Showing papers in "University of Toronto Medical Journal in 2010"

CanMEDS Physician Health Guide: A Practical Handbook for Physician Health and Well-being

Abstract: The textbook, CanMEDS Physician Health Guide: A Practical Handbook for Physician Health and Well-being, recently published by The Royal College of Physicians and Surgeons of Canada sheds light on the depth and scope of the CanMEDS competencies and how they relate to the personal health and the well-being of the medical doctor. This text is the latest addition to a growing library of College publications which serve as professional development resources pertaining to the CanMEDS roles. This particular text has developed a conceptual framework of physician health and evaluates and proposes concise strategies to address personal health issues that any medical student, resident or attending may encounter throughout his career.

High Prevalence of Depression and Anxiety Symptoms among Hospitalized Geriatric Medical Inpatients: A study from a Tertiary Level Hospital in Nepal

Abstract: Introduction: Depression and Anxiety symptoms are widely prevalent in the geriatric population and the prevalence is higher in those suffering from any kind of medical illness. Although the prevalence of anxiety and depression among elderly medical patients have been evaluated in a few studies from developed countries in Europe and the Americas, data from a developing country like Nepal is lacking. The main aim of our study was to estimate the burden of these psychiatric morbidities in our setting. Materials and methods: A cross sectional analytical study where 42 geriatric inpatients admitted to the Department of Internal Medicine of Tribhuvan University Teaching Hospital during the period from April 1st to May 20th 2009 were studied for the prevalence of depressive and anxiety symptoms using the Beck Depression Inventory and Beck Anxiety Inventory respectively. 23 healthy geriatric community dwellers from a senior citizen centre in Kathmandu were taken as the control group. Data was analyzed using SPSS 14.0. Results: Significant anxiety symptoms were present in 76.1% (N=32) of the hospitalized geriatric patients and significant depressive symptoms in 57.1% (n=24) as compared to 21.7% (n=5) and 17.3% (n=4) of healthy community dwellers respectively. Between the hospitalized geriatric medical inpatients and elderly healthy community dwellers, there was statistically significant differences in anxiety scores (F=26.06, p<0.01) and depression scores (F=22.97, p<0.01) as measured by one way analysis of variance (ANOVA). Conclusion: There is a very high prevalence of depressive and anxiety symptoms among hospitalized geriatric medical inpatients as compared to healthy community dwellers in Nepal. Presence of these psychiatric morbidities can further exacerbate the physical illness slowing down recovery and adversely affecting a wide range of outcomes. Such a high amount of psychiatric morbidity in this population needs to be addressed by appropriate mental health interventions.

The Discovery and Preparation of Insulin

Abstract: Nobel prize winner Frederick Banting and Charles Best recount their discovery and preparation of insulin. Reprinted from a UTMJ article originally published in 1924.

Oral Submucous Fibrosis: An Eastern Disease In The Western World

Abstract: Oral submucous fibrosis is a chronic, debilitating and pre-malignant disease; it is also one that is not taught in any significant detail in most medical curricula. The clearest association is with the practice of chewing betel quid containing areca nut, a habit very common amongst South Asian populations. With current migration trends and the establishment of large South Asian communities in the Western world, the disease is being seen with increasing frequency where it was previously seldom encountered. With this background in mind, we aim to present a concise overview of the disease and its prognosis so as to create awareness about an issue of emerging public health relevance. Furthermore, since the etiology is mostly linked to a habit, healthcare professionals have a very important role to play in terms of lifestyle modification advice, which may significantly decrease disease incidence, progression and morbidity, if not mortality.

Vision Screening in the Elderly: Current Literature and Recommendations

Abstract: Vision impairment is one of the leading causes of morbidity in the elderly population. Major causes of vision loss include presbyopia, cataract, age-related macular degeneration, glaucoma, and diabetic retinopathy. A vision screening program has the potential to identify millions of adults at risk for vision loss and vision-related co-morbidities. Previous guidelines in the 1990s recommended routine visual acuity screening by primary care physicians. However, subsequently published data have demonstrated a lack of effectiveness in quality-of-life outcomes with current screening strategies, likely due to the low sensitivity of the screening tests. Until further studies establish the accuracy of any vision test in predicting visual function, routine vision screening in the elderly in the primary care setting is not warranted. The introduction of other vision tests into the screening protocol, including low contrast VA assessment, stereoptic testing, and visual field testing, warrants further investigation and cost-benefit evaluation.

Linguistic and cultural barriers to health care among Chinese patients at the Toronto Western Hospital

Abstract: Objective: Patient satisfaction surveys are primarily conducted in English and thus exclude respondents who cannot read or are not proficient in the English language. This study used a language and culture-specific questionnaire to explore potential barriers to health care among Chinese patients and to determine their satisfaction with health care services received at their visit to the Toronto Western Hospital (TWH), University Health Network. Methods: A cross-sectional survey design was used. Patients were recruited from the General Internal Medicine inpatient ward and Tuberculosis, Liver and Angiography ambulatory care clinics at TWH. A questionnaire was administered by an interviewer to patients who self-identified as Chinese. The interviewer administered the questionnaire in English, Cantonese and Mandarin. The questionnaire explored three main topics which included language barriers, cultural barriers and patient satisfaction. Results: A total of 138 patients were approached to participate in the study over a six week period. There was a 97.1% response rate. Of the 134 patients who participated in the study, 52% reported having difficulty speaking English but only 24% utilized the hospital’s interpretation and translation service. Barriers to health care identified by patients included: limited discussion of use of Chinese medical therapies with physicians, difficulty understanding explanations provided by physicians and nurses, and difficulty finding a hospital staff member who could talk with them about their illness in their preferred language. Conclusion: Language and culture-specific questionnaires can reveal barriers to health care in patients with limited English proficiency. These barriers need to be addressed to ensure delivery of quality health care in a culturally responsive manner.

Molecular Imaging of Atherosclerosis

Abstract: Molecular imaging is a rapidly evolving field that aims to develop novel technologies and methods to image specific biological processes in the living organism at the cellular and molecular level. This review discusses several novel imaging strategies that exploit the unique biological properties of atherosclerosis to detect key aspects of the disease. Among the approaches, targeting macrophage activity, protease activity, apoptosis and angiogenesis for in vivo molecular imaging of atherosclerosis have demonstrated the greatest potential for translation into the clinical setting.

Examining the Demand for Pre-clerkship Global Health Education in Canadian Medical Schools: The Case of the University of Toronto

Abstract: Introduction In the present “globalized society” there is an urgent need to prepare future physicians for dealing with pressing global health issues. This need has already been broadly identified in the national Canadian context. Improved global health education in the undergraduate medical curriculum is warranted and necessary. To this end, an elective course in global health for preclerkship students may serve as a first step towards building a national standard in global health education. Methods In establishing the demands and expectations for such a course, the authors conducted a survey at the University of Toronto. Results The survey revealed broad support and interest in a global health elective course. While some students exhibited a high level of awareness of global health issues, most did not receive any formal education in the field. Alarmingly, some of these students without formalized training even indicated that they had previously worked abroad with an organization. Discussion Clearly, the need for improved global health education at all levels is present, and developing an elective course may be the most practical and feasible method of doing so at the undergraduate level.

Managing the Growing Burden of Rheumatic Heart Disease in Low-Income Countries: A Primary Healthcare Approach in Ethiopia

Abstract: Rheumatic fever and rheumatic heart disease continue to be the most common form of cardiovascular disease in low-income countries. Poor diagnostic and treatment capacity and limited patient understanding of disease etiology have kept both disease recognition and patient adherence to treatment low. In rural and remote areas, this is worsened as a result of poorer access to health facilities for diagnosis, treatment and monitoring. As recommended by the World Health Organization, to treat the chronic effects of rheumatic heart disease, patients must adhere to strict monthly treatment regimes of secondary prophylaxis with penicillin. However, adherence to treatment remains difficult for poor populations who struggle to meet the travel, economic and opportunity costs associated with seeking care. To address these challenges, lessons from Ethiopia suggest that a community-based primary healthcare approach that offers follow-up treatment and care through satellite health centres with health officers can be a sustainable and effective strategy for rheumatic fever and rheumatic heart disease management.

Geriatrics: An Interview with Dr. Sharon Straus

Abstract: Dr. Sharon Straus is the Division Director of Geriatric Medicine at the University of Toronto and practices geriatric and general internal medicine at St. Michael's Hospital. She is the Director of the Knowledge Translation Program at the Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael's Hospital. Her research interests include knowledge translation, quality of care, mentorship, and education, often with an evidence-based medicine approach. She has co-authored several books about the practice of evidence-based medicine in various clinical settings.

Imaging Case Report 1

Abstract: The second part of the UTMJ's first ever imaging case report! The answer to the first part is presented and explained.

Thyroid Cancer: Latest Approaches to Canada's Fastest Growing Cancer

Abstract: Thyroid cancer is the most common endocrinological malignancy worldwide and its incidence is increasing faster than for any other cancer. The majority of this increase has been in well differentiated thyroid carcinoma (WDTC) which comprises 90% of all thyroid malignancies. Recent advances in the diagnosis, surgical treatment, and long-term monitoring have enhanced the detection of primary and recurrent disease, as well as treatment modalities. These developments have prompted institutions to revise their guidelines on the management of thyroid disorders. In the diagnosis of thyroid nodules, recommendations have been made regarding initial evaluation, use of TSH and radionuclide studies, clinical and ultrasound criteria for fine-needle aspiration biopsy (FNAB), and the interpretation of FNAB results. Thyroidectomy (removal of gross thyroid tissue) and lymph node dissection have been established as efficacious initial therapies to reduce disease recurrence although the extent of surgical resection is hotly debated. Following surgical therapy, appropriate use of radioactive iodine (RAI) therapy to destroy microscopic disease is discussed, including its controversial use in low-risk patients. Guidelines for long-term management include recommendations on the use of TSH suppression therapy, surveillance of recurrent disease using ultrasound and serum thyroglobulin, and the treatment of recurrent/metastatic disease. Here, we review the recent developments and recommendations in the management of WDTC.

Acute Panmyelosis with Myelofibrosis: An Unusual Cause of Pancytopenia

Abstract: A 56-year-old woman presented to her family physician with a 2-month history of dizziness, palpitations, dyspnea on exertion,and episodic chest discomfort. Initial investigations revealed amild pancytopenia. Two days later, she presented to emergencywith a low-grade fever (37.8oC), left-sided chest discomfort, andweakness. She denied any infectious or bleeding symptoms andhad no significant past medical history, including no medications. On examination, the patient had no lymphadenopathy, andher cardiac, respiratory, and abdominal examinations were unre-markable, with no hepatosplenomegaly. Her investigationsrevealed a pancytopenia (see Table 1). On the basis of her neu -tropenia and low-grade fever, she was admitted for intravenousantibiotics and work-up of her pancytopenia.In hospital, her pancytopenia persisted; her counts reached anadir of hemoglobin (Hgb) 46 g/L, platelets (Plt) 16 X 10

Calcification of Untreated Mediastinal Hodgkin's Lymphoma: A Case Report

Abstract: Calcification occasionally occurs in Hodgkin’s lymphoma after therapy due to tissue necrosis. Rarely, calcification may be detected prior to treatment. This likely represents a dystrophic process when bulky tumours outgrow their blood supply. Due to this rare presentation, pre treatment calcified Hodgkin’s lymphoma is often mistaken for germ cell tumours on imaging. It is thus important to include Hodgkin’s lymphoma in the differential of this presentation. We present such a case of pre-treatment calcification of Hodgkin’s lymphoma in a young male and discuss the incidence, pathophysiology and imaging findings.

Curing the Heart Under the Wire

Abstract: A significant proportion of patients who sufferfrom heart disease have both these predisposing factors andother comorbidities, making their management more difficult.While medical treatment of heart conditions has helped toextend the durability of the native heart, many patients willeventually reach a point where invasive surgical manoeuvreshave to be considered.Fortunately, there is an emerging field in cardiovascular med -icine that can provide a new alternative for these patients: per-cutaneous cardiac therapies. These procedures are minimallyinvasive and are often associated with fewer peri-proceduralcomplications than a coronary-artery bypass graft (CABG), lead -ing to fewer subsequent morbidities.