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Message from the Division Director

Dear Colleagues,
 
As the COVID-19 pandemic continues, I’d like to give you an update on some activities of relevance to the Division of General Internal Medicine at the University of Toronto.

I must start by acknowledging the incredible contributions of our entire community: our faculty (including many outside of GIM) and clinical associates who have put aside everything to concentrate on patient care and to staff COVID teams, virtual consultation services, and overnight shifts; our residents, (some of whom are grappling with uncertainty over the timing of the Royal College exams), leaving their scheduled rotations and electives to provide front-line patient care where it is most needed; our medical students, who cannot be involved in patient care but are working at screening centres and providing support to healthcare workers; our leaders, who have spent countless hours working on scheduling, protocols, and other aspects of pandemic planning; and all of you who are involved in initiatives such as critical care and GIM capacity planning and modeling, community programs such as the Friendly Neighbour hotline, improving COVID care for people who are underhoused, providing virtual care to outpatients and to long-term care (LTC) facilities, coordinating care between hospitals and the community/LTC, sharing information through publications, editorials, podcasts and platforms such as healthydebate.ca and The Rounds Table, and developing innovative technologies for monitoring and communicating with hospitalized patients in isolation. It is truly impressive to see what has been accomplished in such a short time.

I also recognize that this is a time of anxiety about schedules and pandemic plans, on top of the challenges associated with school closures, physical distancing, concerns about family and uncertainty about what the coming weeks will bring. Things are changing quickly and it can be difficult to keep abreast of everything that is going on. Please be reassured that a great deal of GIM planning and coordination are happening across the city. Our division is well represented on regional and provincial groups focused on issues of importance to GIM, such as inpatient capacity and ALC/LTC transfers. The citywide GIM division heads have a working group to share information and harmonize practices for issues such as COVID teams, capacity planning, patient care protocols, and standard forms. If anyone is interested in contributing to this work, or if you have suggestions for things that should be done, please email me at moira.kapral@uhn.ca.

Throughout all of this, I have seen our division members working together to provide exceptional patient care and to support each other and those who work in healthcare alongside us. I am tremendously proud of our division, and I am confident that your commitment, collegiality and professionalism will see us through the challenging days ahead.

Sincerely,
Dr. Moira Kapral
Director, Division of GIM, University of Toronto

Awards and Announcements

Stephen Hwang Receives President's Impact Award 


Stephen Hwang has received a President's Impact Award from the University of Toronto, in recognition of his work to improve the health of people experiencing homelessness and to make social justice and health equity central to medical practice. 

Reena Pattani Appointed Director of Learner Experience


Reena Pattani has been appointed Director of Learner Experience at the Faculty of Medicine, University of Toronto. In this role she will lead approaches to optimize the learner experience, and will oversee pathways for MD and Post MD learners to report on mistreatment.

Edward Etchells Receives PARO Award 


Ed Etchells has been awarded a 2020 Award for Excellence in Clinical Teaching from the Professional Association of Residents of Ontario (PARO). 

MD Program Teaching Excellence Awards 


The following faculty have received 2018/19 Teaching Excellence Awards from the University of Toronto MD program, in recognition of obtaining teaching evaluation scores in the top 10% (list updated from previous posting):

Tarek Abdelhalim, Nadine Abdullah, Anthony Campbell, Rodrigo Cavalcanti,Caroline Chessex, Irfan Dhalla, Edward Etchells, Zachary Feilchenfeld, Shital Gandhi, Yayi Huang, Ayelet Kuper, Yuna Lee, Ariel Lefkowitz, Anant Murthy, Reena Pattani, Rupal Shah, Gillian Spiegle, Rebecca Stovel, Katina Tzanetos, Farzana Vira and Brian Wong. Congratulations!
.  

University of Toronto Iranian Student Memorial Fund 


The cast of Come From Away has collected more than $16,000 from audience members for U of T's Irianian Student Memorial Fund, which honours eight U of T community members who died in the crash of Flight 752. Details here. 

Meetings/Events

Cancelled - GIM Research Day

GIM Research Day, originally scheduled for April 30, 2020, has been cancelled due to COVID-19.

 

Perioperative Care Congress

The Perioperative Care Congress will be held Nov. 6-8, 2020 in Toronto. Details here. 

 

Journal Articles
Divisional members have published the following journal articles since the last issue of the GIM Update.


1. Beyond CLABSI and CAUTI: broadening our vision of patient safety. 

Shojania KG. BMJ Qual Saf. 2020 Feb 28. pii: bmjqs-2019-010498. doi: 10.1136/bmjqs-2019-010498. 

No abstract available.  PMID: 32111644 [PubMed - as supplied by publisher] 

 

2. Prenatal Biochemical Screening and a Woman's Long-Term Risk of Cancer: A Population-Based Cohort Study. 

Park AL, Huang T, Meschino WS, Iqbal J, Ray JG. 

JNCI Cancer Spectr. 2019 Oct 4;4(1):pkz077. doi: 10.1093/jncics/pkz077. eCollection 2020 Feb. 

PMID: 32110774 [PubMed] 

 

3. Patient-reported reasons for and predictors of noncompliance with compression stockings in a randomized trial of stockings to prevent postthrombotic syndrome. 

Dawson AJ, Akaberi A, Galanaud JP, Morrison DR, Kahn SR; SOX Trial investigators. 

Res Pract Thromb Haemost. 2019 Dec 29;4(2):269-277. doi: 10.1002/rth2.12296. eCollection 2020 Feb. 

PMID: 32110758 [PubMed - as supplied by publisher] 

  

4. Alendronate/Vitamin D for attenuating bone mineral density loss during antiretroviral initiation: a pilot randomized controlled trial. 

Tan DHS, Lee T, Raboud J, Qamar A, Cheung AM, Walmsley S. 

HIV Res Clin Pract. 2020 Feb 27:1-11. doi: 10.1080/25787489.2020.1730114.  

PMID: 32106792 [PubMed - as supplied by publisher] 

  

5. Trajectories and mental health-related predictors of perceived discrimination and stigma among homeless adults with mental illness. 

Mejia-Lancheros C, Lachaud J, O'Campo P, Wiens K, Nisenbaum R, Wang R, Hwang SW, Stergiopoulos V. 

PLoS One. 2020 Feb 27;15(2):e0229385. doi: 10.1371/journal.pone.0229385. eCollection 2020. 

PMID: 32106225 [PubMed - in process] 

  

6. Advanced analytics to improve performance: can healthcare replicate the success of professional sports? 

Mcparland A, Ackery A, Detsky AS. 

BMJ Qual Saf. 2020 Feb 25. pii: bmjqs-2019-010415. doi: 10.1136/bmjqs-2019-010415. [Epub ahead of print] Review. No abstract available.  

PMID: 32098803 [PubMed - as supplied by publisher] 

  

7. Side Effects of Proton Pump Inhibitors: What are Patients' Concerns? 

Rameau A, Andreadis K, Bayoumi A, Kaufman M, Belafsky P. 

J Voice. 2020 Feb 21. pii: S0892-1997(19)30527-2. doi: 10.1016/j.jvoice.2020.01.018. [Epub ahead of print] 

PMID: 32093923 [PubMed - as supplied by publisher]  

  

8. The Evolution of Schools of Thought in Medicine: Healthy Tensions. 

Naylor CD. 

JAMA. 2020 Feb 24. doi: 10.1001/jama.2020.0748. [Epub ahead of print] No abstract available.  

PMID: 32091537 [PubMed - as supplied by publisher] 

  

9. Feedback Frequency in Competence by Design: A Quality Improvement Initiative. 

Arnstead N, Campisi P, Takahashi SG, Hong CJ, Mok F, Noel CW, Siu J, Wong BM, Monteiro E. 

J Grad Med Educ. 2020 Feb;12(1):46-50. doi: 10.4300/JGME-D-19-00358.1. 

PMID: 32089793 [PubMed - in process] 

  

10. Beyond Experiential Learning in Project-Based Quality Improvement Education: Questioning Assumptions and Identifying Future Directions. 

Goldman J, Kuper A, Baker GR, Bulmer B, Coffey M, Jeffs L, Shea C, Whitehead C, Shojania K, Wong B. 

Acad Med. 2020 Feb 11. doi: 10.1097/ACM.0000000000003203.  

PMID: 32079957 [PubMed - as supplied by publisher] 

  

11.The Association of Residential Instability and Hospitalizations among Homeless and Vulnerably Housed Individuals: Results from a Prospective Cohort Study. 

Gadermann AM, Karim ME, Norena M, Emerson SD, Hubley AM, Russell LB, Nisenbaum R, Hwang SW, Aubry T, Palepu A. 

J Urban Health. 2020 Feb 20. doi: 10.1007/s11524-019-00406-9.  

PMID: 32078728 [PubMed - as supplied by publisher] 

  

12. The effect of tenofovir disoproxil fumarate on bone mineral density: a systematic review and meta-analysis. 

Baranek B, Wang S, Cheung AM, Mishra S, Tan DH. 

Antivir Ther. 2020 Feb 20. doi: 10.3851/IMP3346.  

PMID: 32077867 [PubMed - as supplied by publisher] 

  

13. Intraoperative Resuscitation by Specialized Trauma Nurse Clinicians Improves Adherence to Massive Transfusion Protocol. 

May LA, Harrell KN, Bell CM, Basham-Saif A, Barker DE, Maxwell RA. 

Am Surg. 2020 Jan 1;86(1):35-41. 

PMID: 32077414 [PubMed - indexed for MEDLINE]  

  

14. Clinically significant substance use and residential stability among homeless or vulnerably housed persons in Canada: a longitudinal cohort study. 

Nasmith TE, Gadermann A, Jaworsky D, Norena M, To MJ, Hwang SW, Palepu A. 

J Public Health (Oxf). 2020 Feb 19. pii: fdaa018. doi: 10.1093/pubmed/fdaa018. [Epub ahead of print] 

PMID: 32076717 [PubMed - as supplied by publisher] 

  

15. Ethnic variation in the conversion of prediabetes to diabetes among immigrant populations relative to Canadian-born residents: a population-based cohort study. 

Fazli GS, Moineddin R, Bierman AS, Booth GL. 

BMJ Open Diabetes Res Care. 2020 Feb;8(1). pii: e000907. doi: 10.1136/bmjdrc-2019-000907. 

PMID: 32071198 [PubMed - in process] Free Article  

  

16. Association Between Palliative Care and Death at Home in Adults With Heart Failure. 

Quinn KL, Hsu AT, Smith G, Stall N, Detsky AS, Kavalieratos D, Lee DS, Bell CM, Tanuseputro P. 

J Am Heart Assoc. 2020 Mar 3;9(5):e013844. doi: 10.1161/JAHA.119.013844. Epub 2020 Feb 19. 

PMID: 32070207 [PubMed - in process] F 

  

17. Deriving a Passive Surveillance Stroke Severity Indicator From Routinely Collected Administrative Data: The PaSSV Indicator. 

Yu AYX, Austin PC, Rashid M, Fang J, Porter J, Hill MD, Kapral MK. 

Circ Cardiovasc Qual Outcomes. 2020 Feb;13(2):e006269. doi: 10.1161/CIRCOUTCOMES.119.006269. Epub 2020 Feb 14. 

PMID: 32069092 [PubMed - in process] 

  

18. Pharmacological Management of Osteoporosis in Postmenopausal Women: An Endocrine Society Guideline Update. 

Shoback D, Rosen CJ, Black DM, Cheung AM, Murad MH, Eastell R. 

J Clin Endocrinol Metab. 2020 Mar 1;105(3). pii: dgaa048. doi: 10.1210/clinem/dgaa048. 

PMID: 32068863 [PubMed - in process] 

 

19. High Risk Neighbourhoods: The Effect of Neighbourhood Level Factors on Cardiac Arrest Incidence. 

Allan KS, Ray JG, Gozdyra P, Morrison LJ, Kiss A, Buick JE, Zhan CC, Dorian P; Rescu Investigators. 

Resuscitation. 2020 Feb 14. pii: S0300-9572(20)30063-0. doi: 10.1016/j.resuscitation.2020.02.002. [Epub ahead of print] 

PMID: 32068027 [PubMed - as supplied by publisher] 

  

20. Nothing soft about 'soft skills': core competencies in quality improvement and patient safety education and practice. 

Goldman J, Wong BM. 

BMJ Qual Saf. 2020 Feb 17. pii: bmjqs-2019-010512. doi: 10.1136/bmjqs-2019-010512. [Epub ahead of print] No abstract available.  

PMID: 32066572 [PubMed - as supplied by publisher] 

 

21. Identifying adverse events: reflections on an imperfect gold standard after 20 years of patient safety research. 

Shojania KG, Marang-van de Mheen PJ. 

BMJ Qual Saf. 2020 Feb 17. pii: bmjqs-2019-009731. doi: 10.1136/bmjqs-2019-009731. [Epub ahead of print] No abstract available.  

PMID: 32066571 [PubMed - as supplied by publisher] 

  

22. First imported case of 2019 novel coronavirus in Canada, presenting as mild pneumonia. 

Silverstein WK, Stroud L, Cleghorn GE, Leis JA. 

Lancet. 2020 Feb 13. pii: S0140-6736(20)30370-6. doi: 10.1016/S0140-6736(20)30370-6. [Epub ahead of print] No abstract available.  

PMID: 32061312 [PubMed - as supplied by publisher] 

  

23. Treatment of Ebola-related critical illness. 

Kiiza P, Mullin S, Teo K, Adhikari NKJ, Fowler RA. 

Intensive Care Med. 2020 Feb;46(2):285-297. doi: 10.1007/s00134-020-05949-z. Epub 2020 Feb 13. Review. 

PMID: 32055888 [PubMed - in process] 

 

24. Early experience with medical assistance in dying in Ontario, Canada: a cohort study. 

Downar J, Fowler RA, Halko R, Huyer LD, Hill AD, Gibson JL. 

CMAJ. 2020 Feb 24;192(8):E173-E181. doi: 10.1503/cmaj.200016. Epub 2020 Feb 11. 

PMID: 32051130 [PubMed - in process] 

 

25. Canada's federal government should continue to proceed with caution on MAiD policy. 

Laupacis A. 

CMAJ. 2020 Feb 24;192(8):E188-E189. doi: 10.1503/cmaj.200213. Epub 2020 Feb 11. No abstract available.  

PMID: 32051129 [PubMed - in process] 

  

26. Gestational weight gain counselling practices among different antenatal health care providers: a qualitative grounded theory study. 

Murray-Davis B, Berger H, Melamed N, Mawjee K, Syed M, Barrett J, Ray JG, Geary M, McDonald SD; for DOH-NET (Diabetes, Obesity and Hypertension in Pregnancy Research Network) and SOON (Southern Ontario Obstetrical Network) Investigators™. 

BMC Pregnancy Childbirth. 2020 Feb 12;20(1):102. doi: 10.1186/s12884-020-2791-8. 

PMID: 32050930 [PubMed - in process]  

  

27. Subomohyoid Anterior Suprascapular Block versus Interscalene Block for Arthroscopic Shoulder Surgery: A Multicenter Randomized Trial. 

Abdallah FW, Wijeysundera DN, Laupacis A, Brull R, Mocon A, Hussain N, Thorpe KE, Chan VWS. 

Anesthesiology. 2020 Jan 22. doi: 10.1097/ALN.0000000000003132. [Epub ahead of print] 

PMID: 32044802 [PubMed - as supplied by publisher] 

  

28. What is "shared" in shared decision-making? Philosophical perspectives, epistemic justice, and implications for health professions education. 

Thomas A, Kuper A, Chin-Yee B, Park M. 

J Eval Clin Pract. 2020 Feb 7. doi: 10.1111/jep.13370. [Epub ahead of print] 

PMID: 32032468 [PubMed - as supplied by publisher] 

  

29. Visceral Adipose Tissue Depth in Early Pregnancy and Gestational Diabetes Mellitus - a Cohort Study. 

Alves JG, Souza ASR, Figueiroa JN, de Araújo CAL, Guimarães A, Ray JG. 

Sci Rep. 2020 Feb 6;10(1):2032. doi: 10.1038/s41598-020-59065-5. 

PMID: 32029868 [PubMed - in process]  

  

30. De-implementing wisely: developing the evidence base to reduce low-value care. 

Grimshaw JM, Patey AM, Kirkham KR, Hall A, Dowling SK, Rodondi N, Ellen M, Kool T, van Dulmen SA, Kerr EA, Linklater S, Levinson W, Bhatia RS. 

BMJ Qual Saf. 2020 Feb 6. pii: bmjqs-2019-010060. doi: 10.1136/bmjqs-2019-010060. [Epub ahead of print] 

PMID: 32029572 [PubMed - as supplied by publisher]  

  

31. Pulmonary embolism home treatment: What GP want? 

Calais C, Mercier G, Meusy A, Le Collen L, Kahn SR, Quéré I, Galanaud JP. 

Thromb Res. 2020 Mar;187:180-185. doi: 10.1016/j.thromres.2020.01.015. Epub 2020 Jan 16. 

PMID: 32028109 [PubMed - in process] 

  

32. Challenges to Human Drivers in Increasingly Automated Vehicles. 

Hancock PA, Kajaks T, Caird JK, Chignell MH, Mizobuchi S, Burns PC, Feng J, Fernie GR, Lavallière M, Noy IY, Redelmeier DA, Vrkljan BH. 

Hum Factors. 2020 Feb 5:18720819900402. doi: 10.1177/0018720819900402. [Epub ahead of print] 

PMID: 32022583 [PubMed - as supplied by publisher] 

  

33. Sexism in medical care: "Nurse, can you get me another blanket?" 

Manzoor F, Redelmeier DA. 

CMAJ. 2020 Feb 3;192(5):E119-E120. doi: 10.1503/cmaj.191181. No abstract available.  

PMID: 32015082 [PubMed - in process]    

 

34. The mirage of universality: Canada's failure to act on social policy and health care. 

Boozary A, Laupacis A. 

CMAJ. 2020 Feb 3;192(5):E105-E106. doi: 10.1503/cmaj.200085. No abstract available.  

 

35. Understanding Patient and Hospital Level Factors Leading to Differences, and Disparities, in Critical Care. 

Nayfeh A, Fowler RA. 

Am J Respir Crit Care Med. 2020 Feb 3. doi: 10.1164/rccm.202001-0116ED. [Epub ahead of print] No abstract available.  

PMID: 32011903 [PubMed - as supplied by publisher]  

  

36. Older Adults With Cognitive and/or Physical Impairments Can Benefit From Immersive Virtual Reality Experiences: A Feasibility Study. 

Appel L, Appel E, Bogler O, Wiseman M, Cohen L, Ein N, Abrams HB, Campos JL. 

Front Med (Lausanne). 2020 Jan 15;6:329. doi: 10.3389/fmed.2019.00329. eCollection 2019. 

PMID: 32010701 [PubMed]  

Publications and Other Contributions by Internal Medicine Residents

1. First imported case of 2019 novel coronavirus in Canada, presenting as mild pneumonia. 

Silverstein WK, Stroud L, Cleghorn GE, Leis JA. 

Lancet. 2020 Feb 13. pii: S0140-6736(20)30370-6. doi: 10.1016/S0140-6736(20)30370-6. [Epub ahead of print] No abstract available.  

PMID: 32061312 [PubMed - as supplied by publisher] 

2. Advanced analytics to improve performance: can healthcare replicate the success of professional sports? 

Mcparland A, Ackery A, Detsky AS. 

BMJ Qual Saf. 2020 Feb 25. pii: bmjqs-2019-010415. doi: 10.1136/bmjqs-2019-010415. [Epub ahead of print] Review. No abstract available.  

PMID: 32098803 [PubMed - as supplied by publisher] 


3. Prognostic factors for VTE and Bleeding in Hospitalized Medical Patients: a systematic review and meta-analysis.

Darzi AJ, Karam SG, Charide R, Etxeandia Ikobaltzeta I, Cushman M, Gould MK, Mbuagbaw L, Spencer F, Spyropoulos A, Streiff MB, Woller SC, Zakai N, Germini F, Rigoni M, Agarwal A, Morsi RZ, Iorio A, Akl E, Schunemann HJ.

Blood. 2020 Feb 24. pii: blood.2019003603. doi: 10.1182/blood.2019003603. [Epub ahead of print]
 

4. Sexism in medical care: "Nurse, can you get me another blanket?" 

Manzoor F, Redelmeier DA. 

CMAJ. 2020 Feb 3;192(5):E119-E120. doi: 10.1503/cmaj.191181. No abstract available.  

PMID: 32015082 [PubMed - in process]    


5. Patient values and preferences regarding VTE disease: a systematic review to inform American Society of Hematology guidelines.
Etxeandia-Ikobaltzeta I, Zhang Y, Brundisini F, Florez ID, Wiercioch W, Nieuwlaat R, Begum H, Cuello CA, Roldan Y, Chen R, Ding C, Morgan RL, Riva JJ, Zhang Y, Charide R, Agarwal A, Balduzzi S, Morgano GP, Yepes-Nuñez JJ, Rehman Y, Neumann I, Schwab N, Baldeh T, Braun C, Rodríguez MF, Schünemann HJ.
Blood Adv. 2020;4(5):953-968.

6. Arnav Agarwal co-led an Ontario-wide OHIP for All campaign advocating for health care access for all individuals living in the province, irrespective of their immigration status. See some of the media coverage here.

 

Trainees: please email joe.graves@uhn.ca if you have items for inclusion in this section.


Copyright © 2019, Department of Medicine, University of Toronto, All rights reserved.

To submit items for inclusion in this bulletin, or to subscribe, please email Dr. Moira Kapral at Moira.Kapral@uhn.ca






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