Persistence of snowshoe hare virus in Halifax County, NS.
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Pod people. Response of family physicians and family practice nurses to Kosovar refugees in Greenwood, NS.
OBJECTIVE: To explore roles of family physicians and family practice nurses who provided care to Kosovar refugees at Greenwood, NS. DESIGN: Qualitative study based on individual interviews with family physicians and family practice nurses. SETTING: Family practices in Halifax, NS. PARTICIPANTS: Six family practice nurses, four physician faculty members, four community-based family physicians, and two family medicine residents were interviewed. Participants were purposefully chosen from the roster of service providers. METHOD: All interviews were conducted by one of the researchers and were semistructured. Interviews lasted approximately 30 minutes and were immediately transcribed. Key words and phrases were identified and compared with subsequent interviews until saturation was achieved. MAIN FINDINGS: Data yielded four analytical categories: the clinical encounter, expectation and experience, role and team functioning, and response. Participants reported how providing care in the context of a refugee camp was both similar to and different from their daily activities in family practice, as were their working relationships with other health care professionals. CONCLUSION: Primary care for refugees during complex health emergencies is often underreported in the literature. Yet family practice physicians and nurses recounted that they had the requisite skills to provide care in such a context.
Adult↗
Community-acquired pneumonia due to Escherichia coli.
OBJECTIVE: To describe the features of community-acquired Escherichia coli pneumonia and to compare these patients with patients with pneumonia caused by other etiologic agents. PATIENTS AND METHODS: This prospective study was carried out at five medical institutions in three geographic locations---Pittsburgh, PA, Boston, MA and Halifax, NS. Pneumonia etiology was assigned, based on results of microbiological investigations, by a committee consisting of five investigators using rules established prior to the study. Demographic and clinical features and outcomes of patients with E. coli pneumonia were compared with those of pneumonia due to other microorganisms. RESULTS: Nineteen patients (9 (47.4%) blood culture positive) had pneumonia due to E. coli and 430 (69 (16.0%) blood culture positive) had pneumonia caused by other etiologic agents. E. coli was the second most common cause of bacteremic pneumonia. The E. coli patients were older, and more likely to be female, from a nursing home and confused compared with patients with pneumonia due to other microbial agents. They were more severely ill as measured by a validated pneumonia specific severity of illness scoring measure. Although there was no in-hospital mortality for the patients with E. coli pneumonia, the 90-day mortality was 21%. Thirty-two (7.4%) of the patients with pneumonia due to other agents died in hospital and the 90-day mortality rate was 13.5% (p NS). Eight of the 19 patients with E. coli pneumonia were admitted from a nursing home and an additional four patients (63.2%) were discharged to such a facility. In contrast, only 44 (10.2%) of the patients with pneumonia due to other agents were discharged to a nursing home (p<0.001). CONCLUSIONS: Patients diagnosed with E. coli pneumonia are frequently bacteremic. They are older than patients with pneumonia due to other etiologies, and more likely to be female, from a nursing home and severely ill. Despite the absence of in-hospital mortality, 21% of these patients died within 90 days of presentation.
Journal Article↗
Sternal acceleration ballistocardiography and arterial pressure wave analysis to determine stroke volume.
OBJECTIVE: To describe a cardiac output measurement using a new method to derive and analyze the long-axis ballistocardiogram that is less invasive than pulmonary artery thermodilution. DESIGN: Prospective physiologic study. SETTING: Intensive care unit of The Halifax Infirmary, a teaching hospital of Dalhousie University, Halifax, NS. PATIENTS: Thirty-nine patients in sinus rhythm with pulmonary artery thermodilution catheters or radial artery catheters in place. The first 30 subjects were the "learning set" and the next 9 were the "test set." INTERVENTIONS: A small (54-g) accelerometer was taped on the patient's chest. OUTCOME MEASURES: Measurements of time and amplitude coordinates of the acceleration and radial artery pressure wavepeaks, as well as anthropometric information. RESULTS: A stroke volume prediction equation was generated (R2 = 0.76) from the learning set. This equation was applied to the test set and correlated with the pulmonary artery thermodilution-derived stroke volumes (R = 0.79). Stroke volumes were compared using a previously described statistical method: a) bias (predicted > thermodilution) = 0.03 mL (95% confidence interval [CI] -4.2 to 4.8 mL); b) lower limit of agreement = -21 mL (95% CI -29 to -13 mL); c) upper limit of agreement = 22 mL (95% CI 14 to 29 mL). Of derived stroke volumes, 82% were within 15 mL of pulmonary artery thermodilution-derived values. CONCLUSIONS: The sternal acceleration ballistocardiogram combined with hemodynamic and demographic data in a probabilistic model shows promise of providing a less invasive measure of cardiac output than thermodilution.
Aged↗
Comparison of patellar resurfacing versus nonresurfacing in total knee arthroplasty.
OBJECTIVES: To determine whether resurfacing the patellar component during total knee replacement (TKR) influences the clinical outcome. DESIGN: A retrospective study of data gathered prospectively during the recovery course of patients who underwent TKR with or without patellar resurfacing. SETTING: Victoria General Hospital, Halifax, NS. PATIENTS: One hundred and eighty-five patients operated on between 1992 and 1995. The inclusion criteria were (a) osteoarthritis, (b) replacement carried out by 2 independent surgeons, (c) no comorbid illness such as rheumatoid arthritis, cancer or infection, (d) pre- and postoperative attendance at the assessment clinics. INTERVENTION: TKR with (45) or without (140) patellar replacement. MAIN OUTCOME MEASURES: Range of motion (ROM), pain assessment, Hospital Severity Score (HSS) and complications. RESULTS: There was no statistical difference between the 2 groups with respect to ROM, pain, HSS and complications postoperatively. CONCLUSIONS: Resurfacing the patella during TKR does not seem to influence the clinical outcome with respect to ROM, pain and overall complications. The decision should be based on individual criteria, depending on the preoperative and intraoperative findings. Randomized clinical trials assessing ROM, pain, complications and cost-effectiveness with long-term follow-up are necessary to further investigate this controversial issue.
Adult↗
Efficacy of calcium sulfate plus decompression bone in lumbar and lumbosacral spinal fusion: preliminary results in 40 patients.
OBJECTIVE: To compare the efficacy of calcium sulfate pellets plus bone obtained from decompression with fresh autologous iliac crest bone in lumbar and lumbosacral spinal fusion with decompression. DESIGN: A prospective randomized clinical trial. SETTING: Four tertiary care centres in Halifax, NS. PATIENTS: All were consenting, skeletally mature and suffering from degenerative disc disease or spondylolisthesis. The first 40 patients from a single test centre are reported; 32 of these had completed 1-year follow-up. INTERVENTIONS: Posterolateral lumbar or lumbosacral spinal fusion with spinal canal decompression and randomized placement of test material (decompression bone plus an equal volume of calcium sulfate pellets) on one side and control material (autologous posterior iliac crest bone of equal volume to the test material) on the contralateral side, which allowed subjects to act as their own control. OUTCOME MEASURES: Assessment of bone formation by radiographic evaluation at 6 and 12 months after fusion by an independent musculoskeletal radiologist blinded to the placement of test material. RESULTS: At 6 and 12 months after fusion, 78% and 88% of patients, respectively, showed bone formation at the test site that was 75% to 100% of, equal to or more than that at the control site. Increases in bone formation at 6 and 12 months were almost identical at both sites. Smoking status, patient gender or age, instrumentation used and volume of graft used were not predictive of outcome. CONCLUSIONS: Calcium sulfate pellets plus decompression bone provided bone formation equivalent to autologous iliac crest bone in a majority of patients. Calcium sulfate pellets plus decompression bone may provide a viable alternative to autologous iliac crest as a graft material for spinal fusion.
Adult↗
Life-long dream fulfilled.
In the early 1940's, when I was a 14 year old in grade 9 at Chebucto Road School, in Halifax, NS, a Guidance Counsellor taught my class a compulsory subject titled CAREERS. The credit for this subject criteria required development of a 'CAREER BOOK'. The title page for my career book was Nurse As My Career. I had actually chosen this career long before the age of fourteen.
Canada↗
Report of the Canadian Cardiovascular Society's consensus conference on the Management of the Postmyocardial Infarction Patient.
In October 1989, the Canadian Cardiovascular Society announced a program to achieve consensus on important issues in the care of patients with cardiovascular disease. This report on the management of the postmyocardial infarction patient represents the first in a series of these consensus conferences. The process for establishing consensus recommendations involved several steps. A primary panel of 11 experts from various fields was selected to review the available clinical evidence and to make a list of recommendations about management decisions in the postmyocardial infarction period. The initial report was distributed to a secondary panel of 16 reviewers* representing allied health care constituencies from across Canada. On the basis of the critical reviews and feedback from these reviewers, a revised report was distributed to all members (over 800) of the Canadian Cardiovascular Society for further review and feedback. This iterative approach resulted in a penultimate report that was presented at a plenary session of the annual scientific meeting of the Canadian Cardiovascular Society on Oct. 18, 1990, in Halifax, NS. On the basis of discussion and feedback from this symposium, the consensus review was completed.
Canada↗
Prognostic factors in colorectal carcinoma of young adults.
To determine why the prognosis for colorectal cancer in young adults is poor, survival and prognostic factors in patients under 40 years of age were compared with those in patients between 40 and 50 years of age. In a 10-year period, 122 patients less than 50 years of age (88 between 40 and 50 years) presented at the Victoria General Hospital in Halifax, NS, with colorectal cancer. Their charts were retrospectively reviewed. Follow-up was obtained for all patients. Of the 34 patients younger than 40 years, 71% (24) were men compared with 38% (33) of older patients. Symptoms, their duration and the location of primary tumours were similar in the two groups. Patients younger than 40 years presented with advanced lesions (Dukes' stages C and D) in 67% of cases compared with 52% of the older group. Mucinous tumours were twice as common in patients less than 40 years old (p = 0.036) and actuarial survival rates were lower at all stages for the same group. The authors conclude that the poorer prognosis in patients less than 40 years of age is not due to late symptom reporting or delay in diagnosis, but to more aggressive disease.
Adult↗
Posterior sternoclavicular dislocations.
Twelve cases of posterior sternoclavicular dislocation were seen over 15 years at the Victoria General Hospital and the Izaak Walton Kiliam Hospital for Children in Halifax, NS. Two patients required open reduction of the dislocation but the rest were treated by closed reduction. One of the former group required threaded K wires for stability, but all other dislocations were deemed stable after reduction and application of a figure-of-eight bandage and an arm sling. There were no failures of reduction and no recurrent dislocations; the authors have been successful even in late closed reduction (up to 5 days) and therefore recommend it highly as the primary treatment. Open reduction is much more difficult and hazardous.
Adolescent↗
Physician retirement: a case for concern in Canadian hospitals.
Mandatory retirement is being challenged on the basis of age discrimination, and physicians are not divorced from this social trend. In January 1982 legal precedent was set by the Manitoba Court of Appeal concerning the retirement policy for physicians in Canada. Currently, Canadian hospital bylaws include clauses that require a change in membership status once a physician reaches 65 years of age. The main arguments in favour of this change include easier physician manpower management, ensured public safety and, in some instances, greater productivity. The main arguments against this change include loss of income to physicians, loss of skilled manpower to the profession and adverse effects on the mental and physical health of retiring physicians. In an effort to resolve this conflict some Canadian hospitals are developing strategies for reviewing the specific privileges and responsibilities physicians will retain once they reach age 65. The medical staff of the Victoria General Hospital in Halifax, NS have addressed this issue through their annual reappointment process.
Aged↗
Caring for head and neck oncology patients. Does social support lead to better quality of life?
OBJECTIVE: To determine whether social support contributes to better quality of life and psychological state of head and neck oncology patients. DESIGN: A structured questionnaire, administered orally to patients face-to-face, with specific questions about demographic and medical information and social support and two standardized scales; a cancer-specific quality of life scale and a depression scale. SETTING: Head and Neck Oncology Clinic, an institutional referral centre providing ambulatory care at the Camp Hill Medical Centre in Halifax, NS. PARTICIPANTS: Forty-five head and neck oncology patients (33 men, 12 women) who came for follow-up appointments at the clinic. One person did not complete the interview. Fifty patients were approached, but five were not included: one died before the interview, and four agreed to participate but were prevented by transportation or timing problems. MAIN OUTCOME MEASURES: Scores on the Functional Living Index-Cancer Scale and the Center for Epidemiologic Studies Depression scale. RESULTS: Four main factors predicted quality of life: satisfaction with family physician support, severity of cancer, sex of patient, and type of cancer. Three important predictors of psychological state were loss of appetite, family physician support, and sex of patient. CONCLUSION: Social support, particularly from family physicians, contributes greatly to better quality of life and psychological state for head and neck oncology patients.
Adult↗
Death from dialysis termination.
The only detailed analysis of dialysis termination by viable patients was reported by Neu and Kjellstrand (N Engl J Med 1986; 314: 14-20) from the USA. We analysed a similar series from Halifax, Nova Scotia, to add to our understanding of this important mode of treatment rejection by dialysis patients. Of 178 chronic dialysis patients at risk from January 1982 to May 1987, 11 viable patients (6%) stopped dialysis (16% of all patient deaths) after a mean of 22 +/- 7 months of therapy. Mean age at death was 67 +/- 5 years. The majority of these patients were receiving in-centre haemodialysis. Six patients independently decided to stop therapy, while in three cases physicians first proposed termination. In only two cases did the family propose termination. All patients died in hospital a mean of 10 +/- 2 days after the last dialysis. Dementia was the reason for stopping treatment in only two cases, while chronic heart failure with poor exercise tolerance was the major precipitant. One patient suffered from diabetes mellitus. We were not able to differentiate patients terminating therapy from those continuing treatment on the basis of age or co-morbidity, suggesting that subjective patient perception of their condition is a critical factor in stopping dialysis.
Adaptation, Psychological↗
Tracing the source of 3,3'-dichlorobiphenyl found in samples collected in and around Halifax Harbour.
3,3'-dichlorobiphenyl (IUPAC No. 11), a chlorobiphenyl (CB) that is not generally analysed in environmental studies of CBs, is found, sometimes at high concentrations, in water, suspended particulate material, biota and sediments from Halifax Harbour, NS, Canada. The results presented demonstrate the need for investigations of non-Aroclor CBs like CB 11. Not only can they have rather elevated environmental concentrations like those reported here for CB 11, but they also can be members of the more toxic non-ortho class of CBs and thus important from a toxicity standpoint. The focus of this paper was to investigate the possible sources of CB 11, a trace constituent of commercial mixtures, but dominant in various environmental compartments of Halifax Harbour.
Animals↗
"Mercy killing" takes centre stage in Canada.
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Advisory Committees↗