Canadian Journal of Rural Medicine最新文献

{"title":"Une perte toujours présente.","authors":"Peter Hutten-Czapski","doi":"10.4103/1203-7796.379555","DOIUrl":"10.4103/1203-7796.379555","url":null,"abstract":"","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"28 3","pages":"104"},"PeriodicalIF":1.1,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9862239","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":"Urban-rural divide in COVID-19 infection and vaccination rates in healthcare workers in British Columbia, Canada.","authors":"Annalee Yassi,&nbsp;Stephen Barker,&nbsp;Karen Lockhart,&nbsp;Deanne Taylor,&nbsp;Devin Harris,&nbsp;Harsh Hundal,&nbsp;Jennifer M Grant,&nbsp;Arnold Ikedichi Okpan,&nbsp;Sue Pollock,&nbsp;Stacy Sprague,&nbsp;Chad Kim Sing","doi":"10.4103/cjrm.cjrm_24_22","DOIUrl":"https://doi.org/10.4103/cjrm.cjrm_24_22","url":null,"abstract":"<p><strong>Introduction: </strong>Healthcare workers (HCWs) play a critical role in responding to the COVID-19 pandemic. Early in the pandemic, urban centres were hit hardest globally; rural areas gradually became more impacted. We compared COVID-19 infection and vaccine uptake in HCWs living in urban versus rural locations within, and between, two health regions in British Columbia (BC), Canada. We also analysed the impact of a vaccine mandate for HCWs.</p><p><strong>Methods: </strong>We tracked laboratory-confirmed SARS-CoV-2 infections, positivity rates and vaccine uptake in all 29,021 HCWs in Interior Health (IH) and all 24,634 HCWs in Vancouver Coastal Health (VCH), by occupation, age and home location, comparing to the general population in that region. We then evaluated the impact of infection rates as well as the mandate on vaccination uptake.</p><p><strong>Results: </strong>While we found an association between vaccine uptake by HCWs and HCW COVID-19 rates in the preceding 2-week period, the higher rates of COVID-19 infection in some occupational groups did not lead to increased vaccination in these groups. By 27 October 2021, the date that unvaccinated HCWs were prohibited from providing healthcare, only 1.6% in VCH compared with 6.5% in IH remained unvaccinated. Rural workers in both areas had significantly higher unvaccinated rates compared with urban dwellers. Over 1800 workers, comprising 6.7% of rural HCWs and 3.6% of urban HCWs, remained unvaccinated and set to be terminated from their employment. While the mandate prompted a significant increase in uptake of second doses, the impact on the unvaccinated was less clear.</p><p><strong>Conclusions: </strong>As rural areas often suffer from under-staffing, loss of HCWs could have serious impacts on healthcare provision as well as on the livelihoods of unvaccinated HCWs. Greater efforts are needed to understand how to better address the drivers of rural-related vaccine hesitancy.</p>","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"28 2","pages":"47-58"},"PeriodicalIF":1.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9233410","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":"Surgery in the western Canadian Arctic: The relative impact of family physicians with enhanced surgical skills working collaboratively with specialist surgeons.","authors":"Ryan Falk,&nbsp;Dawnelle Topstad","doi":"10.4103/cjrm.cjrm_44_22","DOIUrl":"https://doi.org/10.4103/cjrm.cjrm_44_22","url":null,"abstract":"<p><strong>Introduction: </strong>Little is known about the surgical needs of rural, remote or circumpolar populations in Canada; these same regions are also home to half of all Indigenous people in the country. In the present study, we sought to understand the relative impact of family physicians with enhanced surgical skills (FP-ESS) and Specialist Surgeons in the surgical care of a mostly Indigenous rural and remote community in the western Canadian Arctic.</p><p><strong>Methods: </strong>A descriptive and retrospective quantitative study was conducted to determine the number and range of procedures performed for the defined catchment population of the Beaufort Delta Region of the Northwest Territories, as well as the type of surgical provider and location of that service, over the 5 years from 1 April, 2014, to 31 March, 2019.</p><p><strong>Results: </strong>FP-ESS physicians in Inuvik performed 79% of all endoscopic and 22% of all surgical procedures, which accounted for nearly half of the total procedures performed. Over 50% of all procedures were performed locally (47.7% by FP-ESS and 5.6% by visiting specialist surgeons). For surgical cases alone, nearly one-third were performed locally, one-third in Yellowknife and the remaining one-third out-of-territory.</p><p><strong>Conclusions: </strong>This networked model reduces the overall demand on surgical specialists, who can better focus their efforts on surgical care that is beyond the scope of FP-ESS. With nearly half of the procedural needs of this population being met locally by FP-ESS, there are decreased health-care costs, better access and more surgical care closer to home.</p>","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"28 2","pages":"66-72"},"PeriodicalIF":1.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9233412","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":"Factors and Prediction Models for Unplanned Hospital Readmissions at a Pediatric Tertiary Centre","authors":"Amir Wachtel, M. Irvine, Jennifer Rurak, D. Courtemanche","doi":"10.33844/cjm.2023.6028","DOIUrl":"https://doi.org/10.33844/cjm.2023.6028","url":null,"abstract":"Unplanned Hospital Readmissions (UHRs) are associated with increased morbidity and mortality, and may be preventable. This study identified factors associated with pediatric UHRs and developed prediction models. UHRs for pediatric patients from 2007-2009 and 2017-2019 at British Columbia Children’s Hospital were retrospectively reviewed. Factors for UHRs were analyzed, and prediction models were derived and tested. 5.26% (411/8387) of patients from 2007-2009 and 3.95% (329/8316) from 2017-2019 experienced at least one UHR. Varying by time period, factors for UHRs included: home health authority, age, previous ER visits, preadmission comorbidities, admission type, in-hospital interventions, and intensive care unit stay. Prediction models had areas under the receiver operating characteristic curve of .61 (2007-2009) and .67 (2017-2019). This study identified variables associated with UHRs. Differences in predictor variables between two time periods suggest that UHRs may not reflect quality of care, and future prediction models need to be iteratively refined.","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"128 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76610300","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":"Remplacez-moi... S'il vous plaît.","authors":"Peter Hutten-Czapski","doi":"10.4103/1203-7796.372316","DOIUrl":"https://doi.org/10.4103/1203-7796.372316","url":null,"abstract":"","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"28 2","pages":"44"},"PeriodicalIF":1.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9227797","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":"Systematic review of the use of metformin compared to insulin for the management of gestational diabetes: Implications for low-resource settings.","authors":"Ribal Kattini,&nbsp;Len Kelly,&nbsp;Ruben Hummelen","doi":"10.4103/cjrm.cjrm_40_22","DOIUrl":"https://doi.org/10.4103/cjrm.cjrm_40_22","url":null,"abstract":"<p><strong>Introduction: </strong>This systematic review examines the effectiveness of metformin treatment compared to insulin treatment for gestational diabetes within the context of a low-resource environment.</p><p><strong>Methods: </strong>Electronic data searches of Medline, EMBASE, Scopus and Google scholar databases from 1 January, 2005 to 30 June, 2021 were performed using medical subject headings: 'gestational diabetes or pregnancy diabetes mellitus' AND 'Pregnancy or pregnancy outcomes' AND 'Insulin' AND 'Metformin Hydrochloride Drug Combination/or Metformin/or Hypoglycemic Agents' AND 'Glycemic control or blood glucose'. Randomized controlled trials were included if: participants were pregnant women with gestational diabetes mellitus (GDM); the interventions were metformin and/or insulin. Studies among women with pre-gestational diabetes, non-randomised control trials or studies with a limited description of the methodology were excluded. Outcomes included adverse maternal outcomes: weight gain, C-section, pre-eclampsia and glycaemic control and adverse neonatal outcomes: birth weight, macrosomia, pre-term birth and neonatal hypoglycaemia. The revised Cochrane Risk of Bias Assessment for randomised trials was used for the evaluation of bias.</p><p><strong>Results: </strong>We screened 164 abstracts and 36 full-text articles. Fourteen studies met the inclusion criteria. The studies provide moderate to high-quality evidence demonstrating the effectiveness of metformin as an alternative therapy to insulin. Risk of bias was low; multiple countries and robust sample sizes improved external validity. All studies were from urban centres with no rural data.</p><p><strong>Conclusion: </strong>These recent high quality studies comparing metformin to insulin for the treatment of GDM generally found either improved or equivalent pregnancy outcome and good glycaemic control for most patients, although many required insulin supplementation. Its ease of use, safety and efficacy suggest metformin may simplify the management of gestational diabetes, particularly in rural and other low-resource environments.</p>","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"28 2","pages":"59-65"},"PeriodicalIF":1.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9233413","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":"Social Support for Birthmothers Before and During the COVID-19 Pandemic","authors":"Jiyeon Park, Peter A. Johnson, J. Johnson, A. Mardon","doi":"10.33844/cjm.2023.6027","DOIUrl":"https://doi.org/10.33844/cjm.2023.6027","url":null,"abstract":"Giving birth is not a simple event and requires much attention, care, and support to result in a positive birth experience. However, the process of giving birth changed significantly during the COVID-19 pandemic due to the spread of the virus, the uncertainty of the virus, and the numerous restrictions implemented. These led to isolation, loneliness, a lack of communication, loss of control over the body, and little or no contribution to decision-making for the new birth mother. This, as well as a lack of social support, can harm a mother’s and baby’s mental and physical health. Thus, this article explores the importance of social support and its role before the COVID-19 pandemic, as well as the changes that have occurred in the birth process during the COVID-19 pandemic.","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"30 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83334105","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":"Simulation-Based Software Modeling of CAR T Cell Therapy Efficacy Against Solid Malignant Tumors","authors":"Daivat Bhavsar, Y. Li","doi":"10.33844/cjm.2023.6029","DOIUrl":"https://doi.org/10.33844/cjm.2023.6029","url":null,"abstract":"Genetically engineered T cells with Chimeric Antigen Receptors, CAR T cells, are a revolutionary immunotherapy used to treat advanced blood cancers. The purpose of this experiment was to model the destruction process of tumor cells with CAR T cell therapy using Complexity and Organized Behaviour Within Environmental Bounds (COBWEB), an agent-based simulation software. We designated parameter values for abiotic factors, agents (i.e. tumor cells, T cells) and the general environment in our immunotherapy simulation model to illustrate the interactions between tumor cells and cytotoxic components, which described the binding of innate CD8+ T cells or CAR T cells to tumor antigens. The models were used to observe and comparatively analyze the rate of destruction of a solid tumor by CAR T cells and innate CD8+ T cells. The solid tumor developed in a circular island for 60 ticks, representing days; innate CD8+ or CAR T cells were then able to infiltrate the island and the tumor cell population was monitored over 500 days. The CAR T cells exhibited a significantly powerful, efficient immune response against a general solid tumor relative to the innate CD8+ T cells, yet relapse occurred in both models albeit to a lesser extent with CAR T cells. However, further investigations are required to adequately simulate the side effects and realistically-limiting factors of CAR T cell therapy. Similar comparative analyses may help measure and compare the potency of the immune response of CAR T cells compared to standard, or lack of, treatments.","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"11 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83530547","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":"Increasing Awareness of Low Incidence Disease as Immigration Rates Increase: A Recent Case of Pott’s Disease in Atlantic Canada","authors":"Z. Stanton, Moira A Law, I. Shamputa, D. Webster, Kimberley Barker","doi":"10.33844/cjm.2023.6026","DOIUrl":"https://doi.org/10.33844/cjm.2023.6026","url":null,"abstract":"As Canada experiences and prepares for notable increases in immigration, health care professionals need to be aware of emerging cases of low incidence diseases, particularly when found in higher rates in the foreign-born population. Therefore, we report the case of a 20-year-old male immigrant presenting to a Canadian emergency department with a one year history of worsening back pain. In the emergency department, thoracic radiographs showed pathologic fractures at T10 and T11 with destructive changes from T8 to T12. Further, a computed tomography scan identified a large paravertebral abscess from T6 to L1, with osseous destruction and spinal stenosis. Magnetic resonance imaging showed bony deformity, epidural, pre-and paravertebral, and bilateral psoas abscesses, and a right-sided pleural effusion. Diagnosis was confirmed with direct molecular testing and treatment was initiated in a timely and efficacious manner. This case report highlights the need for health care providers to have a high index of suspicion and consideration of atypical presentations of low incidence diseases, particularly within the burgeoning immigrant population, to ensure quality health care services are delivered.","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"96 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81191525","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":"Staffing rural emergency departments in Ontario: The who, what and where.","authors":"Tyler Randle,&nbsp;Arunim Garg,&nbsp;Vijay Mago,&nbsp;Salimur Choudhury,&nbsp;Robert Ohle,&nbsp;Roger Strasser,&nbsp;Sean W Moore,&nbsp;Aimee Kernick,&nbsp;David W Savage","doi":"10.4103/cjrm.cjrm_51_22","DOIUrl":"https://doi.org/10.4103/cjrm.cjrm_51_22","url":null,"abstract":"<p><strong>Introduction: </strong>The emergency department (ED) in rural communities is essential for providing care to patients with urgent medical issues and those unable to access primary care. Recent physician staffing shortages have put many EDs at risk of temporary closure. Our goal was to describe the demographics and practices of the rural physicians providing emergency medicine services across Ontario in order to inform health human resource planning.</p><p><strong>Methods: </strong>The ICES Physician database (IPDB) and Ontario Health Insurance Plan (OHIP) billing database from 2017 were used in this retrospective cohort study. Rural physician data were analysed for demographic, practice region and certification information. Sentinel billing codes (i.e., a billing code unique to a particular clinical service) were used to define 18 unique physician services.</p><p><strong>Results: </strong>A total of 1192 physicians from the IPDB met inclusion as rural generalist physicians out of a total of 14,443 family physicians in Ontario. From this physician population, a total of 620 physicians practised emergency medicine which accounted for 33% of their days worked on average. The majority of physicians practising emergency medicine were between the ages of 30 and 49 and in their first decade of practice. The most common services in addition to emergency medicine were clinic, hospital medicine, palliative care and mental health.</p><p><strong>Conclusion: </strong>This study provides insight into the practice patterns of rural physicians and the basis for better targeted physician workforce-forecasting models. A new approach to education and training pathways, recruitment and retention initiatives and rural health service delivery models is needed to ensure better health outcomes for our rural population.</p>","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"28 2","pages":"73-81"},"PeriodicalIF":1.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9233414","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}