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  Most popular articles (Since September 24, 2018)

 
 
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THE PRACTITIONER / LE PRATICIEN
The occasional nasal fracture
Mary Ollier, Sarah Ollier, Sarah M Giles
January-March 2019, 24(1):18-22
DOI:10.4103/CJRM.CJRM_7_18  PMID:30638193
  894 211 -
ORIGINAL ARTICLES / ARTICLES ORIGINAUX
Fishhook injury in Eastern Newfoundland: Retrospective review
Christopher Patey, Thomas Heeley, Kris Aubrey-Bassler
January-March 2019, 24(1):7-12
DOI:10.4103/CJRM.CJRM_2_18  PMID:30638191
Abstract Introduction: The Canadian island of Newfoundland has a long history of fishing; however, no study to date has developed a regional profile of fishhook injuries on its east coast. Methods: To this end, we conducted a retrospective review of fishhook injuries at all Newfoundland East coast emergency departments from 2013 to 2015. Patient presentations were reviewed for the date of arrival, sex of the patient, location of fishhook injury, tetanus immunisation status, anaesthetic utilisation, diagnostic imaging, antibiotic management and technique of removal. Results: Information was retrieved for 165 patients. Most injuries occurred to the hand (80.6%), and out of five documented techniques, “advance and cut” was the most common extraction method (55.5%). There was a high percentage of prophylactic oral antibiotics prescribed (57%) and X-ray imaging (20%) utilised. Consultation was required for 4.2% of the fishhook injuries including consultation to a local fire department service. Conclusions: On the east coast of Newfoundland, fishhook injuries are addressed inconsistently, with potentially suboptimal methods for removal, coupled with unnecessary imaging and antibiotics. We believe that there is a role for education and other initiatives to improve the care delivered.
  740 174 1
CPRural
Zoe Evans, Bruce Mcknight
January-March 2019, 24(1):13-17
DOI:10.4103/CJRM.CJRM_13_18  PMID:30638192
Introduction: The purpose of our study was to determine if regular cardiopulmonary resuscitation (CPR) practise improved the quality of nurses' chest compressions in a rural hospital. Methods: The study was a prospective interventional trial measuring the effectiveness of brief, monthly CPR practice for rural nurses. The quality of nurses' chest compressions was measured before and after monthly practise with an interactive feedback device at the Golden and District Hospital, a rural facility in BC. Results: All three components of high-quality CPR (depth, recoil and rate) improved significantly. Conclusion: Monthly practise of chest compressions with an interactive feedback device improved the quality and confidence of nurses' CPR skills. These results suggest that a higher frequency of CPR practice (than the minimum annual recertification) would improve both the quality and retention of CPR skills, specifically for low-volume rural hospitals.
  700 136 -
EDITORIALS / ÉDITORIAUX
All new and improved
Nouveau et amélioré

Peter Hutten-Czapski
January-March 2019, 24(1):3-4
DOI:10.4103/CJRM.CJRM_5_18  PMID:30638189
  512 92 -
ORIGINAL ARTICLES / ARTICLES ORIGINAUX
Physician attendance during interhospital patient transfer in Ontario: 2005–2015
David Wonnacott, Eliot Frymire, Shahriar Khan, Michael E Green
April-June 2019, 24(2):37-43
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.
  449 98 -
EDITORIALS / ÉDITORIAUX
President's message. R-E-S-P-E-C-T
R-E-S-P-E-C-T

Margaret Tromp
January-March 2019, 24(1):5-6
DOI:10.4103/CJRM.CJRM_6_18  PMID:30638190
  468 77 -
The joy of the bread aisle
Peter Hutten-Czapski
April-June 2019, 24(2):31-31
DOI:10.4103/CJRM.CJRM_2_19  PMID:30924455
  399 131 -
CAREERS/CLASSIFIED
Rural Medicine Careers / Classified

January-March 2019, 24(1):27-28
DOI:10.4103/1203-7796.248450  PMID:30638196
Full text not available  [PDF]  [Mobile Full text]  [EPub]  [PubMed]
  353 145 -
THE PRACTITIONER / LE PRATICIEN
Country cardiograms case 65
Charles Helm, Matthew Embree
January-March 2019, 24(1):23-24
DOI:10.4103/CJRM.CJRM_4_18  PMID:30638194
  373 117 -
EDITORIALS / ÉDITORIAUX
Family physicians as generalists
Margaret Tromp
April-June 2019, 24(2):33-34
DOI:10.4103/CJRM.CJRM_6_19  PMID:30924457
  334 143 -
THE PRACTITIONER / LE PRATICIEN
Country cardiograms case 65: Answer
Charles Helm, Matthew Embree
January-March 2019, 24(1):25-26
DOI:10.4103/1203-7796.248418  PMID:30638195
  363 88 -
PROCEDURE
The occasional nasal foreign body
Hashim Kareemi, Jeffrey Gustafson, Sarah M Giles
April-June 2019, 24(2):65-68
DOI:10.4103/CJRM.CJRM_16_18  PMID:30924463
  321 120 -
ORIGINAL ARTICLES / ARTICLES ORIGINAUX
Improving patient preparedness for the operating room: A quality improvement study in Winchester District Memorial Hospital – A rural hospital in Ontario
Mohamed Gazarin, Emily Mulligan, Michelle Davey, Karen Lydiatt, Catherine O'Neill, Kirsti Weekes
April-June 2019, 24(2):44-51
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.
  273 69 -
Getting a Grip on Arthritis Online: Responses of rural/remote primary care providers to a web-based continuing medical education programme
Sydney C Lineker, Lisa J Fleet, Mary J Bell, Raquel Sweezie, Vernon Curran, Gordon Brock, Elizabeth M Badley
April-June 2019, 24(2):52-60
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.
  271 53 -
CASE REPORT
Laparoscopic cholecystectomy for ultrasound normal gallbladders: Should we forego hepatobiliary iminodiacetic acid scans?
Judith Roger, Thomas Heeley, Wendy Graham, Anna Walsh
April-June 2019, 24(2):61-64
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.
  224 80 -
EDITORIALS / ÉDITORIAUX
Les joies du rayon du pain
Peter Hutten-Czapski
April-June 2019, 24(2):32-32
PMID:30924456
  223 47 -
Médecins de famille à titre de généralistes
Margaret Tromp
April-June 2019, 24(2):35-36
  190 54 -
We don't want to think about it
Peter Hutten-Czapski
July-September 2019, 24(3):71-71
DOI:10.4103/CJRM.CJRM_32_19  
  4 2 -
A rural lens
Margaret Tromp
July-September 2019, 24(3):73-73
DOI:10.4103/CJRM.CJRM_33_19  
  4 2 -
Une lentille rurale
Margaret Tromp
July-September 2019, 24(3):74-74
DOI:10.4103/1203-7796.261320  
  4 2 -
ORIGINAL ARTICLES / ARTICLES ORIGINAUX
Telepsychiatry and patient–provider concordance
Nicholas James Schubert, Paul J Backman, Rajiv Bhatla, Kimberly M Corace
July-September 2019, 24(3):75-82
DOI:10.4103/CJRM.CJRM_9_18  
Context: Telepsychiatry has become a common modality for the provision of psychiatric consultations to patients in rural regions. Aims: The aims of this study were to assess and compare patient and provider satisfaction and perceptions of access to care with telepsychiatry. Methods: Telepsychiatric consultations were given by providers based on an urban tertiary academic health centre to patients located in rural primary care clinics. Results: Patients (n = 110) and providers (n = 10) were both highly satisfied with telepsychiatry and both believed that telepsychiatry provided patients with better access to care. Paired patient and provider survey results demonstrated a high level of concordance between patients and provider responses. Conclusions: Concordance between patient and provider satisfaction may contribute to adherence and positive treatment outcomes. These results provide support for the use of telepsychiatry consultations to improve patient access to psychiatric care in rural regions.
  4 2 -
PODIUM
Beyond an admission - Support for an ageing population
Christopher Patey
July-September 2019, 24(3):95-96
DOI:10.4103/CJRM.CJRM_23_18  
  4 2 -
PROCEDURE
The occasional allergy skin test
Peter Hutten-Czapski
July-September 2019, 24(3):92-94
DOI:10.4103/CJRM.CJRM_10_19  
  5 1 -
EDITORIALS / ÉDITORIAUX
Nous ne voulons pas y penser
Peter Hutten-Czapski
July-September 2019, 24(3):72-72
DOI:10.4103/1203-7796.261318  
  4 1 -
ORIGINAL ARTICLES / ARTICLES ORIGINAUX
Standardised early warning scores in rural interfacility transfers: A pilot study into their potential as a decision-making aid
Andrew Stanley, Holly Buhler, Brent Hobbs, Jude Kornelsen, Scott Lamont, Rebecca Kaus, Kari Grant, Stefan Grzybowski
July-September 2019, 24(3):83-91
DOI:10.4103/CJRM.CJRM_17_18  
Introduction: While 12.4% of British Columbians live rurally, only 2.0% of specialists practise rurally, making interfacility transport of high-acuity patients vital. Decision-making aids have been identified as a way to improve the interfacility transfer process. We conducted a pilot study to explore the potential of the Standardised Early Warning Score (SEWS) as a decision-making aid for staff at sending facilities. Methods: SEWSs were calculated from a database of 418 transfers from sending facilities in rural, small and medium population centres to larger receiving facilities. The SEWSs were compared against one another over time using McNemar's and the Wilcoxon signed-ranks tests. The SEWSs were then tested for their association with six outcomes using Pearson's or Fisher's Chi-squared test and the Mann–Whitney U-test. Results: While at the sending facility, both the number of SEWSs that was four or greater and the average SEWS decreased over time (P < 0.001 for both). A first SEWS of four or greater was predictive of more intervention categories during transport (P = 0.047), an adverse event during transport (P = 0.004), an adverse event within 30 min of arrival at the receiving facility (P = 0.004) and death before discharge from the receiving facility (P = 0.043) but not deterioration during transport, or the length of stay at the receiving facility. Conclusion: Overall, the performance of the SEWS in the context of rural interfacility transport suggests that the tool will have utility in supporting decision-making.
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