Development of the Halifax Visual Scanning Test: A New Measure of Visual-Spatial Neglect for Personal, Peripersonal, and Extrapersonal Space.

OBJECTIVES: Visual-spatial neglect is a common attentional disorder after right-hemisphere stroke and is associated with poor rehabilitation outcomes. The presence of neglect symptoms has been reported to vary across personal, peripersonal, and extrapersonal space. Currently, no measure is available to assess neglect severity equally across these spatial regions and may be missing subsets of symptoms or patients with neglect entirely. We sought to provide initial construct validity for a novel assessment tool that measures neglect symptoms equally for these spatial regions: the Halifax Visual Scanning Test (HVST). METHODS: In Study I, the HVST was compared to conventional measures of neglect and functional outcome scores (wheelchair navigation) in 15 stroke inpatients and 14 healthy controls. In Study II, 19 additional controls were combined with the control data from Study I to establish cutoffs for impairment. Patterns of neglect in the stroke group were examined. RESULTS: In Study I, performance on all HVST subtests were correlated with the majority of conventional subtests and wheelchair navigation outcomes. In Study II, neglect-related deficits in visual scanning showed dissociations across spatial regions. Four inpatients exhibited symptoms of neglect on the HVST that were not detected on conventional measures, one of which showed symptoms in personal and extrapersonal space exclusively. CONCLUSIONS: The HVST appears a useful measure of neglect symptoms in different spatial regions that may not be detected with conventional measures and that correlates with functional wheelchair performance. Preliminary control data are presented and further research to add to this normative database appears warranted.

"Industrious, submissive, and free of diseases": 156 years of physicians in Liidlii Kue/Fort Simpson, Northwest Territories.

INTRODUCTION: Physician recruitment to rural and remote communities poses a major challenge to health care delivery in Canada. Rather than focusing solely on the politics and policies that contribute to the shortage of family physicians in Canada's North, we argue that more attention should be paid to the reasons that lead, and have led, family physicians to the North, and also to the factors that contribute to physician retention. METHODS: We used archival research and semi- and unstructured interviews to provide a history of medicine in Liidlii Kue/Fort Simpson, NWT, and to describe the features of physicians who have served and continue to serve this Northern community. RESULTS: Results show that medicine in Liidlii Kue/Fort Simpson can be divided into 4 distinct eras: the prehospital era (1848-1916), the early hospital era (1917-1925), the middle era (1926-1972) and the government era (1973-present). Thirty-eight physicians were identified as having worked in Liidlii Kue/Fort Simpson. Of those, 19 were contacted. Nine physicians and the offspring of 1 deceased physician were interviewed. We found physicians fell into 1 of 4 categories: new graduates, those seeking midcareer (or midlife) change, those about to retire and international medical graduates. CONCLUSION: By examining Liidlii Kue/Fort Simpson as a case study, this research fills the dearth of knowledge in the factors that contribute to physician recruitment and retention in Canada's North.