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1.  Spontaneous tumour lysis syndrome 
PMCID: PMC3348194  PMID: 22496380
2.  Teaching and assessing procedural skills: a qualitative study 
BMC Medical Education  2013;13:69.
Graduating Internal Medicine residents must possess sufficient skills to perform a variety of medical procedures. Little is known about resident experiences of acquiring procedural skills proficiency, of practicing these techniques, or of being assessed on their proficiency. The purpose of this study was to qualitatively investigate resident 1) experiences of the acquisition of procedural skills and 2) perceptions of procedural skills assessment methods available to them.
Focus groups were conducted in the weeks following an assessment of procedural skills incorporated into an objective structured clinical examination (OSCE). Using fundamental qualitative description, emergent themes were identified and analyzed.
Residents perceived procedural skills assessment on the OSCE as a useful formative tool for direct observation and immediate feedback. This positive reaction was regularly expressed in conjunction with a frustration with available assessment systems. Participants reported that proficiency was acquired through resident directed learning with no formal mechanism to ensure acquisition or maintenance of skills.
The acquisition and assessment of procedural skills in Internal Medicine programs should move toward a more structured system of teaching, deliberate practice and objective assessment. We propose that directed, self-guided learning might meet these needs.
PMCID: PMC3658931  PMID: 23672617
Procedural skills; Objective structured clinical examination; Assessment; Deliberate practice; Simulation
3.  Cervical cancer screening among HIV-positive women 
Canadian Family Physician  2010;56(12):e425-e431.
To determine the rate of cervical screening among HIV-positive women who received care at a tertiary care clinic, and to determine whether screening rates were influenced by having a primary care provider.
Retrospective chart review.
Tertiary care outpatient clinic in Ottawa, Ont.
Women who were HIV-positive receiving care at the Ottawa Hospital General Campus Immunodeficiency Clinic between July 1, 2002, and June 30, 2005.
Whether patients had primary care providers and whether they received cervical screening. We recorded information on patient demographics, HIV status, primary care providers, and cervical screening, including date, results, and type of health care provider ordering the screening.
Fifty-eight percent (126 of 218) of the women had at least 1 cervical screening test during the 3-year period. Thirty-three percent (42 of 126) of the women who underwent cervical screening had at least 1 abnormal test result. The proportion of women who did not have any cervical tests performed was higher among women who did not have primary care providers (8 of 12 [67%] vs 84 of 206 [41%]; relative risk 1.6, 95% confidence interval 1.06 to 2.52, P < .05), although this group was small.
Despite the high proportion of abnormal cervical screening test results among HIV-positive women, screening rates remained low. Our results support our hypothesis that those women who do not have primary care providers are less likely to undergo cervical screening.
PMCID: PMC3001950  PMID: 21375064
4.  Discharge Delay in Patients with Community-acquired Pneumonia Managed on a Critical Pathway 
It has previously been reported that a critical pathway for community-acquired pneumonia (CAP) significantly reduces bed days per patient managed but results in no difference in average length of stay, suggesting that discharge criteria were not successfully implemented. The present study sought to identify factors in the timing of discharge not taken into account by discharge criteria.
Patients admitted with CAP and placed on a pneumonia critical pathway were studied. Patients’ functional and cognitive status were evaluated using the Barthel Index, Hierarchical Assessment of Balance and Mobility (HABAM) and the Mini-Mental Status Examination. Once discharge criteria were met, the patient, a family member and the treating physician were interviewed to identify other factors contributing to length of stay.
Thirty-one patients were enrolled in the study; 12 were discharged when they met discharge criteria and 19 stayed in hospital longer. There were no differences between patients discharged at stability versus those with an increased length of stay in terms of demographics, pneumonia severity score, functional or cognitive status at discharge using the Barthel Index (87.3±11.1 versus 83.8±8.6, respectively; P=0.46) and MMSE (27.1±1.1 versus 27.3±1.1, respectively; P=0.64); however, there was a significant difference in HABAM score at the time clinical stability was reached (22.6±1.3 versus 17.4±3.5, respectively; P=0.03), which correlated with physician and family assessments of patients’ readiness for discharge.
HABAM may be a useful tool to identify patients at risk of remaining in hospital after objective discharge criteria are met. Additional resources may be targeted at these patients to reduce length of stay in CAP.
PMCID: PMC2095063  PMID: 18418484
Community-acquired pneumonia; Critical pathway; Discharge criteria; Length of stay
5.  Comparison of community-acquired pneumonia requiring admission to hospital in HIV-and non-HIV-infected patients 
To compare community-acquired pneumonia (CAP) in hospitalized human immunodeficiency virus (HIV)-infected patients with that in hospitalized non-HIV-infected patients by assessing presenting characteristics, etiology and outcomes.
Retrospective chart review.
A tertiary care centre in Halifax, Nova Scotia.
Thirty-two HIV-infected patients requiring hospitalization for treatment of CAP were identified from September 1991 to October 1993 and compared with 33 age-matched non-HIV-infected patients who presented with pneumonia during the same period.
The two populations were comparable in age, sex and race. Fifty per cent of the HIV-infected and 20.8% of the non-HIV-infected patients had had a previous episode of pneumonia. Pneumocystis carinii pneumonia (PCP) accounted for 16 of the 32 episodes of CAP in the HIV-infected patients, while none of the non-HIV-infected patients had PCP. Pneumonia secondary to Streptococcus pneumoniae was more common in the non-HIV-infected patients (five versus one, P=0.02). Vital signs and initial PO2 did not differ between the two groups. White blood cell count was lower at admission for the HIV population (5.7×109/L versus 12.7×109/L, P=0.003). The HIV patients were more likely to undergo bronchoscopy (27.7% versus 0%, P<0.001). The length of stay in hospital, transfer to the intensive care unit and necessity for intubation were the same for both groups. The in-hospital mortality for HIV-infected patients was eight of 32 (25%) while for the non-HIV-infected patients it was none of 33 (P=0.002).
Patients with HIV infection who present with CAP are more likely to have PCP, to have had a past episode of pneumonia and to die while in hospital than age- and sex-matched non-HIV-infected patients with CAP.
PMCID: PMC3327412  PMID: 22514448
Community-acquired pneumonia; Human immunodeficiency virus infection; Hospitalization

Results 1-5 (5)