Katrina Rose DutkiewiczStephan SaadVanessa KitchinRose Hatala...
9页
查看更多>>摘要：Background: The clinical teaching unit is a widespread clinical training model that requires reform to prepare physicians for practice in the 21st century. In this systematic review, we aimed to identify evidence-based practices in internal medicine clinical teaching units that contribute to improved clinical education and health care delivery. Methods: We searched several databases from 1993 until Apr. 5, 2021, to identify published studies in inpatient clinical teaching units that involved medical trainees and reported outcomes related to trainee education or health care delivery. We identified emergent themes using a narrative approach and determined confidence in review findings using the Grading of Recommendations Assessment, Development and Evaluation Confidence in the Evidence from Reviews of Qualitative Research (GRADECERQual) methodology. Results: We included 107 studies of internal medicine clinical teaching units, of which 93 (87%) were conducted in North America. Surveys (n = 31, 29%), trials (n = 17, 16%) and narrative studies (n = 15, 14%) were the most prevalent study designs. Practices identified as contributing to improved clinical education or health care delivery included purposeful rounding (high confidence), bedside rounding (moderate confidence), resource stewardship interventions (high confidence), interprofessional rounds (moderate confidence), geographic wards (moderate confidence), allocating more trainee time to patient care or educational activities (moderate confidence), “drip” continuous models of admission (moderate confidence), limiting duty hours (moderate confidence) and limiting clinical workload (moderate confidence). Interpretation: In this review, we identified several evidence-based practices that may contribute to improved educational and health care outcomes in clinical teaching unit settings. These findings may offer guidance for policies, resource allocation and staffing of teaching hospitals.
查看更多>>摘要：After a recent lecture I delivered at a national conference of Canadian physicians, I reviewed the evaluations received from the attendees. While many commented on what they had learned from my talk on metabolic bone disease, one comment stood out, which had no bearing on the content of my presentation. One of the doctors had written, “Go back to Saudi Arabia” — a country to which I have no connection. This comment could be understood only in context of the fact that I wear a hijab (head scarf) and in this person’s mind, that meant I was not Canadian. Hidden under the cover of anonymity, this physician shared their true feelings and deep-seated hatred for people who look like me. I wonder if this physician would have had the courage to reveal their views publicly if the evaluations had not been anonymous. Even more concerning, it made me shudder to consider the type of treatment I would receive if I were a patient under their care. Their comments indicated they could not see past the scarf on my head. They could not reconcile their negative impression of Muslim women with my presence at the conference as an international expert on parathyroid disease. Nor could they even view me as a fellow human being worthy of basic respect. Through their ignorant comment, they aimed to dehumanize me, implying that I did not belong here — yet I was raised in Canada, I was trained in Canada, and I represent Canada internationally in scientific forums and global research initiatives. Unfortunately, throughout my career as a Canadian Muslim physician, I have observed that sometimes the perpetrators of Islamophobic sentiments are other health care professionals.
Sarah KhanMaysoon EldomaArfeen MalickUmberin Najeeb...
3页
查看更多>>摘要：The image of the oppressed, veiled Muslim woman has long been used to justify ongoing Western colonialism.1 In December 2021, the Letters pages of CMAJ gave voice to a familiar trope: that of the Muslim woman wearing a hijab, or Islamic headscarf, as an “oppressed” figure. Such representations align with prejudiced Orientalist discourses that classify Islam as a “barbaric” religious tradition in need of civilizing.2 This racist sentiment has been used repeatedly to justify a supposed need for Muslim women to be rescued from their cultural and religious practices by Western-European powers, with debates often centred around the hijab.3 Such discourses lie at the root of gendered Islamophobia, defined as “forms of ethno-religious and racialized discrimination levelled at Muslim women that proceed from historically and textualized negative stereotypes that inform individual and systemic forms of oppression.”1 Muslim women in health care professions in Canada face multiple forms of Islamophobia, including systemic barriers, overt discrimination and daily interpersonal macro- and microaggressions. Herein, we discuss gendered Islamophobia in medicine and solutions to address it.
查看更多>>摘要：1 Bronchiolitis has resurged since COVID-19-related physical distancing measures have been relaxedBronchiolitis is a viral lower respiratory tract infection, leading to small airway inflammation and edema, and is usually caused by respiratory syncytial virus. Before the COVID-19 pandemic, in Ontario, 2.6/100 children younger than 1 year had a visit to an emergency department for bronchiolitis. Incidence decreased during 2020 owing to masking, school closures and physical distancing measures. However, when those were relaxed, many countries experienced off-seasonal resurgence and more presentations of children older than 1 year. 2 Infants typically present with symptoms of viral respiratory infection; neonates may present with apneas or cyanosis only Most children present with low-grade fever, tachypnea, chest wall retractions and reduced oral intake, with crackles and wheeze bilaterally. Risk factors for severe bronchiolitis include cardiorespiratory, neuromuscular or immunodeficiency comorbidities; age 3 months or younger; and prematurity. Bacterial pneumonia should be considered if fever is 39°C or higher or there are unilateral chest signs on auscultation. 3 Investigations are not recommended routinely Nasopharyngeal swabs do not alter management but may be used to cohort children in hospital.1 Chest radiographs and blood tests are not indicated unless the presentation is severe (i.e., requiring intensive care) or the diagnosis is unclear. Children should be referred for possible admission if there is moderate increased work in breathing, coughing with sustained vomiting, signs of dehydration, or oxygen saturations less than 90% in room air.
NSTL
Cma-Canadian Medical Assoc