Issue 1


Correspondence

Review Article

A Beginner’s Guide to Clinical Trials

Sarah Keyes; Philippa Hawley

Canadian Journal of Medicine, 2022, Volume 4, Issue 1, Pages 4-12
DOI: 10.33844/cjm.2022.60615

Evidence-based medicine rests upon the pillars of scientific evidence, clinical expertise, and patient values. Evidence comes from various avenues including clinical trials; a branch of experimental research studying interventions in human participants. Clinical trials evaluate the safety and efficacy of interventions, including medications, devices, and procedures that are administered according to a detailed plan. A control group such as no-treatment, placebo, or standard-of-care is used for comparison. A clinical trial determines whether one intervention is better, worse, or no different than another in the specific context and demographics of enrolled participants. Safety and efficacy are established by measuring clinically significant outcomes. Ultimately, the goals of clinical research are to advance medical knowledge and improve patient care through the development of preventative measures, diagnostic and screening tools, treatments, and supportive care. In the rapidly evolving landscape of medical literature, clinicians increasingly consult clinical trials to guide their practice. As such, medical students and trainees stand to benefit from developing a strong understanding of research design and logistics during their training. This article presents a general overview of key elements and practical considerations in clinical trials.

Original Research

A Chart Review of Emergency Department Visits Following Implementation of the Cannabis Act in Canada

Marisa O’Brien; Peter Rogers; Eric Smith

Canadian Journal of Medicine, 2022, Volume 4, Issue 1, Pages 13-21
DOI: 10.33844/cjm.2022.6016

The legalization of cannabis for recreational use remains a controversial topic today. There are multiple known benefits of cannabis which include pain relief and treatment of epilepsy syndromes. However, there are also many associated risks. Shorter-term health consequences include cannabinoid hyperemesis syndrome and cannabis-induced psychosis. These conditions directly impact the influx of patients presenting to emergency departments (ED). This study aims to examine the impact of cannabis legalization on ED presentations. We performed a descriptive study via a retrospective chart review of cannabis-related ED visits in St. John’s, Newfoundland (NL), ranging from six months prior to the date of legalization of cannabis for recreational use, to six months after. We searched the hospital ED visit records using keywords to identify patients who have symptoms relating to cannabis use. We manually reviewed all visit records that included one or more of these terms to distinguish true positives from false-positive cases unrelated to cannabis use. The number of cannabis-related visits increased from 2.56 per 1000 ED visits prior to legalization to 3.56 per 1000 ED visits post legalization (p < 0.01). There was no difference in the age of users between the two groups. Additionally, the most common presenting complaint due to cannabis use was nausea/vomiting (47.7%), followed by anxiety (12.2%). Following the implementation of the Cannabis Act in Canada, the EDs in St. John’s, NL had a significant increase in the number of ED visits related to cannabis use. It is important to determine such consequences to ensure hospitals and public health are prepared to treat the influx of visits and are better equipped to manage the associated symptoms

Review Article

Immunosenescence, COVID-19, and Vaccine Efficacy in the Elderly

Fariha Khan; Peter Anto Johnson; John Christy Johnson; Jasrita Singh; Austin Mardon

Canadian Journal of Medicine, 2022, Volume 4, Issue 1, Pages 22-25
DOI: 10.33844/cjm.2022.6017

Recent research has unveiled and confirmed the deleterious age-related changes of the immune system which result in diminished ability of older adults to effectively respond to pathogens and infection. This degradation is defined by the term immunosenescence. Immunosenescence can also bring with it reduced vaccine efficacy. In an era where the population of older adults is growing exponentially, it is apparent why such dysfunction is concerning. Adding even more pertinence is the COVID-19 pandemic. Since March of 2020, older adults across the globe have borne witness to the disproportional effects of COVID-19 infection on their mortality rates versus younger adults and children. In order to bring the pandemic to an end, the global population must be inoculated. However, concerns have been raised about the effectiveness of the COVID-19 vaccines on the elderly. This article aims to provide a brief overview of immunosenescence, the COVID-19 pandemic, and what research has shown thus far about vaccine efficacy for older adults. As well, potential methods to combat immunosenescence will be explored.

Sickness, Social Isolation, and a Solution: A Brief Exploration of COVID-19 Related Depression and Transcranial Direct Current Stimulation

Fariha Khan; Peter Anto Johnson; John Christy Johnson; Jasrita Singh; Austin Mardon

Canadian Journal of Medicine, 2022, Volume 4, Issue 1, Pages 26-31
DOI: 10.33844/cjm.2022.6018

The COVID-19 pandemic has illuminated a need for accessible, home-based therapies for mental health. In an era of social distancing, lockdowns, and declining global mental health, one promising candidate is transcranial Direct Current Stimulation (tDCS). tDCS is a non-invasive, portable, targeted brain stimulation technique that uses electrical currents to modulate cortical excitability. It has been heavily explored as a treatment for major depressive disorder (MDD) and other mental health issues in recent years. However, before such a treatment may become widespread, certain research questions must be addressed, and safety outcomes must be thoroughly evaluated. This article aims to provide a brief overview of tDCS, the COVID-19 pandemic’s impact on mental health, and tDCS’ potential to be used in such a situation. The article also explores some of the drawbacks and challenges that lie in the way of tDCS being normalized as a mental health therapeutic.

Original Article

Changing Attitudes Toward Specialty Choice and the CaRMS Residency Match During COVID-19: A Cross-sectional Pilot Study of Canadian Medical Students

Stuti M. Tanya; Maia Idzikowski; Bonnie He; Joshua Lakoff; Sanjay Sharma

Canadian Journal of Medicine, 2022, Volume 4, Issue 1, Pages 32-37
DOI: 10.33844/cjm.2022.6019

The Canadian residency match process has been dramatically restructured due to COVID-19. The impact of these changes on specialty choice and access to career-development opportunities among Canadian medical students remains largely unknown. The objective of this study was to assess whether students’ strategy and level of confidence entering the Canadian residency match have changed as a result of the pandemic. A 28-item online survey was distributed to Canadian medical students from the classes of 2021-2024, as well as the class of 2020 graduates planning to enter the 2021 CaRMS (Canadian Resident Matching Service) match. The survey was developed based on existing literature and included questions on demographics, access to educational opportunities, and personal strategies for matching. Descriptive statistics, t-tests, and Spearman’s correlations were used to analyze the data. Eleven percent of respondents reported a change in specialty preference due to COVID-19. Forty-three percent of respondents reported changing their strategy for the CaRMS match. Respondents interested in a surgical specialty were more likely to report a change in their match strategy (p = .0150), including applying to more programs (p = .0012) and exploring other specialties (p = .0118). Clerks were also more likely to report a change in their matching strategy (p = .0195) and specialty choice (p = .0194) compared to pre-clerks. Medical students felt that COVID-19 negatively impacted their ability to access scholarly opportunities and confidence regarding the match, which may have long-term implications for trainee well-being, residency match logistics, and long-term physician resource planning.
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