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Niburski K. The principles and practice of death: The Oslerian conflicted conception of dying. J Med Biogr 2023; 31:50-61. [PMID: 34080927 PMCID: PMC9925907 DOI: 10.1177/09677720211018974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Sir William Osler espoused a particularly idealized medical life that included the patient in the physician's worldview. Disease is not considered a monolith, only a reflection of one's broader health. Death, too, is configured as a part of one's being, not as a thing apart from life. The wholesomeness that characterized Osler's practice is well known-however, his long discussions and thoughts on death have not been sufficiently analyzed. His clinical views have been hinted at and numerous medical historians have noted that Osler's worldview on death was avant-garde for its time, one in which he described finality not as a time of suffering and anguish, but as "singularly free from mental distress." This essay contends with this simple view. This straightforward understanding becomes complicated when delving into such primary resources as Osler's Study on Dying cards, his writings on other medical conditions, and personal reflections following the personal losses of his sons Edward Revere Osler and Paul Revere Osler. This essay contends that the loss and the death he imagines is not one of peace, but rather, of horror and terror. Furthermore, the primary sources show Osler not as the paragon of flawless clinical acumen and reasoning, but a man of personal beliefs that were in conflict with views he espoused more publicly. The essay therefore reconceptualizes the common understanding of a stoic Osler, determines how death prefigures into Oslerian thought, and challenges the idea of an Oslerian simple death.
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Niburski K, Niburski O. Impact of Elon Musk’s Tweeting about Psychiatric Medication on the Internet, Media, and Purchasing: Observational Study. Journal of Consumer Health on the Internet 2023. [DOI: 10.1080/15398285.2022.2133832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Kacper Niburski
- Faculty of Anesthesia, University of British Columbia, Vancouver, Canada
| | - Oskar Niburski
- Faculty of Computer Science, York University, Toronto, Canada
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Niburski K. Panacea. Acad Med 2022; 97:1158. [PMID: 35044976 DOI: 10.1097/acm.0000000000004604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
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Niburski K. Commentary on "Panacea". Acad Med 2022; 97:1159. [PMID: 35917542 DOI: 10.1097/01.acm.0000855444.86437.db] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Kacper Niburski
- K. Niburski is a resident in anesthesia, University of British Columbia, Vancouver, British Columbia, Canada;
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Yan L, Niburski K, Snell L. Sonoist: An Innovative Peer Ultrasound Learning Initiative on Canadian Teaching Hospital Wards. Mcgill J Med 2022. [DOI: 10.26443/mjm.v20i2.856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Students usually learn point-of-care ultrasound (PoCUS) on standardized patients, thus lacking opportunities to correlate their ultrasound findings with clinical abnormalities. Sonoist is a student-led initiative aimed at improving ultrasound training with peer-teaching and real patients. We describe here a pilot project of Sonoist, its implementation and evaluation.
Methods: Sonoist was developed by Independent-Practitioner-certified medical students who teach their peers how to scan patients with abnormal clinical findings, then correlating their ultrasound findings with the physical examination. From May 2019 to February 2020, seven sessions were held, with a sessional average of 3 participants and 3 patients scanned. We collected survey data on ultrasound knowledge, participants’ perceived self-improvement, and general comments. Results were grouped by prior ultrasound training (novice n=8, experienced n=12) and year of study (1-4).
Results: 20/23 completed the survey. An increase in ultrasound skill was perceived by 100% of novices and 66.7% of experienced learners. Knowledge about clinical indications for PoCUS improved in 80% of novice and 81% of experienced students; sonographic knowledge improved in 69% of novices and 81.3% of experienced learners. All novices and 91.7% of experienced learners reported that learning ultrasound was useful for correlating with physical exam and clinical diagnosis. All novices and 83% of experienced students preferred peer-to-peer teaching.
Conclusion: Peer-to-peer PoCUS teaching improved medical students’ sonographic and clinical knowledge, and is perceived as useful by students. A combination of early clinical exposure and a less stressful environment from peer teaching may contribute to these results.
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Nguyen DD, Niburski K, Cheng B, Demir K, Dixon A, Luo OD, de Meulemeester J, Nguyen AXL, Paterson D, Thomson M, de Waal A, Singh L, Hendricks K, Razack S. The Community Health and Social Medicine Incubator: a service-learning framework for medical student-led projects. Can Med Educ J 2021; 12:64-67. [PMID: 34804292 PMCID: PMC8603893 DOI: 10.36834/cmej.70653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The Community Health and Social Medicine (CHASM) Incubator is a social impact venture that gives medical and other health care students the opportunity to develop initiatives that sustainably promote health equity for, and in partnership with, community partners and historically marginalized communities. Students learn how to develop projects with project management curricula, are paired with community health mentors, and are given seed micro-financing. As the first community health incubator driven by medical students, CHASM provides a framework for students interested in implementing sustainable solutions to local health disparities which extends the service-learning opportunities offered in existing curricula.
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Affiliation(s)
| | | | - Brianna Cheng
- Faculty of Medicine, McGill University, Quebec, Canada
| | - Koray Demir
- Faculty of Medicine, McGill University, Quebec, Canada
| | - Andrew Dixon
- Faculty of Medicine, McGill University, Quebec, Canada
| | - Owen D Luo
- Faculty of Medicine, McGill University, Quebec, Canada
| | | | | | | | | | - Anna de Waal
- Faculty of Medicine, McGill University, Quebec, Canada
| | | | - Kristin Hendricks
- Global Health Programs, Faculty of Medicine, McGill University, Quebec, Canada
| | - Saleem Razack
- Department of Pediatrics, Institute of Health Sciences Education, Office of Social Accountability and Community Engagement, McGill University, Quebec, Canada
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Yan L, Niburski K, Snell L. Sonoist: An Innovative Peer Ultrasound Learning Initiative on Canadian Teaching Hospital Wards. Mcgill J Med 2021. [DOI: 10.26443/mjm.v20i1.856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Students usually learn point-of-care ultrasound (PoCUS) on standardized patients, thus lacking opportunities to correlate their ultrasound findings with clinical abnormalities. Sonoist is a student-led initiative aimed at improving ultrasound training with peer-teaching and real patients. We describe here a pilot project of Sonoist, its implementation and evaluation.
Methods: Sonoist was developed by Independent-Practitioner-certified medical students who teach their peers how to scan patients with abnormal clinical findings, then correlating their ultrasound findings with the physical examination. From May 2019 to February 2020, seven sessions were held, with a sessional average of 3 participants and 3 patients scanned. We collected survey data on ultrasound knowledge, participants’ perceived self-improvement, and general comments. Results were grouped by prior ultrasound training (novice n=8, experienced n=12) and year of study (1-4).
Results: 20/23 completed the survey. An increase in ultrasound skill was perceived by 100% of novices and 66.7% of experienced learners. Knowledge about clinical indications for PoCUS improved in 80% of novice and 81% of experienced students; sonographic knowledge improved in 69% of novices and 81.3% of experienced learners. All novices and 91.7% of experienced learners reported that learning ultrasound was useful for correlating with physical exam and clinical diagnosis. All novices and 83% of experienced students preferred peer-to-peer teaching.
Conclusion: Peer-to-peer PoCUS teaching improved medical students’ sonographic and clinical knowledge, and is perceived as useful by students. A combination of early clinical exposure and a less stressful environment from peer teaching may contribute to these results.
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Niburski K, Buu N. Criteria for selection to anesthesia residency programs: a survey of Canadian anesthesia program directors. Can Med Educ J 2021; 12:89-97. [PMID: 34567309 PMCID: PMC8463234 DOI: 10.36834/cmej.71385] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
INTRODUCTION Applicants to specialty programs lack guidance on knowing what exactly is desired by selection committees and program directors. Anesthesia is especially opaque, given its failure to provide transparency reports nationally. This study was developed to survey Canadian anesthesia program directors about the aspects of the application package desired in an anesthesia applicant. The primary objective is to identify the preferred attributes of anesthesia applications by those mandating the selection committees. METHODS Survey was developed via Google Surveys, and sent online over a period of two months in June and July 2020. All program directors were sent requests for filling in the survey. STATA was used for all statistical analyses. Two analyses, Mann-Whitney and ANOVA tests, were performed for comparison groups. A p < 0.05 was considered significant. RESULTS Fourteen of seventeen (83%) Canadian anesthesia program directors completed the survey. Having done an anesthesia elective, good performance in it, and excellence of preclinical academic performance were considered among the most important aspects of the application package with the highest ranking important and smallest standard deviation. Any form of red flag was also considered an important criterion, again with little variation among program directors. The reference letters selected by the applicants were also important, with a personal relationship and well written reference being identified as most important (p < 0.05). CONCLUSIONS An applicant who has good academic performance, having anesthesia elective experience, personal, well-written reference letters, and general activity and interests that are not necessarily anesthesia-focused would be favoured by Canadian anesthesia programs.
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Affiliation(s)
| | - Natalie Buu
- Department of Pediatric Anesthesia, McGill University of Health Center, Quebec, Canada
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Kouri M, Somaini M, Cárdenas VHG, Niburski K, Vigouroux M, Ingelmo P. Transnasal Sphenopalatine Ganglion Block for the Preventive Treatment of Chronic Daily Headache in Adolescents. Children (Basel) 2021; 8:606. [PMID: 34356585 PMCID: PMC8306937 DOI: 10.3390/children8070606] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/13/2021] [Accepted: 07/16/2021] [Indexed: 11/25/2022]
Abstract
Chronic headaches are a major source of morbidity in the pediatric population, affecting physical function, school attendance, social capacity, mood, and sleep. In adults, repetitive sphenopalatine ganglion (SPG) blockade has been studied as a preventive treatment for chronic migraines. This case series aims to evaluate the SPG block for the preventive treatment of chronic daily headache (CDH) in adolescents. We prospectively evaluated 17 adolescents (14 females, 14 ± 1 year) with CDH not responding to cognitive behavioral therapy (CBT), physiotherapy, and standard medications. Each patient received 10 SPG blocks (two blocks/week) using the Tx360® device. At the end of treatment, 10 patients (59%) reported a Patient's Global Impression of Change (PGIC) score ≥ 67%, and 3 months after the end of treatment, nine patients (53%) sustained a PGIC ≥ 67%. There was also a statistically significant reduction in the depression subscale of the Revised Children's Anxiety and Depression Scale (RCADS) at the end of treatment and 3 months post-treatment compared with baseline. The procedure was well tolerated with no adverse effects. In our study, the use of repeat SPG blockade was associated with sustained benefits on the PGIC and the depression subscale of the RCADS when used as preventive headache treatment in adolescents with refractory CDH.
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Affiliation(s)
- Megan Kouri
- Faculty of Medicine, McGill University, Montreal, QC H3G 2M1, Canada; (M.K.); (K.N.)
| | - Marta Somaini
- Department of Anaesthesia, Grande Ospedale Metropolitano Niguarda, 201262 Milano, Italy;
| | - Victor Hugo González Cárdenas
- Faculty of Medicine, Fundación Universitaria de Ciencias de la Salud (FUCS), 111221 Bogotá, Colombia;
- Department of Anesthesia, Los Cobos Medical Center, 110121 Bogotá, Colombia
- Department of Anesthesia, Pain and Palliative Care, Hospital Universitario de la Samaritana, 110411 Bogotá, Colombia
| | - Kacper Niburski
- Faculty of Medicine, McGill University, Montreal, QC H3G 2M1, Canada; (M.K.); (K.N.)
| | - Marie Vigouroux
- Faculty of Dentistry, McGill University, Montreal, QC H3A 1G1, Canada;
- Edwards Family Interdisciplinary Center for Complex Pain, Montreal Children’s Hospital, McGill University Health Center, Montreal, QC H4A 3J1, Canada
| | - Pablo Ingelmo
- Edwards Family Interdisciplinary Center for Complex Pain, Montreal Children’s Hospital, McGill University Health Center, Montreal, QC H4A 3J1, Canada
- The Alan Edwards Centre Research on Pain, McGill University, Montreal, QC H3A 0G1, Canada
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Niburski K. Aspiration. Acad Pediatr 2021; 21:763-764. [PMID: 32896646 DOI: 10.1016/j.acap.2020.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/31/2020] [Accepted: 09/02/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Kacper Niburski
- McGill University, Faculty of Medicine, Montreal, Quebec, Canada.
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Niburski K, Ingelmo P, Buu N. The COVID-19 match: what Canadian anesthesia programs can do for the virtual match cycles. Can J Anaesth 2021; 68:930-931. [PMID: 33598885 PMCID: PMC7889300 DOI: 10.1007/s12630-021-01949-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 01/30/2021] [Accepted: 02/01/2021] [Indexed: 11/27/2022] Open
Affiliation(s)
- Kacper Niburski
- Faculty of Medicine, McGill University, Montreal, QC, Canada.
| | - Pablo Ingelmo
- Department of Pediatric Anesthesia, McGill University of Health Center, Montreal, QC, Canada
| | - Natalie Buu
- Department of Pediatric Anesthesia, McGill University of Health Center, Montreal, QC, Canada
- McGill Residency Program in Anesthesiology, Montreal, QC, Canada
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Niburski K, Ingelmo P, Bertolizio G. Perioperative respiratory adverse events in children with Trisomy 21: good news to look forward to. Paediatr Anaesth 2021; 31:388-389. [PMID: 33772958 DOI: 10.1111/pan.14139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 01/19/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Kacper Niburski
- Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Pablo Ingelmo
- Department of Pediatric Anesthesia, Montreal Children's Hospital, McGill University, Montreal, QC, Canada
| | - Gianluca Bertolizio
- Department of Pediatric Anesthesia, Montreal Children's Hospital, McGill University, Montreal, QC, Canada
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Niburski K, Niburski O. Impact of Trump's Promotion of Unproven COVID-19 Treatments and Subsequent Internet Trends: Observational Study. J Med Internet Res 2020; 22:e20044. [PMID: 33151895 PMCID: PMC7685699 DOI: 10.2196/20044] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 08/04/2020] [Accepted: 10/31/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Individuals with large followings can influence public opinions and behaviors, especially during a pandemic. In the early days of the pandemic, US president Donald J Trump has endorsed the use of unproven therapies. Subsequently, a death attributed to the wrongful ingestion of a chloroquine-containing compound occurred. OBJECTIVE We investigated Donald J Trump's speeches and Twitter posts, as well as Google searches and Amazon purchases, and television airtime for mentions of hydroxychloroquine, chloroquine, azithromycin, and remdesivir. METHODS Twitter sourcing was catalogued with Factba.se, and analytics data, both past and present, were analyzed with Tweet Binder to assess average analytics data on key metrics. Donald J Trump's time spent discussing unverified treatments on the United States' 5 largest TV stations was catalogued with the Global Database of Events, Language, and Tone, and his speech transcripts were obtained from White House briefings. Google searches and shopping trends were analyzed with Google Trends. Amazon purchases were assessed using Helium 10 software. RESULTS From March 1 to April 30, 2020, Donald J Trump made 11 tweets about unproven therapies and mentioned these therapies 65 times in White House briefings, especially touting hydroxychloroquine and chloroquine. These tweets had an impression reach of 300% above Donald J Trump's average. Following these tweets, at least 2% of airtime on conservative networks for treatment modalities like azithromycin and continuous mentions of such treatments were observed on stations like Fox News. Google searches and purchases increased following his first press conference on March 19, 2020, and increased again following his tweets on March 21, 2020. The same is true for medications on Amazon, with purchases for medicine substitutes, such as hydroxychloroquine, increasing by 200%. CONCLUSIONS Individuals in positions of power can sway public purchasing, resulting in undesired effects when the individuals' claims are unverified. Public health officials must work to dissuade the use of unproven treatments for COVID-19.
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Niburski K, Guadagno E, Mohtashami S, Poenaru D. Shared decision making in surgery: A scoping review of the literature. Health Expect 2020; 23:1241-1249. [PMID: 32700367 PMCID: PMC7696205 DOI: 10.1111/hex.13105] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 06/24/2020] [Accepted: 06/26/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Shared decision making (SDM) has been increasingly implemented to improve health-care outcomes. Despite the mixed efficacy of SDM to provide better patient-guided care, its use in surgery has not been studied. The aim of this study was to systematically review SDM application in surgery. DESIGN The search strategy, developed with a medical librarian, included nine databases from inception until June 2019. After a 2-person title and abstract screen, full-text publications were analysed. Data collected included author, year, surgical discipline, location, study duration, type of decision aid, survey methodology and variable outcomes. Quantitative and qualitative cross-sectional studies, as well as RCTs, were included. RESULTS A total of 6060 studies were retrieved. A total of 148 were included in the final review. The majority of the studies were in plastic surgery, followed by general surgery and orthopaedics. The use of SDM decreased surgical intervention rate (12 of 22), decisional conflict (25 of 29), and decisional regret (5 of 5), and increased decisional satisfaction (17 of 21), knowledge (33 of 35), SDM preference (13 of 16), and physician trust (4 of 6). Time increase per patient encounter was inconclusive. Cross-sectional studies showed that patients prefer shared treatment and surgical treatment varied less. The results of SDM per type of decision aid vary in terms of their outcome. CONCLUSION SDM in surgery decreases decisional conflict, anxiety and surgical intervention rates, while increasing knowledge retained decisional satisfaction, quality and physician trust. Surgical patients also appear to prefer SDM paradigms. SDM appears beneficial in surgery and therefore worth promoting and expanding in use.
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Affiliation(s)
| | - Elena Guadagno
- Division of Pediatric General and Thoracic SurgeryThe Montreal Children’s HospitalMcGill University Health CentreMontrealQCCanada
| | - Sadaf Mohtashami
- Division of Pediatric General and Thoracic SurgeryThe Montreal Children’s HospitalMcGill University Health CentreMontrealQCCanada
| | - Dan Poenaru
- Division of Pediatric General and Thoracic SurgeryThe Montreal Children’s HospitalMcGill University Health CentreMontrealQCCanada
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Lytvyn L, Zeraatkar D, Anbari A, Ginex P, Zoratti M, Niburski K, Sadeghirad B, Siedler M, Thabane L, Morgan R. Conservative Intervention Strategies for Adult Cancer-Related Lymphedema: A Systematic Review and Network Meta-Analysis. Oncol Nurs Forum 2020; 47:E171-E189. [DOI: 10.1188/20.onf.e171-e189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Affiliation(s)
- Kacper Niburski
- McGill University and Genome Quebec Innovation Centre - Medicine, Montreal Ontario
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Abstract
This article was migrated. The article was marked as recommended.
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Niburski K. Cheyne-Stokes Breathing. Am J Hosp Palliat Care 2020; 38:98. [PMID: 32351117 DOI: 10.1177/1049909120922776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Kacper Niburski
- Faculty of Medicine, 12367McGill University, Montreal, Quebec, Canada
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Niburski K. Guide to every death and a little life. BMJ Support Palliat Care 2020; 10:e2. [DOI: 10.1136/bmjspcare-2019-001825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Accepted: 03/28/2019] [Indexed: 11/03/2022]
Abstract
The following is a narrativised story of my experience rotating in palliative care. It is lively.
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Abstract
Shared decision-making (SDM), the process where physician and patient reach an agreed-upon choice by understanding the values, concerns, and preferences inherent within each treatment option available, has been increasingly implemented in clinical practice to better health care outcomes. Despite the proven efficacy of SDM to provide better patient-guided care in medicine, its use in surgery has not been studied widely. A search strategy was developed with a medical librarian. It included nine databases from inception until December 2018. After a 2-person title and abstract screen, full-text publications were analyzed in detail. A meta-analysis was done to quantify the impact of SDM in surgical specialties. In total 5,596 studies were retrieved. After duplicates were removed, titles and abstracts were screened, and p-values were recorded, 140 (45 RCTs and 95 cross-sectional studies) were used for the systematic review and 42 for the meta-analyses. Most of the studies noted decreased intervention rate (8 of 14), decisional conflict (13 of 16), and decisional regret (3 of 3), and an increased decisional satisfaction (9 of 12), knowledge (19 of 20), SDM preference (6 of 8), and physician trust (3 of 4) when using SDM. Time increase per patient encounter was inconclusive. The meta-analysis showed that despite high heterogeneity, the results were significant. Far from obviating surgical immediacy, these results suggest that SDM is vital for the best indicators of care. With decreased conflict and anxiety, increasing knowledge and satisfaction, and creating a more whole, trusting relationship, SDM appears to be beneficial in surgery.
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Abstract
The following narrative essay is a combined narrative of many instances during a surgical rotation.
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Niburski K. Cough. CMAJ 2019; 191:E794-E795. [DOI: 10.1503/cmaj.190314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Abstract
The this is a work of fiction. Any resemblance to real persons, living or dead, is purely coincidental in the same way a flower described here would not smell as good as the real.
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Abstract
BACKGROUND Medical records manufacture a representational model of a person. Yet, little has been done to analyze the historical construction of patient charts, the deliberations in the process of their creation, and how early patient charts displaced patients' narratives. OBJECTIVES To retrospectively study the structure and production of old patient charts. METHODS Anchored by the Archives of Ontario's medical records from three 19th century psychiatric asylums-Hamilton, London, and Kingston, Canada-the paper tools are reproduced on the basis of their original manufacturing processes using cast-iron presses and relevant typesetting. This includes mirroring the process of assembly, recontextualizing the form's limitations as a function of its construction, making historical the diagnostic considerations relevant at the time, and noting the continuum of practical and operational choices that have stretched into current records. RESULTS An explication of the advance of physicians' objective records and the decline of the subjective patient view is given from index-card inception through design, accreditation, standardization, forms, and quantity, to analysis replacing narration. CONCLUSION Through this artistic work, medical paradigms become realized through paper borders. With ink, lead, and historical manufacturing, a world view is re-created. Such a marriage of medicine and art challenges the static interpretations of paper tools as only ends to the objectification of patients; instead, a tradition of reconfiguring the medical body as a thing dissolving into objectification becomes apparent. This trend continues now through the lack of narrative balancing a person's health care experience and his/her medical record.
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Affiliation(s)
- Kacper Niburski
- McGill University, Montreal, Ontario, Canada
- McGill Faculty of Medicine, Montreal, Ontario, Canada
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