Journal Médical de l'Université d'Ottawa (JMUO) // University of Ottawa Journal of Medicine (UOJM)

Permanent URI for this collectionhttps://hdl.handle.net/10393/30680

Le JMUO est un journal revu, édité et publié par les étudiants de la Faculté de Médecine. Nous encourageons les soumissions d'une variété de différents domaines en recherche biomédicale et publions des articles de recherche originale, des articles de revue, des nouvelles et commentaires, des rapports de cas et des pièces d'opinion. Nos articles sont écrits en Français et en Anglais et représentent le seul journal médical bilingue au Canada. // UOJM is an international peer-reviewed journal led and published by the students of the Faculty of Medicine. We welcome submissions in a variety of areas in biomedical research and feature original research, review articles, news and commentaries, case reports and opinion pieces. Our articles are written in both English and French, and represent the only bilingual medical journal in Canada.

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UOJM: Preface
(2014-05-07) Suen, Colin; Cheung, Loretta
Double blinding in peer review: is it worth the hype?
(2014-05-07) Suen, Colin
INTRODUCTION Without a doubt, peer review is the measuring stick by which science is judged. Peer review is a longstanding tradition in academic circles as the standard practice for evaluating articles for publication, grants and academic promotions. The term itself conjures up certain connotations and mixed emotions. Knowing that a body of work has successfully gone through peer review immediately increases credibility and, although academics would be hesitant to confess, it is too frequently unquestioned. A recent article by John Bohannon in Science tells the story of how his bogus paper full of glaring fatal flaws was accepted by an astonishing 157 out of 255 open-access “peer reviewed” journals [1], casting doubt on the level of scrutiny from journals claiming to perform peer review. Perhaps it is time to cast aside our blind faith and understand the limitations of peer review.
UOJM editor training: results from the 2013 editor satisfaction survey and highlights from 2013-2014 training workshops
(2014-05-07) Suen, Colin; Cheung, Loretta
BACKGROUND UOJM recognizes that editor competency and preparedness directly impacts the quality of peer review, which holds the key to producing a great publication. We believe that success of our journal is based on a central goal of promoting physician competency in medical communication and developing leaders in medicine. In the age of evidence-based medicine, there are surprisingly few, if at all, opportunities for medical trainees to gain formal training in scientific writing and critical appraisal. Over the last two years, the UOJM has aimed to address these gaps and worked on developing a training program to equip participants with these important skills. Indeed, the merits of involvement in a peer reviewed journal at this stage of medical/research training have been recognized by its trainee participants, and have been reviewed extensively by Kevin Lee [1]. Following the success of the 2013 issue, UOJM made considerable strides to further improve the quality of content in the journal. In 2012-2013, 30 students participated as reviewers on the editorial board and received a practical experience in peer reviewed research. We conducted a year-end survey to identify issues and areas for improving the editor experience.
The advancement of medical education through innovative research and simulation learning: a discussion with Dr. Viren Naik, Medical Director of the University of Ottawa Skills and Simulation Centre
(2014-05-07) Cheung, Loretta; Noel, Ariana
A B S T R A C T The spotlight of UOJM’s 4th issue is medical education. We met with Dr. Viren Naik, anesthesiologist, associate professor at the University of Ottawa (uOttawa), and Medical Director of the University of Ottawa Skills and Simulation Centre (uOSSC). He is also a core team member of the Academy of Innovation in Medical Education (AIME), uOttawa’s centre for advancing medical education research. Dr. Naik is actively involved in research, with over 60 peer-reviewed publications and grants. He was also the previous chair of the Written Examination in Anesthesia with the Royal College of Physicians and Surgeons of Canada. In this interview, we discuss the advancement of medical education with the skills and simulation centre, the future of the medical curriculum, and how to be involved in medical education as students. // R É S U M É Dans cette 4e édition du JMUO, le sujet mis en lumière est l’éducation médicale. Nous avons rencontré le Dr Viren Naik, anesthésiologiste, professeur agrégé de l’Université d’Ottawa (uOttawa) et directeur médical du Centre de compétences et simulation de l’Université d’Ottawa (CCSUO). C’est aussi un membre important de l’Académie pour l’innovation en éducation médicale (AIME), le centre de l’Université d’Ottawa qui a pour but de faire avancer la recherche en éducation médicale. Dr Naik est un chercheur très dynamique qui a plus de 60 publications et subventions évaluées par les pairs à son actif. Dans le passé, il a aussi présidé l’examen écrit en anesthésiologie du Collège royal des médecins et chirurgiens du Canada. Durant l’entrevue, nous avons discuté de l’avancement de l’éducation médicale au Centre de compétences et simulation, de l’avenir du cursus médical et de la façon que les étudiants peuvent participer à l’éducation médicale.
Personalized medicine hits primary practice as genetic testing is being done for the first time in family practice to better select psychiatric medications for patients: an interview with Dr. Nicholas Voudouris
(2014-05-07) Carruthers, Martha
For the first time in Canada, genetic testing done at the Centre for Addiction and Mental Health (CAMH) in Toronto is being made available to family physicians. This leading-edge research started just over a year ago at the Thornhill Medical Centre in Thornhill, Ontario. The aim of the research is to use genetic testing to better select psychiatric drugs and dosages to improve efficacy and reduce side effects in patients suffering from mental illness. Dr. Nicholas Voudouris, a family physician at the Thornhill Medical Centre who is heavily involved in this project, describes it as leading-edge science that has the possibility of having profound impact on personalized medicine at the primary care level. I spoke with Dr. Voudouris to learn more about him, this project, and the future implications genetic testing could have on personalized medicine and reducing health care spending.
Reforming case-based learning with non-linear gameplay: the potential of branched narratives and virtual patient models
(2014-05-07) Whelan, Alexander
Case-Based Learning (CBL) has become a major component of medical curricula and is featured prominently at the University of Ottawa. In this article, CBL is defined as a pedagogical method that uses fictional cases to reinforce important clinical skills [1]. Cases are organized into written sections pertaining to the patient’s chief complaint, a history and physical examination, laboratory and diagnostic investigations, as well as management and follow-up plans [1]. These cases are delivered through selfdirected online teaching modules or through group-oriented discussions. With either method, learners are expected to identify salient points from a given section, in order to anticipate the next steps in the management plan [1]. For example, if the history section describes a patient suffering from epigastric pain, students are encouraged to identify potential pain sources and use this knowledge to recognize the components that should be included in their approach to the physical examination. The ability to synthesize information to direct decision-making is a necessary competency of medicine supported by CBL [1-2]...
The Clinician Investigator Program at the University of Ottawa
(2014-05-07) Angel, Jonathan
Clinician investigators play a critical role in developing new approaches and improving upon existing approaches to medical care, ultimately resulting in improved health of Canadians. Such individuals are uniquely suited to conduct research that addresses clinical observations as well as translates research findings into novel approaches to disease management and prevention. The need for such individuals has long been recognized and in 1995, the Royal College of Physician and Surgeons of Canada (RCPSC) developed the first formal training program in the country to help support the development of clinician investigators. Since its inception, over 200 trainees have completed the RCPSC Clinician Investigator Program (CIP), the details of which are communicated in a review by Cathy Hayward et al. [1] in Clinical and Investigative Medicine. Currently, the CIP is active at 15 (almost all) medical schools across the country. Dr. Andrew Badley, a clinician scientist in the Division of Infectious Disease, led the development of the application for the CIP at the University of Ottawa (U of O), which was ultimately approved in 2002. In 2003 Jonathan Angel became the Director of the CIP at U of O and in 2004, the first trainee was accepted into the program. Since then, approximately 40 trainees have enrolled in the CIP, and as of April 2014, 25 trainees have completed the program. While a few of the recent trainees have resumed clinical training following their research activities, the majority of the graduates (n=14) have gone on to assume academic positions at the University of Ottawa and elsewhere // Les cliniciens-chercheurs jouent un rôle clé dans le développement de nouvelles méthodes et dans l’amélioration des méthodes existantes dans les soins médicaux. Le but est, ultimement, d’améliorer la santé des Canadiens et Canadiennes. Ces personnes sont bien placées pour mener des projets de recherche qui portent sur des observations cliniques et qui traduisent les résultats de recherche en approches novatrices pour la prévention et la prise en charge des maladies. Le besoin pour ces professionnels est reconnu depuis longtemps. En 1995, le Collège royal des médecins et chirurgiens du Canada (CRMCC) a créé le premier programme officiel pour appuyer le perfectionnement des cliniciens-chercheurs. Depuis sa création, plus de 200 personnes ont complété le Programme de cliniciens-chercheurs (PCC) du CRMCC. Une revue du programme a été publiée par Cathy Hayward et coll., dans la revue Clinical and Investigative Medicine. Actuellement, le PCC est offert dans 15 facultés de médecine au Canada, soit presque la totalité d’entre elles. Dr Andrew Badley, un clinicien-scientifique de la Division des maladies infectieuses, a mené l’intégration du PCC à l’Université d’Ottawa, programme qui a été approuvé ultimement en 2002. En 2003, Jonathan Angel est devenu le directeur du PCC de l’Université d’Ottawa et, en 2004, le premier stagiaire du programme était admis. Depuis cette date, environ 40 stagiaires se sont inscrits au PCC et, en avril 2014, 25 d’entre eux avaient terminé le programme. Bien que quelques-uns des plus récents stagiaires aient repris leur formation clinique après avoir achevé leur recherche, la majorité des finissants (n=14) ont accepté des fonctions universitaires à l’Université d’Ottawa ou ailleurs
Neglecting the null: the pitfalls of underreporting negative results in preclinical research
(2014-05-07) Foster, William; Putos, Samantha
Heightened competition for funding and increased pressure to publish in high-impact journals has led to a modern-day publication culture that favours positive results. The underreporting of negative, or null, results is a form of publication bias that occurs when researchers and/or reviewers fail to communicate findings due to unfavourable directionality or perceived unimportance. For nearly three decades, recognition of this bias in clinical research has led to revised policies and guidelines in an effort to improve reporting transparency and accuracy. Only recently has the existence of this reporting bias been fully appreciated as a formidable problem in preclinical research. Considering that preclinical research provides the foundation on which many clinical trials are conceived, finding solutions to increase the reporting accuracy of preclinical studies is of paramount importance. In this commentary, we will explore how the underreporting of negative results in preclinical research distorts scientific knowledge and subsequently misguides clinical research. We will conclude with several suggestions for reducing this bias with the intention of transitioning towards a truly transparent and objective publishing landscape.
Between a rock and a hard place: the incommensurate ethics of emotionally-related living organ donation
(2014-05-07) Cox, Gemma
At the end of 2007, over 71,000 candidates in the United States were awaiting a kidney transplant. That same year, 16,622 kidney transplants took place [1]. The growing shortage of organs in the face of escalating need has placed pressure on transplant centers to accept organs from voluntary living donors. Emotionally- related living organ donation (ERLOD) is becoming increasingly common. In ERLOD, donors and recipients are genetically unrelated but linked by close emotional ties. In the case of kidney transplants, ERLOD achieved over 90% success rates after only one year [2]. However, the significant need and efficacy of this practice are not sufficient for its justification; this program must also be ethically acceptable [3]. Living organ donation in general raises concerns regarding the acceptable standards of medical practice and ERLOD in particular poses unique challenges. This article examines, within a clinical care framework, the ethical concerns surrounding ERLOD and why these concerns may be difficult to reconcile from this perspective alone. Discussion may benefit from using the ethical framework of clinical research in adjunction with the clinical care framework to offer a more flexible scope of analysis.
The challenges facing Ontario’s health care system moving forward: a health policy perspective
(2014-05-07) Micieli, Andrew
The purpose of this commentary is to inform Ontario’s Deputy Minister of Health and Long-Term Care on the province’s current top health priorities and the factors that have pushed these priorities to the top of the agenda. It will include the three most important health policy priorities that should top the health agenda in Ontario over the next 5 years, outlining their incentives and challenges and stating Ontario’s number one top health policy priority
Dying young: Excess morbidity and mortality in individuals with severe mental illness and what we should be doing about it
(2014-05-07) Kurowecki, Darya; Godbout, Justin
“We talk about people with mental illness, and people with diabetes, and smokers and the obese, and so on and so on. We’re talking about the same people – just with different labels.” – Health care professional [1, p. 6] Severe mental illness (SMI) most commonly refers to mental disorders with a psychotic component and significantly reduced functioning despite the presence of inherent differences in risk factors, etiologies, and treatments [1]. The most common disorders that fall under this term include schizophrenia and bipolar disorder [1]. Over a decade of research into the morbidity and mortality of individuals with SMI has consistently revealed mortality rates two to three times higher and a life expectancy of 25-30 years shorter compared to the general population [1-4]. Contrary to popular belief, the main causes of early death are not drug overdose or suicide, but rather, preventable illnesses such as cardiovascular disease, diabetes, and HIV/AIDS [1,3,5-7]. Incidence of other preventable conditions, such as obesity and respiratory disease, is also much higher among patients with SMI, and when present, is associated with a more severe course of mental illness and a reduced quality of life [3,8]. Such findings bring significant questions: what is the cause of this disparity in mortality/ morbidity? What can health care professionals do to help reduce this gap? A recent report by the Early Onset Illness and Mortality Working Group [1] outlines several factors that may contribute to poor physical health of people with SMI. Some factors, such as those related to the mental illness itself (e.g., cognitive impairment, a lack of communication skills, medication side-effects) and socioeconomic status (e.g., poverty, poor education) may be less amenable to modification, but should nevertheless be a target for action. Other contributing factors include behaviour and lifestyle (e.g., physical inactivity, obesity, tobacco smoking), and poor preventative medical care (e.g., disparity in quality of medical care), both of which are more easily modifiable with the assistance of medical care practitioners. Here we will summarize the factors responsible for poor physical health in SMI, specifically focusing on the mental illness itself, socioeconomic status, behaviour and lifestyle, health care system barriers, and insufficient preventative medical care. We will then propose future directions and ways in which medical students and current medical professionals can help reduce this gap.
Healthcare is political: case example of physician advocacy in response to the cuts to refugees’ and claimants’ healthcare coverage under the Interim Federal Health Program
(2014-05-07) Warmington, Rebecca; Lin, Dolly
INTRODUCTION “Healthcare is political.” That phrase seems obvious. While healthcare is constitutionally a provincial responsibility, it has become a hallmark of Canadian federalism with all levels of government taking part in its function. Furthermore, it has become one of the core Canadian values, with Canadians continuing to place healthcare as the strongest symbol of their national identity. Yet, as future physicians, medical students are wary of “getting political” in fear of taking sides, loosing impartiality, and losing focus on patient care. However, political actions and issues can have a significant impact on the clinical practices of all physicians. This article will argue that changes to the Interim Federal Health Program (IFHP) have hindered the ability of physicians to provide best practice, evidence-based medicine, and will outline how members of the medical profession, including University of Ottawa medical students, have played an important role in advocating for those affected by the changes to the IFHP. In April of 2012 the federal government announced changes to the IFHP, a health insurance program developed in 1957, intended to provide temporary coverage to refugees, refugee claimants, and protected persons who are not covered by provincial or territorial health insurance plans. Prior to June 2012, the IFHP covered medical care, diagnostics and laboratory testing similar to that covered by provincial health plans. The IFHP also covered medications, emergency dental and vision, similar to what is available to people on provincial social assistance plans [1]. The changes announced in 2012 created different tiers of coverage for eligible individuals based on their refugee status in Canada. Most refugees (those found by the Government of Canada to be refugees or persons in need of Canada’s protection following an examination of their case) and refugee claimants (those awaiting a decision on their case in Canada) lost supplemental coverage for prescription medication, vision and dental care. Refugee claimants from countries designated by the Government of Canada to not normally produce refugees and failed claimants [2], and those whose cases are determined to not fit the definition of a refugee, retained coverage only for issues posing a risk to public health and safety [3]. The reduction in coverage is resulting in negative health outcomes for refugees and claimants, while also making it difficult for health practitioners to follow best practices and provide evidence-based care. The following case study describes a hypothetical case that illustrates the challenges facing individuals and practitioners affected by the changes to the IFHP.
Designing a multi-disciplinary undergraduate medical school ultrasonography curriculum
(2014-05-07) Stansfield, Elliot; Woo, Michael; Tam, Ron; Pugh, Debra; McInnes, Matthew; Hamstra, Stanley
Objectives: Although there is increasing demand for physicians from various specialties to be trained in ultrasonography (US), it is currently not being taught at most Canadian undergraduate medical schools in a comprehensive manner. The purpose of this study was to develop objectives to form the foundation of a comprehensive undergraduate US curriculum. Methods: After completing an environmental assessment, which included a review of our current undergraduate objectives, a literature review was performed to identify published undergraduate US objectives. Using this information, a preliminary list of objectives was developed. The list was distributed electronically to 12 content experts from 10 disciplines and, using a two-round modified Delphi process, consensus about the inclusion of educational objectives was obtained. An a priori consensus criterion of 75% agreement was used to determine objectives that would be included in the curriculum. Objectives that met consensus in the first round of the survey were excluded from second round evaluation. Results: Review of our undergraduate curriculum revealed that there were already 10 objectives relating to US. Combining existing objectives with those found during the literature review, an initial list of 79 objectives was produced. Sixteen of these were approved during the first Delphi round, while the remaining 63 objectives required rating during a second round. A final list of 25 objectives was produced. Conclusions: Using a modified Delphi process, physicians from diverse backgrounds reflecting current and future use of US developed 25 multi-disciplinary objectives for a comprehensive undergraduate medical school US curriculum. \\ Objectifs: Bien qu’on demande de plus en plus que les médecins de diverses disciplines suivent une formation en échographie, cette méthode d’exploration n’est pas encore enseignée de façon exhaustive dans la plupart des programmes d’études de premier cycle des facultés de médecine canadiennes. Le but de cette étude est d’élaborer des objectifs qui serviront de fondation à la création d’un programme d’enseignement de l’échographie au premier cycle. Méthodes: Après avoir terminé une analyse de contexte qui incluait une revue de nos objectifs d’apprentissage actuels, une revue de la littérature a été effectuée afin de faire ressortir les objectifs publiés pour l’enseignement de l’échographie au premier cycle de médecine. Avec cette information, une liste préliminaire d’objectifs a ensuite été élaborée. La liste a été envoyée électroniquement à 12 experts de contenu dans 10 disciplines différentes. Utilisant un processus de Delphi modifié en deux étapes, un consensus a été établi pour l’inclusion des objectifs d’apprentissage. Un consensus à priori de 75 % approuvant les objectifs a été utilisé pour choisir ceux qui seraient inclus dans le cursus. Les objectifs qui avaient satisfait au consensus lors de la première étape ont été exclus des évaluations lors de la deuxième étape. Résultats: La revue de notre programme d’études de premier cycle a démontré qu’il y avait déjà dix objectifs portant sur l’échographie. En combinant les objectifs actuels et ceux qui ont été relevés lors de la revue de la littérature, une liste initiale de 79 objectifs a été produite. Seize de ces objectifs ont été approuvés lors du premier tour Delphi. Les 63 autres objectifs ont dû être évalués dans le cadre du deuxième tour. Une liste finale de 25 objectifs a été produite. Conclusion: À l’aide d’un processus de Delphi modifié, des médecins provenant de diverses disciplines reflétant l’utilisation courante et éventuelle de l’échographie ont élaboré 25 objectifs multidisciplinaires pour offrir un programme complet de formation en échographie dans le cursus du programme de premier cycle de médecine.
Beyond Words
(2014-05-07) Simms, Kayla
Every now and then, I am humbly reminded that to be an effective medical communicator, one must exceed the bounds of words. Words are, in essence, binding. By that statement, I do not mean to imply that words are a re¬placement for a signed agreement, or that words are to be taken at face value as verbally spoken contracts continuously falling from our tongues onto others’ ears. By the binding of words, I am referring to the bounds they place on our emotions. Words ask us to put what we’re feeling into a communicable context that is somehow supposed to accommo¬date for our indescribable sentiments. Words provide us with a prison in which to place our deepest thoughts and most moving stories, and force us to express them to others in ways that are meant to effectively convey what we authentically feel. In both a literal and figurative context, many things in medicine are beyond words.
University of Ottawa Journal of Medicine Volume 3, Issue 1, FULL
(2013-05) UOJM
Volume 3, Issue 1 of the University of Ottawa Journal of Medicine.
Associations between neighbourhood walkability, active school transport and physical activity levels in primary and secondary school students: A pilot-study
(2013) Larouche, Richard; Faulkner, Guy; Tremblay, Mark
Objectives: This longitudinal pilot-study examined the associations of neighbourhood walkability with active school transport (AST) and pedometer-determined physical activity (PA) immediately before and after the transition from primary to secondary school. Methods: Fifty-five grade 6 students were recruited from 4 primary schools in Ottawa in May/June 2012. They were asked to complete a diary indicating their mode of transport to/from school for 1 week and wear a SC-StepMX pedometer for 8 consecutive days. 48 study packages were returned at baseline and 29 at follow-up (September/October 2012). The Walk Score® application was used as a proxy for walkability around the home and around the school. The associations of walkability with AST and average daily step counts at both time points were respectively examined with binary logistic regression and linear regression models adjusted for gender. Results: At baseline, only walkability around the school was positively associated with AST (OR = 1.04). At follow-up, higher Walk Score ratings around the home and the school were both associated with greater odds of AST (OR = 1.12 and 1.29 respectively). Furthermore, walkability around the home was associated with higher step counts with a large effect size (η2 = 0.19). Conclusions: There was a negative association between having a regular medical doctor and high self-perceived health, modified by age. The findings suggest that individual access to care does not predict health in the same way as physician density.//Objectifs: Cette étude pilote longitudinale vérifiait l’association entre les quartiers favorables à la marche, le transport actif scolaire (TAS) et le niveau d’activité physique (AP) déterminé à l’aide d’un podomètre, immédiatement avant et après la transition de l’école primaire à l’école secondaire. Méthodes: En mai et juin 2012, 55 élèves de la sixième année ont été recrutés dans 4 écoles primaires d’Ottawa. On leur a demandé de remplir quotidiennement un journal de bord dans lequel ils devaient indiquer leur mode de transport pour se rendre à l’école et en revenir durant une semaine. Ils devaient également porter un podomètre SC-StepMX durant huit jours consécutifs. À la première étape, 48 trousses d’étude ont été retournées à la première étape et 29 lors du suivi en septembre et octobre 2012. L’application Walk Score® a été utilisée comme témoin pour déterminer si le milieu environnant le domicile et l’école était favorable à la marche. L’association entre les quartiers favorables à la marche, le TAS et le nombre moyen de pas faits dans une journée a été examinée respectivement aux deux étapes de l’étude à l’aide d’une régression logistique binaire et d’un modèle de régression linéaire ajusté selon le sexe. Résultats: À l’étape initiale, seul un milieu favorable à la marche autour de l’école était associé positivement au TAS (RC = 1,04). Lors du suivi, un indice Walk Score élevé aux alentours de la maison et de l’école était associé à une probabilité supérieure de TAS (RC = 1,12 et 1,29 respectivement). De plus, un quartier favorable à la marche autour du domicile était associé à un nombre plus élevé de pas avec une taille d’effet élevée (η2 = 0,19). Conclusion: Ces observations préliminaires suggèrent qu’il peut s’avérer plus important pour les étudiants de l’école secondaire que leur milieu soit favorable à la marche. Puisqu’aucune autre étude longitudinale n’a été menée pour évaluer si l’association entre les quartiers favorables à la marche, le TAS et le niveau d’AP varie au fil du temps, il serait justifié de procéder à de grandes études prospectives.

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