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   Table of Contents - Current issue
Coverpage
April-June 2019
Volume 24 | Issue 2
Page Nos. 31-68

Online since Friday, March 22, 2019

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EDITORIALS / ÉDITORIAUX  

The joy of the bread aisle p. 31
Peter Hutten-Czapski
DOI:10.4103/CJRM.CJRM_2_19  PMID:30924455
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Les joies du rayon du pain p. 32
Peter Hutten-Czapski
PMID:30924456
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Family physicians as generalists p. 33
Margaret Tromp
DOI:10.4103/CJRM.CJRM_6_19  PMID:30924457
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Médecins de famille à titre de généralistes p. 35
Margaret Tromp
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ORIGINAL ARTICLES / ARTICLES ORIGINAUX Top

Physician attendance during interhospital patient transfer in Ontario: 2005–2015 p. 37
David Wonnacott, Eliot Frymire, Shahriar Khan, Michael E Green
DOI:10.4103/CJRM.CJRM_22_18  PMID:30924459
Introduction: Interhospital transfer of patients may be attended by a variety of healthcare providers, including physicians. The role of physicians in ambulance transfer in Ontario is not well studied. This study aims to describe the cohort of physicians providing intra-ambulance patient care in Ontario from 2005 to 2015. Secondary outcomes of interest were geographical characteristics of physician-attended transfers and patient characteristics. Methods: OHIP billing data were used to find all instances of physician-attended air or land ambulance transfer from 2005 to 2015. These data were matched to physician data from the Corporate Providers Database and the Institute for Clinical Evaluative Sciences Physicians Database to describe the physicians providing intra-ambulance care. Patient and geographical data came from the National Ambulatory Care Reporting System and Registered Persons Database to describe the rurality of physician-attended transfers and patient characteristics. Results: There were 916–1216 physician-attended transfers performed by 508–639 unique physicians in any given year. Physicians were mostly family physicians without anaesthesia or emergency medicine training (58%), with CCFP-EM physicians accounting for 17% and family medicine anaesthetists 10%. Thirty-eight per cent of physicians providing intra-ambulance care practised in rural settings. Seventy-three per cent of physician-attended land transfers originated in suburban, rural or remote hospitals. Conclusions: Physician-attended ambulance transfer in Ontario is largely provided by family physicians in suburban to remote settings. This may have implications for the education of resident physicians in this unique skill set. Further research is needed into current education practices in intra-ambulance care.
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Improving patient preparedness for the operating room: A quality improvement study in Winchester District Memorial Hospital – A rural hospital in Ontario p. 44
Mohamed Gazarin, Emily Mulligan, Michelle Davey, Karen Lydiatt, Catherine O'Neill, Kirsti Weekes
DOI:10.4103/CJRM.CJRM_27_18  PMID:30924460
Introduction: Full completion of the pre-operative checklist is important for proper preparation of patients before they enter the operating room (OR), thus increasing OR efficiency. It is also critical for patient safety and successful outcomes. According to various literature, full completion of pre-operative checklists varies widely between institutions and occurs anywhere between 21% and 92% of cases.[1],[2] Our pre-project audits revealed a suboptimal patient preparedness for the Winchester District Memorial Hospital (WDMH) OR, since only 25% of cases arriving at the OR had their pre-operative checklist completed in its entirety, with no omissions. Methods: WDMH performed a 12-month long quality improvement (QI) study to improve patient preparedness for the OR. Multiple QI initiatives were used to induce behavioural change by incorporating process mapping, enabling communication, adjusting the pre-operative checklist based on qualitative staff feedback and implementing a staff education plan. Interventions also included two post-implementation audits. Results: Remarkably, completion of the pre-operative checklist increased from 25% to 67% and finally to 94%. Furthermore, the previous chart's presence and completion of pre-operative orders improved from 87% to 100% and from 82% to 99%, respectively. Another significantly important secondary outcome was improvement in interdepartmental relationships and collaboration. With better communication and checklist completion rates, there came increased patient preparedness and improved efficiency. Conclusions: Multiple significant improvements and many additional minor improvements strongly suggest that the approaches were used were effective at improving patient preparedness.
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Getting a Grip on Arthritis Online: Responses of rural/remote primary care providers to a web-based continuing medical education programme p. 52
Sydney C Lineker, Lisa J Fleet, Mary J Bell, Raquel Sweezie, Vernon Curran, Gordon Brock, Elizabeth M Badley
DOI:10.4103/CJRM.CJRM_10_18  PMID:30924461
Introduction: Physicians are often challenged with accessing relevant up-to-date arthritis information to enable the delivery of optimal care. An online continuing medical education programme to disseminate arthritis clinical practice guidelines (CPGs) was developed to address this issue. Methods: Online learning modules were developed for osteoarthritis (OA) and rheumatoid arthritis (RA) using published CPGs adapted for primary care (best practices), input from subject matter experts and a needs assessment. The programme was piloted in two rural/remote areas of Canada. Knowledge of best practice guidelines was measured before, immediately after completion of the modules and at 3-month follow-up by assigning one point for each appropriate best practice applied to a hypothetical case scenario. Points were then summed into a total best practice score. Results: Participants represented various professions in primary care, including family physicians, physiotherapists, occupational therapists and nurses (n = 89) and demonstrated significant improvements in total best practice scores immediately following completion of the modules (OA pre = 2.8/10, post = 3.8/10, P < 0.01; RA pre = 3.9/12, post = 4.6/12, P < 0.01). The response rate at 3 months was too small for analysis. Conclusions: With knowledge gained from the online modules, participants were able to apply a greater number of best practices to OA and RA hypothetical case scenarios. The online programme has demonstrated that it can provide some of the information rural/remote primary care providers need to deliver optimal care; however, further research is needed to determine whether these results translate into changes in practice.
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CASE REPORT Top

Laparoscopic cholecystectomy for ultrasound normal gallbladders: Should we forego hepatobiliary iminodiacetic acid scans? p. 61
Judith Roger, Thomas Heeley, Wendy Graham, Anna Walsh
DOI:10.4103/CJRM.CJRM_28_18  PMID:30924462
Introduction: Hepatobiliary iminodiacetic acid (HIDA)-radionuclear scans are used to diagnose biliary dyskinesia, the treatment for which is a laparoscopic cholecystectomy (LC). However, the predictive value of the HIDA scan for LC candidacy is debated. Case: A physical, ultrasound, and blood test for a 53-year-old woman with biliary dyskinesia-like symptoms were normal, contradicting a textbook history. A HIDA-scan was ordered but the results suggested she was not eligible for a LC. The patient insisted on receiving the procedure and gave informed consent to undergo an elective LC. Results: Six-weeks post-surgery, the patient's symptoms had ceased besides one short episode of abdominal pain. Conclusion: A LC relieved the patient's symptoms, suggesting that negative HIDA-scans can mislead correct decisions to perform a LC. Surgeons who receive inconclusive HIDA scan results should consult their patients, and when necessary and agreed-upon, take an informed risk together in an attempt to improve the patient's quality of life.
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PROCEDURE Top

The occasional nasal foreign body p. 65
Hashim Kareemi, Jeffrey Gustafson, Sarah M Giles
DOI:10.4103/CJRM.CJRM_16_18  PMID:30924463
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