Pub Date : 2024-10-01Epub Date: 2024-11-12DOI: 10.4103/cjrm.cjrm_43_23
Tayler Young, Sarah M Giles
{"title":"The Occasional tooth avulsion.","authors":"Tayler Young, Sarah M Giles","doi":"10.4103/cjrm.cjrm_43_23","DOIUrl":"https://doi.org/10.4103/cjrm.cjrm_43_23","url":null,"abstract":"","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"29 4","pages":"177-182"},"PeriodicalIF":0.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630192","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 : 2024-10-01Epub Date: 2024-11-12DOI: 10.4103/cjrm.cjrm_73_24
Gavin Gerard Parker
{"title":"Message du President: Les Relations.","authors":"Gavin Gerard Parker","doi":"10.4103/cjrm.cjrm_73_24","DOIUrl":"https://doi.org/10.4103/cjrm.cjrm_73_24","url":null,"abstract":"","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"29 4","pages":"154"},"PeriodicalIF":0.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630172","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 : 2024-10-01Epub Date: 2024-11-12DOI: 10.4103/cjrm.cjrm_59_23
Rebecca M Afford, Sara D Bolin, Madeleine E Armstrong, Tracy M Scott, Ahmer A Karimuddin
<p><strong>Introduction: </strong>For general surgeons practising in rural areas, multiple factors influence care beyond skills learned in residency. The British Columbia Privileging Dictionary (BCPD) defines core and non-core procedures that shape the scope of general surgeons. Moreover, the Royal College has adopted a Competence by Design (CBD) curriculum which employs entrustable professional activities (EPAs) that list surgical skill residents must be proficient in by graduation. Our goal is to understand the current practice patterns of rural general surgeons in BC based on these policies and local factors.</p><p><strong>Methods: </strong>Medical service plan (MSP) data were collected from 2011 to 2021 based on general surgeons working in rural subsidiary agreement (RSA) communities. The MSP fee codes were organised into core or non-core procedures, as outlined by the BCPD. EPAs were assessed and compared to the non-core procedures.</p><p><strong>Results: </strong>From 2011 to 2021, 223,103 procedures were performed in rural sites in BC. On average, 90.97% (standard deviation = 20.78) of procedures done in all communities were BCPD core procedures. The most common non-core surgical care performed by general surgeons was in plastic surgery (n = 8035). Over 8% of procedures performed were not general surgery EPAs. Notably, none of the EPAs are considered non-core privileges and all EPAs have been performed in rural settings.</p><p><strong>Conclusion: </strong>General surgeons working in rural settings perform multiple procedures outside of EPAs which account for over 8% of their caseload and approximately 6% of procedures performed are non-core privileges. This provides some insight into the potential limitations of the BCPD on graduates hoping to practise in rural communities. As the CBD curriculum has been reported to provide a more flexible approach to learning, it may be tailored to suit residents' learning and career goals, including varied surgical skills to suit rural needs.</p><p><strong>Introduction: </strong>Pour les chirurgiens généraux exerçant en zone rurale, de multiples facteurs influencent les soins, et ce au-delà des compétences acquises en résidence. Le British Columbia Privileging Dictionary (BCPD) définit les procédures essentielles et non essentielles qui déterminent le champ d'action des chirurgiens généraux. En outre, le Collège royal a adopté un programme d'études intitulé « La compétence par conception » (CPC) qui utilise des activités professionnelles confiables (APC) qui énumèrent les compétences chirurgicales que les résidents doivent maîtriser avant d'obtenir leur diplôme. Notre objectif est de comprendre les modes de pratique actuels des chirurgiens généralistes ruraux en Colombie-Britannique en fonction de ces politiques et des facteurs locaux.</p><p><strong>Mthodes: </strong>Les données du Medical Service Plan (MSP, Plan de service médical) ont été recueillies entre 2011 et 2021 auprès des chirurgiens généralist
{"title":"Preparing general surgery residents for rural practice in British Columbia: Competencies, privileging and geography.","authors":"Rebecca M Afford, Sara D Bolin, Madeleine E Armstrong, Tracy M Scott, Ahmer A Karimuddin","doi":"10.4103/cjrm.cjrm_59_23","DOIUrl":"https://doi.org/10.4103/cjrm.cjrm_59_23","url":null,"abstract":"<p><strong>Introduction: </strong>For general surgeons practising in rural areas, multiple factors influence care beyond skills learned in residency. The British Columbia Privileging Dictionary (BCPD) defines core and non-core procedures that shape the scope of general surgeons. Moreover, the Royal College has adopted a Competence by Design (CBD) curriculum which employs entrustable professional activities (EPAs) that list surgical skill residents must be proficient in by graduation. Our goal is to understand the current practice patterns of rural general surgeons in BC based on these policies and local factors.</p><p><strong>Methods: </strong>Medical service plan (MSP) data were collected from 2011 to 2021 based on general surgeons working in rural subsidiary agreement (RSA) communities. The MSP fee codes were organised into core or non-core procedures, as outlined by the BCPD. EPAs were assessed and compared to the non-core procedures.</p><p><strong>Results: </strong>From 2011 to 2021, 223,103 procedures were performed in rural sites in BC. On average, 90.97% (standard deviation = 20.78) of procedures done in all communities were BCPD core procedures. The most common non-core surgical care performed by general surgeons was in plastic surgery (n = 8035). Over 8% of procedures performed were not general surgery EPAs. Notably, none of the EPAs are considered non-core privileges and all EPAs have been performed in rural settings.</p><p><strong>Conclusion: </strong>General surgeons working in rural settings perform multiple procedures outside of EPAs which account for over 8% of their caseload and approximately 6% of procedures performed are non-core privileges. This provides some insight into the potential limitations of the BCPD on graduates hoping to practise in rural communities. As the CBD curriculum has been reported to provide a more flexible approach to learning, it may be tailored to suit residents' learning and career goals, including varied surgical skills to suit rural needs.</p><p><strong>Introduction: </strong>Pour les chirurgiens généraux exerçant en zone rurale, de multiples facteurs influencent les soins, et ce au-delà des compétences acquises en résidence. Le British Columbia Privileging Dictionary (BCPD) définit les procédures essentielles et non essentielles qui déterminent le champ d'action des chirurgiens généraux. En outre, le Collège royal a adopté un programme d'études intitulé « La compétence par conception » (CPC) qui utilise des activités professionnelles confiables (APC) qui énumèrent les compétences chirurgicales que les résidents doivent maîtriser avant d'obtenir leur diplôme. Notre objectif est de comprendre les modes de pratique actuels des chirurgiens généralistes ruraux en Colombie-Britannique en fonction de ces politiques et des facteurs locaux.</p><p><strong>Mthodes: </strong>Les données du Medical Service Plan (MSP, Plan de service médical) ont été recueillies entre 2011 et 2021 auprès des chirurgiens généralist","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"29 4","pages":"155-166"},"PeriodicalIF":0.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630175","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 : 2024-10-01Epub Date: 2024-11-12DOI: 10.4103/cjrm.cjrm_14_24
Gavin Bahadur, Lewis Macdonald, Shawn Lin, Cynthia Boxrud, Ralph Crew
<p><strong>Introduction: </strong>We sought to streamline cataract surgery post-operative care when COVID-19 hit by discontinuing the 1-day post-operative visit. We wanted to know if this change was safe and beneficial to our patients by reducing patients' time and transportation burden, opening appointment slots allowing providers to see more patients and reducing greenhouse gas emissions. By minimising intraoperative use of dispersive viscoelastic, increasing irrigation/aspiration time at the end of the surgery and using intraocular pressure (IOP) lowering medications such as carbachol, brimonidine and acetazolamide routinely, we posit that post-operative day 1 IOP spikes can be avoided, thereby eliminating the need for the 1st post-operative day visit. We also sought to show the positive environmental impact of eliminating that 1st day.</p><p><strong>Methods: </strong>We retrospectively reviewed cataract surgeries performed before COVID-19 to determine the incidence of serious pathology discovered at the post-operative day 1 visit. Subsequently, we examined all the cataract surgeries performed in 2023 by our practice.</p><p><strong>Results: </strong>One hundred and ninety-three cataract surgeries performed before COVID-19 and 832 performed in 2023 were reviewed. We found that the post-operative day 1 visit after cataract surgery is unnecessary in most routine uncomplicated cases.</p><p><strong>Conclusion: </strong>By eliminating hundreds of post-operative day 1 visits for a busy rural practice annually, patients, their friends and relatives are spared an extra trip to the office (that can be 100 km each way), the office schedule is open to accommodate more patients, and the patients' carbon footprint of travel to the office is reduced.</p><p><strong>Introduction: </strong>Nous avons cherché à rationaliser les soins postopératoires de la chirurgie de la cataracte lors de l'arrivée de la Covid en supprimant la visite postopératoire d'un jour. Nous voulions savoir si ce changement était sécuritaire et bénéfique pour nos patients en réduisant le temps et la charge de transport des patients, en ouvrant des créneaux de rendez-vous permettant aux prestataires de voir plus de patients et en réduisant les émissions de gaz à effet de serre. En minimisant l'utilisation peropératoire de viscoélastique dispersif, en augmentant le temps d'irrigation/aspiration à la fin de l'opération et en utilisant systématiquement des médicaments abaissant la PIO, tels que le carbachol, la brimonidine et l'acétazolamide, nous pensons que les PIO postopératoire du premier jour peuvent être évitées, éliminant ainsi la nécessité d'une première visite de jour postopératoire. Nous avons également cherché à démontrer l'impact environnemental positif de l'élimination de ce premier jour.</p><p><strong>Mthodes: </strong>Nous avons examiné rétrospectivement opérations de la cataracte réalisées avant la Covid afin de déterminer l'incidence des pathologies graves découvertes lors de
{"title":"Advantages of eliminating the cataract surgery post-operative day 1 appointment in a rural practice.","authors":"Gavin Bahadur, Lewis Macdonald, Shawn Lin, Cynthia Boxrud, Ralph Crew","doi":"10.4103/cjrm.cjrm_14_24","DOIUrl":"https://doi.org/10.4103/cjrm.cjrm_14_24","url":null,"abstract":"<p><strong>Introduction: </strong>We sought to streamline cataract surgery post-operative care when COVID-19 hit by discontinuing the 1-day post-operative visit. We wanted to know if this change was safe and beneficial to our patients by reducing patients' time and transportation burden, opening appointment slots allowing providers to see more patients and reducing greenhouse gas emissions. By minimising intraoperative use of dispersive viscoelastic, increasing irrigation/aspiration time at the end of the surgery and using intraocular pressure (IOP) lowering medications such as carbachol, brimonidine and acetazolamide routinely, we posit that post-operative day 1 IOP spikes can be avoided, thereby eliminating the need for the 1st post-operative day visit. We also sought to show the positive environmental impact of eliminating that 1st day.</p><p><strong>Methods: </strong>We retrospectively reviewed cataract surgeries performed before COVID-19 to determine the incidence of serious pathology discovered at the post-operative day 1 visit. Subsequently, we examined all the cataract surgeries performed in 2023 by our practice.</p><p><strong>Results: </strong>One hundred and ninety-three cataract surgeries performed before COVID-19 and 832 performed in 2023 were reviewed. We found that the post-operative day 1 visit after cataract surgery is unnecessary in most routine uncomplicated cases.</p><p><strong>Conclusion: </strong>By eliminating hundreds of post-operative day 1 visits for a busy rural practice annually, patients, their friends and relatives are spared an extra trip to the office (that can be 100 km each way), the office schedule is open to accommodate more patients, and the patients' carbon footprint of travel to the office is reduced.</p><p><strong>Introduction: </strong>Nous avons cherché à rationaliser les soins postopératoires de la chirurgie de la cataracte lors de l'arrivée de la Covid en supprimant la visite postopératoire d'un jour. Nous voulions savoir si ce changement était sécuritaire et bénéfique pour nos patients en réduisant le temps et la charge de transport des patients, en ouvrant des créneaux de rendez-vous permettant aux prestataires de voir plus de patients et en réduisant les émissions de gaz à effet de serre. En minimisant l'utilisation peropératoire de viscoélastique dispersif, en augmentant le temps d'irrigation/aspiration à la fin de l'opération et en utilisant systématiquement des médicaments abaissant la PIO, tels que le carbachol, la brimonidine et l'acétazolamide, nous pensons que les PIO postopératoire du premier jour peuvent être évitées, éliminant ainsi la nécessité d'une première visite de jour postopératoire. Nous avons également cherché à démontrer l'impact environnemental positif de l'élimination de ce premier jour.</p><p><strong>Mthodes: </strong>Nous avons examiné rétrospectivement opérations de la cataracte réalisées avant la Covid afin de déterminer l'incidence des pathologies graves découvertes lors de ","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"29 4","pages":"173-176"},"PeriodicalIF":0.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142636143","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 : 2024-10-01Epub Date: 2024-11-12DOI: 10.4103/cjrm.cjrm_1_24
Matthew D Lavery, Rylen A Williamson, Jason Curran, July Wilkey, Kirk McCarroll
<p><strong>Introduction: </strong>We sought to determine the difference between Canadian CT Head Rule (CCHR) indicated imaging rates and actual imaging rates for patients with mild traumatic brain injuries (mTBIs) at a rural emergency department (ED) without in-house computed tomography (CT). In addition, we compared CCHR adherence at a hospital without CT to previous publications from centres with CT to determine if rural populations receive less CT imaging for minor head traumas when indicated by the CCHR.</p><p><strong>Methods: </strong>This retrospective chart review explored individuals who presented to a rural ED (no in-house CT scanner) with a primary diagnosis of mild head injury or concussion between 1 January 2017 and 31 December 2021. Information regarding CCHR criteria, transfer status and patient demographics was collected. Descriptive analyses were completed to determine the percentage of patients who received appropriate transfer for imaging, did not receive transfer for imaging when indicated and received unnecessary transfer.</p><p><strong>Results: </strong>A total of 124 charts met our inclusion criteria (17 [12.1%] charts excluded), with 25.8% transferred to the nearest hospital for CT imaging. After applying the CCHR criteria to our charts, 62.1% were indicated for CT. Of the 62.1%, only 35.1% were transferred for imaging (51.2% of high-risk and 16.7% of medium-risk).</p><p><strong>Conclusion: </strong>By exploring CT rates for mTBIs in a rural Canadian ED, we found low transfer rates (35.1%) of CCHR-indicated patients for imaging needed to guide further healthcare decisions. This work highlights a discrepancy within the Canadian healthcare system between rural and urban centres and allows for opportunities to help narrow the gap in health care.</p><p><strong>Introduction: </strong>Nous avons cherché à déterminer la différence entre les taux d'imagerie indiqués par le Canadian CT Head Rule (CCHR, règlement canadien relatif à la tomodensitométrie de la tête) et les taux d'imagerie réels pour les patients souffrant de traumatismes craniocérébraux légers (TCCL) dans un service d'urgence rural ne disposant pas d'une tomographie par ordinateur interne. En outre, nous avons comparé l'adhésion au CCHR dans un hôpital sans tomographie par ordinateur à des publications antérieures provenant de centres avec tomographie par ordinateur afin de déterminer si les populations rurales reçoivent moins d'imagerie par tomodensitométrie pour les traumatismes crâniens mineurs lorsque le CCHR l'indique.</p><p><strong>Mthodes: </strong>Cette étude rétrospective des dossiers a exploré les personnes qui SE sont présentées à une urgence rurale (sans tomodensitomètre interne) avec un diagnostic primaire de traumatisme crânien léger ou de commotion cérébrale entre le 1er janvier 2017 et le 31 décembre 2021. Les informations concernant les critères du CCHR, l'état de transfert et les données démographiques des patients ont été recueillies. Des analyses de
{"title":"Canadian CT head rule adherence in a rural hospital without in-house computed tomography.","authors":"Matthew D Lavery, Rylen A Williamson, Jason Curran, July Wilkey, Kirk McCarroll","doi":"10.4103/cjrm.cjrm_1_24","DOIUrl":"https://doi.org/10.4103/cjrm.cjrm_1_24","url":null,"abstract":"<p><strong>Introduction: </strong>We sought to determine the difference between Canadian CT Head Rule (CCHR) indicated imaging rates and actual imaging rates for patients with mild traumatic brain injuries (mTBIs) at a rural emergency department (ED) without in-house computed tomography (CT). In addition, we compared CCHR adherence at a hospital without CT to previous publications from centres with CT to determine if rural populations receive less CT imaging for minor head traumas when indicated by the CCHR.</p><p><strong>Methods: </strong>This retrospective chart review explored individuals who presented to a rural ED (no in-house CT scanner) with a primary diagnosis of mild head injury or concussion between 1 January 2017 and 31 December 2021. Information regarding CCHR criteria, transfer status and patient demographics was collected. Descriptive analyses were completed to determine the percentage of patients who received appropriate transfer for imaging, did not receive transfer for imaging when indicated and received unnecessary transfer.</p><p><strong>Results: </strong>A total of 124 charts met our inclusion criteria (17 [12.1%] charts excluded), with 25.8% transferred to the nearest hospital for CT imaging. After applying the CCHR criteria to our charts, 62.1% were indicated for CT. Of the 62.1%, only 35.1% were transferred for imaging (51.2% of high-risk and 16.7% of medium-risk).</p><p><strong>Conclusion: </strong>By exploring CT rates for mTBIs in a rural Canadian ED, we found low transfer rates (35.1%) of CCHR-indicated patients for imaging needed to guide further healthcare decisions. This work highlights a discrepancy within the Canadian healthcare system between rural and urban centres and allows for opportunities to help narrow the gap in health care.</p><p><strong>Introduction: </strong>Nous avons cherché à déterminer la différence entre les taux d'imagerie indiqués par le Canadian CT Head Rule (CCHR, règlement canadien relatif à la tomodensitométrie de la tête) et les taux d'imagerie réels pour les patients souffrant de traumatismes craniocérébraux légers (TCCL) dans un service d'urgence rural ne disposant pas d'une tomographie par ordinateur interne. En outre, nous avons comparé l'adhésion au CCHR dans un hôpital sans tomographie par ordinateur à des publications antérieures provenant de centres avec tomographie par ordinateur afin de déterminer si les populations rurales reçoivent moins d'imagerie par tomodensitométrie pour les traumatismes crâniens mineurs lorsque le CCHR l'indique.</p><p><strong>Mthodes: </strong>Cette étude rétrospective des dossiers a exploré les personnes qui SE sont présentées à une urgence rurale (sans tomodensitomètre interne) avec un diagnostic primaire de traumatisme crânien léger ou de commotion cérébrale entre le 1er janvier 2017 et le 31 décembre 2021. Les informations concernant les critères du CCHR, l'état de transfert et les données démographiques des patients ont été recueillies. Des analyses de","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"29 4","pages":"167-172"},"PeriodicalIF":0.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142636145","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 : 2024-10-01Epub Date: 2024-11-12DOI: 10.4103/cjrm.cjrm_72_24
Peter Hutten-Czapski
{"title":"À la défense de la 'non-adhésion' aux directives.","authors":"Peter Hutten-Czapski","doi":"10.4103/cjrm.cjrm_72_24","DOIUrl":"https://doi.org/10.4103/cjrm.cjrm_72_24","url":null,"abstract":"","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"29 4","pages":"152"},"PeriodicalIF":0.7,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142636141","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：