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   Table of Contents - Current issue
Coverpage
January-March 2021
Volume 26 | Issue 1
Page Nos. 3-43

Online since Tuesday, December 29, 2020

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EDITORIALS / ÉDITORIAUX  

Using Wisely: Our health workforce is our most valuable resource p. 3
Margaret Tromp
DOI:10.4103/cjrm.cjrm_81_20  PMID:33380596
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Utiliser avec soin: Nos travailleurs en santé sont notre ressource la plus précieuse p. 4
Margaret Tromp
DOI:10.4103/1203-7796.305345  PMID:33380597
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President's Message. A productive fall council meeting p. 5
Gabe Woollam
DOI:10.4103/CJRM.CJRM_84_20  PMID:33380598
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Message du président. Une productive réunion d'automne du conseil p. 6
Gabe Woollam
DOI:10.4103/1203-7796.305346  PMID:33380599
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ORIGINAL ARTICLE / ARTICLE ORIGINAUX Top

Integration of care in Northern Ontario: Rural health hubs and the patient medical home concept p. 7
Sarah Newbery, Josée Malette
DOI:10.4103/CJRM.CJRM_103_19  PMID:33380600
Introduction: Primary care reform in Ontario that provides accessible, comprehensive patient-centred care has been a work in progress for more than a decade. With the recent emergence of Ontario Health Teams and the conclusion of the Rural Health Hub (RHH) pilot project, insight into the philosophy, culture and expectations of rural and remote centres with regard to primary care delivery is required. The concept of the patient medical home (PMH) and the RHH offers frameworks that emphasise positive attributes towards quality care systems – continuity, accessibility, comprehensiveness and localisation of services and funding for system efficiency. Methods: The application of these frameworks to rural and remote centres was explored via semi-directed face-to-face and phone interviews with physicians, patients and healthcare administrators at six rural centres in Northern Ontario. Results: Continuity of care, local integration and healthcare culture reform were cited by participants as the most important aspects of optimisation of primary care in their environments. Conclusion: These concepts support the RHH and PMH models and their further implementation as part of healthcare system transformation in Northern Ontario.
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Fluoroquinolone use in a rural practice p. 14
Len Kelly, Yoko S Schreiber, Josh Hopko, T Kirkwood, Ribal Kattini, Denise Poirier, Sharen Madden
DOI:10.4103/cjrm.cjrm_67_20  PMID:33380601
Introduction: Fluoroquinolones (FQs) are a commonly prescribed class of antibiotics in Canada. Evidence of a constellation of possible adverse events is developing. Central and peripheral nervous system abnormalities and collagen-related events (including aortic aneurysm/dissection, tendinopathy/rupture and retinal detachment) are associated with FQ exposure in large population-based aftermarket studies. In 2017, Health Canada warned about rare FQ-related persistent or disabling side effects. This study explores FQ use in a rural community. Methods: Antibiotic prescriptions (including FQs) in the over 18 adult population (5416) were measured in the town of Sioux Lookout for 5 years, January 2013 to 31 December 2017. Results: FQ prescriptions accounted for 16.0% of adult antibiotics, superseded by penicillins (21.1%) and macrolides (18.2%). Ciprofloxacin accounted for one half of FQ use (51.2%), followed by levofloxacin (36.7%) and norfloxacin (13.3%). FQs were commonly used for respiratory (33%) and urinary tract infections (18%). Conclusion: Aftermarket evidence reports increased risk of 'disabling and persistent serious adverse events'(Health Canada) in patients using FQs. Appropriate clinical caution should be exercised in the prescribing of FQs. Common overuse seems to occur in the treatment of uncomplicated community-acquired pneumonia and cystitis, despite recommendations to use other antimicrobial agents as first-line treatments.
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Shared medical appointments for Innu patients with well-controlled diabetes in a Northern First Nation Community p. 19
Yordan Karaivanov, Emily E Philpott, Shabnam Asghari, John Graham, David M Lane
DOI:10.4103/CJRM.CJRM_45_20  PMID:33380602
Introduction: The prevalence of diabetes and its complications in the Innu community of Sheshatshiu is high. We wanted to determine if shared medical appointments (SMAs) could provide culturally appropriate, effective treatment to Innu patients with relatively well-controlled diabetes, as an alternative to standard, 'one-on-one' care. Methods: We conducted a mixed-method study including a randomised controlled trial comparing standard care versus SMAs for patients aged 18–65 years with haemoglobin A1C (HbA1C) of ≤7.5%, followed by a qualitative study using semi-structured interviews with patients who attended SMAs. Results: Among 23 patients, 13 received the intervention. There were no significant differences of HbA1C level or HbA1C percentage of change between intervention and control groups at baseline, 6 months or 12 months. There were no statistical differences between standard care and SMA groups, concerning mortality or the need for haemodialysis. The qualitative analysis found that patients generally enjoyed the SMA model and the peer support and learning benefits of the SMAs. Patients did not believe that the SMA model was more or less culturally appropriate than standard care, but the majority said they felt that the SMAs were good for the community and could be a good venue for incorporating Innu healthy–lifestyle knowledge into medical diabetes care. Conclusions: SMAs may be an efficient way to manage well-controlled diabetic patients in the Innu community of Sheshatshiu and to provide peer support and opportunities for learning and incorporating community-specific knowledge into care.
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SHORT COMMUNICATION Top

Choosing Wisely Canada: Rural medicine list of recommendations p. 28
Margaret Tromp, Alexandra Dozzi, Kathleen Walsh
DOI:10.4103/CJRM.CJRM_83_20  PMID:33380603
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PROCEDURE ARTICLE Top

The occasional anorectal abscess p. 31
Rhiannan Pinnell, Mitchell Crozier, Sarah M Giles
DOI:10.4103/CJRM.CJRM_16_20  PMID:33380604
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CASE REPORT Top

A buprenorphine–naloxone induction in the North p. 35
Marcella K Jones, Matthew Quinn
DOI:10.4103/CJRM.CJRM_10_20  PMID:33380605
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WHAT WORKS Top

A rural community hospital's response to COVID-19 p. 38
Arlan Walsh, Zachary Warren, Pierre Robichaud, Annette Stuart, Kelly Bodie, Julia Lew, Kieran Moore
DOI:10.4103/CJRM.CJRM_46_20  PMID:33380606
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LETTER TO EDITOR Top

Challenges in managing febrile patients in a rural emergency room during the COVID-19 pandemic p. 42
Jooyoung Moon, Hanna Moon
DOI:10.4103/CJRM.CJRM_76_20  PMID:33380607
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