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Barriers to metered-dose inhaler/spacer use in Canadian pediatric emergency departments: a national survey.

https://arctichealth.org/en/permalink/ahliterature161885
Source
Acad Emerg Med. 2007 Nov;14(11):1106-13
Publication Type
Article
Date
Nov-2007
Author
Martin H Osmond
Madlen Gazarian
Richard L Henry
Tammy J Clifford
Jennifer Tetzlaff
Author Affiliation
Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada. osmond@cheo.on.ca
Source
Acad Emerg Med. 2007 Nov;14(11):1106-13
Date
Nov-2007
Language
English
Publication Type
Article
Keywords
Asthma - therapy
Canada
Child
Cross-Sectional Studies
Emergency Service, Hospital - statistics & numerical data
Health Care Surveys
Hospitals, Teaching
Humans
Metered Dose Inhalers - utilization
Abstract
Metered-dose inhalers and spacers (MDI+S) are at least as effective as nebulizers for treating children with mild to moderate asthma exacerbations. Despite advantages in terms of efficacy, side effects, and ease of use, MDI+S are not used in many North American pediatric emergency departments (PEDs).
To survey emergency physicians, emergency nurses, and respirologists in Canadian pediatric teaching hospitals regarding their practices, beliefs, and barriers to change with respect to bronchodilator delivery.
This was a cross-sectional, mailed survey of all emergency physicians, all respirologists, and a random sample of emergency nurses at ten Canadian PEDs.
A total of 291 of 349 health care professionals (83%) responded. Twenty-one percent of emergency physicians use MDI+S in the PED (largely concentrated at two "user sites"). A majority at nonuser sites, and virtually all professionals at user sites, responded that MDI+S are at least as effective as nebulizers, switching to MDI+S is justified by existing research, patient outcomes would be equal or better, and they have the required knowledge and skills to use MDI+S in the emergency department. The largest perceived barriers to MDI+S implementation include concerns regarding safety and costs, related to feasibility of providing and sterilizing spacers, and parental expectations for nebulizers. Other barriers included staff beliefs regarding the effectiveness of MDI+S, changes in nursing workload, and lack of a physician champion for change.
MDI+S are infrequently used to treat patients with acute asthma in Canadian PEDs, despite the fact that most emergency staff believe they are effective. Important barriers to using MDI+S have been identified in this study and should be used to guide future implementation strategies.
PubMed ID
17699806 View in PubMed
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Factors influencing full breastfeeding in a southwestern ontario community: assessments at 1 week and at 6 months postpartum.

https://arctichealth.org/en/permalink/ahliterature168045
Source
J Hum Lact. 2006 Aug;22(3):292-304
Publication Type
Article
Date
Aug-2006
Author
Tammy J Clifford
M Karen Campbell
Kathy N Speechley
Fabian Gorodzinsky
Author Affiliation
Epidemiology and Biotatistics, The University of Western Ontario, Canada.
Source
J Hum Lact. 2006 Aug;22(3):292-304
Date
Aug-2006
Language
English
Publication Type
Article
Keywords
Adult
Anxiety
Breast Feeding - epidemiology - psychology
Cohort Studies
Data Collection
Delivery of Health Care
Employment
Female
Humans
Infant
Infant, Newborn
Male
Ontario
Postpartum Period
Proportional Hazards Models
Smoking
Time Factors
Abstract
Factors associated with full breastfeeding (FBF) at 1 week and at 6 months postpartum were examined in a cohort of 856 mother-infant dyads. Questionnaires were mailed at 4 time points over the first 6 months postpartum. At 1 week, 68% of infants were FBF; at 6 months, 23% were FBF. Factors significantly associated with FBF at 1 week were hospital of delivery, residing with a smoker, maternal shiftwork during pregnancy, and having no prior breast-feeding experience. Cox proportional hazards regression analysis showed that residing with a smoker, having consumed caffeine during pregnancy, reporting elevated maternal trait anxiety at 1 week postpartum, having been employed full-time outside the home prior to delivery, and having received anesthesia/analgesia during labor/delivery were associated with earlier cessation of FBF, whereas not having previous breastfeeding experience predicted its continuation. Although most mothers are breastfeeding early on, a number of factors adversely affect its successful continuation.
PubMed ID
16885489 View in PubMed
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"I never hear what happens, even if they die": a survey of emergency physicians about outcome feedback.

https://arctichealth.org/en/permalink/ahliterature147302
Source
CJEM. 2009 Nov;11(6):523-8
Publication Type
Article
Date
Nov-2009
Author
Curtis F Lavoie
Amy C Plint
Tammy J Clifford
Isabelle Gaboury
Author Affiliation
Emergency Department, Hôpital Montfort, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada. curtislavoie@gmail.ca
Source
CJEM. 2009 Nov;11(6):523-8
Date
Nov-2009
Language
English
Publication Type
Article
Keywords
Adult
Chi-Square Distribution
Clinical Competence
Emergency Medicine - standards
Feedback
Female
Humans
Job Satisfaction
Male
Ontario
Outcome Assessment (Health Care)
Physician's Practice Patterns - standards
Physicians - psychology
Quebec
Questionnaires
Statistics, nonparametric
Abstract
Emergency physicians (EPs) rarely find out what happens to patients after the patients leave their care, a process we call "outcome feedback." Some suggest this hinders the practice of emergency medicine (EM); however, evidence is lacking. We sought to evaluate EPs' perception of the current and potential role of outcome feedback in EM.
We surveyed practising French- and English speaking EPs from emergency departments within 100 km of Ottawa, Ont., in the provinces of Ontario and Quebec. The main outcomes included the prevalence, role and effect of outcome feedback.
Of the 297 physicians surveyed, 231 (77.8%) respond ed. The sample contained good representation of language groups, practice settings, sexes and age groups. All participants indicated that knowing outcomes is "essential" (62.6%) or "beneficial" (37.4%) to gaining experience in EM. Participants reported currently receiving passive outcome feedback in 10.0% of all cases, and seeking out (active) outcome feedback in 7.5% of all cases. The great majority of participants (97.3%) stated that they would like to receive more outcome feedback and believed that this would improve diagnostic accuracy (97.3%), clinical efficiency (85.5%), treatment outcomes (95.6%) and job satisfaction (95.1%). When asked to indicate "any possible negative effects that might arise from increased outcome feedback," 62.1% indicated none.However, 17.9% hypothesized negative emotional effects and 11.5% suggested increased time requirements.
The overwhelming majority of EPs receive very little outcome feedback. Most would like more outcome feedback and believe it would improve the practice of EM.
Notes
Comment In: CJEM. 2009 Nov;11(6):568-7019922720
Comment In: CJEM. 2009 Nov;11(6):566-719922719
Comment In: CJEM. 2010 Jul;12(4):30020650020
PubMed ID
19922711 View in PubMed
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Infant colic: empirical evidence of the absence of an association with source of early infant nutrition.

https://arctichealth.org/en/permalink/ahliterature187892
Source
Arch Pediatr Adolesc Med. 2002 Nov;156(11):1123-8
Publication Type
Article
Date
Nov-2002
Author
Tammy J Clifford
M Karen Campbell
Kathy N Speechley
Fabian Gorodzinsky
Author Affiliation
Department of Epidemiology, The University of Western Ontario, Ottawa, Canada. tclifford@cheo.on.ca
Source
Arch Pediatr Adolesc Med. 2002 Nov;156(11):1123-8
Date
Nov-2002
Language
English
Publication Type
Article
Keywords
Adult
Alcohol Drinking
Anxiety
Breast Feeding
Colic - epidemiology - etiology - prevention & control
Employment
Female
Humans
Infant
Infant Food
Infant, Newborn
Marital status
Maternal Behavior - psychology
Multivariate Analysis
Ontario - epidemiology
Prevalence
Prospective Studies
Questionnaires
Work Schedule Tolerance
Abstract
The etiology of infant colic remains unknown, despite an abundance of research on the topic.
To determine whether breastfeeding has a protective effect in colic's development.
A prospective cohort study of 856 mother-infant dyads. Eligible participants included English-speaking adult residents of a region in Ontario, who gave birth, at term, to a live singleton whose birth weight was appropriate for gestational age. Self-administered questionnaires, mailed to mothers at 1 and 6 weeks post partum, requested information on several infant and maternal factors, including source of infant nutrition (exclusively breastfed, complementary fed, and exclusively formula fed). Cases of colic were identified by applying modified Wessel criteria to data recorded in the Barr Baby Day Diary or by interpreting responses to the Ames Cry Score.
Prevalence of colic among breastfed, formula-fed, and complementary-fed infants; and adjusted odds ratios (AORs) reflecting the prevalence of colic among formula- and complementary-fed infants relative to those who were breastfed.
Of 856 mothers, 733 (86%) completed the first questionnaire and 617 (72%) completed the second questionnaire. Overall, the prevalence of colic at 6 weeks was 24%. No association was seen between the source of infant nutrition and colic's development. In multivariate analyses, higher levels of maternal trait anxiety (AOR, 1.22; 95% confidence interval [CI], 0.96-1.54), maternal alcohol consumption at 6 weeks (AOR, 1.57; 95% CI, 1.03-2.40), and shift work during pregnancy (AOR, 1.27; 95% CI, 0.73-2.21) were associated with an increased likelihood of colic, after controlling for feeding method, maternal age, and parity. In these same analyses, being married or having a common-law partner (AOR, 0.30; 95% CI, 0.10-0.87) and being employed full-time during pregnancy (AOR, 0.60; 95% CI, 0.32-1.14) were associated with a reduced likelihood of colic.
Breastfeeding did not have a protective effect on the development of colic. Although colic was statistically associated with several variables, including preexisting maternal anxiety, much of colic's etiology remains unexplained.
PubMed ID
12413341 View in PubMed
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Sequelae of infant colic: evidence of transient infant distress and absence of lasting effects on maternal mental health.

https://arctichealth.org/en/permalink/ahliterature187596
Source
Arch Pediatr Adolesc Med. 2002 Dec;156(12):1183-8
Publication Type
Article
Date
Dec-2002
Author
Tammy J Clifford
M Karen Campbell
Kathy N Speechley
Fabian Gorodzinsky
Author Affiliation
Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Rd, Ottawa, Ontario, Canada K1H 8L1. tclifford@cheo.on.ca
Source
Arch Pediatr Adolesc Med. 2002 Dec;156(12):1183-8
Date
Dec-2002
Language
English
Publication Type
Article
Keywords
Colic - epidemiology - psychology
Crying - psychology
Female
Humans
Infant
Infant, Newborn
Mental health
Mother-Child Relations
Ontario - epidemiology
Prevalence
Prospective Studies
Questionnaires
Social Class
Abstract
Colic is widely believed to remit by 3 months of age, with little lasting effect on the infant or the family.
To determine the prevalence of colic at 3 months and the proportion of cases of colic (identified at 6 weeks) that remitted by 3 months; to identify the factors predictive of colic's remission; and to explore the potential lasting effects of colic on maternal mental health.
Prospective cohort study of 856 mother-infant dyads. Self-administered questionnaires were mailed to mothers at 1 and 6 weeks and 3 and 6 months post partum. Standardized instruments were incorporated into the first and last questionnaires to assess maternal anxiety, postnatal depression, and social support. At 6 weeks and at 3 months, mothers completed the Barr diary and/or the Ames Cry Score.
Data from 547 dyads were available for analysis. The prevalence of colic at 3 months was 6.4%. More than 85% of cases of colic had remitted by 3 months of age. These infants were more likely to be female, whereas the mothers of these infants were more likely to have received pain relief during labor/delivery and to have been employed during pregnancy. Reductions in scores for trait anxiety and postnatal depression, although smaller for mothers whose infants were colicky at 6 weeks of age, were not significantly different from those of mothers whose infants were never colicky.
This study provides support for the belief that, in most cases, colic is self-limiting and does not result in lasting effects to maternal mental health.
Notes
Comment In: Arch Pediatr Adolesc Med. 2002 Dec;156(12):1172-412444822
Erratum In: Arch Pediatr Adolesc Med. 2003 May;157(5):486
PubMed ID
12444827 View in PubMed
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Use of single-dose activated charcoal among Canadian pediatric emergency physicians.

https://arctichealth.org/en/permalink/ahliterature166994
Source
Pediatr Emerg Care. 2006 Oct;22(10):724-8
Publication Type
Article
Date
Oct-2006
Author
Sarah M Reid
Gina M Neto
Tammy J Clifford
Navdeep Randhawa
Amy Plint
Author Affiliation
Division of Emergency Medicine, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada. Reid_sa@cheo.on.ca
Source
Pediatr Emerg Care. 2006 Oct;22(10):724-8
Date
Oct-2006
Language
English
Publication Type
Article
Keywords
Acetaminophen - poisoning
Adolescent
Antidotes - therapeutic use
Canada
Charcoal - therapeutic use
Child, Preschool
Cross-Sectional Studies
Digoxin - poisoning
Emergency Service, Hospital
Guideline Adherence
Health Care Surveys
Humans
Ibuprofen - poisoning
Iron Compounds - poisoning
Lorazepam - poisoning
Male
Paroxetine - poisoning
Poisoning - drug therapy
Time Factors
Abstract
Gastric decontamination with single-dose activated charcoal (SDAC) is a mainstay in emergency department (ED) treatment of ingestions. Guidelines updated in 2005 encourage practitioners to use SDAC only in toxic ingestions presenting within 1 hour. Despite these guidelines, adult studies demonstrate a significant lack of consensus. This study examined the proposed use of SDAC for gastric decontamination in common pediatric ingestion scenarios by emergency physicians working in Canadian pediatric EDs.
A standardized survey consisting of 5 clinical scenarios was mailed to all physicians with a primary clinical appointment to the ED at 9 Canadian children's hospitals.
One hundred thirty-one physicians were surveyed, and 95 (72%) responded. The majority of respondents were pediatricians (68.1%) with a mean of 15.0 years of experience (SD, 6.8 years). Of those surveyed; 91 (97.8%) would use SDAC for a toxic ingestion presenting in less than 1 hour; 35 (36.8%) would use SDAC for a toxic ingestion presenting after 3 hours; 61 (64.9%) would use SDAC for a nontoxic exploratory ingestion presenting in less than 1 hour; and 29 (30.5%) would use SDAC for a mildly symptomatic intentional ingestion presenting at an unknown time. Eleven (11.7%) would use SDAC for an ingestion of a substance that does not adsorb to SDAC.
There is variation in the use of SDAC among emergency physicians working in Canadian pediatric EDs. This variation suggests that optimal management is not clear and that continued education and research are required.
PubMed ID
17047472 View in PubMed
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6 records – page 1 of 1.