CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne最新文献

{"title":"Pharmaceutical security for Canada.","authors":"Shoo K Lee, Sukhy K Mahl, Brian H Rowe, Joel Lexchin","doi":"10.1503/cmaj.220324","DOIUrl":"https://doi.org/10.1503/cmaj.220324","url":null,"abstract":"CMAJ | August 22, 2022 | Volume 194 | Issue 32 E1113 A secure drug supply is critical for high-quality health care and ensuring the health of all people in Canada. When supplies of medicines are compromised, clinicians might be forced to choose second-line therapies; pharmacists spend unnecessary time procuring supplies and, most critically, patients’ health may be compromised. Canada has experienced persistent pharmaceutical shortages for more than a decade,1 with 1 study finding that nearly onequarter of all marketed pharmaceuticals were in shortage at some point between March 2017 and September 2018.2 This means that health care workers and patients or caregivers are often left scrambling to find alternatives. We argue that people in Canada should be able to access critical drugs at all times and suggest ways to achieve this goal.","PeriodicalId":520595,"journal":{"name":"CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne","volume":" ","pages":"E1113-E1116"},"PeriodicalIF":14.6,"publicationDate":"2022-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/1e/78/194e1113.PMC9528533.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40418108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to \"Bell palsy\".","authors":"","doi":"10.1503/cmaj.221111","DOIUrl":"https://doi.org/10.1503/cmaj.221111","url":null,"abstract":"","PeriodicalId":520595,"journal":{"name":"CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne","volume":" ","pages":"E1093"},"PeriodicalIF":14.6,"publicationDate":"2022-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9377561/pdf/194e1093.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40700954","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional neurologic disorder associated with SARS-CoV-2 vaccination.","authors":"Annie Zhu, Matthew J Burke","doi":"10.1503/cmaj.220039","DOIUrl":"https://doi.org/10.1503/cmaj.220039","url":null,"abstract":"CMAJ | August 15, 2022 | Volume 194 | Issue 31 © 2022 CMA Impact Inc. or its licensors A healthy 50-year-old woman developed involuntary movements of her legs about 4 days after her first dose of vaccine against SARSCoV-2. These involuntary jerks progressed to involve the rest of her body. The movements occurred intermittently during the day, lasting for seconds, but they affected her gait so that she required a cane to walk. In addition, she described fatigue, headache and intermittent paresthesia and pain in different parts of her body. She reported being stressed because of the pandemic and was initially hesitant to receive the SARS-CoV-2 vaccine, but had decided to get her first dose because she was employed in the education sector. She had no history of smoking, recreational drug use or substantial alcohol intake. She had no relevant medical history and no psychiatric history. During childhood, she had had psychological trauma that would be considered an adverse childhood experience. She reported no family history of any neuro logic disorders. Her involuntary movements were pronounced during the physical examination, with “twitching” of her face during activation of her frontalis, and jerky movements of her arms during pronator drift. Her atypical movement patterns (with variability, distractibility and entrainment) were suggestive of a functional movement disorder. The patient had been assessed previously at an emergency department, with consultation to general neurology to investigate potential causes of her acute-onset atypical movements. All laboratory investigations were normal. A computed tomography (CT) venogram and magnetic resonance imaging (MRI) scans of her brain and cervical spine with contrast ruled out structural lesions, including venous sinus thrombosis. A normal electroencephalogram (EEG) showed no evidence of epileptiform activity. She was referred to our functional neurologic disorders clinic for further assessment. Given the clinical findings and normal investigations, the patient received a diagnosis of functional neurologic disorder (FND) following SARS-CoV-2 vaccination. We explained the diagnosis to her and offered FND-associated physiotherapy. In the following weeks, she noticed gradual improvement in her symptoms and no longer required a cane for ambulation. During the consultation she asked, “Is it safe for me to get the second shot?,” as she was worried about developing worsening or new symptoms. Despite our encouragement that she do so, she decided not to receive any further vaccine doses. Discussion","PeriodicalId":520595,"journal":{"name":"CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne","volume":" ","pages":"E1086-E1088"},"PeriodicalIF":14.6,"publicationDate":"2022-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/35/27/194e1086.PMC9377566.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40700949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hot flash: experiencing menopause in medicine.","authors":"Marie K Christakis, Lindsay Shirreff","doi":"10.1503/cmaj.220073","DOIUrl":"https://doi.org/10.1503/cmaj.220073","url":null,"abstract":"© 2022 CMA Impact Inc. or its licensors CMAJ | August 15, 2022 | Volume 194 | Issue 31 E1091 Menopause occurs at a formative time in a physician’s career, with Canadian data showing that age at natural menopause is generally between the ages of 45 and 55 years.1 Menopause is a life stage during which physicians may expect to increase work productivity, seek academic promotions and move into leadership roles. Given that symptoms can be disabling,2 and as many as 80% of people experiencing menopause have common symptoms,3 it is important to consider how to best accommodate phys icians as they experience menopause. However, little discussion has occurred on the effect and potential burden of menopause on physicians who are potentially at the peak of their careers. We discuss menopause, its potential effects on the medical workforce and measures that could lead to better accommodation of physicians experiencing menopause to support equity and strengthen health care systems. A national cohort study in the United States estimated that symptoms typically persist for an average of 7 years over the menopause transition.4 Although excellent treatments are available, crosssectional studies show that 28% and 15% of women aged 40–55 years and 55–59 years, respectively, experience moderate -to-severe vasomotor symptoms.2 Other menopausal symptoms include abnormal uterine bleeding and bother some changes to mood, sleep, cognition and sexual function.3 Much has been written about the impact of menopausal symptoms on work performance in fields other than medicine. Studies have documented a higher likelihood of self-reported poor-to-moderate ability to work among those who report vasomotor symptoms,5 although some research reported decreased productivity only when symptoms were severe.6 Symptomatic women have been found to be 8 times more likely to report low ability to work than asymptomatic peers and were more likely to report prolonged work absences.6 Given the use of self-reported data in these studies, it is possible that, although true job performance is not altered, women with symptoms have an altered perception of their ability to work. A 2019 survey in the United Kingdom also showed that 30% of women had taken sick leave owing to their menopausal symptoms, but only 25% disclosed the reason for their absence.7 Women have reported further difficulty managing symptoms when they perceive stigma surrounding discussions of menopause at work.8 It is unclear whether these findings can be extrapolated to the medical field or industries involving safety-sensitive work. Specifically, the unique experiences of symptomatic health care providers has not yet been well researched. Understanding the experiences of physicians going through menopause and how they align with other health care professionals is an important area for future research. We would suggest that a first step would be to conduct a survey of this population. Despite a relative lack of data, several comp","PeriodicalId":520595,"journal":{"name":"CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne","volume":" ","pages":"E1091-E1092"},"PeriodicalIF":14.6,"publicationDate":"2022-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6a/66/194e1091.PMC9377563.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40700948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe acute hepatitis of unknown cause in children.","authors":"Michelle Science, Aaron Campigotto, Vicky L Ng","doi":"10.1503/cmaj.220956","DOIUrl":"https://doi.org/10.1503/cmaj.220956","url":null,"abstract":"","PeriodicalId":520595,"journal":{"name":"CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne","volume":" ","pages":"E1089"},"PeriodicalIF":14.6,"publicationDate":"2022-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6b/18/194e1089.PMC9377557.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40700950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Umbilicated papules in disseminated cryptococcosis.","authors":"Hayato Mitaka, David C Perlman","doi":"10.1503/cmaj.220354","DOIUrl":"https://doi.org/10.1503/cmaj.220354","url":null,"abstract":"","PeriodicalId":520595,"journal":{"name":"CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne","volume":" ","pages":"E1090"},"PeriodicalIF":14.6,"publicationDate":"2022-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/97/2e/194e1090.PMC9377556.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40700953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Troubling rise in suicides linked with common food preservative.","authors":"Diana Duong","doi":"10.1503/cmaj.1096009","DOIUrl":"https://doi.org/10.1503/cmaj.1096009","url":null,"abstract":"","PeriodicalId":520595,"journal":{"name":"CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne","volume":" ","pages":"E1070-E1071"},"PeriodicalIF":14.6,"publicationDate":"2022-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/61/30/194e1070.PMC9365433.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40593149","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The experiences of family members of deceased organ donors and suggestions to improve the donation process: a qualitative study.","authors":"Aimee J Sarti,&nbsp;Stephanie Sutherland,&nbsp;Maureen Meade,&nbsp;Sam Shemie,&nbsp;Angele Landriault,&nbsp;Brandi Vanderspank-Wright,&nbsp;Sabira Valiani,&nbsp;Sean Keenan,&nbsp;Matthew J Weiss,&nbsp;Kim Werestiuk,&nbsp;Andreas H Kramer,&nbsp;Joann Kawchuk,&nbsp;Stephen Beed,&nbsp;Sonny Dhanani,&nbsp;Giuseppe Pagliarello,&nbsp;Michaël Chassé,&nbsp;Ken Lotherington,&nbsp;Mary Gatien,&nbsp;Kim Parsons,&nbsp;Jennifer A Chandler,&nbsp;Peter Nickerson,&nbsp;Pierre Cardinal","doi":"10.1503/cmaj.220508","DOIUrl":"https://doi.org/10.1503/cmaj.220508","url":null,"abstract":"<p><strong>Background: </strong>Decisions about organ donation are stressful for family members of potential organ donors. We sought to comprehensively explore the donation process from interviews conducted with family members of patients admitted to pediatric and adult intensive care units in Canada.</p><p><strong>Methods: </strong>We conducted a qualitative study using semistructured, in-depth interviews with 271 family members asked to make an organ donation decision. We recruited participants from all provinces with an organ donation organization (<i>n</i> = 10), and analyzed themes using a modified grounded theory approach. On the basis of these interviews, suggestions were made by researchers and family members on how to improve the process of organ donation.</p><p><strong>Results: </strong>We identified 3 main themes and 9 subthemes. Families need more comprehensive support around the time of donation, including having access to someone with shared experiences, support during specific moments as needed and better support during critical transitions (e.g., when the donor body goes to the operating room). The theme of better connection to recipient(s) included receiving information about the donation surgery (e.g., which organs were recovered), establishing connection with recipients (e.g., via social networks or letters) and planned encounters. Support after donation, such as updates on organ transplantation, early mental health checks and continued connection to donor organizations, could be improved. We derived 20 suggestions for improving the organ donation process, derived from interviews with family members of pediatric and adult organ donors.</p><p><strong>Interpretation: </strong>We found gaps in family support during end-of-life and donation care. Feelings of abandonment, lack of support and poor-to-little follow-up provide the empirical findings needed for hospitals and organ donor organizations to provide better support to donor families.</p>","PeriodicalId":520595,"journal":{"name":"CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne","volume":" ","pages":"E1054-E1061"},"PeriodicalIF":14.6,"publicationDate":"2022-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a6/c5/194e1054.PMC9365431.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40593147","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Methemoglobinemia caused by sodium nitrite overdose.","authors":"Dana Saleh,&nbsp;Scott Lucyk,&nbsp;Eric McGillis","doi":"10.1503/cmaj.220434","DOIUrl":"https://doi.org/10.1503/cmaj.220434","url":null,"abstract":"","PeriodicalId":520595,"journal":{"name":"CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne","volume":" ","pages":"E1066-E1067"},"PeriodicalIF":14.6,"publicationDate":"2022-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/92/c5/194e1066.PMC9365438.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40593146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Providing abortions to Americans could land Canadian doctors in legal trouble - without CMPA assistance.","authors":"Lauren Vogel,&nbsp;Diana Duong","doi":"10.1503/cmaj.1096010","DOIUrl":"https://doi.org/10.1503/cmaj.1096010","url":null,"abstract":"","PeriodicalId":520595,"journal":{"name":"CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne","volume":" ","pages":"E1072-E1073"},"PeriodicalIF":14.6,"publicationDate":"2022-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6a/cd/194e1072.PMC9365437.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40595693","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}