Selected Conference Proceedings
Conference Abstracts from the MJM/MASH Symposium

Published online: 07 June 2019

Top 10 Abstracts for publication in the MJM

Selection Process

First, all submitted abstracts were anonymized by removing authors’ names and affiliations. Second, abstracts were independently reviewed and scored by 2 reviewers (two senior PhD candidates who serve as MJM editors and one final-year MSc candidate representing MASH). Abstracts were scored based on the predetermined criteria of interdisciplinarity, originality, clarity, and scientific merit (equal weight for each criterion). Third, the scores from both reviewers were added to obtain the total score which formed the basis for abstract ranking. Fourth, the top 10 abstracts were selected based on the total score and author’s attendance at the symposium and consent to have the abstract published in MJM. Abstracts have not been previously published (authors have filled out a form confirming eligibility criteria).

Antidepressants Prescribing Patterns in Primary Care: Do Primary Care Practitioners Prescribe Obesogenic Antidepressants to Obese Patients?

Svetlana Puzhko1, MD, MSc, Tibor Schuster1, PhD, Gillian Bartlett1, PhD
1Department of Family Medicine, McGill University, Montreal, Quebec, Canada

Introduction: Obese patients often experience more severe depression than normal weight patients and may have poorer responses to antidepressant (AD) treatment. Certain AD are obesogenic, thereby increasing patients weight, further contributing to the prevalence of obesity in patients with depression. Greater understanding of obesogenic AD prescribing patterns is needed to identify problems and improve prescribing policies. The aim of this study is to estimate the association between obesity status and AD prescribing, focusing on obesogenic AD, using the national primary care practice database.

Methods: A cross-sectional analysis of a large primary care practice-based cohort data was conducted using the Electronic Medical Records from the national Canadian Primary Care Sentinel Surveillance Network (CPCSSN) between 2011-2016. Inclusion criteria were adult patients (18 years of age or older) diagnosed with depression. The outcome measure was the AD prescription; prescription for at least one AD, prescription for AD known for its obesogenic effect. Exposure measure was body mass index to categorize patients into obese and non-obese. A multivariable logistic regression, adjusting for age, sex and comorbidities, was performed.

Results: Among 61699 patients with depression, 41389 (67.1%) were prescribed at least one AD between 2011-2016. Compared with normal weight patients, obese patients were more likely to be prescribed AD (adjusted Odds Ratio (aOR)=1.21; 95% Confidence Interval (CI): 1.16-1.26). Obese patients were less likely to receive obesogenic AD, mirtazapine (aOR=0.64; 95% CI: 0.58-0.70), than normal weight patients; however, compared with normal weight patients, obese patients were more likely to receive other medications for depression known for their obesogenic effect: amitriptyline (aOR=1.26; 95% CI: 1.15-1.38), paroxetine (aOR=1.19; 95% CI: 1.06-1.34), and quetiapine (aOR=1.09; 95% CI: 1.00-1.18).

Conclusion: Obese patients are more likely to be prescribed pharmacological treatment with AD and to receive obesogenic AD. While causality cannot be inferred, these prescribing patterns may be implicated in the increased risk for severe depression and poorer response to treatment among obese patients.

Corresponding author: Svetlana Puzhko,

The Community Health And Social Medicine Incubator (CHASM): A Pilot of Student Led Social Change

Anne Xuan-Lan Nguyen1, Andrew Dixon1, Brianna Cheng1, Julie De Meulemeester1, David-Dan Nguyen1, Kacper Niburski1
1Faculty of Medicine, McGill University, Montreal, Quebec, Canada

Introduction: Medical schools across Canada have incorporated service-learning into their curricula. Interdisciplinary service-learning allows students to dismantle the perceived separation of work and civic contributions at the root of many health inequities. We adopt a corporate incubator model for community health needs as an approach to innovative service learning.

Methods: Community Health and Social Medicine Incubator (CHASM) was founded by McGill medical students in June 2017 to improve the health outcomes of local, historically marginalized communities. CHASM’s interprofessional team helps students partner with a community organization, form an interdisciplinary team, and develop a project to address the population’s self-identified social determinants of health. The end goal is for the project to be entirely handed over to the community. The recruited projects are given a framework to scale their ideas, which includes: 1. Mentoring by business and public health experts, largely faculty at McGill University; 2. A social entrepreneurship curriculum with bimonthly, interactive workshops; 3. Funding; 4. A network that supports and publicizes the projects.

Results: The inaugural cohort 2018 is composed of three teams: Monthly Dignity, which provide feminine hygiene products to homeless shelters; Supporting Young Black Students, which mentors Black Montreal youth to facilitate their admission to university health programs; and Community Ambassadors to Conquer HPV, which provides HPV vaccines and pap smears to underprivileged women. The 2019 selected teams are the two following: Student Clinic, which provides educational workshops, health and social services to asylum seekers; and Primary Eye Exposure and Prevention Sessions, which offers ocular prevention and screening tests to the elderly population in Montreal.

Conclusion: This unprecedented educational opportunity allows students to partner with local communities to sustainably address their social determinants of health, while simultaneously acquiring project development and advocacy skills. Successful in its first year, we envision the CHASM incubator model as an integral part of Canadian healthcare programs and medical education.

Corresponding author: Anne Xuan-Lan Nguyen, All authors report equal contribution.

Implementation Matters: Lessons Learned From a Systematic Review of Barriers and Facilitators to Case Management in Primary Care

Matthew Hacker Teper, BA, MSc1, Isabelle Vedel, MD, MPH, PhD1, Xin Qiang Yang1, Eva Margo-Dermer, BSc1, Catherine Hudon, MD, PhD2
1 Department of Family Medicine, McGill University, Montreal, Quebec, Canada
2 Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Sherbrooke, Quebec, Canada

Introduction: In response to an aging global population with increased chronic illness, case management (CM) has emerged as a powerful innovation to address the health challenges of patients with complex needs. Despite growing evidence on the benefits of CM for the care of these patients, implementation of CM in primary care has been challenging worldwide. There remains a dearth of synthesis and evidence surrounding the barriers and facilitators to conducting CM, especially in primary care settings.

Methods: A systematic review and thematic synthesis of qualitative findings was conducted. In collaboration with an academic medical librarian, three electronic databases (OVID Medline, CINAHL, Embase) were searched for qualitative and mixed-methods studies related to factors (barriers and/or facilitators) affecting CM in primary care. Titles, abstracts and full texts were screened in duplicate and assessed for quality. Results from included studies were synthesized according to the method of Thomas and Harden (2008).

Results: Of the 1572 unique records initially located, 19 studies, originating from six countries, met the inclusion criteria. Nine factors affecting the ability of primary care teams to conduct CM were identified: “Family Context”, “Policy and Available Resources”, “Physician Buy-In and Understanding of the Case Manager Role”, “Team Communication Practices”, “Training in Technology”, “Relationships with Physicians”, “Relationships with Patients”, “Time Pressure and Workload”, and “Autonomy of Case Manager”. These factors are described, and presented in a schematic representation designed to demonstrate the relationships between factors.

Conclusions: This systematic review identifies a wide range of barriers and facilitators that influence a primary care team’s capacity to conduct CM. Understanding these barriers and facilitators may allow for the development of policy- or clinic-level interventions to improve CM function and, by extension, to provide better care for patients with complex needs.

Corresponding author: Matthew Hacker Teper, email

Key Factors for Safe Birth Among the Nancue Ñomndaa People in Guerrero, Mexico: Modeling Indigenous Perspectives of Maternal Health

Ivan Sarmiento, MPH1, David Loutfi, MSc1, Sergio Paredes-Solís, MD, MSc, DSc2, Neil Andersson, MD, MSc, MPhil, PhD1,2
1 Department of Family Medicine, McGill University, Montreal, Quebec, Canada
2 Centro Investigación de Enfermedades Tropicales, Universidad Autónoma de Guerrero, Mexico

Introduction: Participatory research involves people affected by an issue in creating the knowledge to solve it. However, ineffective methodologies hinder proper understanding and incorporation of indigenous perspectives on health care. Our objective was to use fuzzy cognitive maps to model indigenous perspectives on maternal health care and develop new tools for intercultural dialogue.

Methods: We worked with 11 traditional midwives from the Nancue-ñomndaa people and used fuzzy cognitive maps to understand their knowledge of risk factors for safe motherhood. These maps illustrated networks of factors (nodes) and relationships between those factors (using arrows). Through consensus, the traditional midwives ranked the importance of the relationship between nodes on a scale of 1 to 5. The analysis normalized the weights between 0 to 1 and calculated fuzzy transitive closure to rank the importance of each factor while taking into account all other factors, and the relationships between them, and to determine optimal paths for intervention.

Results: Traditional midwives described two components (nodes) to safe birth: maternal morbidity and maternal death. They described 13 risk factors and 44 relationships. Transitive closure analysis identified the three most important risk factors for maternal morbidity: women’s disregard for traditional self-care practices (i.e. reduction of heavy work, avoidance of certain foods, hygiene) (0.71), violence against women (0.46), and spiritual imbalances (0.21). For maternal death, maternal morbidity (0.36), disregard of self-care practices (0.30) and violence (0.10) were the most important risks.

Conclusions: According to these traditional midwives, appropriate care for their communities include factors not well understood in Western-based health services (traditional self-care practices and spiritual imbalances). The social and cultural dimensions of gender-based violence require interventions beyond clinical care. Fuzzy cognitive maps offer new approaches for research and co-design of interventions that take cultural context into account, and build on local resources and strengths.

Corresponding author: Ivan Sarmiento, email

Sleep Slow Waves and Spindles in Obstructive Sleep Apnea

Sirin Chami1,2, Katia Gagnon1,2, Andrée-Ann Baril1,2, Hélène Blais1, Jacques Montplaisir1,2, Julie Carrier1,2, Nadia Gosselin1,2
1 Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
2 Université de Montréal, Montreal, Quebec, Canada

Introduction: Obstructive sleep apnea (OSA) is a sleep disorder characterized by cessations (apnea) or reductions (hypopnea) of airflow following upper airway obstructions. These respiratory events cause sleep fragmentation and intermittent hypoxemia. OSA in older adults is a risk factor for dementia, but the mechanisms linking OSA and dementia are not clear and need further investigation. Considering that non-rapid eye movement (NREM) oscillatory events (i.e. sleep slow waves and spindles) are important for memory consolidation and neural plasticity, the aim of the present study was to test the hypothesis that increased OSA severity is associated with lower amplitude, and density slow waves and spindles.

Methods: Our study included a sample of 103 middle-aged and older subjects (mean age = 64.20 years; SD = 6.63) with an OSA varying from absent to severe. They were tested with one night of in-laboratory polysomnography which allowed us to characterize their sleep. Partial correlations controlling for age and sex were performed between slow wave or spindle characteristics (i.e. amplitude, density, durations, slope and frequency) and markers of OSA severity (hypoxemia, respiratory disturbances and sleep fragmentation). We also studied the relationship between the electroencephalogram slow wave activity (0.5 to 4.5 Hz) and OSA severity.

Results: We found that higher sleep fragmentation and respiratory disturbance associated with a decreased slow wave amplitude and density (r varying from -0.260 to -0.315, p varying from 0.002 to 0.010). Moreover, increased sleep fragmentation and respiratory disturbance correlated with a lower power of slow absolute wave activity. No significative correlations were found between spindles characteristics and OSA severity.

Conclusions: Overall, our findings suggest that OSA severity may compromise the regular generation of slow waves in middle-aged and older subjects. Further studies should examine whether these changes in slow wave disturb the neural plasticity and lead to cognitive dysfunctions.

Corresponding author: Sirin Chami, email

The Development of Best Practice Guidelines to Provide Care and Support to Children with Osteogenesis Imperfecta

Teresa Liu1, Jingyi Feng1, Sindhu Tadisetty1, Shirley Xu1, Rosie Zhang1, Athanasoulias Tina, BScN2, Brunelle Johanne, BScN2, Baker Donna, MRT diploma2, Claudette Bilodeau, BScN2, Maria Caruzo, B.A.SET2, Mary Curtin, B.A.CLE2, Monica Chan, MSc, PT2, François Champion, MRT diploma2, Chantal Damas, BA, PT2, Maria Donato, BA2, Lucy Furtado, RNA2, Angie Gugliotti, BA CLE2, Marie-Elaine Lafrance, MSc, OT2, Giuseppina Napoletano, MRT diploma2, Pierre Ouellet, BScN2, Marvline Provost, BScN2, Trudy Wong, MSW2, Frank Rauch, MD1,2, Argerie Tsimicalis, PhD1,2
1 Centre for Advanced Research in Sleep Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
2 Université de Montréal, Montreal, Quebec, Canada

Introduction: Osteogenesis Imperfecta (OI) is a rare genetic disorder affecting the amount or the quality of type I collagen, which decreases the density of bone, increases the rate of fractures, and contributes to children’s fear of fractures. At Shriners Hospitals for Children®-Canada, the interprofessional team has developed varying techniques to to facilitate the provision of medical procedures (e.g. transfers, blood pressure, casting) and help children accomplish various activities of daily living while overcoming their fear of fracture. These techniques have yet to be described in the literature. Objective: The objective of this study is to create best practice guidelines to guide teachers, family caregivers, and healthcare professionals on how to provide care to children with OI in the hospital and community settings (e.g. home and school).

Methods: This knowledge synthesis study was overseen by an interprofessional expert task force at Shriners Hospitals for Children®-Canada and entailed (1) review and synthesis of the literature, (2) description of the context and setting, (3) acknowledgment of potential conflicts of interests, (4) development of guidelines, and (5) plans for approvals and updates.

Results: A review of 5 databases revealed that there is no published literature on the topic. These in-progress practice guidelines are being created from evidence compiled from the clinical expertise of the expert task force and observations derived from the clinical setting, which is a global leader in the provision of OI care. Topics include: (1) always respect the parents’ expertise and involve the parents and children, (2) be attuned to the evolving needs and capacity of the child and parents through development, (3) balance between overprotecting and stimulating appropriate development. Approvals from the directors and OI Foundations will be sought with plans to update the guidelines every 2 years.

Conclusions: The evidence-based guidelines will fill a gap in the literature and offer a rich resource to teachers, family caregivers, and healthcare professionals, who seek to provide care for children with OI. The process of creating these clinically-meaningful best practices guidelines, along with the findings, may serve as a resource to other populations whose fragile bones may need to be handled with care as well.

Corresponding author: Teresa Liu, email

The Moral Experiences of Children with Osteogenesis Imperfecta

Yi Wen Wang1,2, Franco Carnevale, RN, PhD1,2, Maria Ezcurra, MFA, PhD1,2, Khadidja Chougui, BA2, Claudette Bilodeau, RN2, Sophia Siedlikowski, MSc1,2, Argerie Tsimicalis, RN, PhD1,2
1 McGill University, Montreal, Quebec, Canada
2 Shriner’s Hospital for Children, Montreal, Quebec, Canada

Introduction: Osteogenesis Imperfecta (OI) is a rare genetic disorder affecting the amount or the quality of type I collagen, which decreases the density of bone, increases the rate of fractures, and contributes to children’s fear of fractures. At Shriners Hospitals for Children®-Canada, the interprofessional team has developed varying techniques to to facilitate the provision of medical procedures (e.g. transfers, blood pressure, casting) and help children accomplish various activities of daily living while overcoming their fear of fracture. These techniques have yet to be described in the literature. Objective: The objective of this study is to create best practice guidelines to guide teachers, family caregivers, and healthcare professionals on how to provide care to children with OI in the hospital and community settings (e.g. home and school).

Methods: A focused ethnography was conducted at Shriners Hospital for Children®- Canada with 10 children with OI. Data was collected using practice-based research methods permitting the engagement of children in planned artistic workshops. Semi-structured interviews were conducted during art-making to facilitate discussion of children’s artwork and OI experiences. Data was broken down into smaller groups, named according to the theme(s) they represent, and then further grouped according to shared concepts.

Results: Three main findings arose: 1) art is a useful medium through which children can express their voice, 2) children lack encouragement in the hospital setting to participate in their care, and 3) children’s moral experiences are shaped by various interactions with their communities.

Conclusions: Children often experience discrepancies between their actual and desired participation in discussion, decisions, and actions in the OI hospital setting. This can act as an impediment towards their development. Therefore, it is important to elicit a child’s voice throughout their care, which can be facilitated through an arts-based approach. This preliminary evidence allows us to bridge knowledge gaps and permits ongoing research into understanding children’s perspectives living with OI. In doing so, improvements can be made to measures, policies, and procedures to reflect their best interests and moral agency.

Corresponding author: Yi Wen Wang , email

The Association Between Psychotropic Medications and Healthcare Utilization in Quebecois Seniors with Dementia: A Population-Based Study

Eva Margo-Dermer, BSc1, Isabelle Vedel, MD, PhD1, Catherine Hudon, MD, PhD2
1 Department of Family Medicine, McGill University, Montreal, Quebec, Canada
2 Département de médecine de famille et de médecine d’urgence, Université de Sherbrooke, Sherbrooke, Quebec, Canada

Introduction: Canada’s aging population poses challenges to healthcare systems, due in part to a rising incidence of dementia. Persons with dementia have twice the acute hospital use of elders without dementia. Antipsychotics and benzodiazepines are psychotropic medications that are widely prescribed to persons with dementia. Antipsychotic side effects can lead to fall-related injuries, and the medication is linked to cerebrovascular events and mortality. Benzodiazepine prescribing guidelines recommend against their use due to adverse side effects, risks and little evidence for their effectiveness. Adverse medication-linked events may prompt consultations with the healthcare system, which can be distressing for the patient and costly to the system. It is thus essential to understand the implications of psychotropic medication use for dementia patients’ interactions with healthcare systems. Objective: The objective of this research is to evaluate the association between psychotropic medication use and healthcare utilization in persons with dementia.

Methods: Data for this retrospective cohort study will be collected from the Institut national de santé publique du Québec (INSPQ) provincial database. Those with dementia will be identified and divided into exposure groups based on their prescription status March 31st, 2015: 1) antipsychotic (AP) users, 2) benzodiazepine (BZD) users, 3) other prescriptions. Healthcare utilization data (number of emergency visits, number and length of hospitalizations, transfer to long-term care) and mortality in following 3 months will then be collected. Linear regression analyses will be conducted to compare risk for each utilization component and mortality between groups. Multivariate analyses will account for confounders (previous utilization, psychological disorders, polypharmacy, comorbidities, chronic pain, socioeconomic status, sex and age).

Implications: This is the first study to evaluate and compare the associations between specific psychotropic medications and healthcare utilization. This research is expected to contribute to the development of sustainable dementia management strategies, inform guidelines and inform physician decision-making for prescriptions for patients with dementia to minimize unnecessary healthcare utilization.

Corresponding author: Yi Wen Wang , email

Medical Reversals in Primary Health Care: Towards Improved Clinical Decision-Making and Education of Healthcare Professionals

Christian Ruchon1, Roland Grad, MDCM, MSc, FCFP1, Pierre Pluye, MD, PhD1, Kristian B. Filion, PhD2, David C. Slawson, MD3, Allen F. Shaughnessy, PharmD, MMed4, Tibor Schuster, PhD1, Emelie Braschi, MD, PhD5, Mathieu Rousseau, MD, PhD1, Soumya B. Sridhar, MBBS, MSc6, Anupriya Grover, DO7, Jennifer R.-S. Cheung, MD7, Mark H. Ebell, MD, MS8
1 Department of Family Medicine, McGill University, Montreal, Quebec, Canada
2 Departments of Medicine and of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
3 Department of Family Medicine, University of North Carolina at Chapel Hill, Charlotte, North Carolina, USA
4 Department of Family Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
5 Department of Physical Medicine and Rehabilitation, University of Ottawa, Ottawa, Ontario, Canada
6 Department of Family Medicine, University of Rochester, Rochester, New York, USA
7 Cambridge Health Alliance, Cambridge, Massachusetts, USA
8 Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, Georgia, USA

Introduction: The efficacy of clinical interventions is challenged as new research evidence emerges. The concept of medical reversal (MR) occurs when new evidence determines an established evidence-based medical practice to be less effective or more harmful than originally claimed and contributes to practice change. The underlying reasons for MR remain poorly understood in the context of primary healthcare. The purpose of this research is to identify characteristics of randomized controlled trials (RCTs) associated with MR in primary healthcare.

Methods: A dataset of 960 Patient-Oriented Evidence that Matters (POEMs) from 2002-2007 will be studied. These POEMs, written for the purpose of educating clinicians, summarize RCTs selected for their relevance to primary healthcare.
Step 1: From each POEM-RCT, the evidence (E1) will be extracted. Then, evidence about the efficacy of the intervention in each POEM-RCT will be extracted from knowledge resources such as DynaMed in 2019 (E2). Teams of two independent physician-raters will compare the initial (E1) and updated (E2) evidence of efficacy and categorize each POEM as (1) reversed or (2) not reversed, in 2019.
Step 2: From each POEM-RCT, factors that may be associated with MR such as sample size, allocation concealment, or industry sponsorship will be extracted. A logistic regression analysis, where MR (Step 1) is the dependent variable and the factors (Step 2) are the independent variables, and a random forest will be performed. The results from both analyses will be compared.

Results: Step 1: 30-40 POEMs are expected to be categorized as reversed in 2019.
Step 2: Factors such as trial sample size are anticipated to be associated with MR.

Conclusions: Awareness of factors associated with reversal of medical practices will contribute to enhanced clinical decision-making, improve the education of health professionals, and may be predictive of MR.

Corresponding author: Christian Ruchon, email

How Does Participation in Workshops About Basic Assessment Techniques Regarding the Musculoskeletal System Increase the Knowledge and Confidence of Medical Students?

Cyril Boulila, MSc1, Christophe Gendron, MSc1, Élise Girouard-Chantal, MSc1, Tim Dubé, PhD2
1 Faculty of Medicine, McGill University, Montreal, Quebec, Canada
2 Centre for Medical Education, McGill University, Montreal, Quebec, Canada

Introduction: Graduating medical students and physicians identify themselves as having a poor knowledge of musculoskeletal (MSK) conditions, as well as a weak confidence in their ability to assess them. In comparison, Physical and Occupational Therapy programs (PT and OT respectively) dedicate an extensive amount of time to teaching their students detailed MSK disorders and assessment techniques. This premise led a group of medical students to create a series of interprofessional learning activities about MSK assessment in the form of hands-on workshops (referred as MSK-ABA) involving both PT/OT and medical students. The current research aims to determine whether participation in these innovative student-initiated MSK-ABA workshops provides medical students with the possibility to gain knowledge and strengthen their confidence in their ability regarding MSK assessment.

Methods: In this ongoing project, 10 medical students of McGill University will attend 3 MSK-ABA workshops on a voluntary basis, each one covering a different joint. Pre-post quizzes will be used to assess change in knowledge of MSK assessment techniques and a pre-post questionnaire will be used to assess medical students’ confidence in their ability to perform a basic MSK exam. A focus group interview will be conducted to gain an in-depth understanding of the medical students’ perspectives regarding their participation in the workshops

Results: We anticipate this type of innovative interprofessional learning to be highly valued by the students. We also anticipate medical students will show an increased knowledge about common MSK conditions post-workshop, as well as an increased confidence with basic MSK assessment techniques.

Conclusions: Ultimately, by learning and practicing basic MSK assessment in the setting of an interprofessional workshop, we hypothesize that medical students will feel more confident in their knowledge and skills in MSK system examination, preparing them better to address MSK conditions adequately and to work in interprofessional teams.

Corresponding author: Christophe Gendron, email