Dalhousie Medical Journal最新文献

{"title":"The long wait: A discussion of emergency department wait time and its impact on clinical outcomes","authors":"M. Sultan","doi":"10.15273/dmj.vol49no1.11638","DOIUrl":"https://doi.org/10.15273/dmj.vol49no1.11638","url":null,"abstract":"A trip to any emergency department (ED) across the country is usually associated with long wait times that can sometimes stretch over a full day or a night. Recently, wait times have been increasing to a distressing rate and emergency medicine teams having been sounding the alarms. Despite the growing population and the increased demand on emergency departments due to the extreme shortage of family physicians, emergency medicine remains under serviced1. While doctors, nurses and the entire interprofessional health team continue to deliver their best efforts to care for patients in timely matter, the lack of resources and space hurdle their efforts. The impact of ED wait times begins with a concerning percentage of patients leaving without being seen by a healthcare team member. A cohort study from the major emergency departments in Ontario showed that 4.2% of patient visiting EDs across Ontario between 2003-2007 left without being seen2. The same study showed that longer wait times were associated with higher risk of adverse events and/or being admitted to the hospital. Depending on the acuity of the presentation, wait times can vary significantly with higher acuity patients typically seen sooner. However, resources do not exist to monitor patients’ conditions during extended wait times, and changes in acuity have become an increasing issue. Finally, the location of emergency departments contributes to different wait times. A retrospective study of wait times in rural and urban EDs in Ontario revealed that rural emergency departments tend to have shorter wait times3. However, it is important to highlight that large urban centers regularly receive higher acuity transfers from smaller rural EDs which contribute to increasing wait times. Several strategies have been proposed to reduce wait times in EDs. These strategies have been mostly focused on increasing the capacity, decreasing wait time for results after intake and decreasing intake. Several trials across the country showed some degrees of success of these strategies including introduction of satellite health clinics for patients returning to the ED for follow up in British Columbia4. A similar study conducted in Saskatchewan showed a positive impact of the reduction of physician reassessment time on wait times in the ED5. Finally, a study by Wong et al. showed that many patients prefer to access after-hours family medicine practices over EDs, therefore reducing the demand of patients with lower acuity presentation on EDs6. Despite these proposed solutions, wait times continue to increase in EDs across the country. The response to this demand continues to fall short and a system-wide solution is increasingly needed to enhance patient outcome and prevent physician burnout.","PeriodicalId":293977,"journal":{"name":"Dalhousie Medical Journal","volume":"55 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131672613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A medical student’s guide to the slit lamp examination","authors":"Sunil Ruparelia","doi":"10.15273/dmj.vol49no1.11641","DOIUrl":"https://doi.org/10.15273/dmj.vol49no1.11641","url":null,"abstract":"The slit lamp is an essential tool for the diagnosis of common eye pathology. Despite many eye conditions presenting initially to primary care, medical students do not typically receive formal training with the slit lamp in standard medical education curriculum. This guide provides a consistent, systematic framework that may be used by students and clinicians when approaching a slit lamp examination. Additionally, suggestions intended to optimize examination outcomes are described. It is our hope that this guide serves to enhance medical student comfort and proficiency with eye examinations, be it in an ophthalmology clinic, primary care, or emergency department setting.","PeriodicalId":293977,"journal":{"name":"Dalhousie Medical Journal","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117093869","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A youthful take on community-based healthcare","authors":"Hannah Cameron, C. Bray, Tania Wong, K. Blake","doi":"10.15273/dmj.vol48no2.11470","DOIUrl":"https://doi.org/10.15273/dmj.vol48no2.11470","url":null,"abstract":"Youth are at a unique developmental stage, presenting with experiences and needs that can be challenging to address through traditional medical models. Youth health clinics (YHCs) have taken varying approaches to solving this problem; however, there is a paucity of research on adolescents’ perspectives of these clinics. We conducted four focus groups to ask high school students how YHCs could better serve them. Participants identifiedfive essential elements for YHCs. They requested accessibility, reliability, and confidentiality, desiring private access with trusted healthcare professionals that was simple to access. They also emphasized the importance of a range of point-of-care services and proactive advertising of YHC services. Finally, youth prioritized mental health services that were both longitudinal and equipped for crises. Overall, our cohort of youth felt that YHCs could fill an important gap in meeting their healthcare needs.","PeriodicalId":293977,"journal":{"name":"Dalhousie Medical Journal","volume":"196 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127318460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of funding non-invasive prenatal testing (NIPT) on invasive procedures performed to identify trisomy 21 pregnancies: A population-based cohort study","authors":"Marianne Lévesque, V. Allen, C. Woolcott, Jo-Ann K. Brock","doi":"10.15273/dmj.vol48no2.11473","DOIUrl":"https://doi.org/10.15273/dmj.vol48no2.11473","url":null,"abstract":"Background: Screening for Trisomy 21 in Nova Scotia has traditionally included serum integrated prenatal screening (SIPS, maternal serum screening), and integrated prenatal screening (maternal serum screening with nuchal translucency, IPS) for those patients considered to be at high risk. In 2016, non-invasive prenatal testing (NIPT) became available as a funded second tier screen for pregnancies at high risk for Trisomy 21 in Nova Scotia.Objective: To compare pregnancy characteristics and number of diagnostic procedures performed for high risk of Trisomy 21 before and after introduction of funded NIPT in Nova Scotia.Methods: This population-based retrospective cohort study evaluated pregnancies with diagnostic testing and/or NIPT which were identified through the IWK Health Clinical Genomics Laboratory Database. Maternal chart review was performed for each pregnancy to confirm eligibility and collect demographic data. Descriptive statistics comparing number of diagnostic procedures and pregnancy characteristics were performed among two epochs – pre-NIPT (2012-2015) and post-NIPT (2016-2019) using Fisher’s exact test, and rates of Trisomy 21 confirmed by diagnostic testing between the two epochs were described.Results: The population incidence of Trisomy 21 remained stable and maternal demographics were similar between the two epochs; after the introduction of funded NIPT, the number of diagnostic procedures decreased, and when diagnostic testing was performed, the procedures were 6-fold more likely to confirm Trisomy 21 (95% CI 2.6-12.9) following high risk screening.Conclusion: The decrease in diagnostic procedures with an increase in the prenatal detection of Trisomy 21 demonstrated in this study illustrates the value of NIPT in a population with limited resources for first trimester  screening.","PeriodicalId":293977,"journal":{"name":"Dalhousie Medical Journal","volume":"193 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132333639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Workers’ compensation board claims and emergency department diagnostic management of non-specific low back pain","authors":"J. Courville, R. Ogilvie, J. Hayden","doi":"10.15273/dmj.vol48no2.11472","DOIUrl":"https://doi.org/10.15273/dmj.vol48no2.11472","url":null,"abstract":"Background: Low back pain is a leading cause of disability worldwide and results in enormous healthcare and lost productivity costs. Guidelines exist to guide the management of low back pain, but guideline adherence varies.Objective: This study assessed whether initial presentation to the emergency department for non-specific low back pain with a Workers’ Compensation Board of Nova Scotia claim was associated with different diagnostic management from non-claimants.Methods: In this retrospective cohort study, we analyzed administrative data from four emergency departments in Nova Scotia on 18,337 adult patients who presented for non-specific low back pain between July 15, 2009 and May 1, 2019. All data were retrieved from the Nova Scotia Health Authority Emergency Department Information System.Results: Patients had a mean age of 43 years and 51.3% were female. Most patients were assigned a Canadian Triage Acuity Scale score of 3 (51.9%) and reported moderate (51.2%) to severe pain (41.5%). Occupational injuries consisted of 11.6% of visits. More than 37% of patients received one or more diagnostic test. Patients with occupational injuries were less likely to receive diagnostic tests (odds ratio [OR] = 0.52, 95% CI 0.47 to 0.58), imaging (OR = 0.60, 95% CI 0.54 to 0.67), and laboratory tests (OR = 0.35, 95% CI 0.29 to 0.43). These results remained consistent when controlling for covariates.Conclusion: Patients who presented to the emergency department for occupational non-specific low back pain were less likely to receive diagnostic tests compared to non-occupational non-specific low back pain patients.","PeriodicalId":293977,"journal":{"name":"Dalhousie Medical Journal","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123679595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recent medical graduates’ attitudes towards nutrition education and its role in medical practice","authors":"L. Melanson, D. Ramsay, O. Theou, Peri H. Fenwick, Alyson Colborne, L. Cahill","doi":"10.15273/dmj.vol48no2.11471","DOIUrl":"https://doi.org/10.15273/dmj.vol48no2.11471","url":null,"abstract":"The objective of this study was to investigate recent Dalhousie Medical School graduates’ perceptions of nutrition in three domains: attitudes towards its use in medical practice generally, learned body of knowledge in medical school and residency, and satisfaction with how undergraduate and postgraduate medical education aligned their attitudes and knowledge of nutrition in medicine. Graduates of Dalhousie University’s undergraduate medical program from 2013 to 2018 were contacted to complete an internet-based questionnaire of 13 five-point Likert scale questions about attitudes, knowledge, and satisfaction with nutrition education in their undergraduate medical studies and medical practice. Responses ranged from one, “strongly disagree” to five, “strongly agree”. Most respondents (90.2%) agreed that ‘nutrition counseling can make a positive difference to patient outcomes’ and 80.5% agreed that ‘physicians can influence patient behavior related to nutrition’. However, fewer (61.0%) agreed that ‘physicians play a key role in improving patients’ nutritional habits.’ Even fewer participants agreed that nutritional assessment (34.1%) and nutritional counselling (41.5%) should be a routine part of care, regardless of specialty. The mean (standard deviation) overall score of participants with regards to their attitudes about nutrition assessment, counselling, and role in patient health, was 3.60 (0.633). Scores ranged from 1 to 5 with higher score indicating morepositive attitude. Mean overall knowledge and satisfaction scores were 3.76 (0.702) and 2.70 (0.898), respectively. There is a lack of consensus regarding the role of physicians in delivering nutrition care to patients, despite its perceived importance to patient health, requiring further exploration.","PeriodicalId":293977,"journal":{"name":"Dalhousie Medical Journal","volume":"103 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122863243","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pain mitigation during vaccine injections of the frail older adult population: A systematic review","authors":"K. Cull, S. Bowles, J. Isenor","doi":"10.15273/dmj.vol48no1.11261","DOIUrl":"https://doi.org/10.15273/dmj.vol48no1.11261","url":null,"abstract":"Background: Adults require disease-appropriate immunizations against a variety of vaccine preventable illnesses. The frail older adult population is at particular risk if not appropriately immunized due to increased vulnerability of morbidity and mortality. Despite this, adult immunization rates continue to be suboptimal, and studies have shown that pain mitigation is an important, modifiable factor in low immunization rates.Objectives: To determine the effective pain mitigating interventions available for use by the frail older adult population during routine vaccine injections.Methods: A systematic review of randomized controlled trials and quasi-randomized controlled trials was conducted, evaluating the effectiveness of available pain-relieving interventions during vaccine injections of the frail older adult population. Original articles were searched through MEDLINE via Ovid, EMBASE, the Cochrane Central Database, CINAHL via EBSCOhost, and grey literature until February 2017.Results: There were no documented trials to investigate the effectiveness of pain-mitigating strategies during vaccine injections of the frail older adult population.Conclusion: This systematic review demonstrates the need for investigation and further research of pain-mitigating strategies in the immunization of frail older adults. Research in this field may help to improve vaccination rates in this population.","PeriodicalId":293977,"journal":{"name":"Dalhousie Medical Journal","volume":"244 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116248675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A medical student’s guide to flexible nasal pharyngoscopy","authors":"Changseok Lee, C. Purcell, Ayham Al Afif, Yousef Bolous, Danica Vidovic, T. Brown, Mark Taylor","doi":"10.15273/dmj.vol48no1.11260","DOIUrl":"https://doi.org/10.15273/dmj.vol48no1.11260","url":null,"abstract":"Flexible nasopharyngoscopy (FNP) is a specialized skill commonly used by otolaryngologists as an important component of the head and neck examination. FNP can be diagnostic and therapeutic for many head and neck pathologies. Mastering this skill facilitates the effective performance of other specialized skills and procedures such as fibreoptic nasal intubations and flexible bronchoscopies. During otolaryngology rotations and electives, medical students are exposed to a high volume of FNP. Often, they are also asked to perform this procedure in clinic and on-call. There is currently no widely available simulation tool for medical students to practice using FNP, and medical students at our institution do not receive any formal training prior to performing FNP. The following is an introductory guide for medical students to become proficient at performing FNP while on their otolaryngology rotation.","PeriodicalId":293977,"journal":{"name":"Dalhousie Medical Journal","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122329554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anterior urethral trauma in a 5-year-old boy","authors":"K. Moore, Josh White, R. Romao, D. MacLellan.","doi":"10.15273/dmj.vol48no1.11258","DOIUrl":"https://doi.org/10.15273/dmj.vol48no1.11258","url":null,"abstract":"<jats:p>.</jats:p>","PeriodicalId":293977,"journal":{"name":"Dalhousie Medical Journal","volume":"93 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130219025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A lens into the past: The history of cataract surgery","authors":"Sunil Ruparelia","doi":"10.15273/dmj.vol48no1.11257","DOIUrl":"https://doi.org/10.15273/dmj.vol48no1.11257","url":null,"abstract":"Cataract surgery may be one of medicine’s greatest achievements, providing treatment for an otherwise blinding condition. These surgeries are among the most common operative procedures performed worldwide and are also among the most successful. The advancements that have been made in cataract management exemplify the progress that has been made in the field of surgery as a whole. Moreover, the story of the evolution of cataract surgery is fascinating. From humble origins with cataract couching to the use of ultrasonic energy in phacoemulsification, each milestone in the advancement of cataract surgery has had innovative physicians at its forefront, striving for better patient visual outcomes. This article seeks to review these major milestones, including couching, extracapsular cataract extraction, intracapsular cataract extraction, and intraocular lens implantation. Procedural steps of modern-day phacoemulsification and recent advancements that may be incorporated into future practice are also reviewed.","PeriodicalId":293977,"journal":{"name":"Dalhousie Medical Journal","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123559124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}