Sandy Shamon - Academia.edu (original) (raw)
Papers by Sandy Shamon
Palliative care and social practice, 2024
BMC Palliative Care
Background Long-term care (LTC) homes have been disproportionately impacted during COVID-19. Purp... more Background Long-term care (LTC) homes have been disproportionately impacted during COVID-19. Purpose To explore the perspectives of stakeholders across Canada around implementing a palliative approach in LTC home during COVID-19. Methods Qualitative, descriptive design using one-to-one or paired semi-structured interviews. Results Four themes were identified: (1) the influence of the pandemic on implementing a palliative approach, (2) families are an essential part of implementing a palliative approach, (3) prioritizing advance care planning (ACP) and goals of care (GoC) discussions in anticipation of the overload of deaths and (4) COVID-19 highlighting the need for a palliative approach as well as several subthemes. Conclusion The COVID-19 pandemic influenced the implementation of a palliative approach to care, where many LTC homes faced an overwhelming number of deaths and restricted the presence of family members. A more concentrated focus on home-wide ACP and GoC conversations a...
Canadian Family Physician, Jul 1, 2020
The Journal of the American Board of Family Medicine, 2021
Certain members of society are disproportionately affected by the COVID-19 crisis and the added s... more Certain members of society are disproportionately affected by the COVID-19 crisis and the added strain being placed on already overextended health care systems. In this article, we focus on refugee newcomers. We outline vulnerabilities refugee newcomers face in the context of COVID-19, including barriers to accessing health care services, disproportionate rates of mental health concerns, financial constraints, racism, and higher likelihoods of living in relatively higher density and multigenerational dwellings. In addition, we describe the response to COVID-19 by a community-based refugee primary health center in Ontario, Canada. This includes how the clinic has initially responded to the crisis as well as recommendations for providing services to refugee newcomers as the COVID-19 crisis evolves. Recommendations include the following actions: (1) consider social determinants of health in the new context of COVID-19; (2) provide services through a trauma-informed lens; (3) increase focus on continuity of health and mental health care; (4) mobilize International Medical Graduates for triaging patients based on COVID-19 symptoms; and (5) diversify communication efforts to educate refugees about COVID-19. (J Am Board Fam Med 2021;34:S210-S216.
Canadian Family Physician, 2020
Journal of palliative medicine, 2020
Vocal Cord Dysfunction (VCD) is a serious disorder of the vocal cords and laryngeal muscles that ... more Vocal Cord Dysfunction (VCD) is a serious disorder of the vocal cords and laryngeal muscles that mimics asthma and can seriously affect the patient, both physically and emotionally. Patients with this condition are often misdiagnosed and treated inappropriately due to lack of systematic knowledge concerning diagnosis and therapy. The aetiology remains a topic of research; in fact, most experts now agree that vocal cord dysfunction is a group of conditions, or that it has multiple aetiologies. This is appreciated by the extensive number of terms that have been used to describe it. Epidemiological data is also limited, but preliminary investigations suggest that its incidence is higher than initially appreciated. This review summarizes the current existing knowledge and aims to help the reader recognize and develop a management approach to vocal cord dysfunction.
The swift spread of coronavirus disease 2019 (COVID-19) across the globe has challenged health se... more The swift spread of coronavirus disease 2019 (COVID-19) across the globe has challenged health service providers in unprecedented ways. Among the disruptions for general practitioners and allied specialists have been the need to provide in-person care with only limited access to personal protective
The Journal of the American Board of Family Medicine
Certain members of society are disproportionately affected by the COVID-19 crisis and the added s... more Certain members of society are disproportionately affected by the COVID-19 crisis and the added strain being placed on already overextended health care systems. In this article, we focus on refugee newcomers. We outline vulnerabilities refugee newcomers face in the context of COVID-19, including barriers to accessing health care services, disproportionate rates of mental health concerns, financial constraints, racism, and higher likelihoods of living in relatively higher density and multigenerational dwellings. In addition, we describe the response to COVID-19 by a community-based refugee primary health center in Ontario, Canada. This includes how the clinic has initially responded to the crisis as well as recommendations for providing services to refugee newcomers as the COVID-19 crisis evolves. Recommendations include the following actions: (1) consider social determinants of health in the new context of COVID-19; (2) provide services through a trauma-informed lens; (3) increase focus on continuity of health and mental health care; (4) mobilize International Medical Graduates for triaging patients based on COVID-19 symptoms; and (5) diversify communication efforts to educate refugees about COVID-19.
History and Background E vidence-based medicine (EBM) is a relatively new idea in clinical practi... more History and Background E vidence-based medicine (EBM) is a relatively new idea in clinical practice and has been defined as "the conscientious, explicit, and judicious use of the best current evidence in making decisions about the care of individual patients". 1 EBM acts as an important link between current scientific research and clinical practice and aims to provide patients with the best possible care. 2 Although the concept of testing various interventions for efficacy has existed for many centuries, EBM has only started to gain prominence in the late twentieth century. First developed through the work of the Scottish epidemiologist and physician Archie Cochrane in the 1970s, EBM was later introduced into medical practice and education by David Sackett and Gordon Guyatt of McMaster University in the 1990s. 3 A recent online poll conducted by the British Medical Journal named EBM the eighth most important medical breakthrough since 1840, illustrating its increasing significance. 4 The use of EBM in clinical practice is a process that requires the application of five steps. 5 These steps, outlined in Table 1 1 , should be followed in a rigorous manner in order to maximize benefits to patient care. When evaluating studies for EBM, it is essential to use the best available evidence. In most cases, randomized controlled trials (RCTs) are considered to be the best evidence, while noncontrolled trials, observational studies, and medical opinions that are not based on scientific research are considered weaker sources (Table 2). 2 The strength of RCTs lies in the process of
Despite its recent development, evidence-based medicine (EBM) is increasingly being implemented i... more Despite its recent development, evidence-based medicine (EBM) is increasingly being implemented in clinical practice, taught in medi- cal schools, and relied upon in government policy-making. Although the principles guiding EBM may seem simple, the translation of scientific and clinical evidence into medical practice has inherent challenges. This review of EBM provides an overview of the history and development of EBM. In addition, we discuss some of the current academic groups that provide EBM resources, specifically the Cochrane Collaboration and the Therapeutics Initiative. We also present several challenges that face the practice of EBM and the bar - riers that persist in the medical curricula as educators strive to teach these concepts.
Protocols, 1996
ABSTRACT Many antihypertensive agents exist today for the treatment of primary hypertension (syst... more ABSTRACT Many antihypertensive agents exist today for the treatment of primary hypertension (systolic blood pressure >/=140 mmHg and/or diastolic blood pressure >/=90 mmHg). Randomised controlled trials have been carried out to investigate the evidence for these agents.There is, for example, strong RCT evidence that thiazides reduce mortality and morbidity. Reserpine has been used as a second-line therapy in some of those trials. However, the dose-related blood pressure reduction with this agent is not known. To investigate the dose-related effect of reserpine on blood pressure, heart rate and withdrawals due to adverse events. The databases CENTRAL, EMBASE, and MEDLINE were searched. We also traced citations in the reference sections of the retrieved studies. Included studies were truly randomised controlled trials comparing reserpine monotherapy to placebo or no treatment in patients with primary hypertension. Methods of randomization and concealment were assessed. Data on blood pressure reduction, heart rate,and withdrawal due to adverse effects were extracted and analysed. Four RCTs (N =237) were found that met the inclusion criteria. The overall pooled effect demonstrates a statistically significant systolic blood pressure (SBP) reduction in patients taking reserpine compared to placebo (WMD -7.92, 95% CI -14.05, -1.78). Due to significant heterogeneity across trials, a significant effect in diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) could not be found. The SBP effects were achieved with 0.5 mg/day or greater. However, the dose-response pattern could not be determined because of the small number of trials. Data from the trial that investigated Rauwiloid against placebo was not combined with reserpine data from the remaining three trials. This is because Rauwiloid is a different alkaloid extract of the plant Rauwolfia serpentina and the dose used is not comparable to reserpine. None of the included trials reported withdrawals due to adverse effects. Reserpine is effective in reducing SBP roughly to the same degree as other first-line antihypertensive drugs. However, we could not make definite conclusions regarding the dose-response pattern because of the small number of included trials. More RCTs are needed to assess the effects of reserpine on blood pressure and to determine the dose-related safety profile before the role of this drug in the treatment of primary hypertension can be established.
International Journal of Pediatric Otorhinolaryngology Extra, 2011
Despite its recent development, evidence-based medicine (EBM) is increasingly being implemented i... more Despite its recent development, evidence-based medicine (EBM) is increasingly being implemented in clinical practice, taught in medi- cal schools, and relied upon in government policy-making. Although the principles guiding EBM may seem simple, the translation of scientific and clinical evidence into medical practice has inherent challenges. This review of EBM provides an overview of the history and development of EBM. In addition, we discuss some of the current academic groups that provide EBM resources, specifically the Cochrane Collaboration and the Therapeutics Initiative. We also present several challenges that face the practice of EBM and the bar - riers that persist in the medical curricula as educators strive to teach these concepts.
Palliative care and social practice, 2024
BMC Palliative Care
Background Long-term care (LTC) homes have been disproportionately impacted during COVID-19. Purp... more Background Long-term care (LTC) homes have been disproportionately impacted during COVID-19. Purpose To explore the perspectives of stakeholders across Canada around implementing a palliative approach in LTC home during COVID-19. Methods Qualitative, descriptive design using one-to-one or paired semi-structured interviews. Results Four themes were identified: (1) the influence of the pandemic on implementing a palliative approach, (2) families are an essential part of implementing a palliative approach, (3) prioritizing advance care planning (ACP) and goals of care (GoC) discussions in anticipation of the overload of deaths and (4) COVID-19 highlighting the need for a palliative approach as well as several subthemes. Conclusion The COVID-19 pandemic influenced the implementation of a palliative approach to care, where many LTC homes faced an overwhelming number of deaths and restricted the presence of family members. A more concentrated focus on home-wide ACP and GoC conversations a...
Canadian Family Physician, Jul 1, 2020
The Journal of the American Board of Family Medicine, 2021
Certain members of society are disproportionately affected by the COVID-19 crisis and the added s... more Certain members of society are disproportionately affected by the COVID-19 crisis and the added strain being placed on already overextended health care systems. In this article, we focus on refugee newcomers. We outline vulnerabilities refugee newcomers face in the context of COVID-19, including barriers to accessing health care services, disproportionate rates of mental health concerns, financial constraints, racism, and higher likelihoods of living in relatively higher density and multigenerational dwellings. In addition, we describe the response to COVID-19 by a community-based refugee primary health center in Ontario, Canada. This includes how the clinic has initially responded to the crisis as well as recommendations for providing services to refugee newcomers as the COVID-19 crisis evolves. Recommendations include the following actions: (1) consider social determinants of health in the new context of COVID-19; (2) provide services through a trauma-informed lens; (3) increase focus on continuity of health and mental health care; (4) mobilize International Medical Graduates for triaging patients based on COVID-19 symptoms; and (5) diversify communication efforts to educate refugees about COVID-19. (J Am Board Fam Med 2021;34:S210-S216.
Canadian Family Physician, 2020
Journal of palliative medicine, 2020
Vocal Cord Dysfunction (VCD) is a serious disorder of the vocal cords and laryngeal muscles that ... more Vocal Cord Dysfunction (VCD) is a serious disorder of the vocal cords and laryngeal muscles that mimics asthma and can seriously affect the patient, both physically and emotionally. Patients with this condition are often misdiagnosed and treated inappropriately due to lack of systematic knowledge concerning diagnosis and therapy. The aetiology remains a topic of research; in fact, most experts now agree that vocal cord dysfunction is a group of conditions, or that it has multiple aetiologies. This is appreciated by the extensive number of terms that have been used to describe it. Epidemiological data is also limited, but preliminary investigations suggest that its incidence is higher than initially appreciated. This review summarizes the current existing knowledge and aims to help the reader recognize and develop a management approach to vocal cord dysfunction.
The swift spread of coronavirus disease 2019 (COVID-19) across the globe has challenged health se... more The swift spread of coronavirus disease 2019 (COVID-19) across the globe has challenged health service providers in unprecedented ways. Among the disruptions for general practitioners and allied specialists have been the need to provide in-person care with only limited access to personal protective
The Journal of the American Board of Family Medicine
Certain members of society are disproportionately affected by the COVID-19 crisis and the added s... more Certain members of society are disproportionately affected by the COVID-19 crisis and the added strain being placed on already overextended health care systems. In this article, we focus on refugee newcomers. We outline vulnerabilities refugee newcomers face in the context of COVID-19, including barriers to accessing health care services, disproportionate rates of mental health concerns, financial constraints, racism, and higher likelihoods of living in relatively higher density and multigenerational dwellings. In addition, we describe the response to COVID-19 by a community-based refugee primary health center in Ontario, Canada. This includes how the clinic has initially responded to the crisis as well as recommendations for providing services to refugee newcomers as the COVID-19 crisis evolves. Recommendations include the following actions: (1) consider social determinants of health in the new context of COVID-19; (2) provide services through a trauma-informed lens; (3) increase focus on continuity of health and mental health care; (4) mobilize International Medical Graduates for triaging patients based on COVID-19 symptoms; and (5) diversify communication efforts to educate refugees about COVID-19.
History and Background E vidence-based medicine (EBM) is a relatively new idea in clinical practi... more History and Background E vidence-based medicine (EBM) is a relatively new idea in clinical practice and has been defined as "the conscientious, explicit, and judicious use of the best current evidence in making decisions about the care of individual patients". 1 EBM acts as an important link between current scientific research and clinical practice and aims to provide patients with the best possible care. 2 Although the concept of testing various interventions for efficacy has existed for many centuries, EBM has only started to gain prominence in the late twentieth century. First developed through the work of the Scottish epidemiologist and physician Archie Cochrane in the 1970s, EBM was later introduced into medical practice and education by David Sackett and Gordon Guyatt of McMaster University in the 1990s. 3 A recent online poll conducted by the British Medical Journal named EBM the eighth most important medical breakthrough since 1840, illustrating its increasing significance. 4 The use of EBM in clinical practice is a process that requires the application of five steps. 5 These steps, outlined in Table 1 1 , should be followed in a rigorous manner in order to maximize benefits to patient care. When evaluating studies for EBM, it is essential to use the best available evidence. In most cases, randomized controlled trials (RCTs) are considered to be the best evidence, while noncontrolled trials, observational studies, and medical opinions that are not based on scientific research are considered weaker sources (Table 2). 2 The strength of RCTs lies in the process of
Despite its recent development, evidence-based medicine (EBM) is increasingly being implemented i... more Despite its recent development, evidence-based medicine (EBM) is increasingly being implemented in clinical practice, taught in medi- cal schools, and relied upon in government policy-making. Although the principles guiding EBM may seem simple, the translation of scientific and clinical evidence into medical practice has inherent challenges. This review of EBM provides an overview of the history and development of EBM. In addition, we discuss some of the current academic groups that provide EBM resources, specifically the Cochrane Collaboration and the Therapeutics Initiative. We also present several challenges that face the practice of EBM and the bar - riers that persist in the medical curricula as educators strive to teach these concepts.
Protocols, 1996
ABSTRACT Many antihypertensive agents exist today for the treatment of primary hypertension (syst... more ABSTRACT Many antihypertensive agents exist today for the treatment of primary hypertension (systolic blood pressure >/=140 mmHg and/or diastolic blood pressure >/=90 mmHg). Randomised controlled trials have been carried out to investigate the evidence for these agents.There is, for example, strong RCT evidence that thiazides reduce mortality and morbidity. Reserpine has been used as a second-line therapy in some of those trials. However, the dose-related blood pressure reduction with this agent is not known. To investigate the dose-related effect of reserpine on blood pressure, heart rate and withdrawals due to adverse events. The databases CENTRAL, EMBASE, and MEDLINE were searched. We also traced citations in the reference sections of the retrieved studies. Included studies were truly randomised controlled trials comparing reserpine monotherapy to placebo or no treatment in patients with primary hypertension. Methods of randomization and concealment were assessed. Data on blood pressure reduction, heart rate,and withdrawal due to adverse effects were extracted and analysed. Four RCTs (N =237) were found that met the inclusion criteria. The overall pooled effect demonstrates a statistically significant systolic blood pressure (SBP) reduction in patients taking reserpine compared to placebo (WMD -7.92, 95% CI -14.05, -1.78). Due to significant heterogeneity across trials, a significant effect in diastolic blood pressure (DBP), mean arterial pressure (MAP), and heart rate (HR) could not be found. The SBP effects were achieved with 0.5 mg/day or greater. However, the dose-response pattern could not be determined because of the small number of trials. Data from the trial that investigated Rauwiloid against placebo was not combined with reserpine data from the remaining three trials. This is because Rauwiloid is a different alkaloid extract of the plant Rauwolfia serpentina and the dose used is not comparable to reserpine. None of the included trials reported withdrawals due to adverse effects. Reserpine is effective in reducing SBP roughly to the same degree as other first-line antihypertensive drugs. However, we could not make definite conclusions regarding the dose-response pattern because of the small number of included trials. More RCTs are needed to assess the effects of reserpine on blood pressure and to determine the dose-related safety profile before the role of this drug in the treatment of primary hypertension can be established.
International Journal of Pediatric Otorhinolaryngology Extra, 2011
Despite its recent development, evidence-based medicine (EBM) is increasingly being implemented i... more Despite its recent development, evidence-based medicine (EBM) is increasingly being implemented in clinical practice, taught in medi- cal schools, and relied upon in government policy-making. Although the principles guiding EBM may seem simple, the translation of scientific and clinical evidence into medical practice has inherent challenges. This review of EBM provides an overview of the history and development of EBM. In addition, we discuss some of the current academic groups that provide EBM resources, specifically the Cochrane Collaboration and the Therapeutics Initiative. We also present several challenges that face the practice of EBM and the bar - riers that persist in the medical curricula as educators strive to teach these concepts.