Journal articles: 'Vancouver General Hospital'

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Tong, Kevin L., Pat Porterfield, and Isobel Mills. "Vancouver General Hospital Palliative Care Unit Utilization Review." Journal of Palliative Care 9, no. 1 (March 1993): 32–36. http://dx.doi.org/10.1177/082585979300900106.

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This paper describes the utilization pattern in the Palliative Care Unit at Vancouver General Hospital for a six-month period (1 April – 30 September 1991) and relates the information provided to the mandate of the palliative care program. It is a retrospective study of 139 patients discharged during this period. Data were collected from the Hospital Medical Records Institute (HMRI), the Medical Records Department of Vancouver General Hospital, patients’ charts, the palliative care unit admission/discharge book, and palliative care consultation statistics.

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FANCOURT-SMITH, P. F., J. HORNSTEIN, and L. C. JENKINS. "Hospital Admissions from the Surgical Day Care Centre of Vancouver General Hospital, 1977???1987." Survey of Anesthesiology XXXV, no. 2 (April 1991): 99???100. http://dx.doi.org/10.1097/00132586-199104000-00031.

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Fancourt-Smith, Peter F., Jeffrey Hornstein, and Leonard C. Jenkins. "Hospital admissions from the Surgical Day Care Centre of Vancouver General Hospital 1977–1987." Canadian Journal of Anaesthesia 37, no. 6 (September 1990): 699–704. http://dx.doi.org/10.1007/bf03006496.

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Leong, Wendy, and Marshall Dahl. "BC Provincial Diabetes Evaluation: Key Preliminary Results for Vancouver General Hospital." Canadian Journal of Diabetes 41, no. 5 (October 2017): S54. http://dx.doi.org/10.1016/j.jcjd.2017.08.144.

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Li, D., G. Walker, G. Xu, and D. Johnston. "P.063 The evolving epidemiology of infective endocarditis at St. Paul’s Hospital and Vancouver General Hospital." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 44, S2 (June 2017): S29. http://dx.doi.org/10.1017/cjn.2017.147.

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Background: SPH and VGH are the two largest tertiary care centers in BC’s Lower Mainland. Among those served are the low-SES, high-risk population of Vancouver’s Downtown East Side (DTES). We aim to characterize the changing epidemiology of infective endocarditis (IE) in this population from 1995 and 2014. To date, our database is among the world’s largest. Methods: 1337 cases were identified using ICD9/10 codes. A retrospective chart review was conducted to collect demographic data including HIV status, IVDU, neurologic complications and mortality. The cohort was dichotomized into IVDU and non-IVDU, and first (1995-2005) and second (2006-2014) decades. Data analysis was performed using univariate chi-square and t-tests. Results: Age at presentation has increased in the past decade (45 vs 55,p<0.001). Rates of IVDU and HIV have decreased significantly (50.5% vs 44.3%,p<0.001; 21.8% vs 7.9%,p<0.001, respectively). Neurologic complications were less frequent in non-IVDUs (16.5% vs 28.9%,p<0.01). Mortality was greater in those with neurologic complications (RR=2.6 95%CI:2.1-3.3,p<0.001). Patients with neurologic complications were more likely to undergo cardiac surgery (RR=1.6 95%CI:1.3-2.0,p<0.001). Conclusions: Our findings highlight the changing epidemiology of IE. Some discrepancies between our data and the existing literature may be accounted for by Vancouver’s unique DTES population. Further work characterizing this is ongoing.

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Arsenault, Kyle A., Jerry C. Chen, Joel Gagnon, and York N. Hsiang. "Venous Stenting for Lower Extremity Venous Occlusive Disease: The Vancouver General Hospital Experience." Journal of Vascular Surgery 64, no. 5 (November 2016): 1537. http://dx.doi.org/10.1016/j.jvs.2016.08.021.

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Romano, Kali R., Julia M. Cory, Juan J. Ronco, Gerald M. Legiehn, Jeffrey N. Bone, and Gordon N. Finlayson. "Vancouver General Hospital Pulmonary Embolism Response Team (VGH PERT): initial three-year experience." Canadian Journal of Anesthesia/Journal canadien d'anesthésie 67, no. 12 (August 17, 2020): 1806–13. http://dx.doi.org/10.1007/s12630-020-01790-6.

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MacDonald, Valerie, Barbara Arthur, and Sharon Parent. "The Vancouver General Hospital joint replacement rapid recovery program: Optimizing outcomes through focused pathways." Journal of Orthopaedic Nursing 9, no. 2 (May 2005): 95–102. http://dx.doi.org/10.1016/j.joon.2005.03.006.

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Odell, Michael J., and J. Scott Durham. "Parotid Surgery in an Outpatient Setting: The Vancouver Hospital Experience." Journal of Otolaryngology 32, no. 05 (2003): 298. http://dx.doi.org/10.2310/7070.2003.11273.

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Gagan, David, and Rosemary Gagan. "“Evil Reports” for “Ignorant Minds”? Patient Experience and Public Confidence in the Emerging Modern Hospital: Vancouver General Hospital, 1912." Canadian Bulletin of Medical History 18, no. 2 (October 2001): 349–67. http://dx.doi.org/10.3138/cbmh.18.2.349.

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Bates, D. V., M. Baker-Anderson, and R. Sizto. "Asthma attack periodicity: A study of hospital emergency visits in Vancouver." Environmental Research 51, no. 1 (February 1990): 51–70. http://dx.doi.org/10.1016/s0013-9351(05)80182-3.

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Tezcan, H., M. J. Barnett, C. N. Bredeson, D. E. Reece, J. D. Shepherd, B. I. Dalal, D. E. Horsman, et al. "Treatment of Acute Promyelocytic Leukemia in Patients Presenting at Vancouver General Hospital from 1983 to 1992." Leukemia & Lymphoma 16, no. 5-6 (January 1995): 439–44. http://dx.doi.org/10.3109/10428199509054431.

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Heran, M. S., A. Murphy, G. Redekop, C. Haw, and D. A. Graeb. "Abstract No. 63: Emergency Carotid Revascularization in the Acute Stroke Setting: The Vancouver General Hospital Experience." Journal of Vascular and Interventional Radiology 20, no. 2 (February 2009): S26. http://dx.doi.org/10.1016/j.jvir.2008.12.398.

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Leung, Philemon, Abdullah A. Albarrak, Aida Rahavi, Vahid Mehrnoush, Alex Lee, Leo Chen, and Adam Meneghetti. "Effect of epidural analgesia on postoperative opioid requirements following elective laparotomies performed at Vancouver General Hospital." American Journal of Surgery 221, no. 6 (June 2021): 1228–32. http://dx.doi.org/10.1016/j.amjsurg.2021.03.025.

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Sardiwalla, Yaeesh, and Steven F. Morris. "Shaping Plastic Surgery in British Columbia—The Courtemanche Legacy." Plastic Surgery 27, no. 2 (March 21, 2019): 162–66. http://dx.doi.org/10.1177/2292550319826091.

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Dr Albert Douglas Courtemanche was born in Gravenhurst, Ontario on November 16, 1929. In 1949, he was accepted to the University of Toronto Medical School, graduating in 1955. After completing his internship at the Toronto General Hospital and at the Hospital for Sick Children, he completed his surgical training in Vancouver and in the United Kingdom. When Dr Courtemanche returned from his training in 1962, he joined Dr Cowan on the surgical staff at the Vancouver General Hospital. He was responsible for establishing a new plastic surgery ward, a dedicated operating room (OR), an integrated burn unit and also starting the UBC plastic surgery training program. Dr Courtemanche became involved in working with the Royal College, first as an examiner and then as the Chairman of the Plastic Surgery Exam Board in 1981. He eventually became the first and only plastic surgeon to ever hold the position as President of the Royal College. Dr Courtemanche emphasized throughout his career the importance of teaching and role modeling. A very proud moment in Dr Courtemanche’s career was when his son Douglas became a pediatric plastic surgeon. After retiring Dr Courtemanche became a volunteer at the VanDusen Botanical Garden and completed their Master Gardeners Program.

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Brown, OMM, CD, MD, FRCSC, D. Ross, Peter Hennecke, RN, BScN, MA, CD, Doug Nottebrock, MD, and Paul Dhillon, MSc, DM-EMDM, CCFP(EM), DTM&H(Lon), FRGS. "Vancouver Convention Health Centre (COVID-19 Response): Planning, implementation, and four lessons learned." American Journal of Disaster Medicine 15, no. 2 (April 1, 2020): 143–48. http://dx.doi.org/10.5055/ajdm.2020.0365.

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The Vancouver Convention Health Centre (VCHC) was rapidly set up as a part of the COVID-19 response in British Columbia in order to create surge hospital capacity bed space. Multiple field hospitals were set up across the country in preparation for a possible surge and the VCHC utilized a non-traditional health care space and overlaid it with medical infrastructure. Maximum flexibility was required in planning for multiple patient populations and a novel four-box concept to plan for the requirements of the respective possible populations was developed. Key difficulties that needed to be overcome in planning COVID-19 medical care delivery in a non-traditional space included oxygen delivery, unknown future patient populations, and staffing. A clear recommendation can also now be made that healthcare provision should be considered during the design and build of new recreational or convention facilities in all communities.

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McGregor, Margaret J., J. Mark FitzGerald, Robert J. Reid, Adrian R. Levy, Michael Schulzer, David Jung, Horacio E. Groshaus, and Michelle B. Cox. "Determinants of Hospital Length of Stay among Patients with Pneumonia Admitted to a Large Canadian Hospital from 1991 to 2001." Canadian Respiratory Journal 12, no. 7 (2005): 365–70. http://dx.doi.org/10.1155/2005/628367.

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BACKGROUND: Pneumonia is a common reason for hospital admission, and the cost of treatment is primarily determined by length of stay (LOS).OBJECTIVES: To explore the changes to and determinants of hospital LOS for patients admitted for the treatment of community-acquired pneumonia over a decade of acute hospital downsizing.METHODS: Data were extracted from the database of Vancouver General Hospital, Vancouver, British Columbia, on patients admitted with community-acquired pneumonia (International Classification of Diseases, Ninth Revision, Clinical Modification codes 481.xx, 482.xx, 483.xx, 485.xx and 486.xx) from January 1, 1991 to March 31, 2001. The effects of sociodemographic factors, the specialty of the admitting physician (family practice versus specialist), admission from and/or discharge to a long-term care facility (nursing home) and year of admission, adjusted for comorbidity, illness severity measures and other potential confounders were examined. Longitudinal changes in these factors over the 10-year period were also investigated.RESULTS: The study population (n=2495) had a median age of 73 years, 53% were male and the median LOS was six days. Adjusted LOS was longer for women (10% increase, 95% CI 3 to 16), increasing age group (7% increase, 95% CI 4 to 10), admission under a family physician versus specialist (42% increase, 95% CI 32 to 52) and admission from home with subsequent discharge to a long-term care facility (75% increase, 95% CI 47 to 108). Adjusted hospital LOS decreased by an estimated 2% (95% CI 1 to 3) per annum. The mean age at admission and the proportion admitted from long-term care facilities both increased significantly over the decade (P<0.05).CONCLUSIONS: Results suggest that the management of hospitalized patients with pneumonia changed substantially between 1991 and 2001. The interface of long-term care facilities with acute care would be an important future area to explore potential efficiencies in caring for patients with pneumonia.

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Goldstone, Irene L. "Trends in Hospital Utilization in AIDS Care 1987–1991: Implications for Palliative Care." Journal of Palliative Care 8, no. 4 (December 1992): 22–29. http://dx.doi.org/10.1177/082585979200800406.

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St. Paul's Hospital, Vancouver has the largest Canadian experience of the care of persons with HIV/AIDS. This article reviews St. Paul's experience during the period 1987–1991, with particular emphasis on issues in palliative AIDS care. These issues include the implications of prolonged palliative care at home, precipitous readmissions to hospital for terminal care, and long-stay terminal admissions. Aspects of treatment and social factors which have an impact on palliative AIDS care are also identified. The implications for program development in both community and institutional settings are discussed.

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Janssen, Patricia, and Kathleen Mackay. "Prediction of Repeat Visits by Victims of Intimate Partner Violence to a Level III Trauma Centre." ISRN Emergency Medicine 2012 (November 14, 2012): 1–8. http://dx.doi.org/10.5402/2012/484681.

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Background. The purpose of this study was to describe and contrast the population of persons presenting to a Vancouver hospital emergency department two or more times with those presenting once. Methods. Subjects for this study had disclosed intimate partner violence on at least one visit to Vancouver General Hospital Emergency Department during the study period 1997–2009. We compared sociodemographic characteristics, presenting complaints and disposition on discharge among single versus repeat visitors. Results. We identified 2246 single visitors and 257 repeat visitors. In a multivariate model, repeat visitors to the ER were more likely to be of First Nations (aboriginal) status, odds ratio (OR) 2.29, 95% confidence intervals (1.30–4.01); to have had a history of previous abuse 3.38 (1.88–6.08); to have received threats of homicide 2.98 (1.74–5.08); and to present with mental illness 3.03 (1.59–5.77). Police involvement was protective against repeat visits 0.54 (0.36–0.98). Conclusion. Persons with potential for multiple visits to the emergency room can be characterized by a number of factors, the presence of which should trigger targeted assessment for violence exposure in settings where assessment is not routine.

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Canham, Sarah L., Karen Custodio, Celine Mauboules, Chloe Good, and Harvey Bosma. "Health and Psychosocial Needs of Older Adults Who Are Experiencing Homelessness Following Hospital Discharge." Gerontologist 60, no. 4 (June 22, 2019): 715–24. http://dx.doi.org/10.1093/geront/gnz078.

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Abstract Introduction Though hospitals are a common location where older adults experiencing homelessness receive health care, an understanding of the types of supports needed upon hospital discharge is limited. We examined the unique characteristics of older homeless adults and the health and psychosocial supports required upon hospital discharge. Design and Methods Guided by principles of community-based participatory research (CBPR), we conducted 20 in-depth, semi-structured interviews with shelter/housing and health care providers in Metro Vancouver. Results Thematic analyses revealed 6 themes: (a) older people experiencing homelessness have unique vulnerabilities upon hospital discharge; (b) following hospital discharge, general population shelters are inappropriate for older adults; (c) shelter/housing options for older adults who have complex health and social needs are limited; (d) shelter/housing for older adults who require medical stabilization and convalescence after hospital discharge is needed; (e) a range of senior-specific shelter/housing options are needed; and (f) unique community supports are needed for older adults upon hospital discharge. Discussion and Implications As the population of older adults increases across North America, there is a parallel trend in the increased numbers of older adults who are experiencing homelessness. Not only is there often a need for ongoing medical care and respite, but there is a need for both shelter and housing options that can appropriately support individual needs.

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Greanya, Erica D., Nilufar Partovi, Eric M. Yoshida, R. Jean Shapiro, Robert D. Levy, Chris H. Sherlock, and Gwen M. Stephens. "The Role of The Cytomegalovirus Antigenemia Assay in the Detection and Prevention of Cytomegalovirus Syndrome and Disease in Solid Organ Transplant Recipients: A Review of the British Columbia Experience." Canadian Journal of Infectious Diseases and Medical Microbiology 16, no. 6 (2005): 335–41. http://dx.doi.org/10.1155/2005/679386.

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BACKGROUND: The pp65 cytomegalovirus (CMV) antigenemia assay has been used as a means of guiding the pre-emptive therapy of CMV disease in solid organ transplant (SOT) recipients. Recently, concerns have been raised regarding the utility of the test to accurately and precisely detect viral activity early enough to reduce the morbidity and mortality associated with CMV.OBJECTIVE: To determine the performance characteristics of the method of antigenemia testing of SOT recipients used at Vancouver General Hospital, Vancouver, British Columbia.METHODS: All SOT recipients between January 1, 1999, and June 30, 2000, were retrospectively reviewed for six months following transplantation. Physical examination results, laboratory parameters, antigenemia results and treatment information were reviewed.RESULTS: A total of 134 kidney, liver, lung and kidney-pancreas transplant recipients were included in the analysis. The overall performance characteristics of the antigenemia assay in predicting CMV disease included a sensitivity of 64%, a specificity of 81%, a positive predictive value of 76% and a negative predictive value of 71%. A mean of 18 days passed between the onset of signs and symptoms of CMV disease/syndrome and the first recorded positive antigenemia result, and only 26% of patients had a positive test result before the onset of symptoms. It was found that an antigenemia test breakpoint of at least one positive cell for defining a positive test provided the most sensitive and specific prediction, with increased odds of developing CMV disease.CONCLUSIONS: Based on performance characteristics, the Vancouver General Hospital's current method of antigenemia testing to guide pre-emptive ganciclovir therapy in SOT patients is not optimal for the early detection of disease. Further study is needed on new molecular testing methods to determine if our ability to predict CMV disease can be improved.

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Weir, J. "Report of visits to the General Hospital, Vancouver, Canada, the UCSF Melanoma Clinic, San Francisco, USA and the Massachusetts Eye and Ear Hospital, Boston, USA." Journal of Laryngology & Otology 119, no. 3 (March 2005): 241–42. http://dx.doi.org/10.1258/0022215053561648.

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Corcoran, Niall M., Guilherme Godoy, Rodney C. Studd, Rowan G. Casey, Antonio Hurtado-Coll, Scott Tyldesley, S. Larry Goldenberg, and Martin E. Gleave. "Salvage prostatectomy post-definitive radiation therapy: The Vancouver experience." Canadian Urological Association Journal 7, no. 3-4 (April 16, 2013): 87–92. http://dx.doi.org/10.5489/cuaj.816.

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Introduction: Prostate cancer recurrence following primary radiationis common. If the recurrence remains localized to the prostate gland, surgical removal may result in long-term local control orcure. Despite the well-established oncological outcomes, salvage prostatectomy is infrequently performed or reported. We present our experience with salvage prostatectomy at a Canadian centre.Methods: We identified all patients undergoing salvage prostatectomy at the Vancouver General Hospital between 1995 and 2010 from a prospectively recorded and maintained prostate cancer database. Details regarding initial presentation, delivery of radiotherapy, clinical features at the time of recurrence, as well as oncological and functional outcomes, were collected. Information regarding postoperative morbidity was collected prospectively and confirmed by retrospective chart review.Results: Over a 15-year period, salvage prostatectomy was successfully completed in 21 patients. With a median follow-up period of 68 months (range: 2-122), 9 (43%) patients experienced a biochemical recurrence, with most failing within the first 2 years of surgery. There were 3 deaths in the cohort, all from prostate cancer, giving a prostate cancer specific and overall survival of 86%. The main postoperative morbidity was bladder neck contracture, occurring in 40%. One patient each developed a recto-urethral fistula andosteitis pubis. Physician-recorded data regarding continence was available in 13 (62%). Of these 13 patients, 10 (85%) men were recorded as dry or using 1 pad per day.Conclusions: This is the first Canadian centre to report that salvage prostatectomy can be performed with favourable oncological and functional outcomes.

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Sutherland, Jason, Guiping Liu, Trafford Crump, Matthew Bair, and Ahmer Karimuddin. "Relationship between preoperative patient-reported outcomes and hospital length of stay: a prospective cohort study of general surgery patients in Vancouver, Canada." Journal of Health Services Research & Policy 24, no. 1 (August 13, 2018): 29–36. http://dx.doi.org/10.1177/1355819618791634.

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Objectives As an aging population drives more demand for elective inpatient surgery, one approach to reducing length of stay is enhanced evaluation of patients’ preoperative health status. The objective of this research was to determine whether patient-reported outcome measures collected preoperatively can identify patients at risk for longer lengths of stay. Methods This study was based on a prospectively recruited cohort of patients who were scheduled for elective inpatient general surgery in Vancouver, Canada. All participants completed a number of patient-reported outcome measures preoperatively, including the EQ-5D for general health status, the Patient Health Questionnaire (PHQ-9) for depression, and the pain intensity (P), interference with enjoyment of life (E), and interference with general activity (G), known as the PEG, for pain. Patient-reported outcome data were linked to hospital discharge summaries. Multivariate regression was performed to estimate risk of longer lengths of stay, adjusting for patient and clinical characteristics. The primary outcome was length of stay and its associated cost. Data collection took place between October 2012 and November 2016. Results Participation among the population of 2307 eligible patients was 50.5%, providing 1165 participants. Preoperative patient-reported outcomes were not concordant with hospital reported diagnoses of depression or pain. Patients’ preoperative depression and pain scores were independently positively associated with longer length of stay after adjusting for patient-level characteristics. Patients whose PHQ-9 score was 10, representing clinically significant depression, were estimated to have a 1.53 day longer hospitalization, which was associated with an estimated incremental hospital cost of $1667. Conclusions Preoperative self-reported assessment of depression and pain can assist with identifying patients at higher risk of longer lengths of stay. Patient’s self-reported preoperative measures of depression and pain should be incorporated into patient pathways. They provide opportunities for improving management of general surgery patients and possibly play a role in aligning hospital funding with patients’ needs.

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McKenzie, M., B. Toyota, B. Clark, A. Lee, E. Vollans, J. Robar, R. Ma, and K. Goddard. "98 Updated experience in linac stereotactic radiosurgery for arteriovenous malformation at the British Columbia cancer agency and Vancouver General Hospital." Radiotherapy and Oncology 76 (September 2005): S30. http://dx.doi.org/10.1016/s0167-8140(05)80259-2.

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Hentschel, Stephen, Walter Hader, and Michael Boyd. "Head Injuries in Skiers and Snowboarders in British Columbia." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 28, no. 1 (February 2001): 42–46. http://dx.doi.org/10.1017/s0317167100052537.

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ABSTRACT:Background:At the Vancouver General Hospital Neurosurgical Service there have been a significant number of seriously brain injured snowboarders, seemingly out of proportion to the number of skiers. The purpose of this study was to determine whether snowboarders suffered more serious head injuries than skiers in the Vancouver catchment area.Methods:The British Columbia Trauma Registry was searched for patients incurring head injuries while skiing or snowboarding on British Columbia mountains during the period from January 1992 to December 1997. Patients were included if they were admitted to hospital and underwent neurosurgical consultation.Results:A total of 40 skiers and 14 snowboarders met the above criteria. Of the skiers, 15% sustained a severe head injury by Glasgow Coma Score, another 30% sustaining moderate head injuries, while 29% of snowboarders had a severe injury and 36% a moderate injury. A concussion was present in 60% of the skiers and 21% of the snowboarders. Snowboarders suffered an intracranial hemorrhage in 71% of the cases compared to 28% of the skiers. A craniotomy was performed acutely in 10% of skiers and in 29% of snowboarders. Three deaths occurred as a direct result of head injury, one while snowboarding. All but one of the surviving skiers were able to return home, whereas four of 13 surviving snowboarders required additional inpatient rehabilitation or transfer to another acute hospital for ongoing care.Conclusions:Snowboarders suffer more significant head injuries compared to skiers in this series and are much more likely than skiers to require an intracranial procedure. In our opinion, this indicates that additional safety measures, in particular the use of mandatory helmets, should be considered by ski areas and their patrons.

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Hoang, Linda M. N., John A. Maguire, Patrick Doyle, Murray Fyfe, and Diane L. Roscoe. "Cryptococcus neoformans infections at Vancouver Hospital and Health Sciences Centre (19972002): epidemiology, microbiology and histopathology." Journal of Medical Microbiology 53, no. 9 (September 1, 2004): 935–40. http://dx.doi.org/10.1099/jmm.0.05427-0.

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Kapeluto, Jordanna E., Matthew Kadatz, Andrew Wormsbecker, Kiran Sidhu, and Eric M. Yoshida. "Screening, Detecting and Enhancing the Yield of Previously Undiagnosed Hepatitis B and C In Patients with Acute Medical Admissions to Hospital: A Pilot Project Undertaken at the Vancouver General Hospital." Canadian Journal of Gastroenterology and Hepatology 28, no. 6 (2014): 315–18. http://dx.doi.org/10.1155/2014/190210.

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BACKGROUND: Hepatitis B virus (HBV) and hepatitis C virus (HCV) represent an increasing health burden and morbidity in Canada. Viral hepatitis, specifically HCV, has high prevalence among persons born between 1945 and 1965, with 45% to 85% of infected adults asymptomatic and unaware of their infection. Screening has been shown to be cost effective in the detection and treatment of viral hepatitis.OBJECTIVE: To quantify incidence and identify undocumented HBV and HCV infection in hospitalized patients at a single centre with secondary analysis of risk factors as part of a quality improvement initiative.METHODS: A one-time antibody test was conducted in patients admitted to the acute medicine and gastroenterology services.RESULTS: Over a 12-week period, hospital screening for HBV and HCV was performed in 37.3% of 995 admitted patients. There was identification of 15 previously undiagnosed cases of HCV (4%) and 36 undocumented cases of occult (ie, antihepatitis B core antigen seropositive) or active (ie, hepatitis B surface antigen seropositive) HBV (9.7%). Among patients with positive screens, 60% of seropositive HCV patients had no identifiable risk factors.CONCLUSIONS: The prevalence of HBV and HCV infection among hospitalized patients in Vancouver was higher than that of the general population. Risk factors for contraction are often not identified. These results can be used as part of an ongoing discussion regarding a ‘seek and treat’ approach to the detection and treatment of chronic blood-borne viral illnesses.

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Yang, Qiuying, Yue Chen, Daniel Krewski, Yuanli Shi, Richard T. Burnett, and Kimberlyn M. Mcgrail. "Association Between Particulate Air Pollution and First Hospital Admission for Childhood Respiratory Illness in Vancouver, Canada." Archives of Environmental Health: An International Journal 59, no. 1 (January 2004): 14–21. http://dx.doi.org/10.3200/aeoh.59.1.14-21.

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Wang, Linwei, Fahmida Homayra, Lindsay A. Pearce, Dimitra Panagiotoglou, Rachael McKendry, Rolando Barrios, Craig Mitton, and Bohdan Nosyk. "Identifying mental health and substance use disorders using emergency department and hospital records: a population-based retrospective cohort study of diagnostic concordance and disease attribution." BMJ Open 9, no. 7 (July 2019): e030530. http://dx.doi.org/10.1136/bmjopen-2019-030530.

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ObjectivesAdministrative data are increasingly being used for surveillance and monitoring of mental health and substance use disorders (MHSUD) across Canada. However, the validity of the diagnostic codes specific to MHSUD is unknown in emergency departments (EDs). Our objective was to determine the concordance, and individual-level and hospital-level factors associated with concordance, between diagnosis codes assigned in ED and at discharge from hospital for MHSUD-related conditions.DesignPopulation-based retrospective cohort study.SettingEDs and hospitals within Vancouver Coastal Health Authority (VCH), British Columbia, Canada.Participants16 926 individuals who were admitted into a VCH hospital following an ED visit from 1 April 2009 to 31 March 2017, contributing to 48 116 pairs of ED and hospital discharge diagnoses.Primary and secondary outcome measuresWe examined concordance in identifying MHSUD between the primary discharge diagnosis codes based on the International Statistical Classification of Diseases, 9th and 10th Revisions (Canada) assigned in the ED and those assigned in the hospital among all ED visits resulting in a hospital admission. We calculated the percent overall agreement, positive agreement, negative agreement and Cohen’s kappa coefficient. We performed multiple regression analyses to identify factors independently associated with discordance.ResultsWe found a high level of concordance for broad categories of MH conditions (overall agreement=0.89, positive agreement=0.74 and kappa=0.67), and a fair level of concordance for SUDs (overall agreement=0.89, positive agreement=0.31 and kappa=0.27). SUDs were less likely to be indicated as the primary cause in ED as opposed to in hospital (3.8% vs 11.7%). In multiple regression analyses, ED visits occurring during holidays, weekends and overnight (21:00–8:59 hours) were associated with increased odds of discordance in identifying MH conditions (adjusted OR 1.47, 95% CI 1.11 to 1.93; 1.27, 95% CI 1.16 to 1.40; 1.30, 95% CI 1.19 to 1.42, respectively).ConclusionsED data could be used to improve surveillance and monitoring of MHSUD. Future efforts are needed to improve screening for individuals with MHSUD and subsequently connect them to treatment and follow-up care.

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Harrison, Jon, Michael J. Pucci, Scott W. Cowan, and Charles J. Yeo. "A Brief Overview of the Life and Work of Lyon Henry Appleby, M.D. (1895–1970)." American Surgeon 82, no. 12 (December 2016): 1151–54. http://dx.doi.org/10.1177/000313481608201218.

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The life and work of Dr. Lyon Henry Appleby, M.D., portrays the essence of a devoted clinician committed to scholarly excellence. Born in Deseronto, Ontario, in 1895 and passing in 1970, Dr. Appleby influenced all areas of general surgery, most notably popularizing a procedure that bears his name today. After a tour in World War I, he quickly proved himself to be a dedicated clinician with roots in academia, which translated into excellence within the Department of Surgery at St. Paul's Hospital in Vancouver, Canada. He served in various leadership roles including Chair of the Department of Surgery, President of the International College of Surgeons, and Fellow of the Royal College of Physicians and Surgeons. The Appleby procedure, or en bloc removal of the celiac axis, at the time of gastrectomy, is the technical focus of this paper, although reference is made to Appleby's extensive contributions to historical medicine.

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De Francesco, Francesco, Alice Busato, Silvia Mannucci, Nicola Zingaretti, Giuseppe Cottone, Francesco Amendola, Marialuisa De Francesco, et al. "Artificial dermal substitutes for tissue regeneration: comparison of the clinical outcomes and histological findings of two templates." Journal of International Medical Research 48, no. 8 (August 2020): 030006052094550. http://dx.doi.org/10.1177/0300060520945508.

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Objective Artificial dermal substitutes (DSs) are fundamental in physiological wound healing to ensure consistent and enduring wound closure and provide a suitable scaffold to repair tissue. We compared the clinical and histological features of two DSs, Pelnac and Integra, in the treatment of traumatic and iatrogenic skin defects. Methods This prospective observational study involved 71 randomly selected patients from our hospital. Wound healing was analyzed using the Wound Surface Area Assessment, the Vancouver Scar Scale, and a visual analog scale. Histological and immunohistochemical evaluations were also performed. Results At 2 weeks, greater regeneration with respect to proliferation of the epidermis and renewal of the dermis was observed with Pelnac than with Integra. At 4 weeks, the dermis had regenerated with both DSs. Both templates induced renewed collagen and revascularization. Differences in the Vancouver Scar Scale score were statistically significant at 4 weeks and 1 year. Pelnac produced a significant increase in contraction at 2 weeks with increasing effectiveness at 4 weeks. Integra produced a higher percentage reduction in the wound surface area and a shorter healing time than Pelnac for wounds >1.5 cm deep. Conclusion Our observational data indicate that both DSs are effective and applicable in different clinical contexts.

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Hassan, Saber, Rohit Samuel, Andrew Starovoytov, Carolyn Lee, Eve Aymong, and Jacqueline Saw. "Outcomes of Percutaneous Coronary Intervention in Patients with Spontaneous Coronary Artery Dissection." Journal of Interventional Cardiology 2021 (May 15, 2021): 1–9. http://dx.doi.org/10.1155/2021/6686230.

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Objectives. To compare outcomes of percutaneous coronary intervention (PCI) in spontaneous coronary artery dissection (SCAD) patients versus conservative therapy. Background. SCAD is an important cause of myocardial infarction (MI) in young-to-middle-aged women. Percutaneous coronary intervention (PCI) is often pursued, but outcomes compared to conservative therapy are unclear. Methods. 403 nonatherosclerotic SCAD patients were enrolled between 2011 and 2017 and prospectively followed up in our Vancouver General Hospital registries. Detailed baseline, hospital, PCI, and outcomes were recorded. We explored the outcomes of SCAD patients who underwent PCI during their initial presentation. Results. PCI was performed in 75 patients, the average age was 48.9 ± 10.1 yrs, and 94.7% were women. All presented with MI; 50.7% STEMI, 49.3% NSTEMI, and 13.3% had VT/VF. PCI was successful in 34.7%, partially successful in 37.3%, and unsuccessful in 28.0%. Stents were deployed in 73.3%, 16.0% had balloon angioplasty alone, 10.7% had wiring attempts only, and 5.3% required bailout surgery. Major adverse cardiovascular event rates (MACE) were significantly higher with the PCI group in hospital (29.3% versus 2.8%, p < 0.001 ), and at median follow-up of 3.7 yrs (58.7% versus 22.6% ( p < 0.001 ) compared to the non-PCI group. Conclusion. PCI in SCAD patients was associated with high failure rate and MACE in hospital and at long-term follow-up. These findings support the recommendation of conservative therapy as first-line management unless high-risk features are present.

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Ellis, Donelda J., and Roberta J. Hewat. "Patterns of Infant Feeding in the First Six Months." Nutrition and Health 4, no. 3 (July 1986): 167–75. http://dx.doi.org/10.1177/026010608600400306.

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A quasi-experimental six months longitudinal study of women planning to breastfeed was carried out in Vancouver, B.C., Canada. The purpose was to increase breastfeeding duration through the provision of nursing support, and information about breastfeeding. This paper reports on the patterns of infant feeding by 131 mothers for six months postpartum. Included are data on initiation of breastfeeding, feeding intervals, supplementation, initiating semi-solids and duration of breastfeeding. Unsupplemented breastfeeding declined from 90.8%, at the time of discharge from hospital to 65% at one month, 45% at three months and 3.9% at six months. For some infants, semi-solids were introduced at one month and by three months 11.4%, were being fed semi-solids. The implications for health care professionals caring for breastfeeding women are outlined.

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Mangat, Birinder K., Chad Evaschesen, Tim Lee, Eric M. Yoshida, and Baljinder Salh. "Ethnic Variation in the Annual Rates of Adult Inflammatory Bowel Disease in Hospitalized Patients in Vancouver, British Columbia." Canadian Journal of Gastroenterology 25, no. 2 (2011): 73–77. http://dx.doi.org/10.1155/2011/640920.

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BACKGROUND: There is currently little available information regarding the impact of ethnicity on the clinical features of inflammatory bowel disease (IBD). Migrating populations and changing demographics in Vancouver, British Columbia (BC) provide a unique opportunity to examine the role of ethnicity in the prevalence, expression and complications of IBD.OBJECTIVES: To determine the demographics of IBD and its subtypes leading to hospitalization in the adult population of BC.METHODS: A one-year retrospective study was performed for all patients who presented acutely with IBD to Vancouver General Hospital from January 1, 2006 to December 31, 2006. Data regarding sex, age, ethnicity, IBD type and extent of disease, complications and management strategies were collected. Clinical data were confirmed by pathology and radiology reports.RESULTS: There were 186 cases of IBD comprising Crohn’s disease (CD) 56%, ulcerative colitis (UC) 43% and indeterminate colitis (1%) 1%. The annual rate of IBD cases warranting hospitalization in Caucasians was 12.9 per 100,000 persons (7.9 per 100,000 persons for CD and 5.0 per 100,000 persons for UC). This was in contrast to the annual rate of IBD in South Asians at 7.7 per 100,000 persons (1.0 per 100,000 persons for CD and 6.8 per 100,000 persons for UC) and in Pacific Asians at 2.1 per 100,000 persons (1.3 per 100,000 persons for CD, 0.8 per 100,000 persons for UC). The male to female ratio was higher in South Asians and Pacific Asians than in Caucasians. The extent of disease was significantly different across racial groups, as was the rate of complications.CONCLUSIONS: These early results suggest that there are ethnic disparities in the annual rates of IBD warranting hospitalization in the adult population of BC. There was a significantly higher rate of CD in the Caucasian population than in South Asian and Pacific Asian populations. The South Asian population had a higher rate of UC, with an increased rate of complications and male predominance. Interestingly, the rate of CD and UC was lowest in the Pacific Asian population. These racial differences – which were statistically significant – suggest a role for ethnodiversity and environmental changes in the prevalence of IBD in Vancouver.

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Price, James W., Oliver Applegarth, Mark Vu, and John R. Price. "Code Blue Emergencies: A Team Task Analysis and Educational Initiative." Canadian Medical Education Journal 3, no. 1 (April 30, 2012): e4-e20. http://dx.doi.org/10.36834/cmej.36567.

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Introduction: The objective of this study was to identify factors that have a positive or negative influence on resuscitation team performance during emergencies in the operating room (OR) and post-operative recovery unit (PAR) at a major Canadian teaching hospital. This information was then used to implement a team training program for code blue emergencies. Methods: In 2009/10, all OR and PAR nurses and 19 anesthesiologists at Vancouver General Hospital (VGH) were invited to complete an anonymous, 10 minute written questionnaire regarding their code blue experience. Survey questions were devised by 10 recovery room and operation room nurses as well as 5 anesthesiologists representing 4 different hospitals in British Columbia. Three iterations of the survey were reviewed by a pilot group of nurses and anesthesiologists and their feedback was integrated into the final version of the survey. Results: Both nursing staff (n = 49) and anesthesiologists (n = 19) supported code blue training and believed that team training would improve patient outcome. Nurses noted that it was often difficult to identify the leader of the resuscitation team. Both nursing staff and anesthesiologists strongly agreed that too many people attending the code blue with no assigned role hindered team performance. Conclusion: Identifiable leadership and clear communication of roles were identified as keys to resuscitation team functioning. Decreasing the number of people attending code blue emergencies with no specific role, increased access to mock code blue training, and debriefing after crises were all identified as areas requiring improvement. Initial team training exercises have been well received by staff.

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Faddegon, Stephen. "Treatment of angiomyolipoma at a tertiary care centre: the decision between surgery and angioembolization." Canadian Urological Association Journal 5, no. 6 (April 15, 2013): 138. http://dx.doi.org/10.5489/cuaj.758.

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Background: Angiomyolipoma (AML) is a benign renal neoplasm.First-line therapy includes renal preserving surgery or angioembolization(RAE), both with good outcomes in isolated studies.However, there are no comparative randomized trials and no clinicalguidelines to help clinicians decide between these treatmentmodalities. Our study examines the patterns of AML treatment ata tertiary care centre to evaluate how local urologists have beentreating this disease.Methods: This is a retrospective study of all AMLs treated at theVancouver General Hospital (Vancouver, BC, Canada) over thepast 10 years with either RAE or surgical excision. Searches wereperformed of the radiology and pathology dictation systems, usingthe following keywords: AML, angiomyolipoma, angioembolization,embolization, surgery, partial nephrectomy and nephrectomy.Results: At our institution, more AMLs were treated by surgerythan angioembolization (42 vs. 17 cases). Angioembolization wasmore often chosen for cases of multifocal AML (35% vs. 7%) andacute hemorrhage (50% vs. 14%). In the angioembolization cases,particles were the embolic agent of choice (used 40% of the time).Conclusions: Angioembolization allows rapid patient stabilizationin cases of acute hemorrhage, and provides good renal preservationin cases of multifocal AML. It may also be preferred in largemasses when partial nephrectomy is not feasible. Surgery should beperformed in cases of diagnostic uncertainty or complex vascularanatomy not amenable to RAE. Prospective randomized studies areneeded to compare RAE and surgery to better define their indicationsin sporadic AML.Contexte : Un angiomyolipome (AML) est une tumeur bénigne durein. Le traitement de première intention comprend une chirurgiede conservation rénale ou une angioembolisation rénale, quiont toutes deux donné de bons résultats dans des études isolées.Cependant, aucun essai comparatif randomisé n’a été mené et iln’existe pas de lignes directrices pour aider les cliniciens à choisirentre ces modalités thérapeutiques. Notre étude a examiné les tendancesdans le traitement de l’AML à un centre de soins tertiairespour évaluer comment les urologues y traitent cette maladie.Méthodologie : Il s’agit d’une étude rétrospective de tous les AMLtraités au Vancouver General Hospital (Vancouver, C.-B., Canada)au cours des 10 dernières années, soit par chirurgie de conservationrénale ou par angioembolisation. Des recherches ont été effectuéesdans les systèmes de dictée vocale de radiologie et de pathologieen utilisant les mots-clés anglais suivants : AML, angiomyolipoma,angioembolization, embolization, surgery, partial nephrectomy etnephrectomy.Résultats : Dans notre établissement, plus de cas d’AML ont ététraités par chirurgie que par angioembolisation (42 cas contre 17).L’angioembolisation a été plus souvent choisie dans les cas d’AMLmultifocal (35 % contre 7 %) et d’hémorragie aiguë (50 % contre14 %). Dans les cas traités par angioembolisation, les particulesont été l’agent embolique privilégié (utilisées dans 40 % des cas).Conclusions : L’angioembolisation permet de stabiliser rapidementl’état du patient en cas d’hémorragie aiguë, et offre une bonneconservation rénale en cas d’AML multifocale. Elle peut aussi êtrepréférable en présence de larges masses quand la néphrectomiepartielle n’est pas possible. La chirurgie doit être réalisée en casd’incertitude diagnostique ou d’anatomie vasculaire complexe nese prêtant pas à l’angioembolisation rénale. Des études prospectivesrandomisées sont nécessaires pour comparer l’angioembolisationrénale et la chirurgie afin de mieux définir leurs indications dansles formes sporadiques d’AML.

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Cornford, Marcia E., Janet K. Holden, Michael C. Boyd, Kenneth Berry, and Harry V. Vinters. "Neuropathology of the Acquired Immune Deficiency Syndrome (AIDS): Report of 39 Autopsies from Vancouver, British Columbia." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 19, no. 4 (November 1992): 442–52. http://dx.doi.org/10.1017/s0317167100041627.

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ABSTRACT:Neuropathological findings from 39 acquired immune deficiency syndrome (AIDS) autopsies of primarily neurologically symptomatic patients and 7 brain biopsies from AIDS patients performed at St. Paul’s Hospital, Vancouver, British Columbia are reported. Autopsy findings included human immunodeficiency virus-1 (HlV)-type multinucleated giant cell (MNGC)-associated encephalitis seen in 17 patients, toxoplasmosis in 7 patients, and cytomegalovirus encephalitis and/or microglial nodule-associated nuclear inclusions in brain parenchyma in 9 patients. Central nervous system lymphoma was identified in 11 autopsy patients and in 4 of 7 brain biopsies. Infectious processes including HIV encephalitis were seen in 10 of 11 autopsied patients with lymphoproliferative lesions in the brain parenchyma, while 40% of patients without lymphoma had HIV-type MNGC or opportunistic infections. CNS lymphoma was not significantly increased in incidence in patients with a clinical history of zidovudine treatment, but increased duration of survival after the diagnosis of AIDS was associated with increased incidence of lymphoma in both untreated and zidovudine-treated patients. Patients displaying HIV MNGC within microglial nodules had a shorter mean duration of survival after diagnosis of AIDS than those patients with HIV encephalitis with dispersed MNGC, white matter vacuolation, and gliosis.

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Kan, Victoria Y., Vladimir Marquez Azalgara, Jo-Ann E. Ford, WC Peter Kwan, Siegfried R. Erb, and Eric M. Yoshida. "Patient Preference and Willingness to Pay for Transient Elastography versus Liver Biopsy: A Perspective from British Columbia." Canadian Journal of Gastroenterology and Hepatology 29, no. 2 (2015): 72–76. http://dx.doi.org/10.1155/2015/169190.

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BACKGROUND: The cost of liver biopsy (LB) is publicly funded in British Columbia, while the cost of transient elastography (FibroScan [FS], Echosens, France) is not. Consequently, there is regional variation regarding FS access and monitoring of liver disease progression.OBJECTIVE: To evaluate patient preference for FS versus LB and to assess the willingness to self-pay for FS.METHODS: Questionnaires were distributed in clinic and via mail to LB-experienced and LB-naive patients who underwent FS at Vancouver General Hospital, Vancouver, British Columbia.RESULTS: The overall response rate was 76%. Of the 422 respondents, 205 were LB-experienced. The mean age was 53.5 years, 50.2% were male, 54.7% were Caucasian, 38.2% had hepatitis C and 26.3% had an annual household income >$75,000. Overall, 95.4% of patients preferred FS to LB. FS was associated with greater comfort than LB, with the majority reporting no discomfort during FS (84.1% versus 7.8% for LB), no discomfort after (96.2% versus 14.6% LB) and no feelings of anxiety after FS explanation (78.2% versus 12.7% LB). FS was also associated with greater speed, with the majority reporting short test duration (97.2% versus 48.3% LB) and short wait for the test result (95.5% versus 30.2% LB). Most (75.3%) respondents were willing to self-pay for FS, with 26.3% willing to pay $25 to $49. Patients with unknown liver disease preferred LB (OR [FS preference] 0.20 [95% CI 0.07 to 0.53]).CONCLUSIONS: FS was the preferred method of assessing liver fibrosis among patients, with the majority willing to self-pay. To ensure consistency in access, provincial funding for FS is needed. However, LB remains the procedure of choice for individuals with an unknown diagnosis.

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Turner, Mark O., John R. Mayo, Nestor L. Müller, Michael Schulzer, and J. Mark FitzGerald. "The Value of Thoracic Computed Tomography Scans in Clinical Diagnosis: A Prospective Study." Canadian Respiratory Journal 13, no. 6 (2006): 311–16. http://dx.doi.org/10.1155/2006/859870.

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BACKGROUND: Computed tomography (CT) scans are used extensively to investigate chest disease because of their cross-sectional perspective and superior contrast resolution compared with chest radiographs. These advantages lead to a more accurate imaging assessment of thoracic disease. The actual use and evaluation of the clinical impact of thoracic CT has not been assessed since scanners became widely available.OBJECTIVE: To identify patterns of utilization, waiting times and the impact of CT scan results on clinical diagnoses.DESIGN: A before and after survey of physicians who had ordered thoracic CT scans.SETTING: Vancouver General Hospital – a tertiary care teaching centre in Vancouver, British Columbia.SUBJECTS: Physicians who had ordered CT scans.INTERVENTION: Physicians completed a standard questionnaire before and after the CT scan result was available.MEASUREMENTS: Changes in the clinical diagnosis, estimates of the probabilities for the diagnosis both before and after the CT scan, and waiting times.RESULTS: Four hundred fifty-four thoracic CT cases had completed questionnaires, of whom 80% were outpatients. A change in diagnosis was made in 48% of cases (25% with a normal CT scan and 23% with CT scan findings that indicated a different diagnosis). The largest change in probability scores for the clinical diagnosis before and after the CT scan was 43.9% for normal scans, while it was 36.3% for a different diagnosis and 26.3% for the same diagnosis. High-priority scans were associated with decreased waiting time (−7.89 days for each unit increase in priority).CONCLUSIONS: The CT scan results were associated with a change in diagnosis in 48% of cases. Normal scans constituted 25% of the total and had the greatest impact scores. Waiting times were highly correlated with increased urgency of the presenting problem.

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Ahmed Badr, Mohammed Leithy, Tarek Fouad Keshk, Yahia Mohammed Alkhateeb, and Ashraf Moustafa Esmail El Refaai. "Early excision and grafting versus delayed grafting in deep burns of the hand." International Surgery Journal 6, no. 10 (September 26, 2019): 3530. http://dx.doi.org/10.18203/2349-2902.isj20194404.

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Background: Deep burns of the hand are considered severe, because even a small wound may cause profound functional disability, ugly scar and psychosocial problems. The aim of the study is to compare early excision and grafting versus delayed grafting in deep burns of the hand.Methods: This study was conducted on 30 patients with deep burns of the hand. Patients were randomly divided in to two equal groups. Group I included 15 patients who were subjected to early excision and grafting within the first week after injury while group II included 15 patients who were subjected to delayed excision and grafting two weeks after injury. The study was conducted on patients presented to Plastic and Reconstructive Surgery Department of Abou Qir General Hospital in the period from December 2016 to December 2017.Results: The results of early excision and grafting were better than delayed grafting regarding the intake, infection and post-burn contraction (mean 91.33±7.67 in group I and 83.67±10.08 in group II with p value=0.026).Conclusions: Early excision and grafting of the hand is a better alternative than delayed excision and grafting as regards better graft intake, less wound infection, less contractures, less risk of regrafting, less hospital stay, less 5D-itching scale and Vancouver score and more cost effectiveness.

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Brockington, J. L. "The righteous demon: a study of Bali. By Clifford Hospital, pp. ix, 294. Vancouver, University of British Columbia Press, 1984. £24.00." Journal of the Royal Asiatic Society of Great Britain & Ireland 117, no. 2 (April 1985): 212–13. http://dx.doi.org/10.1017/s0035869x00138651.

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Sunkaraneni, V. S., D. Yeh, H. Qian, and A. R. Javer. "Computer or not? Use of image guidance during endoscopic sinus surgery for chronic rhinosinusitis at St Paul's Hospital, Vancouver, and meta-analysis." Journal of Laryngology & Otology 127, no. 4 (March 12, 2013): 368–77. http://dx.doi.org/10.1017/s0022215113000261.

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AbstractBackground:The advantages and limitations of image guidance systems for endoscopic sinus surgery are unclear. We report our experience and present a meta-analysis of the evidence.Methods:We performed a retrospective analysis of endoscopic sinus surgery procedures performed with versus without image guidance. A total of 355 cases was included. Primary outcomes included complication rates and time to revision surgery. A literature search was conducted to enable identification and analysis of studies of similar comparisons.Results:Within 1.5 years of the index sinus surgical procedure, the risk of revision surgery was significantly higher for patients treated with non-assisted versus computer-assisted endoscopic sinus surgery (p = 0.001). Meta-analysis did not indicate a reduction in complications or revision surgery procedures with the use of image guidance systems, although the majority of included studies showed a non-significant reduction in revision surgery.Conclusion:Our study offers some evidence that computer-assisted endoscopic sinus surgery may delay residual disease and reduce the requirement for revision surgery. Although this finding was not borne out in the meta-analysis, the majority of identified studies demonstrated a trend towards fewer revision procedures after computer-assisted endoscopic sinus surgery. This type of surgery may offer other advantages that are not easily measurable.

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Ponzo, Marisa Grace, Monica Miliszewski, Mark G. Kirchhof, Paul A. Keown, and Jan P. Dutz. "HLA-B*58:01 Genotyping to Prevent Cases of DRESS and SJS/TEN in East Asians Treated with Allopurinol—A Canadian Missed Opportunity." Journal of Cutaneous Medicine and Surgery 23, no. 6 (August 5, 2019): 595–601. http://dx.doi.org/10.1177/1203475419867599.

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Background and objective East Asians exposed to the urate-lowering drug allopurinol have a predilection for severe cutaneous drug reactions such as drug-induced hypersensitivity syndrome or drug reaction with eosinophilia and systemic symptoms (DRESS) and Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN). Screening is recommended in patients of East Asian descent for the presence of HLA-B*58:01 prior to allopurinol initiation to avoid these complications. Utilization rates of the HLA-B*58:01 predictive screening test within the Greater Vancouver area, which has a population composed of 40.1% people of East Asian descent, are unknown. Measures We identified cases of DRESS or SJS/TEN due to allopurinol using the Vancouver General Hospital dermatology consult service database. We next compared the frequency in which the HLA-B*58:01 screening test was ordered since 2012 to the estimated frequency of new prescriptions for allopurinol prescribed for the management of gout among the East Asians. Results We report 5 cases of East Asian patients exposed to allopurinol for management of gout between 2012 and 2016, who developed DRESS (4 patients) or SJS/TEN (1 patient). All were of HLA-B*58:01 genotype, representing preventable cases. The HLA-B*58:01 test was ordered 6 times in 2012, whereas the estimated number of new cases of allopurinol-prescribed gout among patients of East Asian descent during that time period was 13. For 2012, testing was ordered for only 46% of at-risk patients. Conclusion We continue to observe cases of severe cutaneous drug reactions among high-risk individuals due to allopurinol exposure. The HLA-B*58:01 screening test for allopurinol hypersensitivity is underutilized in our geographic area.

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Boro, Jordana, Katerina Pavenski, Kimberley L. S. Ambler, Heather A. Leitch, and Lisa K. Hicks. "HIV-Associated Thrombotic Thrombocytopenic Purpura." Blood 118, no. 21 (November 18, 2011): 4677. http://dx.doi.org/10.1182/blood.v118.21.4677.4677.

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Abstract Abstract 4677 Thrombotic thrombocytopenic purpura (TTP) is a rare, life-threatening form of microangiopathic hemolysis that can be associated with HIV infection, and has previously been reported to be associated with low CD4 counts. The existing literature on HIV-TTP is very small and largely made up of small case series generated through databases of patients with HIV. As a result, reports have tended to focus on HIV parameters with limited information available regarding the presentation, management and outcome of the TTP itself. We conducted a retrospective review of TTP cases referred to the pheresis units St. Michael’s Hospital and Vancouver General Hospital in Vancouver between July 1993 and May 2011. Ten cases of HIV associated TTP were identified (8 male; 2 female). Median age at presentation was 38 years. One patient had been previously diagnosed and treated for TTP at a different institution. Average duration of HIV infection prior to TTP diagnosis was 5 years (range 0 to 11). Median CD4 count at TTP diagnosis was 79 × 106/ml (range 2 to 326). Median platelet count at presentation was 14 × 106/ml (range 5 to 233), median haemoglobin was 74 g/L (range 61 to 133), all patients had an LDH > 2x the upper limit of normal, and all for whom data was available (8/10) had fragmentation on blood film. Creatinine was elevated in 9 of 10 patients. ADAMTS13 was assessed in 3 of 10 patients and was deficient in one. Five of 10 patients had fever. At presentation, 6 of 10 patients had neurological symptoms (most commonly seizures and/or confusion), but none suffered permanent neurological deficits. All patients were treated with plasmapheresis and received a median of 16 exchanges (2-56). Four patients received concurrent steroids, two patients received IVIG, and one patient received pheresis, steroids IVIG, vincristine and rituximab. Eight of 10 patients achieved complete remissions, one patient achieved a partial response, and one died on treatment. Four of the responding patients subsequently relapsed (0.6 to 13.8 months after the initial episode of TTP); two achieved second remissions, and two died on treatment. In conclusion, our series of HIV associated-TTP confirms previous reports that HIV-TTP tends to occur in patients with CD4 counts less than 200. Complete remissions can be achieved with standard management. However, based on our small series, relapses may be more common and mortality greater than in the general TTP population. Disclosures: Leitch: Novartis Pharmaceuticals: Honoraria, Membership on an entity’s Board of Directors or advisory committees.

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Novak Lauscher, H., K. Ho, J. L. Cordeiro, A. Bhullar, R. Abu Laban, J. Christenson, H. Harps, et al. "MP44: TEC4Home heart failure: using home telemonitoring to decrease ED readmissions and clinical flow." CJEM 20, S1 (May 2018): S56—S57. http://dx.doi.org/10.1017/cem.2018.198.

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Introduction: Patients with Heart failure (HF) experience frequent decompensation necessitating multiple emergency department (ED) visits and hospitalizations. If patients are able to receive timely interventions and optimize self-management, recurrent ED visits may be reduced. In this feasibility study, we piloted the application of home telemonitoring to support the discharge of HF patients from hospital to home. We hypothesized that TEC4Home would decrease ED revisits and hospital admissions and improve patient health outcomes. Methods: Upon discharge from the ED or hospital, patients with HF received a blood pressure cuff, weight scale, pulse oximeter, and a touchscreen tablet. Participants submitted measurements and answered questions on the tablet about their HF symptoms daily for 60 days. Data were reviewed by a monitoring nurse. From November 2016 to July 2017, 69 participants were recruited from Vancouver General Hospital (VGH), St. Pauls Hospital (SPH) and Kelowna General Hospital (KGH). Participants completed pre-surveys at enrollement and post-surveys 30 days after monitoring finished. Administrative data related to ED visits and hospital admissions were reviewed. Interviews were conducted with the monitoring nurses to assess the impact of monitoring on patient health outcomes. Results: A preliminary analysis was conducted on a subsample of participants (n=22) enrolled across all 3 sites by March 31, 2017. At VGH and SPH (n=14), 25% fewer patients required an ED visit in the post-survey reporting compared to pre-survey. During the monitoring period, the monitoring nurse observed seven likely avoided ED admissions due to early intervention. In total, admissions were reduced by 20% and total hospital length of stay reduced by 69%. At KGH (n=8), 43% fewer patients required an ED visit in the post-survey reporting compared to the pre-survey. Hospital admissions were reduced by 20% and total hospital length of stay reduced by 50%. Overall, TEC4Home participants from all sites showed a significant improvement in health-related quality of life and in self-care behaviour pre- to 90 days post-monitoring. A full analysis of the 69 patients will be complete in February 2018. Conclusion: Preliminary findings indicate that home telemonitoring for HF patients can decrease ED revisits and improve patient experience. The length of stay data may also suggest the potential for early discharge of ED patients with home telemonitoring to avoid or reduce hospitalization. A stepped-wedge randomized controlled trial of TEC4Home in 22 BC communities will be conducted in 2018 to generate evidence and scale up the service in urban, regional and rural communities. This work is submitted on behalf of the TEC4Home Healthcare Innovation Community.

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Kyriakopoulos, Nikolas, and Constantin Christopoulos. "Seismic assessment and upgrade of Type 2 construction steel moment-resisting frames built in Canada between the 1960s and 1980s using passive supplemental damping." Canadian Journal of Civil Engineering 40, no. 7 (July 2013): 644–54. http://dx.doi.org/10.1139/cjce-2012-0404.

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The seismic performance of a typical 1960s Type 2 construction steel moment-resisting frame hospital structure designed only for lateral wind loads was investigated. The structure was found to have a soft first storey and displayed large P–Δ sensitivities. An experimental program determined that the connections had considerable inherent ductility and were stable up to 2.0% interstorey drift, despite not having been designed for a ductile cyclic response. The structure was numerically modelled using advanced strength degradation considerations. A nonlinear time-history analysis was conducted using Montreal and Vancouver ground motions and the structure’s performance was found to be inadequate under the considered design hazard levels. Retrofits were proposed for the two orthogonal frames using a performance-based approach and supplemental damping, rather than local interventions to increase the ductility of these connections, and the performance of the final retrofit designs were investigated numerically to confirm that the desired performance levels were achieved.

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Zed, Peter J., and Lyne Filiatrault. "Clinical outcomes and patient satisfaction of a pharmacist-managed, emergency department–based outpatient treatment program for venous thromboembolic disease." CJEM 10, no. 01 (January 2008): 10–17. http://dx.doi.org/10.1017/s1481803500009957.

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ABSTRACTObjective:The purpose of this study was to evaluate the efficacy, safety and patient satisfaction outcomes of our pharmacist-managed, emergency department (ED)–based outpatient treatment program for venous thromboembolism (VTE) disease.Methods:We conducted a prospective cohort study of all patients who were enrolled in the Vancouver General Hospital (VGH) outpatient VTE treatment program over a 7-year period (1999–2006). Efficacy outcomes include recurrent VTE events at 3 and 6 months following discharge from the program. Safety evaluation included major and minor bleeding complications and the development of thrombocytopenia during the acute phase of therapy. Patient satisfaction was assessed using an 18-question patient satisfaction survey, which was mailed to all patients following discharge from the program.Results:Overall, 305 patients were included in the study. Of the 260 evaluable patients, 2 patients (0.8%, 95% confidence interval [CI] 0.2–2.7) experienced a recurrent VTE at 3 months and 5 patients (1.9%, 95% CI 0.8–4.4) had a recurrence at 6 months. One patient (0.3%, 95% CI 0.1–1.8) experienced a major bleeding complication. Seven patients (2.3%, 95% CI 1.1–4.7) experienced a minor bleeding complication and no patient developed thrombocytopenia. Overall, 96.1% were comfortable having their condition treated as an outpatient and 85.7% felt it was more convenient to return to hospital daily for medications and assessment than to be admitted to hospital. Finally, 96.9% of respondents were very satisfied or satisfied with the treatment they received in the outpatient program, and 96.1% would enroll again if future treatment was indicated.Conclusion:Our pharmacist-managed, ED-based outpatient treatment program for VTE disease is safe, effective and achieves a high level of patient satisfaction.

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Staples, John A., Ketki Merchant, Shannon Erdelyi, Adam Lund, and Jeffrey R. Brubacher. "Emergency department visits during the 4/20 cannabis celebration." Emergency Medicine Journal 37, no. 4 (December 12, 2019): 187–92. http://dx.doi.org/10.1136/emermed-2019-208947.

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BackgroundAnnual ‘4/20’ cannabis festivals occur around the world on April 20 and often feature synchronised consumption of cannabis at 4:20 pm. The relationship between these events and demand for emergency medical services has not been systematically studied.MethodsWe conducted a population-based retrospective cohort study in Vancouver, Canada, using 10 consecutive years of data (2009–2018) from six regional hospitals. The number of emergency department (ED) visits between 4:20 pm and 11:59 pm on April 20 were compared with the number of visits during identical time intervals on control days 1 week earlier and 1 week later (ie, April 13 and April 27) using negative binomial regression.ResultsA total of 3468 ED visits occurred on April 20 and 6524 ED visits occurred on control days. A non-significant increase in all-cause ED visits was observed on April 20 (adjusted relative risk: 1.06; 95% CI 1.00 to 1.12). April 20 was associated with a significant increase in ED visits among prespecified subgroups including a 5-fold increase in visits for substance misuse and a 10-fold increase in visits for intoxication. The hospital closest to the festival site experienced a clinically and statistically significant 17% (95% CI 5.1% to 29.6%) relative increase in ED visits on April 20 compared with control days.InterpretationSubstance use at annual ‘4/20’ festivals may be associated with an increase in ED visits among key subgroups and at nearby hospitals. These findings may inform harm reduction initiatives and festival medical care service planning.

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Zhao, B., D. Chahal, E. Lam, and F. Donnellan. "A80 ADVANCED ENDOSCOPIC RESECTION OF LARGE POLYPS & EARLY NEOPLASIA: OUTCOMES OF ENDOSCOPIC MUCOSAL RESECTION IN BRITISH COLUMBIA." Journal of the Canadian Association of Gastroenterology 3, Supplement_1 (February 2020): 94–95. http://dx.doi.org/10.1093/jcag/gwz047.079.

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Abstract Background Recent advances have resulted in a new technique termed endoscopic mucosal resection (EMR). This procedure has been successful at removing large or complex polyps and achieving remission rates comparable to surgery. EMR can also be used to remove early, non-metastatic cancer and they are less invasive than surgery. However, they have been associated with their own complications, most serious of which being perforation. This procedure has recently become available in British Columbia for resection of both complex polyps and early established cancers in the colon. Aims Here we present patient outcomes of EMR procedures for the resection of colorectal polyps in British Columbia. Methods Retrospective data were collected on all EMR procedures done in Vancouver General Hospital and St. Paul’s Hospital (Vancouver, B.C.) from October 2012 (when procedure became available) to July 2019. Inclusion criteria were all adults who had undergone EMR for resection of polyps in the colon. Exclusion criteria were patients younger than 18 or patients who had EMR that resected polyps in the upper GI tract. Patients were referred to one of two endoscopists when one or more polyps suitable for EMR were identified during colonoscopy by other gastroenterologists. Collected data included patient demographics, polyp characteristics, procedure outcome, and complications. Results There were 211 EMR procedures performed on 182 patients (48.9% male). Patient age ranged from 27 to 86 (mean = 67.1). A total of 244 colon polyps were removed with an average size of 2.91 cm and ranged from 0.8 cm to 15 cm. Resected polyps had the following distribution: ascending colon (63.5%), transverse colon (10.2%), descending colon (5.7%), sigmoid colon (15.2%), and rectum (5.3%). Of those that reported resection type, 84.2% were piecemeal and 15.8% were en bloc. 40.9% of polyps were tubulovillous adenoma, 33.2% were tubular, 16.2% were sessile serrated, 6.4% were villous, and 3.4% were adenocarcinoma. Patients from 11 of the 211 EMR cases (5.2%) experienced post-procedure bleed and 4 of these 11 patients (36.4%) had been on anti-platelet or anti-coagulants (discontinued before procedure). Overall, patients from 51 (24.2%) EMR cases were on anti-platelet or anti-coagulants. 33 cases (15.6%) had residual polyps at the resection site that required additional endoscopic resection during follow-up and 14 patients (6.6%) required surgery. None of the EMR procedures resulted in perforation. Conclusions EMR is an effective minimally-invasive procedures that can be used to remove large, complicated colonic polyps and achieve long-term remission rate. The procedure has an acceptable risk profile, with complication and re-intervention rate similar or less than other procedures used to remove large, complicated polyps. Funding Agencies None

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Journal articles on the topic 'Vancouver General Hospital'

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