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Sheppard G, McIlveen-Brown E, Jacques Q, Barry N, Morris J, Yi Y, Bischoff T, Pham C, Menchetti I, Lim R, Pardhan A, Mann M, Byrne A, Hurley KF, Zia A, Chan TM. Perceptions of gender equity in emergency medicine in Canada. CAN J EMERG MED 2024; 26:271-279. [PMID: 38342855 DOI: 10.1007/s43678-024-00665-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/30/2024] [Indexed: 02/13/2024]
Abstract
INTRODUCTION Women-identifying emergency physicians face gender-based discrimination throughout their careers. The purpose of this study was to explore emergency physician's perceptions and experiences of gender equity in emergency medicine. METHODS We conducted a secondary analysis of data from a previously conducted survey of Canadian emergency physicians on barriers to gender equity in emergency medicine. Survey responses were analyzed using logistic regression to determine the impact that gender, practice setting, years since graduation, race, equity-seeking status, and parental status had on agreement about gender equity in emergency medicine and five of the problem statements. RESULTS A total of 710 participants completed the survey. Most identified as women (58.8%), white (77.4%), graduated between 2010 and 2019 (40%), had CCFP (Emergency Medicine) designation (47.9%), an urban practice (84.4%), were parents (62.4%) and did not identify as equity-seeking (79.9%). Women-identifying physicians were less likely to perceive gender equity in emergency medicine, OR 0.52, CI [0.38, 0.73]. Women-identifying physicians were more likely to agree with statements about microaggressions, OR 4.39, CI [2.66, 7.23]; barriers to leadership, OR 3.51, CI [2.25, 5.50]; gender wage gap, OR 13.46, CI [8.27, 21.91]; lack of support for parental leave, OR 2.85, CI [1.82, 4.44]; and education on allyship, OR 2.23 CI [1.44, 3.45] than men-identifying physicians. CONCLUSION In this study, women-identifying physicians were less likely to perceive that there was gender equity in emergency medicine than men-identifying physicians. Women-identifying physicians agreed that there are greater barriers for career advancement including fewer opportunities for leadership, a gender wage gap, a lack of parental leave policies to support a return to work and a lack of education for men to become allies. Men-identifying physicians were less aware of these inequities. Health systems must work to improve gender equity in emergency medicine and this will require education and allyship from men-identifying physicians.
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Affiliation(s)
- Gillian Sheppard
- Discipline of Emergency Medicine, Memorial University of Newfoundland, St. John's, NL, Canada.
| | - Emma McIlveen-Brown
- Discipline of Emergency Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Queen Jacques
- Division of Population Health and Applied Health Sciences, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Nicole Barry
- Faculty of Business Administration, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Judy Morris
- Department of Family and Emergency Medicine, University of Montreal, Montreal, QC, Canada
| | - Yanqing Yi
- Division of Population Health and Applied Health Sciences, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Taylor Bischoff
- Division of Emergency Medicine, University of Toronto, Toronto, ON, Canada
| | - Chau Pham
- Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Isabella Menchetti
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Rodrick Lim
- Department of Pediatrics, Western University, London, ON, Canada
| | - Alim Pardhan
- Division of Emergency Medicine, Department of Medicine and Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Miriam Mann
- Department of Emergency Medicine, Huron Perth Healthcare Alliance, Stratford, ON, Canada
| | - Alyson Byrne
- Faculty of Business Administration, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Katrina F Hurley
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
| | - Ayesha Zia
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Teresa M Chan
- School of Medicine, Toronto Metropolitan University, Toronto, ON, Canada
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Cherry JC, Fitzpatrick EA, Sandila NK, Lovas D, Hurley KF. Non-suicidal self-injury at a Canadian paediatric emergency department. CAN J EMERG MED 2024; 26:259-265. [PMID: 38565769 DOI: 10.1007/s43678-024-00657-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 01/24/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE Our primary objective was to determine agreement between non-suicidal self-injury recorded at triage and during subsequent mental health assessment. The secondary objective was to describe patients who reported non-suicidal self-injury. METHODS This is a health records review of patients aged 12-18 years who had an Emergency Mental Health Triage form on their health record from an ED visit June 1, 2017-May 31, 2018. We excluded patients with diagnoses of autism spectrum disorder or schizophrenia. We abstracted data from the Mental Health Triage form, Emergency Mental Health and Addictions Service Assessment forms and Assessment of Suicide and Risk Inventory. We calculated Cohen's Kappa coefficient, sensitivity, and negative predictive value to describe the extent to which the forms agreed and the performance of triage for identifying non-suicidal self-injury. We compared the cohort who reported non-suicidal self-injury with those who did not, using t-tests, Wilcoxon rank-sum tests, and chi-square tests. RESULTS We screened 955 ED visits and included 914 ED visits where 558 (58.4%) reported a history of non-suicidal self-injury. There were significantly more females in the group reporting non-suicidal self-injury (82.1%, n = 458) compared to the group not reporting non-suicidal self-injury (45.8%, n = 163). Patients reporting non-suicidal self-injury did so in triage and detailed Mental Health Assessment 64.7% of the time (Cohen's Kappa Coefficient 0.6); triage had sensitivity of 71.5% (95% CI 67.3-75.4) and negative predictive value of 71.2% (95% CI 68.2-74.0). Cutting was the most common method of non-suicidal self-injury (80.3%). CONCLUSION Screening at triage was moderately effective in identifying non-suicidal self-injury compared to a detailed assessment by a specialised mental health team. More than half of children and adolescents with a mental health-related concern in our ED reported a history of non-suicidal self-injury, most of which were female. This symptom is important for delineating patients' coping strategies.
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Affiliation(s)
- Jonathan C Cherry
- Division of Pediatric Emergency Medicine, IWK Health Emergency Department, Dalhousie University, Halifax, NS, Canada.
| | - Eleanor A Fitzpatrick
- Division of Pediatric Emergency Medicine, IWK Health Emergency Department, Dalhousie University, Halifax, NS, Canada
| | | | - David Lovas
- Department of Psychiatry, IWK Health, Dalhousie University, Halifax, NS, Canada
| | - Katrina F Hurley
- Division of Pediatric Emergency Medicine, IWK Health Emergency Department, Dalhousie University, Halifax, NS, Canada
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Gardner K, Hurley KF. Impact of virtual care on planned rechecks in a pediatric emergency department: a quality improvement project. CAN J EMERG MED 2024; 26:156-163. [PMID: 38342856 DOI: 10.1007/s43678-024-00664-w] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 01/30/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND In the absence of accessible urgent follow-up options, emergency physicians may use an in-person recheck (planned return visit) to the Emergency Department (ED) as a safety net for discharged patients. In-person rechecks require travel, triage, and waiting time for patients and families and contribute to ED census. Many of these visits do not result in further investigation or changes in management but can provide reassurance for the family and care providers. We aimed to reduce the volume of in-person rechecks to our ED through an urgent virtual follow-up process. METHODS We conducted a quality improvement project using iterative process mapping and Plan-Do-Study-Act cycles to develop and implement a new model of care for virtual rechecks. An interdisciplinary team tested and refined the virtual care process from December 2020 to June 2022. Outcome, process and balancing measures were tracked continuously and analyzed using statistical process control. RESULTS Baseline data revealed that the majority of in-person rechecks were for young infants with bronchiolitis. Post-implementation of the new process, 50% of all virtual rechecks were for respiratory illnesses. Use of virtual rechecks increased steadily to an average of 6.5 per 1000 ED visits with 58% of all rechecks now completed virtually. The number of in-person rechecks did not decrease during the study period. Virtual rechecks triggered an in-person ED visit in 5.2% of virtual recheck instances. There was no increase in unplanned return ED visits or admissions after implementation of virtual rechecks. CONCLUSION Virtual rechecks can be safely implemented to allow urgent reassessment of patients following an ED visit. Virtual rechecks could be a useful tool for addressing planned reassessments in the pediatric ED, especially during surges of respiratory illness.
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Affiliation(s)
- Katie Gardner
- IWK Health, Dalhousie University, Halifax, NS, Canada.
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Hurley KF, Fitzpatrick EA, Hatchette JE, Slaunwhite EM, Cherry JC. Impact of dexamethasone dose on return visits at a pediatric emergency department. CAN J EMERG MED 2023; 25:785-786. [PMID: 37382768 DOI: 10.1007/s43678-023-00550-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/16/2023] [Indexed: 06/30/2023]
Affiliation(s)
- Katrina F Hurley
- IWK Health, Division of Pediatric Emergency Medicine, Dalhousie University, Halifax, NS, Canada.
| | - Eleanor A Fitzpatrick
- IWK Health, Division of Pediatric Emergency Medicine, Dalhousie University, Halifax, NS, Canada
| | | | - Erin M Slaunwhite
- Saint John Regional Hospital, Department of Emergency Medicine, Dalhousie University, Saint John, NB, Canada
| | - Jonathan C Cherry
- IWK Health, Division of Pediatric Emergency Medicine, Dalhousie University, Halifax, NS, Canada
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Sarty J, Fitzpatrick EA, Taghavi M, T VanBerkel P, Hurley KF. Machine learning to identify attributes that predict patients who leave without being seen in a pediatric emergency department. CAN J EMERG MED 2023; 25:689-694. [PMID: 37507558 DOI: 10.1007/s43678-023-00545-8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/16/2023] [Indexed: 07/30/2023]
Abstract
PURPOSE To characterize patients who left without being seen (LWBS) from a Canadian pediatric Emergency Department (ED) and create predictive models using machine learning to identify key attributes associated with LWBS. METHODS We analyzed administrative ED data from April 1, 2017, to March 31, 2020, from IWK Health ED in Halifax, NS. Variables included: visit disposition; Canadian Triage Acuity Scale (CTAS); triage month, week, day, hour, minute, and day of the week; sex; age; postal code; access to primary care provider; visit payor; referral source; arrival by ambulance; main problem (ICD10); length of stay in minutes; driving distance in minutes; and ED patient load. The data were randomly divided into training (80%) and test datasets (20%). Five supervised machine learning binary classification algorithms were implemented to train models to predict LWBS patients. We balanced the dataset using Synthetic Minority Oversampling Technique (SMOTE) and used grid search for hyperparameter tuning of our models. Model evaluation was made using sensitivity and recall on the test dataset. RESULTS The dataset included 101,266 ED visits where 2009 (2%) records were excluded and 5800 LWBS (5.7%). The highest-performing machine learning model with 16 patient attributes was XGBoost which was able to identify LWBS patients with 95% recall and 87% sensitivity. The most influential attributes in this model were ED patient load, triage hour, driving minutes from home address to ED, length of stay (minutes since triage), and age. CONCLUSION Our analysis showed that machine learning models can be used on administrative data to predict patients who LWBS in a Canadian pediatric ED. From 16 variables, we identified the five most influential model attributes. System-level interventions to improve patient flow have shown promise for reducing LWBS in some centres. Predicting patients likely to LWBS raises the possibility of individual patient-level interventions to mitigate LWBS.
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Affiliation(s)
- Julia Sarty
- Department of Industrial Engineering, Dalhousie University, Halifax, NS, Canada
| | - Eleanor A Fitzpatrick
- IWK Health Emergency Department, Division of Pediatric Emergency Medicine, Dalhousie University, Halifax, NS, Canada
| | - Majid Taghavi
- Sobey School of Business, Saint Mary's University, Halifax, NS, Canada
| | - Peter T VanBerkel
- Department of Industrial Engineering, Dalhousie University, Halifax, NS, Canada
| | - Katrina F Hurley
- IWK Health Emergency Department, Division of Pediatric Emergency Medicine, Dalhousie University, Halifax, NS, Canada.
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Hurley KF, Fitzpatrick EA, Xie J, Urquhart S, Farion KJ, Gouin S, Schuh S, Poonai N, Freedman S. Predictors of Adherence to Short-Course Probiotics Among Children with Gastroenteritis who are Enrolled in a Clinical Trial. CLIN INVEST MED 2023; 46:E15-23. [PMID: 36966390 DOI: 10.25011/cim.v46i1.39560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 11/08/2022] [Indexed: 03/27/2023]
Abstract
BACKGROUND To improve our understanding of adherence to discharge medications in the ED and within research trials, we sought to quantify medication adherence and identify predictors thereof in children with acute gastroenteritis (AGE). METHODS We conducted a secondary analysis of a randomized trial of twice daily probiotic for 5 days. The population included previously healthy children aged 3-47 months with AGE. The primary outcome was patient-reported adherence to the treatment regimen, defined a priori as having received >70% of the prescribed doses. Secondary outcomes included predictors of treatment adherence and concordance between patient-reported adherence and the returned medication sachet counts. RESULTS After excluding participants with missing data on adherence, 760 participants were included in this analysis: 383 in the probiotic arm (50.4%); and 377 in the placebo arm (49.6%). Self-reported adherence was similar in both groups (77.0% in probiotic versus 80.3% in placebo). There was good agreement between self-reported adherence and sachet counts (87% within limits of agreement (-2.9 to 3.5 sachets) on the Bland-Altman plots). In the multivariable regression model, covariates associated with adherence were greater number of days of diarrhea post-emergency department visit, and the study site; covariates negatively associated with adherence were age 12-23 months, severe dehydration and greater total number of vomiting and diarrhea episodes after enrolment. CONCLUSIONS Longer duration of diarrhea and study site were associated with higher probiotic adherence. Age 12-23 months, severe dehydration and greater number of vomiting and diarrhea episodes post enrolment negatively predicted treatment adherence.
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Affiliation(s)
- Katrina F Hurley
- Division of Pediatric Emergency Medicine, IWK Health, Halifax, NS, Canada.
| | | | - Jianling Xie
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sarah Urquhart
- Department of Pediatric Emergency Medicine, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Ken J Farion
- Departments of Pediatrics and Emergency Medicine, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Serge Gouin
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| | - Suzanne Schuh
- Division of Pediatric Emergency Medicine and Research Institute, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Naveen Poonai
- Division of Emergency Medicine, London Health Sciences Centre, Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Stephen Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Horne RG, Freedman SB, Johnson-Henry KC, Pang XL, Lee BE, Farion KJ, Gouin S, Schuh S, Poonai N, Hurley KF, Finkelstein Y, Xie J, Williamson-Urquhart S, Chui L, Rossi L, Surette MG, Sherman PM. Intestinal Microbial Composition of Children in a Randomized Controlled Trial of Probiotics to Treat Acute Gastroenteritis. Front Cell Infect Microbiol 2022; 12:883163. [PMID: 35774405 PMCID: PMC9238408 DOI: 10.3389/fcimb.2022.883163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/18/2022] [Indexed: 11/24/2022] Open
Abstract
Compositional analysis of the intestinal microbiome in pre-schoolers is understudied. Effects of probiotics on the gut microbiota were evaluated in children under 4-years-old presenting to an emergency department with acute gastroenteritis. Included were 70 study participants (n=32 placebo, n=38 probiotics) with stool specimens at baseline (day 0), day 5, and after a washout period (day 28). Microbiota composition and deduced functions were profiled using 16S ribosomal RNA sequencing and predictive metagenomics, respectively. Probiotics were detected at day 5 of administration but otherwise had no discernable effects, whereas detection of bacterial infection (P<0.001) and participant age (P<0.001) had the largest effects on microbiota composition, microbial diversity, and deduced bacterial functions. Participants under 1 year had lower bacterial diversity than older aged pre-schoolers; compositional changes of individual bacterial taxa were associated with maturation of the gut microbiota. Advances in age were associated with differences in gut microbiota composition and deduced microbial functions, which have the potential to impact health later in life.
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Affiliation(s)
- Rachael G. Horne
- Cell Biology Program, Research Institute, Hospital for Sick Children, Toronto, ON, Canada
| | - Stephen B. Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology, Department of Pediatrics, Alberta Children’s Hospital, Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Xiao-Li Pang
- Alberta Precision Laboratories – Public Health Laboratory (ProvLab), Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Bonita E. Lee
- Women and Children’s Research Institute, Stollery Children’s Hospital, University of Alberta, Edmonton, AB, Canada
| | - Ken J. Farion
- Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Serge Gouin
- Departments of Emergency Medicine and Pediatrics, Centre Hospitalier Universitaire (CHU) Sainte-Justine, Université de Montréal, Montréal, QC, Canada
| | - Suzanne Schuh
- Division of Emergency Medicine, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Naveen Poonai
- Division of Pediatric Emergency Medicine, London Children’s Hospital Health Science Centre, Department of Pediatrics, Western University, London, ON, Canada
| | - Katrina F. Hurley
- Pediatric Emergency Medicine, Izaak Walton Killam (IWK) Children’s Hospital, Dalhousie University, Halifax, NS, Canada
| | - Yaron Finkelstein
- Division of Emergency Medicine, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Jianling Xie
- Pediatric Emergency Medicine, Izaak Walton Killam (IWK) Children’s Hospital, Dalhousie University, Halifax, NS, Canada
| | - Sarah Williamson-Urquhart
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Alberta Children’s Hospital, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Linda Chui
- Alberta Precision Laboratories – Public Health Laboratory (ProvLab), Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Laura Rossi
- Department of Biochemistry and Biomedical Sciences, McMaster University Medical Centre, Hamilton, ON, Canada
| | - Michael G. Surette
- Department of Biochemistry and Biomedical Sciences, McMaster University Medical Centre, Hamilton, ON, Canada
| | - Philip M. Sherman
- Cell Biology Program, Research Institute, Hospital for Sick Children, Toronto, ON, Canada
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
- *Correspondence: Philip M. Sherman,
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Freedman D, Silberman AR, Friedberg D, Stewart S, Hurley KF. Musculoskeletal and Head Injuries in a Canadian Summer Camp: A Three-Year Surveillance Study. Cureus 2022; 14:e24358. [PMID: 35607537 PMCID: PMC9123407 DOI: 10.7759/cureus.24358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2022] [Indexed: 11/05/2022] Open
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Levine AC, O’Connell KJ, Schnadower D, VanBuren TJM, Mahajan P, Hurley KF, Tarr P, Olsen CS, Poonai N, Schuh S, Powell EC, Farion KJ, Sapien RE, Roskind CG, Rogers AJ, Bhatt S, Gouin S, Vance C, Freedman SB. Derivation of the Pediatric Acute Gastroenteritis Risk Score to Predict Moderate-to-Severe Acute Gastroenteritis. J Pediatr Gastroenterol Nutr 2022; 74:446-453. [PMID: 35129163 PMCID: PMC9203936 DOI: 10.1097/mpg.0000000000003395] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Although most acute gastroenteritis (AGE) episodes in children rapidly self-resolve, some children go on to experience more significant and prolonged illness. We sought to develop a prognostic score to identify children at risk of experiencing moderate-to-severe disease after an index emergency department (ED) visit. METHODS Data were collected from a cohort of children 3 to 48 months of age diagnosed with AGE in 16 North American pediatric EDs. Moderate-to-severe AGE was defined as a Modified Vesikari Scale (MVS) score ≥9 during the 14-day post-ED visit. A clinical prognostic model was derived using multivariable logistic regression and converted into a simple risk score. The model's accuracy was assessed for moderate-to-severe AGE and several secondary outcomes. RESULTS After their index ED visit, 19% (336/1770) of participants developed moderate-to-severe AGE. Patient age, number of vomiting episodes, dehydration status, prior ED visits, and intravenous rehydration were associated with MVS ≥9 in multivariable regression. Calibration of the prognostic model was strong with a P value of 0.77 by the Hosmer-Lemenshow goodness-of-fit test, and discrimination was moderate with an area under the receiver operator characteristic curve of 0.68 (95% confidence interval [CI] 0.65-0.72). Similarly, the model was shown to have good calibration when fit to the secondary outcomes of subsequent ED revisit, intravenous rehydration, or hospitalization within 72 hours after the index visit. CONCLUSIONS After external validation, this new risk score may provide clinicians with accurate prognostic insight into the likely disease course of children with AGE, informing disposition decisions, anticipatory guidance, and follow-up care.
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Affiliation(s)
- Adam C. Levine
- Department of Emergency Medicine, Rhode Island Hospital/Hasbro Children’s Hospital and Brown University, Providence, RI
| | - Karen J. O’Connell
- Division of Emergency Medicine, Children’s National Hospital, Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - David Schnadower
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | | | - Prashant Mahajan
- Division of Emergency Medicine, Department of Pediatrics, Children’s Hospital of Michigan
- Wayne State University, Detroit
- Departments of Emergency Medicine and Pediatrics, University of Michigan, Ann Arbor, MI
| | - Katrina F. Hurley
- Department of Emergency Medicine, IWK Health, Halifax, Nova Scotia, Canada
| | - Phillip Tarr
- Division of Gastroenterology, Hepatology, & Nutrition, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - Cody S. Olsen
- Department of Pediatrics, University of Utah, Salt Lake City, UT
| | - Naveen Poonai
- Departments of Pediatrics, Internal Medicine, Epidemiology & Biostatistics, Schulich School of Medicine and Dentistry
- Children’s Health Research Institute, London Health Sciences Centre, London
| | - Suzanne Schuh
- Division of Pediatric Emergency Medicine, The Hospital for Sick Children, SickKids Research Institute, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth C. Powell
- Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University, Chicago, IL
| | - Ken J. Farion
- Departments of Pediatrics and Emergency Medicine, University of Ottawa
- Pediatric Emergency Department, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Robert E. Sapien
- Department of Emergency Medicine, University of New Mexico, Albuquerque, NM
| | - Cindy G. Roskind
- Department of Emergency Medicine, Columbia University Vagelos College of Physicians & Surgeons, New York, NY
| | - Alexander J. Rogers
- Departments of Emergency Medicine and Pediatrics, University of Michigan, Ann Arbor, MI
| | - Seema Bhatt
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Serge Gouin
- Departments of Pediatric Emergency Medicine & Pediatrics, Université de Montréal, Montréal, Quebec, Canada
| | - Cheryl Vance
- Departments of Pediatrics and Emergency Medicine, University of California, Davis, School of Medicine, Sacramento, CA
| | - Stephen B. Freedman
- Divisions of Pediatric Emergency Medicine and Gastroenterology, Alberta, Children’s Hospital, Alberta, Canada
- Sections of Pediatric Emergency Medicine and Gastroenterology, Departments of Pediatrics and Emergency Medicine, Alberta Children’s Hospital, Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB
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Abstract
OBJECTIVES Health care providers that experience harm after adverse events have been termed "second victims." Our objective was to characterize the range and context of interventions to support second victims in acute care settings. METHODS We performed a scoping study using Arksey and O'Malley's process. A library scientist searched PubMed, Cumulative Index of Nursing and Allied Health, EMBASE, and Cochrane Central Register of Controlled Trials in September 2017, and updated the search in November 2018. We sought gray literature (Canadian Electronic Library, Proquest and Scopus) and searched reference lists of included studies. Stakeholder organizations and authors of included studies were contacted. Two reviewers independently reviewed titles and abstracts and extracted data. A qualitative approach was used to categorize the context and characteristics of the 22 identified interventions. RESULTS After screening 5634 titles and abstracts, 173 articles underwent full-text screening. Twenty-two interventions met the criteria and were categorized as providing peer support (n = 8), proactive education (n = 6), or both (n = 8). Programs came from Canada (n = 2), Spain (n = 2), and the United States (n = 18). A specific traumatic event triggered the development of 5 programs. Some programs used a standard definition of second victims, (n = 6), whereas other programs had a broader scope (n = 12). Confidentiality was explicitly assured in 9 peer support programs. Outcome measures were often not reported. CONCLUSIONS This is a new area of study with little qualitative data from which to determine whether these programs are effective. Many programs had a similar design, based on the structure proposed by the same small group of experts in this new field. Concerns about potential legal proceedings hinder documentation and study of program effectiveness.
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Affiliation(s)
| | | | | | - Robin Parker
- WK Kellogg Health Science Library, Dalhousie University, Halifax, Nova Scotia, Canada
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11
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Poonai N, Powell EC, Schnadower D, Casper TC, Roskind CG, Olsen CS, Tarr P, Mahajan P, Rogers AJ, Schuh S, Hurley KF, Gouin S, Vance C, Farion KJ, Sapien RE, O’Connell KJ, Levine AC, Bhatt S, Freedman SB. Variables Associated With Intravenous Rehydration and Hospitalization in Children With Acute Gastroenteritis: A Secondary Analysis of 2 Randomized Clinical Trials. JAMA Netw Open 2021; 4:e216433. [PMID: 33871616 PMCID: PMC8056281 DOI: 10.1001/jamanetworkopen.2021.6433] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
IMPORTANCE Despite guidelines endorsing oral rehydration therapy, intravenous fluids are commonly administered to children with acute gastroenteritis in high-income countries. OBJECTIVE To identify factors associated with intravenous fluid administration and hospitalization in children with acute gastroenteritis. DESIGN, SETTING, AND PARTICIPANTS This study is a planned secondary analysis of the Pediatric Emergency Research Canada (PERC) and Pediatric Emergency Care Applied Research Network (PECARN) probiotic trials. Participants include children aged 3 to 48 months with 3 or more watery stools in 24 hours between November 5, 2013, and April 7, 2017, for the PERC study and July 8, 2014, and June 23, 2017, for the PECARN Study. Children were from 16 pediatric emergency departments throughout Canada (6) and the US (10). Data were analyzed from November 2, 2018, to March 16, 2021. EXPOSURES Sex, age, preceding health care visit, distance between home and hospital, country (US vs Canada), frequency and duration of vomiting and diarrhea, presence of fever, Clinical Dehydration Scale score, oral ondansetron followed by oral rehydration therapy, and infectious agent. MAIN OUTCOMES AND MEASURES Intravenous fluid administration and hospitalization. RESULTS This secondary analysis of 2 randomized clinical trials included 1846 children (mean [SD] age, 19.1 [11.4] months; 1007 boys [54.6%]), of whom 534 of 1846 (28.9%) received oral ondansetron, 240 of 1846 (13.0%) received intravenous rehydration, and 67 of 1846 (3.6%) were hospitalized. The following were independently associated with intravenous rehydration: higher Clinical Dehydration Scale score (mild to moderate vs none, odds ratio [OR], 8.73; 95% CI, 5.81-13.13; and severe vs none, OR, 34.15; 95% CI, 13.45-86.73); country (US vs Canada, OR, 6.76; 95% CI, 3.15-14.49); prior health care visit with intravenous fluids (OR, 4.55; 95% CI, 1.32-15.72); and frequency of vomiting (per 5 episodes, OR, 1.66; 95% CI, 1.39-1.99). The following were independently associated with hospitalization: higher Clinical Dehydration Scale score (mild to moderate vs none, OR, 11.10; 95% CI, 5.05-24.38; and severe vs none, OR, 23.55; 95% CI, 7.09-78.25) and country (US vs Canada, OR, 3.37; 95% CI, 1.36-8.40). Oral ondansetron was associated with reduced odds of intravenous rehydration (OR, 0.21; 95% CI, 0.13-0.32) and hospitalization (OR, 0.44; 95% CI, 0.21-0.89). CONCLUSIONS AND RELEVANCE Intravenous rehydration and hospitalization were associated with clinical evidence of dehydration and lack of an oral ondansetron-supported oral rehydration period. Strategies focusing on oral ondansetron administration followed by oral rehydration therapy in children with dehydration may reduce the reliance on intravenous rehydration and hospitalization. TRIAL REGISTRATION ClinicalTrials.gov Identifiers: NCT01853124 (PERC) and NCT01773967 (PECARN).
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Affiliation(s)
- Naveen Poonai
- Department of Pediatrics, Schulich School of Medicine and Dentistry, London, Canada
- Department of Internal Medicine, Schulich School of Medicine and Dentistry, London, Canada
- Department of Epidemiology & Biostatistics, Schulich School of Medicine and Dentistry, London, Canada
- Children's Health Research Institute, London Health Sciences Centre, London, Canada
| | - Elizabeth C. Powell
- Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - David Schnadower
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | | | - Cindy G. Roskind
- Department of Emergency Medicine, Columbia University College of Physicians & Surgeons, New York, New York
| | - Cody S. Olsen
- Department of Pediatrics, University of Utah, Salt Lake City
| | - Philip Tarr
- Division of Gastroenterology, Hepatology, & Nutrition, Department of Pediatrics, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Prashant Mahajan
- Division of Emergency Medicine, Department of Pediatrics, Children’s Hospital of Michigan, Detroit
- Wayne State University, Detroit, Michigan
- Department of Emergency Medicine, University of Michigan, Ann Arbor
| | | | - Suzanne Schuh
- Division of Pediatric Emergency Medicine, The Hospital for Sick Children, SickKids Research Institute, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Katrina F. Hurley
- Department of Emergency Medicine, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Serge Gouin
- Department of Pediatric Emergency Medicine, Université de Montréal, Montréal, Quebec, Canada
- Department of Pediatrics, Université de Montréal, Montréal, Quebec, Canada
| | - Cheryl Vance
- Department of Pediatrics, University of California, Davis, School of Medicine, Sacramento
- Department of Emergency Medicine, University of California, Davis, School of Medicine, Sacramento
| | - Ken J. Farion
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Pediatric Emergency Department, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Robert E. Sapien
- Department of Emergency Medicine, University of New Mexico, Albuquerque
| | - Karen J. O’Connell
- Division of Emergency Medicine, Children's National Hospital, Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Adam C. Levine
- Department of Emergency Medicine, Rhode Island Hospital/Hasbro Children's Hospital and Brown University, Providence
| | - Seema Bhatt
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Stephen B. Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology, Department of Pediatric Medicine, Alberta Children’s Hospital, Alberta, Canada
- Section of Pediatric Emergency Medicine, Department of Emergency Medicine, Alberta Children’s Hospital, Alberta, Canada
- Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Freedman SB, Xie J, Nettel-Aguirre A, Pang XL, Chui L, Williamson-Urquhart S, Schnadower D, Schuh S, Sherman PM, Lee BE, Gouin S, Farion KJ, Poonai N, Hurley KF, Qiu Y, Ghandi B, Lloyd C, Finkelstein Y. A randomized trial evaluating virus-specific effects of a combination probiotic in children with acute gastroenteritis. Nat Commun 2020; 11:2533. [PMID: 32439860 PMCID: PMC7242434 DOI: 10.1038/s41467-020-16308-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 04/25/2020] [Indexed: 01/11/2023] Open
Abstract
Gastroenteritis accounts for nearly 500,000 deaths in children younger than 5 years annually. Although probiotics have been touted as having the potential to expedite diarrhea resolution, recent clinical trials question their effectiveness. A potential explanation is a shift in pathogens following the introduction of a rotavirus vaccine. Here, we report the results of a multi-center, double-blind trial of 816 children with acute gastroenteritis who completed follow-up and provided multiple stool specimens. Participants were randomized to receive a probiotic containing Lactobacillus rhamnosus and Lactobacillus helveticus or placebo. We report no virus-specific beneficial effects attributable to the probiotic, either in reducing clinical symptoms or viral nucleic acid clearance from stool specimens collected up to 28 days following enrollment. We provide pathophysiological and microbiologic evidence to support the clinical findings and conclude that our data do not support routine probiotic administration to children with acute gastroenteritis, regardless of the infecting virus.
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Affiliation(s)
- Stephen B Freedman
- Alberta Children's Hospital Foundation Professor in Child Health and Wellness, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, 28 Oki Drive NW, Calgary, AB, T3B 6A8, Canada.
| | - Jianling Xie
- Alberta Children's Hospital Foundation Professor in Child Health and Wellness, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, 28 Oki Drive NW, Calgary, AB, T3B 6A8, Canada
| | - Alberto Nettel-Aguirre
- Alberta Children's Hospital Foundation Professor in Child Health and Wellness, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, 28 Oki Drive NW, Calgary, AB, T3B 6A8, Canada
| | - Xiao-Li Pang
- University of Alberta, 116 St & 85 Ave., Edmonton, AB, T6G 2R3, Canada
| | - Linda Chui
- University of Alberta, 116 St & 85 Ave., Edmonton, AB, T6G 2R3, Canada
| | - Sarah Williamson-Urquhart
- Alberta Children's Hospital Foundation Professor in Child Health and Wellness, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, 28 Oki Drive NW, Calgary, AB, T3B 6A8, Canada
| | - David Schnadower
- University of Cincinnati, 3333 Burnet Ave, Cincinnati, OH, UCA 45229, USA
| | - Suzanne Schuh
- University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Philip M Sherman
- University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Bonita E Lee
- University of Alberta, 116 St & 85 Ave., Edmonton, AB, T6G 2R3, Canada
| | - Serge Gouin
- Université de Montréal, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C5, Canada
| | - Ken J Farion
- University of Ottawa, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
| | - Naveen Poonai
- University of Western Ontario, 800 Commissioners Road E, London, ON, N6A 5W9, Canada
| | - Katrina F Hurley
- Dalhousie University, 5980 University Avenue, PO Box 9700, Halifax, NS, B3K 6R8, Canada
| | - Yuanyuan Qiu
- University of Alberta, 116 St & 85 Ave., Edmonton, AB, T6G 2R3, Canada
| | - Binal Ghandi
- University of Alberta, 116 St & 85 Ave., Edmonton, AB, T6G 2R3, Canada
| | - Colin Lloyd
- University of Alberta, 116 St & 85 Ave., Edmonton, AB, T6G 2R3, Canada
| | - Yaron Finkelstein
- University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
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Leroux Y, Cook J, Goldstein J, Doucette S, DeMone C, Carter A, Hurley KF. Pediatric Secondary Transfer Percentages: A Retrospective Observational Study. Cureus 2020; 12:e6766. [PMID: 32140333 PMCID: PMC7039349 DOI: 10.7759/cureus.6766] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Certain adult conditions treated by paramedics, such as myocardial infarction or stroke, have better outcomes if transported to a specialty centre, bypassing local generalist facilities when necessary. Little evidence exists to inform guidelines to identify pediatric patients who would benefit from direct transport to a pediatric centre. This study describes the characteristics of children brought to community emergency departments (ED) who subsequently required transfer to pediatric specialty care. METHODS A retrospective observational cohort study was performed in a metropolitan area with one tertiary pediatric specialty centre and four community EDs. The patient care record database was queried for patients under 16 years old transported by paramedics to a community ED during a five-year period. Secondary transfer to the pediatric specialty centre within 24 hours was identified. The primary outcome was percentage of transfers to specialty care. Descriptive statistics were used to characterize the whole group as well as stratified by age category, chief complaint and Canadian Triage Acuity Scale (CTAS). RESULTS A total of 872 pediatric patients were transported to community EDs with 95 (10.9%) requiring secondary transfer to the pediatric specialty centre. CTAS 1 and 2 were associated with increased secondary transfer (p<0.001). There were also differences in transfer proportion by chief complaint. There was no association between age or gender and transfer to pediatric specialty care. CONCLUSIONS This retrospective study shows an association between acuity and certain chief complaints and percentage of secondary transfer to pediatric specialty care.
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Affiliation(s)
- Yves Leroux
- Emergency Medicine, Dalhousie University, Halifax, CAN
| | - Jolene Cook
- Emergency Medicine, Dalhousie University, Halifax, CAN
| | | | - Steve Doucette
- Research Methods Unit, Nova Scotia Health Authority, Halifax, CAN
| | - Corinne DeMone
- Emergency Medicine, Nova Scotia Health Authority, Halifax, CAN
| | - Alix Carter
- Division of Emergency Medical Services, Dalhousie University, Halifax, CAN
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MacMillan KM, MacInnis M, Fitzpatrick E, Hurley KF, MacPhee S, Matheson K, Black EK. Evaluation of a pharmacist-led antimicrobial stewardship service in a pediatric emergency department. Int J Clin Pharm 2019; 41:1592-1598. [PMID: 31650506 DOI: 10.1007/s11096-019-00924-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 10/09/2019] [Indexed: 10/25/2022]
Abstract
Background To improve antimicrobial use, incorporation of a pharmacist in antimicrobial stewardship initiatives in the emergency department has been recommended. Recognizing the potential value, a pharmacist-led antimicrobial stewardship (AMS) service which included review and follow up of microbiology results for patients discharged from the pediatric emergency department (PED) with suspected infections was implemented at our local institution. Objective The objective of this study was to evaluate the impact of pharmacists delivering this service compared to usual care. Setting Pediatric emergency department at the IWK Health Centre in Halifax, Canada. Method This study was completed as a retrospective chart review of pediatric patients discharged from the PED 6 months before and after implementation of the pharmacist-led AMS service. Data was extracted from electronic medical records. Data were reported descriptively and compared using a two-sided chi-square test and ordinal logistic regression. Main outcome measures The primary outcome measure was rate of return visits to the PED within 96 h of initial presentation. Results This study included 1070 patient encounters pre-implementation and 1040 patient encounters post-implementation. The rate of return visits to the PED within 96 h was 12.0% (129/1070) pre-implementation vs. 10.0% (100/1049) post-implementation (p = 0.07). The rate of return visits or hospitalization at 30 days was 22.1% (237/1070) pre-implementation compared to 19.9% (207/1040) in the post-implementation phase (p = 0.21). Inappropriate antimicrobial therapy was identified more often in the pre-implementation phase (7.0%, 68/975) vs. the post-implementation phase (5.0%, 46/952), p = 0.047. Time to notification within the first day after discharge occurred more frequently in the post-implementation phase (53.3%, 80/150) as compared to the pre-implementation phase (40.3%, 52/129, p = 0.0298). Conclusion Although this pharmacist-led AMS service did not significantly affect the rate of return visits or hospitalization, it may have led to more judicious use of antimicrobial agents and faster time to notification.
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Affiliation(s)
- K M MacMillan
- Dalhousie University, Halifax, Canada.,IWK Health Centre, Halifax, Canada
| | - M MacInnis
- Dalhousie University, Halifax, Canada.,IWK Health Centre, Halifax, Canada
| | - E Fitzpatrick
- Dalhousie University, Halifax, Canada.,IWK Health Centre, Halifax, Canada
| | - K F Hurley
- Dalhousie University, Halifax, Canada.,IWK Health Centre, Halifax, Canada
| | - S MacPhee
- Dalhousie University, Halifax, Canada.,IWK Health Centre, Halifax, Canada
| | - K Matheson
- Dalhousie University, Halifax, Canada.,Research Methods Unit, Nova Scotia Health Authority, Halifax, Canada
| | - E K Black
- Dalhousie University, Halifax, Canada. .,IWK Health Centre, Halifax, Canada.
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Handler A, Lustgarten M, Zahavi A, Freedman D, Rosoph L, Hurley KF. Summer Camp Health Initiative: An Overview of Injury and Illness in Two Canadian Summer Camps. Cureus 2018; 10:e2905. [PMID: 30397558 PMCID: PMC6207272 DOI: 10.7759/cureus.2905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction: Summer camp is an important part of the lives of millions of youth worldwide. Injuries and illnesses at general residential camps have not been quantified in a Canadian setting. The objective of this study was to examine the incidence of injuries and illnesses that present to camp health centres at two Canadian residential summer camps. Method: This prospective cross-sectional study examined the incidence of new-onset injuries and illnesses that presented to camp infirmaries and circumstances surrounding their occurrence. Data collection forms were completed by trained infirmary staff during each camper’s presentation to the infirmary at two general residential camps in Canada in the summers of 2015 and 2016. Results: There were 1872 infirmary presentations, resulting in a frequency of 52.6 presentations per 1000 camp days (CD). The incidence of illness was 34.8 per 1000 CD and the incidence of injury was 17.9 per 1000 CD. Communicable disease was the most common diagnosis (15.2/1000 CD), most often an upper respiratory tract infection. The most common symptoms upon presentation were sore throat (14.1/1000 CD), headache (9.9/1000 CD), runny nose/congestion (6.2/1000 CD), cough (6.0/1000 CD) and nausea and vomiting (4.8/1000 CD). The most common injuries were cuts/lacerations/bruises (4.9/1000 CD), followed by muscle/tendon injury (4.9/1000 CD). The most frequent cause of injuries was participation in sports (3.9/1000 CD) and sports fields and courts were the most frequent location for injuries to occur (2.7/1000 CD). Females accounted for 52.8% of infirmary presentations. Senior campers (ages 12-16 years) presented most frequently (43.4%), followed by junior campers (ages 6-11 years; 38.1%) and staff (age ≥17 years; 18.0%). When age-specific CDs were calculated, junior campers had the highest frequency of infirmary presentations relative to their time spent at camp (79.7/1000 CD). Fifty people (1.4/1000 CD) were sent to a hospital for further assessment. Conclusion: Injuries and illnesses presenting for infirmary care in summer camp are generally minor in nature. Canadian data compares similarly to United States (US) studies. Future studies should focus on interventions to reduce these injuries and illnesses, particularly communicable illnesses.
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Affiliation(s)
- Adam Handler
- University of Toronto, Toronto Western Hospital, Torotno, CAN
| | | | - Arielle Zahavi
- Faculty of Medicine, University of Toronto, Toronto, CAN
| | | | - Les Rosoph
- Dermatology, Northern Ontario School of Medicine, North Bay, CAN
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Wilson G, Sameoto C, Fitzpatrick E, Hurley KF. Impact of a Canadian Pediatric Society Position Statement on Trampoline-related Injuries at IWK Health Centre, Halifax, Nova Scotia. Cureus 2018; 10:e2609. [PMID: 30013873 PMCID: PMC6039218 DOI: 10.7759/cureus.2609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: In 2007, the Canadian Pediatric Society (CPS) advised against the recreational use of trampolines at home and reaffirmed that statement in 2013. We evaluated the impact of this position statement on trampoline-related injuries at the IWK Health Centre in Halifax, Nova Scotia. Methods: We completed a retrospective analysis (2001-2015) using the IWK Health Centre‘s Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) database. The time frame was divided into a pre-statement, post-statement, and post-reaffirmed statement. We included data on captured emergency department visits for children aged 0-16 years with trampoline-related injuries. Demographics, location, and injury mechanism were compared using the chi-squared and z tests. The proportions of trampoline injuries for pre-, post-, and post-reaffirmed statements were compared via analysis of variance (ANOVA). Results: Since the CPS statement, trampoline-related injuries significantly increased at the IWK Health Centre from 0.9% to 1.6% (p<0.001). Injuries increased in children under four years old and decreased in children 10-14 years (p=0.009). Recreational use at home (93%) remained the most common location of the incident (p<0.001). Fractures (n=277) and sprains/soft tissue injuries (n=232) to the ankle, head/neck, or elbow remained the most common injuries and did not significantly change post-statement or post-reaffirmed statement (p>0.05). Conclusions: Despite the CPS statement, trampoline-related injuries remain an important source of injuries at the IWK Health Centre. The types of injury did not significantly change during this time frame.
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Abstract
UNLABELLED Phenomenon: A growing number of women are entering the medical workforce, yet their distribution across medical specialties remains nonuniform. We sought to describe how culture, bias, and socialization shape gendered thinking regarding specialty choice at a Canadian undergraduate medical institution. APPROACH We analyzed transcripts from the Career Choices Project: 16 semistructured focus group discussions with 70 students graduating from Memorial University of Newfoundland in 2003, 2006, 2007, and 2008. The questions and prompts were designed to explore factors influencing specialty choice and did not specifically probe gender-based experiences. Focus groups were audio-recorded, transcribed, and deidentified before analysis. Analysis was inductive and guided by principles of orientational qualitative inquiry using a gender-specific lens. FINDINGS The pursuits of personal and professional goals, as well as contextual factors, were the major themes that influenced decision-making for women and men. Composition of these major themes varied between genders. Influence of a partner, consideration of familial commitments (both present and future), feeling a sense of connectedness with the field in question, and social accountability were described by women as important. Both genders hoped to pursue careers that would afford "flexibility" in order to balance work with their personal lives, though the construct of work-life balance differed between genders. Women did not explicitly identify gender bias or sexism as influencing factors, but their narratives suggest that these elements were at play. Insights: Our findings suggest that unlike men, women's decision-making is informed by tension between personal and professional goals, likely related to the context of gendered personal and societal expectations.
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Affiliation(s)
| | - Cheri Bethune
- c Department of Family Medicine , Memorial University , St. John's , Newfoundland , Canada
| | - Katrina F Hurley
- b Department of Emergency Medicine , Dalhousie University , Halifax , Nova Scotia , Canada
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Abstract
Three independent, fatal outbreaks of Streptococcus canis infection occurred in a 2-year period in shelter cats. The outbreaks occurred in Northern California (Yolo County), Southern California (Kern County), and North Carolina (Guilford County). An estimation of the affected population is >150 cats among 3 affected shelters, with a mortality rate of up to 30%. Among 20 cats submitted for necropsy there were 2 distinct pathologic presentations. The first (shelters 1 and 2) was skin ulceration and chronic respiratory infection that progressed, in some cats, to necrotizing sinusitis and meningitis. The second (shelter 3) was rapid progression from necrotizing fasciitis with skin ulceration to toxic shock-like syndrome, sepsis, and death. S canis was the sole pathogen identified in most cases. Whether hypervirulent S canis strains exist is unknown; there is little understanding of how these bacteria cause invasive disease in cats.
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Affiliation(s)
- P A Pesavento
- Department of Pathology, Microbiology and Immunology, UC Davis School of Veterinary Medicine, 1044 Haring Hall, 1 Shields Avenue, Davis, CA 95616, USA.
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Pianosi K, Bethune C, Hurley KF. Medical student career choice: a qualitative study of fourth-year medical students at Memorial University, Newfoundland. CMAJ Open 2016; 4:E147-52. [PMID: 27398357 PMCID: PMC4933642 DOI: 10.9778/cmajo.20150103] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Specialty career choice is a critical decision for medical students, and research has examined factors influencing particular specialties or assessed it from a demographic perspective. The purpose of this study was to explore and describe influential factors in students' decision-making, irrespective of their particular specialty in a Canadian medical school. METHODS Study participants were recruited from fourth-year medical classes at the Memorial University of Newfoundland in 2003, 2006, 2007 and 2008. Sixteen focus groups (n = 70) were led by a nonfaculty facilitator to uncover factors affecting medical student career choice. The analysis was guided by principles of grounded theory methodology. The focus group transcripts were sequentially coded based on recurring topics and themes that arose in the students' discussions. A set of key themes emerged and representative quotations for each theme were tracked. RESULTS Twenty themes were identified from the focus group discussions: 7 major, 3 intermediate and 10 minor themes. The major themes were undergraduate experience, exposure, public perception and recruitment, teacher influence, family/outside influences, residency issues and personal philosophy. Intermediate themes included lifestyle, bad-mouthing/negative perceptions and context. Minor themes included critical incidents/experiences, information gaps, uncertainty, nature of the work, extracurricular programs, timing of decision-making, financial issues, prestige, fit with colleagues and gender issues. INTERPRETATION Exposure to specialties and the timing of this exposure appears to be crucial to career choice, as does the context (who, what, when, where) of any particular rotation. Given the influence of personal philosophy, future research examining students' level of self-assessment and self-reflection in their decision-making processes and level of certainty about their selected specialty would be useful.
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Hill-Taylor BJ, Hurley KF, Sketris I, O'Connell C, Sinclair D, Wing A. Evaluating a clinical practice intervention to promote delivery of salbutamol by metered-dose inhalers with holding chambers in a pediatric emergency department. CAN J EMERG MED 2016; 15:101-8. [PMID: 23458141 DOI: 10.2310/8000.2012.120880] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The primary objective of this study was to quantify the impact of a clinical practice intervention to promote the delivery of salbutamol by metered-dose inhaler (MDI) in a pediatric emergency department (PED). A secondary objective was to retrospectively document the components of the intervention. METHODS PED inventory data for salbutamol inhalation solution (nebules), MDIs, and holding chambers were obtained from the pharmacy department. Patient data were obtained from the hospital's decision support unit. Interrupted time series analysis was used to evaluate trends in salbutamol inventory data, patient triage acuity, and hospital admissions from January 1, 2003, to May 31, 2010. Interviews and administrative documents were used to identify components of the intervention, which began in 2006. RESULTS There was a 1,215% increase in the proportion of salbutamol delivered as MDIs compared to total inhaled salbutamol (MDI plus nebulization solution) following the intervention (95% CI 1,032% to 1,396%, p < 0.001). Increases in salbutamol MDI use were associated with the implementation of an institution-specific asthma care map. A relative decrease of 32% in the hospital admission rate (absolute -7.25%: 95% CI -8.31 to -6.19, p < 0.001) was associated with the change in salbutamol MDI use and the use of the asthma care map. CONCLUSIONS A multifaceted intervention, designed and implemented by local PED clinical leaders, resulted in a pronounced change in salbutamol inhalation practice, with an associated decrease in admission rates. This intervention demonstrated many of the criteria for successful health system change. Findings from this research may be contextualized to inform change elsewhere.
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Abstract
BACKGROUND In cardiac ischaemia, the accumulation of adenosine may lead to or exacerbate bradyasystole and diminish the effectiveness of catecholamines administered during resuscitation. Aminophylline is a competitive adenosine antagonist. Case studies suggest that aminophylline may be effective for atropine-resistant bradyasystolic arrest. OBJECTIVES To determine the effects of aminophylline in the treatment of patients in bradyasystolic cardiac arrest, primarily survival to hospital discharge. We also considered survival to admission, return of spontaneous circulation, neurological outcomes and adverse events. SEARCH METHODS For this updated review, we searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, LILACS, ClinicalTrials.gov and WHO International Clinical Trials Registry Platform in November 2014. We checked the reference lists of retrieved articles, reviewed conference proceedings, contacted experts and searched further using Google. SELECTION CRITERIA All randomised controlled trials comparing intravenous aminophylline with administered placebo in adults with non-traumatic, normothermic bradyasystolic cardiac arrest who were treated with standard advanced cardiac life support (ACLS). DATA COLLECTION AND ANALYSIS Two review authors independently reviewed the studies and extracted the included data. We contacted study authors when needed. Pooled risk ratio (RR) was estimated for each study outcome. Subgroup analysis was predefined according to the timing of aminophylline administration. MAIN RESULTS We included five trials in this analysis, all of which were performed in the prehospital setting. The risk of bias was low in four of these studies (n = 1186). The trials accumulated 1254 participants. Aminophylline was found to have no effect on survival to hospital discharge (risk ratio (RR) 0.58, 95% confidence interval (CI) 0.12 to 2.74) or on secondary survival outcome (survival to hospital admission: RR 0.92, 95% CI 0.61 to 1.39; return of spontaneous circulation: RR 1.15, 95% CI 0.89 to 1.49). Survival was rare (6/1254), making data about neurological outcomes and adverse events quite limited. The planned subgroup analysis for early administration of aminophylline included 37 participants. No one in the subgroup survived to hospital discharge. AUTHORS' CONCLUSIONS The prehospital administration of aminophylline in bradyasystolic arrest is not associated with improved return of circulation, survival to admission or survival to hospital discharge. The benefits of aminophylline administered early in resuscitative efforts are not known.
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Affiliation(s)
- Katrina F Hurley
- Department of Emergency Medicine, IWK Health Centre, 5850/5980 University Ave, PO Box 9700, Halifax, NS, Canada, B3K 6R8
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Hurley KF, Giffin NA, Stewart SA, Bullock GB. Probing the effect of OSCE checklist length on inter-observer reliability and observer accuracy. Med Educ Online 2015; 20:29242. [PMID: 26490948 PMCID: PMC4613902 DOI: 10.3402/meo.v20.29242] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 09/21/2015] [Accepted: 09/21/2015] [Indexed: 05/23/2023]
Abstract
PURPOSE The Objective Structured Clinical Examination (OSCE) is a widely employed tool for measuring clinical competence. In the drive toward comprehensive assessment, OSCE stations and checklists may become increasingly complex. The objective of this study was to probe inter-observer reliability and observer accuracy as a function of OSCE checklist length. METHOD Study participants included emergency physicians and senior residents in Emergency Medicine at Dalhousie University. Participants watched an identical series of four, scripted, standardized videos enacting 10-min OSCE stations and completed corresponding assessment checklists. Each participating observer was provided with a random combination of two 40-item and two 20-item checklists. A panel of physicians scored the scenarios through repeated video review to determine the 'gold standard' checklist scores. RESULTS Fifty-seven observers completed 228 assessment checklists. Mean observer accuracy ranged from 73 to 93% (14.6-18.7/20), with an overall accuracy of 86% (17.2/20), and inter-rater reliability range of 58-78%. After controlling for station and individual variation, no effect was observed regarding the number of checklist items on overall accuracy (p=0.2305). Consistency in ratings was calculated using intraclass correlation coefficient and demonstrated no significant difference in consistency between the 20- and 40-item checklists (ranged from 0.432 to 0.781, p-values from 0.56 to 0.73). CONCLUSIONS The addition of 20 checklist items to a core list of 20 items in an OSCE assessment checklist does not appear to impact observer accuracy or inter-rater reliability.
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Affiliation(s)
- Katrina F Hurley
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada;
| | - Nick A Giffin
- Bachelor of Medicine Class of 2016, Dalhousie University, Halifax, NS, Canada
| | - Samuel A Stewart
- Division of Medical Informatics, Dalhousie University, Halifax, NS, Canada
| | - Graham B Bullock
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
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Scherk MA, Ford RB, Gaskell RM, Hartmann K, Hurley KF, Lappin MR, Levy JK, Little SE, Nordone SK, Sparkes AH. 2013 AAFP Feline Vaccination Advisory Panel Report. J Feline Med Surg 2013. [DOI: 10.1177/1098612x13519377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Regrettably, two errors appeared in the 2013 AAFP Feline Vaccination Advisory Panel Report. Firstly, in the ‘Injectable vaccine administration’ box, on page 798, the pictures in Figures 8 and 9 were swapped with each other. The amended box is reproduced here. Secondly, the penultimate sentence in the second ‘Trap–Neuter–Return’ FAQ on page 804 should have read: ‘In contrast, only inactivated vaccines resulted in a high rate of protective antibodies against FHV-1,’ and not ‘In contrast, only modified-live vaccines …’. The errors appear in the printed copies of the journal, and in online versions downloaded before November 2013. DOI of original article: 10.1177/1098612X13500429 DOI: 10.1177/1098612X13511888
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Scherk MA, Ford RB, Gaskell RM, Hartmann K, Hurley KF, Lappin MR, Levy JK, Little SE, Nordone SK, Sparkes AH. Erratum: 2013 AAFP Feline Vaccination Advisory Panel Report. J Feline Med Surg 2013. [DOI: 10.1177/1098612x13511888] [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: 11/16/2022]
Abstract
Regrettably, an error appeared in the ‘Injectable vaccine administration’ box on page 798: the pictures in Figures 8 and 9 were swapped with each other. ( The error appears in the printed copies of the journal, and in online versions downloaded before mid-October 2013.) The amended box is reproduced here in full. DOI of original article: 10.1177/1098612X13500429
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Abstract
BACKGROUND In cardiac ischaemia, the accumulation of adenosine may lead to or exacerbate bradyasystole and diminish the effectiveness of catecholamines administered during resuscitation. Aminophylline is a competitive adenosine antagonist. Case studies suggest that aminophylline may be effective for atropine-resistant bradyasystolic arrest. OBJECTIVES To determine the effects of aminophylline in the treatment of patients in bradyasystolic cardiac arrest, primarily survival to hospital discharge. We also considered survival to admission, return of spontaneous circulation, neurological outcomes and adverse events. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library, Issue 4, 2009), MEDLINE, EMBASE, CINAHL, LILACS, ClinicalTrials.gov and WHO International Clinical Trials Registry Platform. We checked the reference lists of retrieved articles, reviewed conference proceedings, contacted experts and searched further using Google. The search strategy was updated in March 2012. SELECTION CRITERIA All randomised controlled trials comparing intravenous aminophylline with administered placebo in adults with non-traumatic, normothermic bradyasystolic cardiac arrest who were treated with standard advanced cardiac life support (ACLS). DATA COLLECTION AND ANALYSIS Two review authors independently reviewed the studies and extracted the included data. We contacted study authors when needed. Pooled risk ratio (RR) was estimated for each study outcome. Subgroup analysis was predefined according to the timing of aminophylline administration. MAIN RESULTS Five trials are included in this analysis, all of which were performed in the prehospital setting. The risk of bias was low in four of these studies (n = 1186). The trials accumulated 1254 participants. Aminophylline was found to have no effect on survival to hospital discharge (RR 0.58, 95% confidence interval (CI) 0.12 to 2.74) or on secondary survival outcome (survival to hospital admission: RR 0.92, 95% CI 0.61 to 1.39; return of spontaneous circulation: RR 1.15, 95% CI 0.89 to 1.49). Survival was rare (6/1254), making data about neurological outcomes and adverse events quite limited. The planned subgroup analysis for early administration of aminophylline included 37 participants. No one in the subgroup survived to hospital discharge. AUTHORS' CONCLUSIONS The prehospital administration of aminophylline in bradyasystolic arrest is not associated with improved return of circulation, survival to admission or survival to hospital discharge. The benefits of aminophylline administered early in resuscitative efforts are not known.
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Affiliation(s)
- Katrina F Hurley
- Department of Emergency Medicine, IWK Health Centre, 5850/5980 University Ave, PO Box 9700, Halifax, Nova Scotia, Canada, B3K 6R8
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Wing A, Hill-Taylor B, Sketris I, Smith J, Stewart S, Hurley KF. Medication records in the emergency department: agreement between paper-based charts and automated dispensing device. Can J Hosp Pharm 2012; 65:265-71. [PMID: 22919103 DOI: 10.4212/cjhp.v65i4.1156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Research exploring the agreement between traditional medication records and electronic records generated by an automated dispensing device has been limited. OBJECTIVE To evaluate the extent of agreement between medication administration records written in paper-based emergency department charts and records generated by an automated dispensing device with regard to the presence or absence of a single, prespecified medication. METHODS Medication administration records in paper-based emergency department charts and medication dispensation records generated by an automated dispensing device were evaluated for concordance. The primary outcome measure was agreement between the 2 sources with regard to the presence or absence of a record for salbutamol by metered-dose inhaler (MDI) for randomly selected patients who presented to a pediatric emergency department with wheeze-related illness from January 1, 2008, to December 31, 2009. RESULTS In total, 1172 patient visits met the inclusion criteria. Of these, records for 1013 visits showed agreement between the paper-based emergency department chart and the dispensation record of the automated dispensing device (kappa = 0.71, 95% confidence interval 0.67-0.75). This value did not meet the target kappa of 0.80. Stratification by time of day, day of week, month, season, or year of presentation at triage or by triage level or disposition (whether or not the patient was admitted to the hospital ward) did not significantly affect the level of agreement between the 2 sources. CONCLUSIONS Agreement between records of salbutamol MDI administration in paper-based charts and dispensation records from an automated dispensing device was substantial, but discrepancies were present. There are significant quality management, legal, clinical, and research reasons to strive for concordance between multiple records with respect to medication use in the emergency department. Data generated by automated dispensing devices have potential value for research, but their strengths and limitations need to be understood.
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Affiliation(s)
- Andrew Wing
- , BSc, is a medical student in the Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia
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Sargeant J, Hurley KF, Duffy J, Sketris I, Sinclair D, Ducharme J. Lost in Translation or Just Lost? Ann Emerg Med 2008; 52:575-6; author reply 576-7. [DOI: 10.1016/j.annemergmed.2008.05.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2008] [Revised: 04/11/2008] [Accepted: 05/09/2008] [Indexed: 10/21/2022]
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Hurley KF, Sargeant J, Duffy J, Sketris I, Sinclair D, Ducharme J. Perceptual reasons for resistance to change in the emergency department use of holding chambers for children with asthma. Ann Emerg Med 2007; 51:70-7. [PMID: 17559971 DOI: 10.1016/j.annemergmed.2007.04.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2006] [Revised: 03/29/2007] [Accepted: 04/06/2007] [Indexed: 11/15/2022]
Abstract
STUDY OBJECTIVE We explore perceptions surrounding use of portable inhalers and holding chambers (spacers) for delivery of beta-agonist respiratory medications to children in the emergency department (ED) and factors influencing practice change. METHODS This was a qualitative study guided by principles of grounded theory. Data were collected through focus groups and individual interviews at 2 sites in eastern Canada: Hospital A, where inhalers and holding chambers are used routinely; and Hospital B, where prevailing practice is the use of nebulization. Participant encounters were transcribed verbatim and analyzed for emerging themes. RESULTS At Hospital A, 6 physicians and 7 nurses participated in separate focus groups. Four interviews were conducted with physician, nurse, respiratory therapy, and pharmacy leaders. At Hospital B, 4 physicians and 3 nurses participated in focus groups, and 6 leaders were interviewed. Perceptions negatively influencing the adoption of inhalers and holding chambers included increased workload, increased equipment costs, myths about the superiority of nebulization, and interprofessional conflict. Health professionals reported that their most prominent concern about administering medications with inhalers and holding chambers was the time demand. Nurses especially seemed to think this way, tipping the balance in favor of nebulization despite knowledge of evidence to the contrary and affecting physician decisionmaking as well. Professional territorialism appeared to hinder efforts to ameliorate workload issues through the use of respiratory therapists in the ED. CONCLUSION Findings from this study could be used to inform a change program to close the gap between evidence and practice with respect to use of inhalers and holding chambers in the ED.
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Affiliation(s)
- Katrina F Hurley
- Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
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Hurley KF, Abidi SSR. Ontology Engineering to Model Clinical Pathways: Towards the Computerization and Execution of Clinical Pathways. ACTA ACUST UNITED AC 2007. [DOI: 10.1109/cbms.2007.79] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Pesavento PA, MacLachlan NJ, Dillard-Telm L, Grant CK, Hurley KF. Pathologic, immunohistochemical, and electron microscopic findings in naturally occurring virulent systemic feline calicivirus infection in cats. Vet Pathol 2004; 41:257-63. [PMID: 15133174 DOI: 10.1354/vp.41-3-257] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Infection with feline calicivirus (FCV) is a common cause of upper respiratory and oral disease in cats. FCV infection is rarely fatal, however, virulent, systemic strains of FCV (VS-FCV) that cause alopecia, cutaneous ulcers, subcutaneous edema, and high mortality in affected cats have recently been described. Seven cats with natural VS-FCV infection all had subcutaneous edema and ulceration of the oral cavity, with variable ulceration of the pinnae, pawpads, nares, and skin. Other lesions that were present in some affected cats included bronchointerstitial pneumonia, and pancreatic, hepatic, and splenic necrosis. Viral antigen was present within endothelial and epithelial cells in affected tissues as determined by immunohistochemical staining with a monoclonal antibody to FCV. Mature intranuclear and intracytoplasmic virions in necrotic epithelial cells were identified by transmission electron microscopy. VS-FCV infection causes epithelial cell cytolysis and systemic vascular compromise in susceptible cats, leading to cutaneous ulceration, severe edema, and high mortality.
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Affiliation(s)
- P A Pesavento
- California Animal Health and Food Safety Laboratory, School of Veterinary Medicine, UC Davis, PO Box 1770, Davis, CA 95616-1770, USA.
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Abstract
The purpose of this study was to determine whether student devised and delivered supplemental instruction is beneficial and acceptable to first-year medical students. A student-run Supplemental Instruction Project (SIP) was developed and delivered by second-year medical students and offered free of charge to all first-year medical students at Memorial University of Newfoundland taking the Integrated Study of Disease I course in 1999 and again in 2000. Small-group tutorials focused on subject material that second-year medical students identified as 'difficult'. Five 60- to 90-minute sessions covering topics in cardiology, nephrology and respirology were offered. Student and tutor perceptions about the project were collected using anonymous questionnaires. Students were quizzed before and after each tutorial session. Post-tutorial quiz scores were significantly greater than pre-tutorial scores. Student and tutor perceptions of SIP were positive. It is concluded that the SIP is an acceptable, practical and effective method to supplement delivery of challenging material to first-year medical students.
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Affiliation(s)
- Katrina F Hurley
- Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada.
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