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11 records – page 1 of 2.

Burnout, depression, life and job satisfaction among Canadian emergency physicians.

https://arctichealth.org/en/permalink/ahliterature217864
Source
J Emerg Med. 1994 Jul-Aug;12(4):559-65
Publication Type
Article
Author
S. Lloyd
D. Streiner
S. Shannon
Author Affiliation
Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada.
Source
J Emerg Med. 1994 Jul-Aug;12(4):559-65
Language
English
Publication Type
Article
Keywords
Adult
Burnout, Professional - epidemiology
Canada - epidemiology
Depression - epidemiology
Emergency Medicine - statistics & numerical data
Female
Humans
Job Satisfaction
Male
Personal Satisfaction
Physician Impairment
Physicians - psychology - statistics & numerical data
Prospective Studies
Abstract
Our goal was to determine the level of burnout, depression, life and job satisfaction of Canadian emergency physicians. Six instruments were administered: the emotional exhaustion, depersonalization, and personal accomplishment intensity subscales of the Maslach Burnout Inventory (MBI); the Centre for Epidemiologic Research Self-Report Depression Scale (CES-D); the Satisfaction With Life Scale (SWLS); and the Emergency Physician Job Satisfaction Measurement Instrument (EPJS). Forty-six percent of the sample fell within the medium to high level of emotional exhaustion, 93% within the medium to high range for depersonalization, and 79% within the medium to low range for personal accomplishment. Sixty-one percent were satisfied with their lives, and 75.5% were satisfied with their jobs. Multiple regression analysis showed that increased age, being a department head, and increased weeks of holiday per year were positive contributors to EPJS scores (P
PubMed ID
7963406 View in PubMed
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Cardiorespiratory fitness and atrial fibrillation: A population-based follow-up study.

https://arctichealth.org/en/permalink/ahliterature272309
Source
Heart Rhythm. 2015 Jul;12(7):1424-30
Publication Type
Article
Date
Jul-2015
Author
Hassan Khan
Danesh Kella
Rainer Rauramaa
Kai Savonen
Michael S Lloyd
Jari A Laukkanen
Source
Heart Rhythm. 2015 Jul;12(7):1424-30
Date
Jul-2015
Language
English
Publication Type
Article
Keywords
Atrial Fibrillation - diagnosis - epidemiology - physiopathology
Exercise Test - methods - statistics & numerical data
Finland - epidemiology
Humans
Incidence
Male
Middle Aged
Oxygen consumption
Physical Fitness - physiology
Proportional Hazards Models
Risk factors
Statistics as Topic
Abstract
Atrial fibrillation (AF) is the most common arrhythmia worldwide and has a complex association with physical fitness. The relationship of cardiorespiratory fitness (CRF) with the risk for AF has not been previously investigated in population-based studies.
The purpose of this study was to determine the relationship of CRF with incident AF.
CRF, as assessed by maximal oxygen uptake (VO2max) during exercise testing, was measured at baseline in 1950 middle-aged men (mean age 52.6 years, SD 5.1) from the Kuopio Ischaemic Heart Disease (KIHD) study.
During average follow-up of 19.5 years, there were 305 incident AF cases (annual AF rate of 65.1/1000 person-years, 95% confidence interval [CI] 58.2-72.8). Overall, a nonlinear association was observed between CRF and incident AF. The rate of incident AF varied from 11.5 (95% CI 9.4-14.0) for the first quartile of CRF, to 9.1 (95% CI 7.4-11.2) for the second quartile, 5.7 (95% CI 4.4-7.4) for the third quartile, and 6.3 (95% CI 5.0-8.0) for the fourth quartile. Age-adjusted hazard ratio comparing top vs bottom fourth of usual CRF levels was 0.67 (95% CI 0.48-0.95), attenuated to 0.98 (95% CI 0.66-1.43) upon further adjustment for risk factors. These findings were comparable across age, body mass index, history of smoking, diabetes, and cardiovascular disease status at baseline.
Improved fitness as indicated by higher levels of CRF is protective of AF within a certain range, beyond which the risk of AF rises again. These findings warrant further replication.
PubMed ID
25778429 View in PubMed
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Clinical practice guideline on the optimal radiotherapeutic management of brain metastases.

https://arctichealth.org/en/permalink/ahliterature175430
Source
BMC Cancer. 2005;5:34
Publication Type
Article
Date
2005
Author
May N Tsao
Nancy S Lloyd
Rebecca K S Wong
Author Affiliation
Department of Radiation Oncology, Toronto-Sunnybrook Regional Cancer Centre, Toronto, Ontario, Canada. may.tsao@sw.ca
Source
BMC Cancer. 2005;5:34
Date
2005
Language
English
Publication Type
Article
Keywords
Brain Neoplasms - pathology - radiotherapy
Canada
Cranial Irradiation - methods - standards
Humans
Neoplasm Metastasis
Questionnaires
Radiation-Sensitizing Agents - pharmacology
Radiosurgery - methods
Radiotherapy - methods - standards
Radiotherapy Dosage
Abstract
An evidence-based clinical practice guideline on the optimal radiotherapeutic management of single and multiple brain metastases was developed.
A systematic review and meta-analysis was performed. The Supportive Care Guidelines Group formulated clinical recommendations based on their interpretation of the evidence. External review of the report by Ontario practitioners was obtained through a mailed survey, and final approval was obtained from Cancer Care Ontario's Practice Guidelines Coordinating Committee (PGCC).
One hundred and nine Ontario practitioners responded to the survey (return rate 44%). Ninety-six percent of respondents agreed with the interpretation of the evidence, and 92% agreed that the report should be approved. Minor revisions were made based on feedback from external reviewers and the PGCC. The PGCC approved the final practice guideline report.
For adult patients with a clinical and radiographic diagnosis of brain metastases (single or multiple) we conclude that: surgical excision should be considered for patients with good performance status, minimal or no evidence of extracranial disease, and a surgically accessible single brain metastasis. Postoperative whole brain radiotherapy (WBRT) should be considered to reduce the risk of tumour recurrence for patients who have undergone resection of a single brain metastasis. Radiosurgery boost with WBRT may improve survival in select patients with unresectable single brain metastases. The whole brain should be irradiated for multiple brain metastases. Standard dose-fractionation schedules are 3000 cGy in 10 fractions or 2000 cGy in 5 fractions. Radiosensitizers are not recommended outside research studies. In select patients, radiosurgery may be considered as boost therapy with WBRT to improve local tumour control. Radiosurgery boost may improve survival in select patients. Chemotherapy as primary therapy or chemotherapy with WBRT remains experimental. Supportive care is an option but there is a lack of Level 1 evidence as to which subsets of patients should be managed with supportive care alone. Qualifying statements addressing factors to consider when applying these recommendations are provided in the full report. The rigorous development, external review and approval process has resulted in a practice guideline that is strongly endorsed by Ontario practitioners.
Notes
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PubMed ID
15807895 View in PubMed
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Demographic characteristics of full-time emergency physicians in Canada.

https://arctichealth.org/en/permalink/ahliterature220805
Source
Am J Emerg Med. 1993 Jul;11(4):364-70
Publication Type
Article
Date
Jul-1993
Author
S. Lloyd
D. Streiner
S. Shannon
Author Affiliation
Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada.
Source
Am J Emerg Med. 1993 Jul;11(4):364-70
Date
Jul-1993
Language
English
Publication Type
Article
Keywords
Adult
Analysis of Variance
Canada
Certification
Emergency Medicine - economics - manpower - statistics & numerical data
Female
Humans
Male
Professional Practice - statistics & numerical data
Questionnaires
Salaries and Fringe Benefits - statistics & numerical data
Workload - statistics & numerical data
Abstract
The objective of this study was to describe individual and practice characteristics of Canadian emergency physicians, and to determine if these characteristics varied with geographic region, type of certification, or method of reimbursement. The study took place in emergency departments across Canada, and all full-time physicians with certification in emergency medicine, and a random sample of Canadian Association of Emergency Physician members without certification were surveyed with a 23-item questionnaire. Descriptive statistics on individual and practice characteristics were outcome measures. Comparative statistics evaluating demographic characteristics by region, type of certification, and method of reimbursement were used. There were significant differences between responders and nonresponders based on certification (P
PubMed ID
8216518 View in PubMed
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Family medicine residency programs. Evaluating the need for different third-year programs.

https://arctichealth.org/en/permalink/ahliterature218955
Source
Can Fam Physician. 1994 Feb;40:273-8
Publication Type
Article
Date
Feb-1994
Author
S. Lloyd
D. Streiner
S. Shannon
Author Affiliation
Department of Family Medicine, McMaster University, Hamilton, Ont.
Source
Can Fam Physician. 1994 Feb;40:273-8
Date
Feb-1994
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Chief Executive Officers, Hospital - psychology - statistics & numerical data
Community Health Services - organization & administration
Curriculum
Education, Medical, Graduate - standards
Family Practice - education - manpower
Health services needs and demand
Hospital Bed Capacity
Humans
Internship and Residency - standards
Ontario
Physician Executives - psychology - statistics & numerical data
Questionnaires
Abstract
We asked hospital chief executive officers (CEOs) and District Health Council executive directors (DHCs) to compare third-year family medicine residency programs and judge which are more needed in their communities. Care for the elderly and emergency medicine ranked highest among CEOs, while DHCs ranked care for the elderly and mental health highest. Academic family medicine and northern programs ranked lowest for both groups.
Notes
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Comment In: Can Fam Physician. 1994 May;40:874-68080559
PubMed ID
8080510 View in PubMed
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Improving the cold chain for vaccines.

https://arctichealth.org/en/permalink/ahliterature57946
Source
WHO Chron. 1977 Jan;31(1):13-8
Publication Type
Article
Date
Jan-1977
Author
J S Lloyd
Source
WHO Chron. 1977 Jan;31(1):13-8
Date
Jan-1977
Language
English
Publication Type
Article
Keywords
Freezing
Ghana
Preservation, Biological - instrumentation
Tropical Climate
Vaccines - supply & distribution
Abstract
The cold chain may be defined as a system for transporting and storing vaccines at very low temperataures, particularly in tropical countries. In Ghana, efforts are being made, with the assistance of the World Health Organization (WHO) to develop and test a new cold chain technology. Emphasis is on local production in order to meet the needs of the countrywide immunization program, and, if possible, of similar programs in other West African nations. Focus in this discussion is on the losses resulting from mishandling of vaccines during storage and in transit through various stages in the cold chain as well as the problems, requirements, and proposed solutions. In most countries with immunization programs, breakdowns in refrigeration during the transport and storage of vaccines in remote rural areas or at the regional and national central stores have led to great losses of vaccine. The losses are often caused by inappropriate management and technology. The most promising recent development in the area of storage is an enzyme-based time/temperature indicator contained in a paper tab which is attached to the vaccine packet. In order to reduce to a minimum the handling of vaccines at the national central store it is proposed that the ministry of health submit details of regional requirements in their requisition to the manufacturer. Then the manufacturer can make presealed packages which are dispatched by air to the national central store and from there to the regions, while they are still sealed. Insulated boxes for this purpose have been tested in Sweden and been shown to maintain deep-freezing temperatures for 5 days. Road communications to the regional centers are good in Ghana and the 5-day cold boxes give adequate safety margins. The plan for the immunization program in Ghana is to employ a combination of teams from both fixed and mobile centers. 3 contacts, 3 months apart, will be made by the fixed teams; mobile teams will make 2 contacts, 2 months apart. Mobile teams operating in the south of Ghana, where the road communications are good, will be able to perform a large number of immunizations each day, using a vehicle borne cold box. Vaccine samples, selected in the field, need to be transported under closely controlled refrigeration over considerable distances to reach the national laboratories or even European laboratories for assay. The development and testing of most of the devices described will be done at the Technology Consultancy Center, Kumasi University of Science and Technology, in Ghana.
PubMed ID
842006 View in PubMed
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Molecular genetic characterisation of frontotemporal dementia on chromosome 3.

https://arctichealth.org/en/permalink/ahliterature33221
Source
Dement Geriatr Cogn Disord. 1999;10 Suppl 1:93-101
Publication Type
Article
Date
1999
Author
A. Ashworth
S. Lloyd
J. Brown
S. Gydesen
S A Sorensen
A. Brun
E. Englund
C. Humphreys
D. Housman
M. Badura
V. Stanton
K. Taylor
J. Cameron
D. Munroe
J. Johansson
M. Rossor
E M Fisher
J. Collinge
Author Affiliation
Department of Neurogenetics, Imperial College School of Medicine at St Mary's, London, UK.
Source
Dement Geriatr Cogn Disord. 1999;10 Suppl 1:93-101
Date
1999
Language
English
Publication Type
Article
Keywords
Adult
Child
Chromosomes, Human, Pair 3 - physiology
Cosmids - genetics
DNA Fingerprinting
Dementia - genetics - metabolism
Denmark
Disease Progression
Frontal Lobe - metabolism
Humans
Immunohistochemistry
Linkage (Genetics) - genetics
Pedigree
Research Support, Non-U.S. Gov't
Temporal Lobe - metabolism
Trinucleotide Repeats
Abstract
We have previously localized a locus causing familial nonspecific dementia to the centromeric region of chromosome 3 in a pedigree from the Jutland area of Denmark. This pedigree shows anticipation. Here we present further analysis of these anticipation data which are suggestive of trinucleotide repeat expansion involvement. We also outline our strategies to clone the mutant gene via its putative associated trinucleotide repeat sequence.
PubMed ID
10436350 View in PubMed
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Predictive validity of the emergency physician and global job satisfaction instruments.

https://arctichealth.org/en/permalink/ahliterature206169
Source
Acad Emerg Med. 1998 Mar;5(3):234-41
Publication Type
Article
Date
Mar-1998
Author
S. Lloyd
D. Streiner
S. Shannon
Author Affiliation
Department of Clinical Epidemiology, McMaster University, Hamilton, Ontario, Canada. lloyds@fhs.mcmaster.ca
Source
Acad Emerg Med. 1998 Mar;5(3):234-41
Date
Mar-1998
Language
English
Publication Type
Article
Keywords
Analysis of Variance
Canada
Emergency Medicine - manpower
Humans
Job Satisfaction
Physicians
Questionnaires
ROC Curve
Reproducibility of Results
United States
Abstract
To evaluate the predictive validity of the Emergency Physician Job Satisfaction (EPJS) and Global Job Satisfaction (GJS) instruments.
Prospective mail survey of 223 Canadian emergency physicians (EPs) using a 42-item questionnaire, including 14 items evaluating their reasons for leaving emergency medicine (EM). Original (1990) EPJS and GJS scores were analyzed using 1-way ANOVA and Scheffe's test comparing the physicians who left EM with those still in their original jobs, and those who had left their original jobs but who stayed in EM. Mean scores on the 14 "reason for leaving" items were compared with scores from an earlier sample of U.S. physicians using a t-test for independent means. Criteria for statistical significance were set at alpha = 0.05 for all analyses.
The response rate for the primary study questions was 99.1%. Of the respondents, 29.4% had left their original jobs, and 10.4% had left EM altogether. The GJS scores for the physicians who left EM were significantly different from those for the physicians who stayed (p = 0.004). The EPJS scores for the physicians who left EM were not significantly different from those for the physicians who stayed (p = 0.56). There was no significant difference in scores between the Canadian and U.S. physicians' reasons for leaving EM (all p-values > 0.05). Shiftwork scored the highest as a reason to leave EM.
A low GJS score is associated with physicians' leaving EM, but not with changing jobs. The EPJS instrument was not associated with either outcome. Canadian and U.S. EPs place similar levels of importance on potential reasons for leaving EM.
PubMed ID
9523932 View in PubMed
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The prevention and management of acute skin reactions related to radiation therapy: a systematic review and practice guideline.

https://arctichealth.org/en/permalink/ahliterature168941
Source
Support Care Cancer. 2006 Aug;14(8):802-17
Publication Type
Article
Date
Aug-2006
Author
Amanda Bolderston
Nancy S Lloyd
Rebecca K S Wong
Lori Holden
Linda Robb-Blenderman
Author Affiliation
Department of Radiation Oncology, Princess Margaret Hospital, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada.
Source
Support Care Cancer. 2006 Aug;14(8):802-17
Date
Aug-2006
Language
English
Publication Type
Article
Keywords
Acute Disease
Bandages
Baths - methods
Clinical Trials as Topic
Dermatologic Agents - therapeutic use
Evidence-Based Medicine
Humans
Neoplasms - radiotherapy
Ontario
Radiodermatitis - prevention & control - therapy
Radiotherapy, Adjuvant - adverse effects
Steroids - therapeutic use
Abstract
To develop a practice guideline report on the questions: What are the optimal methods to prevent acute skin reactions (occurring within the first 6 months of irradiation) related to radiation therapy? What are the optimal methods to manage acute skin reactions related to radiation therapy?
Cancer Care Ontario's Supportive Care Guidelines Group (SCGG) conducted a systematic review of literature on this topic. Evidence-based recommendations were formulated to guide clinical decision making, and a formal external review process was conducted to validate the relevance of these opinions for Ontario practitioners.
Twenty-eight trials meeting the inclusion criteria were identified. Of the twenty-three trials that evaluated preventative methods, washing was the only practice which significantly prevented skin reaction. Some evidence suggested topical steroid creams and calendula ointment might be effective. None of the five trials evaluating skin reaction management detected a positive effect using steroid cream, sucralfate cream, or dressings.
Skin washing, including gentle washing with water alone with or without mild soap, should be permitted in patients receiving radiation therapy to prevent acute skin reaction. There is insufficient evidence to support or refute specific topical or oral agents for the prevention or management of acute skin reaction. In the expert opinion from the SCGG, the use of a plain, non-scented, lanolin-free hydrophilic cream may be helpful in preventing radiation skin reactions. In addition, a low dose (i.e., 1%) corticosteroid cream may be beneficial in the reduction of itching and irritation.
Notes
Comment In: Support Care Cancer. 2007 Oct;15(10):1219; author reply 122117372772
PubMed ID
16758176 View in PubMed
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Radiotherapy fractionation for the palliation of uncomplicated painful bone metastases - an evidence-based practice guideline.

https://arctichealth.org/en/permalink/ahliterature178104
Source
BMC Cancer. 2004 Oct 4;4:71
Publication Type
Article
Date
Oct-4-2004
Author
Jackson Sai-Yiu Wu
Rebecca K S Wong
Nancy S Lloyd
Mary Johnston
Andrea Bezjak
Timothy Whelan
Author Affiliation
Department of Radiation Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada. jacksonw@CancerBoard.ab.ca
Source
BMC Cancer. 2004 Oct 4;4:71
Date
Oct-4-2004
Language
English
Publication Type
Article
Keywords
Adult
Bone Neoplasms - radiotherapy - secondary
Dose Fractionation
Evidence-Based Medicine
Humans
Ontario
Pain - etiology - radiotherapy
Palliative Care
Abstract
This practice guideline was developed to provide recommendations to clinicians in Ontario on the preferred standard radiotherapy fractionation schedule for the treatment of painful bone metastases.
A systematic review and meta-analysis was performed and published elsewhere. The Supportive Care Guidelines Group, a multidisciplinary guideline development panel, formulated clinical recommendations based on their interpretation of the evidence. In addition to evidence from clinical trials, the panel also considered patient convenience and ease of administration of palliative radiotherapy. External review of the draft report by Ontario practitioners was obtained through a mailed survey, and final approval was obtained from the Practice Guidelines Coordinating Committee.
Meta-analysis did not detect a significant difference in complete or overall pain relief between single treatment and multifraction palliative radiotherapy for bone metastases. Fifty-nine Ontario practitioners responded to the mailed survey (return rate 62%). Forty-two percent also returned written comments. Eighty-three percent of respondents agreed with the interpretation of the evidence and 75% agreed that the report should be approved as a practice guideline. Minor revisions were made based on feedback from the external reviewers and the Practice Guidelines Coordinating Committee. The Practice Guidelines Coordinating Committee approved the final practice guideline report.
For adult patients with single or multiple radiographically confirmed bone metastases of any histology corresponding to painful areas in previously non-irradiated areas without pathologic fractures or spinal cord/cauda equine compression, we conclude that: Where the treatment objective is pain relief, a single 8 Gy treatment, prescribed to the appropriate target volume, is recommended as the standard dose-fractionation schedule for the treatment of symptomatic and uncomplicated bone metastases. Several factors frequently considered in clinical practice when applying this evidence such as the effect of primary histology, anatomical site of treatment, risk of pathological fracture, soft tissue disease and cord compression, use of antiemetics, and the role of retreatment are discussed as qualifying statements.Our systematic review and meta-analysis provided high quality evidence for the key recommendation in this clinical practice guideline. Qualifying statements addressing factors that should be considered when applying this recommendation in clinical practice facilitate its clinical application. The rigorous development and approval process result in a final document that is strongly endorsed by practitioners as a practice guideline.
Notes
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PubMed ID
15461823 View in PubMed
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11 records – page 1 of 2.