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Background: Transthoracic echocardiography is routinely performed in patients with stroke or transient ischemic attack (TIA) to help plan secondary stroke management, but recent data evaluating its usefulness in this context are lacking. We sought to evaluate the value of echocardiography for identifying clinically actionable findings for secondary stroke prevention.Methods: We conducted a multicentre cohort study of patients admitted to hospital with stroke or TIA between 2010 and 2015 at 2 academic hospitals in Toronto, Ontario, Canada. Clinically actionable echocardiographic findings for secondary stroke prevention included cardiac thrombus, patent foramen ovale, atrial myxoma or valvular vegetation. We identified patient characteristics associated with clinically actionable findings using logistic regression.Results: Of the 1862 patients with stroke or TIA we identified, 1272 (68%) had at least 1 echocardiogram. Nearly all echocardiograms were transthoracic; 1097 (86%) were normal, 1 (0.08%) had an atrial myxoma, 2 (0.2%) had a valvular vegetation, 11 (0.9%) had a cardiac thrombus and 66 (5.2%) had a PFO. Patent foramen ovale was less likely among patients older than 60 years (adjusted odds ratio [OR] 0.34, 95% confidence interval [CI] 0.20-0.57), with prior stroke or TIA (adjusted OR 0.31, 95% CI 0.09-0.76) or with dyslipidemia (adjusted OR 0.39, 95% CI 0.15-0.84). Among the 130 patients with cryptogenic stroke who had an echocardiogram (n = 110), a PFO was detected in 19 (17%) on transthoracic echocardiogram.Interpretation: Most patients with stroke or TIA had a normal echocardiogram, with few having clinically actionable findings for secondary stroke prevention. Clinically actionable findings, specifically PFO, were more common in patients with cryptogenic stroke. [ABSTRACT FROM AUTHOR]

Background: Harm reduction (HR) programs and services have strong empirical support in reducing the negative outcomes associated with substance use and are becoming increasingly recognized across the continuum of healthcare services. Aims: To explore frontline healthcare workers (HWs) experiences and perspectives on the benefits and challenges of providing HR programming and care to HIV-positive clients. Methods: A 20 question survey, inclusive of open-ended questions and quantitative rating scales, was completed by HWs at two HIV/AIDS dedicated facilities in Canada implementing HR services. Findings: A total of 64 HWs participated in the survey, with an average of 6.2 years (range: 0.5-18) of experience in HR programs. HWs identified healthcare system engagement and building positive client relationships as key outcomes for evaluation of HR programs. Personal and inter-team related dynamics were highlighted as challenges experienced when utilizing HR in the provision of care. The absence of clear procedures and policies were identified by HWs as barriers to effective implementation of HR programming. Conclusions: The results of this study can be utilized to inform, establish, and guide HR programs, services, and policy development to ensure the delivery of quality care. [ABSTRACT FROM AUTHOR]

Competing Interests: Competing interests: None declared.

Background: Transthoracic echocardiography is routinely performed in patients with stroke or transient ischemic attack (TIA) to help plan secondary stroke management, but recent data evaluating its usefulness in this context are lacking. We sought to evaluate the value of echocardiography for identifying clinically actionable findings for secondary stroke prevention., Methods: We conducted a multicentre cohort study of patients admitted to hospital with stroke or TIA between 2010 and 2015 at 2 academic hospitals in Toronto, Ontario, Canada. Clinically actionable echocardiographic findings for secondary stroke prevention included cardiac thrombus, patent foramen ovale, atrial myxoma or valvular vegetation. We identified patient characteristics associated with clinically actionable findings using logistic regression., Results: Of the 1862 patients with stroke or TIA we identified, 1272 (68%) had at least 1 echocardiogram. Nearly all echocardiograms were transthoracic; 1097 (86%) were normal, 1 (0.08%) had an atrial myxoma, 2 (0.2%) had a valvular vegetation, 11 (0.9%) had a cardiac thrombus and 66 (5.2%) had a PFO. Patent foramen ovale was less likely among patients older than 60 years (adjusted odds ratio [OR] 0.34, 95% confidence interval [CI] 0.20-0.57), with prior stroke or TIA (adjusted OR 0.31, 95% CI 0.09-0.76) or with dyslipidemia (adjusted OR 0.39, 95% CI 0.15-0.84). Among the 130 patients with cryptogenic stroke who had an echocardiogram ( n = 110), a PFO was detected in 19 (17%) on transthoracic echocardiogram., Interpretation: Most patients with stroke or TIA had a normal echocardiogram, with few having clinically actionable findings for secondary stroke prevention. Clinically actionable findings, specifically PFO, were more common in patients with cryptogenic stroke., Competing Interests: Competing interests: Amol Verma and Fahad Razak report that they are part-time employee of Health Quality Ontario, as the Provincial Clinical Leads for Quality Improvement in General Internal Medicine. No other competing interests were declared., (© 2019 Joule Inc. or its licensors.)

Background: Q fever is an infection caused by Coxiella burnetii, a zoonotic disease acquired from both wild and domestic animals. Northern rural New South Wales (NSW) communities in Australia have an increased risk of exposure to this organism. Both the acute and chronic phases of the infection are associated with significant morbidity, which is often increased by delayed recognition and treatment. Recent termination of vaccination programs in Australia may increase the risk of infection in these populations., Materials and Methods: This cross-sectional study evaluated the current knowledge base and overall understanding of clinicians on the epidemiology, presentation, and diagnosis of Q fever in the Northern New South Wales Local Health District., Results: Forty-five participants responded to the survey. Among those, 35 participants (78%) were hospital based and 10 (22%) were from doctors working in the community. Thirty-one (72%) clinicians answered bacteria as the cause of Q fever, 34 (79.1%) participants selected animals as the reservoir of Q fever infection, and 22 (51%) identified inhalation as the form of transmission. The majority identified livestock rearing occupations (84%) as a high-risk group; however, only 65-70% identified stock yard and meat workers as groups also at risk. Furthermore, 23 (51%) of the participants considered those living in rural and remote communities as high risk., Conclusions: Our results identified gaps in knowledge of clinicians in the epidemiology and diagnosis of acute Q fever infection. With the termination of vaccination programs, this study highlights the need for education programs that can increase Q fever awareness toward prompt identification and treatment.

Competing Interests: Competing interests: Timothy Jackson is a consultant at Health Quality Ontario. He performs bariatric surgery only in the public system. Michael Fralick receives funding from the Eliot Phillipson Clinician–Scientist Training Program at the University of Toronto, the Clinician Investigator Program at the University of Toronto, and from the Detweiler Travelling Fellowship, funded by the Royal College of Physicians and Surgeons of Canada. No other competing interests were declared.