Studying with the cloud: the use of online Web-based resources to augment a traditional study group format.

Cloud-based applications such as Google Docs, Skype, Dropbox, and SugarSync are revolutionizing the way that we interact with the world. Members of the millennial generation (those born after 1980) are now becoming senior residents and junior attending physicians. We describe a novel technique combining Internet- and cloud-based methods to digitally augment the classic study group used by final-year residents studying for the Royal College of Physicians and Surgeons of Canada examination. This material was developed by residents and improved over the course of 18 months. This is an innovation report about a process for enhanced communication and collaboration as there has been little research to date regarding the augmentation of learner-driven initiatives with virtual resources.

A perioperative smoking cessation intervention with varenicline: a double-blind, randomized, placebo-controlled trial.

BACKGROUND: The efficacy of perioperative tobacco interventions on long-term abstinence and the safety of smoking cessation less than 4 weeks before surgery is unclear. Our objective was to determine the efficacy and safety of a perioperative smoking cessation intervention with varenicline to reduce smoking in elective surgical patients. METHODS: In a prospective, multicenter, double-blind, placebo-controlled trial, 286 patients were randomized to receive varenicline or placebo. Both groups received in-hospital and telephone counseling during 12 months. The primary outcome was the 7-day point prevalence abstinence rate 12 months after surgery. Secondary outcomes included abstinence at 3 and 6 months after surgery. Multivariable logistic regression was used to identify independent variables related to abstinence. RESULTS: The 7-day point prevalence abstinence at 12 months for varenicline versus placebo was 36.4% versus 25.2% (relative risk: 1.45; 95%: CI: 1.01-2.07; P = 0.04). At 3 and 6 months, the 7-day point prevalence abstinence was 43.7% versus 31.9% (relative risk: 1.37; 95% CI: 1.01 to 1.86; P = 0.04), and 35.8% versus 25.9% (relative risk: 1.43; 95%: CI 1.01-2.04; P = 0.04) for varenicline versus placebo, respectively. Treatment with varenicline (odds ratio: 1.76; 95% CI: 1.03-3.01; P = 0.04), and preoperative nicotine dependence (odds ratio: 0.82, 95% CI: 0.68 to 0.98; P = 0.03) predicted abstinence at 12 months. The adverse events profile in both groups was similar except for nausea, which occurred more frequently for varenicline versus placebo (13.3% vs. 3.7%, P = 0.004). CONCLUSIONS: A perioperative smoking cessation intervention with varenicline increased abstinence from smoking 3, 6, and 12 months after elective noncardiac surgery with no increase in serious adverse events.

Interventions in the preoperative clinic for long term smoking cessation: a quantitative systematic review.

PURPOSE: To assess the efficacy of interventions offered to patients in the preoperative clinic to promote long-term (> or = three months) smoking cessation following surgery. METHODS: We searched The Cochrane Library, MEDLINE, EMBASE and CINAHL for all randomized controlled trials (RCTs) on smoking-cessation interventions initiated in the preoperative clinic. Trial inclusion, quality assessment, and data extraction were performed independently by two authors. Standard meta-analytic techniques were applied. RESULTS: Four RCTs (n = 610 patients) were included in the review. Interventions included pharmacotherapy, counseling, educational literature and postoperative telephone follow-up. The follow-up period ranged between three to 12 months with only one RCT following up patients for > one year. Two studies used biochemical methods to validate subjects' self-reporting of smoking cessation at the follow-up assessment. Overall, the interventions were associated with a significantly higher cessation rate vs control at the three to six month follow-up period (pooled odds ratio: 1.58, 95% confidence interval (CI) 1.02-2.45, P value = 0.01, I(2) = 0%). The only trial with longer follow-up period (12 months), however, failed to show any significant difference between the intervention and control groups (odds ratio: 1.05, 95% CI 0.53-2.09, P value = 0.88). CONCLUSION: This systematic review suggests that smoking-cessation interventions initiated at the preoperative clinic can increase the odds of abstinence by up to 60% within a three- to six-month follow-up period. To evaluate the possibility of longer abstinence, future trials with at least one-year follow-up are recommended.

Knowledge, attitude and misconceptions regarding tuberculosis in Pakistani patients.

OBJECTIVE: To assess knowledge of patients with tuberculosis; about their disease and misconceptions regarding TB. METHODS: A cross sectional study was conducted at Out-patient clinics of two teaching hospitals (private and public) in Karachi, Pakistan. A questionnaire was filled for the purpose. RESULTS: A total of 170 patients were interviewed, 112 from private and 58 from a public sector hospital. Cough, fever, bloody sputum and chest pain were recognized as the common symptoms of TB. Eleven (7%) patients thought TB was not an infectious disease and 18 (10.6%) did not consider it a preventable disease. Contaminated food was considered the source of infection by 81 (47.6%) and 96 (57%) considered emotional trauma/stress the causative agent of TB. No counseling about preventing spread was received by 81 (50%) patients and 97 (57%) considered separating dishes as an important means of preventing spread. Thirty one (18%) patients would have discontinued their medications following relief of symptoms. Thirty nine (23%) of the respondents thought that TB could lead to infertility and 66 (38.8%) believed that there were reduced chances of getting married following infection. CONCLUSION: Misconceptions concerning TB are common in Pakistani patients. Lack of knowledge on Tuberculosis is alarming.