Pub Date : 2017-05-12DOI: 10.15273/DMJ.VOL43NO2.7062
Sana Basseri, D. Haase
Y are called to the Emergency Department to assess a 63-year-old man with acute onset of shortness of breath. He has no known health conditions but has a 40 pack-year smoking history. He thinks that he may have the flu since his wife was just recovering from flu-like symptoms. He has not seen a healthcare provider in quite some time and this is his first visit to the hospital. Following some initial workup and imaging which showed a collapsed right lung, a chest CT scan was ordered which revealed metastatic lung cancer. As the physician, how would you approach informing the patient of his diagnosis? Bad news can be defined as any information that can drastically and negatively change a person’s expectations or views about their future.1 While typical examples of bad news in the medical context include the diagnosis of terminal illness, it is important to step back and consider a wide spectrum of physical, emotional, social, and occupational factors that may impact a patient and thus could be considered bad news for that individual or their family.1 Breaking bad news is a difficult and complex communication skill to acquire yet one that is essential for physicians. How bad news is delivered can have tremendous implications not just for patients and their families, but also for the physician. Developing this communication skill requires practice, self-reflection, and flexibility to adapt one’s approach according to a given situation as well as to patient preferences, behavior, and understanding. While the focus of this article is on physicians, we acknowledge that other health care professionals are also frequently involved in such discussions and hence may also benefit from this article.2
{"title":"The challenge of breaking bad news","authors":"Sana Basseri, D. Haase","doi":"10.15273/DMJ.VOL43NO2.7062","DOIUrl":"https://doi.org/10.15273/DMJ.VOL43NO2.7062","url":null,"abstract":"Y are called to the Emergency Department to assess a 63-year-old man with acute onset of shortness of breath. He has no known health conditions but has a 40 pack-year smoking history. He thinks that he may have the flu since his wife was just recovering from flu-like symptoms. He has not seen a healthcare provider in quite some time and this is his first visit to the hospital. Following some initial workup and imaging which showed a collapsed right lung, a chest CT scan was ordered which revealed metastatic lung cancer. As the physician, how would you approach informing the patient of his diagnosis? Bad news can be defined as any information that can drastically and negatively change a person’s expectations or views about their future.1 While typical examples of bad news in the medical context include the diagnosis of terminal illness, it is important to step back and consider a wide spectrum of physical, emotional, social, and occupational factors that may impact a patient and thus could be considered bad news for that individual or their family.1 Breaking bad news is a difficult and complex communication skill to acquire yet one that is essential for physicians. How bad news is delivered can have tremendous implications not just for patients and their families, but also for the physician. Developing this communication skill requires practice, self-reflection, and flexibility to adapt one’s approach according to a given situation as well as to patient preferences, behavior, and understanding. While the focus of this article is on physicians, we acknowledge that other health care professionals are also frequently involved in such discussions and hence may also benefit from this article.2","PeriodicalId":293977,"journal":{"name":"Dalhousie Medical Journal","volume":"15 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123923985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-05-12DOI: 10.15273/dmj.Vol43No2.7055
Joseph P. Corkum, K. Calder, J. Paletz
Dislocation of both joints in the same digit due to a single insult is rare. To date there have been no reported cases from Canada. The purpose of our study is to review the literature and to survey plastic surgeons about this injury. We have contributed two case reports as well. Within six months, two patients presented to the Halifax Infirmary plastic surgery clinic for management of a double dislocation of a single digit. A comprehensive literature review of the English and non-English literature was performed. Additionally, a survey on experiences with double disloca- tions was developed and distributed to Plastic Surgeons practicing in Canada. 61 reported cases were identified in the literature, none of which were treated in Canada. 76% of cases were reported in English with the remaining 24% of cases reported in a non-English language (German, French). One hundred of the 373 members of the Canadian Society of Plastic Surgeons contacted replied (27%). Fourteen had previously encountered a double dislocation of a single digit. This injury was treated with closed reduction 90% of the time and splinting (65%) for two to three weeks. All patients regained normal range of motion with the exception of one. Ninety-three and 85% favored closed reduction and splinting, respectively. Two weeks was the preferred immobilization period (36%). We present the first reported cases of double dislocation of a single digit in Canada. We outline the etiology of this rare injury, previous treatments employed, and potential pitfalls encountered. The authors recommend a preferred treatment strategy for the management of double dislocation of a single digit.
{"title":"Double dislocations in a single digit: a Canadian perspective","authors":"Joseph P. Corkum, K. Calder, J. Paletz","doi":"10.15273/dmj.Vol43No2.7055","DOIUrl":"https://doi.org/10.15273/dmj.Vol43No2.7055","url":null,"abstract":"Dislocation of both joints in the same digit due to a single insult is rare. To date there have been no reported cases from Canada. The purpose of our study is to review the literature and to survey plastic surgeons about this injury. We have contributed two case reports as well. Within six months, two patients presented to the Halifax Infirmary plastic surgery clinic for management of a double dislocation of a single digit. A comprehensive literature review of the English and non-English literature was performed. Additionally, a survey on experiences with double disloca- tions was developed and distributed to Plastic Surgeons practicing in Canada. 61 reported cases were identified in the literature, none of which were treated in Canada. 76% of cases were reported in English with the remaining 24% of cases reported in a non-English language (German, French). One hundred of the 373 members of the Canadian Society of Plastic Surgeons contacted replied (27%). Fourteen had previously encountered a double dislocation of a single digit. This injury was treated with closed reduction 90% of the time and splinting (65%) for two to three weeks. All patients regained normal range of motion with the exception of one. Ninety-three and 85% favored closed reduction and splinting, respectively. Two weeks was the preferred immobilization period (36%). We present the first reported cases of double dislocation of a single digit in Canada. We outline the etiology of this rare injury, previous treatments employed, and potential pitfalls encountered. The authors recommend a preferred treatment strategy for the management of double dislocation of a single digit.","PeriodicalId":293977,"journal":{"name":"Dalhousie Medical Journal","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133723395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-05-12DOI: 10.15273/DMJ.VOL43NO2.7057
E. Martin
1. Setting the Standard Excelling in Clinical Care. (2012). Cystic Fibrosis Canada 2012 Annual Report, page 7. 2. Hofer M. Advanced chronic lung disease: need for an active interdisciplinary approach. Swiss Med Wkly 2007;137(4344):593-601. 3. Smith C, Woods S, Beauvais B. Thinking lean: implementing DMAIC methods to improve efficiency within a cystic fibrosis clinic. J Healthc Qual 2011;33(2):37-46. 4. Boffeli TJ, Thongvanh KL, Evans SJ, Ahrens CR. Patient experience and physician productivity: debunking the mythical divide at HealthPartners clinics. Perm J 2012;16(4):19-25. 5. Sandars J. The use of reflection in medical education: AMEE Guide No. 44. Med Teach 2009;31(8):685-695. 6. Murphy M. Eliminating wasteful work in hospitals improves margin, quality and culture. Murphy Leadership Institute Research Briefing: 4, 2003. 7. Sherman J. Achieving real results with Six Sigma. “Six Sigma to the rescue,” declared the title of a June 2002 article in the technology section of Health Care Finance. Almost four years later, has Six Sigma helped healthcare organizations achieve the promised breakthrough improvement in their operations? Healthc Exec. 2006;21(1):8-10, 12-4. 8. Xakellis GC Jr., Bennett A. Improving Clinic Efficiency of a Family Medicine Teaching Clinic. Fam Med 2001;33(7):533-8. 9. Gamble JG, Lee R. Investigating whether education of residents in a group practice increases the length of the outpatient visit. Acad Med 1991;66(8):492-3. Evaluation of efficiency in the adult cystic fibrosis clinic
{"title":"A 25 year-old male with chest pain, fatique, and altered sensation","authors":"E. Martin","doi":"10.15273/DMJ.VOL43NO2.7057","DOIUrl":"https://doi.org/10.15273/DMJ.VOL43NO2.7057","url":null,"abstract":"1. Setting the Standard Excelling in Clinical Care. (2012). Cystic Fibrosis Canada 2012 Annual Report, page 7. 2. Hofer M. Advanced chronic lung disease: need for an active interdisciplinary approach. Swiss Med Wkly 2007;137(4344):593-601. 3. Smith C, Woods S, Beauvais B. Thinking lean: implementing DMAIC methods to improve efficiency within a cystic fibrosis clinic. J Healthc Qual 2011;33(2):37-46. 4. Boffeli TJ, Thongvanh KL, Evans SJ, Ahrens CR. Patient experience and physician productivity: debunking the mythical divide at HealthPartners clinics. Perm J 2012;16(4):19-25. 5. Sandars J. The use of reflection in medical education: AMEE Guide No. 44. Med Teach 2009;31(8):685-695. 6. Murphy M. Eliminating wasteful work in hospitals improves margin, quality and culture. Murphy Leadership Institute Research Briefing: 4, 2003. 7. Sherman J. Achieving real results with Six Sigma. “Six Sigma to the rescue,” declared the title of a June 2002 article in the technology section of Health Care Finance. Almost four years later, has Six Sigma helped healthcare organizations achieve the promised breakthrough improvement in their operations? Healthc Exec. 2006;21(1):8-10, 12-4. 8. Xakellis GC Jr., Bennett A. Improving Clinic Efficiency of a Family Medicine Teaching Clinic. Fam Med 2001;33(7):533-8. 9. Gamble JG, Lee R. Investigating whether education of residents in a group practice increases the length of the outpatient visit. Acad Med 1991;66(8):492-3. Evaluation of efficiency in the adult cystic fibrosis clinic","PeriodicalId":293977,"journal":{"name":"Dalhousie Medical Journal","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132363002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-05-12DOI: 10.15273/DMJ.VOL43NO2.7056
Justin White, P. Landry, M. Chiasson
The adult cystic fibrosis clinic in Halifax provides team-based care. Appointments are lengthy with high truancy. Our two-part efficiency study examined clinic flow, appointment length, and identified inefficiencies. A follow-up study was conducted to assess for improvements. Variables included total clinic time for each patient and total time spent alone waiting. Attempts to rectify problems were made after the first study. Outcomes were compared using analysis of variance. We found that patients wait significantly longer on Fridays (p 0.05), and patients with known methicillin-resistant Staphylococcus aureus wait significantly longer (p < 0.05). Patients who arrive earlier wait significantly longer (p < 0.05), while patients who arrive late wait less overall. No significant difference was found after the second study. Despite changing scheduling, procedures and notifying patients, no significant improvements in efficiency were found. Further measures may be required.
{"title":"Evaluation of efficiency in the adult cystic fibrosis clinic at the Halifax Infirmary","authors":"Justin White, P. Landry, M. Chiasson","doi":"10.15273/DMJ.VOL43NO2.7056","DOIUrl":"https://doi.org/10.15273/DMJ.VOL43NO2.7056","url":null,"abstract":"The adult cystic fibrosis clinic in Halifax provides team-based care. Appointments are lengthy with high truancy. Our two-part efficiency study examined clinic flow, appointment length, and identified inefficiencies. A follow-up study was conducted to assess for improvements. Variables included total clinic time for each patient and total time spent alone waiting. Attempts to rectify problems were made after the first study. Outcomes were compared using analysis of variance. We found that patients wait significantly longer on Fridays (p 0.05), and patients with known methicillin-resistant Staphylococcus aureus wait significantly longer (p < 0.05). Patients who arrive earlier wait significantly longer (p < 0.05), while patients who arrive late wait less overall. No significant difference was found after the second study. Despite changing scheduling, procedures and notifying patients, no significant improvements in efficiency were found. Further measures may be required.","PeriodicalId":293977,"journal":{"name":"Dalhousie Medical Journal","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128889944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2017-05-12DOI: 10.15273/DMJ.VOL43NO2.7063
S. Walsh
{"title":"Reflections on a Haitian global health experience","authors":"S. Walsh","doi":"10.15273/DMJ.VOL43NO2.7063","DOIUrl":"https://doi.org/10.15273/DMJ.VOL43NO2.7063","url":null,"abstract":"","PeriodicalId":293977,"journal":{"name":"Dalhousie Medical Journal","volume":"48 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128991124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-11-21DOI: 10.15273/DMJ.VOL43NO1.6870
Timothy S. H. Kwok
R I finished an Internal Medicine elective at The Ottawa Hospital. There, I was privileged to care for some of the city’s sickest patients. As the elective progressed, I began to notice a pattern. Every time medical staff entered a patient’s room, they would frantically put on gowns, facemasks, and gloves covering every part of their bodies. Curious, I wondered why? Suddenly, out of the corner of my eye, I noticed a sea of signs labeled “MRSA Protocols.” That evening, I reflected on how the problem of “superbugs” had gotten so out of hand. In lectures, we had learned the genetic reasons behind the development of antibiotic resistance but I realized there must be reasons beyond the realm of biology. In fact, there is an interplay of economic, psychosocial, and political factors that also contribute to society’s mishandling of such an invaluable resource. As medical students, we are introduced to the CanMEDS framework at an early point in our training. CanMEDS was created by The Royal College of Physicians and Surgeons of Canada in the 1990s to promote competencies in seven key pillars for physicians in training to improve patient care (Figure 1). I pondered deeply at how the seven roles behind this prominent medical education dogma could play a part in combating the economic, psychosocial, and political factors of antibiotic resistance.
{"title":"CanMEDS and the combat against antibiotic resistance","authors":"Timothy S. H. Kwok","doi":"10.15273/DMJ.VOL43NO1.6870","DOIUrl":"https://doi.org/10.15273/DMJ.VOL43NO1.6870","url":null,"abstract":"R I finished an Internal Medicine elective at The Ottawa Hospital. There, I was privileged to care for some of the city’s sickest patients. As the elective progressed, I began to notice a pattern. Every time medical staff entered a patient’s room, they would frantically put on gowns, facemasks, and gloves covering every part of their bodies. Curious, I wondered why? Suddenly, out of the corner of my eye, I noticed a sea of signs labeled “MRSA Protocols.” That evening, I reflected on how the problem of “superbugs” had gotten so out of hand. In lectures, we had learned the genetic reasons behind the development of antibiotic resistance but I realized there must be reasons beyond the realm of biology. In fact, there is an interplay of economic, psychosocial, and political factors that also contribute to society’s mishandling of such an invaluable resource. As medical students, we are introduced to the CanMEDS framework at an early point in our training. CanMEDS was created by The Royal College of Physicians and Surgeons of Canada in the 1990s to promote competencies in seven key pillars for physicians in training to improve patient care (Figure 1). I pondered deeply at how the seven roles behind this prominent medical education dogma could play a part in combating the economic, psychosocial, and political factors of antibiotic resistance.","PeriodicalId":293977,"journal":{"name":"Dalhousie Medical Journal","volume":"68 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127239476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-11-21DOI: 10.15273/DMJ.VOL43NO1.6867
Rebeccar. George, E. Massoud
{"title":"A 43-year-old female with new onset vertigo","authors":"Rebeccar. George, E. Massoud","doi":"10.15273/DMJ.VOL43NO1.6867","DOIUrl":"https://doi.org/10.15273/DMJ.VOL43NO1.6867","url":null,"abstract":"","PeriodicalId":293977,"journal":{"name":"Dalhousie Medical Journal","volume":"99 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132092999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-11-21DOI: 10.15273/DMJ.VOL43NO1.6872
M. J. Wong, T. Taylor
EM, an 85 year-old female, was admitted to the Medical Teaching Unit with a one-week history of confusion. In the Emergency Department, she was disoriented and later became somnolent. During the month prior to admission, she had experienced progressive mid-back pain, and had been diagnosed with a T8 compression fracture. Laboratory investigations showed a hemoglobin of 81 g/L with mean corpuscular volume of 101 fL. Rouleaux formations were seen on peripheral smear. EM had elevated creatinine (133 mmol/L), urea (11.2 mmol/L), and ionized calcium (1.97 mmol/L); however, parathyroid hormone levels were normal, as were iron studies, vitamin B12, folate, and thyroid stimulating hormone (TSH). Urine culture revealed Escherichia coli bacteriuria, which was treated with ceftriaxone. Pamidronate was administered for hypercalcemia. Early into the admission, she became fluid overloaded and required diuresis, while simultaneously receiving intravenous fluids for her hypercalcemia. Multiple myeloma was considered as the cause of EM’s constellation of symptoms, so a serum protein electrophoresis was performed, revealing an IgA monoclonal protein spike. Free light chain analysis showed an increase in free kappa light chains (7.69 mg/L) with a markedly elevated kappa/lambda ratio of 157.5.
{"title":"Clinical features and diagnosis of multiple myeloma","authors":"M. J. Wong, T. Taylor","doi":"10.15273/DMJ.VOL43NO1.6872","DOIUrl":"https://doi.org/10.15273/DMJ.VOL43NO1.6872","url":null,"abstract":"EM, an 85 year-old female, was admitted to the Medical Teaching Unit with a one-week history of confusion. In the Emergency Department, she was disoriented and later became somnolent. During the month prior to admission, she had experienced progressive mid-back pain, and had been diagnosed with a T8 compression fracture. Laboratory investigations showed a hemoglobin of 81 g/L with mean corpuscular volume of 101 fL. Rouleaux formations were seen on peripheral smear. EM had elevated creatinine (133 mmol/L), urea (11.2 mmol/L), and ionized calcium (1.97 mmol/L); however, parathyroid hormone levels were normal, as were iron studies, vitamin B12, folate, and thyroid stimulating hormone (TSH). Urine culture revealed Escherichia coli bacteriuria, which was treated with ceftriaxone. Pamidronate was administered for hypercalcemia. Early into the admission, she became fluid overloaded and required diuresis, while simultaneously receiving intravenous fluids for her hypercalcemia. Multiple myeloma was considered as the cause of EM’s constellation of symptoms, so a serum protein electrophoresis was performed, revealing an IgA monoclonal protein spike. Free light chain analysis showed an increase in free kappa light chains (7.69 mg/L) with a markedly elevated kappa/lambda ratio of 157.5.","PeriodicalId":293977,"journal":{"name":"Dalhousie Medical Journal","volume":"87 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132457799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-11-21DOI: 10.15273/DMJ.VOL43NO1.6875
Carley Langley, K. Jangaard
Objectives: (1) To describe differences in newborn outcomes with respect to hospital of birth, place of maternal residence, and time epoch for infants born in Nova Scotia between 1988 and 2012. (2) To examine the possible impacts that regionalization of maternal newborn health services between 1988 and 2012 have had on neonatal mortality rates in Nova Scotia. Methods: Data on all infants delivered in Nova Scotia between January 1, 1988 and December 31, 2012 was extracted from the Nova Scotia Perinatal Atlee Database. Infant perinatal mortality and neonatal morbidity rates were calculated in 5-year time epochs and examined by delivery hospital classification (community, regional or tertiary), and maternal driving distance from hospital. Trends by epoch, delivery hospital and driving distance were examined. Results: From 1988 to 2012 perinatal mortality rates per 1000 for all births improved at both regional (from 9.8 to 5.7/1000) and tertiary hospitals (from 12.3 to 8.1/1000). Perinatal mortality rates for low risk births remained low and did not change significantly during this time period. Overall, neonatal morbidity rates fell across the province. Neonatal outcomes did not vary with increasing maternal distance from obstetrical services. Conclusions: Overall, infant perinatal morbidity and mortality outcomes have improved in Nova Scotia between 1988 and 2012. Regionalization of obstetrical care may have played a role in improving neonatal mortality rates among high-risk births. Increasing rural maternal isolation from obstetrical services did not impact infant perinatal mortality and morbidity outcomes when services remained available regionally.
{"title":"Neonatal outcomes by hospital of birth in Nova Scotia between 1988 and 2012: improvements in mortality and morbidity","authors":"Carley Langley, K. Jangaard","doi":"10.15273/DMJ.VOL43NO1.6875","DOIUrl":"https://doi.org/10.15273/DMJ.VOL43NO1.6875","url":null,"abstract":"Objectives: (1) To describe differences in newborn outcomes with respect to hospital of birth, place of maternal residence, and time epoch for infants born in Nova Scotia between 1988 and 2012. (2) To examine the possible impacts that regionalization of maternal newborn health services between 1988 and 2012 have had on neonatal mortality rates in Nova Scotia. Methods: Data on all infants delivered in Nova Scotia between January 1, 1988 and December 31, 2012 was extracted from the Nova Scotia Perinatal Atlee Database. Infant perinatal mortality and neonatal morbidity rates were calculated in 5-year time epochs and examined by delivery hospital classification (community, regional or tertiary), and maternal driving distance from hospital. Trends by epoch, delivery hospital and driving distance were examined. Results: From 1988 to 2012 perinatal mortality rates per 1000 for all births improved at both regional (from 9.8 to 5.7/1000) and tertiary hospitals (from 12.3 to 8.1/1000). Perinatal mortality rates for low risk births remained low and did not change significantly during this time period. Overall, neonatal morbidity rates fell across the province. Neonatal outcomes did not vary with increasing maternal distance from obstetrical services. Conclusions: Overall, infant perinatal morbidity and mortality outcomes have improved in Nova Scotia between 1988 and 2012. Regionalization of obstetrical care may have played a role in improving neonatal mortality rates among high-risk births. Increasing rural maternal isolation from obstetrical services did not impact infant perinatal mortality and morbidity outcomes when services remained available regionally.","PeriodicalId":293977,"journal":{"name":"Dalhousie Medical Journal","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114619275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-11-21DOI: 10.15273/DMJ.VOL43NO1.6869
H. McFadgen, P. Bonnar, I. Davis
In Canada, meningitis is a rare manifestation of Mycobacterium tuberculosis infection. Additionally, a microbiological diagnosis can be difficult because of low sensitivity of mycobacterial tests of cerebrospinal fluid specimens. The typical presentation of meningitis is in the form of subacute meningitis, which is life threatening in the absence of appropriate treatment. Therefore, a high index of suspicion must be maintained. We report a case of tuberculous meningitis highlighting the presentation, workup, and treatment of this serious infection. This report highlights the challenges in identifying cases and establishing a timely diagnosis. Close monitoring of the patient and collecting multiple cerebrospinal fluid samples can improve sensitivity.
{"title":"A case of tuberculous meningitis","authors":"H. McFadgen, P. Bonnar, I. Davis","doi":"10.15273/DMJ.VOL43NO1.6869","DOIUrl":"https://doi.org/10.15273/DMJ.VOL43NO1.6869","url":null,"abstract":"In Canada, meningitis is a rare manifestation of Mycobacterium tuberculosis infection. Additionally, a microbiological diagnosis can be difficult because of low sensitivity of mycobacterial tests of cerebrospinal fluid specimens. The typical presentation of meningitis is in the form of subacute meningitis, which is life threatening in the absence of appropriate treatment. Therefore, a high index of suspicion must be maintained. We report a case of tuberculous meningitis highlighting the presentation, workup, and treatment of this serious infection. This report highlights the challenges in identifying cases and establishing a timely diagnosis. Close monitoring of the patient and collecting multiple cerebrospinal fluid samples can improve sensitivity.","PeriodicalId":293977,"journal":{"name":"Dalhousie Medical Journal","volume":"60 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2016-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127147405","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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