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This retrospective cohort study compared rates of emergency department (ED) visits after a diagnosis of chronic obstructive pulmonary disease (COPD) in the three Aboriginal groups (Registered First Nations, Métis and Inuit) relative to a non-Aboriginal cohort.
We linked eight years of administrative health data from Alberta and calculated age- and sex-standardized ED visit rates in cohorts of Aboriginal and non-Aboriginal individuals diagnosed with COPD. Rate ratios (RR) with 95% confidence intervals (CIs) were calculated in a Poisson regression model that adjusted for important sociodemographic factors and comorbidities. Differences in ED length of stay (LOS) and disposition status were also evaluated.
A total of 2,274 Aboriginal people and 1,611 non-Aboriginals were newly diagnosed with COPD during the study period. After adjusting for important sociodemographic and clinical factors, the rate of all-cause ED visits in all Aboriginal people (RR=1.72, 95% CI: 1.67, 1.77), particularly among Registered First Nations people (RR=2.02; 95% CI: 1.97, 2.08) and Inuit (RR=1.28; 95% CI: 1.22, 1.35), were significantly higher than that in non-Aboriginals, while ED visit rates were significantly lower in the Métis (RR=0.94; 95% CI: 0.90, 0.98). The ED LOS in all Aboriginal groups were significantly lower than that of the non-Aboriginal group.
Aboriginal people with COPD use almost twice the amount of ED services compared to their non-Aboriginal counterparts. There are also important variations in patterns of ED services use among different Aboriginal groups with COPD in Alberta.
Chronic obstructive pulmonary disease (COPD) is a widespread illness with an increasing prevalence in older adults; exacerbations resulting in visits to the emergency department (ED) are common. We sought to determine the epidemiology of COPD presentations to EDs by older adults in Alberta.
Administrative databases were used to examine all ED encounters for COPD from April 1999 to March 2005 in Alberta. Data included demographics of patients and timing of ED visits. Data analysis included descriptive summaries and age–sex directly standardized visit rates (DSVRs).
There were 85 330 ED visits for acute COPD made by 38 638 patients 55 years of age or older during the study period. More men (53.2%) presented, and the mean age at presentation was 72 years. The age–sex DSVRs remained stable from 2000/01 (24.4/1000) to 2004/05 (25.6/1000). Presentation rates differed among population subgroups. Overall, 67% of visits resulted in discharge from the ED.
Chronic obstructive pulmonary disease is a common presentation in Alberta EDs; however, the rates of presentation were stable during the study period, and monthly and hourly trends exhibited similar patterns for each year. Disparities based on age, sex, and socio-economic and cultural statuses were identified. Targeted interventions could be implemented to reduce future ED visits for COPD.
We describe the epidemiology of asthma presentations to emergency departments (EDs) for 3 main regions in the province of Alberta.
We used a comprehensive ED database to identify ED visits in Alberta from April 1999 to March 2005. We linked the visits to other provincial administrative databases to obtain all data on follow-up encounters for asthma during that period. Information extracted included demographics, regions of residence (Edmonton, Calgary or non–major urban [NMU]), timing of ED visits, and subsequent visits to non-ED settings. Data analysis included descriptive summaries and directly standardized visit rates.
During the 6-year study period, 93 146 patients made 199 991 ED visits for asthma. Crude rates in 2004/05 were 7.9/1000, 6.5/1000 and 15.4/1000 in the Edmonton, Calgary and NMU regions, respectively. The Edmonton and Calgary regions had consistently lower visit rates than the NMU regions. The ED visits were followed by low rates of follow-up visits in a variety of non-ED settings, at different intervals.
Asthma is a relatively common presenting problem in Alberta EDs. This study identified relatively stable rates of presentation during the study period, and variation among regions in terms of age and sex. This study provides further understanding of the variation associated with ED presentation and indicates possible targets for specific interventions to reduce asthma-related ED visits.
To quantify the prevalence of cerebral palsy (CP) in British Columbia within a four-year birth cohort.
The study was a population-based record linkage study of a birth cohort of British Columbian children born between April 1, 1991 and March 31, 1995. Cases were identified by the presence of International Classification of Diseases, Version 9 (ICD-9) diagnostic code “343” recorded at three years of age or older or by having the ICD-9 diagnostic code “343” recorded prior to the third birthday with two confirmatory diagnoses within the first three years of life through a record search of the BC Medical Services Plan billing files for the fiscal years 1991 to 1995.
This research has provided an estimate of the prevalence of CP in the four-year birth cohort 1991 to 1995 in British Columbia. An aggregate prevalence rate of CP was measured as 2.68 per 1000 live births, and a congenital rate was measured at 2.57 for the same population. Birth weight and gestational age demonstrated a significant relationship with the development of CP. This study should lend credence to the establishment of a CP register in British Columbia.
To describe the incidence and pattern of traumatic spinal cord injury and cauda equina injury (SCI) in a geographically defined region of Canada.
The study period was April 1, 1997 to March 31, 2000. Data were gathered from three provincial sources: administrative data from the Alberta Ministry of Health and Wellness, records from the Alberta Trauma Registry, and death certificates from the Office of the Medical Examiner.
From all three data sources, 450 cases of SCI were identified. Of these, 71 (15.8%) died prior to hospitalization. The annual incidence rate was 52.5/million population (95% CI: 47.7, 57.4). For those who survived to hospital admission, the incidence rate was 44.3/million/year (95% CI: 39.8, 48.7). The incidence rates for males were consistently higher than for females for all age groups. Motor vehicle collisions accounted for 56.4% of injuries, followed by falls (19.1%). The highest incidence of motor vehicle-related SCI occurred to those between 15 and 29 years (60/million/year). Fall-related injuries primarily occurred to those older than 60 years (45/million/year). Rural residents were 2.5 times as likely to be injured as urban residents.
Prevention strategies for SCI should target males of all ages, adolescents and young adults of both sexes, rural residents, motor vehicle collisions, and fall prevention for those older than 60 years.
Our goal was to determine the effectiveness of an intervention aimed at improving the emergency department (ED) documentation of pediatric injuries.
All physicians and nursing staff in the ED of an urban teaching hospital and trauma centre underwent focused injury surveillance training and were instructed how to document 14 injuryspecific data elements. Pocket reminder cards were provided, and pediatric injury charts were flagged. Subsequently, random samples of pediatric injury charts were analyzed from a 3-month period prior to the intervention and from the corresponding months after the intervention. Postintervention documentation was compared to pre-intervention documentation for the 14 predefined data elements.
Six of the 14 data elements were charted more frequently, and 2 less frequently during the post-intervention phase. Odds ratios ranged from 4.59 (95%CI, 3.40 to 6.19) for charting “the presence of an adult observer” to 0.09 (95%CI, 0.01 to 0.76) for charting “sports equipment related to the injury.” The “flagging” of injury charts, as a visual reminder for clinicians to document injury data, seemed to be the most effective component of the intervention.
A simple intervention, consisting of staff training, chart modification, and visual flagging of charts, can increase the amount of injury information documented by ED clinicians. Efforts to improve ED charting are most likely to succeed if they include visual prompts for clinicians.
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