McGill Journal of Medicine 

About: McGill Journal of Medicine is an academic journal. The journal publishes majorly in the area(s): Medicine & Health care. It has an ISSN identifier of 1201-026X. It is also open access. Over the lifetime, 523 publications have been published receiving 4453 citations. The journal is also known as: MJM.

How Doctors Think.

Abstract: In his latest book, How Doctors Think, Dr. Groopman, a haematologist affiliated with Harvard Medical School, takes the readers on a tour of a wide range of medical fields while jumping swiftly back-and-forth between the physician and the patient’s perspective. Most chapters open with the story of an individual patient and his doctor, whose interactions introduce us to an aspect of problem-solving in medicine. The author then further expands upon the subject in an essay form by weaving into the storytelling opinions from experts of cognitive thinking in medicine as well as evidence from recent research work on the topic. The stories, although slightly melodramatic at times with their predictable climax followed by a happily-ever-after resolution, do provide an accurate and helpful glimpse of the complex infrastructures of health care to those unfamiliar with the field. Dr. Groopman possesses a quite impressive ability for stripping medical facts of their jargon and rendering them accessible to laymen. Each story directs his lens onto particular “cognitive errors” in the practice of medicine, a term he uses to describe flaws in the thinking of physicians that result in misdiagnosis and/or mismanagement of illnesses. Then, deftly alternating the focus between the analysis and the story, he intertwines theory and practice to demonstrate how these mental traps can be averted. A common belief among the general public, fuelled by popular entertainment media, unreservedly equates advanced technology with better medical care. Although health care providers attempt to show a bit more discernment toward the magnetic attraction of technology, we nevertheless find ourselves engulfed by this tornado of armamentarium that allows us to see deeper and smaller into the human body. Certainly, new technology is not portent of the downfall of medicine, on the contrary. But Dr. Groopman guards us against the looming danger of relegating to the back row the time-old skills of speaking and listening to the patient in favour of simply relying on faster and easier tests in making a diagnosis. Example after example, he highlights the risk of overlooking important subtleties, nuances and ambiguities in a patient’s illness if we are not tuned in to their speech, their body language, their personal background. In a similar argument, he calls upon our caution in facing the increasingly influential presence of algorithms and guidelines in clinical practice. He asserts that these recipe-like approaches lead to cognitive errors in hindering creativity and flexibility of our thinking. He concedes that medicine is dominated by uncertainty and practiced with trial-and-error, and it is thus by no hazard that an atmosphere of conformity in medical practice is required to provide a certain structure. However, he urges us to never become passive followers of orthodoxy, to always challenge the rigor and validity of what we are taught and what we believe to be the truth. To those who assert doctors will no longer be needed with the increasing widespread access to information and the technological advancement of diagnosis and treatment modalities, How Doctors Think provides a resounding counterargument to their preposterous claim. Through his vivid story-telling, where individual doctors, the pediatrician, the endocrinologist, the plastic surgeon or the radiologist, come to life each with their own distinct personality and emotional profile, Dr. Groopman reminds us that the most neglected and thus most threatening source of cognitive error is the physician himself. As fallible individuals, our own past experiences and current state of mind can greatly colour and sometimes cloud our judgement. For example, faced with a “difficult” patient who is failing treatment for a chronic illness because of non-compliance to medication, many physicians will feel annoyed or perhaps even disgusted. Dr. Groopman asserts that these are quite natural reactions from a physician; it would be ludicrous to demand complete emotional detachment from physicians, who are also human beings. The danger lies not within the existence of these emotions per se, but rather with the ignoring of them as potential sources of cognitive errors. He further argues that because each physician’s particular temperament precludes him from being compatible with all types of patients, when choosing a physician, one should always keep in mind that a “good doctor” for your neighbour might not turn out to be a “good doctor” for you. This book primarily targets the general public, but it is also of tremendous value to medical practitioners of all levels, especially for those on the giving and receiving ends of medical education. For example, we are taught as beginner medical students to pose diagnoses through a step-wise, logical approach. However, shortcuts and pattern recognition easily find their way into our daily work with patients, most often subconsciously. Again, Dr. Groopman argues that the use of gestalt in clinical practice need not be frowned upon, in fact, it is often necessary in situations of time-restraint. What needs to be amended in the curriculum is the explicit acknowledgment of pattern recognition in clinical practice in order to empower novice medical students to use it consciously and with full awareness of its pitfalls. Medical students are taught many skills to avoid technical errors; it is now time for cognitive errors to share some of the spotlight as well. And this new focus does not only apply to medical students, but to the entire medical community. In How Doctors Think, numerous examples are offered of individual physicians or teams of medical care providers openly discussing cognitive errors and reflecting on changes both at their own individual and institution levels to avoid similar future occurrences. In that respect, Dr. Groopman’s book is more than a candid reflection of our mistakes, it is also a celebration of those who, through creativity, open-mindedness and dedication, have been and will be learning from these mistakes to provide better patient care.

An overview of intracranial aneurysms

Abstract: Intracranial aneurysms are relatively common, with a prevalence of approximately 4%. Unruptured aneurysms may cause symptoms mainly due to a mass effect, but the real danger is when an aneurysm ruptures, leading to a subarachnoid hemorrhage. Most aneurysms are asymptomatic and will not rupture, but they grow unpredictably and even small aneurysms carry a risk of rupture. Intracranial aneurysms are diagnosed and monitored with imaging including intra-arterial digital subtraction angiography, computed tomography angiography, magnetic resonance angiography, and recently transcranial Doppler ultrasonograpy has been proposed as a potential modality. Treatment options include observation, endovascular coiling, and surgical clipping. This paper will review the epidemiology, pathogenesis, clinical presentation, diagnosis, natural history, and management of unruptured saccular intracranial aneurysms.

Anterior cruciate ligament reconstruction: a look at prosthetics--past, present and possible future.

Abstract: Biological tissue autograft reconstruction using the patellar tendon or quadrupled semitendinosus/gracilis tendons has become the most popular procedure in surgical treatment of a ruptured ACL This article provides a review of the history of the use of prosthetics with respect to ACL reconstruction grafts including Carbon Fibre, Gore-Tex and Dacron prosthetics as well as the Leeds-Keio Artificial Ligament and the Kennedy Ligament Augmentation Device (LAD) Emphasis is placed on the Ligament Advanced Reinforcement System (LARS) as preliminary investigations of its use have been encouraging Significant progress has been made recently with respect to the understanding of ACL anatomy, composition, biomechanics, and healing processes, leading to innovative techniques using approaches based in tissue engineering principles and computer – assisted surgery While research into improved ACL treatment options continues, the synthesis of recent advancements provides a new optimism towards the regeneration of an ACL mirroring its original stability, function, and longevity

The significance of nanoparticles in particle-induced pulmonary fibrosis.

Abstract: Exposure to airborne nanoparticles contributes to many chronic pulmonary diseases. Nanoparticles, classified as anthropogenic and natural particles, and fibers of diameters less than 100 nm, have unrestricted access to most areas of the lung due to their size. Size relates to the deposition efficiency of the particle, with particles in the nano-range having the highest efficiencies. The deposition of nanoparticles in the lung can lead to chronic inflammation, epithelial injury, and further to pulmonary fibrosis. Cases of particle-induced pulmonary fibrosis, namely pneumoconiosis, are mostly occupationally influenced, and continue to be documented around the world. The tremendous growth of nanotechnology, however, has spurred fears of increased rates of pulmonary diseases, especially fibrosis. The severity of toxicological consequences warrants further examination of the effects of nanoparticles in humans, possible treatments and increased regulatory measures.

Electromyography and Neuromuscular Disorders: Clinical Electrophysiologic Correlations

Abstract: Seldom in the realm of medical texts does one encounter a truly readable and accessible textbook that doesn't sacrifice content for clarity. Such a truly rare feat is accomplished in the most recent incarnation of Electromyography and Neuromuscular Disorders: Clinical Electrophysiologic Correlations by Preston and Shapiro. Although it has a relatively small readership base, limited to neurologists with an interest in electrophysiology, physiatrists or very enthusiastic residents and medical students, this book is frequently lauded and praised by all those who read it. This most recent edition includes updated content, but the most notable improvement is the addition of two companion compact discs. These CDs provide excellent quality audiovisual aids that compliment the content and help illustrate key electromyographical findings. The book is divided into several sections. Sections one through five focus mainly on explaining fundamental principles of electrodiagnostic tests such as electromyography (EMG) and nerve conduction studies (NCS). In addition to comprehensive explanations about performing and interpreting basic studies, there are also chapters dedicated to other more specialized tests such as repetitive nerve stimulation and the blink reflex. Specific sections are also completely dedicated to important, but frequently overlooked topics such as sources of technical error, anatomical variants and basic statistics for electrodiagnostic studies. These chapters are particularly helpful as they demystify topics that are often not covered in adequate breadth and depth in other textbooks. Section six focuses extensively on clinical-electrophysiologic correlations. This section includes chapters on all of the common mononeuropathies, such as median, ulnar and peroneal. Each chapter provides a detailed review of the relevant anatomy, common clinical presentations, common etiologies, a differential diagnosis, and an approach to the electrophysiologic evaluation. Diagrams and figures illustrating key findings or concepts are interspersed with the text and contribute significantly to clarifying complex concepts. Each chapter also includes several cases that enable the reader to work through actual clinical scenarios and apply the concepts learned in the chapter. These cases are instrumental in reinforcing key concepts and helping the reader consolidate their knowledge. Each of these chapters close with a summary and a Socratic style discussion with responses to commonly asked questions. Section six also includes chapters on polyneuropathy, amyotrophic lateral sclerosis and other motor neuron diseases, radiculopathies, plexopathies, and sciatic neuropathy. Each of these chapters implements the same formula and meticulous approach employed in the earlier chapters, and focuses in detail how to differentiate between these different conditions on the basis of electrophysiologic testing. Numerous cases also help to illustrate important concepts on how to avoid common diagnostic pitfalls. In addition to the ample content, this book also includes two companion CD-ROMs that nicely compliment the explanations in the text. The CDs run on both PC and Mac and provide a comprehensive library of common and rare EMG sounds, waveforms and findings. Each video clip is accompanied by a concise, yet complete explanation of what you are observing and the clinical significance of these findings. The CDs even include a quiz that the viewer can use to test their skills. Overall, Electromyography and Neuromuscular Disorders: Clinical Electrophysiologic Correlations, 2nd edition is a superb book. Its two authors succeed in achieving the rare balance of writing a thorough and comprehensive text while still maintaining an accessible, easy to read style. This book would make a wonderful addition to the library of any neurologist, physiatrist or other physician with an interest in electromyography.