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Objective: To determine how first-year medical students interested in rural family medicine in Canada differ from their peers. Method: From 2002 to 2004, first-year students (n = 2189) from 16 classes in 8 Canadian medical schools ranked intended career choices and indicated influences on their choices using Likert scales. We used t tests and [chi]2 tests to determine demographic influences and factor analysis, and we used analysis of variance to examine associated attitudes. Results: Of the 1978 surveys returned (90.3%), 1905 were used in the analysis. Rural family medicine was ranked first by 11.1%, varying from 4.7% to 20.2% among schools. Students interested in rural family medicine were more likely to have grown up rurally, graduated from a rural high school and have family in a rural location than others ([rho] < 0.001). They were more likely to be older, in a relationship, to have volunteered in a developing nation and less likely to have university-educated parents than those interested in a specialty ([rho] < 0.008). Attitudes of students choosing family medicine, rural or urban, include social orientation, preference for a varied scope of practice and less of a hospital orientation or interest in prestige, compared with students interested in specialties ([rho] < 0.001). Conclusion: Medical schools may address the rural physician shortages by considering student demographic factors and attitudes at admission. [ABSTRACT FROM AUTHOR]

Abstract Background Given the looming shortage of physicians in Canada, we wished to determine how closely the career preference of students entering Canadian medical schools was aligned with the current physician mix in Canada. Methods Career choice information was collected from a survey of 2,896 Canadian medical students upon their entry to medical school. The distribution of career choices of survey respondents was compared to the current physician speciality mix in Canada. Results We show that there is a clear mismatch between student career choice at medical school entry and the current specialty mix of physicians in Canada. This mismatch is greatest in Urban Family Medicine with far fewer students interested in this career at medical school entry compared to the current proportion of practicing physicians. There are also fewer students interested in Psychiatry than the current proportion of practicing physicians. Conclusion This mismatch between the student interest and the current proportion of practicing physicians in the various specialities in Canada is particularly disturbing in the face of the current sub-optimal distribution of physicians. If nothing is done to correct this mismatch of student interest in certain specialities, shortages and misdistributions of physicians will be further amplified. Studies such as this can give a window into the future health human resources challenges for a nation.

Background and Aims: Microbiome dysbiosis is associated with inflammatory destruction in Crohn's disease [CD]. Although gut microbiome dysbiosis is well established in CD, the oral microbiome is comparatively under-studied. This study aims to characterize the oral microbiome of CD patients with/without oral manifestations., Methods: Patients with CD were recruited with age-, gender- and race-matched controls. Potential confounders such as dental caries and periodontal condition were recorded. The oral microbiome was collected using saliva samples. Microbial DNA was extracted and sequenced using shotgun sequencing. Metagenomic taxonomic and functional profiles were generated and analysed., Results: The study recruited 41 patients with CD and 24 healthy controls. Within the CD subjects, 39.0% had oral manifestations with the majority presenting with cobblestoning and/or oral ulcers. Principal coordinate analysis demonstrated distinct oral microbiome profiles between subjects with and without CD, with four key variables responsible for overall oral microbiome variance: [1] diagnosis of CD, [2] concomitant use of steroids, [3] concomitant use of azathioprine and 4] presence of oral ulcers. Thirty-two significant differentially abundant microbial species were identified, with the majority associated with the diagnosis of CD. A predictive model based on differences in the oral microbiome found that the oral microbiome has strong discriminatory function to distinguish subjects with and without CD [AUROC 0.84]. Functional analysis found that an increased representation of microbial enzymes [n = 5] in the butyrate pathway was positively associated with the presence of oral ulcers., Conclusions: The oral microbiome can aid in the diagnosis of CD and its composition was associated with oral manifestations., (© The Author(s) 2022. Published by Oxford University Press on behalf of European Crohn’s and Colitis Organisation.)

Background: This study aims to characterize, the gut and oral microbiome in Asian subjects with Crohn's disease (CD) using whole genome shotgun sequencing, thereby allowing for strain-level comparison., Methods: A case-control study with age, sex and ethnicity matched healthy controls was conducted. CD subjects were limited to well-controlled patients without oral manifestations. Fecal and saliva samples were collected for characterization of gut and oral microbiome respectively. Microbial DNA were extracted, libraries prepared and sequenced reads profiled. Taxonomic diversity, taxonomic association, strain typing and microbial gene pathway analyses were conducted., Results: The study recruited 25 subjects with CD and 25 healthy controls. The oral microbe Streptococcus salivarius was found to be enriched and of concordant strains in the gut and oral microbiome of Crohn's disease subjects. This was more likely in CD subjects with higher Crohn's Disease Activity Index (184.3 ± 2.9 vs 67.1 ± 82.5, p = 0.012) and active disease status (Diarrhoea/abdominal pain/blood-in-stool/fever and fatigue) (p = 0.016). Gut species found to be significantly depleted in CD compared to control (Relative abundance: Median[Range]) include: Faecalibacterium prausnitzii (0.03[0.00-4.56] vs 13.69[5.32-18.71], p = 0.010), Roseburia inulinivorans (0.00[0.00-0.03] vs 0.21[0.01-0.53], p = 0.010) and Alistipes senegalensis (0.00[0.00-0.00] vs 0.00[0.00-0.02], p = 0.029). While Clostridium nexile (0.00[0.00-0.12] vs 0.00[0.00-0.00], p = 0.038) and Ruminococcus gnavus (0.43[0.02-0.33] vs 0.00[0.00-0.13], p = 0.043) were found to be enriched. C. nexile enrichment was not found in CD subjects of European descent. Microbial arginine (Linear-discriminant-analysis: 3.162, p = 0.001) and isoprene (Linear-discriminant-analysis: 3.058, p < 0.001) pathways were found at a higher relative abundance level in gut microbiome of Crohn's disease., Conclusions: There was evidence of ectopic gut colonization by oral bacteria, especially during the active phase of CD. Previously studied gut microbial differences were detected, in addition to novel associations which could have resulted from geographical/ethnic differences to subjects of European descent. Differences in microbial pathways provide possible targets for microbiome modification.

The presence of gastroesophageal varices is a major complication of portal hypertension associated with significant morbidity and mortality. 1 The Baveno VI criteria state that patients with liver stiffness measurement (LSM) <20 kPa by transient elastography (TE) and platelet count >150,000/μL can avoid screening endoscopy for high-risk varix (HRV). 2 However, because TE is not widely available, the Baveno VI criteria could not be applied in many clinical settings. As such, we aim to determine a concise clinical criterion as an alternative noninvasive tool to predict absence of HRV among patients with compensated cirrhosis to avoid screening esophagogastroduodenoscopy (EGD)., (Copyright © 2021 AGA Institute. Published by Elsevier Inc. All rights reserved.)

Objective: To examine the attributes of Canadian medical students at matriculation that predicted later practice in a rural location, with the goal of enhancing evidence-based approaches to increasing the numbers of rural family physicians., Design: Demographic, attitudinal, and career choice data were collected from medical students at matriculation. Students were followed prospectively, and these data were linked to postresidency practice location., Setting: Eight Canadian medical schools., Participants: Study participants were 15 classes of medical students entering medical school between 2002 and 2004., Main Outcome Measures: Backward stepwise logistic regression analysis was used to identify the entry characteristics that predicted postresidency practice as a rural family physician., Results: Data from 1542 students were analyzed. A strong association was found between career interest in rural family medicine at entry into medical school and postresidency rural practice as a family physician. Logistic regression analysis that did not include entry career interest found older age, being in a relationship, having completed school in a rural community, having a societal orientation, and expressing a desire for a varied scope of practice to be predictive of practising in a rural location. When entry career interest in a rural setting was included in the multivariate model, only this variable and older age predicted postresidency rural family practice., Conclusion: This study identified a number of demographic and attitudinal variables at medical school entry that predict postresidency practice in a rural setting. These results suggest multiple potential areas where the pipeline to rural family practice can be further supported in order to address the shortage of rural family physicians., (Copyright© the College of Family Physicians of Canada.)

Purpose: To examine the stability and switching patterns of student career interests over the course of medical school., Method: From 2001 through 2004, during the first two weeks of classes, a survey on career interest was distributed to first-year students in 15 classes at eight Canadian medical schools. Students indicated interest in eight broad career paths (emergency medicine, family medicine, internal medicine, obstetrics-gynecology, pediatrics, psychiatry, surgery, and "other") and ranked their top three. Following these students' residency match three to four years later, student residency career choice was linked to their career interest at medical school entry. For students whose career interests switched be-tween medical school entry and exit, switching patterns were examined in terms of careers' matching difficulty scores (MDSs)., Results: Of 1,941 eligible students, 1,542 contributed to the final analysis. Family medicine, internal medicine, and surgery had the greatest student interest at both the beginning and end of medical school. Family medicine, surgery, obstetrics-gynecology, psychiatry, and "other" careers showed a net gain of student interest during medical school with the remaining careers showing a loss of interest. The most stable careers were family medicine, surgery, and internal medicine. The least stable were pediatrics and obstetrics-gynecology. Students tended to switch between careers with similar MDSs., Conclusions: Student career choice is relatively stable with a number of careers showing approximately 50% of stability from the entrance to the exit of medical school. Students tend to switch to careers with similar MDS, but some specific switching patterns exist.

Metastatic hepatocellular carcinoma is a rare occurrence in the United States. The prognosis is poor, with a survival time of months from the time of diagnosis. This article reports a case of myelopathy that developed from metastases in a patient with no significant medical history. The patient was treated with decompressive laminectomy followed by adjuvant radiotherapy. A review of the literature demonstrated that most cases from hepatocellular carcinoma metastasizing to the spinal cord involve either the thoracic or lumbar levels and arise from the right liver lobe or both lobes. Major risk factors included positive hepatitis B virus serologies. This article also discusses current trends in management of epidural spinal cord compression. Although treatment with chemotherapy has not shown any benefit, surgical management has been shown to decrease morbidity and mortality in some patients.

Background: Student choice is an important determinant of the distribution of specialties of practising physicians in many countries. Understanding characteristics at entry into medical school that are associated with the choice of residency in family medicine can assist medical schools in admitting an appropriate mix of students to serve the health care needs of their regions., Methods: From 2002 to 2004, we collected data from students in 15 classes at 8 of 16 Canadian medical schools at entry. Surveys included questions on career choice, attitudes to practice and socio-demographic characteristics. We followed students prospectively with these data linked to their residency choice. We used multiple logistic regression analysis to identify entry characteristics that predicted a student's ultimate career choice in family medicine., Results: Of 1941 eligible students in the participating classes, 1542 (79.4%) contributed data to the final analyses. The following 11 entry variables predicted whether a student named family medicine as his or her top residency choice: being older, being engaged or in a long-term relationship, not having parents with postgraduate university education nor having family or close friends practicing medicine, having undertaken voluntary work in a developing nation, not volunteering with elderly people, desire for varied scope of practice, a societal orientation, a lower interest in research, desire for short postgraduate training, and lower preference for medical versus social problems., Interpretation: Demographic and attitudinal characteristics at entry into medical school predicted whether students chose a career in family medicine.

Introduction: Student choice is an important determinant of the specialty mix of practicing physicians in Canada. Understanding student characteristics at medical school entry that are associated with a student choosing a residency in surgery can assist surgical educators in supporting medical students interested in surgery and in serving health human resources needs., Methods: From 2002 to 2004, data was collected from entering students in 15 classes at eight of 16 Canadian medical schools. Surveys included questions on career choice, attitudes to practice, and socio-demographics. Students were followed prospectively with survey data linked to their residency choice. Multiple logistic regression analysis was used to identify entry characteristics that predicted a student's ultimate choice of a surgical career., Results: Eight entry variables predicted whether a student named surgery (including obstetrics) as their top residency choice: having surgery as their top career choice, having a relative or friend in a surgical career, having undertaken volunteer work with sports teams, an interest in narrow scope of practice, greater interest in medical the social patient problems, an interest in urgent care, and younger age were identified as predictors of a surgical career choice., Discussion: Surgical educators may wish to attend to the factors that we found that predicted students selecting a surgical residency as their top career choice at medical school exit in order to foster and support students interested in the surgical disciplines during medical school. In addition, these factors could be used to identify students interested in a surgical career at medical school entry.

Objective: To investigate what role family physicians currently play in the management of patients with nutrition-related issues and whether implementation of current nutrition counseling guidelines is feasible in primary care practices., Design: Mailed survey., Setting: Family practice offices in British Columbia., Participants: A total of 451 Canadian-trained family physicians practising in British Columbia., Main Outcome Measures: Respondents' demographic characteristics; respondents' attitudes about and perceived barriers to nutrition counseling, as well as their current practices and training in this area., Results: Among the 757 physicians surveyed, the response rate was 59.6%. Overall, respondents had positive attitudes about the role of nutrition in patient health, and most physicians (58.1%) believed that more than 60% of their patients would benefit from nutrition counseling. However, there was a considerable gap between the proportion of patients who respondents thought would benefit from nutrition counseling and the proportion of patients who received such counseling either in the family physicians' offices or through referral to dietitians. Rural physicians referred patients to dietitian services more frequently than urban physicians did (41.7% vs 21.7% made more than 20 referrals to dietitians each year). Nearly all physicians identified lack of time and compensation as the strongest barriers to providing nutrition guidance. Training was not considered to be as strong a barrier to counseling, even though 82.3% of family physicians reported their formal nutrition training in medical school to be inadequate, and only 30% of family physicians reported currently using any nutrition-related resources., Conclusion: For family physicians, successful implementation of the 2006 Canadian Clinical Practice Guidelines on the Management and Prevention of Obesity requires access to adequate training, compensation, and evidence-based interventions related to nutrition. This study highlights current nutrition counseling practices in family medicine and identifies several obstacles to integrating the current guidelines in primary care settings.

Pain is a subjective experience that is affected by physical, emotional, and psychological factors, and reliable assessment of pain can be a challenge in the pediatric population. A quality improvement project was conducted at one Canadian health care facility to examine the effectiveness of the postoperative pain management strategy for children admitted to the postanesthesia care unit (PACU). Effective control of postoperative pain involves several preventive strategies that include preoperative analgesia, appropriate use of intraoperative analgesic techniques, and identification of children at risk for significant postoperative pain. Successful implementation of these techniques requires a multidisciplinary team approach involving the patient, the PACU nurses, the anesthesia care provider, and other surgical team members.

Children requiring home mechanical ventilation (HMV) represent a select group of technology-dependent patients. We evaluated the prevalence of children using invasive HMV in Utah from 1996 to 2004. Residents of Utah, 16 years old and less ventilated via a tracheostomy between 1996 and 2004 were identified. Children ventilated in 1996 and 2004 were compared. Data including demographic information, diagnosis leading to HMV, and age at initiation were compared between the two groups. The prevalence of HMV in 1996 was 5.0/100,000 (95% CI: 4.4-8.1) and 6.3/100,000 (95% CI: 4.7-8.4) in 2004. Median age at initiation was 6.5 months (IQR: 1.3, 24.0). Sixty-one percent (n = 47) were male, 84% (n = 65) lived in an urban county, and 86% (n = 66) had public insurance. The most frequent diagnostic category was abnormal ventilatory control (n = 36, 47%), followed by chronic lung disease (n = 19, 25%), airway abnormalities (n = 12, 16%), and neuromuscular weakness (n = 10, 13%). Thirteen patients died (17%). The median length of HMV was 39 months (IQR: 15, 102). Diagnostic categories, age at initiation of HMV, and sex did not differ significantly over the 8 years. The prevalence of children requiring HMV differed very little between 1996 and 2004. Moreover, the diagnoses for which children received this therapy remained constant., (2007 Wiley-Liss, Inc.)

Background and Objectives: This study's objective was to evaluate the acceptability, effect, and use of handheld computers (also known as personal digital assistants or PDAs) as a reward for undergraduate rural community-based family medicine preceptors., Methods: All rural, undergraduate family physician teachers who accepted an undergraduate student for a 1-month placement were offered the choice between a PDA that carried medical software or a monetary payment of an equivalent value. Approximately 1 year later, different surveys were sent to both groups of preceptors to collect data on their use of PDAs and computer technology., Results: The most commonly reported reason for choosing a PDA in lieu of payment was that it provided a good opportunity to learn about PDA technology. Of those who accepted a PDA, however, 10% had not yet used it, and another 44% of recipients had difficulty in getting started using the PDA. There were more reported problems with the software than the hardware. When surveyed 1 year later, those who received a PDA and were still using it reported satisfaction with the medical software, ranging from 31% for Epocrates qid to 71% for the 5-Minute Medical Consult. More than 90% of those using their PDA 1 year later reported that they used it in clinical settings, with 68% feeling their PDA had some or a significant effect on patient care., Conclusions: Rural family physicians appeared to find PDAs an acceptable reward for teaching, based on the reported use and utility of their PDA, but many had technical difficulties. Recipients of the PDA reported using their PDA primarily in the clinical setting, with the feeling that the PDA had a positive effect on their patient care. Many users had difficulty with technical aspects of PDA use. To support PDA recipients, technical assistance should be provided.