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   Table of Contents - Current issue
October-December 2021
Volume 26 | Issue 4
Page Nos. 147-196

Online since Wednesday, October 6, 2021

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Under the Hood p. 147
Peter Hutten-Czapski
DOI:10.4103/cjrm.cjrm_50_21  PMID:34643550
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Sous le capot p. 148
Peter Hutten-Czapski
DOI:10.4103/1203-7796.327579  PMID:34643551
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President's message. Rural Advocacy p. 149
Gabe Woollam
DOI:10.4103/cjrm.cjrm_49_21  PMID:34643552
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Message du président. Promotion Rurale p. 150
Gabe Woollam
DOI:10.4103/1203-7796.327577  PMID:34643553
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Patient satisfaction with a pharmacist-led best possible medication discharge plan via tele-robot in a remote and rural community hospital p. 151
Paula Newman, Sammu Dhaliwall, Satvir Bains, Olena Polyakova, Kevin McDonald
DOI:10.4103/cjrm.cjrm_74_20  PMID:34643554
Introduction: Medication reconciliation (MedRec) reduces the risk of preventable medication-related adverse events (ADEs). A best possible medication discharge plan (BPMDP) is a revised list of medications a patient will take when discharged from hospital; a pharmacist review ensures accuracy. For many hospitals, on-site pharmacists are non-existent. Extension of a visual presence via a mobile robotic platform with real-time audiovisual communication by pharmacists to conduct MedRec remains unstudied. This study explored patient perceptions of a pharmacist-led BPMDP using a telepresence robot. Time requirements, unintentional discharge medication discrepancies (UMD), programme inefficiencies/barriers and facilitators involved in pharmacist review of the discharge medication list and patient interviews were also described. Methods: This prospective cohort study enrolled adult patients admitted to a 12-bed community hospital at high risk of an ADE. Remote pharmacists reviewed the discharge prescription list, identified/resolved UMDs, and interviewed/counselled patients using a telepresence robot. Thereafter, patients completed an anonymous satisfaction questionnaire. Prescriber discharge UMDs were classified, and barriers/inefficiencies and facilitators were documented. Results: Nine patients completed an interview, with a 75% interview agreement rate. All patients were comfortable with the robot and 76% felt their care was better. With a median of 11 discharge medications/patient, the UMD rate was 78%; 71% had omitted medications, 43% involved a cardiovascular medication, 88% were due to a hospital system cause, and 43% were specifically due to an inaccurate best possible admission medication history. Median times for interview preparation, interview and UMD/drug therapy problem resolution were 45, 15 and 10 min, respectively. Conclusion: Using a telepresence robot to provide pharmacist-led BPMDPs is acceptable to patients and an innovative, effective solution to identify/resolve UMDs.
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The prevalence and patterns of use of point-of-care ultrasound in Newfoundland and Labrador p. 160
Gillian Sheppard, Augustine Joshua Devasahayam, Craig Campbell, Maisam Najafizada, Yanqing Yi, Amanda Power
DOI:10.4103/cjrm.cjrm_61_20  PMID:34643555
Introduction: Point-of-care ultrasound (POCUS) is used for diagnostic and procedural guidance by physicians in Newfoundland and Labrador (NL). POCUS use is largely limited to urban locations and the training is variable amongst physicians. The primary aim of this study was to determine the prevalence of POCUS devices in NL and the secondary aim was to characterise the patterns of POCUS use amongst physicians in NL. Methods: This is a mixed-methods cross-sectional study. We determined the prevalence of POCUS devices from purchase records and the patterns of POCUS use through theme-based interviews. The interviews were transcribed, coded and analysed using standardised qualitative methods. Results: Ten physicians (3 females, 5 rural) participated in the interviews. The overall prevalence of POCUS devices in NL was 12.5/100,000 population. Participants in urban areas had more access to POCUS training and devices. Participants used POCUS on a daily or weekly basis to rule in or out life-threatening conditions and improve access to specialist care. The benefits of POCUS included expedited investigations, decreased radiation and increased patient satisfaction. The barriers to using POCUS were lack of training, time, devices, image archiving software, difficulty generating and interpreting images and patient body habitus. Conclusion: This is the first study to our knowledge to report the prevalence of POCUS devices in Canada. Physicians who practise in rural NL have limited access to POCUS devices and have identified barriers to POCUS training. Connecting physicians in rural areas with POCUS experts through a province-wide POCUS network may address these barriers and improve healthcare access.
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Building point-of-care ultrasound capacity in rural emergency departments: An educational innovation p. 169
Kathryn Young, Nicole Moon, Tandi Wilkinson
DOI:10.4103/cjrm.cjrm_65_20  PMID:34643556
Introduction: Point-of-care ultrasound (POCUS) use is the standard of care in emergency medicine (EM), but rural physicians face barriers to obtaining and retaining this skill and cite low confidence in their use of POCUS. Without access to high-quality educational opportunities, this important clinical tool may not be used to its full potential in rural hospitals. The Hands-On Ultrasound Education (HOUSE) programme, launched in 2015 by the University of British Columbia's (BC) Division of Rural Continuing Professional Development, is a rurally focused POCUS training and education programme that travels to rural and remote communities and aims to build a rural POCUS community of practice within BC. In this study, we present and evaluate the HOUSE programme. Methods: The HOUSE programme is described. A comprehensive qualitative evaluation of semi-structured interviews pertaining to HOUSE was conducted in the 4th year of the programme to assess participant experience and programme outcomes. Results: Results from 52 semi-structured interviews indicate that there is a significant increase in self-reported confidence on specific POCUS applications and increased POCUS use after completion of the course, and we report positive experiences with the HOUSE programme. Conclusion: By providing a customizable, accessible, hands-on training opportunity, the HOUSE programme removes barriers to POCUS training and education for physicians in rural and remote BC. The rurally focused elements have contributed to education for rural participants that demonstrates increased confidence and the use of POCUS as a clinical tool.
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Evaluation of a pilot rural mentorship programme for and by pre-clerkship medical students p. 176
Jasmine Waslowski, Morag Paton, Mary Freymond, Sagar Patel, Tristan Brownrigg, Shelby Olesovsky, Joyce Nyhof-Young
DOI:10.4103/cjrm.cjrm_82_20  PMID:34643557
Introduction: While medical school interventions can help address rural physician shortages, many urban Canadian medical students lack exposure to rural medicine. The Rural Mentorship Programme (RMP) is a 4-month pilot initiative designed by medical students to bridge this gap by pairing preclerkship medical students at an urban medical school with rural physician mentors to provide exposure to rural careers. Methods: A realist-influenced methodology evaluated perceived benefits and challenges of RMP, assessed how RMP influenced mentee perceptions and intentions towards rural careers, and investigated factors leading to success. Quantitative and qualitative data were collected through evaluative pre-, post-, and 4-month post intervention surveys, mentor interviews and a mentee focus group. Likert scales assessed satisfaction, attainment of objectives and mentee changes in perceptions and intentions. Results: 18/23 mentees and 11/15 mentors completed at least 1 survey; 5 mentees joined the focus group and 3 mentors were interviewed. Most mentees were of non-rural backgrounds and initially neutral about pursuing rural practice. RMP helped mentees better understand rural careers. They especially valued the mandatory community clinical visit and forming relationships with mentors. Mentors enjoyed teaching, reflecting on their careers and demonstrating the merits of rural practice. Transportation and scheduling were major programme challenges. Conclusions: This pilot suggests that structured mentorship programmes can improve understanding of, and provide exposure to, careers in rural medicine for urban medical students. Results will inform future programme development.
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The occasional dental fracture p. 186
Madison Van Dusen, Peter Hutten-Czapski, Sarah M Giles
DOI:10.4103/cjrm.cjrm_79_20  PMID:34643558
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Business as usual p. 192
Kyle William Carter
DOI:10.4103/cjrm.cjrm_78_20  PMID:34643559
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Intravenous iron therapy in a rural hospital p. 194
Beuy Joob, Viroj Wiwanitki
DOI:10.4103/cjrm.cjrm_44_21  PMID:34643560
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Erratum: The occasional maternal cardiac arrest p. 196

DOI:10.4103/1203-7796.327586  PMID:34643561
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