University of Toronto Medical Journal最新文献

{"title":"Navigating long wait times for rheumatological health issues and suggestions for further investigations","authors":"John-Peter Bonello, Claire Sethuram","doi":"10.33137/utmj.v100i2.39276","DOIUrl":"https://doi.org/10.33137/utmj.v100i2.39276","url":null,"abstract":"Canada continues to struggle with wait times for patients transitioning from primary to specialized care. Since 2019, wait times for speciality consultation and time to specialty treatment have increased significantly throughout Canada, with Ontario ranking third overall among the provinces for the longest wait times. In addition to Ontario having the largest population among the provinces, musculoskeletal (MSK) based issues make up approximately 30% of all primary care reasons for visits and ranks among the longest wait times by specialty. Thus, a large proportion of patients seeking MSK based health care in Ontario are experiencing significant delays. This commentary discusses the burden of wait times for MSK patients requiring specialized care and offers a guide on how to assess, interpret, and possibly challenge the current care model. Essentially, this commentary suggests further studies be conducted through a qualitative lens to gather and assess information about patients’ perspectives on access, feasibility, and patient-provider alignment of care. Through this subjective lens, a better understanding may be gained regarding how patients interact with the current model of care for MSK health, and this knowledge can be applied in creating patient-education resources, guiding continuing medical education, and most importantly, increasing awareness for prominent systemic impacts such as wait times.","PeriodicalId":41298,"journal":{"name":"University of Toronto Medical Journal","volume":"13 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75615040","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 unique case report of sigmoid colon cancer metastasising to the breasts, ovaries and stomach in pregnancy","authors":"Victoria Phooi Khei Tan, W. Teng, Fong Juen Kiew, N. Azizan, F. Hayati","doi":"10.33137/utmj.v100i2.37765","DOIUrl":"https://doi.org/10.33137/utmj.v100i2.37765","url":null,"abstract":"Colorectal cancer in pregnancy is an infrequent phenomenon. It is estimated to occur in 1 in 13,000 pregnancies, with 80% representing rectal cancer. We report a rare case of a young pregnant female presenting with primary sigmoid colon adenocarcinoma metastasizing to the breast, ovaries, and stomach. Diagnosing colorectal malignancy in pregnancy is challenging, given the similarities in symptoms. Cancer in pregnancy may take on a more malignant course with rapid progression. Physicians must recognise the potential of this deadly disease lurking undetected in patients of this vulnerable population.","PeriodicalId":41298,"journal":{"name":"University of Toronto Medical Journal","volume":"23 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80130665","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":"Infusing artificial intelligence into hemophilia care: taking the next step","authors":"Pascal Tyrrell","doi":"10.33137/utmj.v100i2.41464","DOIUrl":"https://doi.org/10.33137/utmj.v100i2.41464","url":null,"abstract":"The field of healthcare has witnessed remarkable advancements in recent years, particularly in the care and management of persons with hemophilia. With the advent of artificial intelligence (AI) and the growing importance of ultrasonography in medicine, the future of hemophilia care holds great promise. These developments not only improve the delivery of healthcare but also empower patients, leading to better outcomes and enhanced quality of life. In this article, I will explore the recent developments in hemophilia care, the impact of AI on healthcare delivery, and the significance of ultrasonography in digital health for persons with hemophilia.","PeriodicalId":41298,"journal":{"name":"University of Toronto Medical Journal","volume":"26 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83151181","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":"Clinic furniture arrangements leading to patient self-reported blood pressure discrepancy: a rare case of total occlusion of left subclavian artery","authors":"Mohd Azzahi Mohamed Kamel, I. A. Ismail, Jazlan Jamaluddin, M. F. Hamdan","doi":"10.33137/utmj.v100i2.37887","DOIUrl":"https://doi.org/10.33137/utmj.v100i2.37887","url":null,"abstract":"Subclavian artery occlusion is an uncommon condition affecting approximately 2% of the general population. Only 8.7% of patients with total occlusion of subclavian artery are asymptomatic. It has the potential to cause significant morbidity as it could contribute to the ischemic complications affecting the upper extremities, brain, and heart. We present a case of asymptomatic total occlusion of left subclavian artery which was found following investigations for discrepancy in blood pressure readings from the patient’s right and left arm. The difference was noted due to the clinic’s furniture arrangement. The patient was treated with stent insertion via percutaneous transluminal angioplasty. After three years of follow ups, she remains asymptomatic and free of cardiovascular-related complications.","PeriodicalId":41298,"journal":{"name":"University of Toronto Medical Journal","volume":"20 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85603176","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":"Introduction of a Patient as Teacher Program into family medicine residency: an exploratory pilot study","authors":"Muna Alkhaifi, Emily Peircell, Stephanie Mooney, Adam Clayton, J. Simpson","doi":"10.33137/utmj.v100i2.40384","DOIUrl":"https://doi.org/10.33137/utmj.v100i2.40384","url":null,"abstract":"Background: Family medicine residents should be prepared to address the psychosocial issues that breast cancer survivors may experience. \u0000Objectives: Our study aimed to implement a patient-centred approach model into the family medicine residency program and evaluate the impact of such a program on residents. \u0000Methods: An interactive virtual session (75 minutes), was integrated into the academic half-day of the family medicine residency program at St. Michael’s Hospital. The session was led by a cancer survivor and her partner. They discussed how illness has impacted their lives and reflect on their experiences with the health care system.  The session was facilitated by a trained facilitator in health care. A qualitative approach was used to evaluate the impact of this program. Two focus groups for residents was conducted to evaluate the delivery mode, recommendations and impact of the proposed program. The focus group discussions were recorded, transcribed and thematically analyzed. \u0000Results: This program has had positive influences on residents by improving therapeutic relationships and enhancing the residents' understanding of the experience of illness. This program allowed residents to appreciate the importance of understating patients’ perspectives and values. Additionally, adding the partner perspective to the program was appreciated and valued by residents. \u0000Conclusions: Based on the school’s specific curriculum, this program can be integrated into the residents’ academic activities. This can improve important competencies for family medicine residents including confidence in communication and increased empathy. Family medicine residency programs wishing to enhance such humanism skills by family physicians might consider this model.","PeriodicalId":41298,"journal":{"name":"University of Toronto Medical Journal","volume":"12 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76698618","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":"The knowledge-informed development of inhaled aerosol vaccine strategies","authors":"Z. Xing, F. Smaill","doi":"10.33137/utmj.v100i2.41463","DOIUrl":"https://doi.org/10.33137/utmj.v100i2.41463","url":null,"abstract":"Respiratory infectious diseases including tuberculosis (TB), influenza, and COVID-19 account for significant morbidity and mortality worldwide. However, like most of the other human vaccines, the current-generation vaccines against these respiratory infections are administered parenterally via injection into the skin or muscle. As such, most of these human vaccines remain suboptimal in protection (Lavelle et al, 2022). This calls for developing next-generation vaccine strategies which are expected to perform above and beyond the current-generation vaccines.","PeriodicalId":41298,"journal":{"name":"University of Toronto Medical Journal","volume":"22 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83634908","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":"Dietary intake and vascular disease: you are what you eat","authors":"D. Wan, S. Anand","doi":"10.33137/utmj.v100i2.41466","DOIUrl":"https://doi.org/10.33137/utmj.v100i2.41466","url":null,"abstract":"Peripheral artery disease (PAD) typically refers to atherosclerotic vascular disease, primarily affecting the arteries of the lower extremities. Despite being one of the three major manifestations of atherosclerosis (the others being coronary artery disease and cerebrovascular disease), PAD remains under-appreciated, under-recognized and under-treated. Contemporary estimates suggest that the global prevalence of PAD approaches up to 236 million patients affected and these numbers are expected to rise with an aging demographic.","PeriodicalId":41298,"journal":{"name":"University of Toronto Medical Journal","volume":"28 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86197287","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":"The emerging role of wearables in cardiac care","authors":"Sophie Sigfstead, Christopher Cheung","doi":"10.33137/utmj.v100i2.41461","DOIUrl":"https://doi.org/10.33137/utmj.v100i2.41461","url":null,"abstract":"In recent years the consumer wearable technology market has experienced remarkable growth, offering consumers an increasing variety of health-related metrics, which include heart rate and electrocardiogram (ECG) data. This development has prompted significant investigation into the role of these devices in cardiac care, revealing numerous advantages and possibilities for innovation. Specifically, wearables have demonstrated value in diagnosing cardiac conditions, assisting with personalized disease management, improving health outcomes, and providing continual monitoring. Current limitations are related to issues such as inaccessibility and device inaccuracy, both of which are significant concerns, due to their impacts on patient well-being and appropriate health resource utilization. Despite these issues, wearables remain an incredibly promising frontier in cardiac care, capable of driving innovation in multiple aspects of cardiovascular practice. This article aims to provide an overview of the current technology available, its demonstrated benefits and limitations, and its future advancement opportunities.","PeriodicalId":41298,"journal":{"name":"University of Toronto Medical Journal","volume":"32 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88147531","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":"Survey of the degree of burnout in state hospitals among Durban and Pietermaritzburg anaesthetists in KwaZulu Natal, South Africa.","authors":"Leana Allie, K. Govender","doi":"10.33137/utmj.v100i2.39202","DOIUrl":"https://doi.org/10.33137/utmj.v100i2.39202","url":null,"abstract":"Background: The most widely accepted model that defines the syndrome of burnout is Maslach Multidimensional Theory of Burnout. According to the theory burnout has three dimensions: emotional exhaustion (EE), depersonalisation (DP), and reduced personal accomplishment (PA). The primary aim of this study is to describe the degree of burnout experienced by anaesthetists working in the eThekwini Hospital Complex and Pietermaritzburg Metropolitan state hospitals in KwaZulu Natal in South Africa. \u0000Methods: The Maslach Burnout Inventory a well‐tested instrument with high reliability and validity was used as a measure of burnout with three subscales of emotional exhaustion, depersonalisation, and personal accomplishment. \u0000Results: Of the 160 anaesthetic care givers available, 139 completed the questionnaires giving a response rate of 86.8%. Burnout occurred in all participants that is medical officers (general medical doctors with a diploma in anaesthetics), registrars (general medical doctors with a diploma in anaesthetics or residents training and specializing in anaesthesiology) and consultants (specialists anaesthesiologists with a diploma and a fellowship in anaesthesiology). The prevalence of burnout was 17.9%. Of the total number of participants, greater proportion of anaesthetic care givers were female aged 31 to 40 years and that a substantial percentage had 4 to 8 years’ experience in anaesthesiology. The dimensional scores when considered individually showed that 42% of anaesthetists experienced high levels of emotional exhaustion, 38% reported high levels of depersonalisation and the lack of personal achievements was observed in more than 50% of the practising anaesthetists. \u0000Conclusion:. High levels of burnout were noted among anaesthetists in Kwazulu Natal. An association was noted between quality of sleep and emotional exhaustion and depersonalization. This information could be of value to the department of anaesthesiology as they are in position to implement interventions that promote participants well-being. Anaesthesiology practices should evaluate the balance between the demands they place on anaesthetic care providers and the resources provided to sustain an engaged, productive, and satisfied anaesthetic workforce. If the multiple stressors that lead to burnout are not addressed the department of anaesthesiology will be plagued by burnout.  ","PeriodicalId":41298,"journal":{"name":"University of Toronto Medical Journal","volume":"23 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86040173","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":"Entrepreneurial vision will define health/medical innovation at the University of Toronto over the next decade","authors":"P. Santerre","doi":"10.33137/utmj.v100i2.41462","DOIUrl":"https://doi.org/10.33137/utmj.v100i2.41462","url":null,"abstract":"If I had been invited to write this article two decades ago, here at the University of Toronto, my definition of innovation for the University of Toronto would have been very similar to what the University aspired to for the previous 50 years, back to 1950. The vision at that time was to generate knowledge creation by training students via the process of curiosity-driven discovery. This prepared them for a singular career path in research by cultivating their direction towards academia within the post-doctoral pathway. In that mindset, discovery was only shared with the public through peer reviewed publications, housed within the ivory towers of universities, far out of reach from the entrepreneurs of the day. The role of the Canadian University was to impact academia. If society benefited from innovative discoveries, it would happen by random osmosis, as it was most certainly not a deliberate mandate of universities to prepare the entrepreneurial minds of scientific translation to in turn deliver the fruits of discoveries for society’s benefit. Rather, that task would be relegated to the established medical and pharmaceutical industry. However, dramatic shifts have occurred in our fields of health sciences and medical care over the last two decades. These have turned the ivory towers of medical science in Canada onto their side.","PeriodicalId":41298,"journal":{"name":"University of Toronto Medical Journal","volume":"6 1","pages":""},"PeriodicalIF":0.7,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88595779","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}