Timing of Etonogestrel Implant Insertion After Dilation and Evacuation: A Randomized Controlled Trial.

Objective: To compare the 6-month use rate of the etonogestrel implant placed immediately after dilation and evacuation (D&E) with placement 2-4 weeks postprocedure.

Methods: This is a randomized controlled trial of women seeking abortion between 14 0/7 and 23 5/7 weeks of gestation and desiring the etonogestrel contraceptive implant at an urban family planning clinic. Participants were randomized to device insertion immediately after the D&E compared with delayed insertion in 2-4 weeks.

Post electrical or lightning injury syndrome: a proposal for an American Psychiatric Association's Diagnostic and Statistical Manual formulation with implications for treatment.

In the past, victims of electrical and lightning injuries have been assessed in a manner lacking a systematic formulation, and against criteria, particularly in the area of neuropsychological disability. In this manner patients have, for example, only been partially treated, been poorly or incorrectly diagnosed, and have been denied the full benefit of compensation for their injuries. This paper contains a proposal for diagnostic criteria particularly for the neuropsychological aspects of the post injury syndrome.

The Most Effective Methods for Delivering Severe Weather Early Warnings to Fishermen on Lake Victoria.

: It is estimated that five thousand people die on Lake Victoria every year by drowning which is triggered by severe weather hazards like lightning. :  In order to improve predictability of severe weather conditions on Lake Victoria, there is need to deliver timely and effective Severe Weather Early Warning Systems (SWEWS) to those at risk. On Lake Victoria, previous SWEW service trials ceased with the end of the funding grants.

A follow-up study of a large group of children struck by lightning.

Background: On 11 November 1994, 26 preadolescent girls, 2 adult supervisors and 7 dogs were sleeping in a tent in rural South Africa when the tent was struck by lightning. Four of the girls and 4 of the dogs were killed. The 2 adults were unharmed, but all but 3 of the children suffered significant injuries.

Gastrointestinal Endoscopy Competency Assessment Tool: reliability and validity evidence.

Background: Rigorously developed and validated direct observational assessment tools are required to support competency-based colonoscopy training to facilitate skill acquisition, optimize learning, and ensure readiness for unsupervised practice.

Objective: To examine reliability and validity evidence of the Gastrointestinal Endoscopy Competency Assessment Tool (GiECAT) for colonoscopy for use within the clinical setting.

Design: Prospective, observational, multicenter validation study.

Surgical residents' perceptions on learning gastrointestinal endoscopy: more hours and more standardization wanted.

Objective: Gastrointestinal endoscopy is a complex task that involves an interaction of cognitive and manual skills. There is no consensus on the optimal way to teach endoscopy. We sought to evaluate our formal endoscopy curriculum for general surgery trainees to improve the effectiveness and quality of the endoscopy teaching in this program.

Registered nurse-performed flexible sigmoidoscopy in Ontario: development and implementaton of the curriculum and program.

Although colorectal cancer is a leading cause of death in Canada, it is curable if detected in the early stages. Flexible sigmoidoscopy has been shown to reduce the incidence and mortality of colorectal cancer in patients who are at average risk for this disease and, therefore, is an appropriate screening intervention. Moreover, it may be performed by nonphysicians.

Gastrointestinal Endoscopy Competency Assessment Tool: development of a procedure-specific assessment tool for colonoscopy.

Background: Ensuring competence remains a seminal objective of endoscopy training programs, professional organizations, and accreditation bodies; however, no widely accepted measure of endoscopic competence currently exists.

Objective: By using Delphi methodology, we aimed to develop and establish the content validity of the Gastrointestinal Endoscopy Competency Assessment Tool for colonoscopy.

Design: An international panel of endoscopy experts rated potential checklist and global rating items for their importance as indicators of the competence of trainees learning to perform colonoscopy.

National Athletic Trainers' Association position statement: lightning safety for athletics and recreation.

Objective: To present recommendations for the education, prevention, and management of lightning injuries for those involved in athletics or recreation.

Background: Lightning is the most common severe-storm activity encountered annually in the United States. The majority of lightning injuries can be prevented through an aggressive educational campaign, vacating outdoor activities before the lightning threat, and an understanding of the attributes of a safe place from the hazard.

Qualitative study of physician perspectives on classifying screening and nonscreening colonoscopy using administrative health data: adding practice does not make perfect.

Background: Previously developed screening colonoscopy algorithms based on diagnostic and endoscopy procedural variables have not been sufficiently accurate for use in epidemiological and health services research.

Objective: To increase understanding of the administrative health database variables that could help to discern screening and nonscreening colonoscopy.

Methods: A qualitative study using physician focus groups was conducted in Montreal (Quebec), Calgary (Alberta) and Toronto (Ontario).

How well is Helicobacter pylori treated in usual practice?

Background: Helicobacter pylori is a WHO class I carcinogen also associated with nonmalignant gastrointestinal diseases. Effective treatment exists, and all persons infected with H pylori should receive treatment. However, data regarding the rates of treatment prescription in clinical practice are lacking.

Comparing patient and endoscopist perceptions of the colonoscopy indication.

Background: determining whether a colonoscopy is performed for screening or nonscreening purposes can facilitate clinical practice and research. However, there is no simple method to determine the colonoscopy indication using patient medical files or health administrative databases.

Objective: to determine patient-endoscopist agreement on the colonoscopy indication.

Psychiatric morbidity following electrical injury and its effects on cognitive functioning.

Objective: This study examines the prevalence of psychiatric morbidity in a large sample of electrical injury (EI) patients in three phases of recovery and its effects on cognitive functioning.

Methods: Eight-six self-referred EI patients received psychiatric and neuropsychological evaluations. Descriptive statistics were conducted to examine the prevalence of psychiatric morbidity.

Alteration in functional brain systems after electrical injury.

Neuropsychological studies in electrical injury patients have reported deficits in attention, learning, and working memory, but the neural substrates of these deficits remain poorly characterized. In this study we sought to examine whether electrical injury subjects demonstrate abnormal patterns of brain activation during working memory and procedural learning tasks. Fourteen electrical injury subjects and fifteen demographically matched healthy control subjects performed a spatial working memory paradigm and a procedural learning paradigm during functional MRI studies.

Referring patients to nurses: outcomes and evaluation of a nurse flexible sigmoidoscopy training program for colorectal cancer screening.

Colorectal cancer is a significant health burden. Several screening options exist that can detect colorectal cancer at an early stage, leading to a more favourable prognosis. However, despite years of knowledge on best practice, screening rates are still very low in Canada, particularly in Ontario.

Clinical recommendations for the use of recombinant human erythropoietin in patients with hepatitis C virus being treated with ribavirin.

Today, combination antiviral therapy with pegylated interferon-alpha and ribavirin (RBV) allows many patients infected with hepatitis C virus (HCV) to achieve a sustained virological response, which is equivalent to cure. Data also support the clinical benefit of combination antiviral therapy in patients coinfected with HCV and HIV, and in patients who have received a liver transplant. Antiviral therapy with pegylated interferon-alpha and RBV is, however, associated with a high incidence and significant magnitude of anemia.

Lightning Strike and Electric Shock Survivors, International.

Prior to1989 no known support group existed for victims of lightning or electrical shock injury and their families. A lightning strike survivor of twenty years, Steve Marshburn, recognized the need both from his personal experience and after meeting two other survivors. With his wife and psychologist, he formed Lightning Strike and Electric Shock Survivors International.

Chemical peritonitis from champagne.

Abdominal pain is a frequent presentation to the Emergency Department and it is often difficult to find a clear diagnosis. This is a unique case of a woman with worsening abdominal pain over 2 days with no clear etiology despite extensive, repeat evaluations with eventual spontaneous resolution. The diagnosis of chemical peritonitis was established when the patient revealed an extremely rare mechanism of injury the night before presentation that has never been described previously.

Electron paramagnetic resonance spectroscopic evidence of increased free radical generation and selective damage to skeletal muscle following lightning injury.

The present case study examined changes in peripheral markers of free radical metabolism and skeletal/myocardial muscle damage 30 h after a mountaineer had survived a lightning storm, having experienced contact with what was considered to be "upward leaders" at 4200 m. Sea-level control data were available between 3 and 8 weeks prior to the altitude sojourn for comparative purposes. Follow-up measurements were obtained for the same individual 3 weeks following the incident after simulated exposure to the combined stresses of inspiratory hypoxia and physical exercise.

Clinical pharmacology consultations: consultation requests may be misleading -- an organized approach to drug-induced hepatitis.

The present case report describes a consultation with the Clinical Pharmacology Consultation Service at the Sunnybrook & Women's College Health Sciences Centre, Toronto, Ontario, for drug-induced hepatitis in a patient with multiple drug exposures. The original question to be addressed was whether dalteparin was responsible for an acute rise in liver transaminases. The approach involved establishing a best possible diagnosis of the adverse event, obtaining a comprehensive history of drug exposure and evaluating the possible contributory role of alternate etiologies supported by a literature search.

Lower gastrointestinal bleeding and ischemic colitis.

Objective: To compare the incidence and clinical characteristics of lower gastrointestinal (LGI) bleeding due to ischemic colitis with those with LGI bleeding of other causes.

Methods: A chart review was performed of patients admitted with LGI bleeding to Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, between July 1, 1997 and January 31, 2000.

Results: Of 124 patients with LGI bleeding, 24 cases were due to ischemic colitis, 62 to diverticulosis, 11 to inflammatory bowel disease (IBD) and 27 to all other causes ('others').