Declining Clinical Autopsy Rates Versus Increasing Medicolegal Autopsy Rates in Halifax, Nova Scotia

2001 ◽  
Vol 125 (7) ◽  
pp. 924-930 ◽  
Author(s):  
Marnie J. Wood ◽  
Ashim K. Guha
Keyword(s):  
Nova Scotia ◽  
Retrospective Review ◽  
Health Sciences ◽  
Downward Trend ◽  
Medical Examiner ◽  
Autopsy Rate ◽  
Autopsy Data ◽  
Medicolegal Autopsy ◽  
Over Time

Abstract The downward trend in the rate of clinical autopsies has been extensively documented in the literature. This decline is of concern when the benefits of the clinical autopsy are considered. In contrast, the rate of medicolegal autopsies has not been studied in such detail. What little reference there is to medicolegal autopsy rates suggests an absence of the same downward trend. A retrospective review of autopsy data over a 13-year period from the Queen Elizabeth II Health Sciences Centre in Halifax, Nova Scotia, and from the Office of the Chief Medical Examiner of Nova Scotia was conducted. This review showed a difference between the rates of clinical and medicolegal autopsies for the metro Halifax area. The clinical autopsy rate was consistently less than 30% and declined to 15% in 1999, while the medicolegal autopsy rate was consistently greater than 40% and rose to 62% in 1999. The literature proposes many reasons for the decline in the clinical autopsy rate, but none for this difference between rates. The explanation proposed here is the changing and currently uncertain purpose of the clinical autopsy versus the clear, and consistent over time, purpose of the medicolegal autopsy.

A History of Interprofessional Education and Assessment at WesternU

2020 ◽  
pp. 286-310
Author(s):  
David N. Dickter ◽  
Daniel C. Robinson
Keyword(s):  
Interprofessional Education ◽  
Growth And Development ◽  
The United States ◽  
Health Sciences ◽  
Early History ◽  
Patient Centered ◽  
Education Practice ◽  
History Of ◽  
The U.S ◽  
Over Time

This chapter traces the early history and progress of a pioneering interprofessional practice and education (IPE) program at Western University of Health Sciences (WesternU), whose growth and development can be viewed in the context of the broader IPE field, that of a nascent movement within the United States to recognize and facilitate collaborative, patient-centered healthcare. This chapter provides some of the background and details from the early design years at WesternU. The IPE movement in the U.S. worked with general principles and broad conceptual outcomes such as safety and quality but it took time to delineate more specific guidelines and practices. Over the years, frameworks and standards for education, practice, and outcomes assessment have developed that have helped to guide the program. Similarly, WesternU has developed and refined its education and assessment methods over time.

A Review of Black Widow (Araneae: Theridiidae) Envenomation, Epidemiology, and Antivenom Utilization in Canada

2020 ◽  
Author(s):  
Gwynn Curran-Sills ◽  
Steven M Wilson ◽  
Robb Bennett
Keyword(s):  
British Columbia ◽  
Nova Scotia ◽  
Geographical Distribution ◽  
Retrospective Review ◽  
Black Widow ◽  
Latrodectus Hesperus ◽  
Average Patient ◽  
Health Canada ◽  
Access Program ◽  
Widow Spider

Abstract Two species of black widow spider (BWS—Latrodectus hesperus Chamberlin & Ivie and Latrodectus variolus Walckenaer) naturally occur in Canada and are capable of causing deleterious envenomation to humans. No Canadian literature exists on the frequency of envenomations by these species or the use of antivenom in the treatment of those patients. A review of primary Canadian arachnology data was undertaken to identify BWS populations. A retrospective review of the Health Canada Special Access Program records generated epidemiology and the utilization of antivenom for BWS envenomations in Canada. The geographical distribution of BWS species is limited to along the southern Canadian border. From January 2009 to December 2015, there were five BWS envenomations that required treatment with antivenom and all cases occurred in British Columbia. An average patient age of 41 yr ± 21 SD (range 7–59) was observed, along with three of the five patients being female. The average number of vials used for treatment was 2 ± 1 SD (range 1–3). BWS Antivenin was also obtained by facilities in Alberta, Ontario, and Nova Scotia, but not used in any of these jurisdictions. Further investigation is necessary to determine the annual incidence of BWS envenomations and if treatment with BWS antivenin is required.

Declining Trust in Congress: Effects of Polarization and Consequences for Democracy

The Forum ◽  
2015 ◽  
Vol 13 (3) ◽  
Author(s):  
David R. Jones
Keyword(s):  
Public Trust ◽  
Downward Trend ◽  
Trust In Government ◽  
Political Consequences ◽  
Party Polarization ◽  
Dramatic Decline ◽  
Legislative Branch ◽  
Trends Over Time ◽  
Over Time

AbstractWhy has Congress, once a widely trusted institution, experienced such a uniquely dramatic decline in the public’s confidence, and what are the consequences for democracy? This article sets out to systematically address these questions. First, I discuss how we can gauge Americans’ levels of trust in Congress. Second, I examine trends over time in public trust in Congress, looking both partisan differences within this measure, and also overall differences in comparison to other institutions. Third, I examine various ways in which the much-noted rise in party polarization in Congress might explain the downward trend in Americans’ trust in that institution. Finally, I explore one potentially important consequence of declining trust in the legislative branch: Americans’ willingness to obey laws. The results suggest that those interested in the problem of declining trust in government would be wise to focus their attention on Congress. Compared to other institutions, the problem in Congress appears more severe, more intractable, and carries greater political consequences.

scholarly journals Radiographic predictors of deterioration in patients with lumbosacral lipomas

2016 ◽  
Vol 18 (2) ◽  
pp. 171-176 ◽  
Author(s):  
Albert Tu ◽  
Alexander R. Hengel ◽  
D. Douglas Cochrane
Keyword(s):  
Retrospective Review ◽  
Surgical Intervention ◽  
Clinical History ◽  
Motor Dysfunction ◽  
Clinical Deterioration ◽  
Prophylactic Surgery ◽  
Motor Deficits ◽  
Imaging Results ◽  
Early Surgical Intervention ◽  
Over Time

OBJECTIVE Although patients with lumbosacral lipomas may be asymptomatic at presentation, most develop neurological symptoms over time. Given the challenges in examining infants, the authors sought to determine whether MRI would be helpful in identifying patients who are more likely to deteriorate early in life and who would potentially benefit from early surgical intervention. METHODS A retrospective review of all patients with lumbosacral lipomas who were seen at the authors' institution between 1997 and 2013 and who were managed without prophylactic surgery was performed. The clinical history and imaging results for each patient were reviewed in detail and then correlated to the pattern of and age at clinical deterioration. RESULTS Twenty-four patients were identified. Nine worsened within the first 18 months of life (early deterioration), and 15 patients deteriorated or remained stable after 30 months (late deterioration/stable). No patients worsened between 18 and 30 months of age. Patients who deteriorated early were more likely to have large intradural lipomas that filled the canal, increased during the 1st year of life, and compressed neurological structures. Some had a syrinx extending above the neural-lipoma interface. Syrinxes in patients with early deterioration were large and expanded in infancy. Patients with early deterioration had motor deficits at the time of deterioration, whereas patients with late deterioration developed mixed urological and motor dysfunction. CONCLUSIONS Patients with large lipomas displacing the cord and an enlarging syrinx have a propensity for early clinical deterioration. Given this, their families may be counseled that 1) the risk of deterioration in infancy may be higher than in infants without these features, and 2) they require more diligent observation. Intervention before deterioration in these infants should also be considered. Patients without these features may be safely observed to a lesser extent.

scholarly journals Retrospective Review of the Drop in Observer Detection Performance Over Time in Lesion-enriched Experimental Studies

2014 ◽  
Vol 28 (1) ◽  
pp. 32-40 ◽  
Author(s):  
Sian Taylor-Phillips ◽  
Markus C. Elze ◽  
Elizabeth A. Krupinski ◽  
Kathryn Dennick ◽  
Alastair G. Gale ◽  
...  
Keyword(s):  
Retrospective Review ◽  
Experimental Studies ◽  
Detection Performance ◽  
Over Time

scholarly journals Doctor, There's a Tadpole in my Feces!

2006 ◽  
Vol 17 (3) ◽  
pp. 189-191 ◽  
Author(s):  
Rosemary Drisdelle ◽  
Kevin R Forward
Keyword(s):  
Nova Scotia ◽  
Family Physician ◽  
Fecal Sample ◽  
Moving Objects ◽  
Intestinal Parasite ◽  
Health Sciences ◽  
Male Resident

A 36-year-old male resident of a coastal Nova Scotia community presented to his family physician after he noted moving objects in his feces (Figure 1). Although concerned and revolted, he was asymptomatic. He was worried that the organisms were an intestinal parasite he had passed in his stool. The organisms were approximately 2.5 cm long and resembled tadpoles. The fecal sample was sent to the Parasitology Section at the Queen Elizabeth II Health Sciences Centre in Halifax, Nova Scotia, for identification.

scholarly journals Using administrative health data to inform health service planning for specialist cancer care in Nova Scotia, Canada

2018 ◽  
Vol 3 (4) ◽  
Author(s):  
Robin Urquhart ◽  
Lynn Lethbridge
Keyword(s):  
Primary Care ◽  
Nova Scotia ◽  
Health Service ◽  
Service Planning ◽  
Decision Makers ◽  
Health Service Planning ◽  
Cancer Centre ◽  
Follow Up Care ◽  
Over Time

IntroductionResearch has demonstrated that primary care providers can safely and effectively provide follow-up care after a person has received treatment for cancer. Yet, discharge to primary care after cancer treatment is variable, despite the fact that cancer systems are challenged to provide follow-up care given constrained cancer specialist resources. Objectives and ApproachTo inform cancer system planning, we examined (1) cancer centre routine follow-up (CC-FUP) care for prevalent cancer types and (2) changes in CC-FUP over time. From the Nova Scotia Cancer Registry, we identified all persons diagnosed in Nova Scotia, Canada, with an invasive breast, colorectal, gynecological, or prostate cancer between 01/01/2006 and 31/12/2013. We linked this dataset to cancer centre/clinic data and identified a non-metastatic cancer survivor cohort (n=12,267). Descriptive statistics were computed to describe patterns of care. Negative binomial regression was used to examine changes over time for both CC-FUP and all cancer centre visits, adjusting for other covariates. ResultsNearly half of survivors (48.4\%) had at least one CC-FUP visit, which varied by disease site (range: 30.2-62.4\%). Variation existed across providers, with six oncologists providing 34.7\% of the CC-FUP visits to the study population. Year of diagnosis was associated with receipt of CC-FUP care, with each successive calendar year associated with an 8\% increase in CC-FUP visits (IRR=1.08, 95\%CI=1.07-1.10). Similarly, each successive calendar year was associated with a 14\% increase in all cancer centre visits (IRR=1.14, 95\%CI=1.13-1.15). Results were shared with cancer system decision-makers at regular intervals to inform ongoing analyses. Conclusion/ImplicationsBoth the number of CC-FUP visits and all visits increased over time, with the latter at a greater rate. The increases were much higher than assumed by cancer system decision makers (2\% increase per year) for resource planning, demonstrating the value of population-based administrative data to informing health service planning.

scholarly journals At-a-glance - Concurrent monitoring of opioid prescribing practices and opioid-related deaths: the context in Nova Scotia, Canada

2018 ◽  
Vol 38 (9) ◽  
pp. 334-338 ◽  
Author(s):  
Emily Schleihauf ◽  
Kirstin Crabtree ◽  
Carolyn Dohoo ◽  
Sarah Fleming ◽  
Heather McPeake ◽  
...  
Keyword(s):  
Nova Scotia ◽  
Public Health Surveillance ◽  
Monitoring Program ◽  
Population Level ◽  
Medical Examiner ◽  
Opioid Use ◽  
Prescribing Practices ◽  
Opioid Prescribing ◽  
Prescription Monitoring ◽  
Dispensing Data

Timely public health surveillance is required to understand trends in opioid use and harms. Here, opioid dispensing data from the Nova Scotia Prescription Monitoring Program are presented alongside fatality data from the Nova Scotia Medical Examiner Service. Concurrent monitoring of trends in these data sources is essential to detect population-level effects (whether intended or unintended) of interventions related to opioid prescribing.

scholarly journals Problems in Coordinating and Accessing Primary Care for Attached and Unattached Patients Exacerbated During the COVID-19 Pandemic Year (the PUPPY Study): Protocol for a Longitudinal Mixed Methods Study (Preprint)

2021 ◽  
Author(s):  
Emily Gard Marshall ◽  
Mylaine Breton ◽  
Benoit Cossette ◽  
Jennifer Isenor ◽  
Maria Mathews ◽  
...  
Keyword(s):  
Primary Care ◽  
Mixed Methods ◽  
Nova Scotia ◽  
Research Ethics ◽  
Health Research ◽  
Health Sciences ◽  
Mixed Methods Study ◽  
Care Practice ◽  
Research Ethics Board ◽  
Unattached Patients

BACKGROUND The COVID-19 pandemic has significantly disrupted primary care in Canada, with many walk-in clinics and family practices initially closing or being perceived as inaccessible; pharmacies remaining open with restrictions on patient interactions; rapid uptake of virtual care; and reduced referrals for lab tests, diagnostics, and specialist care. OBJECTIVE The PUPPY Study (Problems in Coordinating and Accessing Primary Care for Attached and Unattached Patients Exacerbated During the COVID-19 Pandemic Year) seeks to understand the impact of the COVID-19 pandemic across the quadruple aims of primary care, with particular focus on the effects on patients without attachment to a regular provider and those with chronic health conditions. METHODS The PUPPY study builds on an existing research program exploring patients’ access and attachment to a primary care practice, pivoted to adapt to the emerging COVID-19 context. We intend to undertake a longitudinal mixed methods study to understand critical gaps in primary care access and coordination, as well as compare prepandemic and postpandemic data across 3 Canadian provinces (Quebec, Ontario, and Nova Scotia). Multiple data sources will be used such as a policy review; qualitative interviews with primary care policymakers, providers (ie, family physicians, nurse practitioners, and pharmacists), and patients (N=120); and medication prescriptions and health care billing data. RESULTS This study has received funding by the Canadian Institutes of Health Research COVID-19 Rapid Funding Opportunity Grant. Ethical approval to conduct this study was granted in Ontario (Queens Health Sciences & Affiliated Teaching Hospitals Research Ethics Board, file 6028052; Western University Health Sciences Research Ethics Board, project 116591; University of Toronto Health Sciences Research Ethics Board, protocol 40335) in November 2020, Québec (Centre intégré universitaire de santé et de services sociaux de l'Estrie, project 2020-3446) in December 2020, and Nova Scotia (Nova Scotia Health Research Ethics Board, file 1024979) in August 2020. CONCLUSIONS To our knowledge, this is the first study of its kind to explore the effects of the COVID-19 pandemic on primary care systems, with particular focus on the issues of patient’s attachment and access to primary care. Through a multistakeholder, cross-jurisdictional approach, the findings of the PUPPY study will inform the strengthening of primary care during and beyond the COVID-19 pandemic, as well as have implications for future policy and practice. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/29984

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