International health experiences in postgraduate medical education: A meta-analysis of their effect on graduates' clinical practice among underserved populationsExpériences internationales de soins de santé en formation médicale post-doctorale : une méta-analyse des effets sur la pratique clinique des diplômés au sein des populations mal desservies.

BACKGROUND: International health experiences (IHEs) are popular among medical learners and provide a valuable learning experience. IHE participants have demonstrated an increased intention to care for underserved populations in the future, but what is its actual impact on practice? This study evaluates the effect of postgraduate IHE participation on the future careers of clinicians regarding their work among underserved populations. METHODS: We conducted a systematic review and meta-analysis of peer-reviewed articles comparing the populations served by physicians who had participated in an IHE with those of physicians who had not participated in an IHE. RESULTS: 764 titles were scanned, 28 articles were reviewed, with an eventual 3 studies of fair-good or good quality identified. These addressed physicians' service to domestic underserved populations, and also addressed future service in a low- or middle-income country (LMIC). Meta-analysis demonstrated a statistically-significant increase in service by IHE graduates to domestic underserved populations (OR = 2.12; CI = 95%; P = 0.03). The certainty of the evidence was low due to limitations in study design (non-randomised studies) and inconsistency in effects. CONCLUSION: Participation in an IHE may cause an increase in care for domestic underserved populations in future clinical practice, though further research from high quality randomised trials is needed to increase the certainty of the effect. Further study is needed to establish whether there is a similar effect with increased future service in a LMIC setting.

CONTEXTE: Les expériences internationales de soins de santé sont populaires auprès des étudiants en médecine et fournissent une expérience d'apprentissage enrichissante. Les participants aux expériences internationales de soins de santé démontrent une intention accrue de prodiguer des soins aux populations mal desservies dans leur future pratique,; mais quelle est l'incidence réelle sur la pratique ? Cette étude évalue l'effet de la participation des résidents aux expériences internationales de soins de santé sur leur carrière future au sein des populations mal desservies. MÉTHODES: Nous avons réalisé une revue systématique et une méta-analyse des articles évalués par des pairs comparant les populations desservies par les médecins ayant participé aux expériences internationales de soins de santé et celles desservies par des médecins n'ayant pas participé à celles-ci. RÉSULTATS: 764 titres ont été analysés et 28 articles ont été révisés pour arriver à identifier trois études de qualité passable à bonne. Ces études portaient sur les services médicaux aux populations locales mal desservies, et de la pratique future dans un pays à revenu faible ou intermédiaire. La méta-analyse a démontré une augmentation statistiquement significative des soins aux populations locales mal desservies fournis par les diplômés avant participé à des expériences internationales de soins de santé (RC = 2,12; IC = 95 %; valeur p = 0,03). Le degré de certitude des preuves était plutôt bas en raison des limites associées aux devis (études non randomisées) et des tailles d'effet inconstantes. CONCLUSIONS: La participation aux expériences internationales de soins de santé peut augmenter les soins médicaux aux populations locales mal desservies dans une future pratique clinique, mais des recherches supplémentaires à partir d'essais randomisés de haute qualité doivent être menées pour établir la certitude de l'effet. D'autres études sont nécessaires pour savoir s'il existe un effet similaire lié à l'augmentation de la pratique future dans un pays à revenu faible ou intermédiaire.

Beware the Innocent Presentation of a Spontaneous Perforated Meckel Diverticulum: A Rare Case and Review of the Literature.

Perforation of a Meckel diverticulum in a preterm neonate is very rare. To our knowledge, only 7 cases of spontaneous Meckel perforation in a preterm neonate have previously been described in the literature. The etiology is uncertain. We present the case of a 30-week preterm female twin with a spontaneous Meckel diverticulum perforation discovered on day 3 of life and review the published cases. A possible etiological explanation for this rare entity at this age group is also suggested.

Rare postoperative complication: Clostridium perfringens septic shock following elective abdominal surgery.

Postoperative infections are one of the most common complications in general surgery, and while rates have reduced with the routine administration of perioperative antibiotics, around 5% of patients undergoing a surgical procedure will develop an infective complication.1 The Gram-positive, obligate anaerobe, Clostridium perfringens, is a well-known pathogen that forms part of both the environmental and gastrointestinal flora.2 While more commonly associated with food poisoning, anaerobic cellulitis and traumatic gas gangrene, rare cases of spontaneous non-traumatic gas gangrene of abdominal viscera have also been recorded.3 Although potentially treatable with appropriate antibiotic cover, cases of C. perfringens can rapidly progress into fulminant and fatal sepsis.4 Moreover, the timing of symptom onset postoperatively can vary significantly, reports ranging from hours to days.5 6 We report a case of C. perfringens-induced septic shock following elective bowel resection.

Paralytic Ileus Secondary to Methamphetamine Abuse: A Rare Case.

Methamphetamine hydrochloride, colloquially referred to as "crystal meth," is a potent psychoactive amphetamine derivate. Methamphetamine produces stimulant effects in the user including increased energy and alertness as well as inducing intense euphoric symptoms and suppressing appetite through its dopaminergic, serotonergic, and adrenergic actions. Use of methamphetamine can adversely affect cardiovascular, neurological, and gastrointestinal physiology leading to significant morbidity. We present a rare case of paralytic ileus secondary to methamphetamine abuse which has only once before been described in the literature.

A case of hepatic, renal and duodenal penetration by a Celect inferior vena caval filter.

Inferior vena caval (IVC) filters are used as a mechanical option for the treatment of venous thromboembolism (VTE) when standard anticoagulation therapy is either contraindicated or VTE recurs despite adequate anticoagulation. Filters are not without risk, however. Reported complications include filter migration and fracture of filter components, leading to IVC rupture and penetration into pericaval tissues (notably kidney, heart, pericardium, thoracic cavity, liver, bowel and aorta). Here we describe an extreme case of multiple organ penetration by a standard Celect caval filter.

"Other" Troubles: Deconstructing Perceptions and Changing Responses to Refugees in Canada.

Canadian national identity is based on a self-image of humanitarianism and liberality governed by ethical and moral principles of social justice, universal health care and equity for all. However, recent changes to the Interim Federal Health Program (IFHP) demonstrate that the current discourse on refugee policy in Canada is built on a socially constructed image of "the refugee." Drawing on contemporary refugee literature we look at how refugees are constructed as the 'Other,' both nationally and internationally. Using the recent changes to the IFHP as a case example, we demonstrate that the construction of "the refugee" as an Other has informed the cuts to refugee care in Canada. Exposing Othering in Canadian refugee policy is necessary for providing helpful and equitable treatment to refugees in Canada.