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   Table of Contents - Current issue
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July-September 2021
Volume 26 | Issue 3
Page Nos. 99-136

Online since Friday, July 2, 2021

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EDITORIALS / ÉDITORIAUX  

Rural resiliency p. 99
Peter Hutten-Czapski
DOI:10.4103/cjrm.cjrm_24_21  PMID:34259219
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La résilience rurale p. 100
Peter Hutten-Czapski
DOI:10.4103/1203-7796.320526  PMID:34259220
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President's Message. Summer 2021 – A virtual success! p. 101
Gabe Woollam
DOI:10.4103/cjrm.cjrm_25_21  PMID:34259221
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Message du président. Virtuellement un succès! p. 102
Gabe Woollam
DOI:10.4103/1203-7796.320528  PMID:34259222
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ORIGINAL ARTICLE / ARTICLE ORIGINAUX Top

Assessing a research training programme for rural physicians p. 103
Cameron MacLellan, Cheri Bethune, Thomas Heeley, Wendy Graham, Cathryn Button, Shabnam Asghari
DOI:10.4103/CJRM.CJRM_53_20  PMID:34259223
Introduction: To assess the effect of a training programme called 6for6 (the programme) on research competency and productivity amongst rural physicians. The programme develops the research skills of six rural physicians over six weekends. Physicians learn about various research methods and writing techniques through blended learning components. Methods: We conducted a quasi-experimental study, comparing research competency and productivity between intervention and non-equivalent control groups and over time through a repeated measures design. Generalized linear mixed model (GLMM), ANOVA, and Cochran Q tests were conducted. The intervention was provided to five groups of 6 rural physicians each between 2014 and 2019. Main outcome measures: self-assessed research competency (knowledge, attitudes and skills) and productivity (publications, grants and presentations of research-related work at conferences) were our primary and secondary outcomes, respectively. We measured the outcomes before, during and after the programme. Controls: Rural physicians who expressed interest in the programme and later enrolled. Results: This study shows that, amongst its thirty participants, overall research competency was significantly different between intervention and control groups (65.7% ± 37.6% and 58.6% ± 14.4%, P < 0.05 for GLMM). The percentage of participants who were productive before, during and after the programme was 26.7%, 16.7% and 50.0%, respectively. Overall, productivity rates were significantly different between intervention and control groups (rate difference was 72.2/100 person-years, P < 0.05 for GLMM). Conclusion: This study suggests that the programme improves research competency and productivity for rural physicians. Rural physicians who wish to improve their research competency would benefit from participating in similar programmes.
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Evidence-based support for community outreach worker programme in Rural British Columbia, Canada p. 110
Izabela Szelest, Colleen Black, Susan M Brown, Ella Monro, NP Tanya Ter Keurs, Jenny Pedwell, Aarin Frigon
DOI:10.4103/cjrm.cjrm_63_20  PMID:34259224
Introduction: Community outreach workers (CWs) provide critical services to their community by connecting marginalised people to community and primary care services. The importance of CWs is overlooked in the current provincial primary health-care transformation due to perceived lack of evidence. This evaluation describes the efficacy of the CW programme in a rural British Columbian community. Methods: Capacity of the programme was determined by reviewing service and financial reports. Outcomes of the programme were analyzed from the electronic medical records and health systems data. Group discussions were conducted with providers, care team members and CWs for a deeper understanding of programme efficacy and impact. Results: For 64 h per month, CWs supported 15 clients, provided 28 visits and executed 10 referrals to community resources. The typical client was an adult of low socioeconomic status, unable to effectively organise themselves and navigate the health-care system and/or community resources, often as a result of undiagnosed low mental or cognitive functioning. The programme positively impacted the health-care system by facilitating 142 attachments to providers, reducing client emergency department use by 41%, while marginally increasing primary care services (6%), and supporting more appropriate emergency department visits. Conclusion: Clients enrolled in the programme did not fit into already defined services offered by the health authority. However, they required support to effectively function in their community. With the current health-care system transformation in British Columbia, it is imperative that the CW programme is recognised for its value to attract and maintain stable funding.
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Assessment of rural emergency department physician staff, hiring practices and needs p. 119
Zachary Hallgrimson, Anne-Marie Friesen, Darmyn Ritchie, Douglas Archibald, Charles Su
DOI:10.4103/cjrm.cjrm_57_20  PMID:34259225
Introduction: Rural communities suffer from an unequal access to health-care resources. The purpose of this study was to characterise Emergency Departments (EDs) in the Champlain Local Health Integration Network (LHIN) and determine their barriers to recruitment and retention of emergency physicians. Methods: A survey was sent to the 17 ED chiefs in the Champlain LHIN area by E-mail through May to December 2019. Results were analyzed for common themes and trends. Results: Seven of the 17 hospitals responded to the survey. The average number of physicians staffing the ED was 16, with the majority being Canadian College of Family Physicians certified without additional emergency training. Common described barriers to recruitment include lack of incentives for physicians to work in rural communities, lack of available resources at rural centres, such as specialists and poor flexibility in terms of shift coverage. Barriers to retention included limited incentives to remain in rural communities. Conclusion: This study analyzed the demographics and barriers to recruitment and retention in rural EDs. These results can be used to help build strategies that encourage physicians to practise in rural EDs.
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Intravenous iron therapy in a rural hospital: A retrospective chart review p. 123
Ribal Kattini, Jenna Poirier, Lauren Minty, Danielle LaJuenesse, Len Kelly, Sharen Madden, Robert Minty, Sydney Larsen, Ruben Hummelen
DOI:10.4103/CJRM.CJRM_4_20  PMID:34259226
Introduction: Intravenous iron infusion therapy is commonly delivered in rural hospitals, but there are no common guidelines for dosing or choice of agent. The objective of the study was to understand present practice and alternate therapies and develop practical recommendations for small hospital use. Methods: This was a retrospective chart review of all non-dialysis patients aged 15 years or older who received iron replacement therapy at Sioux Lookout Meno Ya Win Health Centre from May 2013 to May 2019 and a literature review of available iron preparations. Results: Of the 147 patients who received intravenous iron replacement, 75 were administered a single dose of 200 mg or 500 mg iron sucrose. Commonly used in pregnant patients, an increase in haemoglobin by an average of 9.2 g/L followed a 200 mg dose and 12.5 g/L after 500 mg. The 3-h infusion time for the 500 mg dose consumed considerably more nursing resources. Non-pregnant patients can be transfused more effectively with iron maltoside which can efficiently deliver larger doses of iron. Conclusion: We recommend iron maltoside for efficient intravenous iron replacement in non-pregnant patients and single or multiple doses of 200 mg iron sucrose during pregnancy.
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THE OCCASIONAL Top

The occasional maternal cardiac arrest p. 128
Andre N Jakubow
DOI:10.4103/cjrm.cjrm_70_20  PMID:34259227
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CASE REPORT Top

Detention of patients in rural hospitals: Can we hold the patient awaiting transfer to a psychiatric facility? p. 134
Christopher R Foerster, Monica Blichowski, Inderjeet Panesar, Kyle MD Carter
DOI:10.4103/cjrm.cjrm_75_20  PMID:34259228
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