Gibsonmccracken7132

OBJECTIVE To provide an overview of the use and possible overuse of diagnostic neck ultrasound (DNUS) by describing and comparing both the ordering rates and the downstream results of DNUS by regions across Ontario. DESIGN Retrospective population-based cohort study based on electronic health care data. SETTING Ontario. CPT-11 manufacturer PARTICIPANTS Ontario residents (adults aged > 18 years) who had a diagnosis of thyroid cancer between October 1, 1999, and June 30, 2014, and residents who had a DNUS in 2012. MAIN OUTCOME MEASURES Proportion of Ontario residents in each sub-Local Health Integration Network (LHIN) group who had their first DNUS in 2012 and went on to other relevant tests, diagnoses, and surgery. The sub-LHIN groups were based on increasing age- and sex-adjusted rates of first DNUS. RESULTS There were 77 238 DNUS tests in 2012 and there was a 7.4-fold variation in the rate of test ordering across the sub-LHIN populations leading to variable rates of actual disease, suggesting screening or uncertain indications for tests. CONCLUSION Across Ontario, the indications for ordering DNUS are variable, and screening or testing without indication might be a common practice. Establishing effective guidelines for the ordering of DNUS would potentially reduce costs and ultimately reduce the rates of thyroid cancer. Copyright© the College of Family Physicians of Canada.OBJECTIVE To explore how family medicine (FM) residents experience role modeling of professionalism by FM preceptors. DESIGN Qualitative design using semistructured, one-on-one interviews. SETTING Two FM teaching units at the University of Toronto in Ontario. PARTICIPANTS Sixteen first- and second-year FM residents. METHODS This study employed a qualitative description design. The CanMEDS-Family Medicine 2009 framework was used to help design interview questions. Interviews were audiorecorded and transcribed verbatim. Transcripts were coded and themes were developed. MAIN FINDINGS Some residents described insufficient experience with role modeling in general. Two main findings were that a longitudinal relationship with a role model was important and that residents desired a close working relationship with a role model in a clinical setting. Most participants could identify experiences with role modeling of ethical practice; many examples were in the context of challenging patients. Some, but not all, residents could identify experiences with role modeling of profession-led regulation and reflective practice. Of note, there were mixed responses with respect to role modeling a commitment to personal health. CONCLUSION Reassuringly, many FM residents described experiences with positive role modeling of professionalism. However, some residents believed that role modeling was limited by the brevity of their interactions with potential role models. To optimize the effect of role modeling, educators should support opportunities for residents to develop close, longitudinal working relationships with faculty. Copyright© the College of Family Physicians of Canada.in French OBJECTIF Aider les fournisseurs de soins obstétriques, y compris les médecins de famille, infirmières praticiennes, sages-femmes et obstétriciens, à renseigner les patientes sur les risques liés à l’usage de cannabis durant la grossesse et le post-partum, et sur son lien avec les nausées et les vomissements durant la grossesse. SOURCES D’INFORMATION Une recherche a été effectuée dans les banques de données Ovid MEDLINE à l’aide de diverses combinaisons des mots-clés anglais pregnancy, cannabis, lactation et cannabinoid hyperemesis. Les articles pertinents ont été étudiés, et d’autres sources ont été relevées dans la liste de références de ces articles. MESSAGE PRINCIPAL L’exposition in utero au cannabis est liée à des conséquences prolongées sur le développement neurologique, qui persistent au début de l’âge adulte. Le cannabis ne doit pas être utilisé pour traiter les nausées et les vomissements durant la grossesse, et son usage prolongé serait lié au syndrome cannabinoïde. link2 CONCLUSION Aucun niveau de consommation de cannabis n’est sécuritaire durant la grossesse et l’allaitement. Il faut renseigner les femmes enceintes quant aux risques liés à l’exposition in utero et les encourager à s’abstenir de consommer durant la grossesse et l’allaitement.OBJECTIVE To examine the evidence for intermittent fasting (IF), an alternative to calorie-restricted diets, in treating obesity, an important health concern in Canada with few effective office-based treatment strategies. DATA SOURCES A MEDLINE and EMBASE search from January 1, 2000, to July 1, 2019, yielded 1200 results using the key words fasting, time restricted feeding, meal skipping, alternate day fasting, intermittent fasting, and reduced meal frequency. STUDY SELECTION Forty-one articles describing 27 trials addressed weight loss in overweight and obese patients 18 small randomized controlled trials (level I evidence) and 9 trials comparing weight after IF to baseline weight with no control group (level II evidence). Studies were often of short duration (2 to 26 weeks) with low enrolment (10 to 244 participants); 2 were of 1-year duration. Protocols varied, with only 5 studies including patients with type 2 diabetes. SYNTHESIS All 27 IF trials found weight loss of 0.8% to 13.0% of baseline weight with no serious adverse events. Twelve studies comparing IF to calorie restriction found equivalent results. The 5 studies that included patients with type 2 diabetes documented improved glycemic control. CONCLUSION Intermittent fasting shows promise for the treatment of obesity. To date, the studies have been small and of short duration. Longer-term research is needed to understand the sustainable role IF can play in weight loss. Copyright© the College of Family Physicians of Canada.OBJECTIVE To contrast how Brazil's and Canada's different jurisdictional and judicial realities have led to different types of telemedicine and how further scale and improvement can be achieved. COMPOSITION OF THE COMMITTEE A subgroup of the Besrour Centre of the College of Family Physicians of Canada and Canadian telemedicine experts developed connections with colleagues in Porto Alegre, Brazil, and collaborated to undertake a between-country comparison of their respective telemedicine programs. METHODS Following a literature review, the authors collectively reflected on their experiences in an attempt to explore the past and current state of telemedicine in Canada and Brazil. REPORT Both Brazil and Canada share expansive geographies, creating substantial barriers to health for rural patients. Telemedicine is an important part of a universal health system. Both countries have achieved telemedicine programs that have scaled up across large regions and are showing important effects on health care costs and outcomes. However, each system is unique in design and implementation and faces unique challenges for further scale and improvement. Addressing regional differences, the normalization of telemedicine, and potential alignment of telemedicine and artificial intelligence technologies for health care are seen as promising approaches to scaling up and improving telemedicine in both countries. Copyright© the College of Family Physicians of Canada.OBJECTIVE To help obstetric care providers, including family physicians, nurse practitioners, midwives, and obstetricians, educate patients on the risks of cannabis use in pregnancy and postpartum and its relationship to nausea and vomiting in pregnancy. SOURCES OF INFORMATION The Ovid MEDLINE database was searched using the MeSH terms pregnancy, cannabis, lactation, and cannabinoid hyperemesis in various combinations. The relevant articles were reviewed and further sources were found within the references of these articles. MAIN MESSAGE In utero exposure to cannabis has been associated with long-term neurodevelopmental outcomes that persist into young adulthood. Cannabis should not be used to treat nausea and vomiting in pregnancy and its chronic use might lead to the development of cannabinoid hyperemesis syndrome. link3 CONCLUSION There is no known safe level of cannabis use during pregnancy or lactation. Pregnant women should be counseled regarding the risks of in utero exposure and encouraged to abstain from use in pregnancy and while breastfeeding. Copyright© the College of Family Physicians of Canada.Acyl carrier proteins (ACPs) are the scaffolds for fatty acid biosynthesis in living systems, rendering them essential to a comprehensive understanding of lipid metabolism. However, accurate quantitative methods to assess individual acyl-ACPs do not exist. We developed a robust method to quantify acyl-ACPs to the picogram level. We successfully identified acyl-ACP elongation intermediates (3-hydroxyacyl-ACPs and 2, 3-trans-enoyl-ACPs), and unexpected medium-chain (C101, C141) and polyunsaturated long-chain acyl-ACPs (C163), indicating both the sensitivity of the method and how current descriptions of lipid metabolism and ACP function are incomplete. Such ACPs are likely important to medium-chain lipid production for fuels and highlight poorly understood lipid remodeling events in the chloroplast. The approach is broadly applicable to Type II fatty acid synthase systems found in plants, bacteria, as well as mitochondria from mammals and fungi because it capitalizes on a highly conserved Asp-Ser-Leu-Asp (DSLD) amino acid sequence in ACPs to which acyl groups attach. Our method allows for sensitive quantification using LC-MS/MS with de novo generated standards and an isotopic dilution strategy and will fill a gap in our understanding, providing insights through quantitative exploration of fatty acid biosynthesis processes for optimal biofuels, renewable feed stocks, and medical studies in health and disease. © 2020 American Society of Plant Biologists. All rights reserved.DELLA proteins are repressors of the gibberellin (GA) hormone signaling pathway that act mainly by regulating transcription factor activities in plants. GAs induce DELLA repressor protein degradation and thereby control a number of critical developmental processes as well as stress responses such as cold stress. The strong impact of cold temperatures on many physiological processes has rendered it difficult to assess, based on phenotypic criteria, the role of GA and DELLAs in plant growth during cold stress. Here, we uncover substantial differences in the GA transcriptomes between plants grown at ambient temperature (21°C) and plants exposed to cold stress (4°C). We further identify over 250, to the largest extent new, DELLA-transcription factor interactions using the yeast two-hybrid system. By integrating both data sets, we reveal that most members of the nine-membered GRF (GROWTH REGULATORY FACTOR) transcription factor family are DELLA interactors and, at the same time, that several GRFs are targets of DELLA-modulated transcription after exposure to cold stress. We find that plants with altered GRF dosage are differentially sensitive to the manipulation of GA and hence DELLA levels, also after cold stress, and identify a subset of cold stress-responsive genes that qualify as targets of this DELLA-GRF regulatory module. © 2020 American Society of Plant Biologists. All rights reserved.