University of Toronto Medical Journal最新文献_第2页

Nasal leiomyoma presenting as sphenopalatine neuralgia: a case report and literature review 以蝶腭神经痛为表现的鼻平滑肌瘤1例报告并文献复习

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University of Toronto Medical Journal Pub Date : 2023-07-31 DOI: 10.33137/utmj.v100i2.39000

W. E. Wong, J. Saniasiaya, Abdul Ghani Fauzah, A. Ibrahim, T. L. Loh, A. Zakaria

引用次数: 0

Applying the principles of Design Thinking to the Intensive Care Environment 将设计思维原则应用于重症监护环境

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University of Toronto Medical Journal Pub Date : 2023-02-28 DOI: 10.33137/utmj.v100i1.40352

Chijindu Ukagwu, Seth Gray

{"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}

引用次数: 1

Canadian family medicine residency program survey of physical activity curriculum content 加拿大家庭医学住院医师项目体育活动课程内容调查

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University of Toronto Medical Journal Pub Date : 2023-02-28 DOI: 10.33137/utmj.v100i1.39215

Cliff Lindeman, M. Filion, Doug Klein, M. Stickland, N. Drummond, J. Spence

{"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}

引用次数: 0

Student and educator perceptions of an evidence-based medicine research curriculum: recommendations for research curriculum development 学生和教育工作者对循证医学研究课程的看法:对研究课程开发的建议

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University of Toronto Medical Journal Pub Date : 2023-02-28 DOI: 10.33137/utmj.v100i1.38689

Dario Ferri, Clara Moore, K. Mun, Anna Chen, Debra Katzman, J. Nyhof-Young

{"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}

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

University of Toronto Medical Journal Pub Date : 2023-02-28 DOI: 10.33137/utmj.v100i1.38937

Arthur Tung, Michael Melchiorre

{"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}

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使用酒精和大麻的不同影响:来自COVID-19大流行的教训

University of Toronto Medical Journal Pub Date : 2023-02-28 DOI: 10.33137/utmj.v100i1.38056

Michelle Blumberg, Lindsay Lo, Geoffrey Harrison, Alison Dodwell, Samantha Irwin, Mary Olmstead

{"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}

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?

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University of Toronto Medical Journal Pub Date : 2023-02-28 DOI: 10.33137/utmj.v100i1.39079

Jo-Lynn Jean D’Oliveiro, J. Saniasiaya, J. Kulasegarah

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

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University of Toronto Medical Journal 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

{"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}

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

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University of Toronto Medical Journal Pub Date : 2023-02-28 DOI: 10.33137/utmj.v100i1.38865

M. Wunder, Dana Seslija, N. Liem

{"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}

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

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University of Toronto Medical Journal Pub Date : 2023-02-28 DOI: 10.33137/utmj.v100i1.39014

Immanuel Sani

引用次数: 0