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Robb L, Joubert G, Jordaan E, Ngounda J, Walsh C. Reported Health, Social Support, Stress And Associations With Choline Intake In Pregnant Women: The Nuemi Study. Clin Nutr ESPEN 2023. [DOI: 10.1016/j.clnesp.2022.09.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2023]
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Plint AC, Newton AS, Stang A, Cantor Z, Hayawi L, Barrowman N, Boutis K, Gouin S, Doan Q, Dixon A, Porter R, Joubert G, Sawyer S, Crawford T, Gravel J, Bhatt M, Weldon P, Millar K, Tse S, Neto G, Grewal S, Chan M, Chan K, Yung G, Kilgar J, Lynch T, Aglipay M, Dalgleish D, Farion K, Klassen TP, Johnson DW, Calder LA. How safe are paediatric emergency departments? A national prospective cohort study. BMJ Qual Saf 2022; 31:806-817. [PMID: 35853646 PMCID: PMC9606537 DOI: 10.1136/bmjqs-2021-014608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 06/02/2022] [Indexed: 12/21/2022]
Abstract
BACKGROUND Despite the high number of children treated in emergency departments, patient safety risks in this setting are not well quantified. Our objective was to estimate the risk and type of adverse events, as well as their preventability and severity, for children treated in a paediatric emergency department. METHODS Our prospective, multicentre cohort study enrolled children presenting for care during one of 168 8-hour study shifts across nine paediatric emergency departments. Our primary outcome was an adverse event within 21 days of enrolment which was related to care provided at the enrolment visit. We identified 'flagged outcomes' (such as hospital visits, worsening symptoms) through structured telephone interviews with patients and families over the 21 days following enrolment. We screened admitted patients' health records with a validated trigger tool. For patients with flags or triggers, three reviewers independently determined whether an adverse event occurred. RESULTS We enrolled 6376 children; 6015 (94%) had follow-up data. Enrolled children had a median age of 4.3 years (IQR 1.6-9.8 years). One hundred and seventy-nine children (3.0%, 95% CI 2.6% to 3.5%) had at least one adverse event. There were 187 adverse events in total; 143 (76.5%, 95% CI 68.9% to 82.7%) were deemed preventable. Management (n=98, 52.4%) and diagnostic issues (n=36, 19.3%) were the most common types of adverse events. Seventy-nine (42.2%) events resulted in a return emergency department visit; 24 (12.8%) resulted in hospital admission; and 3 (1.6%) resulted in transfer to a critical care unit. CONCLUSION In this large-scale study, 1 in 33 children treated in a paediatric emergency department experienced an adverse event related to the care they received there. The majority of events were preventable; most were related to management and diagnostic issues. Specific patient populations were at higher risk of adverse events. We identify opportunities for improvement in care.
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Affiliation(s)
- Amy C Plint
- Pediatric Emergency, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Amanda S Newton
- Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Antonia Stang
- Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Zach Cantor
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Lamia Hayawi
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Nick Barrowman
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Kathy Boutis
- Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Pediatrics and Child Health Evaluative Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Serge Gouin
- Pediatric Emergency Department, CHU Sainte-Justine, Montreal, Québec, Canada
- Pediatrics, Université de Montreal, Montreal, Québec, Canada
| | - Quynh Doan
- Evidence to Innovations, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
- Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew Dixon
- Stollery Children's Hospital, Edmonton, Alberta, Canada
- Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Robert Porter
- Janeway Children's Health and Rehabilitation Centre, St John's, Newfoundland and Labrador, Canada
- Pediatrics, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada
| | - Gary Joubert
- Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
- Pediatrics, Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Scott Sawyer
- Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
- Pediatric Emergency, Health Sciences Centre Winnipeg Children's Hospital, Winnipeg, Manitoba, Canada
| | - Tyrus Crawford
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Jocelyn Gravel
- Pediatric Emergency Department, CHU Sainte-Justine, Montreal, Québec, Canada
- Pediatrics, Université de Montreal, Montreal, Québec, Canada
| | - Maala Bhatt
- Pediatric Emergency, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Patrick Weldon
- Pediatric Emergency, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Kelly Millar
- Pediatrics, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Sandy Tse
- Pediatric Emergency, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Gina Neto
- Pediatric Emergency, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Simran Grewal
- Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada
- Emergency Medicine, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Melissa Chan
- Emergency Medicine, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Kevin Chan
- Janeway Children's Health and Rehabilitation Centre, St John's, Newfoundland and Labrador, Canada
- Pediatrics, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada
| | - Grant Yung
- Pediatric Emergency, Health Sciences Centre Winnipeg Children's Hospital, Winnipeg, Manitoba, Canada
| | - Jennifer Kilgar
- Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
- Pediatrics, Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Tim Lynch
- Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
- Pediatrics, Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Mary Aglipay
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Dale Dalgleish
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Ken Farion
- Pediatric Emergency, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Terry P Klassen
- Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
- Pediatrics and Child Health, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
| | - David W Johnson
- Paediatrics, Alberta Health Services, Edmonton, Alberta, Canada
| | - Lisa A Calder
- Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Robb L, Joubert G, Jordaan M, van den Berg L, Osei Ngounda J, Walsh C. Diet quality and associations with choline intake in pregnant women in Bloemfontein, South Africa. Clin Nutr ESPEN 2021. [DOI: 10.1016/j.clnesp.2021.09.230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Blake N, Edeling H, Bekker D, Kotzé PJ, du Plessis R, Steyn JJF, Joubert G, Jooste JF. The spectrum of orofacial clefts and treatment logistics at Universitas Academic Hospital, Bloemfontein, South Africa. S AFR J SURG 2021; 59:57-61. [PMID: 34212572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Cleft lips and/or palates should be identified early and be operated on at specific ages according to international recommendations. In African countries, however, cleft lip and palate surgeries are often delayed. METHODS A retrospective, descriptive study was done to determine the distribution, specific time delays, demographics and loss to follow-up of patients with cleft lip and/or palates treated at Universitas Academic Hospital over a 10-year period. Data was obtained from outpatient files from the Plastic and Reconstructive Surgery Department at Universitas Academic Hospital. Two hundred and three of 318 records (63.8%) had the defined variables documented. RESULTS The median time from first presentation to specialist consultation was 1.9 months. The median ages for first presentation was 2.2 months and for specialist consultation 5.2 months. Patients mainly had isolated cleft palates (42.4%), followed by both cleft lip and palate (31%) and isolated cleft lips (24.6%). A quarter of patients (25.6%) were lost to follow-up. More than a third (36.5%) of patients were referred from the local Motheo district and 12.8% were referred from Lesotho. CONCLUSION In our setting, patients with cleft lip and/or palate are generally diagnosed and referred late. These patients also have delayed access to specialist consultation. Often patients are only evaluated by specialists at ages whereby they should have already undergone their first surgeries. Too many patients are lost to follow-up.
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Affiliation(s)
- N Blake
- Department of Plastic and Reconstructive Surgery, Universitas Hospital, University of the Free State, South Africa
| | - H Edeling
- School of Clinical Medicine, Faculty of Health Sciences, University of the Free State, South Africa
| | - D Bekker
- School of Clinical Medicine, Faculty of Health Sciences, University of the Free State, South Africa
| | - P J Kotzé
- School of Clinical Medicine, Faculty of Health Sciences, University of the Free State, South Africa
| | - R du Plessis
- School of Clinical Medicine, Faculty of Health Sciences, University of the Free State, South Africa
| | - J J F Steyn
- School of Clinical Medicine, Faculty of Health Sciences, University of the Free State, South Africa
| | - G Joubert
- Department of Biostatistics, School of Biomedical Sciences, University of the Free State, South Africa
| | - J F Jooste
- Department of Plastic and Reconstructive Surgery, Universitas Hospital, University of the Free State, South Africa and School of Clinical Medicine, Faculty of Health Sciences, University of the Free State, South Africa
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Abdullah K, Fell DB, Radhakrishnan D, Hawken S, Johnson DW, Mandhane P, To T, Joubert G, Plint AC. Risk of asthma in children diagnosed with bronchiolitis during infancy: protocol of a longitudinal cohort study linking emergency department-based clinical data to provincial health administrative databases. BMJ Open 2021; 11:e048823. [PMID: 33941638 PMCID: PMC8098926 DOI: 10.1136/bmjopen-2021-048823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The Canadian Bronchiolitis Epinephrine Steroid Trial (CanBEST) and the Bronchiolitis Severity Cohort (BSC) study enrolled infants with bronchiolitis during the first year of life. The CanBEST trial suggested that treatment of infants with a combined therapy of high-dose corticosteroids and nebulised epinephrine reduced the risk of admission to hospital. Our study aims to-(1) quantify the risk of developing asthma by age 5 and 10 years in children treated with high-dose corticosteroid and epinephrine for bronchiolitis during infancy, (2) identify risk factors associated with development of asthma in children with bronchiolitis during infancy, (3) develop asthma prediction models for children diagnosed with bronchiolitis during infancy. METHODS AND ANALYSIS We propose a longitudinal cohort study in which we will link data from the CanBEST and BSC study with routinely collected data from provincial health administrative databases. Our outcome is asthma incidence measured using a validated health administrative data algorithm. Primary exposure will be treatment with a combined therapy of high-dose corticosteroids and nebulised epinephrine for bronchiolitis. Covariates will include type of viral pathogen, disease severity, medication use, maternal, prenatal, postnatal and demographic factors and variables related to health service utilisation for acute lower respiratory tract infection. The risk associated with development of asthma in children treated with high-dose corticosteroid and epinephrine for bronchiolitis will be assessed using multivariable Cox proportional hazards regression models. Prediction models will be developed using multivariable logistic regression analysis and internally validated using a bootstrap approach. ETHICS AND DISSEMINATION Our study has been approved by the ethics board of all four participating sites of the CanBEST and BSC study. Finding of the study will be disseminated to the academic community and relevant stakeholders through conferences and peer-reviewed publications. TRIAL REGISTRATION NUMBER ISRCTN56745572; Post-results.
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Affiliation(s)
- Kawsari Abdullah
- Research Institute, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- ICES, Ottawa, Ontario, Canada
| | - Deshayne B Fell
- Research Institute, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- ICES, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Dhenuka Radhakrishnan
- Research Institute, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- ICES, Ottawa, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Steven Hawken
- ICES, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - David W Johnson
- Departments of Pediatrics and Physiology and Pharmacology, University of Calgary, Calgery, Alberta, Canada
- Maternal Newborn Child & Youth SCN, Alberta Health Services, Calgery, Alberta, Canada
| | - Piush Mandhane
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Teresa To
- ICES, Ottawa, Ontario, Canada
- Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Gary Joubert
- London Health Sciences Centre, London, Ontario, Canada
| | - Amy C Plint
- Research Institute, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Swart R, Strydom C, Joubert G. The influence of a Perspex intubation box on time to intubation : a simulation-based randomised crossover study. Southern African Journal of Anaesthesia and Analgesia 2021. [DOI: 10.36303/sajaa.2021.27.1.2452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Swart R, Joubert G, Lamacraft G, Maasdorp S. The association between dexmedetomidine as a single or adjuvant sedative versus other sedatives and the duration of mechanical ventilation and ICU stay in critically ill patients in a central South African ICU. Southern African Journal of Anaesthesia and Analgesia 2021. [DOI: 10.36303/sajaa.2021.27.1.2400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Robb L, Joubert G, Jordaan M, Ngounda JO, Walsh C. Dietary intake and food sources of choline in pregnant women in bloemfontein, South Africa. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Jordaan E, Robb L, Joubert G, Ngounda JO, Walsh C. Household food security and exposure to stress amongst pregnant women attending the antenatal clinic at Pelonomi hospital. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Poonai N, Kumar K, Coriolano K, Thompson G, Brahmbhatt S, Dzongowski E, Stevens H, Gupta P, Miller M, Elsie S, Ashok D, Joubert G, Lim R, Bütter A, Ali S. Hyoscine butylbromide versus acetaminophen for nonspecific colicky abdominal pain in children: a randomized controlled trial. CMAJ 2020; 192:E1612-E1619. [PMID: 33257343 DOI: 10.1503/cmaj.201055] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Less than two-thirds of children with abdominal pain in the emergency department receive analgesia. We sought to determine whether hyoscine butylbromide was superior to acetaminophen for children with nonspecific colicky abdominal pain. METHODS We randomly allocated children aged 8-17 years with nonspecific colicky abdominal pain who presented to the pediatric emergency department of London Health Sciences Centre, London, Ontario to receive hyoscine butylbromide, 10 mg given orally, or acetaminophen, 15 mg/kg given orally (maximum 975 mg). We considered the minimal clinically important difference for the primary outcome (self-reported pain at 80 min) to be 13 mm on a 100 mm visual analogue scale. Secondary outcomes included administration of rescue analgesia, adverse effects and pain score less than 30 mm at 80 minutes. RESULTS A total of 236 participants (120 in the hyoscine butylbromide group and 116 in the acetaminophen group) were included in the trial. The mean visual analogue scale scores at 80 minutes were 29 mm (standard deviation [SD] 26 mm) and 30 mm (SD 29 mm) with hyoscine butylbromide and acetaminophen, respectively (adjusted difference 1, 95% confidence interval -7 to 7). Rescue analgesia was administered to 4 participants (3.3%) in the hyoscine butylbromide group and 1 participant (0.9%) in the acetaminophen groups (p = 0.2). We found no significant differences in rates of adverse effects between hyoscine butylbromide (32/116 [27.6%]) and acetaminophen (28/115 [24.3]) (p = 0.5); no serious adverse effects were observed. The proportion with a pain score less than 30 mm at 80 minutes was 66 (55.0%) with hyoscine butylbromide and 63 (54.3%) with acetaminophen (p = 0.9). INTERPRETATION Hyoscine butylbromide was not superior to acetaminophen in this setting. Both agents were associated with clinically important pain reduction, and either can be considered for children presenting to the emergency department with nonspecific colicky abdominal pain. Trial registration: Clinicaltrials.gov, no. NCT02582307.
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Affiliation(s)
- Naveen Poonai
- Division of Emergency Medicine (Poonai, Kumar, Coriolano, Brahmbhatt, Dzongowski, Stevens, Gupta, Miller, Elsie, Joubert, Lim), Department of Paediatrics, and Departments of Internal Medicine (Poonai, Elsie) and Epidemiology and Biostatistics (Poonai, Elsie), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller, Lim), London Health Sciences Centre, London, Ont.; Departments of Pediatrics (Thompson) and Emergency Medicine (Thompson), Cumming School of Medicine, and Alberta Children's Hospital Research Institute (Thompson), University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ashok), Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University; Division of Paediatric Surgery (Bütter), Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Pediatrics (Ali), Faculty of Medicine & Dentistry, and Women and Children's Health Research Institute (Ali), University of Alberta, Edmonton, Alta.
| | - Kriti Kumar
- Division of Emergency Medicine (Poonai, Kumar, Coriolano, Brahmbhatt, Dzongowski, Stevens, Gupta, Miller, Elsie, Joubert, Lim), Department of Paediatrics, and Departments of Internal Medicine (Poonai, Elsie) and Epidemiology and Biostatistics (Poonai, Elsie), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller, Lim), London Health Sciences Centre, London, Ont.; Departments of Pediatrics (Thompson) and Emergency Medicine (Thompson), Cumming School of Medicine, and Alberta Children's Hospital Research Institute (Thompson), University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ashok), Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University; Division of Paediatric Surgery (Bütter), Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Pediatrics (Ali), Faculty of Medicine & Dentistry, and Women and Children's Health Research Institute (Ali), University of Alberta, Edmonton, Alta
| | - Kamary Coriolano
- Division of Emergency Medicine (Poonai, Kumar, Coriolano, Brahmbhatt, Dzongowski, Stevens, Gupta, Miller, Elsie, Joubert, Lim), Department of Paediatrics, and Departments of Internal Medicine (Poonai, Elsie) and Epidemiology and Biostatistics (Poonai, Elsie), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller, Lim), London Health Sciences Centre, London, Ont.; Departments of Pediatrics (Thompson) and Emergency Medicine (Thompson), Cumming School of Medicine, and Alberta Children's Hospital Research Institute (Thompson), University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ashok), Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University; Division of Paediatric Surgery (Bütter), Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Pediatrics (Ali), Faculty of Medicine & Dentistry, and Women and Children's Health Research Institute (Ali), University of Alberta, Edmonton, Alta
| | - Graham Thompson
- Division of Emergency Medicine (Poonai, Kumar, Coriolano, Brahmbhatt, Dzongowski, Stevens, Gupta, Miller, Elsie, Joubert, Lim), Department of Paediatrics, and Departments of Internal Medicine (Poonai, Elsie) and Epidemiology and Biostatistics (Poonai, Elsie), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller, Lim), London Health Sciences Centre, London, Ont.; Departments of Pediatrics (Thompson) and Emergency Medicine (Thompson), Cumming School of Medicine, and Alberta Children's Hospital Research Institute (Thompson), University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ashok), Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University; Division of Paediatric Surgery (Bütter), Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Pediatrics (Ali), Faculty of Medicine & Dentistry, and Women and Children's Health Research Institute (Ali), University of Alberta, Edmonton, Alta
| | - Shaily Brahmbhatt
- Division of Emergency Medicine (Poonai, Kumar, Coriolano, Brahmbhatt, Dzongowski, Stevens, Gupta, Miller, Elsie, Joubert, Lim), Department of Paediatrics, and Departments of Internal Medicine (Poonai, Elsie) and Epidemiology and Biostatistics (Poonai, Elsie), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller, Lim), London Health Sciences Centre, London, Ont.; Departments of Pediatrics (Thompson) and Emergency Medicine (Thompson), Cumming School of Medicine, and Alberta Children's Hospital Research Institute (Thompson), University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ashok), Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University; Division of Paediatric Surgery (Bütter), Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Pediatrics (Ali), Faculty of Medicine & Dentistry, and Women and Children's Health Research Institute (Ali), University of Alberta, Edmonton, Alta
| | - Emily Dzongowski
- Division of Emergency Medicine (Poonai, Kumar, Coriolano, Brahmbhatt, Dzongowski, Stevens, Gupta, Miller, Elsie, Joubert, Lim), Department of Paediatrics, and Departments of Internal Medicine (Poonai, Elsie) and Epidemiology and Biostatistics (Poonai, Elsie), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller, Lim), London Health Sciences Centre, London, Ont.; Departments of Pediatrics (Thompson) and Emergency Medicine (Thompson), Cumming School of Medicine, and Alberta Children's Hospital Research Institute (Thompson), University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ashok), Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University; Division of Paediatric Surgery (Bütter), Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Pediatrics (Ali), Faculty of Medicine & Dentistry, and Women and Children's Health Research Institute (Ali), University of Alberta, Edmonton, Alta
| | - Holly Stevens
- Division of Emergency Medicine (Poonai, Kumar, Coriolano, Brahmbhatt, Dzongowski, Stevens, Gupta, Miller, Elsie, Joubert, Lim), Department of Paediatrics, and Departments of Internal Medicine (Poonai, Elsie) and Epidemiology and Biostatistics (Poonai, Elsie), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller, Lim), London Health Sciences Centre, London, Ont.; Departments of Pediatrics (Thompson) and Emergency Medicine (Thompson), Cumming School of Medicine, and Alberta Children's Hospital Research Institute (Thompson), University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ashok), Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University; Division of Paediatric Surgery (Bütter), Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Pediatrics (Ali), Faculty of Medicine & Dentistry, and Women and Children's Health Research Institute (Ali), University of Alberta, Edmonton, Alta
| | - Priti Gupta
- Division of Emergency Medicine (Poonai, Kumar, Coriolano, Brahmbhatt, Dzongowski, Stevens, Gupta, Miller, Elsie, Joubert, Lim), Department of Paediatrics, and Departments of Internal Medicine (Poonai, Elsie) and Epidemiology and Biostatistics (Poonai, Elsie), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller, Lim), London Health Sciences Centre, London, Ont.; Departments of Pediatrics (Thompson) and Emergency Medicine (Thompson), Cumming School of Medicine, and Alberta Children's Hospital Research Institute (Thompson), University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ashok), Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University; Division of Paediatric Surgery (Bütter), Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Pediatrics (Ali), Faculty of Medicine & Dentistry, and Women and Children's Health Research Institute (Ali), University of Alberta, Edmonton, Alta
| | - Michael Miller
- Division of Emergency Medicine (Poonai, Kumar, Coriolano, Brahmbhatt, Dzongowski, Stevens, Gupta, Miller, Elsie, Joubert, Lim), Department of Paediatrics, and Departments of Internal Medicine (Poonai, Elsie) and Epidemiology and Biostatistics (Poonai, Elsie), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller, Lim), London Health Sciences Centre, London, Ont.; Departments of Pediatrics (Thompson) and Emergency Medicine (Thompson), Cumming School of Medicine, and Alberta Children's Hospital Research Institute (Thompson), University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ashok), Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University; Division of Paediatric Surgery (Bütter), Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Pediatrics (Ali), Faculty of Medicine & Dentistry, and Women and Children's Health Research Institute (Ali), University of Alberta, Edmonton, Alta
| | - Sharlene Elsie
- Division of Emergency Medicine (Poonai, Kumar, Coriolano, Brahmbhatt, Dzongowski, Stevens, Gupta, Miller, Elsie, Joubert, Lim), Department of Paediatrics, and Departments of Internal Medicine (Poonai, Elsie) and Epidemiology and Biostatistics (Poonai, Elsie), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller, Lim), London Health Sciences Centre, London, Ont.; Departments of Pediatrics (Thompson) and Emergency Medicine (Thompson), Cumming School of Medicine, and Alberta Children's Hospital Research Institute (Thompson), University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ashok), Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University; Division of Paediatric Surgery (Bütter), Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Pediatrics (Ali), Faculty of Medicine & Dentistry, and Women and Children's Health Research Institute (Ali), University of Alberta, Edmonton, Alta
| | - Dhandapani Ashok
- Division of Emergency Medicine (Poonai, Kumar, Coriolano, Brahmbhatt, Dzongowski, Stevens, Gupta, Miller, Elsie, Joubert, Lim), Department of Paediatrics, and Departments of Internal Medicine (Poonai, Elsie) and Epidemiology and Biostatistics (Poonai, Elsie), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller, Lim), London Health Sciences Centre, London, Ont.; Departments of Pediatrics (Thompson) and Emergency Medicine (Thompson), Cumming School of Medicine, and Alberta Children's Hospital Research Institute (Thompson), University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ashok), Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University; Division of Paediatric Surgery (Bütter), Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Pediatrics (Ali), Faculty of Medicine & Dentistry, and Women and Children's Health Research Institute (Ali), University of Alberta, Edmonton, Alta
| | - Gary Joubert
- Division of Emergency Medicine (Poonai, Kumar, Coriolano, Brahmbhatt, Dzongowski, Stevens, Gupta, Miller, Elsie, Joubert, Lim), Department of Paediatrics, and Departments of Internal Medicine (Poonai, Elsie) and Epidemiology and Biostatistics (Poonai, Elsie), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller, Lim), London Health Sciences Centre, London, Ont.; Departments of Pediatrics (Thompson) and Emergency Medicine (Thompson), Cumming School of Medicine, and Alberta Children's Hospital Research Institute (Thompson), University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ashok), Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University; Division of Paediatric Surgery (Bütter), Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Pediatrics (Ali), Faculty of Medicine & Dentistry, and Women and Children's Health Research Institute (Ali), University of Alberta, Edmonton, Alta
| | - Rod Lim
- Division of Emergency Medicine (Poonai, Kumar, Coriolano, Brahmbhatt, Dzongowski, Stevens, Gupta, Miller, Elsie, Joubert, Lim), Department of Paediatrics, and Departments of Internal Medicine (Poonai, Elsie) and Epidemiology and Biostatistics (Poonai, Elsie), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller, Lim), London Health Sciences Centre, London, Ont.; Departments of Pediatrics (Thompson) and Emergency Medicine (Thompson), Cumming School of Medicine, and Alberta Children's Hospital Research Institute (Thompson), University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ashok), Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University; Division of Paediatric Surgery (Bütter), Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Pediatrics (Ali), Faculty of Medicine & Dentistry, and Women and Children's Health Research Institute (Ali), University of Alberta, Edmonton, Alta
| | - Andreana Bütter
- Division of Emergency Medicine (Poonai, Kumar, Coriolano, Brahmbhatt, Dzongowski, Stevens, Gupta, Miller, Elsie, Joubert, Lim), Department of Paediatrics, and Departments of Internal Medicine (Poonai, Elsie) and Epidemiology and Biostatistics (Poonai, Elsie), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller, Lim), London Health Sciences Centre, London, Ont.; Departments of Pediatrics (Thompson) and Emergency Medicine (Thompson), Cumming School of Medicine, and Alberta Children's Hospital Research Institute (Thompson), University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ashok), Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University; Division of Paediatric Surgery (Bütter), Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Pediatrics (Ali), Faculty of Medicine & Dentistry, and Women and Children's Health Research Institute (Ali), University of Alberta, Edmonton, Alta
| | - Samina Ali
- Division of Emergency Medicine (Poonai, Kumar, Coriolano, Brahmbhatt, Dzongowski, Stevens, Gupta, Miller, Elsie, Joubert, Lim), Department of Paediatrics, and Departments of Internal Medicine (Poonai, Elsie) and Epidemiology and Biostatistics (Poonai, Elsie), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Poonai, Miller, Lim), London Health Sciences Centre, London, Ont.; Departments of Pediatrics (Thompson) and Emergency Medicine (Thompson), Cumming School of Medicine, and Alberta Children's Hospital Research Institute (Thompson), University of Calgary, Calgary, Alta.; Division of Gastroenterology (Ashok), Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University; Division of Paediatric Surgery (Bütter), Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Pediatrics (Ali), Faculty of Medicine & Dentistry, and Women and Children's Health Research Institute (Ali), University of Alberta, Edmonton, Alta
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11
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Heath A, Rios JD, Williamson-Urquhart S, Pechlivanoglou P, Offringa M, McCabe C, Hopkin G, Plint AC, Dixon A, Beer D, Gouin S, Joubert G, Klassen TP, Freedman SB. A pragmatic randomized controlled trial of multi-dose oral ondansetron for pediatric gastroenteritis (the DOSE-AGE study): statistical analysis plan. Trials 2020; 21:735. [PMID: 32838813 PMCID: PMC7445935 DOI: 10.1186/s13063-020-04651-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 08/04/2020] [Indexed: 11/23/2022] Open
Abstract
Background Acute gastroenteritis is a leading cause of emergency department visits and hospitalizations among children in North America. Oral-rehydration therapy is recommended for children with mild-to-moderate dehydration, but children who present with vomiting are frequently offered intravenous rehydration in the emergency department (ED). Recent studies have demonstrated that the anti-emetic ondansetron can reduce vomiting, intravenous rehydration, and hospitalization when administered in the ED to children with dehydration. However, there is little evidence of additional benefit from prescribing ondansetron beyond the initial ED dose. Moreover, repeat dosing may increase the frequency of diarrhea. Despite the lack of evidence and potential adverse side effects, many physicians across North America provide multiple doses of ondansetron to be taken following ED disposition. Thus, the Multi-Dose Oral Ondansetron for Pediatric Gastroenteritis (DOSE-AGE) trial will evaluate the effectiveness of prescribing multiple doses of ondansetron to treat acute gastroenteritis-associated vomiting. This article specifies the statistical analysis plan (SAP) for the DOSE-AGE trial and was submitted before the outcomes of the study were available for analysis. Methods/design The DOSE-AGE study is a phase III, 6-center, placebo-controlled, double-blind, parallel design randomized controlled trial designed to determine whether participants who are prescribed multiple doses of oral ondansetron to administer, as needed, following their ED visit have a lower incidence of experiencing moderate-to-severe gastroenteritis, as measured by the Modified Vesikari Scale score, compared with a placebo. To assess safety, the DOSE-AGE trial will investigate the frequency and maximum number of diarrheal episodes following ED disposition, and the occurrence of palpitations, pre-syncope/syncope, chest pain, arrhythmias, and serious adverse events. For the secondary outcomes, the DOSE-AGE trial will investigate the individual elements of the Modified Vesikari Scale score and caregiver satisfaction with the therapy. Discussion The DOSE-AGE trial will provide evidence on the effectiveness of multiple doses of oral ondansetron, taken as needed, following an initial ED dose in children with acute gastroenteritis-associated vomiting. The data from the DOSE-AGE trial will be analyzed using this SAP. This will reduce the risk of producing data-driven results and bias in our reported outcomes. The DOSE-AGE study was registered on ClinicalTrials.gov on February 22, 2019. Trial registration ClinicalTrials.gov NCT03851835. Registered on 22 February 2019.
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Affiliation(s)
- Anna Heath
- University of Toronto, Toronto, Ontario, Canada. .,University College London, London, United Kingdom. .,Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.
| | - Juan David Rios
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sarah Williamson-Urquhart
- Pediatric Emergency Research Team, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Petros Pechlivanoglou
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Martin Offringa
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Division of Neonatology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | - Gareth Hopkin
- Institute of Health Economics, Edmonton, Alberta, Canada
| | - Amy C Plint
- Division of Emergency Medicine, Children's Hospital of Eastern Ontario, Ottawa, Canada.,University of Ottawa, Ottawa, Canada.,Children's Hospital Research Institute, Ottawa, Canada
| | - Andrew Dixon
- Stollery Children's Hospital, University of Alberta, Women's and Children's Health Research Institute, Edmonton, Canada
| | - Darcy Beer
- Pediatrics/Pediatric Emergency Medicine, Department of Pediatrics and Child Health, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Serge Gouin
- Université de Montréal, Montréal, Québec, Canada.,CHU Sainte-Justine, Montréal, Québec, Canada
| | - Gary Joubert
- Children's Hospital, Western University, London, Ontario, Canada
| | - Terry P Klassen
- University of Manitoba, Winnipeg, Manitoba, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Stephen B Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology, Department of Pediatrics, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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12
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iedericks BJS, Grobbelaar L, Joubert G. Hypophosphataemia after cardiopulmonary bypass – incidence and clinical significance, a South African perspective. Southern African Journal of Anaesthesia and Analgesia 2020. [DOI: 10.36303/sajaa.2020.26.1.2247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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13
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Freedman SB, Williamson-Urquhart S, Heath A, Pechlivanoglou P, Hopkin G, Gouin S, Plint AC, Dixon A, Beer D, Joubert G, McCabe C, Finkelstein Y, Klassen TP. Multi-dose Oral Ondansetron for Pediatric Gastroenteritis: study Protocol for the multi-DOSE oral ondansetron for pediatric Acute GastroEnteritis (DOSE-AGE) pragmatic randomized controlled trial. Trials 2020; 21:435. [PMID: 32460879 PMCID: PMC7251709 DOI: 10.1186/s13063-020-04347-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 04/24/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND There are limited treatment options that clinicians can provide to children presenting to emergency departments with vomiting secondary to acute gastroenteritis. Based on evidence of effectiveness and safety, clinicians now routinely administer ondansetron in the emergency department to promote oral rehydration therapy success. However, clinicians are also increasingly providing multiple doses of ondansetron for home use, creating unquantified cost and health system resource use implications without any evidence to support this expanding practice. METHODS/DESIGN DOSE-AGE is a randomized, placebo-controlled, double-blinded, six-center, pragmatic clinical trial being conducted in six Canadian pediatric emergency departments (EDs). In September 2019 the study began recruiting children aged 6 months to 18 years with a minimum of three episodes of vomiting in the 24 h preceding enrollment, <72 h of gastroenteritis symptoms and who were administered a dose of ondansetron during their ED visit. We are recruiting 1030 children (1:1 allocation via an internet-based, third-party, randomization service) to receive a 48-h supply (i.e., six doses) of ondansetron oral solution or placebo, administered on an as-needed basis. All participants, caregivers and outcome assessors will be blinded to group assignment. Outcome data will be collected by surveys administered to caregivers 24, 48 and 168 h following enrollment. The primary outcome is the development of moderate-to-severe gastroenteritis in the 7 days following the ED visit as measured by a validated clinical score (the Modified Vesikari Scale). Secondary outcomes include duration and frequency of vomiting and diarrhea, proportions of children experiencing unscheduled health care visits and intravenous rehydration, caregiver satisfaction with treatment and safety. A preplanned economic evaluation will be conducted alongside the trial. DISCUSSION Definitive data are lacking to guide the clinical use of post-ED visit multidose ondansetron in children with acute gastroenteritis. Usage is increasing, despite the absence of supportive evidence. The incumbent additional costs associated with use, and potential side effects such as diarrhea and repeat visits, create an urgent need to evaluate the effect and safety of multiple doses of ondansetron in children focusing on post-emergency department visit and patient-centered outcomes. TRIAL REGISTRATION ClinicalTrials.gov: NCT03851835. Registered on 22 February 2019.
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Affiliation(s)
- Stephen B Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology, Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | | | - Anna Heath
- The Hospital for Sick Children, Division of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Statistical Science, University College London, London, UK
| | - Petros Pechlivanoglou
- The Hospital for Sick Children, Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | | | - Serge Gouin
- Departments of Pediatric Emergency Medicine and Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| | - Amy C Plint
- Children's Hospital of Eastern Ontario, Departments of Pediatric and Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Andrew Dixon
- Stollery Children's Hospital, Department of Pediatrics, University of Alberta, Women and Children's Health Research Institute, Edmonton, AB, Canada
| | - Darcy Beer
- Max Rady College of Medicine, Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, and the Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Gary Joubert
- Division of Paediatric Emergency Medicine, Department of Paediatrics, Children's Hospital LHSC, Western University, London, ON, Canada
| | - Christopher McCabe
- Institute of Health Economics and the Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada
| | - Yaron Finkelstein
- Divisions of Emergency Medicine and Clinical Pharmacology and Toxicology, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Terry P Klassen
- Max Rady College of Medicine, Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, and the Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
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14
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Doan Q, Wong H, Meckler G, Johnson D, Stang A, Dixon A, Sawyer S, Principi T, Kam AJ, Joubert G, Gravel J, Jabbour M, Guttmann A. The impact of pediatric emergency department crowding on patient and health care system outcomes: a multicentre cohort study. CMAJ 2020; 191:E627-E635. [PMID: 31182457 DOI: 10.1503/cmaj.181426] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2019] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Emergency department overcrowding has been associated with increased odds of hospital admission and mortality after discharge from the emergency department in predominantly adult cohorts. The objective of this study was to evaluate the association between crowding and the odds of several adverse outcomes among children seen at a pediatric emergency department. METHODS We conducted a retrospective cohort study involving all children visiting 8 Canadian pediatric emergency departments across 4 provinces between 2010 and 2014. We analyzed the association between mean departmental length of stay for each index visit and hospital admission within 7 days or death within 14 days of emergency department discharge, as well as hospital admission at index visit and return visits within 7 days, using mixed-effects logistic regression modelling. RESULTS A total of 1 931 465 index visits occurred across study sites over the 5-year period, with little variation in index visit hospital admission or median length of stay. Hospital admission within 7 days of discharge and 14-day mortality were low across provinces (0.8%-1.5% and < 10 per 100 000 visits, respectively), and their association with mean departmental length of stay varied by triage categories and across sites but was not significant. There were increased odds of hospital admission at the index visit with increasing departmental crowding among visits triaged to Canadian Triage and Acuity Scale (CTAS) score 1-2 (odds ratios [ORs] ranged from 1.01 to 1.08) and return visits among patients with a CTAS score of 4-5 discharged at the index visit at some sites (ORs ranged from 1.00 to 1.06). INTERPRETATION Emergency department crowding was not significantly associated with hospital admission within 7 days of the emergency department visit or mortality in children. However, it was associated with increased hospital admission at the index visit for the sickest children, and with return visits to the emergency department for those less sick.
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Affiliation(s)
- Quynh Doan
- Division of Pediatric Emergency Medicine, Department of Pediatrics (Doan, Meckler), University of British Columbia; School of Population and Public Health (Wong), University of British Columbia; BC Children's Hospital Research Institute (Doan, Meckler), Vancouver, BC; Alberta Children's Hospital Research Institute (Johnson, Stang), University of Calgary, Calgary, Alta; Stollery Children's Hospital, and Women and Children's Health Research Institute (Dixon), University of Alberta, Edmonton, Alta.; Pediatric Emergency Medicine (Sawyer), University of Manitoba; Children's Hospital, Health Sciences Centre Winnipeg (Sawyer), Winnipeg, Man.; Paediatric Emergency Medicine (Principi), University of Toronto; The Hospital for Sick Children (Principi), Toronto, Ont.; Department of Pediatrics (Kam), McMaster University; McMaster Children's Hospital (Kam), Hamilton, Ont.; Paediatric Emergency Medicine (Joubert), Western University; Children's Hospital of Western Ontario (Joubert), London, Ont.; Département de pédiatrie (Gravel), Université de Montréal; CHU Sainte-Justine (Gravel), Montréal, Que.; Department of Pediatrics (Jabbour), University of Ottawa; Children's Hospital of Eastern Ontario (Jabbour), Ottawa, Ont.; ICES (Guttmann); Department of Paediatrics (Guttmann), University of Toronto, Toronto, Ont.
| | - Hubert Wong
- Division of Pediatric Emergency Medicine, Department of Pediatrics (Doan, Meckler), University of British Columbia; School of Population and Public Health (Wong), University of British Columbia; BC Children's Hospital Research Institute (Doan, Meckler), Vancouver, BC; Alberta Children's Hospital Research Institute (Johnson, Stang), University of Calgary, Calgary, Alta; Stollery Children's Hospital, and Women and Children's Health Research Institute (Dixon), University of Alberta, Edmonton, Alta.; Pediatric Emergency Medicine (Sawyer), University of Manitoba; Children's Hospital, Health Sciences Centre Winnipeg (Sawyer), Winnipeg, Man.; Paediatric Emergency Medicine (Principi), University of Toronto; The Hospital for Sick Children (Principi), Toronto, Ont.; Department of Pediatrics (Kam), McMaster University; McMaster Children's Hospital (Kam), Hamilton, Ont.; Paediatric Emergency Medicine (Joubert), Western University; Children's Hospital of Western Ontario (Joubert), London, Ont.; Département de pédiatrie (Gravel), Université de Montréal; CHU Sainte-Justine (Gravel), Montréal, Que.; Department of Pediatrics (Jabbour), University of Ottawa; Children's Hospital of Eastern Ontario (Jabbour), Ottawa, Ont.; ICES (Guttmann); Department of Paediatrics (Guttmann), University of Toronto, Toronto, Ont
| | - Garth Meckler
- Division of Pediatric Emergency Medicine, Department of Pediatrics (Doan, Meckler), University of British Columbia; School of Population and Public Health (Wong), University of British Columbia; BC Children's Hospital Research Institute (Doan, Meckler), Vancouver, BC; Alberta Children's Hospital Research Institute (Johnson, Stang), University of Calgary, Calgary, Alta; Stollery Children's Hospital, and Women and Children's Health Research Institute (Dixon), University of Alberta, Edmonton, Alta.; Pediatric Emergency Medicine (Sawyer), University of Manitoba; Children's Hospital, Health Sciences Centre Winnipeg (Sawyer), Winnipeg, Man.; Paediatric Emergency Medicine (Principi), University of Toronto; The Hospital for Sick Children (Principi), Toronto, Ont.; Department of Pediatrics (Kam), McMaster University; McMaster Children's Hospital (Kam), Hamilton, Ont.; Paediatric Emergency Medicine (Joubert), Western University; Children's Hospital of Western Ontario (Joubert), London, Ont.; Département de pédiatrie (Gravel), Université de Montréal; CHU Sainte-Justine (Gravel), Montréal, Que.; Department of Pediatrics (Jabbour), University of Ottawa; Children's Hospital of Eastern Ontario (Jabbour), Ottawa, Ont.; ICES (Guttmann); Department of Paediatrics (Guttmann), University of Toronto, Toronto, Ont
| | - David Johnson
- Division of Pediatric Emergency Medicine, Department of Pediatrics (Doan, Meckler), University of British Columbia; School of Population and Public Health (Wong), University of British Columbia; BC Children's Hospital Research Institute (Doan, Meckler), Vancouver, BC; Alberta Children's Hospital Research Institute (Johnson, Stang), University of Calgary, Calgary, Alta; Stollery Children's Hospital, and Women and Children's Health Research Institute (Dixon), University of Alberta, Edmonton, Alta.; Pediatric Emergency Medicine (Sawyer), University of Manitoba; Children's Hospital, Health Sciences Centre Winnipeg (Sawyer), Winnipeg, Man.; Paediatric Emergency Medicine (Principi), University of Toronto; The Hospital for Sick Children (Principi), Toronto, Ont.; Department of Pediatrics (Kam), McMaster University; McMaster Children's Hospital (Kam), Hamilton, Ont.; Paediatric Emergency Medicine (Joubert), Western University; Children's Hospital of Western Ontario (Joubert), London, Ont.; Département de pédiatrie (Gravel), Université de Montréal; CHU Sainte-Justine (Gravel), Montréal, Que.; Department of Pediatrics (Jabbour), University of Ottawa; Children's Hospital of Eastern Ontario (Jabbour), Ottawa, Ont.; ICES (Guttmann); Department of Paediatrics (Guttmann), University of Toronto, Toronto, Ont
| | - Antonia Stang
- Division of Pediatric Emergency Medicine, Department of Pediatrics (Doan, Meckler), University of British Columbia; School of Population and Public Health (Wong), University of British Columbia; BC Children's Hospital Research Institute (Doan, Meckler), Vancouver, BC; Alberta Children's Hospital Research Institute (Johnson, Stang), University of Calgary, Calgary, Alta; Stollery Children's Hospital, and Women and Children's Health Research Institute (Dixon), University of Alberta, Edmonton, Alta.; Pediatric Emergency Medicine (Sawyer), University of Manitoba; Children's Hospital, Health Sciences Centre Winnipeg (Sawyer), Winnipeg, Man.; Paediatric Emergency Medicine (Principi), University of Toronto; The Hospital for Sick Children (Principi), Toronto, Ont.; Department of Pediatrics (Kam), McMaster University; McMaster Children's Hospital (Kam), Hamilton, Ont.; Paediatric Emergency Medicine (Joubert), Western University; Children's Hospital of Western Ontario (Joubert), London, Ont.; Département de pédiatrie (Gravel), Université de Montréal; CHU Sainte-Justine (Gravel), Montréal, Que.; Department of Pediatrics (Jabbour), University of Ottawa; Children's Hospital of Eastern Ontario (Jabbour), Ottawa, Ont.; ICES (Guttmann); Department of Paediatrics (Guttmann), University of Toronto, Toronto, Ont
| | - Andrew Dixon
- Division of Pediatric Emergency Medicine, Department of Pediatrics (Doan, Meckler), University of British Columbia; School of Population and Public Health (Wong), University of British Columbia; BC Children's Hospital Research Institute (Doan, Meckler), Vancouver, BC; Alberta Children's Hospital Research Institute (Johnson, Stang), University of Calgary, Calgary, Alta; Stollery Children's Hospital, and Women and Children's Health Research Institute (Dixon), University of Alberta, Edmonton, Alta.; Pediatric Emergency Medicine (Sawyer), University of Manitoba; Children's Hospital, Health Sciences Centre Winnipeg (Sawyer), Winnipeg, Man.; Paediatric Emergency Medicine (Principi), University of Toronto; The Hospital for Sick Children (Principi), Toronto, Ont.; Department of Pediatrics (Kam), McMaster University; McMaster Children's Hospital (Kam), Hamilton, Ont.; Paediatric Emergency Medicine (Joubert), Western University; Children's Hospital of Western Ontario (Joubert), London, Ont.; Département de pédiatrie (Gravel), Université de Montréal; CHU Sainte-Justine (Gravel), Montréal, Que.; Department of Pediatrics (Jabbour), University of Ottawa; Children's Hospital of Eastern Ontario (Jabbour), Ottawa, Ont.; ICES (Guttmann); Department of Paediatrics (Guttmann), University of Toronto, Toronto, Ont
| | - Scott Sawyer
- Division of Pediatric Emergency Medicine, Department of Pediatrics (Doan, Meckler), University of British Columbia; School of Population and Public Health (Wong), University of British Columbia; BC Children's Hospital Research Institute (Doan, Meckler), Vancouver, BC; Alberta Children's Hospital Research Institute (Johnson, Stang), University of Calgary, Calgary, Alta; Stollery Children's Hospital, and Women and Children's Health Research Institute (Dixon), University of Alberta, Edmonton, Alta.; Pediatric Emergency Medicine (Sawyer), University of Manitoba; Children's Hospital, Health Sciences Centre Winnipeg (Sawyer), Winnipeg, Man.; Paediatric Emergency Medicine (Principi), University of Toronto; The Hospital for Sick Children (Principi), Toronto, Ont.; Department of Pediatrics (Kam), McMaster University; McMaster Children's Hospital (Kam), Hamilton, Ont.; Paediatric Emergency Medicine (Joubert), Western University; Children's Hospital of Western Ontario (Joubert), London, Ont.; Département de pédiatrie (Gravel), Université de Montréal; CHU Sainte-Justine (Gravel), Montréal, Que.; Department of Pediatrics (Jabbour), University of Ottawa; Children's Hospital of Eastern Ontario (Jabbour), Ottawa, Ont.; ICES (Guttmann); Department of Paediatrics (Guttmann), University of Toronto, Toronto, Ont
| | - Tania Principi
- Division of Pediatric Emergency Medicine, Department of Pediatrics (Doan, Meckler), University of British Columbia; School of Population and Public Health (Wong), University of British Columbia; BC Children's Hospital Research Institute (Doan, Meckler), Vancouver, BC; Alberta Children's Hospital Research Institute (Johnson, Stang), University of Calgary, Calgary, Alta; Stollery Children's Hospital, and Women and Children's Health Research Institute (Dixon), University of Alberta, Edmonton, Alta.; Pediatric Emergency Medicine (Sawyer), University of Manitoba; Children's Hospital, Health Sciences Centre Winnipeg (Sawyer), Winnipeg, Man.; Paediatric Emergency Medicine (Principi), University of Toronto; The Hospital for Sick Children (Principi), Toronto, Ont.; Department of Pediatrics (Kam), McMaster University; McMaster Children's Hospital (Kam), Hamilton, Ont.; Paediatric Emergency Medicine (Joubert), Western University; Children's Hospital of Western Ontario (Joubert), London, Ont.; Département de pédiatrie (Gravel), Université de Montréal; CHU Sainte-Justine (Gravel), Montréal, Que.; Department of Pediatrics (Jabbour), University of Ottawa; Children's Hospital of Eastern Ontario (Jabbour), Ottawa, Ont.; ICES (Guttmann); Department of Paediatrics (Guttmann), University of Toronto, Toronto, Ont
| | - April J Kam
- Division of Pediatric Emergency Medicine, Department of Pediatrics (Doan, Meckler), University of British Columbia; School of Population and Public Health (Wong), University of British Columbia; BC Children's Hospital Research Institute (Doan, Meckler), Vancouver, BC; Alberta Children's Hospital Research Institute (Johnson, Stang), University of Calgary, Calgary, Alta; Stollery Children's Hospital, and Women and Children's Health Research Institute (Dixon), University of Alberta, Edmonton, Alta.; Pediatric Emergency Medicine (Sawyer), University of Manitoba; Children's Hospital, Health Sciences Centre Winnipeg (Sawyer), Winnipeg, Man.; Paediatric Emergency Medicine (Principi), University of Toronto; The Hospital for Sick Children (Principi), Toronto, Ont.; Department of Pediatrics (Kam), McMaster University; McMaster Children's Hospital (Kam), Hamilton, Ont.; Paediatric Emergency Medicine (Joubert), Western University; Children's Hospital of Western Ontario (Joubert), London, Ont.; Département de pédiatrie (Gravel), Université de Montréal; CHU Sainte-Justine (Gravel), Montréal, Que.; Department of Pediatrics (Jabbour), University of Ottawa; Children's Hospital of Eastern Ontario (Jabbour), Ottawa, Ont.; ICES (Guttmann); Department of Paediatrics (Guttmann), University of Toronto, Toronto, Ont
| | - Gary Joubert
- Division of Pediatric Emergency Medicine, Department of Pediatrics (Doan, Meckler), University of British Columbia; School of Population and Public Health (Wong), University of British Columbia; BC Children's Hospital Research Institute (Doan, Meckler), Vancouver, BC; Alberta Children's Hospital Research Institute (Johnson, Stang), University of Calgary, Calgary, Alta; Stollery Children's Hospital, and Women and Children's Health Research Institute (Dixon), University of Alberta, Edmonton, Alta.; Pediatric Emergency Medicine (Sawyer), University of Manitoba; Children's Hospital, Health Sciences Centre Winnipeg (Sawyer), Winnipeg, Man.; Paediatric Emergency Medicine (Principi), University of Toronto; The Hospital for Sick Children (Principi), Toronto, Ont.; Department of Pediatrics (Kam), McMaster University; McMaster Children's Hospital (Kam), Hamilton, Ont.; Paediatric Emergency Medicine (Joubert), Western University; Children's Hospital of Western Ontario (Joubert), London, Ont.; Département de pédiatrie (Gravel), Université de Montréal; CHU Sainte-Justine (Gravel), Montréal, Que.; Department of Pediatrics (Jabbour), University of Ottawa; Children's Hospital of Eastern Ontario (Jabbour), Ottawa, Ont.; ICES (Guttmann); Department of Paediatrics (Guttmann), University of Toronto, Toronto, Ont
| | - Jocelyn Gravel
- Division of Pediatric Emergency Medicine, Department of Pediatrics (Doan, Meckler), University of British Columbia; School of Population and Public Health (Wong), University of British Columbia; BC Children's Hospital Research Institute (Doan, Meckler), Vancouver, BC; Alberta Children's Hospital Research Institute (Johnson, Stang), University of Calgary, Calgary, Alta; Stollery Children's Hospital, and Women and Children's Health Research Institute (Dixon), University of Alberta, Edmonton, Alta.; Pediatric Emergency Medicine (Sawyer), University of Manitoba; Children's Hospital, Health Sciences Centre Winnipeg (Sawyer), Winnipeg, Man.; Paediatric Emergency Medicine (Principi), University of Toronto; The Hospital for Sick Children (Principi), Toronto, Ont.; Department of Pediatrics (Kam), McMaster University; McMaster Children's Hospital (Kam), Hamilton, Ont.; Paediatric Emergency Medicine (Joubert), Western University; Children's Hospital of Western Ontario (Joubert), London, Ont.; Département de pédiatrie (Gravel), Université de Montréal; CHU Sainte-Justine (Gravel), Montréal, Que.; Department of Pediatrics (Jabbour), University of Ottawa; Children's Hospital of Eastern Ontario (Jabbour), Ottawa, Ont.; ICES (Guttmann); Department of Paediatrics (Guttmann), University of Toronto, Toronto, Ont
| | - Mona Jabbour
- Division of Pediatric Emergency Medicine, Department of Pediatrics (Doan, Meckler), University of British Columbia; School of Population and Public Health (Wong), University of British Columbia; BC Children's Hospital Research Institute (Doan, Meckler), Vancouver, BC; Alberta Children's Hospital Research Institute (Johnson, Stang), University of Calgary, Calgary, Alta; Stollery Children's Hospital, and Women and Children's Health Research Institute (Dixon), University of Alberta, Edmonton, Alta.; Pediatric Emergency Medicine (Sawyer), University of Manitoba; Children's Hospital, Health Sciences Centre Winnipeg (Sawyer), Winnipeg, Man.; Paediatric Emergency Medicine (Principi), University of Toronto; The Hospital for Sick Children (Principi), Toronto, Ont.; Department of Pediatrics (Kam), McMaster University; McMaster Children's Hospital (Kam), Hamilton, Ont.; Paediatric Emergency Medicine (Joubert), Western University; Children's Hospital of Western Ontario (Joubert), London, Ont.; Département de pédiatrie (Gravel), Université de Montréal; CHU Sainte-Justine (Gravel), Montréal, Que.; Department of Pediatrics (Jabbour), University of Ottawa; Children's Hospital of Eastern Ontario (Jabbour), Ottawa, Ont.; ICES (Guttmann); Department of Paediatrics (Guttmann), University of Toronto, Toronto, Ont
| | - Astrid Guttmann
- Division of Pediatric Emergency Medicine, Department of Pediatrics (Doan, Meckler), University of British Columbia; School of Population and Public Health (Wong), University of British Columbia; BC Children's Hospital Research Institute (Doan, Meckler), Vancouver, BC; Alberta Children's Hospital Research Institute (Johnson, Stang), University of Calgary, Calgary, Alta; Stollery Children's Hospital, and Women and Children's Health Research Institute (Dixon), University of Alberta, Edmonton, Alta.; Pediatric Emergency Medicine (Sawyer), University of Manitoba; Children's Hospital, Health Sciences Centre Winnipeg (Sawyer), Winnipeg, Man.; Paediatric Emergency Medicine (Principi), University of Toronto; The Hospital for Sick Children (Principi), Toronto, Ont.; Department of Pediatrics (Kam), McMaster University; McMaster Children's Hospital (Kam), Hamilton, Ont.; Paediatric Emergency Medicine (Joubert), Western University; Children's Hospital of Western Ontario (Joubert), London, Ont.; Département de pédiatrie (Gravel), Université de Montréal; CHU Sainte-Justine (Gravel), Montréal, Que.; Department of Pediatrics (Jabbour), University of Ottawa; Children's Hospital of Eastern Ontario (Jabbour), Ottawa, Ont.; ICES (Guttmann); Department of Paediatrics (Guttmann), University of Toronto, Toronto, Ont
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Poonai N, Spohn J, Vandermeer B, Ali S, Bhatt M, Hendrikx S, Trottier ED, Sabhaney V, Shah A, Joubert G, Hartling L. Intranasal Dexmedetomidine for Procedural Distress in Children: A Systematic Review. Pediatrics 2020; 145:peds.2019-1623. [PMID: 31862730 DOI: 10.1542/peds.2019-1623] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/21/2019] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Intranasal dexmedetomidine (IND) is an emerging agent for procedural distress in children. OBJECTIVE To explore the effectiveness of IND for procedural distress in children. DATA SOURCES We performed electronic searches of Medline (1946-2019), Embase (1980-2019), Google Scholar (2019), Cumulative Index to Nursing and Allied Health Literature (1981-2019), and Cochrane Central Register. STUDY SELECTION We included randomized trials of IND for procedures in children. DATA EXTRACTION Methodologic quality of evidence was evaluated by using the Cochrane Collaboration's risk of bias tool and the Grading of Recommendations Assessment, Development, and Evaluation system, respectively. The primary outcome was the proportion of participants with adequate sedation. RESULTS Among 19 trials (N = 2137), IND was superior to oral chloral hydrate (3 trials), oral midazolam (1 trial), intranasal midazolam (1 trial), and oral dexmedetomidine (1 trial). IND was equivalent to oral chloral hydrate (2 trials), intranasal midazolam (2 trials), and intranasal ketamine (3 trials). IND was inferior to oral ketamine and a combination of IND plus oral ketamine (1 trial). Higher doses of IND were superior to lower doses (4 trials). Adverse effects were reported in 67 of 727 (9.2%) participants in the IND versus 98 of 591 (16.6%) in the comparator group. There were no reports of adverse events requiring resuscitative measures. LIMITATIONS The adequacy of sedation was subjective, which possibly led to biased outcome reporting. CONCLUSIONS Given the methodologic limitations of included trials, IND is likely more effective at sedating children compared to oral chloral hydrate and oral midazolam. However, this must be weighed against the potential for adverse cardiovascular effects.
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Affiliation(s)
- Naveen Poonai
- Department of Pediatrics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada; .,Division of Emergency Medicine and.,Children's Health Research Institute, London Health Sciences Centre, London, Ontario, Canada
| | | | - Ben Vandermeer
- Department of Pediatrics and Alberta Research Centre for Health Evidence
| | - Samina Ali
- Department of Pediatrics, Faculty of Medicine and Dentistry, and.,Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Maala Bhatt
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Shawn Hendrikx
- Department of Pediatrics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Evelyne D Trottier
- Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal, Montréal, Québec, Canada; and
| | - Vikram Sabhaney
- BC Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Gary Joubert
- Department of Pediatrics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.,Division of Emergency Medicine and
| | - Lisa Hartling
- Department of Pediatrics and Alberta Research Centre for Health Evidence
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16
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Van Zyl PM, Brisley C, Halberg L, Matthysen M, Toerien M, Joubert G. The use, knowledge and attitudes regarding hormonal contraceptive products of female first-year students in a Faculty of Health Sciences. S Afr Fam Pract (2004) 2019. [DOI: 10.4102/safp.v61i5.4947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background: Effective contraception plays a major role in the economic advancement of women. New hormonal products offer more effective solutions with fewer side effects. This study aimed to assess the use, knowledge and attitudes regarding hormonal contraception of female first-year students across various health profession courses.Methods: A descriptive study was conducted during August to October 2017 targeting all female first-year students of the Faculty of Health Sciences at the University of the Free State.Results: Self-administered anonymous questionnaires were completed by 261 students (response rate 81.6%). At the time of the study, 29.6% of the study population reported using hormonal contraceptive products; 51.7% of users cited acne as the indication. Among users of hormonal contraceptives, combined oral contraception was the most commonly used (86.0%), and was regarded as the most effective (33.2%). A third of the students (36.2%) were aware that some medication could influence the effectiveness of combined oral contraception. Half (52.3%) had no knowledge of the subdermal implant and 34.8% did not know what an intrauterine system was. According to 28.2%, post-coital use of hormonal products is not an acceptable method of contraception. Almost 90% (87.3%) indicated that an education intervention regarding hormonal contraception is needed at the university.Conclusion: The study population lacks detailed and sufficient knowledge of critical aspects of contraception, such as relative effectiveness, and factors that affect these; long-acting reversible contraceptives; and emergency contraception. A formal education intervention is proposed.
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17
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Osmond MH, Klassen TP, Wells GA, Davidson J, Correll R, Boutis K, Joubert G, Gouin S, Khangura S, Turner T, Belanger F, Silver N, Taylor B, Curran J, Stiell IG. Validation and refinement of a clinical decision rule for the use of computed tomography in children with minor head injury in the emergency department. CMAJ 2019; 190:E816-E822. [PMID: 29986857 DOI: 10.1503/cmaj.170406] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND There is uncertainty about which children with minor head injury need to undergo computed tomography (CT). We sought to prospectively validate the accuracy and potential for refinement of a previously derived decision rule, Canadian Assessment of Tomography for Childhood Head injury (CATCH), to guide CT use in children with minor head injury. METHODS This multicentre cohort study in 9 Canadian pediatric emergency departments prospectively enrolled children with blunt head trauma presenting with a Glasgow Coma Scale score of 13-15 and loss of consciousness, amnesia, disorientation, persistent vomiting or irritability. Phys icians completed standardized assessment forms before CT, including clinical predictors of the rule. The primary outcome was neurosurgical intervention and the secondary outcome was brain injury on CT. We calculated test characteristics of the rule and used recursive partitioning to further refine the rule. RESULTS Of 4060 enrolled patients, 23 (0.6%) underwent neurosurgical intervention, and 197 (4.9%) had brain injury on CT. The original 7-item rule (CATCH) had sensitivities of 91.3% (95% confidence interval [CI] 72.0%-98.9%) for neurosurgical intervention and 97.5% (95% CI 94.2%-99.2%) for predicting brain injury. Adding "≥ 4 episodes of vomiting" resulted in a refined 8-item rule (CATCH2) with 100% (95% CI 85.2%-100%) sensitivity for neurosurgical intervention and 99.5% (95% CI 97.2%-100%) sensitivity for brain injury. INTERPRETATION Among children presenting to the emergency department with minor head injury, the CATCH2 rule was highly sensitive for identifying those children requiring neurosurgical intervention and those with any brain injury on CT. The CATCH2 rule should be further validated in an implementation study designed to assess its clinical impact.
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Affiliation(s)
- Martin H Osmond
- Department of Pediatrics and Children's Hospital of Eastern Ontario Research Institute (Osmond), University of Ottawa, Ottawa, Ont.; Department of Pediatrics and Child Health (Klassen, Silver), University of Manitoba, Winnipeg, Man.; School of Epidemiology and Public Health (Wells), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Davidson, Belanger), University of Calgary, Calgary, Alta.; Clinical Research Unit (Correll), Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ont.; Department of Pediatrics, and Child Health Evaluative Sciences Research Institute, Hospital for Sick Children (Boutis), University of Toronto, Toronto, Ont.; Department of Paediatrics (Joubert), Western University, London, Ont.; Paediatric Department (Gouin), CHU Sainte-Justine, Montréal, Que.; Department of Pediatrics (Khangura), University of British Columbia, Vancouver, BC; Department of Pediatrics (Turner), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Taylor, Curran), Dalhousie University, Halifax, NS; Department of Emergency Medicine and Ottawa Hospital Research Institute (Stiell), University of Ottawa, Ottawa, Ont.
| | - Terry P Klassen
- Department of Pediatrics and Children's Hospital of Eastern Ontario Research Institute (Osmond), University of Ottawa, Ottawa, Ont.; Department of Pediatrics and Child Health (Klassen, Silver), University of Manitoba, Winnipeg, Man.; School of Epidemiology and Public Health (Wells), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Davidson, Belanger), University of Calgary, Calgary, Alta.; Clinical Research Unit (Correll), Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ont.; Department of Pediatrics, and Child Health Evaluative Sciences Research Institute, Hospital for Sick Children (Boutis), University of Toronto, Toronto, Ont.; Department of Paediatrics (Joubert), Western University, London, Ont.; Paediatric Department (Gouin), CHU Sainte-Justine, Montréal, Que.; Department of Pediatrics (Khangura), University of British Columbia, Vancouver, BC; Department of Pediatrics (Turner), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Taylor, Curran), Dalhousie University, Halifax, NS; Department of Emergency Medicine and Ottawa Hospital Research Institute (Stiell), University of Ottawa, Ottawa, Ont
| | - George A Wells
- Department of Pediatrics and Children's Hospital of Eastern Ontario Research Institute (Osmond), University of Ottawa, Ottawa, Ont.; Department of Pediatrics and Child Health (Klassen, Silver), University of Manitoba, Winnipeg, Man.; School of Epidemiology and Public Health (Wells), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Davidson, Belanger), University of Calgary, Calgary, Alta.; Clinical Research Unit (Correll), Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ont.; Department of Pediatrics, and Child Health Evaluative Sciences Research Institute, Hospital for Sick Children (Boutis), University of Toronto, Toronto, Ont.; Department of Paediatrics (Joubert), Western University, London, Ont.; Paediatric Department (Gouin), CHU Sainte-Justine, Montréal, Que.; Department of Pediatrics (Khangura), University of British Columbia, Vancouver, BC; Department of Pediatrics (Turner), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Taylor, Curran), Dalhousie University, Halifax, NS; Department of Emergency Medicine and Ottawa Hospital Research Institute (Stiell), University of Ottawa, Ottawa, Ont
| | - Jennifer Davidson
- Department of Pediatrics and Children's Hospital of Eastern Ontario Research Institute (Osmond), University of Ottawa, Ottawa, Ont.; Department of Pediatrics and Child Health (Klassen, Silver), University of Manitoba, Winnipeg, Man.; School of Epidemiology and Public Health (Wells), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Davidson, Belanger), University of Calgary, Calgary, Alta.; Clinical Research Unit (Correll), Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ont.; Department of Pediatrics, and Child Health Evaluative Sciences Research Institute, Hospital for Sick Children (Boutis), University of Toronto, Toronto, Ont.; Department of Paediatrics (Joubert), Western University, London, Ont.; Paediatric Department (Gouin), CHU Sainte-Justine, Montréal, Que.; Department of Pediatrics (Khangura), University of British Columbia, Vancouver, BC; Department of Pediatrics (Turner), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Taylor, Curran), Dalhousie University, Halifax, NS; Department of Emergency Medicine and Ottawa Hospital Research Institute (Stiell), University of Ottawa, Ottawa, Ont
| | - Rhonda Correll
- Department of Pediatrics and Children's Hospital of Eastern Ontario Research Institute (Osmond), University of Ottawa, Ottawa, Ont.; Department of Pediatrics and Child Health (Klassen, Silver), University of Manitoba, Winnipeg, Man.; School of Epidemiology and Public Health (Wells), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Davidson, Belanger), University of Calgary, Calgary, Alta.; Clinical Research Unit (Correll), Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ont.; Department of Pediatrics, and Child Health Evaluative Sciences Research Institute, Hospital for Sick Children (Boutis), University of Toronto, Toronto, Ont.; Department of Paediatrics (Joubert), Western University, London, Ont.; Paediatric Department (Gouin), CHU Sainte-Justine, Montréal, Que.; Department of Pediatrics (Khangura), University of British Columbia, Vancouver, BC; Department of Pediatrics (Turner), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Taylor, Curran), Dalhousie University, Halifax, NS; Department of Emergency Medicine and Ottawa Hospital Research Institute (Stiell), University of Ottawa, Ottawa, Ont
| | - Kathy Boutis
- Department of Pediatrics and Children's Hospital of Eastern Ontario Research Institute (Osmond), University of Ottawa, Ottawa, Ont.; Department of Pediatrics and Child Health (Klassen, Silver), University of Manitoba, Winnipeg, Man.; School of Epidemiology and Public Health (Wells), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Davidson, Belanger), University of Calgary, Calgary, Alta.; Clinical Research Unit (Correll), Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ont.; Department of Pediatrics, and Child Health Evaluative Sciences Research Institute, Hospital for Sick Children (Boutis), University of Toronto, Toronto, Ont.; Department of Paediatrics (Joubert), Western University, London, Ont.; Paediatric Department (Gouin), CHU Sainte-Justine, Montréal, Que.; Department of Pediatrics (Khangura), University of British Columbia, Vancouver, BC; Department of Pediatrics (Turner), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Taylor, Curran), Dalhousie University, Halifax, NS; Department of Emergency Medicine and Ottawa Hospital Research Institute (Stiell), University of Ottawa, Ottawa, Ont
| | - Gary Joubert
- Department of Pediatrics and Children's Hospital of Eastern Ontario Research Institute (Osmond), University of Ottawa, Ottawa, Ont.; Department of Pediatrics and Child Health (Klassen, Silver), University of Manitoba, Winnipeg, Man.; School of Epidemiology and Public Health (Wells), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Davidson, Belanger), University of Calgary, Calgary, Alta.; Clinical Research Unit (Correll), Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ont.; Department of Pediatrics, and Child Health Evaluative Sciences Research Institute, Hospital for Sick Children (Boutis), University of Toronto, Toronto, Ont.; Department of Paediatrics (Joubert), Western University, London, Ont.; Paediatric Department (Gouin), CHU Sainte-Justine, Montréal, Que.; Department of Pediatrics (Khangura), University of British Columbia, Vancouver, BC; Department of Pediatrics (Turner), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Taylor, Curran), Dalhousie University, Halifax, NS; Department of Emergency Medicine and Ottawa Hospital Research Institute (Stiell), University of Ottawa, Ottawa, Ont
| | - Serge Gouin
- Department of Pediatrics and Children's Hospital of Eastern Ontario Research Institute (Osmond), University of Ottawa, Ottawa, Ont.; Department of Pediatrics and Child Health (Klassen, Silver), University of Manitoba, Winnipeg, Man.; School of Epidemiology and Public Health (Wells), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Davidson, Belanger), University of Calgary, Calgary, Alta.; Clinical Research Unit (Correll), Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ont.; Department of Pediatrics, and Child Health Evaluative Sciences Research Institute, Hospital for Sick Children (Boutis), University of Toronto, Toronto, Ont.; Department of Paediatrics (Joubert), Western University, London, Ont.; Paediatric Department (Gouin), CHU Sainte-Justine, Montréal, Que.; Department of Pediatrics (Khangura), University of British Columbia, Vancouver, BC; Department of Pediatrics (Turner), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Taylor, Curran), Dalhousie University, Halifax, NS; Department of Emergency Medicine and Ottawa Hospital Research Institute (Stiell), University of Ottawa, Ottawa, Ont
| | - Simi Khangura
- Department of Pediatrics and Children's Hospital of Eastern Ontario Research Institute (Osmond), University of Ottawa, Ottawa, Ont.; Department of Pediatrics and Child Health (Klassen, Silver), University of Manitoba, Winnipeg, Man.; School of Epidemiology and Public Health (Wells), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Davidson, Belanger), University of Calgary, Calgary, Alta.; Clinical Research Unit (Correll), Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ont.; Department of Pediatrics, and Child Health Evaluative Sciences Research Institute, Hospital for Sick Children (Boutis), University of Toronto, Toronto, Ont.; Department of Paediatrics (Joubert), Western University, London, Ont.; Paediatric Department (Gouin), CHU Sainte-Justine, Montréal, Que.; Department of Pediatrics (Khangura), University of British Columbia, Vancouver, BC; Department of Pediatrics (Turner), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Taylor, Curran), Dalhousie University, Halifax, NS; Department of Emergency Medicine and Ottawa Hospital Research Institute (Stiell), University of Ottawa, Ottawa, Ont
| | - Troy Turner
- Department of Pediatrics and Children's Hospital of Eastern Ontario Research Institute (Osmond), University of Ottawa, Ottawa, Ont.; Department of Pediatrics and Child Health (Klassen, Silver), University of Manitoba, Winnipeg, Man.; School of Epidemiology and Public Health (Wells), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Davidson, Belanger), University of Calgary, Calgary, Alta.; Clinical Research Unit (Correll), Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ont.; Department of Pediatrics, and Child Health Evaluative Sciences Research Institute, Hospital for Sick Children (Boutis), University of Toronto, Toronto, Ont.; Department of Paediatrics (Joubert), Western University, London, Ont.; Paediatric Department (Gouin), CHU Sainte-Justine, Montréal, Que.; Department of Pediatrics (Khangura), University of British Columbia, Vancouver, BC; Department of Pediatrics (Turner), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Taylor, Curran), Dalhousie University, Halifax, NS; Department of Emergency Medicine and Ottawa Hospital Research Institute (Stiell), University of Ottawa, Ottawa, Ont
| | - Francois Belanger
- Department of Pediatrics and Children's Hospital of Eastern Ontario Research Institute (Osmond), University of Ottawa, Ottawa, Ont.; Department of Pediatrics and Child Health (Klassen, Silver), University of Manitoba, Winnipeg, Man.; School of Epidemiology and Public Health (Wells), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Davidson, Belanger), University of Calgary, Calgary, Alta.; Clinical Research Unit (Correll), Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ont.; Department of Pediatrics, and Child Health Evaluative Sciences Research Institute, Hospital for Sick Children (Boutis), University of Toronto, Toronto, Ont.; Department of Paediatrics (Joubert), Western University, London, Ont.; Paediatric Department (Gouin), CHU Sainte-Justine, Montréal, Que.; Department of Pediatrics (Khangura), University of British Columbia, Vancouver, BC; Department of Pediatrics (Turner), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Taylor, Curran), Dalhousie University, Halifax, NS; Department of Emergency Medicine and Ottawa Hospital Research Institute (Stiell), University of Ottawa, Ottawa, Ont
| | - Norm Silver
- Department of Pediatrics and Children's Hospital of Eastern Ontario Research Institute (Osmond), University of Ottawa, Ottawa, Ont.; Department of Pediatrics and Child Health (Klassen, Silver), University of Manitoba, Winnipeg, Man.; School of Epidemiology and Public Health (Wells), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Davidson, Belanger), University of Calgary, Calgary, Alta.; Clinical Research Unit (Correll), Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ont.; Department of Pediatrics, and Child Health Evaluative Sciences Research Institute, Hospital for Sick Children (Boutis), University of Toronto, Toronto, Ont.; Department of Paediatrics (Joubert), Western University, London, Ont.; Paediatric Department (Gouin), CHU Sainte-Justine, Montréal, Que.; Department of Pediatrics (Khangura), University of British Columbia, Vancouver, BC; Department of Pediatrics (Turner), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Taylor, Curran), Dalhousie University, Halifax, NS; Department of Emergency Medicine and Ottawa Hospital Research Institute (Stiell), University of Ottawa, Ottawa, Ont
| | - Brett Taylor
- Department of Pediatrics and Children's Hospital of Eastern Ontario Research Institute (Osmond), University of Ottawa, Ottawa, Ont.; Department of Pediatrics and Child Health (Klassen, Silver), University of Manitoba, Winnipeg, Man.; School of Epidemiology and Public Health (Wells), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Davidson, Belanger), University of Calgary, Calgary, Alta.; Clinical Research Unit (Correll), Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ont.; Department of Pediatrics, and Child Health Evaluative Sciences Research Institute, Hospital for Sick Children (Boutis), University of Toronto, Toronto, Ont.; Department of Paediatrics (Joubert), Western University, London, Ont.; Paediatric Department (Gouin), CHU Sainte-Justine, Montréal, Que.; Department of Pediatrics (Khangura), University of British Columbia, Vancouver, BC; Department of Pediatrics (Turner), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Taylor, Curran), Dalhousie University, Halifax, NS; Department of Emergency Medicine and Ottawa Hospital Research Institute (Stiell), University of Ottawa, Ottawa, Ont
| | - Janet Curran
- Department of Pediatrics and Children's Hospital of Eastern Ontario Research Institute (Osmond), University of Ottawa, Ottawa, Ont.; Department of Pediatrics and Child Health (Klassen, Silver), University of Manitoba, Winnipeg, Man.; School of Epidemiology and Public Health (Wells), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Davidson, Belanger), University of Calgary, Calgary, Alta.; Clinical Research Unit (Correll), Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ont.; Department of Pediatrics, and Child Health Evaluative Sciences Research Institute, Hospital for Sick Children (Boutis), University of Toronto, Toronto, Ont.; Department of Paediatrics (Joubert), Western University, London, Ont.; Paediatric Department (Gouin), CHU Sainte-Justine, Montréal, Que.; Department of Pediatrics (Khangura), University of British Columbia, Vancouver, BC; Department of Pediatrics (Turner), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Taylor, Curran), Dalhousie University, Halifax, NS; Department of Emergency Medicine and Ottawa Hospital Research Institute (Stiell), University of Ottawa, Ottawa, Ont
| | - Ian G Stiell
- Department of Pediatrics and Children's Hospital of Eastern Ontario Research Institute (Osmond), University of Ottawa, Ottawa, Ont.; Department of Pediatrics and Child Health (Klassen, Silver), University of Manitoba, Winnipeg, Man.; School of Epidemiology and Public Health (Wells), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Davidson, Belanger), University of Calgary, Calgary, Alta.; Clinical Research Unit (Correll), Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ont.; Department of Pediatrics, and Child Health Evaluative Sciences Research Institute, Hospital for Sick Children (Boutis), University of Toronto, Toronto, Ont.; Department of Paediatrics (Joubert), Western University, London, Ont.; Paediatric Department (Gouin), CHU Sainte-Justine, Montréal, Que.; Department of Pediatrics (Khangura), University of British Columbia, Vancouver, BC; Department of Pediatrics (Turner), University of Alberta, Edmonton, Alta.; Department of Pediatrics (Taylor, Curran), Dalhousie University, Halifax, NS; Department of Emergency Medicine and Ottawa Hospital Research Institute (Stiell), University of Ottawa, Ottawa, Ont
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18
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van Zyl PM, Brisley C, Halberg L, Matthysen M, Toerien M, Joubert G. The use, knowledge and attitudes regarding hormonal contraceptive products of female first-year students in a Faculty of Health Sciences. S Afr Fam Pract (2004) 2019. [DOI: 10.1080/20786190.2019.1643197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- PM van Zyl
- Department of Pharmacology, University of the Free State, Bloemfontein, South Africa
| | - C Brisley
- Department of Pharmacology, University of the Free State, Bloemfontein, South Africa
| | - L Halberg
- Department of Pharmacology, University of the Free State, Bloemfontein, South Africa
| | - M Matthysen
- Department of Pharmacology, University of the Free State, Bloemfontein, South Africa
| | - M Toerien
- Department of Pharmacology, University of the Free State, Bloemfontein, South Africa
| | - G Joubert
- Department of Pharmacology, University of the Free State, Bloemfontein, South Africa
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19
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Doan Q, Wong H, Meckler G, Johnson D, Stang A, Dixon A, Sawyer S, Principi T, Kam AJ, Joubert G, Gravel J, Jabbour M, Guttmann A. The impact of pediatric emergency department crowding on patient and health care system outcomes: a multicentre cohort study. CMAJ 2019; 191:E627-E635. [PMID: 31182457 DOI: 10.1503/cmaj.181426/-/dc1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2019] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Emergency department overcrowding has been associated with increased odds of hospital admission and mortality after discharge from the emergency department in predominantly adult cohorts. The objective of this study was to evaluate the association between crowding and the odds of several adverse outcomes among children seen at a pediatric emergency department. METHODS We conducted a retrospective cohort study involving all children visiting 8 Canadian pediatric emergency departments across 4 provinces between 2010 and 2014. We analyzed the association between mean departmental length of stay for each index visit and hospital admission within 7 days or death within 14 days of emergency department discharge, as well as hospital admission at index visit and return visits within 7 days, using mixed-effects logistic regression modelling. RESULTS A total of 1 931 465 index visits occurred across study sites over the 5-year period, with little variation in index visit hospital admission or median length of stay. Hospital admission within 7 days of discharge and 14-day mortality were low across provinces (0.8%-1.5% and < 10 per 100 000 visits, respectively), and their association with mean departmental length of stay varied by triage categories and across sites but was not significant. There were increased odds of hospital admission at the index visit with increasing departmental crowding among visits triaged to Canadian Triage and Acuity Scale (CTAS) score 1-2 (odds ratios [ORs] ranged from 1.01 to 1.08) and return visits among patients with a CTAS score of 4-5 discharged at the index visit at some sites (ORs ranged from 1.00 to 1.06). INTERPRETATION Emergency department crowding was not significantly associated with hospital admission within 7 days of the emergency department visit or mortality in children. However, it was associated with increased hospital admission at the index visit for the sickest children, and with return visits to the emergency department for those less sick.
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Affiliation(s)
- Quynh Doan
- Division of Pediatric Emergency Medicine, Department of Pediatrics (Doan, Meckler), University of British Columbia; School of Population and Public Health (Wong), University of British Columbia; BC Children's Hospital Research Institute (Doan, Meckler), Vancouver, BC; Alberta Children's Hospital Research Institute (Johnson, Stang), University of Calgary, Calgary, Alta; Stollery Children's Hospital, and Women and Children's Health Research Institute (Dixon), University of Alberta, Edmonton, Alta.; Pediatric Emergency Medicine (Sawyer), University of Manitoba; Children's Hospital, Health Sciences Centre Winnipeg (Sawyer), Winnipeg, Man.; Paediatric Emergency Medicine (Principi), University of Toronto; The Hospital for Sick Children (Principi), Toronto, Ont.; Department of Pediatrics (Kam), McMaster University; McMaster Children's Hospital (Kam), Hamilton, Ont.; Paediatric Emergency Medicine (Joubert), Western University; Children's Hospital of Western Ontario (Joubert), London, Ont.; Département de pédiatrie (Gravel), Université de Montréal; CHU Sainte-Justine (Gravel), Montréal, Que.; Department of Pediatrics (Jabbour), University of Ottawa; Children's Hospital of Eastern Ontario (Jabbour), Ottawa, Ont.; ICES (Guttmann); Department of Paediatrics (Guttmann), University of Toronto, Toronto, Ont.
| | - Hubert Wong
- Division of Pediatric Emergency Medicine, Department of Pediatrics (Doan, Meckler), University of British Columbia; School of Population and Public Health (Wong), University of British Columbia; BC Children's Hospital Research Institute (Doan, Meckler), Vancouver, BC; Alberta Children's Hospital Research Institute (Johnson, Stang), University of Calgary, Calgary, Alta; Stollery Children's Hospital, and Women and Children's Health Research Institute (Dixon), University of Alberta, Edmonton, Alta.; Pediatric Emergency Medicine (Sawyer), University of Manitoba; Children's Hospital, Health Sciences Centre Winnipeg (Sawyer), Winnipeg, Man.; Paediatric Emergency Medicine (Principi), University of Toronto; The Hospital for Sick Children (Principi), Toronto, Ont.; Department of Pediatrics (Kam), McMaster University; McMaster Children's Hospital (Kam), Hamilton, Ont.; Paediatric Emergency Medicine (Joubert), Western University; Children's Hospital of Western Ontario (Joubert), London, Ont.; Département de pédiatrie (Gravel), Université de Montréal; CHU Sainte-Justine (Gravel), Montréal, Que.; Department of Pediatrics (Jabbour), University of Ottawa; Children's Hospital of Eastern Ontario (Jabbour), Ottawa, Ont.; ICES (Guttmann); Department of Paediatrics (Guttmann), University of Toronto, Toronto, Ont
| | - Garth Meckler
- Division of Pediatric Emergency Medicine, Department of Pediatrics (Doan, Meckler), University of British Columbia; School of Population and Public Health (Wong), University of British Columbia; BC Children's Hospital Research Institute (Doan, Meckler), Vancouver, BC; Alberta Children's Hospital Research Institute (Johnson, Stang), University of Calgary, Calgary, Alta; Stollery Children's Hospital, and Women and Children's Health Research Institute (Dixon), University of Alberta, Edmonton, Alta.; Pediatric Emergency Medicine (Sawyer), University of Manitoba; Children's Hospital, Health Sciences Centre Winnipeg (Sawyer), Winnipeg, Man.; Paediatric Emergency Medicine (Principi), University of Toronto; The Hospital for Sick Children (Principi), Toronto, Ont.; Department of Pediatrics (Kam), McMaster University; McMaster Children's Hospital (Kam), Hamilton, Ont.; Paediatric Emergency Medicine (Joubert), Western University; Children's Hospital of Western Ontario (Joubert), London, Ont.; Département de pédiatrie (Gravel), Université de Montréal; CHU Sainte-Justine (Gravel), Montréal, Que.; Department of Pediatrics (Jabbour), University of Ottawa; Children's Hospital of Eastern Ontario (Jabbour), Ottawa, Ont.; ICES (Guttmann); Department of Paediatrics (Guttmann), University of Toronto, Toronto, Ont
| | - David Johnson
- Division of Pediatric Emergency Medicine, Department of Pediatrics (Doan, Meckler), University of British Columbia; School of Population and Public Health (Wong), University of British Columbia; BC Children's Hospital Research Institute (Doan, Meckler), Vancouver, BC; Alberta Children's Hospital Research Institute (Johnson, Stang), University of Calgary, Calgary, Alta; Stollery Children's Hospital, and Women and Children's Health Research Institute (Dixon), University of Alberta, Edmonton, Alta.; Pediatric Emergency Medicine (Sawyer), University of Manitoba; Children's Hospital, Health Sciences Centre Winnipeg (Sawyer), Winnipeg, Man.; Paediatric Emergency Medicine (Principi), University of Toronto; The Hospital for Sick Children (Principi), Toronto, Ont.; Department of Pediatrics (Kam), McMaster University; McMaster Children's Hospital (Kam), Hamilton, Ont.; Paediatric Emergency Medicine (Joubert), Western University; Children's Hospital of Western Ontario (Joubert), London, Ont.; Département de pédiatrie (Gravel), Université de Montréal; CHU Sainte-Justine (Gravel), Montréal, Que.; Department of Pediatrics (Jabbour), University of Ottawa; Children's Hospital of Eastern Ontario (Jabbour), Ottawa, Ont.; ICES (Guttmann); Department of Paediatrics (Guttmann), University of Toronto, Toronto, Ont
| | - Antonia Stang
- Division of Pediatric Emergency Medicine, Department of Pediatrics (Doan, Meckler), University of British Columbia; School of Population and Public Health (Wong), University of British Columbia; BC Children's Hospital Research Institute (Doan, Meckler), Vancouver, BC; Alberta Children's Hospital Research Institute (Johnson, Stang), University of Calgary, Calgary, Alta; Stollery Children's Hospital, and Women and Children's Health Research Institute (Dixon), University of Alberta, Edmonton, Alta.; Pediatric Emergency Medicine (Sawyer), University of Manitoba; Children's Hospital, Health Sciences Centre Winnipeg (Sawyer), Winnipeg, Man.; Paediatric Emergency Medicine (Principi), University of Toronto; The Hospital for Sick Children (Principi), Toronto, Ont.; Department of Pediatrics (Kam), McMaster University; McMaster Children's Hospital (Kam), Hamilton, Ont.; Paediatric Emergency Medicine (Joubert), Western University; Children's Hospital of Western Ontario (Joubert), London, Ont.; Département de pédiatrie (Gravel), Université de Montréal; CHU Sainte-Justine (Gravel), Montréal, Que.; Department of Pediatrics (Jabbour), University of Ottawa; Children's Hospital of Eastern Ontario (Jabbour), Ottawa, Ont.; ICES (Guttmann); Department of Paediatrics (Guttmann), University of Toronto, Toronto, Ont
| | - Andrew Dixon
- Division of Pediatric Emergency Medicine, Department of Pediatrics (Doan, Meckler), University of British Columbia; School of Population and Public Health (Wong), University of British Columbia; BC Children's Hospital Research Institute (Doan, Meckler), Vancouver, BC; Alberta Children's Hospital Research Institute (Johnson, Stang), University of Calgary, Calgary, Alta; Stollery Children's Hospital, and Women and Children's Health Research Institute (Dixon), University of Alberta, Edmonton, Alta.; Pediatric Emergency Medicine (Sawyer), University of Manitoba; Children's Hospital, Health Sciences Centre Winnipeg (Sawyer), Winnipeg, Man.; Paediatric Emergency Medicine (Principi), University of Toronto; The Hospital for Sick Children (Principi), Toronto, Ont.; Department of Pediatrics (Kam), McMaster University; McMaster Children's Hospital (Kam), Hamilton, Ont.; Paediatric Emergency Medicine (Joubert), Western University; Children's Hospital of Western Ontario (Joubert), London, Ont.; Département de pédiatrie (Gravel), Université de Montréal; CHU Sainte-Justine (Gravel), Montréal, Que.; Department of Pediatrics (Jabbour), University of Ottawa; Children's Hospital of Eastern Ontario (Jabbour), Ottawa, Ont.; ICES (Guttmann); Department of Paediatrics (Guttmann), University of Toronto, Toronto, Ont
| | - Scott Sawyer
- Division of Pediatric Emergency Medicine, Department of Pediatrics (Doan, Meckler), University of British Columbia; School of Population and Public Health (Wong), University of British Columbia; BC Children's Hospital Research Institute (Doan, Meckler), Vancouver, BC; Alberta Children's Hospital Research Institute (Johnson, Stang), University of Calgary, Calgary, Alta; Stollery Children's Hospital, and Women and Children's Health Research Institute (Dixon), University of Alberta, Edmonton, Alta.; Pediatric Emergency Medicine (Sawyer), University of Manitoba; Children's Hospital, Health Sciences Centre Winnipeg (Sawyer), Winnipeg, Man.; Paediatric Emergency Medicine (Principi), University of Toronto; The Hospital for Sick Children (Principi), Toronto, Ont.; Department of Pediatrics (Kam), McMaster University; McMaster Children's Hospital (Kam), Hamilton, Ont.; Paediatric Emergency Medicine (Joubert), Western University; Children's Hospital of Western Ontario (Joubert), London, Ont.; Département de pédiatrie (Gravel), Université de Montréal; CHU Sainte-Justine (Gravel), Montréal, Que.; Department of Pediatrics (Jabbour), University of Ottawa; Children's Hospital of Eastern Ontario (Jabbour), Ottawa, Ont.; ICES (Guttmann); Department of Paediatrics (Guttmann), University of Toronto, Toronto, Ont
| | - Tania Principi
- Division of Pediatric Emergency Medicine, Department of Pediatrics (Doan, Meckler), University of British Columbia; School of Population and Public Health (Wong), University of British Columbia; BC Children's Hospital Research Institute (Doan, Meckler), Vancouver, BC; Alberta Children's Hospital Research Institute (Johnson, Stang), University of Calgary, Calgary, Alta; Stollery Children's Hospital, and Women and Children's Health Research Institute (Dixon), University of Alberta, Edmonton, Alta.; Pediatric Emergency Medicine (Sawyer), University of Manitoba; Children's Hospital, Health Sciences Centre Winnipeg (Sawyer), Winnipeg, Man.; Paediatric Emergency Medicine (Principi), University of Toronto; The Hospital for Sick Children (Principi), Toronto, Ont.; Department of Pediatrics (Kam), McMaster University; McMaster Children's Hospital (Kam), Hamilton, Ont.; Paediatric Emergency Medicine (Joubert), Western University; Children's Hospital of Western Ontario (Joubert), London, Ont.; Département de pédiatrie (Gravel), Université de Montréal; CHU Sainte-Justine (Gravel), Montréal, Que.; Department of Pediatrics (Jabbour), University of Ottawa; Children's Hospital of Eastern Ontario (Jabbour), Ottawa, Ont.; ICES (Guttmann); Department of Paediatrics (Guttmann), University of Toronto, Toronto, Ont
| | - April J Kam
- Division of Pediatric Emergency Medicine, Department of Pediatrics (Doan, Meckler), University of British Columbia; School of Population and Public Health (Wong), University of British Columbia; BC Children's Hospital Research Institute (Doan, Meckler), Vancouver, BC; Alberta Children's Hospital Research Institute (Johnson, Stang), University of Calgary, Calgary, Alta; Stollery Children's Hospital, and Women and Children's Health Research Institute (Dixon), University of Alberta, Edmonton, Alta.; Pediatric Emergency Medicine (Sawyer), University of Manitoba; Children's Hospital, Health Sciences Centre Winnipeg (Sawyer), Winnipeg, Man.; Paediatric Emergency Medicine (Principi), University of Toronto; The Hospital for Sick Children (Principi), Toronto, Ont.; Department of Pediatrics (Kam), McMaster University; McMaster Children's Hospital (Kam), Hamilton, Ont.; Paediatric Emergency Medicine (Joubert), Western University; Children's Hospital of Western Ontario (Joubert), London, Ont.; Département de pédiatrie (Gravel), Université de Montréal; CHU Sainte-Justine (Gravel), Montréal, Que.; Department of Pediatrics (Jabbour), University of Ottawa; Children's Hospital of Eastern Ontario (Jabbour), Ottawa, Ont.; ICES (Guttmann); Department of Paediatrics (Guttmann), University of Toronto, Toronto, Ont
| | - Gary Joubert
- Division of Pediatric Emergency Medicine, Department of Pediatrics (Doan, Meckler), University of British Columbia; School of Population and Public Health (Wong), University of British Columbia; BC Children's Hospital Research Institute (Doan, Meckler), Vancouver, BC; Alberta Children's Hospital Research Institute (Johnson, Stang), University of Calgary, Calgary, Alta; Stollery Children's Hospital, and Women and Children's Health Research Institute (Dixon), University of Alberta, Edmonton, Alta.; Pediatric Emergency Medicine (Sawyer), University of Manitoba; Children's Hospital, Health Sciences Centre Winnipeg (Sawyer), Winnipeg, Man.; Paediatric Emergency Medicine (Principi), University of Toronto; The Hospital for Sick Children (Principi), Toronto, Ont.; Department of Pediatrics (Kam), McMaster University; McMaster Children's Hospital (Kam), Hamilton, Ont.; Paediatric Emergency Medicine (Joubert), Western University; Children's Hospital of Western Ontario (Joubert), London, Ont.; Département de pédiatrie (Gravel), Université de Montréal; CHU Sainte-Justine (Gravel), Montréal, Que.; Department of Pediatrics (Jabbour), University of Ottawa; Children's Hospital of Eastern Ontario (Jabbour), Ottawa, Ont.; ICES (Guttmann); Department of Paediatrics (Guttmann), University of Toronto, Toronto, Ont
| | - Jocelyn Gravel
- Division of Pediatric Emergency Medicine, Department of Pediatrics (Doan, Meckler), University of British Columbia; School of Population and Public Health (Wong), University of British Columbia; BC Children's Hospital Research Institute (Doan, Meckler), Vancouver, BC; Alberta Children's Hospital Research Institute (Johnson, Stang), University of Calgary, Calgary, Alta; Stollery Children's Hospital, and Women and Children's Health Research Institute (Dixon), University of Alberta, Edmonton, Alta.; Pediatric Emergency Medicine (Sawyer), University of Manitoba; Children's Hospital, Health Sciences Centre Winnipeg (Sawyer), Winnipeg, Man.; Paediatric Emergency Medicine (Principi), University of Toronto; The Hospital for Sick Children (Principi), Toronto, Ont.; Department of Pediatrics (Kam), McMaster University; McMaster Children's Hospital (Kam), Hamilton, Ont.; Paediatric Emergency Medicine (Joubert), Western University; Children's Hospital of Western Ontario (Joubert), London, Ont.; Département de pédiatrie (Gravel), Université de Montréal; CHU Sainte-Justine (Gravel), Montréal, Que.; Department of Pediatrics (Jabbour), University of Ottawa; Children's Hospital of Eastern Ontario (Jabbour), Ottawa, Ont.; ICES (Guttmann); Department of Paediatrics (Guttmann), University of Toronto, Toronto, Ont
| | - Mona Jabbour
- Division of Pediatric Emergency Medicine, Department of Pediatrics (Doan, Meckler), University of British Columbia; School of Population and Public Health (Wong), University of British Columbia; BC Children's Hospital Research Institute (Doan, Meckler), Vancouver, BC; Alberta Children's Hospital Research Institute (Johnson, Stang), University of Calgary, Calgary, Alta; Stollery Children's Hospital, and Women and Children's Health Research Institute (Dixon), University of Alberta, Edmonton, Alta.; Pediatric Emergency Medicine (Sawyer), University of Manitoba; Children's Hospital, Health Sciences Centre Winnipeg (Sawyer), Winnipeg, Man.; Paediatric Emergency Medicine (Principi), University of Toronto; The Hospital for Sick Children (Principi), Toronto, Ont.; Department of Pediatrics (Kam), McMaster University; McMaster Children's Hospital (Kam), Hamilton, Ont.; Paediatric Emergency Medicine (Joubert), Western University; Children's Hospital of Western Ontario (Joubert), London, Ont.; Département de pédiatrie (Gravel), Université de Montréal; CHU Sainte-Justine (Gravel), Montréal, Que.; Department of Pediatrics (Jabbour), University of Ottawa; Children's Hospital of Eastern Ontario (Jabbour), Ottawa, Ont.; ICES (Guttmann); Department of Paediatrics (Guttmann), University of Toronto, Toronto, Ont
| | - Astrid Guttmann
- Division of Pediatric Emergency Medicine, Department of Pediatrics (Doan, Meckler), University of British Columbia; School of Population and Public Health (Wong), University of British Columbia; BC Children's Hospital Research Institute (Doan, Meckler), Vancouver, BC; Alberta Children's Hospital Research Institute (Johnson, Stang), University of Calgary, Calgary, Alta; Stollery Children's Hospital, and Women and Children's Health Research Institute (Dixon), University of Alberta, Edmonton, Alta.; Pediatric Emergency Medicine (Sawyer), University of Manitoba; Children's Hospital, Health Sciences Centre Winnipeg (Sawyer), Winnipeg, Man.; Paediatric Emergency Medicine (Principi), University of Toronto; The Hospital for Sick Children (Principi), Toronto, Ont.; Department of Pediatrics (Kam), McMaster University; McMaster Children's Hospital (Kam), Hamilton, Ont.; Paediatric Emergency Medicine (Joubert), Western University; Children's Hospital of Western Ontario (Joubert), London, Ont.; Département de pédiatrie (Gravel), Université de Montréal; CHU Sainte-Justine (Gravel), Montréal, Que.; Department of Pediatrics (Jabbour), University of Ottawa; Children's Hospital of Eastern Ontario (Jabbour), Ottawa, Ont.; ICES (Guttmann); Department of Paediatrics (Guttmann), University of Toronto, Toronto, Ont
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Van Aswegen R, Kuzhivelil JT, Strydom C, Connellan G, Ravgee A, Joubert G, Botes J, Steinberg WJ. Exploring the differences in psychological traits between surgical specialties at an academic hospital in Bloemfontein. S AFR J SURG 2019; 57:32-39. [PMID: 31342682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Studies have attempted to categorise undergraduate medical and postgraduate students and specialists into personality types, to determine what influences personality has on specialty choice and job satisfaction. This study explored the personality characteristics of doctors in four surgical and three consulting specialties at an academic hospital in Bloemfontein, South Africa. METHOD This analytical cross-sectional study used the Zuckerman-Kuhlman Personality Questionnaire as a measuring tool which included five scales: impulsive sensation seeking (subscales impulsivity and sensation seeking), neuroticismanxiety, aggression-hostility, sociability (parties and friends and isolation intolerance), and activity ( work activity and general activity). Overall, 70 consultants and senior registrars from surgical specialties (anaesthesiology, obstetrics and gynaecology, orthopaedic surgery, surgery), (response rate 60.3%) and 58 consultants and senior registrars from three consulting specialties (internal medicine, paediatrics, family medicine) (response rate 71.6%) participated. RESULTS Respondents from four surgical specialties had higher medians than the overall consulting group for the subscale sensation seeking. The subscale sensation seeking scored higher than impulsivity across surgical and consulting groups. The surgical group scored lower than the consulting group in neuroticism-anxiety, with anaesthesiology scoring the highest (42.1%) and orthopaedic surgery scoring the lowest (15.8%). Orthopaedic surgery scored the highest (50.0%) in aggressionhostility, sociability (52.9%), parties and friends (44.4%) and isolation intolerance (65.5%). The surgical group scored significantly higher than the consulting group for activity (p < 0.01). CONCLUSION In exploring the personality types of specialists, the orthopaedic surgeons in specialist departments in Bloemfontein seem unique in their sociability and aggression-hostility traits, anaesthesiologists scored strongly on the sensation seeking and neuroticism-anxiety scales, while the obstetricians and gynaecologists did not manifest either of these traits strongly. This data contributes to a growing discussion on personality choice and job satisfaction.
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Affiliation(s)
- R Van Aswegen
- Undergraduate medical student at time of study, Department of Family Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - J T Kuzhivelil
- Undergraduate medical student at time of study, Department of Family Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - C Strydom
- Undergraduate medical student at time of study, Department of Family Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - G Connellan
- Undergraduate medical student at time of study, Department of Family Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - A Ravgee
- Undergraduate medical student at time of study, Department of Family Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - G Joubert
- Department of Biostatistics, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - J Botes
- Department of Family Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - W J Steinberg
- Department of Family Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
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Arnold R, Khokho K, Narrainsamy K, Brits E, Joubert G. Infantile hypertrophic pyloric stenosis: profile, management and outcome of patients admitted to a tertiary hospital in Bloemfontein, South Africa. S AFR J SURG 2019; 57:64. [PMID: 31342689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Infantile hypertrophic pyloric stenosis (IHPS) is the thickening of both muscle layers of the pylorus and is most commonly found in first-born males. It usually presents with projectile, non-bilious vomiting. Late presentation leads to severe dehydration and malnutrition with deranged serum-electrolytes and acid-base imbalance delaying treatment and prolonging hospital stay. This study aims to evaluate the profile, management and outcome of IHPS at a tertiary hospital in Bloemfontein, South Africa. METHOD The study was a retrospective, descriptive record review including all patients with IHPS admitted to Universitas Hospital from January 2008 to February 2016. Of the 22 patients admitted, files for 19 patients were available for inclusion. RESULTS Sixteen (84.2%) of the 19 patients were male. Of the 11 patients with available birth order, two were first-, two second-, six third- and one fourth-born. The patients' ages ranged from 27 to 194 days (median 51 days). The most common symptoms were projectile vomiting (78.9%) and poor weight gain (68.4%). Six patients had no ultrasound done, and 17 patients underwent a Ramstedt-pyloromyotomy. Eight patients received atropine as part of their initial management. The duration of symptoms ranged from 1 to 58 days (median 14 days). There was no reported mortality. The length of stay ranged from 2 to 60 days (median 7 days). CONCLUSION The gender distribution and age at presentation were in keeping with the literature but not the birth order. The delay before surgery emphasises the poor general health and deranged biochemical state the patients present at the hospital.
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Affiliation(s)
- R Arnold
- Undergraduate medical student, Department of Surgery, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - K Khokho
- Undergraduate medical student, Department of Surgery, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - K Narrainsamy
- Undergraduate medical student, Department of Surgery, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - E Brits
- Department of Surgery, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - G Joubert
- Department of Biostatistics, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
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Poonai N, Elsie S, Kumar K, Coriolano K, Brahmbhatt S, Dzongkowski E, Stevens H, Gupta P, Miller M, Ashok D, Joubert G, Butter A, Ali S. 116 Hyoscine butylbromide (Buscopan) for abdominal pain in children: a randomized controlled trial. Paediatr Child Health 2019. [DOI: 10.1093/pch/pxz066.115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Barrett WJ, Diedericks BJS, Barrett CL, Joubert G, Turton EW. Congenital heart defects in children with cleft lips and/or palates at an academic hospital in central South Africa. South Afr J Anaesth Analg 2019. [DOI: 10.36303/sajaa.2019.25.2.2195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background: Globally, cleft deformities are the most common craniofacial anomalies and show an association with congenital heart defects. Little research on cleft lips and/or palates (CL/P) and congenital heart defects has been reported from Africa, and none from South Africa. In 2001, it was proposed that CL/P be listed as one of six priority conditions for monitoring and notification to South African health authorities. This goal of creating a national registry has not been achieved. A near-fatal anaesthetic incident following a missed cardiac lesion in a child with a cleft lip and palate prompted this study.
Objectives: To describe the prevalence of congenital heart defects diagnosed in children with CL/P presenting for corrective surgery during the Smile Week over three consecutive years (2013–2015) at an academic hospital in South Africa.
Methods: A retrospective, descriptive file review of 62 patients with CL/P was performed. Since 2013, echocardiography has been performed on all patients with CL/P.
Results: Twenty-three, 21 and 18 patients were operated in 2013, 2014 and 2015, respectively. Of these patients, 85.5% (n = 53) had no clinical evidence of a cardiac defect, of which eight did have clinically significant cardiac defects on echocardiography. Sixteen patients (25.8%) in total (n = 16/62) with a cleft deformity had a clinically significant congenital heart lesion. Of the 16 patients with a cardiac defect on transthoracic echocardiography, only four had clinical evidence of cardiac defect. Therefore, sensitivity of clinical examination was 25%, whereas the specificity was 89.1%. Three of the four patients with a syndrome had a clinically significant echocardiographic finding.
Conclusion: A national guideline for the preoperative care of patients with CL/P, including routine echocardiography, is needed. Furthermore, a national registry is required for patients with CL/P with associated congenital anomalies.
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Arnold R, Khokho K, Narrainsamy K, Brits E, Joubert G. Infantile hypertrophic pyloric stenosis: profile, management and outcome of patients admitted to a tertiary hospital in Bloemfontein, South Africa. S AFR J SURG 2019. [DOI: 10.17159/2078-5151/2019/v57n2a2811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Poonai N, Canton K, Ali S, Hendrikx S, Shah A, Miller M, Joubert G, Hartling L. Intranasal ketamine for anesthetic premedication in children: a systematic review. Pain Manag 2018; 8:495-503. [PMID: 30394192 DOI: 10.2217/pmt-2018-0039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
AIM In children, intravenous anesthetic premedication can be distressing. Intranasal (IN) ketamine offers a less invasive approach. MATERIALS AND METHODS We included randomized trials of IN ketamine in anesthetic premedication in children 0-19 years. We performed electronic searches of MEDLINE, EMBASE, Google Scholar, CINAHL, Cochrane Library, Web of Science, Scopus, clinical trial registries and conference proceedings. RESULTS Among the 23 trials (n = 1680) included, IN ketamine adequately sedated 220/311 (70%) for face mask application, 217/308 (70%) for caregiver separation, 200/371 (54%) for iv. insertion and 19/30 (63%) for monitor application. Vomiting was the most common adverse effect (35/1579 [2.2%]). CONCLUSION There is a need for sufficiently powered, methodologically rigorous trials, using psychometrically evaluated, objective outcome measures to meaningfully inform practice.
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Affiliation(s)
- Naveen Poonai
- Department of Pediatrics, Schulich School of Medicine & Dentistry, London, Canada.,Division of Emergency Medicine, Western University, London, Canada.,Children's Health Research Institute, London Health Sciences Centre, London, Canada
| | - Kyle Canton
- Division of Emergency Medicine, Western University, London, Canada
| | - Samina Ali
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada.,Women & Children's Health Research Institute, University of Alberta, Edmonton, Canada
| | - Shawn Hendrikx
- Department of Pediatrics, Schulich School of Medicine & Dentistry, London, Canada
| | - Amit Shah
- Division of Emergency Medicine, Western University, London, Canada
| | - Michael Miller
- Department of Pediatrics, Schulich School of Medicine & Dentistry, London, Canada.,Children's Health Research Institute, London Health Sciences Centre, London, Canada
| | - Gary Joubert
- Department of Pediatrics, Schulich School of Medicine & Dentistry, London, Canada.,Division of Emergency Medicine, Western University, London, Canada.,Children's Health Research Institute, London Health Sciences Centre, London, Canada
| | - Lisa Hartling
- Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, Canada
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Daffue B, Moolman D, Ferreira S, Roos L, Schoeman L, Smit SJ, Joubert G. The causes of burn wounds among adult patients treated at Pelonomi Tertiary Hospital, Bloemfontein. S AFR J SURG 2018; 56:31-36. [PMID: 30264940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Burn injuries account for approximately 180 000 deaths per annum, mostly in low- and middle-income countries. METHOD This was a prospective, cross-sectional study. The target population consisted of adult patients, hospitalised for burn wounds at Pelonomi Tertiary Hospital in Bloemfontein, between July 2016 and early January 2017. Relevant data was collected by means of a structured interview using a questionnaire. RESULTS A total of 49 patients were interviewed during the study period. Almost two-thirds of the patients were male (65.3%, n=32). The median age was 33 years (range 18 to 64 years). In most cases, the injury occurred at home (77.6%, n=38). Three quarters of the reported incidents (77.6%, n=38) were considered accidental of which 68.4% (n=26) were related to domestic activities. At the time of the accidental incident, 39.5% (n=15) patients had consumed alcohol. Eleven (22.4%) of the incidents were intentional with 63.6% (n=7) attributed to assault. The two main causes of burn injuries were flames including flaming liquids (59.2%, n=29) and hot liquids (22.5%, n=11). The most frequent area of injury was the left front thigh. CONCLUSION The predominant cause of burn wounds was flames including flaming liquids, and injuries were mostly accidental in nature. Alcohol consumption and domestic activities were common in accidental burns.
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Affiliation(s)
- B Daffue
- Undergraduate medical student, School of Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - D Moolman
- Undergraduate medical student, School of Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - S Ferreira
- Undergraduate medical student, School of Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - L Roos
- Undergraduate medical student, School of Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - L Schoeman
- Undergraduate medical student, School of Medicine, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - S Ja Smit
- Department of Surgery, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - G Joubert
- Department of Biostatistics, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
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Wentzel SW, Vermeulen LP, Beukes CA, Thiart J, Joubert G, Goedhals J. Human immunodeficiency virus (HIV) infection in men with penile carcinoma is associated with increased prevalence of human papilloma virus infection and younger age at presentation. S AFR J SURG 2018; 56:47-50. [PMID: 30264943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND We investigated the prevalence of HIV and human papilloma virus (HPV) infection in men with penile carcinoma. METHODS This retrospective study investigated all men with penile carcinoma at the Universitas Academic Hospital in Bloemfontein, South Africa (January 2000-December 2008). Patients' age, HIV status, histological type of carcinoma and evidence of HPV infection were recorded. Statistical analyses included Student's t-test and Fisher's exact test where appropriate (2-tailed p-value < 0.05 indicated statistical significant). RESULTS Among 65 patients (mean age 50.9 years, range 37-69), the most common histological type was squamous cell carcinoma (80.0%). HIV status was known for 48 patients; 27 (56.2%) were HIV-positive. The mean age at presentation was 43.7 years (range 26-69) years in the HIV-positive and 57.2 years (range 26-89) years in the HIV-negative group. Approximately 55% of HIV-positive and 24% of HIV-negative patients showed histological evidence of HPV infection (p = 0.04). No significant difference was found with regard to histological type of carcinoma. CONCLUSION Patients with penile carcinoma had a high prevalence of HIV infection. The HIV-positive group were significantly younger at presentation, with a higher prevalence of HPV infection, suggesting that HIV may contribute to HPV-associated penile cancer at a younger age.
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Affiliation(s)
- S W Wentzel
- Department of Urology, Faculty of Health Sciences, University of the Free State
| | - L P Vermeulen
- Department of Urology, Faculty of Health Sciences, University of the Free State
| | - C A Beukes
- Department of Anatomical Pathology, Faculty of Health Sciences, University of the Free State and National Health Laboratory Services (NHLS), Universitas Academic Hospital, Bloemfontein, South Africa
| | - J Thiart
- Department of Anatomical Pathology, Faculty of Health Sciences, University of the Free State and National Health Laboratory Services (NHLS), Universitas Academic Hospital, Bloemfontein, South Africa
| | - G Joubert
- Department of Biostatistics, Faculty of Health Sciences, University of the Free State
| | - J Goedhals
- Department of Anatomical Pathology, Faculty of Health Sciences, University of the Free State and National Health Laboratory Services (NHLS), Universitas Academic Hospital, Bloemfontein, South Africa
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Seedat RY, Sujee M, Ismail W, Vallybhai NY, Cassim MI, Khan S, Solwa A, Joubert G. Allergic rhinitis in medical students at the University of the Free State. S Afr Fam Pract (2004) 2018. [DOI: 10.4102/safp.v60i4.4907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background: Allergic rhinitis, the most common form of chronic rhinitis, can adversely affect quality of life. The prevalence of allergic rhinitis in adolescents in South Africa has been estimated to be 38.5%, but there is a paucity of data from African countries on allergic rhinitis.Aim: The aim of this study was to determine the prevalence of allergic rhinitis in medical students in the Faculty of Health Science at the University of the Free State (UFS). Information was acquired on the effects that the condition had on participants with regard to symptoms, quality of life, disease management and treatment.Methods: A cross-sectional study design was used. A self-administered anonymous questionnaire was distributed to all medical students registered with the Faculty of Health Sciences at UFS in 2016. The estimated population was 706 students.Results: The response rate was 62.6%. The prevalence of allergic rhinitis was 39.1%. The most common symptoms were rhinorrhoea (64.8%), repeated sneezing (64.3%) and nasal obstruction (58.5%). Symptoms were at their worst during August to October. Antihistamines had been used by 82.4% of participants to treat their symptoms in the previous 12 months, while 28.8% had used an intranasal steroid spray.Conclusion: The prevalence of allergic rhinitis in medical students at UFS was 39.1%. Rhinorrhoea, sneezing and nasal obstruction were the most frequent and bothersome symptoms.
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Trottier ED, Ali S, Thull-Freedman J, Meckler G, Stang A, Porter R, Blanchet M, Dubrovsky AS, Kam A, Jain R, Principi T, Joubert G, Le May S, Chan M, Neto G, Lagacé M, Gravel J. Treating and reducing anxiety and pain in the paediatric emergency department-TIME FOR ACTION-the TRAPPED quality improvement collaborative. Paediatr Child Health 2018; 23:e85-e94. [PMID: 30046273 PMCID: PMC6054215 DOI: 10.1093/pch/pxx186] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND/OBJECTIVES In 2013, the TRAPPED-1 survey reported inconsistent availability of pain and distress management strategies across all 15 Canadian paediatric emergency department (PEDs). The objective of the TRAPPED-2 study was to utilize a procedural pain quality improvement collaborative (QIC) and evaluate the number of newly introduced pain and distress-reducing strategies in Canadian PEDs over a 2-year period. METHODS A QIC was created to increase implementation of new strategies, through collaborative information sharing among PEDs. In 2015, 11 of the 15 Canadian PEDs participated in the TRAPPED QIC. At the end of the year, the TRAPPED-2 survey was electronically sent to a representative member at each of the 15 PEDs. The successful introduction of the chosen strategies by the QIC was assessed as well as the addition of new strategies per site. The number of new strategies introduced in the participating and nonparticipating QIC sites were described. RESULTS All 15 PEDs (100%) completed the TRAPPED-2 survey. Overall, 10/11 of QIC-participating sites implemented the strategy they had initially identified. All 15 Canadian PEDs implemented some new strategies during the study period; participants in the QIC reported a mean of 5.2 (1-11) new strategies compared to 2.5 (1-4) in the nonactively participating sites. CONCLUSION While all PEDs introduced new strategies during the study, QIC-participating sites successfully introduced the majority of their previously identified new strategies in a short time period. Sharing deadlines and information between centres may have contributed to this success.
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Affiliation(s)
| | - Samina Ali
- Stollery Children’s Hospital, University of Alberta, Edmonton, Alberta
| | | | - Garth Meckler
- BC Children’s Hospital, University of British Columbia, Vancouver, British Columbia
| | - Antonia Stang
- Alberta Children’s Hospital, University of Calgary, Calgary, Alberta
| | - Robert Porter
- Janeway Children’s Hospital, Memorial University, St-Johns, Newfoundl
| | | | | | - April Kam
- McMaster Children’s Hospital, McMaster University, Hamilton, Ontario
| | | | - Tania Principi
- Hospital for Sick Children, University of Toronto, Toronto, Ontario
| | | | - Sylvie Le May
- CHU Sainte-Justine, Université de Montréal, Montréal, Québec
| | - Melissa Chan
- Stollery Children’s Hospital, University of Alberta, Edmonton, Alberta
| | - Gina Neto
- CHEO, University of Ottawa, Ottawa, Ontario
| | - Maryse Lagacé
- CHU Sainte-Justine, Université de Montréal, Montréal, Québec
| | - Jocelyn Gravel
- CHU Sainte-Justine, Université de Montréal, Montréal, Québec
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Bouwer M, Labuschagne S, Spamer S, Vermaak C, Zietsman LM, Steyn D, Joubert G. Knowledge of final-year medical students at the University of the Free State of hand hygiene as a basic infection control measure. S Afr Fam Pract (2004) 2018. [DOI: 10.4102/safp.v60i3.4883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background: One of the main reasons for the spread of infection in the healthcare environment is inadequate hand hygiene. Poor knowledge of hand hygiene techniques leads to poor compliance. This study aimed to determine Free State University finalyear medical students’ knowledge of hand hygiene as a basic infection control measure. Methods: This was a cross-sectional study using self-administered anonymous questionnaires. The questions and memorandum were based on an extensive literature review with WHO documentation on the guidelines for hand hygiene in health care. Each participant received an envelope with an optical computer card, questionnaire and information document during a pre-arranged class. Participants recorded their answers on the card by shading in the squares corresponding to their responses.Results: The average score of the 107 participants was 46.8% (range 10.1–73.6%). Participants who felt that they had basic knowledge of hand hygiene (n = 32, 30.5%) had an average score of 47.9%. Participants with a self-reported knowledge level of more than basic but less than advanced (n = 56, 53.3%) had an average score of 44.9% while those who reported advanced knowledge (n = 17, 16.2%) had an average score of 50.8%. Three-quarters (n = 81, 77.1%) felt that their training was sufficient. Only 53.3% knew that the most important way to prevent the spread of infection is good hand hygiene. Only 10.5% of the students knew that hands should not be rinsed with water after using alcohol-based sanitisers.Conclusion: Medical students have a poor level of knowledge regarding hand hygiene as a basic measure of infection control.
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Makwero MT, Mollentze WF, Joubert G, Steinberg WJ. Anthropometric profile and complications in patients with diabetes mellitus seen at Maluti Adventist Hospital, Lesotho. S Afr Fam Pract (2004) 2018. [DOI: 10.4102/safp.v60i3.4885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background: Patients attending outpatient departments for follow-up of diabetes mellitus (DM) may seem content about the control of their disease. However, complications resulting from DM may present before diagnosis and treatment initiation or continue to develop while on treatment.Aim: This study aimed to report on the prevalence of DM complications in patients with DM at Maluti Adventist Hospital, Lesotho.Methods: A cross-sectional study was conducted in 150 DM patients recruited from Maluti Adventist Hospital’s newly formed clinic between May and June 2009. Demographic information was obtained through a structured interview. Patients underwent physical and eye examinations to obtain an anthropometric profile and identify DM complications. Laboratory and ECG investigations were done to establish level of glycaemic control and identify other complications.Results: Patients were female (80.7%) with a mean age of 58.2 years (standard deviation 13.2). Almost all patients had type 2 DM (94.7%) and 60.1% had been diagnosed during the preceding five years. The most common co-morbidity was hypertension (85.3%) and 49.7% of patients were obese (mean body mass index 30.4 kg/m2). Patients had poor short-term (46.2%) and longterm (57.5%) glycaemic control. Nearly half (43.3%) of the patients had evidence of peripheral neuropathy. Almost 60% of the patients had a blood pressure of 130/80 mmHg. Of the 128 patients seen by the ophthalmologist, 29.9% had evidence of cataracts in both eyes. Funduscopic abnormalities were found in 32.8% of the patients. Patients with complications or poor glycaemic control had been diagnosed for a significantly longer time.Conclusion: Patients showed evidence of DM complications at the time of study. Coupled with significant co-morbidities and high body mass index, the risk of morbidity and mortality is high. A comprehensive approach is needed in managing these patients, if meaningful reductions in morbidity and mortality are to be achieved.
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Seedat RY, Sujee M, Ismail W, Vallybhai NY, Cassim MI, Khan S, Solwa A, Joubert G. Allergic rhinitis in medical students at the University of the Free State. S Afr Fam Pract (2004) 2018. [DOI: 10.1080/20786190.2018.1437869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Affiliation(s)
- RY Seedat
- Department of Otorhinolaryngology, Faculty of Health Sciences, University of the Free State , Bloemfontein, South Africa
| | - M Sujee
- School of Medicine, Faculty of Health Sciences, University of the Free State , Bloemfontein, South Africa
| | - W Ismail
- School of Medicine, Faculty of Health Sciences, University of the Free State , Bloemfontein, South Africa
| | - NY Vallybhai
- School of Medicine, Faculty of Health Sciences, University of the Free State , Bloemfontein, South Africa
| | - MI Cassim
- School of Medicine, Faculty of Health Sciences, University of the Free State , Bloemfontein, South Africa
| | - S Khan
- School of Medicine, Faculty of Health Sciences, University of the Free State , Bloemfontein, South Africa
| | - A Solwa
- School of Medicine, Faculty of Health Sciences, University of the Free State , Bloemfontein, South Africa
| | - G Joubert
- Department of Biostatistics, Faculty of Health Sciences, University of the Free State , Bloemfontein, South Africa
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Harrold J, Langevin M, Barrowman N, Sprague AE, Fell DB, Moreau KA, Lacaze-Masmonteil T, Schuh S, Joubert G, Moore A, Solano T, Zemek RL. Parental characteristics and perspectives pertaining to neonatal visits to the emergency department: a multicentre survey. CMAJ Open 2018; 6:E423-E429. [PMID: 30266780 PMCID: PMC6182114 DOI: 10.9778/cmajo.20180015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Parents take neonates to the emergency department for many reasons, often nonurgent, pressuring an already burdened system. We aimed to characterize these visits and families to identify potential strategies to decrease neonatal emergency department visits. METHODS We developed and implemented a survey that explored characteristics of neonates and parents/guardians evaluated in the emergency department, perspectives of parents and use of health care services. Parents presenting with a neonate to the emergency department in 5 large academic hospitals in Ontario were surveyed between December 2013 and June 2015. We used descriptive statistics to report survey data and explored correlations between factors. RESULTS A total of 1533 surveys were completed. The most common reasons for presenting were jaundice (441 [28.8%]) and feeding issues (251 [16.4%]). The majority of respondents (73.9% [1104/1494]) had received advice before going to the emergency department. In most cases (86.4% [954/1104]), this was from a health care provider, who frequently advised going to the emergency department. Although most parents (86.8% [1280/1475]) reported high confidence in caring for a sick or injured child, 42.3% (643/1519) were unsure of the severity, and most (90.4% [578/639]) of these parents felt that the infant required assessment immediately or the same day. Of parents who felt the condition was not serious, 83.2% (198/238) thought that same-day evaluation was required. Nearly half of respondents (44.4% [621/1400]) said they would have gone to their health care provider with a same-day appointment, and 28.1% (344/1225) would have gone to their care provider with a next-day appointment. INTERPRETATION Parents' reported confidence in caring for sick or injured infants does not match the perceived urgency of neonatal conditions, which likely contributes to emergency department overuse. Any system to decrease nonurgent emergency department use by neonates would need to be immediately responsive, providing same-day help.
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Affiliation(s)
- JoAnn Harrold
- Department of Pediatrics (Harrold, Langevin, Barrowman, Lacaze-Masmonteil, Zemek), Children's Hospital of Eastern Ontario; Children's Hospital of Eastern Ontario Research Institute (Harrold, Barrowman, Sprague, Fell, Moreau, Zemek); Better Outcomes Registry & Network Ontario (Sprague); School of Epidemiology and Public Health (Fell) and Faculty of Education (Moreau), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Lacaze-Masmonteil), Cumming School of Medicine, University of Calgary, Calgary, Alta.; The Hospital for Sick Children (Schuh); University of Toronto (Schuh), Toronto, Ont.; Children's Hospital (Joubert), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Joubert), London, Ont.; Department of Pediatrics (Moore), Queen's University, Kingston, Ont.; McMaster University (Solano); Department of Pediatrics (Solano), McMaster Children's Hospital, Hamilton, Ont.
| | - Mélissa Langevin
- Department of Pediatrics (Harrold, Langevin, Barrowman, Lacaze-Masmonteil, Zemek), Children's Hospital of Eastern Ontario; Children's Hospital of Eastern Ontario Research Institute (Harrold, Barrowman, Sprague, Fell, Moreau, Zemek); Better Outcomes Registry & Network Ontario (Sprague); School of Epidemiology and Public Health (Fell) and Faculty of Education (Moreau), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Lacaze-Masmonteil), Cumming School of Medicine, University of Calgary, Calgary, Alta.; The Hospital for Sick Children (Schuh); University of Toronto (Schuh), Toronto, Ont.; Children's Hospital (Joubert), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Joubert), London, Ont.; Department of Pediatrics (Moore), Queen's University, Kingston, Ont.; McMaster University (Solano); Department of Pediatrics (Solano), McMaster Children's Hospital, Hamilton, Ont
| | - Nick Barrowman
- Department of Pediatrics (Harrold, Langevin, Barrowman, Lacaze-Masmonteil, Zemek), Children's Hospital of Eastern Ontario; Children's Hospital of Eastern Ontario Research Institute (Harrold, Barrowman, Sprague, Fell, Moreau, Zemek); Better Outcomes Registry & Network Ontario (Sprague); School of Epidemiology and Public Health (Fell) and Faculty of Education (Moreau), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Lacaze-Masmonteil), Cumming School of Medicine, University of Calgary, Calgary, Alta.; The Hospital for Sick Children (Schuh); University of Toronto (Schuh), Toronto, Ont.; Children's Hospital (Joubert), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Joubert), London, Ont.; Department of Pediatrics (Moore), Queen's University, Kingston, Ont.; McMaster University (Solano); Department of Pediatrics (Solano), McMaster Children's Hospital, Hamilton, Ont
| | - Ann E Sprague
- Department of Pediatrics (Harrold, Langevin, Barrowman, Lacaze-Masmonteil, Zemek), Children's Hospital of Eastern Ontario; Children's Hospital of Eastern Ontario Research Institute (Harrold, Barrowman, Sprague, Fell, Moreau, Zemek); Better Outcomes Registry & Network Ontario (Sprague); School of Epidemiology and Public Health (Fell) and Faculty of Education (Moreau), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Lacaze-Masmonteil), Cumming School of Medicine, University of Calgary, Calgary, Alta.; The Hospital for Sick Children (Schuh); University of Toronto (Schuh), Toronto, Ont.; Children's Hospital (Joubert), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Joubert), London, Ont.; Department of Pediatrics (Moore), Queen's University, Kingston, Ont.; McMaster University (Solano); Department of Pediatrics (Solano), McMaster Children's Hospital, Hamilton, Ont
| | - Deshayne B Fell
- Department of Pediatrics (Harrold, Langevin, Barrowman, Lacaze-Masmonteil, Zemek), Children's Hospital of Eastern Ontario; Children's Hospital of Eastern Ontario Research Institute (Harrold, Barrowman, Sprague, Fell, Moreau, Zemek); Better Outcomes Registry & Network Ontario (Sprague); School of Epidemiology and Public Health (Fell) and Faculty of Education (Moreau), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Lacaze-Masmonteil), Cumming School of Medicine, University of Calgary, Calgary, Alta.; The Hospital for Sick Children (Schuh); University of Toronto (Schuh), Toronto, Ont.; Children's Hospital (Joubert), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Joubert), London, Ont.; Department of Pediatrics (Moore), Queen's University, Kingston, Ont.; McMaster University (Solano); Department of Pediatrics (Solano), McMaster Children's Hospital, Hamilton, Ont
| | - Katherine A Moreau
- Department of Pediatrics (Harrold, Langevin, Barrowman, Lacaze-Masmonteil, Zemek), Children's Hospital of Eastern Ontario; Children's Hospital of Eastern Ontario Research Institute (Harrold, Barrowman, Sprague, Fell, Moreau, Zemek); Better Outcomes Registry & Network Ontario (Sprague); School of Epidemiology and Public Health (Fell) and Faculty of Education (Moreau), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Lacaze-Masmonteil), Cumming School of Medicine, University of Calgary, Calgary, Alta.; The Hospital for Sick Children (Schuh); University of Toronto (Schuh), Toronto, Ont.; Children's Hospital (Joubert), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Joubert), London, Ont.; Department of Pediatrics (Moore), Queen's University, Kingston, Ont.; McMaster University (Solano); Department of Pediatrics (Solano), McMaster Children's Hospital, Hamilton, Ont
| | - Thierry Lacaze-Masmonteil
- Department of Pediatrics (Harrold, Langevin, Barrowman, Lacaze-Masmonteil, Zemek), Children's Hospital of Eastern Ontario; Children's Hospital of Eastern Ontario Research Institute (Harrold, Barrowman, Sprague, Fell, Moreau, Zemek); Better Outcomes Registry & Network Ontario (Sprague); School of Epidemiology and Public Health (Fell) and Faculty of Education (Moreau), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Lacaze-Masmonteil), Cumming School of Medicine, University of Calgary, Calgary, Alta.; The Hospital for Sick Children (Schuh); University of Toronto (Schuh), Toronto, Ont.; Children's Hospital (Joubert), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Joubert), London, Ont.; Department of Pediatrics (Moore), Queen's University, Kingston, Ont.; McMaster University (Solano); Department of Pediatrics (Solano), McMaster Children's Hospital, Hamilton, Ont
| | - Suzanne Schuh
- Department of Pediatrics (Harrold, Langevin, Barrowman, Lacaze-Masmonteil, Zemek), Children's Hospital of Eastern Ontario; Children's Hospital of Eastern Ontario Research Institute (Harrold, Barrowman, Sprague, Fell, Moreau, Zemek); Better Outcomes Registry & Network Ontario (Sprague); School of Epidemiology and Public Health (Fell) and Faculty of Education (Moreau), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Lacaze-Masmonteil), Cumming School of Medicine, University of Calgary, Calgary, Alta.; The Hospital for Sick Children (Schuh); University of Toronto (Schuh), Toronto, Ont.; Children's Hospital (Joubert), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Joubert), London, Ont.; Department of Pediatrics (Moore), Queen's University, Kingston, Ont.; McMaster University (Solano); Department of Pediatrics (Solano), McMaster Children's Hospital, Hamilton, Ont
| | - Gary Joubert
- Department of Pediatrics (Harrold, Langevin, Barrowman, Lacaze-Masmonteil, Zemek), Children's Hospital of Eastern Ontario; Children's Hospital of Eastern Ontario Research Institute (Harrold, Barrowman, Sprague, Fell, Moreau, Zemek); Better Outcomes Registry & Network Ontario (Sprague); School of Epidemiology and Public Health (Fell) and Faculty of Education (Moreau), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Lacaze-Masmonteil), Cumming School of Medicine, University of Calgary, Calgary, Alta.; The Hospital for Sick Children (Schuh); University of Toronto (Schuh), Toronto, Ont.; Children's Hospital (Joubert), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Joubert), London, Ont.; Department of Pediatrics (Moore), Queen's University, Kingston, Ont.; McMaster University (Solano); Department of Pediatrics (Solano), McMaster Children's Hospital, Hamilton, Ont
| | - Andrea Moore
- Department of Pediatrics (Harrold, Langevin, Barrowman, Lacaze-Masmonteil, Zemek), Children's Hospital of Eastern Ontario; Children's Hospital of Eastern Ontario Research Institute (Harrold, Barrowman, Sprague, Fell, Moreau, Zemek); Better Outcomes Registry & Network Ontario (Sprague); School of Epidemiology and Public Health (Fell) and Faculty of Education (Moreau), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Lacaze-Masmonteil), Cumming School of Medicine, University of Calgary, Calgary, Alta.; The Hospital for Sick Children (Schuh); University of Toronto (Schuh), Toronto, Ont.; Children's Hospital (Joubert), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Joubert), London, Ont.; Department of Pediatrics (Moore), Queen's University, Kingston, Ont.; McMaster University (Solano); Department of Pediatrics (Solano), McMaster Children's Hospital, Hamilton, Ont
| | - Tanya Solano
- Department of Pediatrics (Harrold, Langevin, Barrowman, Lacaze-Masmonteil, Zemek), Children's Hospital of Eastern Ontario; Children's Hospital of Eastern Ontario Research Institute (Harrold, Barrowman, Sprague, Fell, Moreau, Zemek); Better Outcomes Registry & Network Ontario (Sprague); School of Epidemiology and Public Health (Fell) and Faculty of Education (Moreau), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Lacaze-Masmonteil), Cumming School of Medicine, University of Calgary, Calgary, Alta.; The Hospital for Sick Children (Schuh); University of Toronto (Schuh), Toronto, Ont.; Children's Hospital (Joubert), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Joubert), London, Ont.; Department of Pediatrics (Moore), Queen's University, Kingston, Ont.; McMaster University (Solano); Department of Pediatrics (Solano), McMaster Children's Hospital, Hamilton, Ont
| | - Roger L Zemek
- Department of Pediatrics (Harrold, Langevin, Barrowman, Lacaze-Masmonteil, Zemek), Children's Hospital of Eastern Ontario; Children's Hospital of Eastern Ontario Research Institute (Harrold, Barrowman, Sprague, Fell, Moreau, Zemek); Better Outcomes Registry & Network Ontario (Sprague); School of Epidemiology and Public Health (Fell) and Faculty of Education (Moreau), University of Ottawa, Ottawa, Ont.; Department of Pediatrics (Lacaze-Masmonteil), Cumming School of Medicine, University of Calgary, Calgary, Alta.; The Hospital for Sick Children (Schuh); University of Toronto (Schuh), Toronto, Ont.; Children's Hospital (Joubert), Schulich School of Medicine and Dentistry, Western University; Children's Health Research Institute (Joubert), London, Ont.; Department of Pediatrics (Moore), Queen's University, Kingston, Ont.; McMaster University (Solano); Department of Pediatrics (Solano), McMaster Children's Hospital, Hamilton, Ont
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Bouwer M, Labuschagne S, Spamer S, Vermaak C, Zietsman LM, Steyn D, Joubert G. Knowledge of final-year medical students at the University of the Free State of hand hygiene as a basic infection control measure. S Afr Fam Pract (2004) 2018. [DOI: 10.1080/20786190.2017.1396789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- M Bouwer
- Faculty of Health Sciences, School of Medicine, University of the Free State , Bloemfontein, South Africa
| | - S Labuschagne
- Faculty of Health Sciences, School of Medicine, University of the Free State , Bloemfontein, South Africa
| | - S Spamer
- Faculty of Health Sciences, School of Medicine, University of the Free State , Bloemfontein, South Africa
| | - C Vermaak
- Faculty of Health Sciences, School of Medicine, University of the Free State , Bloemfontein, South Africa
| | - L-M Zietsman
- Faculty of Health Sciences, School of Medicine, University of the Free State , Bloemfontein, South Africa
| | - D Steyn
- Faculty of Health Sciences, Department of Internal Medicine, University of the Free State , Bloemfontein, South Africa
| | - G Joubert
- Faculty of Health Sciences, Department of Biostatistics, University of the Free State , Bloemfontein, South Africa
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Holtzhausen L, Smit C, Joubert G, Von Hagen K. Injury and illness profiles during the 2014 South African Ironman triathlon. S Afr j sports med 2018. [DOI: 10.17159/2078-516x/2018/v30i1a1509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: There is a need for ongoing scrutiny of injury and illness profiles of ultra-distance athletes. This study aimed to record the medical history, illness and injuries of athletes receiving medical attention during the 2014 Ironman South Africa (IMSA) triathlon, and to investigate the temporal presentation of medical encounters.
Methods: This was a retrospective, cross-sectional study. All athletes who required medical attention at the main medical tent and all of the medical posts or mobile units along the route were included in this study A total of 2 331 athletes started the race. Data included age, gender, time and stage of the race when medical attention was required, pre-race medical history and medication use, illness and injuries treated, special investigations performed, and weather conditions.
Results: Overall, 179 athletes (7.7%) required medical attention. The incidence of medical encounters was 7.8%. A significantly higher percentage of younger participants encountered medical problems (P = 0.04). Most patient encounters (80.1%) occurred after the race. The median duration of treatment was 26 minutes. Medication was used by 35.1% of patients during the race. The most common medical encounters were exertion-related (71.2%), gastro-intestinal (16.4%), dermatological (11.9%), musculoskeletal (9.6%) and cardiorespiratory conditions (2.4%).
Conclusion: Medical encounters occurred more frequently in later stages of the race. Most medical conditions were exertion-related. Potential higher risk may be associated with medication use, recent illness, and in younger participants. Temporal stacking of medical personnel, planning of resources according to expected conditions, preventative measures for high-risk behaviour, and on-going data collection with comparable methodology are recommended.
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Procter NJ, Lamacraft G, Joubert G. Intravenous paracetamol — waste not, want not: a retrospective audit on the appropriate use of intravenous paracetamol at Universitas Academic Hospital Complex—Bloemfontein. Southern African Journal of Anaesthesia and Analgesia 2018. [DOI: 10.1080/22201181.2018.1426208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- NJ Procter
- Department of Anaesthesiology, University of the Free State, Bloemfontein, South Africa
| | - G Lamacraft
- Department of Anaesthesiology, University of the Free State, Bloemfontein, South Africa
| | - G Joubert
- Department of Biostatistics, University of the Free State, Bloemfontein, South Africa
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Makwero MT, Mollentze WF, Joubert G, Steinberg WJ. Anthropometric profile and complications in patients with diabetes mellitus seen at Maluti Adventist Hospital, Lesotho. S Afr Fam Pract (2004) 2018. [DOI: 10.1080/20786190.2018.1426901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- MT Makwero
- Department of Family Medicine, University of the Free State , Bloemfontein, South Africa
| | - WF Mollentze
- Department of Internal Medicine, University of the Free State , Bloemfontein, South Africa
| | - G Joubert
- Department of Biostatistics, University of the Free State , Bloemfontein, South Africa
| | - WJ Steinberg
- Department of Family Medicine, University of the Free State , Bloemfontein, South Africa
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Daffue B, Moolman D, Ferreira S, Roos L, Schoeman L, Smit SJA, Joubert G. The causes of burn wounds among adult patients treated at Pelonomi Tertiary Hospital, Bloemfontein. S AFR J SURG 2018. [DOI: 10.17159/2078-5151/2018/v56n3a2592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Wentzel SW, Vermeulen LP, Beukes CA, Thiart J, Joubert G, Goedhals J. Human immunodeficiency virus (HIV) infection in men with penile carcinoma is associated with increased prevalence of human papilloma virus infection and younger age at presentation. S AFR J SURG 2018. [DOI: 10.17159/2078-5151/2018/v56n3a2075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Beukes A, Mabasa T, Mkhungo L, Olivier C, Ramoo N, Van Rooi D, Dawadi BR, Joubert G. Women who give birth before arriving at National District Hospital in Bloemfontein, Free State. S Afr Fam Pract (2004) 2017. [DOI: 10.1080/20786190.2017.1313485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- A Beukes
- Faculty of Health Sciences, School of Medicine, University of the Free State, Bloemfontein, South Africa
| | - T Mabasa
- Faculty of Health Sciences, School of Medicine, University of the Free State, Bloemfontein, South Africa
| | - L Mkhungo
- Faculty of Health Sciences, School of Medicine, University of the Free State, Bloemfontein, South Africa
| | - C Olivier
- Faculty of Health Sciences, School of Medicine, University of the Free State, Bloemfontein, South Africa
| | - N Ramoo
- Faculty of Health Sciences, School of Medicine, University of the Free State, Bloemfontein, South Africa
| | - D Van Rooi
- Faculty of Health Sciences, School of Medicine, University of the Free State, Bloemfontein, South Africa
| | - BR Dawadi
- Faculty of Health Sciences, Department of Family Medicine, University of the Free State, Bloemfontein, South Africa
| | - G Joubert
- Faculty of Health Sciences, Department of Biostatistics, University of the Free State, Bloemfontein, South Africa
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Hagemeister DT, Pal A, Naidoo N, Kristen U, Mokgosana N, Joubert G. Undergraduate medical students’ interest in specialising in Family Medicine at the University of the Free State, 2014. S Afr Fam Pract (2004) 2017. [DOI: 10.1080/20786190.2017.1317977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- DT Hagemeister
- Faculty of Health Sciences, School of Medicine, University of the Free State, Bloemfontein, South Africa
| | - A Pal
- Faculty of Health Sciences, School of Medicine, University of the Free State, Bloemfontein, South Africa
| | - N Naidoo
- Faculty of Health Sciences, School of Medicine, University of the Free State, Bloemfontein, South Africa
| | - U Kristen
- Faculty of Health Sciences, School of Medicine, University of the Free State, Bloemfontein, South Africa
| | - N Mokgosana
- Faculty of Health Sciences, School of Medicine, University of the Free State, Bloemfontein, South Africa
| | - G Joubert
- Faculty of Health Sciences, Department of Biostatistics, University of the Free State, Bloemfontein, South Africa
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Van Zyl PM, Joubert G, Fechter L, Griesel J, Nel M, Honiball A, Serfontein L, Diedericks M. Methylphenidate use among students living in junior on-campus residences of the University of the Free State. S Afr Fam Pract (2004) 2017. [DOI: 10.4102/safp.v59i4.4736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background: The use of methylphenidate as cognitive enhancer is a growing trend among students at tertiary institutions globally. This study aimed to determine the prevalence of methylphenidate use and co-use with alcohol among on-campus residence students of the University of the Free State (UFS).
Methods: For this cross-sectional study, 10 junior residences were randomly selected and 1 761 anonymous questionnaires handed out for all students living in these residences during 2015. Data were collected on demographics, use of methylphenidate and co-use of methylphenidate with alcohol.
Results: In total, 585 questionnaires (response rate 33.2%) were received and analysed. Sixty-six (11.3%) participants reported past-year use of methylphenidate. While only 18 (27.3%) of past-year users were diagnosed with ADHD, 44 (66.7%) obtained their supply through doctors’ prescriptions, 21 (31.8%) from friends without payment, and 4 (6.1%) bought it from illegal sources. Of the past-year users, 24.2% had used methylphenidate before consuming alcohol.
Conclusion: Off-label prescribing, diversion of prescriptions and illegal trade in methylphenidate occur among students at the UFS. The frequent co-use of methylphenidate and alcohol may indicate a lack of information on the effects of the medication, rather than deliberate misuse.
(Full text of the research articles are available online at www.medpharm.tandfonline.com/ojfp)
S Afr Fam Pract 2017; DOI: 10.1080/20786190.2017.1292695
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Hagemeister DT, Pal A, Kristen U, Mokgosana N, Joubert G. Undergraduate medical students’ interest in specialising in Family Medicine at the University of the Free State, 2014. S Afr Fam Pract (2004) 2017. [DOI: 10.4102/safp.v59i5.4768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background: There is a large demand for Family Medicine specialists, yet not enough medical students specialise in this field. This study investigated the interest of undergraduate medical students at the University of the Free State in pursuing a career in Family Medicine, factors associated with this interest, and their opinion of Family Medicine as a specialty.
Methods: In this prospective cross-sectional study, anonymous, self-reporting questionnaires, available in English and Afrikaans, were distributed to first- to fifth-year undergraduates. Data were collected on demographic variables and interest in Family Medicine and other disciplines. The students had to rate the likelihood of them selecting 15 different specialties as a future career according to a five-point Likert scale. Opinions concerning Family Medicine were tested with a yes/no response as to the agreement to five statements.
Results: Fifth-year students were excluded due to poor response rate (13.6%). The response rate for the first- to fourth-year groups was 86.4%. Interest in Family Medicine decreased from first to third year (22.4, 21.2 and 14.0%, respectively), but increased again in the fourth year (23.3%). Females and speakers of African languages showed the most interest in this field. Medical students, especially first years, generally had poor knowledge regarding Family Medicine.
Conclusion: Family Medicine is not a preferred specialty in any of the four year groups, and students had insufficient knowledge of the field. Family Medicine should be introduced earlier into the medical curriculum.
(Full text of the research articles are available online at www.medpharm.tandfonline.com/ojfp)
S Afr Fam Pract 2017; DOI: 10.1080/20786190.2017.1317977
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Brits H, Botha A, Niksch L, Terblanché R, Venter K, Joubert G. Illegible handwriting and other prescription errors on prescriptions at National District Hospital, Bloemfontein. S Afr Fam Pract (2004) 2017. [DOI: 10.4102/safp.v59i1.4658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background: It is generally accepted that doctors have illegible handwriting. The writer usually knows what is written, but other parties often have problems with reading and interpreting.
Aim: The aim of the study was to determine whether illegible doctors’ handwriting and other factors that can lead to dispensing errors occur on prescriptions at National District Hospital.
Method: In part one the prescriptions of 20 doctors were read by five doctors, nurses and pharmacists to detect who could read it most accurately. In part two, these doctors were asked to write a prescription with an IntelliPen®.
Results: From the 300 measurements, 88% of the doctors read the prescriptions correctly, compared with 82% of the nurses and 75% of the pharmacists. A potential fatal error was lorazepam injection 4 mg, which was read as 40 mg (lethal dose) by 20% of healthcare workers (HCWs). With the IntelliPen® only 39% of the prescriptions were readable. Only 65% of prescribers could be identified from their handwriting or the name stamp used.
Conclusion: Pharmacists read the prescriptions worst and they are the people who must dispense the prescriptions. Some of the reading mistakes were critical and could be lethal. Many of the prescriptions did not meet the legal requirement for prescriptions.
(Full text of the research articles are available online at www.medpharm.tandfonline.com/ojfp)
S Afr Fam Pract 2017; DOI: 10.1080/20786190.2016.1254932
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De Klerk C, Du Plessis G, Fourie JJ, O'Neill A, Smit SJA, Joubert G. The eventual outcome of patients who had lower limb amputations due to peripheral vascular disease at Pelonomi Hospital, Bloemfontein. S Afr Fam Pract (2004) 2017. [DOI: 10.4102/safp.v59i1.4655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background: Peripheral vascular disease (PVD) presenting with irreversible lower limb pathology has a high morbidity and mortality rate. This study aimed to determine the outcome of patients who underwent lower limb amputations (LLAs) because of PVD at Pelonomi Hospital, Bloemfontein, 2008–2011.
Methods: Prospective data collection of a retrospective cohort study group was performed. Included were patients with PVDinduced LLAs. Demographic and contact information was collected from Meditech. Living status (alive or dead) was determined using the Department of Home Affairs database and interviews with relatives.
Results: Of the study population (n = 224), 119 had contact information. Data of 158 people were available to determine living status: 71.5% had died by follow-up in 2014. Forty-nine interviews were possible, 31 patients had died, with cause of death reported to be primarily vascular related. The cumulative mortality showed that 16.1% died within a month and 48.4% within one year post-amputation. Among the 18 living amputees, 50.0% became unemployed, 77.8% used wheelchairs, 11.1% used crutches and 11.1% a prosthesis.
Conclusion: Lower limb amputation due to PVD is indicative of a poor prognosis. In our study only 28.5% of patients survived 3–6 years post-amputation. Restoration to ideal mobility was achieved in a minority of cases.
(Full text of the research articles are available online at www.medpharm.tandfonline.com/ojfp)
S Afr Fam Pract 2017; DOI: 10.1080/20786190.2016.12481450
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Poonai N, Myslik F, Joubert G, Fan J, Misir A, Istasy V, Columbus M, Soegtrop R, Goldfarb A, Thompson D, Dubrovsky AS. Point-of-care Ultrasound for Nonangulated Distal Forearm Fractures in Children: Test Performance Characteristics and Patient-centered Outcomes. Acad Emerg Med 2017; 24:607-616. [PMID: 27976448 DOI: 10.1111/acem.13146] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 11/16/2016] [Accepted: 11/23/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Distal forearm fractures are the most common fracture type in children. Point-of-care-ultrasound (POCUS) is increasingly being used, and preliminary studies suggest that it offers an accurate approach to diagnosis. However, outcomes such as pain, satisfaction, and procedure duration have not been explored but may be salient to the widespread acceptance of this technology by caregivers and children. Our objectives were to examine the test performance characteristics of POCUS for nonangulated distal forearm injuries in children and compare POCUS to x-ray with respect to pain, caregiver satisfaction, and procedure duration. METHODS We conducted a cross-sectional study involving children aged 4-17 years with a suspected nonangulated distal forearm fracture. Participants underwent both x-ray and POCUS assessment. The primary outcome was sensitivity between POCUS and x-ray, the reference standard. Secondary outcomes included self-reported pain using the Faces Pain Scale-Revised, caregiver satisfaction using a five-item Likert scale, and procedure duration. RESULTS POCUS was performed in 169 children of whom 76 were diagnosed with a fracture including 61 buckle fractures. Sensitivity of POCUS for distal forearm fractures was 94.7% (95% confidence interval [CI] = 89.7-99.8) and specificity was 93.5% (95% CI = 88.6-98.5). POCUS was associated with a significantly lower median (interquartile range [IQR]) pain score compared to x-ray: 1 (0-2) versus 2 (1-3), respectively (median difference = 0.5; 95% CI = 0.5-1; p < 0.001) and no significant difference in median (IQR) caregiver satisfaction score: 5 (0) versus 5 (4-5), respectively (median difference = 0, 95% CI = 0, p = 1.0). POCUS was associated with a significantly lower median (IQR) procedure duration versus x-ray: 1.5 (0.8-2.2) minutes versus 27 (15-58) minutes, respectively (median difference = 34.1, 95% CI = 26.8-41.5, p < 0.001). CONCLUSIONS Our findings suggest that POCUS assessment of distal forearm injuries in children is accurate, timely, and associated with low levels of pain and high caregiver satisfaction.
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Affiliation(s)
- Naveen Poonai
- Department of Pediatrics; Western University; London Ontario
- Division of Emergency Medicine; Western University; London Ontario
- Children's Health Research Institute; London Health Sciences Centre; London Ontario
| | - Frank Myslik
- Division of Emergency Medicine; Western University; London Ontario
| | - Gary Joubert
- Department of Pediatrics; Western University; London Ontario
- Division of Emergency Medicine; Western University; London Ontario
| | - Josiah Fan
- Department of Pediatrics; Western University; London Ontario
| | - Amita Misir
- Department of Pediatrics; Western University; London Ontario
- Division of Emergency Medicine; Western University; London Ontario
| | - Victor Istasy
- Department of Pediatrics; Western University; London Ontario
- Division of Emergency Medicine; Western University; London Ontario
| | - Melanie Columbus
- Division of Emergency Medicine; Western University; London Ontario
| | - Robert Soegtrop
- Division of Emergency Medicine; Western University; London Ontario
| | - Alex Goldfarb
- Division of Emergency Medicine; Western University; London Ontario
| | - Drew Thompson
- Division of Emergency Medicine; Western University; London Ontario
| | - Alexander Sasha Dubrovsky
- Division of Pediatric Emergency Medicine; Montreal Children's Hospital; McGill University Health Centre; Montreal Quebec Canada
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Poonai N, Canton K, Ali S, Hendrikx S, Shah A, Miller M, Joubert G, Rieder M, Hartling L. Intranasal ketamine for procedural sedation and analgesia in children: A systematic review. PLoS One 2017; 12:e0173253. [PMID: 28319161 PMCID: PMC5358746 DOI: 10.1371/journal.pone.0173253] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 02/04/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Ketamine is commonly used for procedural sedation and analgesia (PSA) in children. Evidence suggests it can be administered intranasally (IN). We sought to review the evidence for IN ketamine for PSA in children. METHODS We performed a systematic review of randomized trials of IN ketamine in PSA that reported any sedation-related outcome in children 0 to 19 years. Trials were identified through electronic searches of MEDLINE (1946-2016), EMBASE (1947-2016), Google Scholar (2016), CINAHL (1981-2016), The Cochrane Library (2016), Web of Science (2016), Scopus (2016), clinical trial registries, and conference proceedings (2000-2016) without language restrictions. The methodological qualities of studies and the overall quality of evidence were evaluated using the Cochrane Collaboration's Risk of Bias tool, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system, respectively. RESULTS The review included 7 studies (n = 264) of children ranging from 0 to 14 years. Heterogeneity in study design precluded meta-analysis. Most studies were associated with a low or unclear risk of bias and outcome-specific ratings for quality of evidence were low or very low. In four of seven studies, IN ketamine provided superior sedation to comparators and resulted in adequate sedation for 148/175 (85%) of participants. Vomiting was the most common adverse effect; reported by 9/91 (10%) of participants. CONCLUSIONS IN ketamine administration is well tolerated and without serious adverse effects. Although most participants were deemed adequately sedated with IN ketamine, effectiveness of sedation with respect to superiority over comparators was inconsistent, precluding a recommendation for PSA in children.
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Affiliation(s)
- Naveen Poonai
- Department of Pediatrics, Schulich School of Medicine and Dentistry, London, Ontario, Canada
- Division of Emergency Medicine, London Health Sciences Centre, London, Ontario, Canada
- Children's Health Research Institute, London Health Sciences Centre, London, Ontario, Canada
| | - Kyle Canton
- Division of Emergency Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Samina Ali
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Women and Children’s Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Shawn Hendrikx
- Department of Pediatrics, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Amit Shah
- Division of Emergency Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Michael Miller
- Department of Pediatrics, Schulich School of Medicine and Dentistry, London, Ontario, Canada
- Children's Health Research Institute, London Health Sciences Centre, London, Ontario, Canada
| | - Gary Joubert
- Department of Pediatrics, Schulich School of Medicine and Dentistry, London, Ontario, Canada
- Division of Emergency Medicine, London Health Sciences Centre, London, Ontario, Canada
- Children's Health Research Institute, London Health Sciences Centre, London, Ontario, Canada
| | - Michael Rieder
- Department of Pediatrics, Schulich School of Medicine and Dentistry, London, Ontario, Canada
- Children's Health Research Institute, London Health Sciences Centre, London, Ontario, Canada
| | - Lisa Hartling
- Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, Alberta
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Van Zyl PM, Joubert G, Fechter L, Griesel J, Nel M, Honiball A, Serfontein L, Diedericks M. Methylphenidate use among students living in junior on-campus residences of the University of the Free State. S Afr Fam Pract (2004) 2017. [DOI: 10.1080/20786190.2017.1292695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- PM Van Zyl
- Department of Pharmacology, University of the Free State, Bloemfontein, South Africa
| | - G Joubert
- Department of Biostatistics, University of the Free State, Bloemfontein, South Africa
| | - L Fechter
- School of Medicine, University of the Free State, Bloemfontein, South Africa
| | - J Griesel
- School of Medicine, University of the Free State, Bloemfontein, South Africa
| | - M Nel
- School of Medicine, University of the Free State, Bloemfontein, South Africa
| | - A Honiball
- School of Medicine, University of the Free State, Bloemfontein, South Africa
| | - L Serfontein
- School of Medicine, University of the Free State, Bloemfontein, South Africa
| | - M Diedericks
- School of Medicine, University of the Free State, Bloemfontein, South Africa
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50
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Brits H, Botha A, Niksch L, Terblanché R, Venter K, Joubert G. Illegible handwriting and other prescription errors on prescriptions at National District Hospital, Bloemfontein. S Afr Fam Pract (2004) 2017. [DOI: 10.1080/20786190.2016.1254932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- H. Brits
- Department of Family Medicine, University of the Free State, Bloemfontein, South Africa
| | - A. Botha
- Department of Family Medicine, University of the Free State, Bloemfontein, South Africa
| | - L. Niksch
- Department of Family Medicine, University of the Free State, Bloemfontein, South Africa
| | - R. Terblanché
- Department of Family Medicine, University of the Free State, Bloemfontein, South Africa
| | - K. Venter
- Department of Family Medicine, University of the Free State, Bloemfontein, South Africa
| | - G. Joubert
- Department of Biostatistics, University of the Free State, Bloemfontein, South Africa
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