TagAnnals of Internal Medicine

Reading of the Week: Our Pandemic Reality – How It Affected Our Patients, How It Changed Our Practice, How It Changed Us

From the Editor

A year ago this week, provinces across the country ordered the first lockdown. In the days that followed, I remember driving to the hospital and noting the eerie quiet of the streets with almost no cars or trucks on the morning commute.

Now, a year later, we can ask some questions. How has the pandemic affected our patients? How did it change our practice? How has it changed us?

This week, we have four selections that explore our pandemic reality.

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We begin by focusing on patients. In the first selection, we look at a paper from Annals of Internal Medicine. Dr. Jonathan S. Zipursky (of the University of Toronto) and his co-authors consider alcohol sales and ED visits. They find that there was an increase in alcohol sales of 38% at the start of the pandemic. They write: “Higher alcohol sales during the lockdown are worrisome because alcohol consumption can cause poor judgment, medical complications, and immune suppression.”

In the second selection, we consider an editorial from BMJ. Though some have predicated a significant increase in suicide completions, there is little evidence. Still, the authors write: “We must remain vigilant and responsive, sharing evidence early and internationally… in these evolving uncertain times.”

Then we pivot and look at providers. In the third selection, Dr. Daniel Guinart (of Hofstra/Northwell) and his co-authors report on the findings of a survey on telepsychiatry. “In this study, we report highly favorable attitudes toward telepsychiatry in its diverse forms, across a large and wide array of mental health care professionals.”

In the fourth selection, Andrea Frolic (of McMaster University) talks about the pain of the past year. After breaking a toe, she notes about the psychological injuries of our pandemic life. “As a health care leader, I am supposed to be a cheerleader, a silver-lining finder, an opportunity-seeker – a hero, not a human.”

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Some good news: the Reading of the Week was just awarded the Ivan Silver Innovation Award by Continuing Professional Development of the University of Toronto’s Faculty of Medicine. Many thanks to Drs. Rajeevan Rasasingham and Sanjeev Sockalingam for the nomination.

But I’m committed to developing this program further, not resting on our laurels – in late April, we will be conducting focus groups to better understand what works and what needs improvement. Interested in being involved? Please contact smit.mistry@camh.ca. Time commitment: under one hour.

DG

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Reading of the Week: Cannabis, Cannabis, Cannabis – With Papers from Psychological Medicine, Psychiatric Services, and Annals of Internal Medicine

From the Editor

“It’s the only thing that works.”

So many of our patients swear by cannabis. It has become a popular choice for everything from anxiety to chronic pain. And though the literature is relatively young, now we know more about cannabis than before. This week, we focus on three new papers.

The first selection is a paper by Dr. Emmet Power (of the Royal College of Surgeons in Ireland) and his co-authors from Psychological Medicine. Does frequent and dependent cannabis use in youth affect IQ? Doing a systematic review and meta-analysis, they find seven papers. They conclude: “We found that young people who use cannabis frequently or dependently by age 18 have declined in IQ at follow up and this may be due to a decline in verbal IQ.”

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In the second selection, we consider a new paper from Psychiatric Services. Dr. Corneliu N. Stanciu (of Dartmouth College) and his co-authors did a systematic review of cannabis for several disorders. “With only eight very small studies, insufficient evidence was found for efficacy of CBD and THC to manage affective disorders, anxiety disorders, or PTSD.”

Finally, in the third selection, we look at a paper from Annals of Internal Medicine. Drs. Arthur Robin Williams (of Columbia University) and Kevin P. Hill (of Harvard University) pose 15 questions about cannabis and answer them. The authors are practical and thoughtful. The clinical bottom line: “Millions more adults now meet criteria for cannabis use disorder in a given year, and all clinicians, not just mental health professionals, have vital roles in improving clinical management, from screening and diagnosis to overseeing treatment plans.”

DG

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Reading of the Week: “The Name of the Dog” – Dr. Tafder’s Excellent NEJM Paper & More

From the Editor

There is something often dehumanizing about the health-care experience – the way patients can be reduced to medical-record numbers, the way lives can be summarized in disease names and a few demographic details (“a 30 year old woman with schizophrenia”).

This week, we consider two essays that are about people who happen to be patients – and the lessons that our colleagues have drawn from their stories.

In the first selection, we look at a paper written by Dr. Taimur Safder that was published in The New England Journal of Medicine. It’s about the name of a dog – and much more. During his training, Dr. Safder presents the case of a person who develops chest pain when walking his dog. When the supervisor asks the name of the dog, the physician isn’t sure. “Four years later, I’m not sure anything I’ve carried from residency has been more useful than that question.”

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And, in the second selection, we consider a short essay by Dr. Lee Lu. The Texas doctor describes her experiences working with a patient with substance use problems – and wrestling with her own biases.

Finally, returning to the topic of cannabis legalization, we consider some responses to last week’s Reading, and a CMAJ editorial on the topic.

DG

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Reading of the Week: I Can’t Sleep – Insomnia, Part I of II

From the Editor

It’s one of the most common patient complaints: I can’t sleep.

What many of our patients aspire to…

Insomnia affects 6 to 10% of the population. It’s a common problem – and often chronic. But are we mishandling insomnia?

In a two-part, two-week series, we look at the latest in insomnia research.

This week. Fewer Pills, More Therapy. The new Clinical Practice Guideline.

Next week. Insomnia, Is There an App for That? The GoodNight Study.

This week, we look at the new American College of Physicians Clinical Practice Guideline on insomnia that suggests that CBT-Insomnia should be the first-line treatment.

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