British Columbia Womens Hospital and Health Center

Vancouver, Canada

British Columbia Womens Hospital and Health Center

Vancouver, Canada
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Goodacre S.,University of Sheffield | Nelson-Piercy C.,Womens Health Academic Center | Hunt B.,Guys and St Thomass NHS Foundation Trust | Chan W.-S.,British Columbia Womens Hospital and Health Center
Emergency Medicine Journal | Year: 2015

Pulmonary embolism (PE) is a leading cause of death in pregnancy and postpartum. Clinicians face a difficult choice when deciding whether to use diagnostic imaging to investigate for suspected PE in these patients, between risking potentially catastrophic consequences of missed diagnosis if imaging is withheld and risking unnecessary iatrogenic harm to both mother and fetus if imaging is overused. This paper explores the options for imaging and evidence for the use of clinical features, clinical predictions scores or biomarkers to select pregnant and postpartum women for imaging. It also considers where future research could be most appropriately directed.


Ashab H.A.-D.,University of British Columbia | Lessoway V.A.,British Columbia Womens Hospital and Health Center | Khallaghi S.,University of British Columbia | Cheng A.,Johns Hopkins University | And 2 more authors.
IEEE Transactions on Biomedical Engineering | Year: 2013

We propose an augmented reality system to identify lumbar vertebral levels to assist in spinal needle insertion for epidural anesthesia. These procedures require careful placement of a needle to ensure effective delivery of anesthetics and to avoid damaging sensitive tissue such as nerves. In this system, a trinocular camera tracks an ultrasound transducer during the acquisition of a sequence of B-mode images. The system generates an ultrasound panorama image of the lumbar spine, automatically identifies the lumbar levels in the panorama image, and overlays the identified levels on a live camera view of the patient's back. Validation is performed to test the accuracy of panorama generation, lumbar level identification, overall system accuracy, and the effect of changes in the curvature of the spine during the examination. The results from 17 subjects demonstrate the feasibility and capability of achieving an error within clinically acceptable range for epidural anaesthesia. © 1964-2012 IEEE.


PubMed | University of Sheffield, Guys & St Thomass NHS Foundation Trust, Womens Health Academic Center and British Columbia Womens Hospital and Health Center
Type: Journal Article | Journal: Emergency medicine journal : EMJ | Year: 2014

Pulmonary embolism (PE) is a leading cause of death in pregnancy and postpartum. Clinicians face a difficult choice when deciding whether to use diagnostic imaging to investigate for suspected PE in these patients, between risking potentially catastrophic consequences of missed diagnosis if imaging is withheld and risking unnecessary iatrogenic harm to both mother and fetus if imaging is overused. This paper explores the options for imaging and evidence for the use of clinical features, clinical predictions scores or biomarkers to select pregnant and postpartum women for imaging. It also considers where future research could be most appropriately directed.


De Silva D.A.,University of British Columbia | Halstead A.C.,University of British Columbia | Cote A.-M.,Université de Sherbrooke | Sabr Y.,University of British Columbia | And 3 more authors.
Pregnancy Hypertension | Year: 2013

We evaluated the frequency of measurable albuminuria (≥6.00 mg/L) for albumin:creatinine ratios (ACr) among 160 consecutive women attending high-risk clinics. Of last urine samples before delivery, 76 had measurable albuminuria and 41/76 (53.9%) had ACr ≥2 mg/mmol of which 7.3% had normal pregnancy outcome. 84 samples had albuminuria <6.00 mg/L and 43/84 (51.2%) had ACr ≥2 mg/mmol of which 25.6% had normal pregnancy outcome (p = 0.025). Excluding 48/160 (30.0%) dilute samples (urinary creatinine <3 mM), no samples with unmeasurable albuminuria had ACr ≥2 mg/mmol. In pregnancy, urine is often dilute and without measurable albuminuria, leading to a clinically relevant proportion of false positive results by ACr. © 2013 International Society for the Study of Hypertension in Pregnancy. Published by Elsevier B.V. All rights reserved.


Kathirgamanathan A.,British Columbia Womens Hospital and Health Center | Kathirgamanathan A.,Kings Mill Hospital | Douglas M.J.,British Columbia Womens Hospital and Health Center | Tyler J.,British Columbia Womens Hospital and Health Center | And 4 more authors.
Anaesthesia | Year: 2013

Controversy exists as to whether effective spinal anaesthesia can be achieved as quickly as general anaesthesia for a category-1 caesarean section. Sixteen consultants and three fellows in obstetric anaesthesia were timed performing spinal and general anaesthesia for category-1 caesarean section on a simulator. The simulation time commenced upon entry of the anaesthetist into the operating theatre and finished for the spinal anaesthetic at the end of intrathecal injection and for the general anaesthetic when the anaesthetist was happy for surgery to start. In the second clinical part of the study, the time from intrathecal administration to 'adequate surgical anaesthesia' (defined as adequate for start of a category-1 caesarean section) was estimated in 100 elective (category-4) caesarean sections. The median (IQR [range]) times (min:s) for spinal procedure, onset of spinal block and general anaesthesia were 2:56 (2:32-3:32 [1:22-3:50]), 5:56 (4:23-7:39 [2:9-13:32]) and 1:56 (1:39-2:9 [1:13-3:12]), respectively. The limiting factor in urgent spinal anaesthesia is the unpredictable time needed for adequate surgical block to develop. © Anaesthesia © 2013 The Association of Anaesthetists of Great Britain and Ireland.


Tran D.,University of British Columbia | Kamani A.A.,British Columbia Womens Hospital and Health Center | Al-Attas E.,British Columbia Womens Hospital and Health Center | Lessoway V.A.,British Columbia Womens Hospital and Health Center | And 2 more authors.
Canadian Journal of Anesthesia | Year: 2010

Purpose: In conventional practice of epidural needle placement, determining the interspinous level and choosing the puncture site are based on palpation of anatomical landmarks, which can be difficult with some subjects. Thereafter, the correct passage of the needle towards the epidural space is a blind "feel as you go" method. An aim-and-insert single-operator ultrasound-guided epidural needle placement is described and demonstrated. Method: Nineteen subjects undergoing elective Cesarean delivery consented to undergo both a pre-puncture ultrasound scan and real-time paramedian ultrasound-guidance for needle insertion. Following were the study objectives: to measure the success of a combined spinal-epidural needle insertion under real-time guidance, to compare the locations of the chosen interspinous levels as determined by both ultrasound and palpation, to measure the change in depth of the epidural space from the skin surface as pressure is applied to the ultrasound transducer, and to investigate the geometric limitations of using a fixed needle guide. Results: One subject did not participate in the study because pre-puncture ultrasound examination showed unrecognizable bony landmarks. In 18 of 19 subjects, the epidural needle entered the epidural space successfully, as defined by a loss-of-resistance. In two subjects, entry into the epidural space was not achieved despite ultrasound guidance. Eighteen of the 19 interspinous spaces that were identified using palpation were consistent with those determined by ultrasound. The transducer pressure changed the depth of the epidural space by 2.8 mm. The measurements of the insertion lengths corresponded with the geometrical model of the needle guide, but the needle required a larger insertion angle than would be needed without the guide. Conclusion: This small study demonstrates the feasibility of the ultrasound-guidance technique. Areas for further development are identified for both ultrasound software and physical design. © Canadian Anesthesiologists' Society 2009.


De Silva D.A.,University of British Columbia | Halstead A.C.,University of British Columbia | Cote A.-M.,Université de Sherbrooke | Sabr Y.,University of British Columbia | And 3 more authors.
Journal of Obstetrics and Gynaecology Canada | Year: 2014

Objective: To compare the diagnostic test properties of automated and visually read urine dipstick screening for detection of a random protein:creatinine ratio (PrCr) ≥ 30 mg/mmol Methods: Urine samples were collected prospectively from 160 women attending high-risk maternity clinics at a tertiary care facility. Samples were divided into two aliquots; one aliquot was tested using two different urine test strips, one read visually and one by an automated reader. A second aliquot of the same urine was analyzed for urinary protein and creatinine. Performance of visual and automated dipstick results (proteinuria ≥ 1 +) were compared for detection of PrCr. ≥ 30 mg/mmol using non-dilute urine samples (urinary creatinine ≥ 3 mmol/L). Results: Both urine test strips showed low sensitivity (visual 56.0% and automated 53.8%). Positive likelihood ratios were 15.0 for visual dipstick testing (95% CI 5.9 to 37.9) and 24.6 for automated (95% CI 7.6 to 79.6). Negative likelihood ratios were 0.46 for visual dipstick testing (95% CI 0.29 to 0.71) and 0.47 for automated (95% CI 0.31 to 0.72). Conclusion: Automated dipstick testing was not superior to visual testing for detection of proteinuria in pregnant women in a primarily outpatient setting. Sensitivity may depend on the test strips and/or analyzer used. © 2014 Society of Obstetricians and Gynaecologists of Canada.


PubMed | University of British Columbia and British Columbia Womens Hospital and Health Center
Type: Journal Article | Journal: Contraception | Year: 2015

Access to prescription contraception is often limited by the availability of physicians, particularly in rural areas. Pharmacists are available but are not authorized in Canada to prescribe contraceptives, an innovation proved successful in the United States. It is unknown whether Canadian pharmacists, particularly those in rural areas, are willing to adopt this innovation and what barriers and facilitators they predict. We explored the acceptability and feasibility for independent provision of contraception at pharmacies throughout British Columbia (BC).This mixed-methods study used validated questionnaires followed by optional structured interviews among all rural, and a sample of urban, community pharmacies in BC. Analyses use descriptive, logistic regression and qualitative thematic evaluation.Responding community pharmacies represent all geographic health regions of BC and the range of pharmacy business models. Respondents reported a mean of 17 years in practice. Seventy percent of pharmacies reported a private counseling area. Over 80%, including pharmacies in all regions, indicated willingness to prescribe hormonal contraceptives. Factors associated with willingness to prescribe were comfort using a protocol to assess sexual history, confidence about staff availability and public acceptability, and fewer years in practice. Pharmacists requested training in assessment protocols and liability issues prior to implementation.Pharmacies from all areas throughout BC, responded and report a high degree of acceptability and feasibility for independent prescription of hormonal contraceptives. As pharmacists are often the most accessible health professional in rural areas, pharmacist provision of hormonal contraceptives has potential to improve access to contraception.


PubMed | University of British Columbia and British Columbia Womens Hospital and Health Center
Type: Journal Article | Journal: BMC medical education | Year: 2016

The Virtual Interprofessional Patients-Computer-Assisted Reproductive Health Education for Students (VIP-CARES) Project took place during the summers of 2010-2012 for eight weeks each year at the University of British Columbia(UBC). Undergraduate health care students worked collaboratively to develop virtual patient case-based learning modules on the topic of family planning. The purpose of this study was to evaluate the changes in perception towards interprofessional collaboration (IPC) among the participants, before and after the project.This study utilized a mixed methods evaluation using self-assessment survey instruments, semi-structured interviews, and reflective essays. Pre- and post- project surveys were adapted from the Canadian Medical Education Determinants (CanMEDS) and Canadian Interprofessional Health Collaborative (CIHC) frameworks, as well as the Memorial University Interprofessional Attitudes (IPA) questionnaire. The survey results were analyzed as mean (M) and standard deviation (SD) on Likert scales. The non-parametric Wilcoxon signed-rank test was used to determine if any significant changes were measured between each participants differences in score (p0.05). Post-project interview transcripts and essays were analyzed using recursive abstraction to elicit any themes.Altogether, 26 students in medicine, pharmacy, nursing, midwifery, dentistry, counselling psychology, and computer science participated in VIP-CARES, during the three years. Student attitudes toward IPC were positive before and after the project. At the projects conclusion, there was a statistically significant increase in the participants self-assessment competency scores in the CanMEDS roles of health advocate (p=0.05), manager (p=0.02), and medical expert (p=0.03), as well as the CIHC domains of interprofessional communication (p=0.04), role clarification (p=0.01), team functioning (p=0.05), and collaborative leadership (p=0.01). Qualitative evaluations yielded three major themes: communication and respect as key to team functioning, importance of role clarification within the team, and existence of inherent challenges to IPC. From the reflections, students generally felt more comfortable with their improvements in the CIHC domains of interprofessional communication, team functioning, and role clarification.After working within an interdisciplinary team developing virtual patient learning modules on family planning, the student participants of the VIP-CARES Project indicated general improvement in the skills necessary for effective interprofessional collaboration. Triangulation of the overall data suggests this was especially observed within the areas of interprofessional communication, team functioning, and role clarification.


Oliveira J.,Instituto Nacional Of Saude Dr Ricardo Jorge | Dias C.,Instituto Nacional Of Saude Dr Ricardo Jorge | Dias C.,British Columbia Womens Hospital and Health Center | Redeker E.,University of Amsterdam | And 6 more authors.
Human Mutation | Year: 2010

The establishment of Locus Specific Databases (LSDB) is a crucial aspect for the Human Genetics field and one of the aims of the Human Variation Project. We report the development of a publicly accessible LSDB for the NIPBL gene () implicated in Cornelia de Lange Syndrome (CdLS). This rare disorder is characterized by developmental and growth retardation, typical facial features, limb anomalies, and multiple organ involvement. Mutations in the NIPBL gene, the product of which is involved in control of the cohesion complex, account for over half of the patients currently characterized. The NIPBL LSDB adopted the Leiden Open Variation database (LOVD) software platform, which enables the comprehensive Web-based listing and curation of sequence variations and associated phenotypical information. The NIPBL-LOVD database contains 199 unique mutations reported in 246 patients (last accessed April 2010). Information on phenotypic characteristics included in the database enabled further genotype-phenotype correlations, the most evident being the severe form of CdLS associated with premature termination codons in the NIPBL gene. In addition to the NIPBL LSDB, 50 novel mutations are described in detail, resulting from a collaborative multicenter study. © 2010 Wiley-Liss, Inc.

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