Interview with Dr. Jocelyn Gravel, pediatric emergency physician and research director at Sainte-Justine hospital in Montreal. In a research article published in CMAJ, Dr. Gravel and colleagues derived and validated a clinical decision rule to identify skull fracture following minor head trauma in young children. The rule should make it possible to identify about 90% of skull fractures in young children with mild head trauma and reduce the use of radiologic investigations by about 60% compared with current practice.
Interview with Dr. Matthew Johnson, Associate Professor of Psychiatry and Behavioral Sciences at Johns Hopkins University School of Medicine. Renewed interest in the use of psychedelic drugs as treatments for illnesses such as anxiety, addiction and post-traumatic stress disorder has led to small controlled studies. In association with psychotherapy some psychedelic drugs have shown good effects with adequate safety. In an analysis article published in CMAJ, Dr. Johnson and colleagues look at new emerging evidence.
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Martin Roland is Professor of Health Services Research at the University of Cambridge in the UK. He was previously a Professor of General Practice and a practising GP.
Are single disease guidelines and indicators are going out of fashion? Well they are with people interested in multi-morbidity. The argument is straightforward. Single disease guidelines are usually based on trials which exclude people with multiple complex problems. So how does the physician know how a cholesterol guideline developed from trials on 65 year old CHD patients relates to the 85 year old in front of him with seven other comorbid conditions? The risks of polypharmacy are increased as the number of prescribed meds goes up, so what is the physician to do? Does he follow eight disease guidelines for the old lady in front of him? Or is there another way?
Well, Victor Montori thinks there needs to be. He gave the opening keynote at this year’s NAPCRG conference. Despite being an endocrinologist, he sees clear problems in attempting to apply multiple single disease guidelines to our increasingly multi-morbid patients. His answers were about meaningful engagement with patients and their priorities, and shared decision making which takes into account a clear explanation of risks, benefits and alternative treatment approaches. That’s good, but it’s not good enough. We’ve opened up an intellectual space by criticising the single disease approach in multi-morbid older populations, but we haven’t yet filled it adequately. ...continue reading