Author: UBC Abbotsford-Mission Family Practice Residency Program

“At the start of last summer, my 13-year-old daughter Martha was busy with life. She’d meet her friends in the park, make silly videos on her phone and play “kiss, marry, kill”. Her days were filled with books and memorising song lyrics. She’d wonder aloud if she might become an author, an engineer or a film director. Her future was brimming with promise, crowded with plans.

By the end of the summer she was dead, after shocking mistakes were made at one of the UK’s leading hospitals.

What follows is an account of how Martha was allowed to die, but also what happens when you have blind faith in doctors – and learn too late what you should have known to save your child’s life. What I learned, I now want everyone to know. In a small way, I hope Martha’s story might change how some people think about healthcare; it might even save a life.

I am a fierce supporter of the principles of the NHS and realise how many excellent doctors are practising today. There’s no need for the usual political arguments: as the hospital in question has confirmed to me, what happened to Martha had nothing to do with insufficient resources or overstretched doctors and nurses; it had nothing to do with austerity or cuts, or a health service under strain.

No matter how many times I’m told that ‘it was the doctors’ job to look after Martha’, I know, deep down, that had I acted differently, she’d still be living, and my life would not now be broken. It’s not that I think I’m to blame: the hospital has admitted breach of duty of care and talked of a ‘catastrophic error’. But if I’d been more aware of how hospitals work and how some doctors behave, my daughter would be with me now.

As another bereaved parent told me, life after the death of your child is like being on an island, separate from the mainland where the ‘normal people’ live. You so badly want to go back there but you never can. You’re stuck on the island for ever.”

Learn more on ‘We had such trust, we feel such fools’: how shocking hospital mistakes led to our daughter’s death via The Guardian.

“We provide support for 36 Community Action Teams across BC to reduce overdose deaths with the CAT Knowledge Exchange initiative, which recently included a session on how to implement safer supply projects.

For International Overdose Awareness Day, explore resources that can help your community save lives.”

Learn more on the CAT Knowledge Exchange, Safer Supply Project Session (Part 1 & Part 2) via BC Patient Safety & Quality Council.

Artificial intelligence (AI) in medicine can potentially create workplace efficiencies and aid in clinical decision making. To guide AI applications safely, clinicians need some understanding of AI. Numerous commentaries advocate for AI concepts to be taught, such as interpreting AI models and validation processes. However, few structured programs have been implemented, especially on national scales. Pinto Dos Santos et al. surveyed 263 medical students and 71% agreed they needed AI training. Teaching AI to medical audiences requires nuanced design to balance technical and non-technical concepts for learners who typically have a broad range of prior knowledge. We describe our experiences delivering an AI workshop series to three cohorts of medical students and make recommendations for future AI medical education based on this.

Learn more on Insights from teaching artificial intelligence to medical students in Canada via Communications Medicine.

“Academic coaching requires an inquiry-based approach to framing questions that will lead learners to their own conclusions. It complements advising, which answers specific questions, and mentoring, which is longitudinal and relational. Coaches see the learner as expert, and they assist with planning, achieving goals, and remaining accountable. Coaching can support academic performance, wellness, professionalism, leadership development, or skills training and does not require subject expertise. Notably, in skills coaching, coaching may look more directive than described above. All 3 roles—coach, advisor, and mentor—entail developing a trusted relationship designed to support the learner; however, coaches spend more time probing and listening than telling and answering, as depicted above.”

Introduction

Patient ownership is an important element of physicians’ professional responsibility, but important gaps remain in our understanding of this concept. We sought to develop a theory of patient ownership by studying it in continuity clinics from the perspective of residents, attending physicians, and patients.

Methods

Using constructivist grounded theory, we conducted 27 semi-structured interviews of attending physicians, residents, and patient families within two pediatric continuity clinics to examine definitions, expectations, and experiences of patient ownership from March–August 2019. We constructed themes using constant comparative analysis and developed a theory describing patient ownership that takes into account a diversity of perspectives.

Results

Patient ownership was described as a bi-directional, relational commitment between patient/family and physician that includes affective and behavioral components. The experience of patient ownership was promoted by continuity of care and constrained by logistical and other systems-based factors. The physician was seen as part of a medical care team that included clinic staff and patient families. Physicians adjusted expectations surrounding patient ownership for residents based on scheduling limitations.

Discussion

Our theory of patient ownership portrays the patient/family as an active participant in the patient–physician relationship, rather than a passive recipient of care. While specific expectations and tasks will vary based on the practice setting, our findings reframe the way in which patient ownership can be viewed and studied in the future by attending to a diversity of perspectives.

Learn more on “It is you, me on the team together, and my child”: Attending, resident, and patient family perspectives on patient ownership via Perspectives on Medical Education.

“Could masks help prevent the spread of monkeypox?

PHAC is recommending healthcare settings adopt precautions against airborne, droplet, and contact transmission until more information is available.

The federal government is also generally encouraging “good hand hygiene and respiratory etiquette,” including wearing a mask or covering coughs, along with limiting sexual partners and practising safer sex.

Other public health authorities have emphasized avoiding close physical contact without much reference to spraying droplets or inhaling aerosols.

The United States Centers for Disease Control and Prevention initially warned travellers to wear face masks to prevent the spread of monkeypox but later dropped the recommendation, noting it “caused confusion.”

Now, the agency only suggests masks for those in close contact with infected people.

‘For people out and about, or travelling, the individual risk of having any contact with somebody with monkeypox remains incredibly low,’ Hugh Adler of the Respiratory Infections Group at the Liverpool School of Tropical Medicine told Reuters.”

Read more on Is monkeypox airborne? via CMAJ.

“Earlier this year, physicians in the United Kingdom raised alarm over an apparent surge in cases of unexplained severe acute hepatitis in children.

By late June, the U.K. reported 258 cases, 12 of which required liver transplants, up from about 20 in a normal year.

As of mid-July, 35 countries reported more than 1000 probable cases, including 22 deaths, with most cases occurring in Europe.

Canada has reported 23 cases so far, two of which required liver transplants. An expert told CMAJ that’s roughly the number you would expect to see given the size of Canada’s population.

It’s not unusual for the causes of severe liver inflammation in children to be unknown – by some estimates, up to half of such cases are unexplained. And it’s still unclear whether the numbers reported globally reflect a true uptick in unexplained cases versus increased attention to the issue.”

More on Emerging clues to unexplained pediatric hepatitis via CMAJ.

Thanks to a recent decision by Health Canada, children in British Columbia over the age of six months are now eligible for COVID-19 vaccinations. And a recent study by UBC researchers reveals some surprising attitudes about child vaccination from parents who remain unvaccinated.

Dr. Ran Goldman, professor of pediatrics at UBC, answers some questions for parents looking for more information before vaccinating their children.

What did your new study find?

In collaboration with 21 hospitals across four countries including Canada, we interviewed 4,500 parents and caregivers—19 per cent were unvaccinated, but among the unvaccinated, seven per cent still said they planned to vaccinate their kids. While that may seem like a small percentage, it proves that even some parents who do not get vaccinated understand the vaccine’s importance for children.

Some parents are worried about side-effects—should they be?

Any vaccine will have some side effects, not just COVID vaccines. But many studies have shown that most side effects, including soreness or redness where the shot was given, are mild. And that the risks associated with COVID far outweigh any risks associated with getting the vaccine.

If parents remain skeptical of the vaccine for their child, who should they talk to?

They should speak to someone with firsthand knowledge—family physicians, pediatricians, nurses or pharmacists. Ask questions about the vaccine, its efficacy and the risks of COVID. It’s important to arm yourself with knowledge to protect your family from the virus.

Learn more on COVID-19 vaccine and young children via UBC Faculty of Medicine.

“Beating the bite of mosquitoes this spring and summer could hinge on your attire and your skin. New research led by scientists at the University of Washington indicates that a common mosquito species — after detecting a telltale gas that we exhale — flies toward specific colors, including red, orange, black and cyan. The mosquitoes ignore other colors, such as green, purple, blue and white. The researchers believe these findings help explain how mosquitoes find hosts, since human skin, regardless of overall pigmentation, emits a strong red-orange “signal” to their eyes.

‘Mosquitoes appear to use odors to help them distinguish what is nearby, like a host to bite,’ said Jeffrey Riffell, a UW professor of biology. ‘When they smell specific compounds, like CO2 from our breath, that scent stimulates the eyes to scan for specific colors and other visual patterns, which are associated with a potential host, and head to them.’

The results, published Feb. 4 in Nature Communications, reveal how the mosquito sense of smell — known as olfaction — influences how the mosquito responds to visual cues. Knowing which colors attract hungry mosquitoes, and which ones do not, can help design better repellants, traps and other methods to keep mosquitoes at bay.”

More on Mosquitoes are seeing red: Why new findings about their vision could help you hide from these disease vectors via UW.

“After new reports of polio cases abroad, and virus samples in the wastewater of several other developed countries, Canada intends to start testing wastewater from a number of cities ‘as soon as possible,’ CBC News has learned.

The Public Health Agency of Canada (PHAC) already works to monitor polio activity around the world, a spokesperson said in an email response to CBC News questions.

Currently, PHAC’s National Microbiology Laboratory in Winnipeg does have the diagnostic tools available to test samples for poliovirus. Any suspected positive Canadian samples of poliovirus will be sent to that lab for further laboratory analysis and confirmation, with results shared with the respective local health authorities “so appropriate public health measures can be taken if necessary.”

According to the statement, PHAC has been communicating with national and international partners who are experts in this field to finalize a wastewater testing strategy. It will be testing wastewater samples that were collected earlier this year from ‘key high-risk municipalities’ to determine if polio was present prior to the reported international cases.

Read more on Wastewater tests will focus on ‘key high-risk municipalities,’ says Public Health Agency of Canada via CBC.