Facteurs influençant le choix du futur lieu d’exercice chez les résidents en rhumatologie

Background: There are regional disparities in the distribution of Canadian rheumatologists. The objective of this study was to identify factors impacting rheumatology residents’ postgraduate practice decisions to inform Canadian Rheumatology Association workforce recommendations. Methods: An online survey was developed, and invitations were sent to all current Canadian rheumatology residents in 2019 (n = 67). Differences between subgroups of respondents were examined using the Pearson χ2 test. Results: A total of 34 of 67 residents completed the survey. Seventy-three percent of residents planned to practice in the same province as their rheumatology training. The majority of residents (80%) ranked proximity to friends and family as the most important factor in planning. Half of participants had exposure to alternative modes of care delivery (e.g. telehealth) during their rheumatology training with fifteen completing a community rheumatology elective (44%). Conclusions: The majority of rheumatology residents report plans to practice in the same province as they trained, and close to home. Gaps in training include limited exposure to community electives in smaller centers, and training in telehealth and travelling clinics for underserviced populations. Our findings highlight the need for strategies to increase exposure of rheumatology trainees to underserved areas to help address the maldistribution of rheumatologists. Contexte : Au Canada, il existe des disparités régionales dans la répartition des rhumatologues. La présente étude recense les facteurs qui influencent les choix des résidents en rhumatologie concernant leur lieu d’exercice futur afin de guider les recommandations de Société canadienne de rhumatologie relatives aux effectifs. Méthodes : Après l’élaboration d’un sondage en ligne, une invitation a été envoyée à tous les résidents en rhumatologie au Canada en 2019 (n = 67). Les différences entre les groupes ont été examinées à l’aide du test Pearson χ2. Résultats : Trente-quatre des 67 résidents contactés ont répondu au sondage. Soixante-treize pour cent des répondants prévoyaient d’exercer dans la province où ils avaient fait leur formation en rhumatologie. La majorité des résidents (80 %) ont classé la proximité des amis et de la famille comme le facteur le plus important dans leur choix de lieu d’exercice. La moitié des participants s’étaient familiarisés avec d’autres modes de prestation de soins (par exemple, la télésanté) pendant leur formation en rhumatologie et 15 d’entre eux (44 %) avaient fait un stage en rhumatologie communautaire. Conclusions : La majorité des résidents en rhumatologie déclarent avoir l’intention d’exercer près de chez eux, dans la province où ils ont fait leurs études. Les lacunes dans la formation comportent l’exposition limitée à des stages dans les petits centres en milieu communautaire, en télésanté et dans les cliniques mobiles ciblant les populations mal desservies. Nos conclusions soulignent le besoin de stratégies visant à augmenter l’exposition des résidents en rhumatologie à des zones mal desservies afin de remédier à la mauvaise répartition géographique des rhumatologues

Ischemic preconditioning of the myocardium, role of chloride and inward-rectifier potassium channels

grantor: University of TorontoIschemic preconditioning (IP) is a cardioprotective phenomenon potentially mediated through multiple signal transduction pathways. Given the importance of chloride (Cl-) channels in cell volume regulation and the disordered cell volume regulation known to occur in ischemia/reperfusion injury, together with the need to maintain electroneutrality via an efflux of potassium ions (K+) via the inward rectifier potassium channel (IK1), I hypothesize that Cl-- and IK 1 channels are end-effectors of IP. Pharmacological preconditioning by direct activation of angiotensin II AT1 and adenosine A 1/A3 receptors and by stimulation of PKC was abolished by Cl- channel inhibition in both the isolated rabbit ventricular myocyte and buffer-perfused whole heart model. In addition, IK1 channel inhibition blocked the protection induced by IP, hypo-osmotic stress and of angiotensin AT1 receptor activation. These results support the hypothesis that CI- and IK1 channels act as end-effectors of ischemic preconditioning.M.Sc

Organizational Learning in the Morbidity and Mortality Rounds

The morbidity and mortality conference (M) is one of many organizational strategies used to address patient safety and quality of care. Organizational learning theory would suggest that learning from error in the M would be optimized by particular organizational and team cultures. The aim of this study was to describe how adverse events are reviewed in the M using an organizational learning framework. I used a qualitative, prospective, multiple Case study design for this study. I selected three Cases, which were running well-structured M All three Cases displayed double-loop learning and utilized organizational memory strategies to ensure that new knowledge stemming from their reviews was being retained within the organization. The presence of a patient safety culture was linked to the promotion of open communication, thereby fostering learning from adverse events. The M can therefore provide a context for organizational learning, allowing optimal learning from adverse events.M.Sc

A unique, interactive and web-based pediatric rheumatology teaching module: residents’ perceptions

Abstract Background The limited availability of pediatric rheumatologists for teaching in pediatric residency programs negatively impacts resident education about rheumatology. At present, there are no educational websites available for trainees to learn about pediatric rheumatology. We are planning to develop an interactive web-based teaching module to improve resident learning about rheumatology (“POINTER”: Pediatric Online INteractive TEaching in Rheumatology). The aim of this study was to perform a needs assessment of pediatric residents who will be using POINTER. Methods Pediatric residents (n = 60) at The Hospital for Sick Children were emailed an online survey. This was designed to assess prior use of online teaching modules, the utility of an online teaching module for rheumatology and which technologies should be included on such a site. Results Forty-seven residents participated in the survey (78.3% response rate). Ninety-one percent of the respondents thought that an interactive teaching website would enhance their learning and should include case-based teaching modules. Several web-based technologies were felt to be important for inclusion on the teaching modules. These included graphics and animation (86.4%), interactivity (93.2%), pictures (100%), live digital videos (88.9%) and links to articles and research (88.6%). Conclusions An interactive web-based rheumatology teaching module would be well utilized by pediatric residents. Residents showed preference for case-based teaching modules as well as multimedia modalities for learning a detailed musculoskeletal examination

A unique, interactive and web-based pediatric rheumatology teaching module: residents’ perceptions

BACKGROUND: The limited availability of pediatric rheumatologists for teaching in pediatric residency programs negatively impacts resident education about rheumatology. At present, there are no educational websites available for trainees to learn about pediatric rheumatology. We are planning to develop an interactive web-based teaching module to improve resident learning about rheumatology (“POINTER”: Pediatric Online INteractive TEaching in Rheumatology). The aim of this study was to perform a needs assessment of pediatric residents who will be using POINTER. METHODS: Pediatric residents (n = 60) at The Hospital for Sick Children were emailed an online survey. This was designed to assess prior use of online teaching modules, the utility of an online teaching module for rheumatology and which technologies should be included on such a site. RESULTS: Forty-seven residents participated in the survey (78.3% response rate). Ninety-one percent of the respondents thought that an interactive teaching website would enhance their learning and should include case-based teaching modules. Several web-based technologies were felt to be important for inclusion on the teaching modules. These included graphics and animation (86.4%), interactivity (93.2%), pictures (100%), live digital videos (88.9%) and links to articles and research (88.6%). CONCLUSIONS: An interactive web-based rheumatology teaching module would be well utilized by pediatric residents. Residents showed preference for case-based teaching modules as well as multimedia modalities for learning a detailed musculoskeletal examination

Enhanced Cell Volume Regulation: A Key Protective Mechanism of Ischemic Preconditioning in Rabbit Ventricular Myocytes

Accumulation of osmotically active metabolites, which create an osmotic gradient estimated at ∼60 mOsM, and cell swelling are prominent features of ischemic myocardial cell death. This study tests the hypothesis that reduction of ischemic swelling by enhanced cell volume regulation is a key mechanism in the delay of ischemic myocardial cell death by ischemic preconditioning (IPC). Experimental protocols address whether: (i) IPC triggers a cell volume regulation mechanism that reduces cardiomyocyte swelling during subsequent index ischemia; (ii) this reduction in ischemic cell swelling is sufficient in magnitude to account for the IPC protection; (iii) the molecular mechanism that mediates IPC also mediates cell volume regulation. Two experimental models with rabbit ventricular myocytes were studied: freshly isolated pelleted myocytes and 48-h cultured myocytes. Myocytes were preconditioned either by distinct short simulated ischemia (SI)/simulated reperfusion protocols (IPC), or by subjecting myocytes to a pharmacological preconditioning (PPC) protocol (1 μM calyculin A, or 1 μM N6-2-(4-aminophenyl)ethyladenosine (APNEA), prior to subjecting them to either different durations of long SI or 30 min hypo-osmotic stress. Cell death (percent blue square myocytes) was monitored by trypan blue staining. Cell swelling was determined by either the bromododecane cell flotation assay (qualitative) or video/confocal microscopy (quantitative). Simulated ischemia induced myocyte swelling in both the models. In pelleted myocytes, IPC or PPC with either calyculin A or APNEA produced a marked reduction of ischemic cell swelling as determined by the cell floatation assay. In cultured myocytes, IPC substantially reduced ischemic cell swelling (P \u3c 0.001). This IPC effect on ischemic cell swelling was related to an IPC and PPC (with APNEA) mediated triggering of cell volume regulatory decrease (RVD). IPC and APNEA also significantly (P \u3c 0.001) reduced hypo-osmotic cell swelling. This IPC and APNEA effect was blocked by either adenosine receptor, PKC or Cl- channel inhibition. The osmolar equivalent for IPC protection approximated 50-60 mOsM, an osmotic gradient similar to the estimated ischemic osmotic load for preconditioned and non-preconditioned myocytes. The results suggest that cell volume regulation is a key mechanism that accounts for most of the IPC protection in cardiomyocytes

Factors influencing rheumatology residents’ decision on future practice location

Background: There are regional disparities in the distribution of Canadian rheumatologists. The objective of this study was to identify factors impacting rheumatology residents’ postgraduate practice decisions to inform Canadian Rheumatology Association workforce recommendations.Methods: An online survey was developed, and invitations were sent to all current Canadian rheumatology residents in 2019 (n = 67). Differences between subgroups of respondents were examined using the Pearson χ2 test.Results: A total of 34 of 67 residents completed the survey. Seventy-three percent of residents planned to practice in the same province as their rheumatology training. The majority of residents (80%) ranked proximity to friends and family as the most important factor in planning. Half of participants had exposure to alternative modes of care delivery (e.g. telehealth) during their rheumatology training with fifteen completing a community rheumatology elective (44%).Conclusions: The majority of rheumatology residents report plans to practice in the same province as they trained, and close to home. Gaps in training include limited exposure to community electives in smaller centers, and training in telehealth and travelling clinics for underserviced populations. Our findings highlight the need for strategies to increase exposure of rheumatology trainees to underserved areas to help address the maldistribution of rheumatologists.Contexte : Au Canada, il existe des disparités régionales dans la répartition des rhumatologues. La présente étude recense les facteurs qui influencent les choix des résidents en rhumatologie concernant leur lieu d’exercice futur afin de guider les recommandations de Société canadienne de rhumatologie relatives aux effectifs.Méthodes : Après l’élaboration d’un sondage en ligne, une invitation a été envoyée à tous les résidents en rhumatologie au Canada en 2019 (n = 67). Les différences entre les groupes ont été examinées à l’aide du test Pearson χ2.Résultats : Trente-quatre des 67 résidents contactés ont répondu au sondage. Soixante-treize pour cent des répondants prévoyaient d’exercer dans la province où ils avaient fait leur formation en rhumatologie. La majorité des résidents (80 %) ont classé la proximité des amis et de la famille comme le facteur le plus important dans leur choix de lieu d’exercice. La moitié des participants s’étaient familiarisés avec d’autres modes de prestation de soins (par exemple, la télésanté) pendant leur formation en rhumatologie et 15 d’entre eux (44 %) avaient fait un stage en rhumatologie communautaire.Conclusions : La majorité des résidents en rhumatologie déclarent avoir l’intention d’exercer près de chez eux, dans la province où ils ont fait leurs études. Les lacunes dans la formation comportent l’exposition limitée à des stages dans les petits centres en milieu communautaire, en télésanté et dans les cliniques mobiles ciblant les populations mal desservies. Nos conclusions soulignent le besoin de stratégies visant à augmenter l’exposition des résidents en rhumatologie à des zones mal desservies afin de remédier à la mauvaise répartition géographique des rhumatologues