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Introduction: The use of search engines and online social media (OSM) websites by healthcare providers is increasing and may even be used to search for patient information. This raises several ethical issues. The objective of this study is to evaluate the prevalence of OSM and web-searching for patient information and to explore attitudes towards the ethical appropriateness of these practices by physicians and trainees in the emergency department (ED). Methods: We conducted an online survey study of Canadian emergency physicians and trainees listed under then Canadian Association of Emergency Physicians (CAEP) and senior medical students at the University of Toronto. Results: We received 530 responses (response rate 49.1%): 34.9% medical students, 15.5% residents, 49.6% staff physicians. Most had an active Facebook account (74%). Sixty-four participants (13.5%) had used Google to research a patient and 10 (2.1%) had searched for patients on Facebook. There were no differences in these results based on level of training, and 25% of physicians considered using Facebook to learn about a patient “very unethical.” The most frequent ethical concerns were with violation of patient confidentiality, dignity, and consent. The practice was usually not disclosed to patients (14%), but often disclosed to senior colleagues (83%). Conclusion: This is the first study examining the prevalence of and attitudes towards online searching for obtaining patient information in the ED. This practice occurs among staff physicians and trainees despite ethical concerns. Future work should explore the utility and desirability of searching for patient information online. [West J Emerg Med. 2015;16(2):234–239.]

Introduction: Lower extremity amputation (LEA) is a life altering procedure, with significant negative impacts to patients, care partners, and the overall health system. There are gaps in knowledge with respect to patterns of healthcare utilization following LEA due to dysvascular etiology. Objective: To examine inpatient acute and emergency department (ED) healthcare utilization among an incident cohort of individuals with major dysvascular LEA 1 year post-initial amputation; and to identify factors associated with acute care readmissions and ED visits. Design: Retrospective cohort study using population-level administrative data. Setting: Ontario, Canada. Population: Adults individuals (18 years or older) with a major dysvascular LEA between April 1, 2004 and March 31, 2018. Interventions: Not applicable. Main outcome measures: Acute care hospitalizations and ED visits within one year post-initial discharge. Results: A total of 10,905 individuals with major dysvascular LEA were identified (67.7% male). There were 14,363 acute hospitalizations and 19,660 ED visits within one year post-discharge from initial amputation acute stay. The highest common risk factors across all the models included age of 65 years or older (versus less than 65 years), high comorbidity (versus low), and low and moderate continuity of care (versus high). Sex differences were identified for risk factors for hospitalizations, with differences in the types of comorbidities increasing risk and geographical setting. Conclusion: Persons with LEA were generally more at risk for acute hospitalizations and ED visits if higher comorbidity and lower continuity of care. Clinical care efforts might focus on improving transitions from the acute setting such as coordinated and integrated care for sub-populations with LEA who are more at risk. [ABSTRACT FROM AUTHOR]

Background: Recent evidence suggests that home care nursing is variably prescribed after vascular surgery, and may reduce emergency department visits and hospital readmissions. We therefore sought to characterize the indications for home care nursing following vascular surgery from the surgeon's perspective. Methods: An online survey was distributed to the 141 members of the Canadian Society for Vascular Surgery with questions related to home care nursing after carotid endarterectomy (CEA), endovascular aortic aneurysm repair (EVAR), open abdominal aortic aneurysm (AAA) repair and open or hybrid revascularization for peripheral arterial disease (PAD). We included all questionnaires in our analysis; the frequency denominator changes according to the number of respondents who completed each survey item. Results: There were 46 survey respondents (33% of 141) from across the country. A total of 28 (62% of 45) worked in a teaching hospital. Home care nursing was routinely prescribed by 5%, 10%, 31% and 41% of respondents following CEA, EVAR, open AAA repair and open or hybrid revascularization for PAD, respectively. Across all procedure types, the same procedure-related criteria were most often deemed to warrant a prescription for home care nursing: surgical site infection, wound complications (e.g., open wound, lymphatic leak) and use of negative-pressure wound therapy. Across all procedure types, lack of social support, physical frailty and cognitive impairment were most frequently identified as patient-specific considerations for prescribing home care nursing. Few respondents reported restrictions or standards that informed their prescribing practice. Conclusion: Most surgeon respondents agreed on the indications for home care nursing after vascular surgery. However, evidence-based standards to guide patient selection for home care nursing after vascular surgery are needed. Contexte : Selon des donnees recentes, les soins infirmiers a domicile sont prescrits aleatoirement apres la chirurgie vasculaire, et pourraient reduire les consultations aux urgences et les rehospitalisations. Nous avons donc voulu caracteriser les indications des soins infirmiers a domicile apres la chirurgie vasculaire, du point de vue des chirurgiens. Methodes : Nous avons transmis un sondage en ligne aux 141 membres de la Societe canadienne de chirurgie vasculaire (SCCV); les questions portaient sur les soins infirmiers a domicile apres l'endarteriectomie carotidienne, la reparation endovasculaire de l'anevrisme de l'aorte, la reparation chirurgicale de l'anevrisme de l'aorte abdominale (AAA) et la revascularisation chirurgicale ou hybride de la maladie arte rielle peripherique (MAP). Nous avons inclus tous les questionnaires dans notre analyse; le denominateur de frequence change en fonction du nombre de repondants qui ont repondu a chaque element du sondage. Resultats : Quarante-six chirurgiens des quatre coins du pays ont repondu (33 % des 141 membres de la SCCV). En tout, 28 (62 % des of 45) travaillaient dans un etablissement universitaire. Les soins infirmiers a domicile etaient prescrits d'emblee par 5 %, 10 %, 31 % et 41 % des repondants suite a l'endarteriectomie carotidienne, la reparation endovasculaire de l'anevrisme de l'aorte, la chirurgie pour AAA et la revascularisation chirurgicale ou hybride de la MPA, respectivement. Pour tous les types d'interventions, les memes criteres lies aux interventions ont semble justifier la pres cription de soins infirmiers a domicile : infection de plaie, complications au niveau de la plaie (p. ex., plaie ouverte, plaie exsudative) et traitement de plaie par pression negative. Pour tous les types d'intervention, l'absence de soutien social, la fragilite physique et le declin cognitif ont le plus souvent ete identifies parmi les criteres specifiques aux patients pour la prescription de soins infirmiers a domicile. Peu de repondants ont mentionne de possibles restrictions ou normes sur lesquelles fonder leurs habitudes de prescription a ce chapitre. Conclusion : La plupart des chirurgiens participants se sont entendus sur les indications des soins infirmiers a domicile apres la chirurgie vasculaire. Il faudrait toutefois etablir des normes fondees sur des donnees probantes pour guider la selection des patients candidats aux soins infirmiers a domicile apres la chirurgie vasculaire., When patients are discharged from hospital after surgery, home care support can be provided to optimize their recovery at home. (1) In a recent study of vascular surgery quality outcomes [...]

Indigenous Canadians experience a disproportionate burden of chronic atherosclerotic diseases, including peripheral artery disease (PAD). Despite an estimated prevalence of 800 000 patients with PAD in Canada, the burden of the disease among Indigenous Canadians is unclear. Available evidence suggests that this population has a higher prevalence of several major risk factors associated with PAD (diabetes, smoking and kidney disease). Unique socioeconomic, geographic and systemic obstacles affecting Indigenous Canadians' health and health care access may worsen chronic disease outcomes. Little is known about the cardiovascular and limb outcomes of Indigenous peoples with PAD. A novel approach via multidisciplinary vascular health teams engaging Indigenous communities in a culturally competent manner may potentially provide optimal vascular care to this population. Further research into the prevalence and outcomes of PAD among Indigenous Canadians is necessary to define the problem and allow development of more effective initiatives to alleviate the disease burden in this marginalized group. Au Canada, les membres des communautes autochtones sont affectes de maniere disproportionnee par les maladies atherosclereuses chroniques, y compris par l'arterio pa thie peripherique (AP). Malgre une prevalence estimee de 800 000 patients atteints d'AP au Canada, on ignore quel est le fardeau de la maladie chez les membres des communautes autochtones. Selon les donnees accessibles, cette population presente une prevalence plus elevee de plusieurs facteurs de risque majeurs associe a l'AP (diabete, tabagisme et maladie renale). Certains obstacles socioeconomiques, geographiques et systemiques particuliers nuisent aussi a leur sante et leur com pliquent l'acces aux soins de sante, ce qui pourrait aggraver les repercussions des maladies chroniques. On en sait peu sur l'issue des problemes cardiovasculaires et circulatoires peripheriques chez les membres des communautes autochtones touches par l'AP. Une approche nouvelle, impliquant les communautes concernees et offerte de maniere culturellement competente par des equipes de sante vasculaire multidisciplinaires, serait propice a la prestation de soins vasculaires optimaux. Il faudra approfondir la recherche sur la prevalence et l'issue de l'AP chez les membres des communautes autochtones pour cerner le probleme et permettre la mise en place d'initiatives plus efficaces afin d'alleger le fardeau de la maladie dans ce groupe marginalise., Peripheral artery disease (PAD) refers to atherosclerotic narrowing of the noncardiac, noncranial peripheral arteries. It affects more than 200 million people worldwide and is associated with substantial cardiovascular morbidity, mortality [...]

Purpose: Following major lower extremity amputation (LEA), patients experience significant emotional distress and are at risk for anxiety and depression. There is a lack of mental health supports for this population, and internet-based cognitive behavioural therapy (iCBT) may be a useful resource to meet this need. The purpose of this study was to use a qualitative approach to explore the mental health needs of LEA patients and to gauge their attitudes of the use of iCBT to help them cope with their amputation. Methods: Semi-structured qualitative interviews were conducted with inpatients and outpatients with LEA recruited from a major urban rehabilitation hospital. Data were analysed using inductive codebook thematic analysis (TA). Results: Ten interviews were completed with individuals with LEA. The main themes identified were: (1) Fixating on the past; (2) Worry about the future; (3) Unmet mental health needs; (4) Barriers to Mental Health Support; (5) Importance of peer support; and (6) Tailoring iCBT. Conclusions: Our findings highlight that patients with LEA are open to learning more about iCBT to meet their mental health needs. Key iCBT implementation considerations include taking into account issues of stigma associated with mental health, timing of delivery, levels of digital literacy, online security, and interactive content. [ABSTRACT FROM AUTHOR]