Background: Adverse cardiovascular events are a leading cause of perioperative morbidity and mortality. The definitions of perioperative cardiovascular adverse events are heterogeneous. As part of the international Standardized Endpoints in Perioperative Medicine initiative, this study aimed to find consensus amongst clinical trialists on a set of standardised and valid cardiovascular outcomes for use in future perioperative clinical trials. Methods: We identified currently used perioperative cardiovascular outcomes by a systematic review of the anaesthesia and perioperative medicine literature (PubMed/Ovid, Embase, and Cochrane Library). We performed a three-stage Delphi consensus-gaining process that involved 55 clinician researchers worldwide. Cardiovascular outcomes were first shortlisted and the most suitable definitions determined. These cardiovascular outcomes were then assessed for validity, reliability, feasibility, and clarity. Results: We identified 18 cardiovascular outcomes. Participation in the three Delphi rounds was 100% (n¼19), 71% (n¼55), and 89% (n¼17), respectively. A final list of nine cardiovascular outcomes was elicited from the consensus: myocardial infarction, myocardial injury, cardiovascular death, non-fatal cardiac arrest, coronary revascularisation, major adverse cardiac events, pulmonary embolism, deep vein thrombosis, and atrial fibrillation. These nine cardiovascular outcomes were rated by the majority of experts as valid, reliable, feasible, and clearly defined.
The health advocate role is an essential and underappreciated component of the CanMEDs competency framework. It is tied to the concept of social accountability and its application to medical schools for preparing future physicians who will work to ensure an equitable healthcare system. Student involvement in health advocacy throughout medical school can inspire a long-term commitment to address health disparities. The Social Medicine Network (SMN) provides an online platform for medical trainees to seek opportunities to address health disparities, with the goal of bridging the gap between the social determinants of health and clinical medicine. This online platform provides a list of health advocacy related opportunities for addressing issues that impede health equity, whether through research, community engagement, or clinical care. First implemented at the University of British Columbia, the SMN has since expanded to other medical schools across Canada. At the University of Ottawa, the SMN is being used to augment didactic teachings of health advocacy and social accountability. This article reports on the development and application of the SMN as a resource for medical trainees seeking meaningful and actionable opportunities to enact their role as health advocates.
Background:Primary central nervous system lymphoma (PCNSL) is a rare malignancy with a median survival of less than 3 months, if untreated. Multimodality treatments with high‐dose methotrexate (HD‐MTX)‐based systemic therapy and/or whole brain irradiation for consolidation or salvage constitutes the most commonly used treatment approach. Due to severe treatment toxicity and aggressive course of the disease, not all patients benefit from this treatment approach.Aims:In this retrospective study, we aimed to identify various clinical parameters that predicted outcomes on survival, and response to various treatments in patients with PCNSL.Methods:Patients diagnosed with PCNSL between 2002 and 2017 were selected for analysis. Data on patient demographics, tumor characteristics and treatment were collected and analyzed for correlation with clinical outcomes. Survival curves were generated with the Kaplan‐Meier method and compared using log‐rank test. Multivariate analysis was performed where prognostic variables and patient outcome were correlated with Cox proportional hazard model.Results:A total of 82 patients were identified and selected for analysis. Median age at diagnosis was 68 years (range 30‐89 years) and median follow up was 3.7 years. The majority (86.6%) of tumors were identified as diffuse large B‐cell lymphoma on histology. Among the 82 patients, 10 (12.2%), 31 (37.8%) and 23 (28.0%) patients received systemic therapy (CT) only, radiotherapy (RT) only and systemic therapy followed by salvage radiotherapy (CRT), respectively, while 18 (22.0%) patients received supportive care (SC) only. Median time interval between diagnosis and treatment was 33 days for CT group and 63 days for RT group. Median overall survival (OS) of the entire cohort was 11.1 months (95% CI 6.1‐15.5 months), while median OS for RT, CRT and SC groups were 8.8 months (95% CI 4.5‐11.3 months), 30.1 months (95% CI 19.3‐41.0 months) and 3.3 months (95% CI 0.8‐5.8 months), respectively (median OS for CT group not reached). Multivariate analysis demonstrated that both the use of systemic therapy (hazard ratio [HR] 0.23, 95% CI 0.11‐0.49, p < 0.001) and radiotherapy (HR 0.54, 95% CI 0.32‐0.92, p = 0.022) were associated with improved survival in the total population, while age (p = 0.48) or type of tumor (p = 0.88) did not demonstrate any statistical significance. Subgroup analysis showed that systemic therapy in patients younger than 70 years of age was associated with improved OS (HR 0.13, 95% CI 0.05‐0.32, p < 0.001), whereas in elderly patient population (70 years of age or older), addition of radiotherapy was associated with improved OS (HR 0.45, 95% CI 0.21‐0.96, p = 0.039).Summary/Conclusion:Our results concur with the published literature demonstrating the survival benefit with the use of systemic therapy in younger patient population. Radiotherapy was independently associated with an improved overall survival in older patient population and therefore should be considered as palliative treatment of choice in the elderly population who may not be candidates for systemic therapy. Further prospective studies are required to validate our findings as well as optimization of radiotherapy in this population.
Primary Central Nervous system lymphoma (PCNSL) is an uncommon type of central nervous system lymphoma, most commonly presenting as hemiparesis and headache. Currently, there is a wide range of treatments for PCNSL, consisting of various permutations between chemotherapy, radiation and autologous stem cell transplant (ASCT). Although the backbone of PCNSL treatment consists of High-dose Methotrexate (HD-MTX), the role of combination versus single agent chemotherapy, combined modality (chemotherapy + radiation) versus chemotherapy or radiation alone, and the use of consolidative ASCT are contested. Surgery does not have a role in the treatment of PCNSL although stereotactic biopsies tend to help with symptomatic relief. Radiation monotherapy is generally reserved for patients with contraindications to chemotherapy or as a palliative measure. Combined chemotherapy and radiation treatment has been shown to have a great efficacy, although its increased neurotoxicity compared to chemotherapy alone is a major drawback. A growing body of research is focused on comparing the efficacy of various chemotherapeutic regimens. Currently, the MATRix regimen comprising of HD-MTX(3.5g/m2)-cytarabine/rituximab/thiotepa is widely used. The additional survival benefit of ASCT is contested although its role in the treatment of refractory or relapsed PCNSL is generally agreed upon. Finally, intrathecal HD-MTX has been shown to have added survival benefit when added to the standard therapies. Further retrospective and prospective studies are required to compare the efficacy and toxicity of various treatment options, with a focus on different chemotherapeutic agents and ASCT.
Social media platforms like Facebook are designed to facilitate online communication and networking, primarily around content posted by users. As such, these technologies are being considered as potential enhancements to traditional learning environments. However, various barriers to effective use may arise. Our research investigated the effectiveness of a students-as-partners near-peer moderation project, arising from collaboration between instructors and senior students, as a vehicle for enhancing student interaction in a Facebook group associated with a large introductory science course. The quantity and quality of sample posts and comments from Facebook groups from three successive academic years were evaluated using a rubric that considered characteristics such as civility, content accuracy, critical thinking and psychological support. Two of these groups were moderated by near-peer students while the third group was not moderated. We found improved course discussion associated with moderated groups in addition to benefits to moderators and the faculty partner. This suggests that near-peer moderation programs working in collaboration with faculty may increase student engagement in social media platforms.
Lecture has historically been a core method used for content delivery in healthcare profession education. However, lecture attendance has decreased within the recent generations of students. The current study focus was to assess the medical and nursing students’ perceptions regarding lecture attendance. To assist with this, second year medical (110/320) and nursing students (95/215) were requested to answer a 10-item survey. The results show that the top reasons why medical and nursing students attended lectures, respectively included: “lectures were mandatory” (81.8% and 68.8%), “socializing with peers” (68.2% and 30.1%), and “professor emphasized important points” (67.3% and 90.3%). While some reasons for students not attending lectures were that the lecture format was not effective (63.5% and 67.7%), students preferred to use recordings of the lectures (43.3% and 18.1%). Overall, 64.6% of medical students and 63.4% of nursing students agree that traditional lectures are an effective way of learning. Sixty two percent of medical students (62% n=68) of medical students stated that traditional lectures is their preferred method of learning compared to flipped classroom (27%), small group learning (30%), and online learning (31%). While (39%) of nursing students stated that traditional lectures is their preferred method of learning compared to flipped classroom (21.5% ), small group learning (3.2%), and online learning (7.4%). The results suggest that there is variability in students’ preferred learning style. While some prefer the face-to-face interaction with the professor, other students favour studying at their own pace. The majority of medical and nursing students think traditional lectures continue to play a major educational role.
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