Health Effects of Electronic Cigarettes

ABSTRACT: The use of electronic cigarettes (e-cigarettes) is rapidly growing. Recent surveys demonstrate particularly high uptake among young never-smokers and a possible association with increased uptake of combustible cigarette smoking. E-cigarettes may be associated with increased risk of cardiovascular disease, including myocardial infarction, stroke, coronary artery disease, hypertension, and elevated heart rate. However, there is a paucity of long-term clinical data to show the cardiovascular disease implications of these changes. With regard to pulmonary disease, e-cigarettes appear to be strongly implicated in the recent outbreak of acute e-cigarette, or vaping, product use–associated lung injury. The relationship between e-cigarettes and chronic pulmonary disease is less clear, though possible associations with obstructive spirometric changes, chronic obstructive pulmonary disease, asthma, and chronic cough have been demonstrated. Nonetheless, the literature suggests that e-cigarettes are likely less harmful to the cardiovascular and respiratory systems than combustible cigarettes, and emerging evidence suggests that e-cigarettes can be an effective smoking cessation aid for smokers who are motivated to quit.

Quality Improvement and Patient Safety (QIPS)

Providing training in quality improvement and patient safety (QIPS) is an important consideration for all of our residency programs. This has been fortified by its specific inclusion in the new accreditation standards. PGME’s aim is to provide a foundational QIPS curriculum to supplement what already exists and for the curriculum to be integrated into each residency program as needed.

Residents

You can access the Intro to PS Primer and QI Project Guide through the Quality Improvement and Patient Safety community in Entrada. To access the community, follow the two steps outlined below:

Step One: Log into Entrada using CWL

Step Two: Copy and paste the following link: https://entrada.med.ubc.ca/community/qips into the address bar. Press Enter on your keyboard.

For visual step-by-step instructions, click here.
Please Note: Entrada is not mobile friendly.

Learn more here.

Monkeypox Declared a Global Emergency

“Over the weekend, the World Health Organization (WHO) declared that the monkeypox outbreak spreading globally is a ‘public health emergency of international concern’ (PHEIC). Researchers hope that the declaration — the agency’s highest alarm — might serve as a wake-up call for countries as they struggle to contain the spread of the virus that causes monkeypox.

Since the first cases were detected outside Africa in May, more than 16,500 people have been confirmed infected in nearly 80 countries that don’t typically see cases. Monkeypox has been circulating in parts of Africa for decades.

This is the seventh time since the alarm system originated in 2005 that the WHO has declared a PHEIC — a step it reserves for events that pose a risk to multiple countries, and that require a coordinated international response (see ‘The highest alarm’). Two of those warnings, for COVID-19 and polio, are still in place.”

More on Monkeypox declared a global emergency: will it help contain the outbreak? via Nature.

Patient Perceptions of Quality of Care through Telemedicine

“Telemedicine can be broadly defined as the use of electronic information and telecommunications technologies to facilitate health care services, with a common form being virtual care. Prior to the COVID-19 pandemic, telemedicine was used primarily to bridge the gap for rural or remote locations where there is lack of transport, mobility, or funding. While there has been increasing patient demand for telemedicine, many barriers existed with regard to governance of compensation mechanisms, licensure restrictions, and technology infrastructure across health care platforms and facilities. At the start of the COVID-19 pandemic, the use of telemedicine was expanded due to the necessity to limit vectors of disease spread. Primary care has been significantly impacted by this change. In-person visits have been limited to those deemed necessary, and telemedicine has been widely used as a tool to provide patient care while maintaining social distancing. Throughout this rapid period of change, there has been limited literature on patient perceptions of their quality of care with the widespread use of telemedicine. In this study, we aimed to identify the proportion of patients who received telemedicine versus in-person appointments during the pandemic, and the number who required in-person follow-up after a phone consultation. In addition, we aimed to identify patient perceptions of their health care experience via telemedicine versus an in-person appointment. With this information, in conjunction with current technological capabilities of health care delivery, we aim to inform the projected need for telemedicine and identify potential areas of improvement during and beyond the COVID-19 pandemic. From a policy and technology perspective, we believe this information could help improve the delivery of health care, both locally and remotely, thereby improving access to primary care across Canada.”

Learn more on Evaluating patient perceptions of quality of care through telemedicine during the COVID-19 pandemic via BCMJ.

Refugee Health Care: Ukraine

KEY POINTS

  • Canada has launched a 3-year temporary visa pathway to shelter nationals fleeing from Ukraine, which may allow for more rapid approval and integration than regular refugee pathways, but may also leave gaps in access to essential medications and social and refugee protection services.
  • Clinical considerations for practitioners caring for people fleeing conflict in Ukraine include screening for noncommunicable and infectious diseases, anticipating mental health conditions and offering available vaccinations as needed.
  • Key gaps in the health system in Canada include lack of universal access to interpreters and lack of supports for coordination of care across health services; addressing these will require a multistakeholder approach and multisectoral partnerships.
  • Health care providers and civil society should take a trauma-and violence-informed care approach when engaging with people fleeing the war in Ukraine.

The war in Ukraine has driven global counts of displaced people and refugees to an all-time high, with numbers expected to continue to increase as a result of global instability and the impacts of climate change. As of May 25, 2022, 8 million people were internally displaced from Ukraine and more than 6.6 million had fled the country. Most have entered neighbouring Eastern European countries, but Western European countries, the United States and Canada have also accepted people fleeing from Ukraine. Canada has granted 112,035 temporary visas for Ukrainians; 241,620 people have applied; and as of May 18, 2022, 32,201 had arrived. Refugees fleeing traumatic situations face socioeconomic stressors and barriers to services after arrival and are more likely to transition to poor health than other immigrants, but this can be mitigated by supportive resettlement services. Although Canada has a long history of welcoming and integrating refugee groups and other humanitarian migrants, the concurrent arrival of Ukranians displaced by the war and refugees from Afghanistan into health systems strained by COVID-19 requires an examination of current refugee health practices and programs and demands creative solutions. We outline clinical considerations for health providers caring for people displaced by the war in Ukraine, based on available evidence and guidance, and discuss how Canada can strengthen its measures to provide health care to currently arriving refugees and prepare for future refugee waves.

The war in Ukraine and refugee health care: considerations for health care providers in Canada via CMAJ.

New Clinic Brings Cancer Care to Nunavut

“When Ellen King’s husband Eliyah was diagnosed with pancreatic cancer in 2020, it was just the start of a long health journey — one that would require the couple to travel far from home to Ottawa frequently and for long periods.

That’s because there are few oncologists — cancer specialists — who work in the North. The first time King and her husband travelled for Eliyah’s treatments, they left in December, and they didn’t return home until May.

‘It’s horrible, cause we have to leave our family, we have to leave our friends and worst of all we have to leave our fur baby — and the dog is Eliyah’s shadow and they do everything together,’ King said.

Starting this week, the couple’s stress over cancer treatments might lift at least a little — for the first time ever in Nunavut, an oncologist team will be offering follow-up care to some cancer patients at the Qikiqtani General Hospital in Iqaluit, in the territory’s first specialty cancer clinic.”

More on ‘It’s just better being at home’: New clinic brings cancer care to Nunavut via CBC.

Diabetes in Canada

Diabetes Canada’s Recommendations to the Government of Canada
1. Implement a nationwide diabetes framework based on Diabetes 360°, aimed at achieving measurable improvements in diabetes outcomes and reducing its burden on Canadians and the health-care system.

2. Ensure fairness in access to the Disability Tax Credit and Registered Disability Savings Plan for Canadians living with type 1 diabetes.

3. Adopt a nationwide approach to reduce out-of-pocket costs for people living with diabetes and facilitate their achievement of better health outcomes while maintaining or improving access to evidence-based therapy.

4. Take a leadership role in implementing decision support tools for diabetes management by incorporating electronic medical records into health systems within federal jurisdiction and support provinces/territories to do the same.

More on Diabetes Canada: The Backgrounder via Diabetes Canada.

Curriculum & Assessment/Evaluation Resources

Greetings Residents!

Here are a series of resources that we will reference during tomorrow’s presentations on Curriculum and Assessment/Evaluation.

Curriculum
+ Domains of Care & Core Activities: Core Learning Outcomes via UBC (May 2020)
+ Residency Training Profile for Family Medicine and Enhanced Skills Programs Leading to Certificates of Added Competence via CFPC (May 2021)
+ CanMEDS-Family Medicine Indigenous Health Supplement via CFPC
+ UBC Family Medicine Curriculum Learning Outcomes & Repository

Assessment & Evaluation
We invite each of you to check out the newly updated Assessment and Evaluation section of the program website. It just went up today! A big thank you goes out to our former Assessment and Evaluation Portfolio Director Dr. Theresa van der Goes who worked very hard to revise the website content. As with every first iteration, feedback is welcome. Please email me if you have any issues.

The following sections have been added or updated: 
1. Resident Assessment
2. Field Notes
3. In-Training Assessment Report Process
4. Periodic Review
5. Benchmarks (Assessment Objectives for 2021 to 2022 Cohort and Assessment Objectives for 2022 to 2024 Cohort
6. Video Review
7. Decisions on Progress and Advancement
8. Resident in Difficulty

Best,
Jacqueline