Médecine // Medicine

Permanent URI for this collectionhttps://hdl.handle.net/10393/19692

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Are sequential compression devices routinely necessary following enhanced recovery after thoracic surgery?
(2022) Abdul, Sami Aftab; Anstee, Caitlin; Villeneuve, Patrick J; Gilbert, Sebatien; Seely, Andrew J E; Sundaresan, Sudhir; Maziak, Donna E
The prominence of "enhanced recovery after surgery" (ERAS) protocols being adopted in thoracic surgery requires a re-evaluation of mechanical venous thromboembolism (VTE) prophylaxis guidelines. The goal of this study was to assess the role of sequential compression devices (SCD) in the prevention of VTEs such as deep vein thrombosis and pulmonary embolism (PE) in thoracic surgical patients.
Communication Assessment Tool for Ethically Sensitive Scenarios: ACT4Ethics
(2021) Daboval, Thierry; Lambrinakos-Raymond, Alicia; Schoenherr, Jordan R; Ward, Natalie; Moore, Gregory P; Ferretti, Emanuela
Although well-designed instruments to assess communication during medical interviews and complex encounters exist, assessment tools that differentiate between communication, empathy, decision-making, and moral judgment are needed to assess different aspects of communication during situations defined by ethical conflict. To address this need, we developed an assessment tool that differentiates competencies associated with practice in ethically challenging situations: The Assessment Communication Tool for Ethics (ACT4Ethics) instrument. The competencies included in this assessment tool are grouped into three distinct categories: communication skills, civility and respectful behavior, clinical and ethical judgment and decision-making. [Updated from the version published in JMIR Research Protocols in 2019].
Hip preservation surgery and the acetabular fossa
(2020) Slullitel, Pablo A.; Coutu, Daniel; Buttaro, Martin A.; Beaule, Paul Edgar; Grammatopoulos, George
As our understanding of hip function and disease improves, it is evident that the acetabular fossa has received little attention, despite it comprising over half of the acetabulum's surface area and showing the first signs of degeneration. The fossa's function is expected to be more than augmenting static stability with the ligamentum teres and being a templating landmark in arthroplasty. Indeed, the fossa, which is almost mature at 16 weeks of intrauterine development, plays a key role in hip development, enabling its nutrition through vascularization and synovial fluid, as well as the influx of chondrogenic stem/progenitor cells that build articular cartilage. The pulvinar, a fibrofatty tissue in the fossa, has the same developmental origin as the synovium and articular cartilage and is a biologically active area. Its unique anatomy allows for homogeneous distribution of the axial loads into the joint. It is composed of intra-articular adipose tissue (IAAT), which has adipocytes, fibroblasts, leucocytes, and abundant mast cells, which participate in the inflammatory cascade after an insult to the joint. Hence, the fossa and pulvinar should be considered in decision-making and surgical outcomes in hip preservation surgery, not only for their size, shape, and extent, but also for their biological capacity as a source of cytokines, immune cells, and chondrogenic stem cells. Cite this article: Bone Joint Res 2020;9(12):857-869.
Randomized controlled trials assessing different dose regimens for anticoagulant thromboprophylaxis in patients with COVID-19: protocol for a scoping review
(2020) Tritschler, Tobias; Mathieu, Marie-Eve; Rodger, Marc; Le Gal, Grégoire
Protocol for a scoping review of outcomes in clinical studies of interventions for venous thromboembolism in adults
(2020) Tritschler, Tobias; Langlois, Nicole; Hutton, Brian; Shea, Beverley J.; Shorr, Risa; Ng, Sara; Dubois, Suzanne; West, Carol; Iorio, Alfonso; Tugwell, Peter; Le Gal, Grégoire
Impact of group practices on patients, physicians and healthcare systems: protocol for a scoping review
(2018) Zwiep, Terry Murray; Greenberg, Joshua A; Balaa, Fady; McIsaac, Daniel I; Musselman, Reilly P; Raiche, Isabelle; Williams, Lara; Moloo, Husein
Introduction Group practices have potential benefits for patients, physicians and healthcare systems. Although group practices have been around for many years, research in this area is lacking and generally is centred around the economic benefits that may be realised from group practice. The aim of this scoping review is to identify the impact that group practices have on patients, physicians and healthcare systems to guide further research in this area. Methods and analysis A scoping review will be performed based on the methodology proposed by Arksey and O’Malley and refined by Levac and colleagues. MEDLINE, EMBASE, Cochrane Central and Cochrane Economic Database will be searched from inception to present day to identify relevant studies that assess the impact of group practices on patient care, satisfaction and outcomes; physician quality of life, satisfaction and income and healthcare systems. Titles and abstracts will be screened by two members and the abstraction results charted and verified. Qualitative and quantitative analyses will be performed to identify key themes. Ethics and dissemination Research ethics board approval is not required for this scoping review. A consultation phase will be used to discuss the results with key stakeholders followed by dissemination at local and national levels. We will also publish the results in a peer-reviewed journal.
The Changing Landscape of Journalology in Medicine
(2018) Wilson, Mitch; Moher, David
In the early 1970s, when Seminars in Nuclear Medicine started publication, little was known about the quality of reporting in biomedical journals. Senior scholars were invited to become scientific editors of journals based on their research credibility and stature. Their knowledge of journalology (publication science) was not assessed. Similarly, while the use of peer review was gaining momentum, there was limited guidance on the tasks and expectations of peer reviewing. Almost fifty years later the evidence base regarding the quality of reporting is vast. This paper highlights some of this evidence including that relevant to imaging and nuclear medicine research. In biomedical publications there is a crisis in reproducibility; high prevalence rates of reporting biases, such as selective outcome reporting; spin; low registration rates of research protocols; and endemic poor reporting of research across biomedicine. These issues and some more immediate solutions are also discussed in the paper. The use of reporting guidelines has been shown to be associated with better reporting of clinical trials and other research articles. The use of audit and feedback tools is likely to provide an important gauge about the functions of biomedical journals. Finally, the push to better equip scientific editors and peer reviewers is taking a more concerted effort.
Evaluating the Predictive Capabilities of Hematoma Expansion Scores in Patients with Acute Intracerebral Hemorrhage: Protocol for a Scoping Review
(2018) Yogendrakumar, Vignan; Moores, Margaret; Sikora, Lindsey; Ramsay, Tim; Fergusson, Dean; Dowlatshahi, Dar
Introduction: Patients presenting with acute intracerebral hemorrhage are at a high risk of exhibiting hematoma expansion, a phenomenon that can significantly worsen long-term functioning. Numerous clinical and radiological factors are associated with expansion. In a bid to better select patients at increased risk of expanding, these factors have been collated together into clinical scores. Several clinical scores have been developed, but comparisons of diagnostic potential between these scores are limited and the frequency of use in clinical trial enrollment is unknown. Objective: To perform a scoping review of hematoma expansion scores and explore numerous factors such as methodology of development, and diagnostic capabilities. Methods and Analysis: MEDLINE, PUBMED, EMBASE, CENTRAL, and ClinicalTrials.org will be searched with assistance from an experienced information specialist. Eligible studies will involve adults presenting with spontaneous intracerebral hemorrhage who received baseline assessments, follow-up imaging, and risk stratification through a hematoma expansion score. Reviewers will independently extract data from the included studies and will collect data on patient demographics and medical history, details on score development, diagnostic capabilities, and usage proportions. Analysis of extracted data will focus on comparing the predictive capability of each score and similarities/differences in score development. The exact analysis technique will be dictated on the type of data extracted. Ethics and dissemination: Formal ethics is not required as primary data will not be collected. The findings of this study will be disseminated through conference presentations, and peer-reviewed publications.
Impact of Unexpected Death in Simulation: Skill Retention, Stress and Emotions
(2018-02-06) Boet, Sylvain; Schebesta, Karl; Khanduja, Kristina; Andrews, Meghan; LeBlanc, Vicki; Bould, M. Dylan
Background High-fidelity simulation is an increasingly used teaching tool that is proven to be effective for learning. According to the literature, by gradually increasing stress and emotions, more effective learning can be achieved. However, allowing the simulated patient to “die”, as a deliberate stressor, is controversial. There is no previous research on the educational effect of letting a simulated patient die. We aim to evaluate the effects of simulated unexpected death on skill retention, stress levels, and emotions. We hypothesize that the occurrence of unexpected death will impact skill retention, and will be associated with higher stress levels and stronger emotions. Methods After Institutional Research Ethics Board approval, 56 residents and fellows of different medical specialties will be randomized to either the intervention (unexpected death) or control (survive) group. Participants from both groups will have to individually manage a simulated cardiac arrest crisis. In the intervention group, the scenario will end by the death of the simulated patient, whilst in the control group the simulated patient will survive. Each participant will be immediately debriefed by a trained instructor. Three months later, skill retention will be assessed in a similar scenario. Crisis management performance of all scenarios will be rated by 2 blinded raters. Biological stress, cognitive appraisal, and emotions will be measured during both scenarios. Implications The impact of simulated unexpected death on skill retention of residents and fellows will provide instructors with evidence to optimize scenario design and approach the role of stress and emotions in simulation-based education.
Patient Activation Levels Among Patients Living with HIV Compared to Patients Living with Diabetes Mellitus
(2016-09-29) Levreault, Eleni; Kendall, Claire; Liddy, Clare
The Patient Activation Measure (PAM®) survey is a validated tool used to assess a patient’s level of engagement. It uses a 4-point Likert scale to assess patient activation levels. The objectives of this study were to 1) establish a baseline measure of activation using the PAM® amongst people living with HIV to help inform future self-management frameworks, and 2) compare PAM® scores between people living with HIV and with diabetes mellitus (DM). DM is a chronic disease for which self-management been extensively studied and reported on in the literature, and will provide a strong basis for comparison. To our knowledge, this is the first study comparing PAM® survey scores across chronic conditions.
Symptom Prevalence in Patients with Advanced, Incurable Illness in Bangladesh
(2017-10-06) Doherty, Megan; Khan, Farzana; Biswas, Fazle Noor; Khanom, Marufa; Rahman, Rubayat; Tanvir, Mohammad Munirul Islam; Akter, Farhana; Sarker, Mridul; Ahmad, Nezamuddin
Context: There is a signi cant need for palliative care for patients living in low- and middle-income countries. The presence and intensity of physical symptoms is a major factor in uencing the suffering of patients at the end of life. Objectives: The primary aim of this study was to determine the prevalence and characteristics of common physical symptoms experienced by patients with advanced, incurable illness in a developing country. Method: This study used semi-structured interviews in patients with advanced cancer or HIV/AIDS in Bangladesh. Results: Pain was the most common symptom (70.6%) and was frequently reported to be severe (62.6%). Very few patients received strong opioids to treat their pain (13.7%). Other frequent symptoms included loss of appetite (23.5%) and fever (19.9%). The average number of physical symptoms reported was 3 (range: 0–23). The majority of patients rated their most recent symptom (excluding pain) as severe (64.3%), with 35.8% continuing to have severe symptom intensity despite treatment. Conclusions: This study reveals the signi cant burden of symptoms, and the associated suffering for patients living with incurable illness, in a developing country. Very few patients received strong opioids, despite frequently having severe pain. Frequently, the treatments that patients received did not alleviate their symptoms. Palliative care is vital for the relief of suffering for patients with advanced and incurable diseases, especially in low- and middle-income countries where access to curative treatments may be limited and patients often present to medical personnel when their illness is in an advanced stage or incurable.
Chrysalis. A Collection of Art by University of Ottawa Medical Students
(2017-02) Aesculapian Society, Faculty of Medicine
The University of Ottawa Medical Student Art Show, under the auspices of the Aesculapian Society, is an initiative that celebrates artistic expression as a meaningful method of promoting personal wellness for medical students. This art show is a way to ensure that medical students in all four years can be exposed to the benefits of art-based learning through the creation of reflective art.
The Use of Tranexamic Acid in Trauma Patients- a Retrospective Review
(2014-10-07) Yelle, Katie; Lampron, Jacinthe; Woo, Michael; Saidenberg, Elianna
Background: Hemorrhagic shock is a leading cause of death in traumatically injured patients. Tranexamic acid (TXA) is an inexpensive antifibrinolytic agent that has been shown to decrease mortality in trauma patients. This study evaluated adherence to TXA use recommendations at a level 1 Trauma Centre. Methods: A retrospective cohort study of consecutive trauma patients who received a blood transfusion in the Emergency Department (ED) from Sept 2011 to February 2014 was undertaken. Data was collected from a prospectively collected trauma database, which included demographic information as well as injury characteristics, baseline physiology, coagulation profile, blood product and TXA use. Results: There were 103 patients of whom 87 met a priori criteria for analysis. The mean age was 43.5 years (range 16-92 years). 71.2% were male. TXA was administered in 62.1% (n=54). 18.4% of patients received the full TXA dose (1g initially followed by 1g infusion over 8h) initiated within 3 hours of injury time. Wide variation in practices between speciality care providers was observed. Initiation of a trauma code was a protective factor. Discussion: TXA administration is present at our centre, although overall compliance to the CRASH-2 protocol merits improvement. Reasons for lack of compliance are unclear and require more investigation. Conclusion: Knowledge translation regarding TXA in trauma resuscitation takes time. This study highlights the need for educational interventions to trauma health care providers. Current models of knowledge dissemination may be ineffective and novel methods to do so should be investigated.
Murmurs : the bilingual journal of art and healing
(2016) Ontario Medical Students Association; University of Ottawa. Faculty of Medicine
Published in collaboration between the University of Ottawa and the Shanghai Jiao Tong University, we hope to open your mind to new artistic perspectives, foreign languages and cultures, and to tease your artistic right hemispheres. Our vision is to expand your own view of medicine and art as two unique worlds that can collide into an expressive harmony. Indulge yourself in the beauteous paintings, savouring the nuances of poems and reliving focal moments through photography and stories. This year’s Murmurs is the first international medical humanities journal proudly showcasing visual and literary pieces created by medical students across Canada and in Shanghai.
Discovery - Art Show Booklet
(2016-02-10) Aesculapian Society, Faculty of Medicine
The Discovery booklet contains submissions from medical students that participated in the UOttawa Med 2016 Art Show.
Psychosocial Constructs and Self-Reported Driving Restriction in the Candrive II Older Adult Baseline Cohort
(2014) Jouk, Alexandra; Tuokko, Holly; Myers, Anita; Marshall, Shawn; Man-Son-Hing, Malcolm; Porter, Michelle M.; Bédard, Michel; Gélinas, Isabelle; Mazer, Barbara; Naglie, Gary; Rapoport, Mark; Vrkljan, Brenda
Baseline data from a large cohort of 928 older drivers (aged 70 and older) in the Canadian Driving Research Initiative for Vehicular Safety in the Elderly (Candrive II) study permitted the examination of driving specific constructs of perceptions and attitudes based on Social Cognition Theory, the Transtheoretical Model of Behavior Change, and the Theory of Planned Behavior (e.g., driving confidence/comfort, perceived driving ability, and decisional balance) in relation to each other and to various self-reported measures of driving restrictions (i.e., kilometers driven, situations frequently encountered and avoided, degree of driving restriction). Although several of the psychosocial measures were correlated, the magnitudes of the correlations were low enough to suggest that multiple factors were being assessed. In addition, perceptions and attitudes were associated with driving exposure and patterns such that the more positive/comfortable older adults felt about driving and their driving ability, the greater their self-reported driving exposure (e.g., more kilometers driven per week, increased exposure to challenging driving situations/decreased avoidance of challenging situations, fewer restrictions). Conversely, older adults who expressed more negative views about driving, including feeling less comfortable behind the wheel, self-reported driving fewer kilometers per week, avoiding challenging driving situations, and engaging more in active driving restriction compared to more comfortable/confident older drivers. These findings support previous research and extend our understanding of the specific perceptions and attitudes that can contribute to behavior change, particularly for constructs derived from Social Cognitive Theory and the Transtheoretical Model.
A Re-examination of Driving-Related Attitudes and Readiness to Change Driving Behaviour in Older Adults
(2014) Tuokko, Holly; Jouk, Alexandra; Myers, Anita; Marshall, Shawn; Man-Son-Hing, Malcolm; Porter, Michelle M.; Bédard, Michel; Gélinas, Isabelle; Korner-Bitensky, Nicol; Mazer, Barbara; Naglie, Gary; Rapoport, Mark; Vrkljan, Brenda
Aims: A detailed, in-depth examination of attitudes relevant to driving restriction practices was examined in 928 active drivers aged 70 and older. Method: The number of reported conditions and reasons for restricting driving were examined in relation to theory-based (Transtheoretical Model, Theory of Planned Behavior) attitudinal constructs. Results: Those more likely to restrict driving consistently showed more negative attitudes toward driving, whereas those less likely to restrict were inconsistent with respect to perceived benefits of driving and social pressure to continue driving. Self-referent attitudes toward driving were more strongly associated with reported restricted driving than attitudes toward driving held in relation to others. Attitudinal constructs from the Transtheoretical Model were more consistently related to driving restriction than those from the Theory of Planned Behavior. Conclusion: Theory-based attitudinal constructs are strongly related to driving restriction practices, but longitudinal data is needed to examine in more detail the role of attitudes in the behavior change process.
Protocol for Candrive II/Ozcandrive, a multicentre prospective older driver cohort study
(2013) Marshall, Shawn; Man-Son-Hing, Malcolm; Bedard, Michel; Charlton, Judith; Gagnon, Sylvain; Gelinas, Isabelle; Koppel, Sjaan; Korner-Bitensky, Nicol; Langford, Jim; Mazar, Barbara; Myers, Anita; Naglie, Gary; Polgar, Jan; Porter, Michelle; Rapoport, Mark; Tuokko, Holly; Vrkljan, Brenda; Woolnough, Andrew
The Candrive II/Ozcandrive study, a multicentre prospective cohort study examining the predictive validity of tools for assessing fitness to drive, aims to develop an in-office screening tool that will help clinicians identify older drivers who may be unsafe to drive. This paper describes the study protocol. We are following a cohort of drivers aged ≥ 70 years for up to 4 years. A total of 928 participants were recruited in seven cities in four Canadian provinces, as well as 302 participants in two sites in Melbourne, Australia and Wellington, New Zealand. Participants underwent a comprehensive assessment at baseline and repeat the assessment yearly thereafter, as well as a brief follow-up assessment at 4 and 8 months each year. A recording device is installed in participants’ vehicles to assess driving patterns, and driving records are obtained from licensing authorities to determine the outcomes: at-fault crashes per kilometre driven and violations. The Candrive II/Ozcandrive study is unique owing to its size, duration, partnerships with Canad
The Canadian Safe Driving Study – phase I pilot: Examining potential logistical barriers to the full cohort study
(2013) Marshall, Shawn; Wilson, Keith E.; Man-Song-Hing, Malcolm; Stiell, Ian; Smith, Andrew; Weegar, Kelly; Kadulina, Yara; Molnar, Frank
Multiple organizations and task forces have called for a reliable and valid method to identify older drivers who are medically unfit to drive. The development of a clinical decision rule for this type of screening requires data from a longitudinal prospective cohort of older drivers. The aim of this article is to identify and examine potential barriers to such studies based on an analysis of the Canadian Safe Driving Study – phase I pilot (Candrive I). A convenience sample of 100 active older drivers aged 70 years or more was recruited through the aid of a seniors’ organization, 94 of whom completed the full study (retention rate 94%). Data were collected over the course of 1 year on various driving behaviours, as well as on cognitive, physical and mental functioning. Driving patterns were recorded using driving diaries, logs and electronic devices. Driving records from the Ministry of Transportation of Ontario (MTO) were obtained for the 3-year period preceding the study initiation and up to 1 year following study completion. An increased burden of illness was observed as the number of medical diagnoses and medication use increased over the study period. Study participants were involved in a total of five motor vehicle collisions identified through MTO records, which was comparable to the Ontario annual collision rate of 4.1% for drivers aged 75 years or older. The results support the feasibility of completing a large prospective cohort study of older drivers and indicate that successful recruitment and retention is possible with endorsement from recognized organizations representing older adults.
Determining the validity of the AMA guide: A retrospective analysis of the Assessment of Driving Related Skills and crash rate among older drivers
(2013) Woolnough, Andrew; Salim, Danish; Marshall, Shawn; Weegar, Kelly; Porter, Michelle; Rapoport, Mark; Man-Song-Hing, Malcolm; Bedard, Michel; Gelinas, Isabelle; Korner-Bitensky, Nicol; Mazer, Barbara; Naglie, Gary; Tuokko, Holly; Vrkljan, Brenda
Background: Chronic health conditions associated with aging can lead to changes in driving ability. The Canadian Driving Research Initiative for Vehicular Safety in the Elderly (Candrive II) is a 5-year prospective study funded by the Canadian Institutes of Health Research aiming to develop an in-office screening tool that will help clinicians identify potentially at-risk older drivers. Currently, no tools exist to directly predict the risk of motor vehicle collision (MVC) in this population. The American Medical Association (AMA), in collaboration with the National Highway Traffic Safety Association, has designed an opinion-based guide for assessing medical fitness to drive in older adults and recommends that physicians use the Assessment of Driving Related Skills (ADReS) as a test battery to measure vision, cognition and motor/somatosensory functions related to driving. The ADReS consists of the Snellen visual acuity test, visual fields by confrontation test, Trail Making Test part B, clock drawing test, Rapid Pace Walk test, and manual tests of range of motion and motor strength. We used baseline data from the Candrive II/Ozcandrive common cohort of older drivers to evaluate the validity of the ADReS subtests. We hypothesized that participants who crashed in the 2 years before the baseline assessment would have poorer scores on the ADReS subtests than participants who had not crashed. Methods: In the Candrive II/Ozcandrive study, 1230 participants aged 70 years or older were recruited from 7 Canadian cities, 1 Australian city and 1 New Zealand city, all of whom completed a comprehensive clinical assessment at study entry. The assessment included all tests selected as part of the ADReS. Data on crashes that occurred within 2 years preceding the baseline assessment were obtained from the respective licensing jurisdictions. Those who crashed were compared to those who had not crashed on their ADReS subtest scores using Pearson’s chi-squared test and Student’s t-test. Results: Sixty-three of the 1230 participants (5.1%) were involved in an MVC within the 2 years preceding the baseline assessment. Contrary to what was expected based on the AMA guide, there were no statistically significant associations between abnormal performance on the tests constituting the ADReS and history of crash (p > 0.01). Discussion: Although limitations are inherent in a retrospective analysis, we found that abnormalities on the subtests comprising the ADReS were not associated with a recent history of crash. This suggests the need for more sensitive tools to properly assess crash risk in older drivers, for prospective analyses of risk over time and for an evidence base to support influential clinical practice guidelines.

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