Canadian Journal of Rural Medicine最新文献

{"title":"Message de la présidente. Un Program national de compétences et formation avancées pour la pratique en milieu rural.","authors":"Sarah Lesperance","doi":"10.4103/1203-7796.372318","DOIUrl":"https://doi.org/10.4103/1203-7796.372318","url":null,"abstract":"","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"28 2","pages":"46"},"PeriodicalIF":1.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9227798","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":"Remplacez-moi... S'il vous plaît.","authors":"Peter Hutten-Czapski","doi":"10.4103/1203-7796.372316","DOIUrl":"https://doi.org/10.4103/1203-7796.372316","url":null,"abstract":"","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"28 2","pages":"44"},"PeriodicalIF":1.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9227797","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":"Systematic review of the use of metformin compared to insulin for the management of gestational diabetes: Implications for low-resource settings.","authors":"Ribal Kattini,&nbsp;Len Kelly,&nbsp;Ruben Hummelen","doi":"10.4103/cjrm.cjrm_40_22","DOIUrl":"https://doi.org/10.4103/cjrm.cjrm_40_22","url":null,"abstract":"<p><strong>Introduction: </strong>This systematic review examines the effectiveness of metformin treatment compared to insulin treatment for gestational diabetes within the context of a low-resource environment.</p><p><strong>Methods: </strong>Electronic data searches of Medline, EMBASE, Scopus and Google scholar databases from 1 January, 2005 to 30 June, 2021 were performed using medical subject headings: 'gestational diabetes or pregnancy diabetes mellitus' AND 'Pregnancy or pregnancy outcomes' AND 'Insulin' AND 'Metformin Hydrochloride Drug Combination/or Metformin/or Hypoglycemic Agents' AND 'Glycemic control or blood glucose'. Randomized controlled trials were included if: participants were pregnant women with gestational diabetes mellitus (GDM); the interventions were metformin and/or insulin. Studies among women with pre-gestational diabetes, non-randomised control trials or studies with a limited description of the methodology were excluded. Outcomes included adverse maternal outcomes: weight gain, C-section, pre-eclampsia and glycaemic control and adverse neonatal outcomes: birth weight, macrosomia, pre-term birth and neonatal hypoglycaemia. The revised Cochrane Risk of Bias Assessment for randomised trials was used for the evaluation of bias.</p><p><strong>Results: </strong>We screened 164 abstracts and 36 full-text articles. Fourteen studies met the inclusion criteria. The studies provide moderate to high-quality evidence demonstrating the effectiveness of metformin as an alternative therapy to insulin. Risk of bias was low; multiple countries and robust sample sizes improved external validity. All studies were from urban centres with no rural data.</p><p><strong>Conclusion: </strong>These recent high quality studies comparing metformin to insulin for the treatment of GDM generally found either improved or equivalent pregnancy outcome and good glycaemic control for most patients, although many required insulin supplementation. Its ease of use, safety and efficacy suggest metformin may simplify the management of gestational diabetes, particularly in rural and other low-resource environments.</p>","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"28 2","pages":"59-65"},"PeriodicalIF":1.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9233413","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":"Social Support for Birthmothers Before and During the COVID-19 Pandemic","authors":"Jiyeon Park, Peter A. Johnson, J. Johnson, A. Mardon","doi":"10.33844/cjm.2023.6027","DOIUrl":"https://doi.org/10.33844/cjm.2023.6027","url":null,"abstract":"Giving birth is not a simple event and requires much attention, care, and support to result in a positive birth experience. However, the process of giving birth changed significantly during the COVID-19 pandemic due to the spread of the virus, the uncertainty of the virus, and the numerous restrictions implemented. These led to isolation, loneliness, a lack of communication, loss of control over the body, and little or no contribution to decision-making for the new birth mother. This, as well as a lack of social support, can harm a mother’s and baby’s mental and physical health. Thus, this article explores the importance of social support and its role before the COVID-19 pandemic, as well as the changes that have occurred in the birth process during the COVID-19 pandemic.","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"30 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83334105","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":"Simulation-Based Software Modeling of CAR T Cell Therapy Efficacy Against Solid Malignant Tumors","authors":"Daivat Bhavsar, Y. Li","doi":"10.33844/cjm.2023.6029","DOIUrl":"https://doi.org/10.33844/cjm.2023.6029","url":null,"abstract":"Genetically engineered T cells with Chimeric Antigen Receptors, CAR T cells, are a revolutionary immunotherapy used to treat advanced blood cancers. The purpose of this experiment was to model the destruction process of tumor cells with CAR T cell therapy using Complexity and Organized Behaviour Within Environmental Bounds (COBWEB), an agent-based simulation software. We designated parameter values for abiotic factors, agents (i.e. tumor cells, T cells) and the general environment in our immunotherapy simulation model to illustrate the interactions between tumor cells and cytotoxic components, which described the binding of innate CD8+ T cells or CAR T cells to tumor antigens. The models were used to observe and comparatively analyze the rate of destruction of a solid tumor by CAR T cells and innate CD8+ T cells. The solid tumor developed in a circular island for 60 ticks, representing days; innate CD8+ or CAR T cells were then able to infiltrate the island and the tumor cell population was monitored over 500 days. The CAR T cells exhibited a significantly powerful, efficient immune response against a general solid tumor relative to the innate CD8+ T cells, yet relapse occurred in both models albeit to a lesser extent with CAR T cells. However, further investigations are required to adequately simulate the side effects and realistically-limiting factors of CAR T cell therapy. Similar comparative analyses may help measure and compare the potency of the immune response of CAR T cells compared to standard, or lack of, treatments.","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"11 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83530547","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":"Increasing Awareness of Low Incidence Disease as Immigration Rates Increase: A Recent Case of Pott’s Disease in Atlantic Canada","authors":"Z. Stanton, Moira A Law, I. Shamputa, D. Webster, Kimberley Barker","doi":"10.33844/cjm.2023.6026","DOIUrl":"https://doi.org/10.33844/cjm.2023.6026","url":null,"abstract":"As Canada experiences and prepares for notable increases in immigration, health care professionals need to be aware of emerging cases of low incidence diseases, particularly when found in higher rates in the foreign-born population. Therefore, we report the case of a 20-year-old male immigrant presenting to a Canadian emergency department with a one year history of worsening back pain. In the emergency department, thoracic radiographs showed pathologic fractures at T10 and T11 with destructive changes from T8 to T12. Further, a computed tomography scan identified a large paravertebral abscess from T6 to L1, with osseous destruction and spinal stenosis. Magnetic resonance imaging showed bony deformity, epidural, pre-and paravertebral, and bilateral psoas abscesses, and a right-sided pleural effusion. Diagnosis was confirmed with direct molecular testing and treatment was initiated in a timely and efficacious manner. This case report highlights the need for health care providers to have a high index of suspicion and consideration of atypical presentations of low incidence diseases, particularly within the burgeoning immigrant population, to ensure quality health care services are delivered.","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"96 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81191525","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":"Staffing rural emergency departments in Ontario: The who, what and where.","authors":"Tyler Randle,&nbsp;Arunim Garg,&nbsp;Vijay Mago,&nbsp;Salimur Choudhury,&nbsp;Robert Ohle,&nbsp;Roger Strasser,&nbsp;Sean W Moore,&nbsp;Aimee Kernick,&nbsp;David W Savage","doi":"10.4103/cjrm.cjrm_51_22","DOIUrl":"https://doi.org/10.4103/cjrm.cjrm_51_22","url":null,"abstract":"<p><strong>Introduction: </strong>The emergency department (ED) in rural communities is essential for providing care to patients with urgent medical issues and those unable to access primary care. Recent physician staffing shortages have put many EDs at risk of temporary closure. Our goal was to describe the demographics and practices of the rural physicians providing emergency medicine services across Ontario in order to inform health human resource planning.</p><p><strong>Methods: </strong>The ICES Physician database (IPDB) and Ontario Health Insurance Plan (OHIP) billing database from 2017 were used in this retrospective cohort study. Rural physician data were analysed for demographic, practice region and certification information. Sentinel billing codes (i.e., a billing code unique to a particular clinical service) were used to define 18 unique physician services.</p><p><strong>Results: </strong>A total of 1192 physicians from the IPDB met inclusion as rural generalist physicians out of a total of 14,443 family physicians in Ontario. From this physician population, a total of 620 physicians practised emergency medicine which accounted for 33% of their days worked on average. The majority of physicians practising emergency medicine were between the ages of 30 and 49 and in their first decade of practice. The most common services in addition to emergency medicine were clinic, hospital medicine, palliative care and mental health.</p><p><strong>Conclusion: </strong>This study provides insight into the practice patterns of rural physicians and the basis for better targeted physician workforce-forecasting models. A new approach to education and training pathways, recruitment and retention initiatives and rural health service delivery models is needed to ensure better health outcomes for our rural population.</p>","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"28 2","pages":"73-81"},"PeriodicalIF":1.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9233414","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":"Replace me... please?","authors":"Peter Hutten-Czapski","doi":"10.4103/cjrm.cjrm_3_23","DOIUrl":"https://doi.org/10.4103/cjrm.cjrm_3_23","url":null,"abstract":"","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"28 2","pages":"43"},"PeriodicalIF":1.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9233408","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":"President's Message - A national advanced skills and training program for rural practice.","authors":"Sarah Lesperance","doi":"10.4103/cjrm.cjrm_4_23","DOIUrl":"https://doi.org/10.4103/cjrm.cjrm_4_23","url":null,"abstract":"","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"28 2","pages":"45"},"PeriodicalIF":1.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9233409","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 occasional bone marrow biopsy.","authors":"Peter Hutten-Czapski","doi":"10.4103/cjrm.cjrm_64_22","DOIUrl":"https://doi.org/10.4103/cjrm.cjrm_64_22","url":null,"abstract":"","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"28 2","pages":"82-85"},"PeriodicalIF":1.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9239834","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}