skip to main content
Menu
Back to Top
Jun 8, 2018 | Editorial 

From the Editor 2018

Elizabeth Simms

THE McMASTER UNIVERSITY MEDICAL JOURNAL (MUMJ) was established in 2003 to share advances in medicine, augment our understanding of the social issues impacting individual and population health, and encourage the discussion of ethical and legal issues as they apply to the profession. Our mandate is to share bright ideas in science and medicine that are relevant to our McMaster readers, as well as the wider medical community, and we publish work by medical and graduate students from across Canada.

The 15th volume of MUMJ includes a broad array of original research, commentary pieces, and review articles. Our authors outline the usefulness of simulation training in improving pediatric trauma care, delve into the role of mentorship in medical school, and examine how growing up alongside a sibling with a chronic disease can shape one’s civic views. They challenge the effectiveness of Ontario’s approach to...

Downloadables

Jun 8, 2018 | Original Research 

Assessment of rural colonoscopy wait times, quality, and safety

Fraser Kegel, BHSc, BFsc; Emma Wallace, BHSc, BSc; Darrell Baker, MD, FRCSC, FACS

ABSTRACT:

Introduction: Although colonoscopies performed in rural settings have been shown to be safe and of high quality, screening occurs less frequently among these populations than in urban centres and colorectal cancer rates are higher. The aim of this study was to evaluate the wait times, quality, and safety of colonoscopies performed by a single endoscopist in a rural Ontario hospital and to determine whether any patient and operative factors were associated with higher relative risks of discovering a pathology during colonoscopy.

Methods: This was a prospective, observational study examining consecutive patients undergoing colonoscopy in a rural setting for any indication over a five-month period. Patient demographic information, referral methods and wait times, colonoscopy indication, procedural findings and timing, adenoma detection rates (ADR), polypectomy detection rates (PR), cecal intubation rates (CIR), and complication rates were collected from medical records at the Haldimand War Memorial Hospital.

Results: A total of 222 patients were included. Median patient wait times were 57 days for patients with symptoms concerning for colorectal cancer. The CIR was 96.7%. Inadequate bowel preparation was observed in 2.3% of patients. The ADRs and PRs varied from 4.4-30.0% and 8.9-40.0%, respectively, depending on patient risk category. There were no complications of bowel perforation or postoperative hemorrhage. A colonoscopy withdrawal time of greater than six minutes was associated with higher
PR (RR = 13.4, 95% CI [7.77, 23.1], p < 0.001) and higher ADR (RR = 19.0, 95% CI [9.78,36.7], p < 0.001). Finally, there were no significant differences in PR (p = 0.66), ADR (p = 0.64), CIR (p = 0.58), mean total colonoscopy time (p = 0.64), or mean colonoscopy withdrawal time (p = 0.16) between patients who underwent procedures earlier in the operating room schedule compared with later in the day.

Conclusion: We demonstrate that rural colonoscopies continue to be safe, effective, and high-quality procedures. We also show that patient wait times for rural colonoscopies are within the established recommendations.

Downloadables

Jun 8, 2018 | Original Research 

Does mode of arrival to the emergency department influence door-to-electrocardiogram or door-to-troponin times?

Andrea Gubert, MD; Nikita Arora, MD; Elizabeth Simms, MD, MSc; Rachel Snaidero, MD; Daniel Goodman, MD; Andrew Worster, MD

ABSTRACT:

Background: The morbidity and mortality of acute myocardial infarction (AMI) is dependent upon time to diagnosis and treatment. Delays to early diagnosis in the emergency department (ED) can have  important clinical impact. We sought to determine whether ED patients with chest pain who arrived by self-transport to a Hamilton emergency department experienced a significant delay in door toelectrocardiogram (DTE) and door-to-troponin (DTT) times compared to patients with chest pain that arrived by emergency medical services (EMS).

Methods: We randomly selected 1 000 charts from the over 13 000 visits with “cardiac chest pain” as the chief complaint at two EDs in the city of Hamilton in 2013. We divided these patients into two groups: those arriving by EMS and those arriving by self-transport. We then compared these two groups with respect to mean sex, age, DTE and DTT times.

Results: The self-transport group had a significantly longer door-to-troponin time (mean 4260 seconds) than the group that arrived via EMS (mean 3000 seconds) (p<0.001) and both groups had comparable DTE times. The nationally recommended benchmark was met for DTT time for the group that arrived via EMS, but not for the self-transport group. Recommended benchmarks for DTE times were not met, regardless of mode of arrival.

Conclusion: There was a significant difference in mean DTT times between patients who arrived to the ED via self-transport, versus patients who arrived via EMS. This study also revealed that the two EDs studied were not meeting the recommended benchmark times of ten minute DTE time.

Downloadables

Jun 8, 2018 | Original Research 

Evaluating the role of physician mentorship among undergraduate medical students

Lazar Milovanovic, BASc, MD; Jason Martin, MD; Sriharsha Athreya, MS, MRCS, FRCR

ABSTRACT:

Background: Mentorship is a key factor for a successful academic medical career, earlier career choices, and increased research productivity. This study characterized the prevalence and medical student perception of physician-medical student mentorships. It also aimed to provide guidance for physicians on finding, mentoring and inspiring young medical minds.

Methods: A 23-question survey was sent electronically to medical students at McMaster University, Hamilton, Ontario. Questions examined the initiation, duration, and productivity of mentorship relationships, and the characteristics of mentors and mentees. Population data was collated and analyzed. Fill-in responses were manually tabulated.

Results: Of 629 medical students, 244 (38.7%) responded. Mentors were largely academic (63.89%) and in the students’ field of interest (53.85%). Mentored students exhibited no difference in years of education, age or intention to pursue specialty training, compared non-mentored students. Mentored students had more intent to pursue an academic practice (p<0.05), and less intent to pursue community practice (p<0.05). Research publications (13.33%), presentations (18.89%) and establishing connections in a field of interest (57.78%) were identified as productivity arising from mentorship.

Conclusion: Mentorship enhances career planning, research productivity and education. Mentored students express more intent in practicing academic medicine. Medical schools may benefit from programs that pair students with clinical mentors. Communication, respect, and genuine interest form the foundation for a good mentorship.

Downloadables

Jun 8, 2018 | Original Research 

Longitudinal civic-mindedness in siblings of Ontario children with chronic illness

Kristen Salena, BArts & Sc; Juliana I. Tobon, PhD; Michael H. Boyle, PhD

ABSTRACT:

Introduction: The purpose of this study was to examine longitudinal associations between being a sibling of a child with chronic illness and civic-mindedness in adulthood.

Methods: Secondary data analysis was conducted using data from the Ontario Child Health Study (OCHS) in 1983 and 2000. Multiple linear regression was used to examine adult civic-mindedness in healthy siblings of children with and without chronic illness (N = 1,051).

Results: For healthy siblings, adult civic-mindedness was significantly associated with the age (older), higher family socioeconomic status (SES), being a good student and participating in extra-curricular activities. There was a positive association between family SES and adult civic-mindedness for siblings of healthy children, but this relationship was weaker for the siblings of children with chronic illness. SES significantly moderated the interaction between sibling status and adult civic mindedness for siblings of healthy children (p < .001), but not for siblings of children with chronic illness.

Conclusion: Research supports that certain advantages in childhood, including socioeconomic advantage, are related to civic-mindedness as an adult. Siblings of children with chronic illness may develop greater social maturity than healthy siblings of healthy children in low SES households, effectively making these children equally civic-minded in adulthood as siblings who come from high- SES households.

Downloadables

Jun 8, 2018 | Original Research 

Pediatric trauma in situ simulation facilitates identification and resolution of system issues

Karen Bailey, BSc, MD, FRCSC, MHM; Jennifer Z. Li, MD

ABSTRACT:

Background: Trauma is one of the leading causes of pediatric disability and death in Canada. Mortality is lower in trauma centres where a trained trauma team exists, signifying the importance of having efficient trauma care. At McMaster Children (MCH)’s hospital, a series of trauma simulations were conducted in attempt to improve patient care. The objective of this study was to review the participant evaluations of 10 simulation sessions and examine how feedback was used to resolve systems issues locally.

Methods: Serial pediatric trauma in situ simulations were performed at the MCH Emergency Department (ED), a level 2 trauma centre with multidisciplinary ad hoc teams, from 2011 to 2012 to improve the quality of trauma care. Evaluation forms were distributed to participants and observers of the simulated trauma, asking what was learned, liked, and what should be changed. The comments on the form were collated and analyzed. Changes to the system made in response to the evaluations were reviewed.

Results: Participants and observers completed a total of 119 evaluation forms voluntarily during 10 simulations (mean 12 per session, ranging 9 - 16). Feedback was obtained with regard to trauma team dynamics, educational needs, and system issues. Changes made to the system in response to the feedback included but were not limited to: improved communication processes, documentation processes, nursing education, defining roles and responsibilities, the relocation and acquisition of equipment in the ER, reorganization of the trauma bay, and identifying smocks for team members.

Conclusion: Pediatric trauma in situ simulations are valuable in helping to identify and resolve system issues. They also provide an excellent opportunity for an “ad hoc” multidisciplinary team to rehearse trauma care and to promote continuous quality improvement.

Downloadables

Jun 8, 2018 | Systematic Review 

Advancing glioblastoma treatment with oncolytic virotherapy

Danny Jomaa, BSc, MSc(c)

ABSTRACT:

Glioblastoma is a highly invasive brain tumor with few therapeutic options for those affected. Since the 1990’s, when an oral chemotherapy drug named temozolomide was introduced, the standard of care for glioblastoma has remained largely unchanged. A pressing need for novel therapeutics has been met with innovative research that aims to tackle glioblastoma with virotherapy. The discovery of oncolytic viruses that can selectively infect and eradicate tumors has revolutionized the therapeutic landscape. Since the first proof-of-principle experiments, the number of candidate viruses being evaluated for their oncolytic activity has exploded. This opportunity has been met with cautious optimism; rigorous safety testing has ensured that only the safest and most targeted viruses progress to clinical trials. Meanwhile, several groups have been constructing immune-stimulating recombinant viruses and evaluating their potential to enhance the oncolytic virotherapy movement. Simultaneously, numerous studies are assessing the efficacy of virus administration with concomitant immunotherapies. The results have brought astounding promise to the future of a glioblastoma treatment that is eager to be translated into the clinic.

Downloadables

Jun 8, 2018 | Systematic Review 

The efficacy of peptide immunotherapy for cat-induced respiratory allergy

Jia Lu, BHSc(c); Matthew Boroditsky, MD(c); John Paul Oliveria, PhD

ABSTRACT:

Allergen immunotherapy (AIT) can be defined as the repeated administration of specific allergens to patients with IgE-mediated inflammatory diseases, with the ultimate goal of providing protection against allergic symptoms and inflammatory reactions associated with natural exposure to these allergens. Specifically, the therapy primarily strives to establish long-term tolerance against allergens by inducing allergen-specific regulatory B and T cell responses, in addition to modulating the mast cell and basophil activation thresholds to mitigate allergic pathogenesis. AIT is conventionally administered to patients both subcutaneously and sublingually; however, additional routes of administration (ie. intralymphatic immunotherapy) are under investigation. AIT is suitable for both adults and children for a variety of allergens including pollen, pet dander, house dust mite, venom, and a number of food allergens including peanut, egg, and milk. Nevertheless, more research is needed to elucidate many of the direct mechanisms in which AIT suppresses inflammatory immune responses.

Downloadables

Jun 8, 2018 | Commentary 

Current evidence in bariatric surgery for the medical student and primary practitioner: A call for more exposure

Zainab Najarali, BSc; Gayathri Naganathan, BSc, MSc; Aristithes Doumouras, MD, MPH; Dennis Hong, MD, MSc

INTRODUCTION

Severe obesity is a chronic disease and is defined as a BMI greater than 35 with comorbid health conditions, or a BMI greater than 40 without comorbidities1. It increases morbidity, premature mortality, impairs quality of life, leads to excess healthcare spending, and increases the risk of developing type II diabetes mellitus, micro and macrovascular
complications. Conservative treatment measures commonly used for severe obesity, including lifestyle modifications and pharmacotherapy, often fail in the long term.

An important and under-discussed tool to treat severe obesity and diabetes is bariatric surgery. Bariatric surgery generally consists of surgeries which either limit the size of the stomach (restrictive procedures), bypass part of the small intestine (malabsorbtive), or both2. The two main procedures performed in Canada are...

Downloadables

Jun 8, 2018 | Commentary 

Public health, risk discourse, and steoporosis: A critical assessment of osteoporosis prevention in Ontario

Alyson Holland, PhD

INTRODUCTION

Since the 1980s osteoporosis has been viewed as a public health crisis in North America1 The concern over osteoporosis has intensified in recent decades due to an aging population, which has created a greater focus on osteoporosis prevention and management approaches carried out by public health organizations. Public health in North America is grounded in risk-based epidemiological models that are used to identify what populations or groups are in need of prevention. Riskbased approaches have been common since the emergence of the “new” public health after the first world war. A reimagining of public health was driven by the constant threat of risk posed by...

Downloadables

Jun 8, 2018 | Medical Education 

MMSRD Recap and Winners

Aadil Bharwani & Jennifer Asselstine

MMSRD Recap

It was our immense pleasure this year to host the 9th annual McMaster Medical Research (MMSRD), held on April 25th, 2018. Every year, MMSRD proudly showcases the tremendous efforts and achievements of McMaster University’s MD and MD-PhD students, in the hopes of encouraging students and faculty to consider the nuances of medicine by exploring research endeavours that highlight the diversity of modern healthcare. Success in improving patient care and medical practice relies upon individuals who embrace the astonishingly interdisciplinary nature of medicine to embark upon initiatives that range from examining the chemistry of novel antibiotics to efforts that...

Downloadables

© 2015 McMaster University  |  1280 Main Street West  |  Hamilton, Ontario L8S4L8  |  905-525-9140  |  Contact Us  | Terms of Use & Privacy Policy

More than one Google Analytics scripts are registered. Please verify your pages and templates.