Beyond residency: 'The imperative of lifelong learning in medical practice'.

The CPD landscape is rapidly evolving and may be affecting patient outcomes. This also poses challenges to healthcare professionals, some of whom are experiencing a lot of stress leading to burnout. Medical and residency training are very structured and the importance of CPD occurring in a non-structured setting to prevent professional stagnation cannot be overemphasized. The need for lifelong learning post- residency, which encompasses a much longer period until retirement, is underscored hence the need for a cultural shift. Adult learning needs emphasis and a focus on addressing individual needs is required. Reasons for physician reluctance and inertia towards CPD such as lack of time, self-sufficiency, occasional journal reading, and skepticism need ongoing exploration. Comprehensive measures, including integrated EMR designs, personal learning projects, practice updates, reward systems, physician surveys, equal weight for formal and informal CPD, and promoting a learning mindset are proposed.

Impact of an urban regional medical campus: perceptions of community stakeholders.

BACKGROUND: Regional medical campuses (RMC) have shown promise in addressing physician shortages. RMCs have been positively evaluated in rural/remote communities, however, it is unclear whether this model will be as beneficial in underserved urban areas. This study evaluated the impact of a RMC on a midsized urban city (Windsor, Ontario). We compare our results with a similar study conducted in a remote community in British Columbia (BC). METHODS: A broad array of community stakeholders representing different sectors were consulted using a semi-structured interview format replicated from the BC Northern Medical Program (NMP) study. Thematic analysis based on the resulting rich data was conducted within a grounded theory context. RESULTS: Twenty-three participants (52% male) representing healthcare, education, business, community and government/politico sectors were consulted. Their views regarding the Windsor Regional Medical Campus (WRMC) aligned around several themes: improved healthcare, enhanced community reputation, stimulated economic/community development, expanded training opportunities and an engaged community regarding the WRMC. These results were compared to the main findings of the NMP study with both similarities (e.g. increased community pride) and differences (e.g. resource concerns) discussed. CONCLUSION: Community stakeholders provided strong support for the WRMC through their perceptions of its positive impact on this urban region. These findings are consistent with similar RMC studies in rural/remote areas. Those interested in developing a RMC might benefit from considering these findings.

CONTEXTE: Les campus cliniques régionaux (CCR) se sont révélés prometteurs pour remédier à la pénurie de médecins. Les CCR ont été évalués positivement dans les collectivités rurales/éloignées, mais il n'est pas certain que ce modèle soit aussi bénéfique dans les zones urbaines mal desservies. La présente étude évalue l'impact d'un CCR dans une ville de taille moyenne (Windsor, Ontario). Nous comparons nos résultats avec ceux d'une étude similaire menée dans une collectivité éloignée en Colombie-Britannique (BC). MÉTHODE: Un large éventail de parties prenantes de la collectivité représentant différents secteurs a été consulté par le biais d'entrevues semi-structurées calquées sur celles de l'étude du BC Northern Medical Program (NMP). L'analyse thématique des riches données obtenues a été faite selon l'approche de la Grounded Theory (théorie ancrée). RÉSULTATS: Vingt-trois participants (52 % d'hommes) des secteurs de la santé, de l'éducation, des affaires, de la vie communautaire, du gouvernement ou encore du monde politique ont été consultés. Leurs opinions concernant le campus clinique régional de Windsor (WRMC) s'articulaient autour de plusieurs thèmes : l'amélioration des soins de santé, le renforcement de la réputation de la collectivité, la stimulation du développement économique et communautaire, l'élargissement des possibilités de formation et l'engagement de la communauté envers le WRMC. Les résultats ont été comparés aux principales conclusions de l'étude du NMP, en analysant aussi bien les similitudes (par exemple, fierté accrue de la collectivité) que les différences (par exemple, les préoccupations en matière de ressources). CONCLUSION: Percevant l'impact positif qu'a eu le WRMC dans la région urbaine, les acteurs de la collectivité témoignent d'un ferme appui à son égard. Ces résultats sont conformes aux études similaires portant sur des CCR dans les zones rurales/éloignées. Les résultats de l'étude seraient utiles à tous ceux qui souhaitant mettre sur pied un CCR.

The Importance of Accurately Assessing Renal Function in the Neonate and Infant.

Measuring renal function in neonates and small infants is important to ensure that drugs are safely dosed and to detect acute kidney injuries early on. Serum creatinine (Cr) remains the most widely used marker, but its shortcomings are particularly important in neonates. For example, neonatal Cr largely depends on maternal renal function for at least the first 72 h of life. Novel approaches for assessing neonatal renal function include cystatin C and beta-trace protein. Another way to assess renal function is to measure renal volume by ultrasound. Although this approach may assess neonatal nephron endowment, it is insensitive to the postnatal adaptation of renal function in term and preterm neonates. The purpose of this review is to summarize what is known about measuring renal function in term and preterm newborns, and to summarize existing knowledge gaps, including a description of steps to take to close these gaps.

Clinical, environmental, and genetic determinants of multiple sclerosis in children with acute demyelination: a prospective national cohort study.

BACKGROUND: HLA-DRB1*15 genotype, previous infection with Epstein-Barr virus, and vitamin D insufficiency are susceptibility factors for multiple sclerosis, but whether they act synergistically to increase risk is unknown. We aimed to assess the contributions of these risk factors and the effect of established precursors of multiple sclerosis, such as brain lesions on MRI and oligoclonal bands in CSF at the time of incident demyelination, on development of multiple sclerosis in children. METHODS: In our prospective national cohort study, we assessed children who presented with incident CNS demyelination to any of the 16 paediatric health-care facilities or seven regional health-care facilities in Canada. We did univariate and multivariable analyses to assess contributions of HLA-DRB1*15, Epstein-Barr virus, vitamin D status, MRI evidence of brain lesions, and CSF oligoclonal bands as determinants of multiple sclerosis. We used classification and regression tree analyses to generate a risk stratification algorithm for clinical use. FINDINGS: Between Sept 1, 2004, and June 30, 2010, we screened 332 children of whom 302 (91%) were eligible and followed-up for a median of 3·14 years (IQR 1·61-4·51). 63 (21%) children were diagnosed with multiple sclerosis after a median of 127 days (99-222). Although the risk of multiple sclerosis was increased with presence of one or more HLA-DRB1*15 alleles (hazard ratio [HR] 2·32, 95% CI 1·25-4·30), reduced serum 25-hydroxyvitamin D concentration (HR per 10 nmol/L decrease 1·11, 1·00-1·25), and previous Epstein-Barr-virus infection (HR 2·04, 0·99-4·20), no interactions between these variables were detected on multivariate analysis. Multiple sclerosis was strongly associated with baseline MRI evidence of one or more brain lesion (HR 37·9, 5·26-273·85) or CSF oligoclonal bands (6·33, 3·35-11·96), suggesting established disease. One patient diagnosed with multiple sclerosis had a normal MRI scan, and therefore sensitivity of an abnormal MRI scan for multiple sclerosis diagnosis was 98·4%. INTERPRETATION: Risk of multiple sclerosis in children can be stratified by presence of HLA-DRB1*15 alleles, remote Epstein-Barr virus infection, and low serum 25-hydroxyvitamin D concentrations. Similar to previous studies in adults, brain lesions detected on MRI and CSF oligoclonal bands in children are probable precursors to the clinical onset of multiple sclerosis. Children with a normal MRI are very likely to have a monophasic illness. FUNDING: Canadian Multiple Sclerosis Scientific Research Foundation.