Authors:
Khenti, A; Thomas, F. C, Mohamoud, S, Diaz, P, Vaccarino, O, Dunbar, K, Sapag, J. C. Abstract: Problem addressedIn recent years, there has been increased recognition in Canada of the need to strengthen mental health services in primary health care (PHC). Collaborative models, including partnerships between PHC and specialized mental health care providers, have emerged as effective ways for improving access to mental health care and strengthening clinical capacity. Primary health care physicians and other health professionals are well positioned to facilitate the early detection of mental disorders and provide appropriate treatment and follow-up care, helping to tackle stigma toward mental health problems in the process.Objective of programThis 4-year mental health and addiction capacity-building initiative for PHC addressed competency needs at the individual, interprofessional, and organizational levels.Program descriptionThe program included 5 key components: a needs assessment; interprofessional education; mentoring; development of organizational mental health and addiction action plans for each participating community health centre; and creation of an advanced resource manual to support holistic and culturally competent collaborative mental health care. A comprehensive evaluation framework using a mixed-methods approach was applied from the initiation of the program. A total of 184 health workers in 10 community health centres in Ontario participated in the program, including physicians, nurses, social workers, and administrative staff.ConclusionEvaluation findings demonstrated high satisfaction with the training, improved competencies, and individual behavioural and organizational changes. By building capacity to integrate holistic and culturally appropriate care, this competency-based program is a promising model with strong potential to be adapted and scaled up for PHC organizations nationally and internationally. PubDate: 2017-10-12T10:43:45-07:00 Issue No:Vol. 63, No. 10 (2017)
Authors:
Gateman, D; Trojnar, M. E, Agarwal, G. Abstract: ObjectiveTo evaluate the effectiveness of an outpatient, nurse-administered warfarin anticoagulation protocol for the treatment of atrial fibrillation, and to identify clinical or biographical data that predict poor international normalized ratio control.DesignRetrospective cohort study.SettingSt Paul Family Health Network in Brantford, Ont.ParticipantsA total of 150 patients with nonvalvular atrial fibrillation.Main outcome measuresTime in therapeutic range (TTR) for each patient and for the clinic overall. The groups of patients above and below a target TTR of 60% were compared by stepwise binomial logistic regression.ResultsA time-weighted average TTR for the clinic was determined to be 58.76%, based on 183 452 patient-days taking warfarin. The regression analysis did not find a statistically significant association between TTR and any predictors. A trend indicating a 5-fold increase in the odds of inadequate anticoagulation was observed in current smokers (odds ratio of 4.71; 95% CI 0.97 to 22.93).ConclusionCompared with data from prospective randomized trials and meta-analysis, the anticoagulation protocol employed at the St Paul Family Health Network produced an average TTR near the lower end of the target threshold. Current smokers might be at greater risk of being below this target. PubDate: 2017-10-12T10:43:45-07:00 Issue No:Vol. 63, No. 10 (2017)
Authors:
Szafran, O; Woloschuk, W, Torti, J. M. I, Myhre, D. Abstract: ObjectiveTo determine family medicine graduates’ professional and personal well-being, general health status, stress levels, coping strategies, and the degree to which they felt supported or isolated in professional life; and to compare findings by sex, practice location, and location of medical school (Canadian medical graduates [CMGs] vs international medical graduates [IMGs]).DesignRetrospective, cross-sectional survey.SettingUniversity of Alberta in Edmonton and the University of Calgary in Alberta.ParticipantsA total of 651 graduates who completed one of the family medicine residency programs during 2006 to 2011.Main outcome measuresUsing a 5-point Likert scale, graduates rated their general health status, their personal and professional well-being, their level of stress, and the degree to which they felt supported or isolated in professional life. Respondents also identified important life events, their caregiving roles, and stress-coping strategies.ResultsOf 651 graduates, 307 (47.2%) responded to the survey. Personal and professional well-being and general health status were rated as very good or excellent by 72.0%, 76.6%, and 74.7% of graduates, respectively. Overall, 39.3% reported high or extremely high levels of stress, with CMGs exhibiting significantly higher stress levels than IMGs (P = .02). Stress scores were inversely related to personal and professional well-being and health status. In terms of coping strategies, a significantly greater proportion of female than male graduates reported talking to colleagues (76.5% vs 64.3%; P = .026) and seeking professional counseling (18.7% vs 6.1%; P = .002). Also, a significantly greater proportion of IMGs than CMGs (52.9% vs 32.5%; P = .003), as well as those in rural (35.8%) or urban (49.3%) practices than those in metropolitan locations (30.1%) (P = .03), turned to spiritual or religious practices for stress management. Of all respondents, 54.8% felt highly or extremely supported and 18.4% felt isolated in their professional lives.ConclusionWhile family medicine graduates are primarily healthy and have a strong sense of personal and professional well-being, many experience high levels of stress. Coping strategies generally include social contact with family, friends, or colleagues and differ by sex, whether respondents are CMGs or IMGs, and practice location. Professional isolation appears to be prevalent in both rural and urban practice locations. Physician well-being programs should include a multifaceted approach to accommodate a range of physician preferences. PubDate: 2017-10-12T10:43:45-07:00 Issue No:Vol. 63, No. 10 (2017)
Authors:
Soon, G. S; Laxer, R. M. Pages: 756 - 762 Abstract: ObjectiveTo provide an approach to recurrent fever in childhood, explain when infections, malignancies, and immunodeficiencies can be excluded, and describe the features of periodic fever and other autoinflammatory syndromes.Sources of informationPubMed was searched for relevant articles regarding the pathogenesis, clinical findings, diagnosis, prognosis, and treatment of periodic fever and autoinflammatory syndromes.Main messageFever is a common sign of illness in children and is most frequently due to infection. However, when acute and chronic infections have been excluded and when the fever pattern becomes recurrent or periodic, the expanding spectrum of autoinflammatory diseases, including periodic fever syndromes, should be considered. Familial Mediterranean fever is the most common inherited monogenic autoinflammatory syndrome, and early recognition and treatment can prevent its life-threatening complication, systemic amyloidosis. Periodic fever, aphthous stomatitis, pharyngitis, and adenitis syndrome is the most common periodic fever syndrome in childhood; however, its underlying genetic basis remains unknown.ConclusionPeriodic fever syndromes and other autoinflammatory diseases are increasingly recognized in children and adults, especially as causes of recurrent fevers. Individually they are rare, but a thorough history and physical examination can lead to their early recognition, diagnosis, and appropriate treatment. PubDate: 2017-10-12T10:43:45-07:00 Issue No:Vol. 63, No. 10 (2017)
Authors:
Sakulchit, T; Goldman, R. D. Pages: 763 - 765 Abstract: Question Among young children suffering from pneumonia, zinc deficiency has been documented in many countries. Is supplementation with zinc effective in the treatment and prevention of childhood pneumonia'Answer Several studies reported that zinc supplementation for more than 3 months was effective for preventing pneumonia in children younger than 5 years of age; however, the evidence is not sufficient to confirm its prophylactic properties if it is given for shorter periods of time. Adjunctive zinc supplementation for treatment of pneumonia has failed to show a benefit. PubDate: 2017-10-12T10:43:45-07:00 Issue No:Vol. 63, No. 10 (2017)
Authors:
Mathews, M; Kandar, R, Slade, S, Yi, Y, Beardall, S, Bourgeault, I. Pages: 776 - 783 Abstract: ObjectiveTo describe the postgraduate medical education (PGME) examination outcomes and work locations of international medical graduates (IMGs); and to identify differences between Canadians studying abroad (CSAs) and non-CSAs.DesignCohort study using data from the National IMG Database and Scott’s Medical Database.SettingCanada.ParticipantsAll IMGs who had first entered a family medicine residency program between 2005 and 2009, with the exclusion of US graduates, visa trainees, and fellowship trainees.Main outcome measuresWe examined 4 outcomes: passing the Medical Council of Canada Qualifying Examination Part 2 (MCCQE2), obtaining Certification in Family Medicine (CCFP), working in Canada within 2 years of completing PGME training, and working in Canada in 2015.ResultsOf the 876 residents in the study, 96.1% passed the MCCQE2, 78.1% obtained a specialty designation, 37.7% worked in Canada within 2 years after their PGME, and 91.2% worked in Canada in 2015. Older graduates were more likely (odds ratio [OR] = 3.45; 95% CI 1.52 to 7.69) than recent graduates were to pass the MCCQE2, and residents who participated in a skills assessment program before their PGME training were more likely (OR = 9.60; 95% CI 1.29 to 71.63) than those who had not were to pass the MCCQE2. Women were more likely (OR = 1.67; 95% CI 1.20 to 2.33) to obtain a specialty designation than men were. Recent graduates were more likely (OR = 1.36; 95% CI 1.03 to 1.79) than older graduates were to work in Canada following training. Residents who were eligible for a full licence were more likely (OR = 3.72; 95% CI 2.30 to 5.99) to work in Canada in 2015 than those who were not eligible for a full licence were.ConclusionWhile most IMGs who entered the family medicine PGME program passed the MCCQE2, 1 in 5 did not obtain Certification. Most IMG residents remain in Canada. Canadians studying abroad and non-CSA IMGs share similar examination success rates and retention rates. PubDate: 2017-10-12T10:43:45-07:00 Issue No:Vol. 63, No. 10 (2017)
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