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Volesky, K. D; Villeneuve, P. J. Abstract: ObjectiveTo examine participation in screening mammography among women aged 40 to 74 and identify which factors are associated with those women who participate in screening.DesignSecondary analysis of the cross-sectional 2012 Canadian Community Health Survey.SettingCanada.ParticipantsA population-based national sample of 18 312 women aged 40 to 74.Main outcome measuresWomen’s participation in screening mammography in the 2 years preceding the 2012 Canadian Community Health Survey; women’s preventive health activities (ie, having a regular doctor, a recent physical checkup, and a Papanicolaou test), which were adjusted for sociodemographic factors.ResultsParticipation in recent screening mammography was highest among women aged 60 to 69 (70.3%), followed by those aged 50 to 59 (63.4%) and those aged 70 to 74 (58.4%). Almost one-third (31.4%) of women aged 40 to 49 had had a screening mammogram in the past 2 years. Having a regular doctor (odds ratio [OR] = 3.30, 95% CI 2.90 to 3.73), a physical checkup in the past year (OR = 3.06, 95% CI 2.30 to 4.08), or a Pap test in the past 3 years (OR = 3.47, 95% CI 3.18 to 3.79) more than tripled the odds that women had had a recent screening mammogram.ConclusionAside from age being a factor associated with women’s participation in screening mammography, factors related to women’s health care use (having a regular doctor, a recent physical checkup, and a recent Pap test) demonstrated a stronger association with women aged 40 to 74 having had recent mammograms. The association between women’s participation in screening and their preventive health activities implies that the doctor’s office is an appropriate venue for conversations regarding the potential benefits and harms of screening mammography. PubDate: 2017-06-14T14:32:57-07:00 Issue No:Vol. 63, No. 6 (2017)
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Nair, R; Kachan, P. Abstract: ObjectiveTo critically review and evaluate the psychometric properties and practical considerations of administering generic and diabetes-specific quality-of-life (QoL) tools in the clinical environment and provide recommendations.Data sources and tool selectionA MEDLINE search was carried out from January 1950 to August 2015 using the MeSH terms diabetes, quality of life, and questionnaires. Four generic and 4 diabetes-specific tools were selected based on the frequency of their use and the existence of published evidence of strong psychometric properties in patients with diabetes (either type 1 or 2). The generic tools included the Short Form-36 (SF-36), Short Form-12 (SF-12), Sickness Impact Profile, and EuroQol EQ-5D instruments. Diabetes-specific tools included the Audit of Diabetes-Dependent Quality of Life, Diabetes Quality of Life, Appraisal of Diabetes Scale (ADS), and Diabetes Health Profile instruments.SynthesisThe SF-36 is one of the most widely used general health measures in QoL research and it has proven reliability and validity. However, the SF-12 is a better option for a family practice owing to its shorter length. The SF-12 has been shown to be closely correlated with the SF-36. Of the diabetes-specific measures, the ADS is known be valid, short, and relatively straightforward in terms of scoring, thereby increasing its usefulness in routine clinical practice. The Audit of Diabetes-Dependent Quality of Life and Diabetes Quality of Life tools have been widely tested and have generally been found to be more valid and reliable than the ADS, but specific issues with feasibility make them unappealing for the clinical setting. The rationale was to find the most rigorously tested instrument within the scientific literature in terms of validity, reliability, and responsiveness. However, this was not done, as judging the quality of a measure is not simply a matter of determining its psychometric properties but rather requires qualitative judgment about the entirety of the evidence.ConclusionFinding ideal tools and procedures for routine data collection in the clinic setting requires organization and groundwork that will eventually assist both clinicians and researchers by providing reliable information on QoL for patients with diabetes. Further research is necessary to assess the validity and responsiveness of these tools specifically relating to evaluation of QoL for those with diabetes. PubDate: 2017-06-14T14:32:57-07:00 Issue No:Vol. 63, No. 6 (2017)
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Landry, A; Docherty, P, Ouellette, S, Cartier, L. J. Abstract: ObjectiveTo characterize the causes of marked elevation of C-reactive protein (CRP) levels, investigate patient outcomes, and examine factors that might influence the CRP response.DesignHealth records were used to retrospectively determine patient characteristics, diagnoses, and outcomes over a 2-year period (2012 to 2013).SettingA large referral centre in Moncton, NB.ParticipantsAdult inpatients and outpatients with a CRP level above 100 mg/L.Main outcome measuresDifferences among the CRP distributions of various diagnosis categories were examined using Kruskal-Wallis tests, and factors affecting outcomes were examined using Fisher exact tests.ResultsOver the 2-year period, 1260 CRP levels (839 patients; 3.1% of all tests) were above 100 mg/L (range 100.1 to 576.0 mg/L). The mean age was 63 years (range 18 to 101) and 50.2% of patients were men. Infection was the most prevalent cause (55.1%), followed by rheumatologic diseases (7.5%), multiple causes (5.6%), other inflammatory conditions (5.4%), malignancy (5.1%), drug reactions (1.7%), and other conditions (2.0%). A diagnosis could not be established in 17.6% of cases. On average, infections caused higher peak CRP levels (W = 34 519, P < .001) and infection was present in 88.9% of cases with CRP levels greater than 350 mg/L. Rheumatologic causes were associated with only 5.6% of CRP levels above 250 mg/L. The overall mortality was 8.6% and was higher in patients with malignancy (37.0%), multiple diagnoses (21.0%), and leukopenia (20.7%, P = .002).ConclusionMost patients had infections and the proportion of patients with infections increased with the level of CRP, although many diagnoses were associated with markedly elevated CRP levels. These data could help guide health care professionals in the evaluation and management of these patients. PubDate: 2017-06-14T14:32:57-07:00 Issue No:Vol. 63, No. 6 (2017)
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Mau, E. E; Leonard, M. P. Pages: 432 - 435 Abstract: ObjectiveTo review the differences between normal, retractile, ectopic, ascended, and undescended testes and to describe the optimal way to perform a testicular examination to distinguish one from the other, as well as to demonstrate that ultrasound imaging is not necessary and to clarify when to consider specialist referral.Sources of informationThis paper is based on selected findings from a MEDLINE search on undescended testes and orchiopexy referrals, and on our experience at the Urology Clinic at the Children’s Hospital of Eastern Ontario in Ottawa, including review of referrals to our clinic for undescended testes and the resultant findings of normal variants versus surgical cases. The MeSH headings used in our MEDLINE search included undescended testicle, retractile testicle, ectopic testicle, ascended testicle, referral and consultation, and orchiopexy.Main messageAn undescended testis is defined as the true absence of one testis (or both testes) from normal scrotal position. Ectopic and ascended testes will likewise be absent from the scrotum, the latter having been present at one point in development. Differentiating among testicular examination findings is important, as descended and retractile testes are managed conservatively, while prompt surgical intervention should be offered for ascended, ectopic, and undescended testes. Uncertainty surrounding the diagnosis of an undescended testis causes anxiety, might lead to unwarranted imaging, and might increase the wait list for specialty assessment. For this reason, avoidance of ultrasound in the evaluation of undescended testes was included in the recent Choosing Wisely Canada campaign. We seek to clarify the physical examination findings in the evaluation of possible undescended testes, the suggested referral parameters, and the subsequent management.ConclusionUndescended testes and their variants are common. As decision for referral is based on the primary care physician’s physical examination findings, we clarify distinguishing between normal and abnormal findings on testicular examination to aid in appropriate referral for subspecialist evaluation. Consultation, if needed, should be sought at 6 months’ corrected gestational age, or at detection if later than 6 months, without delay for ultrasound imaging, as surgical management is recommended for those patients with undescended, ectopic, or ascended testes. PubDate: 2017-06-14T14:32:57-07:00 Issue No:Vol. 63, No. 6 (2017)
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Arya, N; Gibson, C, Ponka, D, Haq, C, Hansel, S, Dahlman, B, Rouleau, K. Pages: 436 - 441 Abstract: ObjectiveTo demonstrate how family medicine has been recognized and integrated into primary health care systems in contrasting contexts around the world and to provide an overview of how family physicians are trained and certified.Composition of the committeeSince 2012, the College of Family Physicians of Canada has hosted the Besrour Conferences to reflect on its role in advancing the discipline of family medicine globally. The Besrour Papers Working Group, which was struck at the 2013 conference, was tasked with developing a series of papers to highlight the key issues, lessons learned, and outcomes emerging from the various activities of the Besrour collaboration. The working group comprised members of various academic departments of family medicine in Canada and abroad who attended the conferences.MethodsAn initial search was conducted in PubMed using a family medicine hedge of MeSH terms, text words, and family medicine journals, combined with text words and terms representing low- and middle-income countries and the concept of family medicine training programs. A second search was completed using only family medicine terms in the CAB Direct and World Bank databases. Subsequent PubMed searches were conducted to identify articles about specific conditions or services based on suggestions from the authors of the articles selected from the second search. Additional articles were identified through reference lists of key articles and through Google searches. We then attempted to verify and augment the information through colleagues and partners.ReportThe scope of family medicine and the nature of family medicine training vary considerably worldwide. Challenges include limited capacity, incomplete understanding of roles, and variability of standards and recognition. Opportunities for advancement might include technology, collaboration, changes in pedagogy, flexible training methods, and system-wide support. PubDate: 2017-06-14T14:32:57-07:00 Issue No:Vol. 63, No. 6 (2017)
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Sakulchit, T; Ladish, C, Goldman, R. D. Pages: 446 - 448 Abstract: Question As autism spectrum disorder (ASD) is a multifactorial condition, with genetic and environmental risk factors contributing to children’s unique presentation and symptom severity, a range of treatments have been suggested. Parents of children with ASD in my clinic are asking me about alternative therapies to improve their children’s condition. One of those therapies is hyperbaric oxygen therapy (HBOT); commercial advertisement in the past has suggested good results with this approach. Should I recommend the use of HBOT for children with ASD'Answer Hyperbaric oxygen therapy provides a higher concentration of oxygen delivered in a chamber or tube containing higher than sea level atmospheric pressure. Case series and randomized controlled trials show no evidence to support the benefit of HBOT for children with ASD. Only 1 randomized controlled trial reported effectiveness of this treatment, and those results have yet to be repeated. PubDate: 2017-06-14T14:32:57-07:00 Issue No:Vol. 63, No. 6 (2017)
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Mann, A; Tator, C. H, Carson, J. D. Pages: 460 - 466 Abstract: ObjectiveTo assess the knowledge of, attitudes toward, and learning needs for concussion diagnosis and management among family medicine residents.DesignE-mail survey.SettingUniversity of Toronto in Ontario.ParticipantsFamily medicine residents (N = 348).Main outcome measuresTo describe relationships between awareness of concussion management and lifestyle, education background, and residency placement, t tests and 2 tests were used as appropriate. Linear regression was used to compare self-reported concussion knowledge with knowledge scores. Thematic analysis was used to interpret answers to the qualitative question asking residents to describe challenges they foresee physicians facing when diagnosing and managing concussion.ResultsThe residents who responded (n = 73, response rate 21%) correctly answered an average of 5.2 questions out of 9 (58%) regarding the diagnosis and management of concussion. Postgraduate year, sex, personal history of concussion, and clinical exposure to concussion were not significant factors in predicting the number of correct answers. Several misconceptions and knowledge gaps were revealed. Of residents who responded, 71% did not recognize chronic traumatic encephalopathy and only 63% recognized second-impact syndrome as consequences of repetitive concussions. Moreover, 32% of residents did not think that every individual with a concussion should see a physician as part of management. Knowledge scores did not predict self-reported concussion knowledge. Thematic analysis revealed 4 themes related to the challenges of concussion diagnosis and management: the nonspecificity and vagueness of symptoms, lack of formal diagnostic criteria, patient compliance with management, and counseling patients with respect to return to play, work, or learning.ConclusionWe found substantial gaps in knowledge surrounding concussion diagnosis and management among family medicine residents. This lack of knowledge should be addressed at both the undergraduate medical education level and the residency training level to improve concussion-related care and patient outcomes. PubDate: 2017-06-14T14:32:57-07:00 Issue No:Vol. 63, No. 6 (2017)
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