Legal Privilege Legislation: Consequences for Patient Safety.

Increasing awareness of the extent of preventable harm from healthcare has led to efforts to improve patient safety through a variety of efforts, including legislation. Extending legal privilege to quality and safety reviews leads to further harm for many patients, families and healthcare providers. The intentional isolation, silencing and exclusion after the incident undermines trust, prevents learning and impedes an opportunity to heal and recover for all those directly involved.

Sport for Indigenous resurgence: Toward a critical settler-colonial reflection.

This article examines the field of sport for development (SFD) while considering Indigenous resurgence amidst Canada's neoliberal settler-colonial landscape. While sharing challenges encountered within their practice, program staff from the Promoting Life-skills in Aboriginal Youth program revealed high levels of constructive self-criticism and reflexivity. There are three emergent themes, the adoption of which appeared essential for transforming the sector in recognition of Indigenous resurgence: growth and pace; Indigenous agency and knowledge; and political engagement.

The Experience of Family Physicians and Home Health Staff Involved in an Intervention to Increase Patient-Related Collaboration.

Les médecins de famille (MF) et le personnel de soins de santé à domicile (PSD) canadiens rencontrent d'importants obstacles lorsqu'ils doivent collaborer pour la prestation de soins aux patients qu'ils ont en commun. Cette étude à méthodologie mixte visait à évaluer la qualité et la viabilité de l'utilisation de l'audioconférence sécurisée dans une optique d'amélioration de la planification des soins pour ces patients. Les données primaires incluaient les résultats d'un sondage réalisé avant et après l'intervention, ainsi que des entretiens semi-structurés et des groupes de discussion post-intervention.

The accessibility and utilization of genetic testing for inherited heart rhythm disorders: a Canadian cross-sectional survey study.

The genetic basis of many sudden death-related conditions has been elucidated. These include inherited arrhythmias and arrhythmogenic cardiomyopathies, termed inherited heart rhythm disorders (IHRD). Advising on and interpreting genetic testing is challenging for the general cardiologist.

Forecasting the effect of physician assistants in a pediatric ED.

Background: Most pediatric ED visits are for nonemergent problems. Physician assistants are well trained to manage these patients; however, their effect on patient flow in a pediatric ED is unknown.

Objectives: To compare the effect on key pediatric ED efficiency indicators of extending physician coverage versus adding PAs with equivalent incremental costs.

Social media: a review and tutorial of applications in medicine and health care.

Background: Social media are dynamic and interactive computer-mediated communication tools that have high penetration rates in the general population in high-income and middle-income countries. However, in medicine and health care, a large number of stakeholders (eg, clinicians, administrators, professional colleges, academic institutions, ministries of health, among others) are unaware of social media's relevance, potential applications in their day-to-day activities, as well as the inherent risks and how these may be attenuated and mitigated.

Objective: We conducted a narrative review with the aim to present case studies that illustrate how, where, and why social media are being used in the medical and health care sectors.

Parents' willingness to have their child receive care by physician assistants in a pediatric emergency department.

Objective: To determine the willingness of parents of children visiting a pediatric emergency department to have a physician assistant (PA) assess and treat their child and the waiting time reduction sufficient for them to choose to receive treatment by a PA rather than wait for a physician.

Method: After describing the training and scope of practice of PAs, we asked caregivers of children triaged as urgent to nonurgent if they would be willing to have their child assessed and treated by a PA on that visit: definitely, maybe, or never. We also asked the minimum amount of waiting time reduction they would want to see before choosing to receive treatment by a PA rather than wait for a physician.

The role of physician assistants in pediatric emergency medicine: the physician's view.

Objective: To define the range of clinical conditions Canadian emergency pediatricians consider appropriate for management by physician assistants (PAs) and the degree of autonomy PAs should have in the pediatric emergency department (PED).

Methods: We conducted a cross-sectional, pan-Canadian survey using electronic questionnaire technology: the Active Campaign Survey tool. We targeted PED physicians using the Pediatric Emergency Research Canada (PERC) network database (N  =  297).

Maternal-infant health outcomes and nursing practice in a remote First Nations community in northern Canada.

This article reports those findings related to maternal-infant health outcomes of an ethnographic study that explored nursing practice, continuity of care, and health outcomes in one remote First Nations community in northern Canada. Use of multiple data sources within an ethnographic design ensured that quantitative health outcomes data were interpreted within a contextualized understanding of the remote First Nations community.The sample comprised the charts of 65 mothers and 63 infants randomly selected for retrospective chart review.

The role of diet in predicting iron deficiency anemia in HIV-positive women.

Purpose: The association between medical, social, and nutritional factors and iron deficiency anemia was examined in adult women who had tested positive for human immunodeficiency virus (HIV) and were living in the Greater Vancouver Area.

Methods: This was a cross-sectional observational study of 102 HIV-positive women, aged 19 or older, who were patients of one of three chosen community health clinics in Vancouver, British Columbia. Information on usual dietary intake and other nutrition-related factors was collected with a short diet survey, while medical information and laboratory data were obtained from each participant's medical chart.

Canadians' willingness to receive care from physician assistants.

Objective: To determine the willingness of Canadians to accept treatment from physician assistants (PAs).

Design: Respondents were asked to be surrogate patients or parents under 1 of 3 conditions selected at random. Two scenarios involved injury to themselves, with the third involving injury to their children.

The role of physician assistants in a pediatric emergency department: a center review and survey.

Objectives: The objectives of this study were to outline the clinical conditions presenting to a Canadian pediatric emergency department (ED), survey the opinions of physician assistants (PAs) and emergency pediatricians to determine which conditions they consider could be managed by PAs, and to estimate the proportion of the total pediatric ED volume that PAs could potentially manage.

Methods: We reviewed the 2007 British Columbia Children's Hospital database of ED visits to identify clinical presentation and chief complaint of all patients seen. International Classification of Diseases, 10th Revision codes were used to categorize the presenting complaint of each ED visit.

Clinical decision rules to improve the detection of adverse drug events in emergency department patients.

Objectives: Adverse drug events (ADEs) are unintended and harmful consequences of medication use. They are associated with high health resource use and cost. Yet, high levels of inaccuracy exist in their identification in clinical practice, with over one-third remaining unidentified in the emergency department (ED).

DETERMINANTS OF CUTANEOUS INJECTION-RELATED INFECTIONS AMONG INJECTION DRUG USERS AT AN EMERGENCY DEPARTMENT.

Introduction: Cutaneous injection-related infections (CIRI) are a primary reason injection drug users (IDU) access the emergency department (ED).

Methodology: Using Cox proportional hazard regression, we examined predictors of ED use for CIRI, stratified by sex, among 1083 supervised injection facility (SIF) users.

Results: Over a four-year period, 289 (27%) visited the ED for CIRI, yielding an incidence density for females of 23.

Patterns of physician follow-up among young cancer survivors: report of the Childhood, Adolescent, and Young Adult Cancer Survivors (CAYACS) research program.

Objective: To describe the frequency and pattern of physician visits in 1998 to 2000 among childhood and adolescent cancer survivors in British Columbia (BC), to compare their use of physician services with use in the general population, and to examine the effects of clinical and sociodemographic factors on care.

Design: Retrospective, observational, population-based cohort study, with a comparison group. Cohort records from population registries were linked to physician claim data and oncology visit records for 1998 to 2000.

Knowledge translation in the discourse of professional practice.

Clients and practitioners desire up-to-date, safe and effective healthcare. Knowledge translation, a term used to describe the interchange of knowledge between its producers and users, aims to support this desire. Knowledge, and by extension knowledge translation, is subject to varying perspectives ranging from the objective truth-tested knowledge of empiricism, associated by some with academia, to knowledge in the practitioner realm.

Birth outcomes among older mothers in rural versus urban areas: a residence-based approach.

Purpose: We examined the association between rural residence and birth outcomes in older mothers, the effect of parity on this association, and the trend in adverse birth outcomes in relation to the distance to the nearest hospital with cesarean-section capacity.

Methods: A population-based retrospective cohort study, including all singleton births to 35+ year-old women in British Columbia (Canada), 1999-2003. We compared birth outcomes in rural versus urban areas, and between 3 distance categories to a hospital (<50, 50-150, >150 km).

Outcomes of emergency department patients presenting with adverse drug events.

Study Objective: Our objectives are to describe the outcomes of patients presenting to the emergency department (ED) because of an adverse drug event and to compare them with outcomes of patients presenting for other reasons.

Methods: This prospective observational study was conducted at Vancouver General Hospital, a 955-bed tertiary care hospital. We prospectively enrolled adults presenting to the ED between March and June 2006, using a systematic sampling algorithm.

Mandatory public reporting: build it and who will come?

Rates of healthcare-associated infections (HAI) are being reported on an increasing number of public information websites in response to legislative mandates driven by consumer advocacy. This represents a new strategy to advance patient safety and quality of care by informing a broad audience about the relative performance of individual healthcare facilities. Unlike typical consumer health informatics products, the target audience and targeted health behaviors are less easily defined; further, the impact on providers to improve care is unknown relative to other incentives to improve.

A systematic review: The role and impact of the physician assistant in the emergency department.

This systematic review describes the role and impact of physician assistants (PAs) in the ED. It includes reports of surveys, retrospective and prospective studies as well as guidelines and reviews. Seven hundred and twelve studies were identified of which only 66 were included, and many of these studies were limited by methodological quality.

Hospitalisations 1998-2000 in a British Columbia population-based cohort of young cancer survivors: report of the Childhood/Adolescent/Young Adult Cancer Survivors (CAYACS) Research Program.

Background And Objectives: Because of late effects among survivors of cancer in young people, increased hospitalisations would be expected. This study determined the occurrence, frequency and days in hospital (DIH) of hospital admissions among 5-year survivors of childhood and adolescent cancer diagnosed in British Columbia (BC), compared hospitalisation risk with the general population and examined the impact of sociodemographic, health care system and clinical factors.

Design: This population-based study frequency matched 1157 survivors of cancer diagnosed before 20 years of age from 1970 to 1992 from the BC Cancer Registry with 11,570 randomly selected individuals from BC's health insurance plan Client Registry.

Effect of older maternal age on birth outcomes in twin pregnancies: a population-based study.

Objective: We compared perinatal mortality, preterm birth (<37, <33 and <28 weeks), small for gestational age (SGA), Apgar score (<4), mechanical ventilation (1 days) and prolonged neonatal intensive care unit (NICU) hospitalization (13 days) between twins of 25 to 34 and >35-year-old women. Further, we examined whether older maternal age effects were modified by parity or otherwise affected by chorionicity.

Study Design: We carried out a population-based retrospective cohort study including all twin births in British Columbia (BC), Canada, from 1999 to 2003.

Childhood, adolescent, and young adult cancer survivors research program of British Columbia: objectives, study design, and cohort characteristics.

Background: The Childhood, Adolescent, and Young Adult Cancer Survivors Research Program (CAYACS) has been established in the province of British Columbia (BC), Canada, to carry out research into late effects and survivor care in multiple domains, and to inform policy and practice.

Procedure: This program identifies a survivor cohort and comparison groups from population-based registries and links their records to population-based files of outcomes and outcome determinants, to create a research database and conduct studies of long-term outcomes and care.

Results: The initial cohort consisted of all 5-year survivors of cancer or a tumor diagnosed under age 25 years from 1970 to 1995, who were residents in BC at the time of diagnosis, and followed till 2000 (3,841 subjects).

The effect of maternal age on adverse birth outcomes: does parity matter?

Objectives: To examine the effect of parity on the association between older maternal age and adverse birth outcomes, specifically stillbirth, neonatal death, preterm birth, small for gestational age, and neonatal intensive care unit admission.

Methods: We conducted a retrospective cohort study of singleton births in British Columbia between 1999 and 2004. In the cohort, 69 023 women were aged 20 to 29, 25 058 were aged 35 to 39, and 4816 were aged 40 and over.

Determinants of hospitalization for a cutaneous injection-related infection among injection drug users: a cohort study.

Background: Cutaneous injection-related infections (CIRI) are a primary reason individuals who inject drugs (IDU) are hospitalized. The objective of this study was to investigate determinants of hospitalization for a CIRI or related infectious complication among a cohort of supervised injection facility (SIF) users.

Methods: From 1 January 1 2004 until 31 January 2008, using Cox proportional hazard regression, we examined determinants of hospitalization for a CIRI or related infectious complication (based on ICD 10 codes) among 1083 IDU recruited from within the SIF.