations were unre-markable, with no hepatosplenomegaly. Her investigationsrevealed a pancytopenia (see Table 1). On the basis of her neu -tropenia and low-grade fever, she was admitted for intravenousantibiotics and work-up of her pancytopenia.In hospital, her pancytopenia persisted; her counts reached anadir of hemoglobin (Hgb) 46 g/L, platelets (Plt) 16 X 10","PeriodicalId":41298,"journal":{"name":"University of Toronto Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2010-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90609664","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}
Objective: Patient satisfaction surveys are primarily conducted in English and thus exclude respondents who cannot read or are not proficient in the English language. This study used a language and culture-specific questionnaire to explore potential barriers to health care among Chinese patients and to determine their satisfaction with health care services received at their visit to the Toronto Western Hospital (TWH), University Health Network. Methods: A cross-sectional survey design was used. Patients were recruited from the General Internal Medicine inpatient ward and Tuberculosis, Liver and Angiography ambulatory care clinics at TWH. A questionnaire was administered by an interviewer to patients who self-identified as Chinese. The interviewer administered the questionnaire in English, Cantonese and Mandarin. The questionnaire explored three main topics which included language barriers, cultural barriers and patient satisfaction. Results: A total of 138 patients were approached to participate in the study over a six week period. There was a 97.1% response rate. Of the 134 patients who participated in the study, 52% reported having difficulty speaking English but only 24% utilized the hospital’s interpretation and translation service. Barriers to health care identified by patients included: limited discussion of use of Chinese medical therapies with physicians, difficulty understanding explanations provided by physicians and nurses, and difficulty finding a hospital staff member who could talk with them about their illness in their preferred language. Conclusion: Language and culture-specific questionnaires can reveal barriers to health care in patients with limited English proficiency. These barriers need to be addressed to ensure delivery of quality health care in a culturally responsive manner.
{"title":"Linguistic and cultural barriers to health care among Chinese patients at the Toronto Western Hospital","authors":"E. Lam, E. Heathcote","doi":"10.5015/UTMJ.V87I3.1173","DOIUrl":"https://doi.org/10.5015/UTMJ.V87I3.1173","url":null,"abstract":"Objective: Patient satisfaction surveys are primarily conducted in English and thus exclude respondents who cannot read or are not proficient in the English language. This study used a language and culture-specific questionnaire to explore potential barriers to health care among Chinese patients and to determine their satisfaction with health care services received at their visit to the Toronto Western Hospital (TWH), University Health Network. \u0000Methods: A cross-sectional survey design was used. Patients were recruited from the General Internal Medicine inpatient ward and Tuberculosis, Liver and Angiography ambulatory care clinics at TWH. A questionnaire was administered by an interviewer to patients who self-identified as Chinese. The interviewer administered the questionnaire in English, Cantonese and Mandarin. The questionnaire explored three main topics which included language barriers, cultural barriers and patient satisfaction. \u0000Results: A total of 138 patients were approached to participate in the study over a six week period. There was a 97.1% response rate. Of the 134 patients who participated in the study, 52% reported having difficulty speaking English but only 24% utilized the hospital’s interpretation and translation service. \u0000Barriers to health care identified by patients included: limited discussion of use of Chinese medical therapies with physicians, difficulty understanding explanations provided by physicians and nurses, and difficulty finding a hospital staff member who could talk with them about their illness in their preferred language. \u0000Conclusion: Language and culture-specific questionnaires can reveal barriers to health care in patients with limited English proficiency. These barriers need to be addressed to ensure delivery of quality health care in a culturally responsive manner.","PeriodicalId":41298,"journal":{"name":"University of Toronto Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2010-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73124015","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}
NOTE: This is a History of Medicine submission and does not have an abstract. As such the Introduction section has been pasted here as an "abstract". Obstructive sleep apnea (OSA) is a condition characterized by repeated occlusion of the upper airway (UA) during sleep. From OSA’s initial clinical description less than 50 years ago to present day, progression in respiratory sleep medicine has vastly expanded the scope of our knowledge of OSA. What was once regarded as a rare affliction that simply led to daytime hypersomnelence1 is now recognized as a common and serious condition capable wreaking havoc in the cardiovascular system, independently promoting heart failure, stroke, hypertension and likely atherosclerosis.At the beginning of a new decade, the field of OSA research finds itself at yet another frontier as a radically new etiological perspective emerges. This new paradigm of the cause of OSA promises the possibility of novel OSA treatments and prophylaxes. This article will follow the progression of OSA research, from the condition's initial discovery, on to the current widely-accepted view of OSA and finally to the future of respiratory sleep medicine.
{"title":"Historical changes in perspective of the etiology, pathophysiology and treatment of obstructive sleep apnea","authors":"J. Gabriel","doi":"10.5015/UTMJ.V87I3.1175","DOIUrl":"https://doi.org/10.5015/UTMJ.V87I3.1175","url":null,"abstract":"NOTE: This is a History of Medicine submission and does not have an abstract. As such the Introduction section has been pasted here as an \"abstract\". \u0000 \u0000 \u0000Obstructive sleep apnea (OSA) is a condition characterized by repeated occlusion of the upper airway (UA) during sleep. From OSA’s initial clinical description less than 50 years ago to present day, progression in respiratory sleep medicine has vastly expanded the scope of our knowledge of OSA. What was once regarded as a rare affliction that simply led to daytime hypersomnelence1 is now recognized as a common and serious condition capable wreaking havoc in the cardiovascular system, independently promoting heart failure, stroke, hypertension and likely atherosclerosis.At the beginning of a new decade, the field of OSA research finds itself at yet another frontier as a radically new etiological perspective emerges. This new paradigm of the cause of OSA promises the possibility of novel OSA treatments and prophylaxes. This article will follow the progression of OSA research, from the condition's initial discovery, on to the current widely-accepted view of OSA and finally to the future of respiratory sleep medicine.","PeriodicalId":41298,"journal":{"name":"University of Toronto Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2010-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85817766","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}
Rheumatic fever and rheumatic heart disease continue to be the most common form of cardiovascular disease in low-income countries. Poor diagnostic and treatment capacity and limited patient understanding of disease etiology have kept both disease recognition and patient adherence to treatment low. In rural and remote areas, this is worsened as a result of poorer access to health facilities for diagnosis, treatment and monitoring. As recommended by the World Health Organization, to treat the chronic effects of rheumatic heart disease, patients must adhere to strict monthly treatment regimes of secondary prophylaxis with penicillin. However, adherence to treatment remains difficult for poor populations who struggle to meet the travel, economic and opportunity costs associated with seeking care. To address these challenges, lessons from Ethiopia suggest that a community-based primary healthcare approach that offers follow-up treatment and care through satellite health centres with health officers can be a sustainable and effective strategy for rheumatic fever and rheumatic heart disease management.
{"title":"Managing the Growing Burden of Rheumatic Heart Disease in Low-Income Countries: A Primary Healthcare Approach in Ethiopia","authors":"Kadia Petricca","doi":"10.5015/UTMJ.V87I3.1176","DOIUrl":"https://doi.org/10.5015/UTMJ.V87I3.1176","url":null,"abstract":"Rheumatic fever and rheumatic heart disease continue to be the most common form of cardiovascular disease in low-income countries. Poor diagnostic and treatment capacity and limited patient understanding of disease etiology have kept both disease recognition and patient adherence to treatment low. In rural and remote areas, this is worsened as a result of poorer access to health facilities for diagnosis, treatment and monitoring. As recommended by the World Health Organization, to treat the chronic effects of rheumatic heart disease, patients must adhere to strict monthly treatment regimes of secondary prophylaxis with penicillin. However, adherence to treatment remains difficult for poor populations who struggle to meet the travel, economic and opportunity costs associated with seeking care. To address these challenges, lessons from Ethiopia suggest that a community-based primary healthcare approach that offers follow-up treatment and care through satellite health centres with health officers can be a sustainable and effective strategy for rheumatic fever and rheumatic heart disease management.","PeriodicalId":41298,"journal":{"name":"University of Toronto Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2010-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84745171","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":"Guilt and Time: My Enemies","authors":"Jay M. Baruch","doi":"10.5015/UTMJ.V87I2.1258","DOIUrl":"https://doi.org/10.5015/UTMJ.V87I2.1258","url":null,"abstract":"","PeriodicalId":41298,"journal":{"name":"University of Toronto Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2010-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74420815","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":"For David: After Words","authors":"S. Cox","doi":"10.5015/UTMJ.V87I2.1257","DOIUrl":"https://doi.org/10.5015/UTMJ.V87I2.1257","url":null,"abstract":"","PeriodicalId":41298,"journal":{"name":"University of Toronto Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.7,"publicationDate":"2010-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74079291","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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