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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
  2,873 621 -
REVIEW ARTICLE
Recruitment and retention of healthcare professionals in rural Canada: A systematic review
Savanna Heidi Koebisch, Jacqueline Rix, Michelle M Holmes
April-June 2020, 25(2):67-78
DOI:10.4103/CJRM.CJRM_43_19  PMID:32235108
Introduction: This review explores a pertinent issue for healthcare professionals and recruiters alike: which factors are most important in the recruitment and retention of these professionals in rural practice in Canada. Existing research concentrates on specific factors or focused populations. This review was created to explore multiple factors and a wider population of healthcare professionals, including chiropractors, osteopaths, dentists and physiotherapists. Methods: A literature search was carried out on four databases. Data from included studies were extracted, and thematic analysis was conducted on relevant findings. The quality of individual studies was assessed, and then themes were evaluated for overall confidence based on four components, using the Confidence in the Evidence for Reviews of Qualitative Research. Results: One quantitative and four qualitative articles were identified, all of which targeted physicians. Five themes – Personal/family matters, Community factors, Professional practice factors, Professional education factors and Economic factors – were generated in two domains, recruitment and retention. Forty major codes were generated through axial coding of open codes. Codes included attraction to rural lifestyle, recreational activities, Scope of practice, rural training and incentives. Scope of practice was deemed very important as a factor of recruitment, as was attraction to rural lifestyle. Incentives were found to be of little importance in influencing the recruitment of healthcare professionals, and even less important for retention. Conclusion: Wide scope of practice and attraction to the rural lifestyle were considered the most important for recruitment and to a lesser extent, retention, among the five papers studied. A lack of research was determined in the realm of factors influencing the recruitment and retention in healthcare professionals other than medical doctors in Canada. Therefore, it is recommended that further such studies investigate specific healthcare professionals.
  2,358 299 -
RURAL RECOMMENDATIONS
Progress made on access to rural healthcare in Canada
C Ruth Wilson, James Rourke, Ivy F Oandasan, Carmela Bosco
January-March 2020, 25(1):14-19
DOI:10.4103/CJRM.CJRM_84_19  PMID:31854338
  2,191 357 1
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  PMID:31249155
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.
  1,906 512 2
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.
  1,887 373 1
PROGRAM DESCRIPTION
Project ECHO: Building capacity to manage complex conditions in rural, remote and underserved areas
Andrea D Furlan, Kathleen A Pajer, William Gardner, Bryan MacLeod
October-December 2019, 24(4):115-120
DOI:10.4103/CJRM.CJRM_20_18  PMID:31552868
There is a need to bring specialized medical expertise to rural and remote areas. Project ECHO offers a method to move knowledge from specialists in academic centres using videoconference, case-base learning, and best-practices knowledge sharing. Ontario has implemented ECHO since 2014 and has demonstrated favourable outcomes among primary care clinicians.
  1,891 345 -
ORIGINAL ARTICLES / ARTICLES ORIGINAUX
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.
  1,777 429 -
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.
  1,896 293 1
REVIEW ARTICLE
Impact of telemedicine on diagnosis, clinical management and outcomes in rural trauma patients: A rapid review
Luc Lapointe, Marie-Helene Lavallee-Bourget, Alexia Pichard-Jolicoeur, Catherine Turgeon-Pelchat, Richard Fleet
January-March 2020, 25(1):31-40
DOI:10.4103/CJRM.CJRM_8_19  PMID:31854340
Abstract Introduction: Rural trauma patients are at increased risk of morbidity and mortality compared to trauma patients treated in urban facilities. Factors contributing to this disparity include differences in resource availability and increased time to definitive treatment for rural patients. Telemedicine can improve the early management of these patients by enabling rural providers to consult with trauma specialists at urban centres. The purpose of this study was to assess the impact of telemedicine utilisation on the diagnosis, clinical management and outcomes of rural trauma patients. Materials and Methods: A rapid review of the literature was performed using the concepts 'trauma', 'rural' and 'telemedicine'. Fifteen electronic databases were searched from inception to 29th June 2018. Manual searches were also conducted in relevant systematic reviews, key journals and bibliographies of included studies. Results: The literature search identified 187 articles, of which 8 articles were included in the review. All 8 studies reported on clinical management, while the impact of telemedicine use on diagnosis and outcomes was reported in 4 and 5 studies, respectively. Study findings suggest that the use of telemedicine may improve patient diagnosis, streamline the process of transferring patients and reduce length of stay. Use of telemedicine had minimal impact on mortality and complications in rural trauma patients. Conclusions: The evidence identified by this rapid review suggests that telemedicine may improve the diagnosis, management and outcomes of rural trauma patients. Further research is required to validate these findings by performing large and well-designed studies in rural areas, ideally as randomised clinical trials.
  1,634 335 2
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.
  1,697 262 -
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
  1,588 361 -
ORIGINAL ARTICLES / ARTICLES ORIGINAUX
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.
  1,490 260 -
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  PMID:31249156
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.
  1,482 238 2
ORIGINAL ARTICLE / ARTICLE ORIGINAUX
Use of point-of-care ultrasound for the assessment of intravascular volume in five rural New Zealand hospitals
Garry Nixon, Katharina Blattner, Wendy Finnie, Ross Lawrenson, Ngaire Kerse
October-December 2019, 24(4):109-114
DOI:10.4103/CJRM.CJRM_26_18  PMID:31552867
Introduction: Measuring the diameter of the inferior vena cava (IVC) or the height of the jugular venous pressure (JVP) with point-of-care ultrasound (POCUS) is a practical alternative method for estimating a patient's intravascular volume in the rural setting. This study aims to determine whether or not POCUS of the IVC or JVP generates additional useful clinical information over and above routine physical examination in this context. Methods: Twenty generalist physicians, working in five New Zealand rural hospitals, recorded their estimation of a patient's intravascular volume based on physical examination and then again after performing POCUS of the IVC or JVP, using a visual scale from 1 to 11. Results: Data were available for 150 assessments. There was an only moderate agreement between the pre- and post-test findings (Spearman's correlation coefficient = 0.46). In 28% (42/150) of cases, the difference was four or more points on the scale, and therefore, had the potential to be clinically significant. Conclusion: In the rural context, POCUS provides new information that frequently alters the clinician's estimation of a patient's intravascular volume.
  1,367 285 -
ORIGINAL ARTICLES / ARTICLES ORIGINAUX
Demographics, prevalence and outcomes of diabetes in pregnancy in NW Ontario
Ruben Hummelen, Ribal Kattini, Jenna Poirier, Sharen Madden, Holly Ockenden, Joseph Dooley, Len Kelly
July-September 2020, 25(3):99-104
DOI:10.4103/CJRM.CJRM_71_19  PMID:32611874
Introduction: Diabetes in pregnancy confers increased risk. This study examines the prevalence and birth outcomes of diabetes in pregnancy at the Sioux Lookout Meno Ya Win Health Centre (SLMHC) and other small Ontario hospitals. Methods: This was a retrospective study of maternal profile: age, parity, comorbidities, mode of delivery, neonatal birth weight, APGARS and complications. Data were compared to other Ontario hospitals offering an equivalent level of obstetrical services. Results: Type 2 diabetes mellitus in pregnancy is far more prevalent in mothers who deliver at SLMHC (relative risk [RR]: 20.9, 95% confidence interval [CI]: 16.0–27.2); the rates of gestational diabetes (GDM) are double (RR: 2.0, 95% CI: 1.7–2.3). SLMHC mothers with diabetes were on average 5 years younger and of greater parity with increased substance use. Neonates largely had equivalent outcomes except for increased macrosomia, neonatal hypoglycaemia and hyperbilirubinaemia in GDM pregnancies. Conclusion: Patients with diabetes in pregnancy at SLMHC differ substantially from mothers delivering at Ontario hospitals with a comparable level of service. Programming and resources must meet the service needs of these patients.
  1,315 162 -
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.
  1,203 237 2
EDITORIALS / …DITORIAUX
Family physicians as generalists
Margaret Tromp
April-June 2019, 24(2):33-34
DOI:10.4103/CJRM.CJRM_6_19  PMID:30924457
  1,096 335 -
Is Northern Ontario School of Medicine there yet?
Peter Hutten-Czapski
October-December 2019, 24(4):103-103
DOI:10.4103/CJRM.CJRM_56_19  PMID:31552861
  1,153 231 1
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
  1,167 196 -
ORIGINAL ARTICLE / ARTICLE ORIGINAUX
Screening for gestational diabetes in pregnancy in Northwestern Ontario
Jenna Poirier, Ribal Kattini, Len Kelly, Sharen Madden, Brenda Voth, Joe Dooley, Brent Marazan, Ruben Hummelen
April-June 2020, 25(2):61-66
DOI:10.4103/CJRM.CJRM_51_19  PMID:32235107
Introduction: We estimate the screening and prevalence of gestational diabetes mellitus (GDM) in a primarily first nations obstetrical population in Northwestern Ontario. Methods: The study is an 8-year retrospective analysis of all gestational glucose challenge and tolerance tests performed at the Sioux Lookout Meno Ya Win Health Centre (SLMHC) laboratory from 1 January, 2010 to 31 December, 2017. Test, gestational timing and completion rate of screening were recorded, and GDM prevalence was calculated on the tested population. Screening completion rates were recorded for the subset of women who delivered at SLMHC from 2014 to 2017. Results: The average annual GDM prevalence was 12%, double the Ontario rate. Over the 8-year period, 513 patients were diagnosed with GDM among the 4298 patients screened. Patients were screened with the 2-step (90%) or the 1-step (10%) protocol. Screening occurred <20 weeks in 3%; 54% occurred in <28 weeks and 40% >28 weeks. Seventy percent of the tests were from remote nursing stations. The screening completion rate for women delivering at SLMHC in 2017 was 80.8%. Conclusion: The prevalence of GDM in Northwestern Ontario is twice the provincial rate. Most screening used the 2-step protocol; early screening was underused. Improvements in screening programming are underway and future research may match surveillance rates and results to GDM outcomes.
  1,174 171 -
EDITORIALS / …DITORIAUX
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
  1,077 261 -
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
  1,130 180 -
PROCEDURE
The occasional bougie-assisted cricothyroidotomy
Tyler M C. Johnston, Philip J Davis
January-March 2020, 25(1):41-48
DOI:10.4103/CJRM.CJRM_50_19  PMID:31854341
  1,123 158 -
SYSTEMATIC REVIEW
A systematic review of reviews: Recruitment and retention of rural family physicians
Shabnam Asghari, Megan C Kirkland, Jillian Blackmore, Sarah Boyd, Alison Farrell, James Rourke, Kris Aubrey-Bassler, Marshall Godwin, Ivy Oandasan, Aleksandra Walczak
January-March 2020, 25(1):20-30
DOI:10.4103/CJRM.CJRM_4_19  PMID:31854339
Abstract Introduction: The recruitment and retention of family physicians in rural and remote communities has been the topic of many reviews; however, a lack of consensus among them with regard to which factors are most influential makes it difficult for setting priorities. We performed a systematic review of reviews which helped to establish an overall conclusion and provided a set of fundamental influential factors, regardless of the consistency or generalisability of the findings across reviews. This review also identified the knowledge gaps and areas of priority for future research. Methods: A literature search was conducted to find the review articles discussing the factors of recruitment or retention of rural family physicians. Results were screened by two independent reviewers. The number of times that each factor was mentioned in the literature was counted and ordered in terms of frequency. Results: The literature search identified 84 systematic reviews. Fourteen met the inclusion criteria, from which 158 specific factors were identified and summarised into 11 categories: personal, health, family, training, practice, work, professional, pay, community, regional and system/legislation. The three categories referenced most often were training, personal and practice. The specific individual factors mentioned most often in the literature were 'medical school characteristics', 'longitudinal rural training' and 'raised in a small town'. Conclusion: The three most often cited categories resemble three distinct phases of a family physician's life: pre-medical school, medical school and post-medical school. To increase the number of physicians who choose to work in rural practice, strategies must encompass and promote continuity across all three of these phases. The results of this systematic review will allow for the identification of areas of priority that require further attention to develop appropriate strategies to improve the number of family physicians working in rural and remote locations.
  1,029 236 1
PROCEDURE
The occasional allergy skin test
Peter Hutten-Czapski
July-September 2019, 24(3):92-94
DOI:10.4103/CJRM.CJRM_10_19  PMID:31249157
  1,002 246 -