Baseline Competency Assessment of Pharmacists Prescribing and Managing Vancomycin Therapy in the Regina Qu'Appelle Health Region.

BACKGROUND: Pharmacists in the Regina Qu'Appelle Health Region (RQHR), Saskatchewan, independently dose, monitor, and adjust vancomycin therapy. No framework exists for ongoing competency assessment of pharmacists. OBJECTIVES: The primary objective was to determine pharmacists' overall level of competency for all components of the vancomycin prescribing procedure. The secondary objectives were to determine competency for individual prescribing phases, to stratify overall competency in relation to pharmacist and patient factors, and to identify the 3 most frequent errors. METHODS: A retrospective chart audit was performed of patients who received a prescription for vancomycin between November 1, 2015, and January 31, 2016. Patients were included if they received pharmacist-prescribed vancomycin as an inpatient or outpatient of an RQHR facility. Patients under the care of a pediatrician, those receiving vancomycin for surgical prophylaxis or via any route other than the IV route, and those whose vancomycin was prescribed by a current pharmacy resident were excluded. A rubric was created that assigned a numeric value for the appropriate completion of various procedure criteria. RESULTS: A total of 326 patients received vancomycin during the study period, of whom 200 met the inclusion criteria, representing 511 discrete episodes of prescribing by 42 pharmacists. The median overall competency rate, for all phases of prescribing, was 100% (interquartile range [IQR] 90.1%-100%). The median competency rates for the empiric therapy and monitoring phases were 94.4% (IQR 88.9%-100%) and 100% (IQR 87.5%-100%), respectively. No statistically significant differences were found in relation to pharmacists' experience or postbaccalaureate education, patients' level of acuity, or timing of prescribing. The competency score was significantly higher among pharmacists prescribing for patients with normal renal function than among those prescribing for patients with reduced renal function (p = 0.008). The 3 most common errors were failure to document risk factors for nephrotoxicity, failure to document requirement to obtain future trough levels, and failure to document that samples for trough levels had been drawn correctly. CONCLUSIONS: During the study period, pharmacists at RQHR showed competency in all phases of vancomycin prescribing using the approved procedure. Documentation of clinical plans and assessments was identified as an area for improvement.

CONTEXTE: Des pharmaciens de la régie régionale de la santé de Regina Qu'Appelle (RRSRQ) en Saskatchewan s'occupent euxmêmes de doser la vancomycine ainsi que d'en surveiller et d'en ajuster la posologie. Or, à ce jour, aucun cadre n'entoure l'évaluation continue de la compétence de ces pharmaciens. OBJECTIFS: L'objectif principal était de déterminer le niveau global de compétence des pharmaciens pour tous les éléments de la marche à suivre pour prescrire la vancomycine. Les objectifs secondaires consistaient à déterminer le niveau de compétence pour chaque étape de la prescription, à stratifier le niveau global de compétence en fonction de facteurs se rapportant au pharmacien et au patient et à identifier les trois erreurs les plus courantes. MÉTHODES: On a réalisé une vérification rétrospective des dossiers médicaux de patients qui se sont fait prescrire la vancomycine entre le 1er novembre 2015 et le 31 janvier 2016. Les patients admis à l'étude devaient avoir reçu la vancomycine sur la prescription d'un pharmacien alors qu'ils étaient hospitalisés ou en consultation externe dans un établissement de la RRSRQ. Les patients soignés par un pédiatre, ceux ayant reçu un traitement prophylactique de vancomycine pour une intervention chirurgicale, ceux ayant reçu le médicament autrement que par voie intraveineuse et ceux dont la vancomycine a été prescrite par un résident en pharmacie à l'époque ont été exclus. Une grille d'évaluation a été créée afin d'accorder une valeur numérique selon le degré de conformité de l'exécution aux différents critères de la marche à suivre. RÉSULTATS: Au total, 326 patients ont reçu la vancomycine pendant la période d'étude. Parmi eux, 200 répondaient aux critères d'inclusion, ce qui représentait 511 actes distincts de prescription réalisés par 42 pharmaciens. Le taux de compétence global médian pour toutes les phases de la prescription était de 100 % (écart interquartile [ÉIQ] de 90,1 % à 100 %). Les taux de compétence médians pour les phases de l'antibiothérapie empirique et du suivi étaient respectivement de 94,4 % (ÉIQ de 88,9 % à 100 %) et de 100 % (ÉIQ de 87,5 % à 100 %). Aucune différence statistiquement significative quant à la compétence n'a été relevée par rapport à l'expérience du pharmacien, aux études universitaires de cycles supérieurs, à la gravité de l'état du patient ou au moment de la réalisation de la prescription. Le score de compétence était significativement plus élevé chez les pharmaciens prescrivant à des patients dont la fonction rénale est normale que pour ceux prescrivant à des patients atteints d'insuffisance rénale (p = 0,008). Les trois erreurs les plus courantes étaient : négliger de consigner les facteurs de risque néphrotoxique, négliger de consigner que l'obtention de futures concentrations minimales était nécessaire et négliger de consigner que les échantillons pour les concentrations minimales avaient été prélevés correctement. CONCLUSIONS: Pendant la période d'étude, les pharmaciens travaillant à la RRSRQ ont fait preuve de compétence dans l'ensemble des phases de prescription de la vancomycine en utilisant la marche à suivre approuvée. On a noté qu'il fallait améliorer la consignation des plans cliniques et des évaluations.

Development of a Documentation Rubric and Assessment of Pharmacists' Competency for Documentation in the Patient Health Record.

BACKGROUND: Documentation of information in the health record by pharmacists is vital to patient care. Failure to document, or failure to document appropriately, may have negative effects on patients. OBJECTIVES: The primary objective was to determine pharmacists' competency in 18 elements of chart note documentation at 2 tertiary care centres and 1 rehabilitation centre. The secondary objectives were to quantify the number of episodes of documentation by pharmacists, to characterize the clinical activities associated with this documentation, and to determine whether there were differences in level of competency according to years of hospital experience, additional clinical training, and note type. METHODS: This study used prospective audit methodology. Notes documented during a 6-week study period (February to April 2015) were assessed using a rubric specifically created to evaluate 18 of the essential elements of documentation, as defined by the Canadian Society of Hospital Pharmacists. Four of the elements of chart note documentation were assessed on a yes/no basis, and Bloom's taxonomy was used to define the level of competency for the other 14 elements. Values were assigned to each level and were then used to calculate mean scores. RESULTS: A total of 115 pharmacist notes, created by 29 of the 35 pharmacists included in the study, were assessed. The mean competency score per pharmacist was 2.2 (standard deviation [SD] 0.3; maximum score 3). Elements of documentation with the highest level of competency were diplomatic tone, conciseness, and clarity; elements with the lowest level of competency were medication list, note title, monitoring, and drug-related problem statements. The most frequent note types concerned drug-related problems (50 [43%]), pharmacokinetics (25 [22%]), and patient education (19 [17%]). Levels of competency were highest for notes related to patient education (mean 2.4, SD 0.2) and lowest for notes concerning drug-related problems (mean 2.1, SD 0.3) and notes providing clarification (mean 2.1, SD 0.3). The level of competency was not significantly affected by additional clinical training or years of hospital experience. CONCLUSIONS: Pharmacists in this study documented concisely, clearly, and in a diplomatic tone; however, there was room for improvement in the frequency and elements of chart note documentation in the patient health record.

CONTEXTE: La consignation d'information par les pharmaciens dans les dossiers de santé est essentielle aux soins des patients. Négliger de consigner l'information ou le faire inadéquatement peut avoir des effets négatifs pour les patients. OBJECTIFS: L'objectif principal était de déterminer le niveau de compétence des pharmaciens en ce qui concerne 18 éléments de consignation aux dossiers médicaux de patients dans deux établissements de soins tertiaires et dans un établissement de réadaptation. Les objectifs secondaires étaient de quantifier le nombre de cas de consignation par les pharmaciens, d'offrir un portrait des activités cliniques associées à cette prise de notes et de déterminer s'il y avait des différences quant au niveau de compétence selon le nombre d'années d'expérience en hôpital, la formation clinique supplémentaire et le type de notes. MÉTHODES: La présente étude a employé l'audit prospectif comme méthodologie. Les notes consignées durant une période de 6 semaines (de février à avril 2015) ont été jugées à l'aide d'une grille conçue spécialement pour évaluer 18 des éléments essentiels de la prise de notes tels qu'ils sont définis par la Société canadienne des pharmaciens d'hôpitaux. Une évaluation dichotomique (soit oui soit non) a été utilisée pour quatre des éléments de la prise de notes et la taxonomie de Bloom a servi à définir le niveau de compétence pour les 14 autres éléments. Des valeurs ont été attribuées à chaque niveau et ont ensuite été utilisées pour calculer les scores moyens. RÉSULTATS: Au total, 115 notes rédigées par 29 des 35 pharmaciens visés par l'étude ont été analysées. Le score moyen de compétence par pharmacien était de 2,2 (écart-type de 0,3; score maximum de 3). Les éléments de la prise de notes présentant le niveau de compétence le plus élevé étaient : le ton diplomatique, la concision et la clarté. Les éléments affichant le plus bas niveau de compétence étaient : la liste des médicaments, le titre de la note, le suivi et l'énonciation des problèmes liés à la pharmacothérapie. Les types de notes les plus fréquents traitaient : de problèmes liés à la pharmacothérapie (50 [43 %]), de la pharmacocinétique (25 [22 %]) et des conseils aux patients (19 [17 %]). Les niveaux de compétence étaient plus élevés pour les notes à propos des conseils aux patients (moyenne de 2,4, écart-type de 0,2) et les niveaux étaient plus faibles pour les notes concernant les problèmes liés à la pharmacothérapie (moyenne de 2,1, écart-type de 0,3) et celles fournissant un éclaircissement (moyenne de 2,1, écart-type de 0.3). Le niveau de compétence n'était pas significativement influencé par une formation clinique supplémentaire ou les années d'expérience en hôpital. CONCLUSION: Les pharmaciens évalués dans la présente étude consignaient leurs notes de façon concise et claire sur un ton diplomatique. Par contre, il y avait lieu d'améliorer la fréquence et les éléments des notes consignées dans les dossiers médicaux des patients.

High-Dose, Extended-Interval Gentamicin and Tobramycin for Pediatric Inpatients: A Survey of Canadian Hospital Pharmacists.

BACKGROUND: The use of high-dose, extended-interval aminoglycosides, a common practice in adult populations, is less well established for pediatric patients. In younger populations, these drugs are often administered according to a multiple daily dosing method. OBJECTIVE: To characterize prescribing practices for aminoglycosides in pediatric inpatients across Canada, with a focus on high-dose, extended-interval regimens. METHODS: This study was based on an electronic survey of pharmacists representing Canadian health care delivery organizations that provided pediatric inpatient services, which was distributed in March 2015. Questions focused on demographic characteristics; indications for high-dose, extended-interval tobramycin or gentamicin; use of these regimens in patients with particular comorbidities; empiric dosing; monitoring parameters; and the extent of pharmacists' authority to independently prescribe doses and order monitoring parameters for aminoglycosides at their respective institutions. RESULTS: Forty-five (48%) of the 94 prospective participants responded to the survey. Of these 45 respondents, 35 (78%) indicated that their respective health regions used high-dose, extended-interval tobramycin or gentamicin in pediatric inpatients. The patient characteristics for use of such regimens were varied. The median reported doses were 10 mg/kg for pulmonary exacerbation in cystic fibrosis, 7 mg/kg for urinary tract infection, and 8 mg/kg for febrile neutropenia. Thirty-one (89%) of the 35 respondents using these regimens reported that they monitored serum levels, and 27 (77%) reported monitoring for nephrotoxicity. With regard to prescriptive authority, 7 (16%) of the 45 respondents indicated that pharmacists were authorized to independently adjust dosing at their institutions, and pharmacists at 14 (31%) of 45 sites were authorized to order monitoring parameters. CONCLUSIONS: High-dose, extended-interval aminoglycoside therapy was frequently used for pediatric patients across Canada, although the dosages and monitoring practices varied greatly. The information from this study can be used for cross-comparison of practice by other centres across Canada.

L'utilisation de doses élevées d'aminosides administrées à intervalle prolongé est une pratique répandue chez l'adulte, mais moins bien établie chez l'enfant. Dans les populations plus jeunes, ces médicaments sont souvent donnés selon une méthode d'administration multiquotidienne.

A Canadian Survey of Pharmacist Participation during Cardiopulmonary Resuscitation.

BACKGROUND: The participation of pharmacists on cardiopulmonary resuscitation (CPR) teams has been associated with improvements in patient outcomes secondary to lower rates of adverse drug events and higher rates of compliance with guidelines for advanced cardiac life support (ACLS). The degree to which Canadian pharmacists participate on CPR teams and the services they provide have not previously been assessed. OBJECTIVES: To measure the frequency of pharmacists' involvement on CPR teams in Canadian health care delivery organizations, to characterize the services provided by these pharmacists, to identify positive predictors of participation, and, for health care delivery organizations without pharmacists on CPR teams, to determine the reasons for the lack of involvement. METHODS: An electronic survey was distributed to key informants in Canadian health care delivery organizations. The survey consisted of questions about characteristics of the health care delivery organizations, pharmacists' participation and role on the CPR team, training, and barriers to implementation. The primary outcome was the percentage of health care delivery organizations with pharmacists participating on CPR teams in at least one centre within the organization. The secondary outcomes were pharmacists' activities, training, and reasons for not participating on CPR teams. RESULTS: Forty-three of 99 key informants responded to the survey. Twenty-nine respondents (67%) indicated that their organization had a CPR team, and 10 (23%) indicated participation by pharmacists on a CPR team. Roles reported to be performed by pharmacists during CPR events were provision of drug information, preparation and administration of medications, record-keeping, and chest compressions. Training for these pharmacists was variable: ACLS training for 4 (40%) of the 10 organizations with pharmacist participation, in-house training for 3 (30%), and no training for 2 (20%); one respondent (10%) did not report the level of training. Reasons for not having pharmacists on CPR teams included inconsistent coverage, lack of training, and staff shortages. CONCLUSIONS: This study characterized current pharmacist participation on CPR teams in Canadian health care delivery organizations. As evidence arises showing the impact of this practice on patient outcomes, pharmacist participation on CPR teams may become more common.

CONTEXTE: L'intégration des pharmaciens aux équipes de réanimation cardio-respiratoire (RCR) a été associée à une amélioration des résultats thérapeutiques, qui est due à des taux plus faibles d'événements indésirables liés aux médicaments et à un meilleur degré de conformité aux lignes directrices portant sur la technique spécialisée de réanimation cardiorespiratoire. Or, aucune étude n'a encore analysé la mesure dans laquelle les pharmaciens canadiens participent aux équipes de RCR et l'éventail des services qu'ils fournissent en leur sein. OBJECTIFS: Évaluer dans quelle mesure les pharmaciens participent aux équipes de RCR des organismes canadiens de prestation de soins de santé, décrire les services fournis par ces pharmaciens, identifier les facteurs prédictifs de participation et, dans les organismes de prestation de soins de santé où aucun pharmacien ne fait partie des équipes de RCR, déterminer les raisons expliquant cette absence. MÉTHODES: Un sondage électronique a été donné aux informateurs clés des organismes canadiens de prestation de soins de santé. Le sondage contenait des questions portant sur les caractéristiques des organimes de prestation de soins de santé, la présence des pharmaciens au sein de l'équipe de RCR et le rôle qu'ils y jouent, leur formation en RCR et les obstacles s'opposant à leur participation. Le principal paramètre d'évaluation était le pourcentage d'organismes de prestation de soins de santé où des pharmaciens faisaient partie d'équipes de RCR dans au moins l'un des centres de l'organisme. Les paramètres d'évaluation secondaires comprenaient les activités et la formation des pharmaciens ainsi que les raisons expliquant leur absence des équipes de RCR. RÉSULTATS: En tout, 43 des 99 informateurs clés ont répondu au sondage. Vingt-neuf répondants (67 %) ont indiqué que leur organisme avait une équipe de RCR et 10 (23 %) ont souligné la participation de pharmaciens dans l'équipe. Selon les réponses, les pharmaciens jouaient différents rôles pendant les épisodes de RCR, notamment : fournir des renseignements sur des médicaments, préparer et administrer des médicaments, effectuer la tenue de dossiers et réaliser des compressions thoraciques. La formation de ces pharmaciens était inégale : 4 (40 %) des 10 organismes où des pharmaciens participaient offraient une formation en technique spécialisée de réanimation cardio-respiratoire, 3 (30 %) offraient une formation interne et 2 (20 %) n'offraient aucune formation; un répondant (10 %) n'a pas précisé le niveau de formation. L'inégalité du service, le manque de formation et les pénuries de personnel faisaient partie des raisons expliquant l'absence des pharmaciens des équipes de RCR. CONCLUSIONS: La présente étude a dressé le portrait actuel de la participation des pharmaciens dans les équipes de RCR des organismes canadiens de prestation de soins de santé. Au fur et à mesure qu'apparaîtront des données illustrant l'effet de cette pratique sur les résultats thérapeutiques, il est possible que la participation de pharmaciens dans les équipes de RCR devienne de plus en plus fréquente.

Southern Saskatchewan Ticagrelor Registry experience.

BACKGROUND: As ticagrelor enters into clinical use for acute coronary syndrome, it is important to understand patient/physician behavior in terms of appropriate use, adherence, and event rates. METHODS: The Southern Saskatchewan Ticagrelor Registry is a prospective, observational, multicenter cohort study that identifies consecutive patients started on ticagrelor. We aimed to evaluate both on- and off-label use, identify characteristics of patients who prematurely stop ticagrelor, and describe patient/physician behavior contributing to inappropriate stoppage of this medication. RESULTS: From April 2012 to September 2013, 227 patients were initiated on ticagrelor, with a mean age of 62.2±12.1 years. The participants were 66% men and had a mean follow up of 157.4±111.7 days. Seventy-four patients (32.4%) had off-label indications. Forty-seven patients (20.7%) prematurely stopped ticagrelor and were more likely to be older, women, nonwhite, present with shock, and complain of dyspnea. Twenty-six of the 47 patients stopped ticagrelor inappropriately because of patient nonadherence (18 patients) and physician advice (eight patients). A composite outcome event of death from vascular causes, myocardial infarction, or stroke occurred in 8.8% of the entire cohort and was more likely to occur in those older then 65 years, those presenting with cardiogenic shock, and those who prematurely stopped ticagrelor. CONCLUSION: In this real-world registry of patients started on ticagrelor, a third have off-label indications and a fifth prematurely stop the medication. Premature discontinuation was an independent predictor of major life-threatening bleeding and increased composite event rate of death from vascular causes, myocardial infarction, or stroke.

Urinary Tract Infections: Leading Initiatives in Selecting Empiric Outpatient Treatment (UTILISE).

BACKGROUND: Overuse of fluoroquinolone antibiotics is associated with outbreaks of methicillin-resistant Staphylococcus aureus and of Clostridium difficile-associated diarrhea and increasing resistance in gram-negative organisms. Over the past decade, resistance of Escherichia coli to ciprofloxacin has increased in the Regina Qu'Appelle Health Region. In August 2011, an exploratory audit of the Regina General Hospital (RGH) emergency department showed that 20% of new antibiotic orders were for fluoroquinolones, and 60% of these new fluoroquinolone orders were for ciprofloxacin. It was postulated that ciprofloxacin was predominantly prescribed for outpatients with urinary tract infection. OBJECTIVE: To develop, implement, and evaluate a best-practice algorithm for the empiric treatment of uncomplicated urinary tract infection in the RGH emergency department, as part of an educational initiative for emergency physicians. METHODS: A literature review was conducted and local antibiogram data were analyzed to establish a best-practice algorithm for treatment of uncomplicated urinary tract infection in outpatients seen in the emergency department. A chart review was conducted from January to March 2011 to establish a baseline of empiric antibiotic use. An educational strategy targeting emergency physicians described changes in antibiotic resistance patterns in the health region, principles of antimicrobial stewardship, drivers of resistance, and the results of a literature review of best practice for urinary tract infection in outpatients. A post-intervention audit was conducted from January to March 2012 to determine changes in practice. RESULTS: Comparison of results from the post-intervention audit with baseline data showed that adherence to best practice increased significantly, from 41% (39/96) before the intervention to 66% (50/76) after the intervention (odds ratio [OR] 2.81, 95% confidence interval [CI] 1.51-5.25; p < 0.001). There was also a significant change in overall antibiotic selection (OR 0.25, 95% CI 0.11-0.58; p < 0.001). Further analysis suggested that this significant change was driven by a decrease in use of ciprofloxacin, from 32% (31/96) to 11% (8/76). CONCLUSION: Creation of a best-practice algorithm and education focused on emergency physicians significantly increased adherence to best practice and optimized antibiotic prescribing for outpatients with uncomplicated urinary tract infection by limiting overuse of fluoroquinolones, primarily ciprofloxacin.

CONTEXTE: L'utilisation abusive d'antibiotiques de la famille des fluoroquinolones est associée à des éclosions de Staphylococcus aureus résistant à la méthicilline et de diarrhée provoquée par le Clostridium difficile ainsi qu'à une augmentation de la résistance des bactéries à Gram négatif. Au cours de la dernière décennie, la résistance d'Escherichia coli à la ciprofloxacine a augmenté dans la régie régionale de la santé de Regina Qu'Appelle. En août 2011, une vérification préliminaire du service des urgences de l'Hôpital général de Régina (HGR) a montré que 20 % des nouvelles ordonnances d'antibiotiques étaient pour des fluoroquinolones et que 60 % de ces ordonnances étaient pour de la ciprofloxacine. On a émis l'hypothèse selon laquelle on prescrivait principalement la ciprofloxacine aux patients externes atteints d'une infection urinaire. OBJECTIF: Élaborer, mettre en place et évaluer un algorithme des meilleures pratiques pour le traitement empirique d'infections urinaires non compliquées au service des urgences de l'HGR dans le cadre d'une initiative de formation destinée aux urgentologues. MÉTHODES: Une revue de la littérature a été menée et les données locales d'antibiogrammes ont été analysées afin de définir un algorithme des meilleures pratiques destiné au traitement des infections urinaires non compliquées chez les patients externes rencontrés au service des urgences. Une analyse des dossiers médicaux a été effectuée de janvier à mars 2011 dans le but d'établir le traitement antibiotique empirique de référence. Une stratégie de formation destinée aux urgentologues décrivait : les changements dans les profils de résistance aux antibiotiques au sein de la régie régionale de la santé, les principes d'une gestion responsable des antimicrobiens, ainsi que les facteurs de résistance. Elle contenait aussi une revue de la littérature des meilleures pratiques pour traiter les infections urinaires chez les patients externes. Une vérification post-intervention a été menée de janvier à mars 2012 afin de déterminer les changements dans la pratique. RÉSULTATS: Une comparaison entre la vérification post-intervention et les données de référence a montré une augmentation significative de l'observance des meilleures pratiques, qui est passée de 41 % (39/96) avant l'intervention à 66 % (50/76) après l'intervention (risque relatif approché [RRA] de 2,81, intervalle de confiance [IC] à 95 % de 1,51­5,25; p < 0,001). On a aussi observé un changement significatif dans les habitudes de choix d'antibiotiques (RRA de 0,25, IC à 95 % de 0,11­0,58; p < 0,001). D'après d'autres analyses, ce changement significatif a été causé par une baisse de l'utilisation de la ciprofloxacine, qui est passée de 32 % (31/96) à 11 % (8/76). CONCLUSION: L'élaboration d'un algorithme des meilleures pratiques ainsi qu'une formation destinée aux urgentologues ont permis d'augmenter de manière significative l'observance des meilleures pratiques. Elles ont aussi permis d'optimiser la prescription d'antibiotiques aux patients externes atteints d'une infection urinaire non compliquée en réduisant l'utilisation abusive des fluoroquinolones, notamment celle de la ciprofloxacine. [Traduction par l'éditeur].

Practice patterns of Canadian Ophthalmological Society members in cataract surgery: 2011 survey.

OBJECTIVE: To establish the practice patterns of the members of the Canadian Ophthalmological Society (COS) in cataract surgery. DESIGN: Web-based questionnaire. PARTICIPANTS: Members of the COS indicating practice focus to be cataract surgery. METHODS: In January 2011 an e-mail with a link to Fluid Surveys was sent from the COS office to the 292 members who had indicated their practices' focus to be cataract surgery. A reminder e-mail was sent 3 weeks later. Approval for the survey was obtained from the Regina Qu'Appelle Health Region Research Ethics Board. All responses were collected anonymously. RESULTS: There were 92 responses (31.5%). In 2009, the response rate was 20.7%, and in 2010 it was 32.5%. The results of the 3 surveys were compared. There was a gradual increase in the use of topical-only anaesthesia, in the number of days during which the nonsteroidal anti-inflammatory drug (NSAID) eye drops were used preoperatively, and in the use of multifocal and toric intraocular lenses. Postoperatively, the use of an NSAID eye drop alone remained unchanged, but there was a decrease in the use of steroid eye drops alone and a corresponding increase in the use of a combination steroid and NSAID eye drop. CONCLUSIONS: Over the past 3 years the majority of the practice patterns in cataract surgery by the members of the Canadian Ophthalmological Society have remained unchanged. However, there were certain areas where definite trends were noted.

Temporal artery thermometer use in the prehospital setting.

OBJECTIVES: Prehospital vital signs are an important and required component of patient assessment. We compared the temporal artery thermometer (TAT) to the digital thermometer currently used in our emergency medical service (EMS) system and then to the digital thermometer used in the emergency department. The primary objective of this study was to assess the usefulness of the TAT in the prehospital setting. Other outcomes of interest included whether extraneous factors or cold ambient temperatures affected the TAT readings and paramedic satisfaction with the TAT. METHODS: This was a prospective, observational study. Patient temperature was taken by EMS personnel with both the digital thermometer and the TAT, and a chart review was conducted on a sample of these patients to compare the TAT to the emergency department digital thermometer. RESULTS: A total of 818 patients had their temperatures taken with both thermometers in the prehospital setting. The relationship between the TAT and digital thermometer measurement was positive and moderate; however, there was poor agreement between the two devices. Sixty-nine charts were reviewed, and a positive correlation was found between the TAT and the emergency department digital thermometer, with good agreement between the two devices. No extraneous factors were found to have a noticeable effect on the temperature measurements; the TAT performed well in cold weather, and the EMS personnel reported it to be easy to use. CONCLUSION: The TAT appears to be a suitable alternative to digital thermometers currently used in many EMS systems. The paramedics involved in this study liked the TAT better than the in-ambulance digital thermometer and believed it to be more accurate. Further research on this topic is required.

Practice patterns of Canadian Ophthalmological Society members in cataract surgery--2010 survey.

OBJECTIVE: To establish the cataract surgery practice patterns of the members of the Canadian Ophthalmological Society (COS). STUDY DESIGN: Web-based questionnaire. METHODS: In January 2010, an email with a link to SurveyMonkey was sent from the COS office to its 305 members who had indicated their practice focus is cataract surgery. A reminder email was sent 2 weeks later. All responses were collected anonymously. RESULTS: There was a 32.5% response rate (99 responses), compared with 20.7% in 2009. Two respondents volunteered that they no longer performed cataract surgery and 1 response was incomplete; therefore, 96 responses were analyzed. The results of the 2010 survey were compared to those of the 2009 survey. CONCLUSIONS: While the majority of the practice patterns analyzed were unchanged between the 2009 and 2010 surveys, there appears to be a trend to start nonsteroidal anti-inflammatory drug eye drops earlier preoperatively and an increase in the use of one-piece hydrophobic acrylic, aspheric, and blue-blocking intraocular lenses. The use of the fourth generation fluoroquinolone antibiotic gatifloxacin has increased at the expense of older antibiotics.

Practice patterns of Canadian Ophthalmological Society members in cataract surgery--2009 survey.

OBJECTIVE: To establish the practice patterns of the members of the Canadian Ophthalmological Society (COS) in cataract surgery. DESIGN: A questionnaire consisting of multiple choice questions on cataract surgery practices was sent as an attachment by email to the members of the COS. PARTICIPANTS: Seven-hundred and seventy-seven COS members with a valid email address in the Society's database. METHODS: A 29-item questionnaire pertaining to cataract surgery practices was sent by email. A reminder email with the attached questionnaire was sent 3 weeks later. The survey data were descriptively analyzed with the Statistical Package for the Social Sciences (SPSS) v 16.0 software and the results compared with those from surveys by the American Society of Cataract and Refractive Surgery and the European Society of Cataract and Refractive Surgeons. RESULTS: There were 161 responses. Of these, 30 members did not do any cataract surgery, and a further 8 responses were incomplete, therefore, 123 responses were analyzed. The majority of the respondents (69.1%) were between 40-59 years old. Phacoemulsification was the procedure of choice of all the respondents. Topical anaesthesia with clear corneal incisions was the most popular technique. Only 59.8% of respondents used a NSAID drop while 90.1% used a steroid drop postoperatively. CONCLUSIONS: The practice patterns of the members of the COS for cataract surgery have not been reported before. This survey will serve as a baseline for future ones.

A core stability group program for children with developmental coordination disorder: 3 clinical case reports.

PURPOSE: This series of case reports documents the response of 3 children with developmental coordination disorder to a group intervention program. SUMMARY OF KEY POINTS: The 3 children, 9-11 years old, who participated in the 6-week group exercise program, illustrate the heterogeneity of this population. Two group sessions per week and a home program included a core stability program, fitness activities, and task-specific intervention based on child-chosen goals. The effect of the program on motor skills, self-perceived adequacy for physical activity and balance, strength, and core stability activities was examined. Each child improved in 1 or more areas of motor skill, self-efficacy for physical activity, and core stability outcome measures. Possible reasons for the range of outcomes are discussed. CONCLUSIONS AND IMPLICATIONS FOR CLINICAL PRACTICE: Physical activity promotion in this population has the potential to improve the quality of life and reduce health risks associated with sedentary lifestyles.

Pupil size with and without adrenaline with diclofenac use before cataract surgery.

PURPOSE: To determine whether adrenaline in the irrigating solution is necessary when diclofenac eyedrops are used before cataract surgery. SETTING: Pasqua Hospital, Regina, Saskatchewan, Canada. METHODS: In this prospective randomized masked study, all patients used diclofenac eyedrops 2 days preoperatively. The pupils were dilated with a wick soaked in a dilating solution containing diclofenac. Patients were divided into 2 groups. One group had 0.5 mL of 1:1000 adrenaline in 500.0 mL of fortified balanced salt solution (BSS Plus) (adrenaline group). The other group did not (no-adrenaline group). The horizontal diameter of the pupils was measured with calipers. RESULTS: The study included 207 patients. There were no surgical complications. In the adrenaline group, the mean pupil size was 8.19 mm +/- 0.86 (SD) before the first incision, 8.14 +/- 0.87 mm after phacoemulsification, and 8.14 +/- 0.85 mm after cortical removal. In the no-adrenaline group, the means were 8.19 +/- 0.87 mm, 7.94 +/- 0.99 mm, and 7.87 +/-1.03 mm, respectively. The mean pupil constriction was 0.05 +/- 0.21 mm in the adrenaline group and 0.33 +/- 0.43 mm in the no-adrenaline group. The difference was statistically significant (Mann-Whitney test). Further analysis of preoperative pupil size showed a significant difference for smaller pupils only. CONCLUSIONS: When diclofenac eyedrops were used before cataract surgery, the smaller preoperative pupils constricted significantly less when adrenaline was added to the irrigating solution. This was not true for larger pupils. Thus, adrenaline in the irrigating solution does not appear necessary in eyes with large preoperative pupils.

Dietary supplement use in adolescents.

PURPOSE OF REVIEW: As prevalence rates of dietary supplement use are observed to be increasing in adolescents and the population in general, questions need to be asked about the efficacy, motivations, and consequences of such usage. Focusing mainly on individuals between the ages of 12 to 19 (adolescents) this review will highlight current prevalence rates, types of supplements being consumed, reasons for consumption, and concerns regarding physiological, psychological, knowledge transfer, and regulatory aspects of supplement use. RECENT FINDINGS: Studies have indicated the prevalence of dietary supplement usage by adolescents range from approximately 10% to as high as 74%. Some of the highest rates of usage appear in chronically ill adolescents. Multivitamin and mineral preparations are the most common supplements being consumed; however, many studies indicate that adolescents are using other substances like creatine, herbals, or protein supplements. Some of the most appealing supplements among this age group are those that enhance athletic performance or physical appearance. Recent literature suggests three key moderating factors for supplement use in adolescents: health status, gender, and level of physical activity involvement. SUMMARY: As the dietary supplement industry is now a multi-billion dollar industry, there is growing pressure, and a subsequent need for research to establish the efficacy and safety of these products particularly for adolescent users. The psychological and educational components of such use cannot be ignored as they play an equally important role in the health and safety of adolescents.

A look at nutritional supplement use in adolescents.

PURPOSE: To examine the use of nutritional supplements by adolescents. Supplements examined were those purported to influence performance and body mass. METHODS: 333 adolescents (190 male, 139 female, 4 nonrespondents) between the ages of 13 and 19 years, from a midwestern province in Canada, completed a pencil-and-paper survey. Participants, who were enrolled in health and wellness/physical education classes, were requested to provide information about current and potential use of 10 readily available nutritional supplements, as well as their knowledge of these products as potentially performance enhancing. Differences in use, potential use, and knowledge, as a function of gender, age, and level of physical activity were examined using Chi-square analyses and ANOVA techniques. RESULTS: The most popular dietary aids were multivitamin/mineral preparations (42.5%). More adolescent males than females reported that they currently used both creatine and diuretics. Female respondents indicated that they would consume herbal weight control products significantly more than males. Older students and students reporting high levels of physical activity were significantly more likely to be supplementing with creatine and protein. Males were more likely than females to believe that creatine and androsterone were performance-enhancing agents. Individuals highly involved in physical activity tended to believe that multivitamins, creatine, L-carnitine, energizers, and protein supplements could enhance their performance. CONCLUSIONS: This study highlights the fact that many nutritional supplements fall within the spectrum of adolescent use, and that this use may be driven by misguided beliefs in their performance-enhancing abilities. Groups at particular risk, such as individuals involved in physical activity to a high degree, are highlighted and the need for gender-specific information is suggested.