Weather, Chinook, and stroke occurrence. (57/878)

BACKGROUND: Changes in weather and season have been linked to stroke occurrence. However, the association has been inconsistent across stroke types. Calgary is a city in the Chinook belt and is subject to high variability in weather conditions. METHODS: We obtained hourly weather data over a 5-year period from 1996 to 2000; Chinook events were identified according to the accepted definition. We reviewed administrative data to determine stroke occurrence and defined stroke types to maximize specificity of diagnosis. To examine the hypothesis that weather affected the number of strokes occurring in a given day, we compared average daily stroke occurrence on Chinook days and non-Chinook days; we compared mean daily temperature, relative humidity, barometric pressure, and wind speed by the number of strokes occurring on any given day. RESULTS: Annual variation in stroke frequency was observed. No seasonal, monthly, or weekly variation in overall stroke occurrence or occurrence by type was evident. No relationship with changes in weather parameters was observed. CONCLUSIONS: We found no association between weather changes and stroke occurrence. A cause-and-effect relationship between weather and stroke occurrence is dubious because of a lack of consistency across studies.  (+info)

Occurrence and characterization of resistance to extended-spectrum cephalosporins mediated by beta-lactamase CMY-2 in Salmonella isolated from food-producing animals in Canada. (58/878)

Resistance of Salmonella to extended-spectrum cephalosporins (ESCs) is being reported with increasing frequency. In humans, infections with Salmonella resistant to ESCs threaten the efficacy of ceftriaxone, the drug of choice for treating salmonellosis in children. To determine the occurrence of resistance to ESCs, we examined 8426 strains isolated from food-producing animals in Canada in 1994-99 for reduced susceptibility or resistance to ceftriaxone. Of the 8 such strains identified (7 from turkeys and 1 from cattle), 5 had reduced susceptibility, and 3 were resistant; 2 were isolated in 1995, 1 was isolated in each of 1996 and 1997, and 4 were isolated in 1999. Isoelectric focusing showed that all 8 isolates produced a beta-lactamase with a pI > or = 9. The strains were resistant to cefoxitin and not inhibited by clavulanic acid. Primers specific for the Citrobacter freundii blaAmpC gene produced the expected product in the polymerase chain reaction. DNA sequencing showed that all isolates possessed the blaCMY-2 gene. Plasmid DNA from all 8 isolates transformed Escherichia coli DH10B, whereas only 1 isolate transferred blaCMY-2 conjugally. All transformants and the transconjugant were resistant to ampicillin, cefoxitin, ceftiofur, cephalothin, streptomycin, sulfisoxazole, and tetracycline. Southern blots of plasmids from the isolates, the transformants, and the transconjugant showed that blaCMY-2 was located on similar-sized plasmids (60 or 90 MDa) in the transformants and the transconjugant. In the S. Typhimurium DT104 and S. Ohio isolates, the floSt gene was found on the same plasmid. Class 1 integrons with the aadB gene cassette were detected in the S. Bredeney isolates but not in their transformants or the transconjugant. Pulsed-field gel electrophoresis and plasmid profiles indicated that both clonal dispersion and horizontal transfer of blaCMY-2 may have caused dissemination of the resistance determinant.  (+info)

Low-volume obstetrics. Characteristics of family physicians' practices in Alberta. (59/878)

OBJECTIVE: To compare the obstetric practices of family physicians who attended fewer than 25 births per year (low-volume) with the practices of family physicians who attended more than 25 births per year (high-volume) and the practices of obstetricians. DESIGN: Retrospective cohort study using data from administrative databases. SETTING: Alberta. PARTICIPANTS: All physicians who provided intrapartum care between April 1, 1997, and March 31, 2000. MAIN OUTCOME MEASURES: Type of delivery, size of hospitals where deliveries took place, characteristics of patients, and number of medical interventions. RESULTS: Of 1026 family physicians, 543 (53%) were low-volume providers of intrapartum care. In 1997-1998, low-volume family physicians (LVFPs) attended 24% of all vaginal and cesarean births attended by family physicians; by 1998-1999, that percentage had decreased to 9%; and by 1999-2000, to 5%. In contrast, the number of births attended by all family physicians remained relatively constant at 43% during the 3 years. In hospitals that had fewer than 50 deliveries a year, LVFPs attended almost half the births. Although LVFPs did fewer medical inductions, vacuum extractions, and epidural anesthetics and more forceps extractions, episiotomies, and cesarean sections than high-volume family physicians (HVFPs), the differences between their practices were much smaller than the differences between all family physicians' practices and the practices of obstetricians (who treat higher-risk mothers and newborns). CONCLUSION: The decrease in LVFPs' obstetric practices could make a pronounced difference at smaller hospitals where most low-volume practice occurs.  (+info)

Surveillance for porcine proliferative enteropathy in Alberta by using routine diagnostic laboratory data. (60/878)

Data from the Food Safety Division, Alberta Agriculture, Food and Rural Development were analyzed to determine the frequency of diagnosis of porcine proliferative enteropathy (PPE) relative to the diagnosis of other porcine enteric infections between 1993 and 1997. Next to colibacillosis, PPE was the most commonly diagnosed enteric disease among those reported.  (+info)

Variations in treatment of femoral neck fractures in Alberta. (61/878)

OBJECTIVES: To examine, in the province of Alberta, temporal trends, regional variations in treatment options and in-hospital death rates after a femoral neck fracture. DESIGN: A retrospective cohort study. PATIENTS: Six years' data were abstracted from the Alberta Morbidity File, the Alberta Health Stakeholder File and the Alberta Health Care Claims File. Patients were included if they were Alberta residents, aged 65 years or older, had sustained a femoral neck fracture and had undergone internal fixation, hemiarthroplasty or total hip arthroplasty. MAIN OUTCOME MEASURES: Death rates, arthroplasty rates and hospital stay. RESULTS: In-hospital death rates were similar across hospitals, with risks being higher for men, patients aged 80 years or older and those with more comorbid conditions. Arthroplasty rates varied from 58% to 77% among hospitals, and hospital stays associated with arthroplasty were significantly longer than those associated with internal fixation. The chance of undergoing arthroplasty varied from hospital to hospital by gender and by the number of comorbid conditions. CONCLUSION: Regional variations suggest lack of agreement among Alberta's surgeons as to how best to treat femoral neck fractures.  (+info)

Equity in waiting times for major joint arthroplasty. (62/878)

OBJECTIVE: To ascertain whether waiting lists are managed in an equitable fashion in a universal health system by examining demographic, socioeconomic and clinical factors, along with 2 health systems variables. DESIGN: A prospective survey by questionnaire. SETTING: The Capital Health Region of Edmonton, Alta. PATIENTS AND METHODS: A cohort of 553 patients, who were waiting for either total hip or total knee replacement surgery, seen between Dec. 18, 1995, and Jan. 24, 1997. INTERVENTIONS: A home visit was made when the patient was first placed on the waiting list and again just before surgery to complete the questionnaires. The Western Ontario and McMaster Universities (WOMAC) instrument and the Medication Quantification Score were administered at the time the patient was placed on the waiting list. MAIN OUTCOME MEASURE: The length of waiting time, defined as the date the patient was put on the waiting list to the date the patient was operated on. RESULTS: There were no biases in waiting time with respect to age, gender, education or work status. Although pain and function were not related to waiting time, multivariate analyses found that marital status, primary language, body mass index, pain medication use and the size of the surgeons' major joint replacement practice determined waiting time for surgery. However, this model explained only 10% of the variance in waiting time. CONCLUSION: Waiting lists were managed unfairly in terms of clinical equity (clinical severity) but managed fairly in terms of social equity.  (+info)

Predictors of survival following in-hospital adult cardiopulmonary resuscitation. (63/878)

BACKGROUND: This study was undertaken to provide up-to-date survival data for Canadian adult in-patients following attempted resuscitation from cardiac or respiratory arrest. We hope that objective data might encourage more meaningful dialogue between physicians, patients and their families regarding resuscitation wishes. METHODS: We reviewed all records of adult cardiopulmonary arrest that occurred between Jan. 1, 1997, and Jan. 31, 1999, at the 3 main teaching hospitals in Edmonton. We then abstracted data from the full inpatient medical records to describe patient characteristics, type of arrest and survival details. The family physicians of survivors were contacted to confirm the outcomes. We included only adults admitted to hospital but not to a critical care bed. RESULTS: There were 247 arrests during the study period; 143 (57.9%) were witnessed, and 104 (42.1%) were unwitnessed). Of the patients whose arrests were witnessed, 48.3% (95% confidence interval [CI] 39.8%-56.8%) were able to be resuscitated, 22.4% (95% CI 1 5.8%-30.1%) survived to hospital discharge, and 18.9% (95% CI 12.8%-26.3%) were able to return home. Survival was highest after primary respiratory arrest and lowest after pulseless electrical activity or asystole. Of the patients with unwitnessed arrests, 21.2% (95% CI 13.8%-30.3%) were able to be resuscitated, but only 1 patient (1.0% [95% CI 0.0%-5.2%]) survived to hospital discharge and was able to return home. This patient survived an unwitnessed respiratory arrest. No patient who had an unwitnessed cardiac arrest survived to discharge. Most of the respiratory arrests were witnessed (93.1%), and most of the pulseless electrical activity or asystole arrests were unwitnessed (54.6%). We did not find age or sex to be independent predictors of survival. However, the risk of not returning home was higher among patients whose arrest occurred between 2301 and 0700 than among those whose arrest was between 0701 and 1500 (adjusted OR 3.2, 95% CI 1.0-10.1). Survival was significantly decreased after pulseless ventricular tachycardia or ventricular fibrillation arrest (adjusted OR 4.2, 95% CI 1.4-12.5) and even more so after pulseless electrical activity or asystole arrest (adjusted OR 21.0, 95% CI 6.2-71.7) than after respiratory arrest. INTERPRETATION: Overall, survival following cardiopulmonary resuscitation in hospital does not appear to have changed markedly in 40 years. The type of arrest is highly predictive of survival, whereas age and sex are not.  (+info)

Understanding coordination of care from the consumer's perspective in a regional health system. (64/878)

OBJECTIVE: To understand and develop a model about the meaning of coordination to consumers who experienced a transition from acute care to home care. STUDY DESIGN: A qualitative, exploratory study using Grounded Theory. DATA SOURCES/ANALYSIS: Thirty-three consumers in the Calgary Regional Health Authority who had experienced the transition from an acute care hospital back into the community with home care support were interviewed. They were asked to describe their transition experience and what aspects of coordination were important to them. Interviews were recorded, transcribed, and analyzed using constant comparison. The coding and retrieval of information was facilitated by the computer software program Nud*ist. PRINCIPAL FINDINGS: The resulting model has four components: (1) the meaning of coordination to consumers; (2) aspects of health care system support that are important for coordination; (3) elements that prepared consumers to return home; and (4) the components of a successful transition experience. Consumers appeared to play a crucial role in spanning organizational boundaries by participating in the coordination of their own care. CONCLUSIONS: Consumers must be included in health care decisions as recipients of services and major players in the transition processes related to their care. Health care providers need to ensure that consumers are prepared to carry out their coordination role and managers need to foster a culture that values the consumer "voice" in organizational processes.  (+info)