Sarita Verma

Quality of Life in Women With Urinary Tract Infections: Is Benign Disease a Misnomer?

Background: The objective of this study was to undertake an exploratory evaluation of quality-of-life indicators for women suffering from urinary tract infections. Methods: The RAND 36-Item Health Survey 1.0 (SF-36) was administered to 47 women with a diagnosed urinary tract infection who were being cared for in the Family Medicine Center, Student Health Services, or Urology Outpatient Clinic. A control population of 71 women was obtained from the female members of an undergraduate geography class, a community basketball league, and a local womens choir. Results: All subsections of the SF-36 quality-of-life indices were significantly decreased in the subject population compared with the control population (lower score indicates lower quality of life): patient general health perception (63.3 vs 78.9, P < .001) physical functioning (76.6 vs 87.6, P = .012), role limitation owing to physical health (53.8 vs 93.0, P < .001) and emotional health (67.4 vs 88.3, P < .001), vitality (43.0 vs 64.9, P < .001), emotional well-being (64.4 vs 80.2, P < .001), pain (58.7 vs 91.5, P < .001), and social functioning (60.4 vs 90.4. P < .001). Conclusion: Suffering from an urinary tract infection has a detrimental influence on patient quality of life. The effect of urinary tract infections on women and their perception of quality of life have not been hitherto reported in the medical literature. The Significant findings in this study call into question whether acute, non-life-threatening illness should be regarded as benign.

Faculty's and residents' perceptions of teaching and evaluating the role of health advocate: a study at one Canadian university.

Purpose To examine the views of faculty and residents about teaching and evaluating health advocacy, one of the more difficult CanMEDS roles to integrate into postgraduate medical education. Method In 2002, two focus groups of faculty and two of residents at Queens University, Kingston, Ontario, Canada, were asked standardized questions to elicit their answers to what was a health care advocate as understood and reported by teachers and residents, and what were the reported barriers and enhancers to teaching and evaluating the role of residents as health care advocates. Results The study found that faculty and residents knew little about how to teach and evaluate the role of the health advocate. There was consensus between the two types of groups with congruity between residents and faculty about the key issues. The one exception to this was the disconnect between the faculty members’ belief that advocacy was an aspect of their daily work and the residents’ apparent lack of awareness of this. The majority of participants were not familiar with the Royal Colleges description of the role of health advocate and were very keen to receive further guidance on teaching tools and methods of evaluation. Conclusion The authors’ hypothesis was that little is known about how to teach and evaluate the role of the health advocate. The results confirmed this and identified important areas upon which to build an educational framework. The definition of the health advocate and the expectations require clarity and direction. Academic programs would benefit from clear objectives.

Remediation of residents in difficulty: a retrospective 10-year review of the experience of a postgraduate board of examiners.

Purpose To determine, through a 10-year review, (1) the prevalence of residents in difficulty, (2) characteristics of these residents, (3) areas of residents’ weakness, and (4) outcomes of residents who undergo remediation. Method A retrospective review of resident records for the University of Toronto Faculty of Medicine’s (UT-FOM) Board of Examiners for Postgraduate Programs (BOE-PG) was done from July 1, 1999 to June 30, 2009 using predetermined data elements entered into a standardized form and analyzed for trends and significance. Outcomes for residents in difficulty were tracked through university registration systems and licensure databases. Results During 10 years, 103 UT-FOM residents were referred to the BOE-PG, representing 3% of all residents enrolled. The annual prevalence of residents referred to the BOE-PG ranged from 0.2% to 1.5%. The CanMEDS framework was used to classify areas of residents’ weaknesses and organize remediation plans. All 100 residents studied had either medical expertise (85%) or professionalism (15%) weaknesses or both. Residents had difficulties with an average of 2.6 CanMEDS Roles, with highest frequencies of Medical Expert (85%) Professional (51%), Communicator (49%), Manager (43%), and Collaborator (20%). Often, there were multiple remediation periods, with an average of six months’ duration. Usually, remediation was successful; 78% completed residency education, 17% were unsuccessful, and 5% remained in training. Conclusion Residents in difficulty have multiple areas of weakness. The CanMEDS framework is an effective approach to classifying problems and designing remediation plans. Successful completion of residency education after remediation is the most common outcome.

Comparison of Canadian medical graduates and international medical graduates in Canada: 1989-2007.

Purpose To compare Canadian medical graduates (CMGs) and international medical graduates (IMGs) who completed postgraduate medical education in Canada from 1989 to 2007 by age, gender, specialty, and practice characteristics. Method Data on all CMGs and IMGs who completed residencies or fellowships in Canada from 1989 to 2007 were extracted from the Canadian Post-M.D. Education Registry. Data from 1989–1993 and 2003–2007 were pooled for analysis. Results A total of 8,501 CMGs and 1,828 IMGs completed post-MD training at Canadian institutions between 1989 and 1993 inclusive; 7,734 CMGs and 1,879 IMGs completed such training between 2003 and 2007. From 1989–1993 to 2003–2007, the average age of CMGs increased from 29.8 to 31.1 years, and average age of IMGs increased from 36.1 to 37.0 years. From 1989–1993 to 2003–2007, the percentage of women increased from 41% (3,471/8,501) to 52% (4,016/7,734) and from 28% (509/1,828) to 42% (791/1,879) for CMGs and IMGs, respectively. The proportion of CMGs who trained in family medicine declined from 54% (4,568/8,501) to 38% (2,921/7,734) from 1989–1993 to 2003–2007. The percentage of IMGs who trained in family medicine increased from 19% (344/1,828) to 37% (699/1,879) during the same period. Conclusions IMGs tended to be older, more likely to be men, and more likely to pursue family medicine than their CMG counterparts. These differences have implications in designing future health care policy and recruiting physicians from abroad. Other countries could look at their own physician demographics using this studys methods.

Wellness Programmes: Primary-Care Medicine

The evidence suggests that there are benefits associated with wellness programmes but there are methodological limitations with the current state of studies which prohibit strong conclusions in favour of wellness programmes. Concepts of ‘holistic health’ and ‘traditional’ or ‘alternative health’ care have emerged in the past decade as challenges to conventional medical therapies. Wellness programmes may emerge as adjunctive or complementary modalities in primary care, both for the management of chronic illnesses and for the prevention of debilitating diseases. Although the scientific evidence in the form of randomised controlled trials is not conclusive, there is no doubt that a wide spectrum of ‘wellness’ activities are popular and attracting increased public interest. Further knowledge and understanding of wellness programmes, either as a whole or in their multitude of interventions, is important for primary-care physicians as these programmes may address many psychosocial and spiritual issues in patient care.

Universal Lessons for Academic Health Science Centers—Recognizing the Value of Integration

Abstract The concept of an Academic Health Science Center (AHSC)—a term equated to academic health center, but more globally applied—embraces a spectrum of relationships among universities, hospitals and, increasingly, community-based health care sites. Within this myriad of AHSCs, it is possible to identify common elements that drive successful performance and lessons learned. These lessons include the recognition that integration across disciplines and institutions facilitates innovation. The seamless flow of knowledge among research, education, and health care systems enables leading-edge research and advances in health professions education. The development of robust affiliation agreements between university and hospitals is a critical success factor. But fulfilling the potential of the AHSC falls short without leadership that values the contributions of every member of the academic collective.