RESUMEN

Premenstrual symptoms are experienced by most women of reproductive age, but effective therapies are limited. Carotenoids may have an attenuating effect on premenstrual symptoms; however, studies to date are equivocal. The objective of the present study was to examine the association between plasma concentrations of seven carotenoids and premenstrual symptom severity in 553 women from the Toronto Nutrigenomics and Health study. Participants provided information on fifteen common premenstrual symptoms and severities. Each participant completed a General Health and Lifestyle Questionnaire and provided a fasting blood sample from which plasma carotenoid concentrations were measured. Multinomial logistic regressions were used to determine associations between plasma carotenoid concentrations and premenstrual symptom severity. Beta-cryptoxanthin was associated with moderate/severe increased appetite for women in the highest compared to the lowest tertile (OR: 2.33; 95% CI: 1.39, 3.89). This association remained significant after adjusting for multiple comparisons. There were no observed associations between other plasma carotenoids and any premenstrual symptoms. In summary, higher concentrations of beta-cryptoxanthin were associated with an increased appetite as a premenstrual symptom, but no associations were observed for any other carotenoid and for any other symptom.

Asunto(s)

RESUMEN

There is a paucity of literature that explores whether students use clinical skills learned during medical school in practice. The study aimed to report on the most clinically relevant examination skills to focus on and increase student preparedness for clinical practice. We disseminated a 10-minute online anonymised survey to residents and physicians using an open recruitment strategy with convenience and snowball sampling. This survey sought to determine the practical use of respiratory exam skills. We conducted basic quantitative and descriptive content analysis to evaluate results.From a total of 161 respondents, 148 completed the entire survey. The majority of respondents found all 12 inspection skills to be useful in practice. Tracheal deviation was the only palpation skill found useful (68.63% useful). Auscultating for breath sounds was found to be unanimously useful, while all other percussion and auscultation skills were not found useful. In qualitative analysis, the major theme was that skills should be taught despite minimal use as they help teach disease pathophysiology, help in limited resource settings, and have usefulness in particular situations (e.g. traumas or different specialities).There is a discrepancy between the clinical skills taught to students and the ones actually used in practice. Despite this, there is still utility in teaching these skills to medical students. Rather than removing skills from the curriculum, a better avenue would be to emphasise manoeuvres that are clinically important to help guide preparation for clinical settings.

Asunto(s)

RESUMEN

Rationale: Patients with hematologic malignancies requiring mechanical ventilation have historically experienced poor outcomes.Objectives: We aimed to determine whether body composition characteristics derived from thoracic computed tomographic (CT) imaging were associated with time to liberation from mechanical ventilation.Methods: We evaluated mechanically ventilated patients with hematological malignancies admitted between 2014 and 2018. We included patients with thoracic CT imaging completed between 1 month before and 48 hours after intensive care unit (ICU) admission. We assessed the association of carinal skeletal muscle cross-sectional area (CSA), subcutaneous fat CSA, and fat index (fat/skeletal muscle ratio) with time to liberation from mechanical ventilation within 28 days. We accounted for the competing event of death within 28 days of mechanical ventilation.Results: One hundred fifty-six patients were included; the mean age was 57 years (standard deviation 14) and 39% were female. Thirty-seven percent had received a hematopoietic stem cell transplant, and the median ratio of arterial oxygen tension/pressure to fraction of inspired oxygen was 134 mm Hg (interquartile range [IQR], 92-205). Median skeletal muscle CSA was 68 cm2 (IQR, 54-88) and subcutaneous fat CSA was 38 cm2 (IQR, 27-52). Forty-two percent of patients were liberated from mechanical ventilation within 28 days and 56% died in the ICU. Subcutaneous fat CSA (subdistribution hazard ratio [sHR], 0.81; 95% confidence interval [95% CI], -0.68 to 0.97) and fat index (sHR, 0.81; 95% CI, -0.68 to 0.97) were significantly associated with longer time to liberation from mechanical ventilation. Skeletal muscle CSA was not associated with time to liberation from ventilation (sHR, 1.08; 95% CI, -0.94 to 1.23).Conclusions: Body composition measurements based on thoracic CT scans were associated with time to liberation from ventilation. These could represent novel surrogate markers of physical frailty in patients with hematologic malignancies receiving mechanical ventilation.

Asunto(s)

RESUMEN

Online clinical skills videos can supplement teaching and allow for greater flexibility when learning physical examination skills. There are currently few open access clinical skills video resources available for Canadian medical students. Stethopedia is an easy-to-use, open-access library of clinical skills teaching videos based on the Canadian medical curriculum. We created Stethopedia to increase accessibility to clinical skills resources and improve the competency and confidence of medical students performing clinical skills on examinations and clerkship rotations. Medical students would benefit from similar resources based on their school's specific curriculum in order to improve clinical skill performance.

Les vidéos disponibles en ligne sur les habiletés cliniques peuvent améliorer l'apprentissage de nouvelles compétences cliniques. Cependant, il existe très peu de ressources canadiennes gratuites qui enseignent les compétences cliniques basées sur la vidéo. Stethopedia est une bibliothèque qui est facile à utiliser et à l'accès libre avec des vidéos d'enseignement des compétences cliniques basées sur le curriculum médical canadien. Nous avons créé Stethopedia pour accroître l'accessibilité aux ressources de compétences cliniques et améliorer la compétence et la confiance des étudiants en médecine qui exécutent des compétences cliniques pendant leurs examens et l'externat. Les étudiants en médecine bénéficieraient de ressources similaires basées sur le programme spécifique de leur école afin d'améliorer leurs compétences cliniques.