Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC, 2014
To provide guidelines for the health care provider on the prevention, diagnosis, and clinical man... more To provide guidelines for the health care provider on the prevention, diagnosis, and clinical management of postmenopausal osteoporosis. Strategies for identifying and evaluating high-risk individuals, the use of bone mineral density (BMD) and bone turnover markers in assessing diagnosis and response to management, and recommendations regarding nutrition, physical activity, and the selection of pharmacologic therapy to prevent and manage osteoporosis. Published literature was retrieved through searches of PubMed and The Cochrane Library on August 30 and September 18, 2012, respectively. The strategy included the use of appropriate controlled vocabulary (e.g., oteoporosis, bone density, menopause) and key words (e.g., bone health, bone loss, BMD). Results were restricted to systematic reviews, practice guidelines, randomized and controlled clinical trials, and observational studies published in English or French. The search was limited to the publication years 2009 and following, and...
Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC, 2014
To provide updated guidelines for health care providers on the management of menopause in asympto... more To provide updated guidelines for health care providers on the management of menopause in asymptomatic healthy women as well as in women presenting with vasomotor or urogenital symptoms and on considerations related to cardiovascular disease, breast cancer, urogynaecology, and sexuality. Lifestyle interventions, prescription medications, and complementary and alternative therapies are presented according to their efficacy in the treatment of menopausal symptoms. Counselling and therapeutic strategies for sexuality concerns in the peri- and postmenopausal years are reviewed. Approaches to the identification and evaluation of women at high risk of osteoporosis, along with options for prevention and treatment, are presented in the companion osteoporosis guideline. Published literature was retrieved through searches of PubMed and The Cochrane Library in August and September 2012 with the use of appropriate controlled vocabulary (e.g., hormone therapy, menopause, cardiovascular diseases,...
Background: Although students' transition into medical school is a critical step in their pro... more Background: Although students' transition into medical school is a critical step in their professional journey, orientation has been relatively under-researched, particularly with regard to its intersections with schools' social missions. This paper reports on a study looking at the implicit messages of orientation to the Northern Ontario School of Medicine's undergraduate program.
To examine the relationship between objective assessment of performance and self-rated competence... more To examine the relationship between objective assessment of performance and self-rated competence immediately before and after participation in a required summative family medicine clerkship objective structured clinical examination (OSCE). Learners rated their competence (on a 7-point Likert scale) before and after an OSCE along 3 dimensions: general, specific, and professional competencies relevant to family medicine. McGill University in Montreal, Que. All 168 third-year clinical clerks completing their mandatory family medicine rotation in 2010 to 2011 were invited to participate. Self-ratings of competence and objective performance scores were compared, and were examined to determine if OSCEs could be a "corrective" tool for self-rating perceived competence (ie, if the experience of undergoing an assessment might assist learners in recalibrating their understanding of their own performance). A total of 140 (83%) of the third-year clinical clerks participated. Particip...
Elaine is a 48-year-old woman with chronic pain due to fibromyalgia and postsurgical pain, and sh... more Elaine is a 48-year-old woman with chronic pain due to fibromyalgia and postsurgical pain, and she has been prescribed opioids for this pain for a number of years. Elaine works full-time and has followed all the recommendations made by her family physician. She exercises regularly and has participated in the Chronic Pain Self-Management Program. She has been honest with her family doctor that she uses small amounts of cannabis to help her sleep, but has exhibited no concerning behaviour. However, she missed her last appointment with her doctor as a result of the sudden unexpected death of her mother, and has now run out of her medication. She presents to the emergency department asking for a refill and is scolded by the emergency physician, who gives her a few days' supply of medications and tells her to see her own physician. On her way out of the emergency department, Elaine overhears another staff member saying to the physician, "Another drug-seeking addict clogging up t...
Background and Objectives: Family physicians are positioned to provide care for transgender patie... more Background and Objectives: Family physicians are positioned to provide care for transgender patients, but few are trained in this care during residency. This study examines associations between program directors’ (PDs) perceptions/beliefs on transgender health care and inclusion of gender-affirming health care (GAH) in residency curriculum. Methods: Questions regarding current training in GAH, provision of GAH, competency in GAH delivery, barriers to GAH training, resident desire for GAH training, access to GAH curriculum, and feelings/perceptions about GAH were included in the 2020 Council of Academic Family Medicine Educational Research Alliance (CERA) Program Director Survey. Results: Challenges to including GAH in residency curriculum were inadequate numbers of transgender patients for residents to provide care (35.4%) and lack of faculty expertise in GAH for transgender patients (24.6%). PDs were more likely to include GAH into curriculum when they provided care for transgender...
Preconception health impacts perinatal outcomes, but the difficulty in engaging reproductive-aged... more Preconception health impacts perinatal outcomes, but the difficulty in engaging reproductive-aged individuals in health promotion activities is a barrier to effective implementation of preconception interventions. Since most women have more than one pregnancy and many risk factors repeat across pregnancies, the time between pregnancies—the interconception period—may be an opportune time to improve health. Our objective was to examine the feasibility and acceptability of an interconception intervention delivered by public health nurses. We conducted a pilot randomized controlled trial in three small urban and rural public health units in Ontario, Canada, in 2017–2018 among women who were ≥ 18 years of age and between 2 and 12 months postpartum after a first birth. Women randomly allocated to the intervention group received a preconception risk assessment, tailored health education, and referral for clinical follow-up as needed, while those in the control group received standard care. Primary outcomes were intervention feasibility, adherence, and acceptability. Of 66 eligible women, 61% agreed to participate and were randomized to the intervention (n = 16) or control (n = 24) groups. The follow-up rate was 78% at 1 month and 71% at 3 months. Most women (83%) were satisfied with the intervention, including the number and length of sessions and content of recommendations. Results demonstrate the potential feasibility and acceptability of an interconception intervention delivered in a public health setting. The short- and long-term impacts of the intervention on knowledge, behavior, and health should be tested in a larger sample.
Objective: Understanding the effects of benzodiazepines (BZDs) on maternal/fetal health remains i... more Objective: Understanding the effects of benzodiazepines (BZDs) on maternal/fetal health remains incomplete despite their frequent use. This article quantifies the effects of antenatal BZD exposure on delivery outcomes. Methods Data Sources: Medline, PsycINFO, CINAHL, Embase, and the Cochrane Library were searched till June 30, 2018. Study Selection: English-language cohort studies comparing antenatal BZD exposure to an unexposed group on any delivery outcome were eligible. In all, 23,909 records were screened, 56 studies were assessed, and 14 studies were included. Data Extraction: Two reviewers independently assessed quality and extracted data. Estimates were pooled using random effects meta-analysis. Sub-analyses examined several potential moderators including timing of exposure. Results: There were 9 outcomes with sufficient data for meta-analysis. Antenatal BZD exposure was significantly associated with increased risk of 6 outcomes initially: spontaneous abortion (pooled odds ra...
Pregnant immigrant women without medical insurance often receive inadequate prenatal care. They a... more Pregnant immigrant women without medical insurance often receive inadequate prenatal care. They are more likely to present late in their pregnancy for care, to receive less prenatal testing, and to receive inadequate prenatal follow-up. There is a documented association between inadequate prenatal care and poor birth outcomes, including preterm delivery and low birth weight. Caring for uninsured women causes stress for physicians and health care teams. A standardized approach to caring for uninsured pregnant women has the potential to improve access to care while providing a framework to healthcare providers that may decrease the tensions that arise within health care teams caring for these patients. We believe that giving uninsured women and the physicians who care for them a voice in constructing a system to address barriers to care is essential.
Journal of Obstetrics and Gynaecology Canada, 2012
Resume Objectif Offrir un apercu des donnees actuelles sur les questions de soins de maternite qu... more Resume Objectif Offrir un apercu des donnees actuelles sur les questions de soins de maternite qui sont pertinentes pour les populations des regions rurales. Resultats Des recherches ont ete menees dans Medline en vue d'en tirer les articles publies en anglais, entre 1995 et 2012, au sujet des soins de maternite en region rurale. Les publications et les exposes de principe pertinents issus d'organisations appropriees ont egalement ete analyses. Issues Ces donnees aideront les fournisseurs de soins obstetricaux des regions rurales a continuer d'offrir des soins de qualite aux femmes de leurs communautes.
Canadian family physician Medecin de famille canadien, 2012
She is 36 weeks pregnant. She worries that if she leaves her community now she will spend weeks w... more She is 36 weeks pregnant. She worries that if she leaves her community now she will spend weeks waiting for this second baby. She knows her husband and her aunt will take good care of the little one she leaves behind, but her daughter is too young to understand why her mother is leaving. Will her husband and family be able to join her when she welcomes her newborn? Will she be alone? She is any woman living in a community where maternity care is no longer available. Access to rural maternity care-updated Declining access to maternity care is a reality for many pregnant women living in rural areas, especially at great distances from urban or suburban centres. Owing to a recent combination of factors-concerns about safety and a scarcity of health resources-many rural maternity care centres face closure. 1 In tandem with this trend, some rural hospitals are reducing family physician privileges, including those related to maternity care. This combination of factors presents ongoing challenges to pregnant women in rural communities, their families, and their health care providers. The consequences of traveling long distances to give birth have been reflected in the experiences of individual women and also affect the ability of their physicians and health care providers to ensure safe and supported delivery. Aboriginal and Inuit mothers are frequently among those forced to travel for maternity care. They might live in low-density population regions, or in geographically remote communities, and often lack the appropriate health facilities nearby. Physicians and health care professionals who provide maternity care are aware that there are financial, psychological, and social consequences for women who must travel far from home to give birth. 2 The aboriginal and Inuit cultures in particular have a strong emphasis on family and extended support systems. 3-5 Separation from older children, partners, family, and friends at the time of birth is particularly stressful for new mothers. Additional worries about income loss and travel expenses add to her stress, as there will be costs for accommodation and food. Although the length of time away from home varies, periods of 3 to 4 weeks are not unusual; the mother might experience social and emotional isolation at the crucial time of giving birth. 2
Canadian family physician Medecin de famille canadien, 2017
OBJECTIVE To examine the relationship between objective assessment of performance and self-rated ... more OBJECTIVE To examine the relationship between objective assessment of performance and self-rated competence immediately before and after participation in a required summative family medicine clerkship objective structured clinical examination (OSCE). DESIGN Learners rated their competence (on a 7-point Likert scale) before and after an OSCE along 3 dimensions: general, specific, and professional competencies relevant to family medicine. SETTING McGill University in Montreal, Que. PARTICIPANTS All 168 third-year clinical clerks completing their mandatory family medicine rotation in 2010 to 2011 were invited to participate. MAIN OUTCOME MEASURES Self-ratings of competence and objective performance scores were compared, and were examined to determine if OSCEs could be a "corrective" tool for self-rating perceived competence (ie, if the experience of undergoing an assessment might assist learners in recalibrating their understanding of their own performance). RESULTS A total o...
Cannabis is one of the most commonly used substances in Canada with 15% of Canadians reporting us... more Cannabis is one of the most commonly used substances in Canada with 15% of Canadians reporting use in 2019. There is emerging evidence that cannabis is linked to an impact on the developing brain in utero and adverse outcomes in infants, children, and adolescents. The impact of cannabis during breastfeeding has been limited by studies with small sample sizes, follow-up limited to 1 year and the challenge of separating prenatal exposure from that during breastfeeding. In the absence of high-quality evidence, health care providers need to continue to engage women in conversation about the potential concerns related to breastfeeding and cannabis use.
Exploring the perceived environment where students are educated, as well as where they practice, ... more Exploring the perceived environment where students are educated, as well as where they practice, is particularly important for educators and practitioners working in situations of interprofessional rural and remote health. In this study, we explored the perceptions of undergraduate medical students regarding interprofessionalism across their four-year undergraduate program which focuses on rural health. A thematic content analysis of the text-data was conducted on a convenience sample of 47 student responses to essay questions across four cohorts of a four-year undergraduate medical program. The medical program has an explicit social accountability mandate for responsiveness to the needs of a rural population and thus students have multiple opportunities to experience interprofessional education and collaboration in rural contexts. Participants reported (a) blurring and flexibility of roles in a primarily positive manner, (b) participating in unstructured interprofessional learning ...
Objective: To review, through case-based learning, the screening for and treatment of cannabis us... more Objective: To review, through case-based learning, the screening for and treatment of cannabis use disorders in primary care. Harm reduction modalities as it pertains to cannabis use are also reviewed. Methods: PubMed was searched for studies on cannabis use disorders with a specific focus on screening and treatment modalities. The literature cited was reviewed for those relevant studies identified through PubMed. Results: Problematic cannabis use can be screened for with a single question. A positive screening question can lead to more intensive screening with a validated questionnaire. A high score on a validated questionnaire may lead to examination of the DSMV criteria. Withdrawal symptoms can be treated with synthetic cannabinoids. Maintenance may involve cannabinoids or other medications but the evidence is more mixed for this setting. Harm reduction techniques may be useful in those that are not interested in cutting down or in those that are willing to reduce but not stop cannabis consumption. Brief intervention may be effective in the primary care setting. There are patients who should not use cannabis. Conclusion: Primary care providers should screen for cannabis use disorders with a single question in those patients presenting with problems that could be related to substance use. More in-depth screening is triggered by a positive response. Withdrawal management, maintenance therapy and harm reduction are all within the scope of primary care providers and should be explored with the patients. If these interventions are unsuccessful, the patient can be referred to an addiction medicine specialist.
Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC, 2014
To provide guidelines for the health care provider on the prevention, diagnosis, and clinical man... more To provide guidelines for the health care provider on the prevention, diagnosis, and clinical management of postmenopausal osteoporosis. Strategies for identifying and evaluating high-risk individuals, the use of bone mineral density (BMD) and bone turnover markers in assessing diagnosis and response to management, and recommendations regarding nutrition, physical activity, and the selection of pharmacologic therapy to prevent and manage osteoporosis. Published literature was retrieved through searches of PubMed and The Cochrane Library on August 30 and September 18, 2012, respectively. The strategy included the use of appropriate controlled vocabulary (e.g., oteoporosis, bone density, menopause) and key words (e.g., bone health, bone loss, BMD). Results were restricted to systematic reviews, practice guidelines, randomized and controlled clinical trials, and observational studies published in English or French. The search was limited to the publication years 2009 and following, and...
Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC, 2014
To provide updated guidelines for health care providers on the management of menopause in asympto... more To provide updated guidelines for health care providers on the management of menopause in asymptomatic healthy women as well as in women presenting with vasomotor or urogenital symptoms and on considerations related to cardiovascular disease, breast cancer, urogynaecology, and sexuality. Lifestyle interventions, prescription medications, and complementary and alternative therapies are presented according to their efficacy in the treatment of menopausal symptoms. Counselling and therapeutic strategies for sexuality concerns in the peri- and postmenopausal years are reviewed. Approaches to the identification and evaluation of women at high risk of osteoporosis, along with options for prevention and treatment, are presented in the companion osteoporosis guideline. Published literature was retrieved through searches of PubMed and The Cochrane Library in August and September 2012 with the use of appropriate controlled vocabulary (e.g., hormone therapy, menopause, cardiovascular diseases,...
Background: Although students' transition into medical school is a critical step in their pro... more Background: Although students' transition into medical school is a critical step in their professional journey, orientation has been relatively under-researched, particularly with regard to its intersections with schools' social missions. This paper reports on a study looking at the implicit messages of orientation to the Northern Ontario School of Medicine's undergraduate program.
To examine the relationship between objective assessment of performance and self-rated competence... more To examine the relationship between objective assessment of performance and self-rated competence immediately before and after participation in a required summative family medicine clerkship objective structured clinical examination (OSCE). Learners rated their competence (on a 7-point Likert scale) before and after an OSCE along 3 dimensions: general, specific, and professional competencies relevant to family medicine. McGill University in Montreal, Que. All 168 third-year clinical clerks completing their mandatory family medicine rotation in 2010 to 2011 were invited to participate. Self-ratings of competence and objective performance scores were compared, and were examined to determine if OSCEs could be a "corrective" tool for self-rating perceived competence (ie, if the experience of undergoing an assessment might assist learners in recalibrating their understanding of their own performance). A total of 140 (83%) of the third-year clinical clerks participated. Particip...
Elaine is a 48-year-old woman with chronic pain due to fibromyalgia and postsurgical pain, and sh... more Elaine is a 48-year-old woman with chronic pain due to fibromyalgia and postsurgical pain, and she has been prescribed opioids for this pain for a number of years. Elaine works full-time and has followed all the recommendations made by her family physician. She exercises regularly and has participated in the Chronic Pain Self-Management Program. She has been honest with her family doctor that she uses small amounts of cannabis to help her sleep, but has exhibited no concerning behaviour. However, she missed her last appointment with her doctor as a result of the sudden unexpected death of her mother, and has now run out of her medication. She presents to the emergency department asking for a refill and is scolded by the emergency physician, who gives her a few days' supply of medications and tells her to see her own physician. On her way out of the emergency department, Elaine overhears another staff member saying to the physician, "Another drug-seeking addict clogging up t...
Background and Objectives: Family physicians are positioned to provide care for transgender patie... more Background and Objectives: Family physicians are positioned to provide care for transgender patients, but few are trained in this care during residency. This study examines associations between program directors’ (PDs) perceptions/beliefs on transgender health care and inclusion of gender-affirming health care (GAH) in residency curriculum. Methods: Questions regarding current training in GAH, provision of GAH, competency in GAH delivery, barriers to GAH training, resident desire for GAH training, access to GAH curriculum, and feelings/perceptions about GAH were included in the 2020 Council of Academic Family Medicine Educational Research Alliance (CERA) Program Director Survey. Results: Challenges to including GAH in residency curriculum were inadequate numbers of transgender patients for residents to provide care (35.4%) and lack of faculty expertise in GAH for transgender patients (24.6%). PDs were more likely to include GAH into curriculum when they provided care for transgender...
Preconception health impacts perinatal outcomes, but the difficulty in engaging reproductive-aged... more Preconception health impacts perinatal outcomes, but the difficulty in engaging reproductive-aged individuals in health promotion activities is a barrier to effective implementation of preconception interventions. Since most women have more than one pregnancy and many risk factors repeat across pregnancies, the time between pregnancies—the interconception period—may be an opportune time to improve health. Our objective was to examine the feasibility and acceptability of an interconception intervention delivered by public health nurses. We conducted a pilot randomized controlled trial in three small urban and rural public health units in Ontario, Canada, in 2017–2018 among women who were ≥ 18 years of age and between 2 and 12 months postpartum after a first birth. Women randomly allocated to the intervention group received a preconception risk assessment, tailored health education, and referral for clinical follow-up as needed, while those in the control group received standard care. Primary outcomes were intervention feasibility, adherence, and acceptability. Of 66 eligible women, 61% agreed to participate and were randomized to the intervention (n = 16) or control (n = 24) groups. The follow-up rate was 78% at 1 month and 71% at 3 months. Most women (83%) were satisfied with the intervention, including the number and length of sessions and content of recommendations. Results demonstrate the potential feasibility and acceptability of an interconception intervention delivered in a public health setting. The short- and long-term impacts of the intervention on knowledge, behavior, and health should be tested in a larger sample.
Objective: Understanding the effects of benzodiazepines (BZDs) on maternal/fetal health remains i... more Objective: Understanding the effects of benzodiazepines (BZDs) on maternal/fetal health remains incomplete despite their frequent use. This article quantifies the effects of antenatal BZD exposure on delivery outcomes. Methods Data Sources: Medline, PsycINFO, CINAHL, Embase, and the Cochrane Library were searched till June 30, 2018. Study Selection: English-language cohort studies comparing antenatal BZD exposure to an unexposed group on any delivery outcome were eligible. In all, 23,909 records were screened, 56 studies were assessed, and 14 studies were included. Data Extraction: Two reviewers independently assessed quality and extracted data. Estimates were pooled using random effects meta-analysis. Sub-analyses examined several potential moderators including timing of exposure. Results: There were 9 outcomes with sufficient data for meta-analysis. Antenatal BZD exposure was significantly associated with increased risk of 6 outcomes initially: spontaneous abortion (pooled odds ra...
Pregnant immigrant women without medical insurance often receive inadequate prenatal care. They a... more Pregnant immigrant women without medical insurance often receive inadequate prenatal care. They are more likely to present late in their pregnancy for care, to receive less prenatal testing, and to receive inadequate prenatal follow-up. There is a documented association between inadequate prenatal care and poor birth outcomes, including preterm delivery and low birth weight. Caring for uninsured women causes stress for physicians and health care teams. A standardized approach to caring for uninsured pregnant women has the potential to improve access to care while providing a framework to healthcare providers that may decrease the tensions that arise within health care teams caring for these patients. We believe that giving uninsured women and the physicians who care for them a voice in constructing a system to address barriers to care is essential.
Journal of Obstetrics and Gynaecology Canada, 2012
Resume Objectif Offrir un apercu des donnees actuelles sur les questions de soins de maternite qu... more Resume Objectif Offrir un apercu des donnees actuelles sur les questions de soins de maternite qui sont pertinentes pour les populations des regions rurales. Resultats Des recherches ont ete menees dans Medline en vue d'en tirer les articles publies en anglais, entre 1995 et 2012, au sujet des soins de maternite en region rurale. Les publications et les exposes de principe pertinents issus d'organisations appropriees ont egalement ete analyses. Issues Ces donnees aideront les fournisseurs de soins obstetricaux des regions rurales a continuer d'offrir des soins de qualite aux femmes de leurs communautes.
Canadian family physician Medecin de famille canadien, 2012
She is 36 weeks pregnant. She worries that if she leaves her community now she will spend weeks w... more She is 36 weeks pregnant. She worries that if she leaves her community now she will spend weeks waiting for this second baby. She knows her husband and her aunt will take good care of the little one she leaves behind, but her daughter is too young to understand why her mother is leaving. Will her husband and family be able to join her when she welcomes her newborn? Will she be alone? She is any woman living in a community where maternity care is no longer available. Access to rural maternity care-updated Declining access to maternity care is a reality for many pregnant women living in rural areas, especially at great distances from urban or suburban centres. Owing to a recent combination of factors-concerns about safety and a scarcity of health resources-many rural maternity care centres face closure. 1 In tandem with this trend, some rural hospitals are reducing family physician privileges, including those related to maternity care. This combination of factors presents ongoing challenges to pregnant women in rural communities, their families, and their health care providers. The consequences of traveling long distances to give birth have been reflected in the experiences of individual women and also affect the ability of their physicians and health care providers to ensure safe and supported delivery. Aboriginal and Inuit mothers are frequently among those forced to travel for maternity care. They might live in low-density population regions, or in geographically remote communities, and often lack the appropriate health facilities nearby. Physicians and health care professionals who provide maternity care are aware that there are financial, psychological, and social consequences for women who must travel far from home to give birth. 2 The aboriginal and Inuit cultures in particular have a strong emphasis on family and extended support systems. 3-5 Separation from older children, partners, family, and friends at the time of birth is particularly stressful for new mothers. Additional worries about income loss and travel expenses add to her stress, as there will be costs for accommodation and food. Although the length of time away from home varies, periods of 3 to 4 weeks are not unusual; the mother might experience social and emotional isolation at the crucial time of giving birth. 2
Canadian family physician Medecin de famille canadien, 2017
OBJECTIVE To examine the relationship between objective assessment of performance and self-rated ... more OBJECTIVE To examine the relationship between objective assessment of performance and self-rated competence immediately before and after participation in a required summative family medicine clerkship objective structured clinical examination (OSCE). DESIGN Learners rated their competence (on a 7-point Likert scale) before and after an OSCE along 3 dimensions: general, specific, and professional competencies relevant to family medicine. SETTING McGill University in Montreal, Que. PARTICIPANTS All 168 third-year clinical clerks completing their mandatory family medicine rotation in 2010 to 2011 were invited to participate. MAIN OUTCOME MEASURES Self-ratings of competence and objective performance scores were compared, and were examined to determine if OSCEs could be a "corrective" tool for self-rating perceived competence (ie, if the experience of undergoing an assessment might assist learners in recalibrating their understanding of their own performance). RESULTS A total o...
Cannabis is one of the most commonly used substances in Canada with 15% of Canadians reporting us... more Cannabis is one of the most commonly used substances in Canada with 15% of Canadians reporting use in 2019. There is emerging evidence that cannabis is linked to an impact on the developing brain in utero and adverse outcomes in infants, children, and adolescents. The impact of cannabis during breastfeeding has been limited by studies with small sample sizes, follow-up limited to 1 year and the challenge of separating prenatal exposure from that during breastfeeding. In the absence of high-quality evidence, health care providers need to continue to engage women in conversation about the potential concerns related to breastfeeding and cannabis use.
Exploring the perceived environment where students are educated, as well as where they practice, ... more Exploring the perceived environment where students are educated, as well as where they practice, is particularly important for educators and practitioners working in situations of interprofessional rural and remote health. In this study, we explored the perceptions of undergraduate medical students regarding interprofessionalism across their four-year undergraduate program which focuses on rural health. A thematic content analysis of the text-data was conducted on a convenience sample of 47 student responses to essay questions across four cohorts of a four-year undergraduate medical program. The medical program has an explicit social accountability mandate for responsiveness to the needs of a rural population and thus students have multiple opportunities to experience interprofessional education and collaboration in rural contexts. Participants reported (a) blurring and flexibility of roles in a primarily positive manner, (b) participating in unstructured interprofessional learning ...
Objective: To review, through case-based learning, the screening for and treatment of cannabis us... more Objective: To review, through case-based learning, the screening for and treatment of cannabis use disorders in primary care. Harm reduction modalities as it pertains to cannabis use are also reviewed. Methods: PubMed was searched for studies on cannabis use disorders with a specific focus on screening and treatment modalities. The literature cited was reviewed for those relevant studies identified through PubMed. Results: Problematic cannabis use can be screened for with a single question. A positive screening question can lead to more intensive screening with a validated questionnaire. A high score on a validated questionnaire may lead to examination of the DSMV criteria. Withdrawal symptoms can be treated with synthetic cannabinoids. Maintenance may involve cannabinoids or other medications but the evidence is more mixed for this setting. Harm reduction techniques may be useful in those that are not interested in cutting down or in those that are willing to reduce but not stop cannabis consumption. Brief intervention may be effective in the primary care setting. There are patients who should not use cannabis. Conclusion: Primary care providers should screen for cannabis use disorders with a single question in those patients presenting with problems that could be related to substance use. More in-depth screening is triggered by a positive response. Withdrawal management, maintenance therapy and harm reduction are all within the scope of primary care providers and should be explored with the patients. If these interventions are unsuccessful, the patient can be referred to an addiction medicine specialist.
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Papers by Lisa Graves