Savage R.,Lions Gate Hospital
Journal of the Canadian Academy of Child and Adolescent Psychiatry | Year: 2010
Objective: To review the background and mechanisms behind how certain psychotropic medications cause adverse drug reactions. Methods: A literature review pertaining to several interesting and unusual adverse drug reactions attributed to selected psychotropic medications was conducted. These include: 1) QTc interval prolongation secondary to ziprasidone, pimozide, and other antipsychotic agents. 2) Nephrogenic diabetes insipidus and hypernatremia secondary to lithium. 3) Hypothyroidism secondary to lithium. 4) Erectile dysfunction secondary to selective serotonin and serotonin/norepinephrine reuptake inhibitors (SSRIs/SNRIs). Results: Biochemical mechanisms of how certain psychotropic medications cause adverse drug reactions were reviewed. Specific interventions and monitoring recommendations to prevent or reduce the impact of these adverse reactions are discussed briefly. Conclusion: Knowledge of risk factors and mechanisms of adverse drug reactions with psychotropic medications can help to guide medication prescribing, monitoring and interventions to prevent or mitigate these reactions.
Zarkadas P.C.,Lions Gate Hospital |
Dahm D.L.,Mayo Medical School |
Sperling J.,Mayo Medical School |
Schleck C.D.,Mayo Medical School |
Cofield R.,Mayo Medical School
Journal of Shoulder and Elbow Surgery | Year: 2011
Hypothesis/Background: The indication to perform a shoulder arthroplasty is guided in part by a patient's intended level of activity after surgery. What level of activity should be safely recommended, and, presently, patient reported activity level is unknown. The purpose of this study was to define and compare the self-reported activities of patients following shoulder arthroplasty either total (TSA) or hemiarthroplasty (HA). Methods: Two groups of 75 patients each following TSA or HA were matched by age, sex, operative side, timing from surgery, and state of residence. A mailed questionnaire asked patients to report on their level of pain, motion, strength, and choice of 72 different activities. Reported activities were classified as low demand, intermediate demand, or high demand. Results: Ninety-nine patients completed the survey, 52 in the TSA group (average age 62 years; 30F:22M), and 47 in the HA group (average age 62 years; 27F:20M). No difference on a pain scale was reported between groups. Better results were reported in the TSA group in forward flexion (P = 006), internal rotation (P = 04), and strength (P = 04). The most commonly reported activities in each category were: low demand (eg, cooking), medium demand (eg, gardening), and high demand (eg, snow shoveling). For each activity there was no significant difference between groups. Discussion/Conclusion: Conventional thinking that HA provides for more activity is not supported by patient-reported activities when compared with TSA. Patients following TSA reported better motion and strength and were equally as active as the HA group. © 2011 Journal of Shoulder and Elbow Surgery Board of Trustees.
Raji C.A.,University of California at Los Angeles |
Tarzwell R.,University of British Columbia |
Pavel D.,PathFinder Brain SPECT |
Schneider H.,Sheppard Associates |
And 5 more authors.
PLoS ONE | Year: 2014
Purpose: This systematic review evaluated the clinical utility of single photon emission computed tomography (SPECT) in traumatic brain injury (TBI). Methods: After defining a PICO Statement (Population, Intervention, Comparison and Outcome Statement), PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria were applied to identify 1600 articles. After screening, 374 articles were eligible for review. Inclusion for review was focus on SPECT in the setting of mild, moderate, or severe TBI with cerebral lobar specificity of SPECT findings. Other inclusion criteria were comparison modalities in the same subjects and articles in English. Foreign language articles, SPECT studies that did not include comparison modalities, and case reports were not included for review. Results: We identified 19 longitudinal and 52 cross-sectional studies meeting inclusion criteria. Three longitudinal studies examined diagnostic predictive value. The first showed positive predictive value increases from initial SPECT scan shortly after trauma to one year follow up scans, from 59% to 95%. Subsequent work replicated these results in a larger cohort. Longitudinal and cross sectional studies demonstrated SPECT lesion localization not detected by CT or MRI. The most commonly abnormal regions revealed by SPECT in cross-sectional studies were frontal (94%) and temporal (77%) lobes. SPECT was found to outperform both CT and MRI in both acute and chronic imaging of TBI, particularly mild TBI. It was also found to have a near 100% negative predictive value. Conclusions: This review demonstrates Level IIA evidence (at least one non-randomized controlled trial) for the value of SPECT in TBI. Given its advantages over CT and MRI in the detection of mild TBI in numerous studies of adequate quality, and given its excellent negative predictive value, it may be an important second test in settings where CT or MRI are negative after a closed head injury with post-injury neurological or psychiatric symptoms. © 2014 Raji et al.
Blonna D.,Mayo Medical School |
Blonna D.,University of Turin |
Zarkadas P.C.,Mayo Medical School |
Zarkadas P.C.,Lions Gate Hospital |
And 2 more authors.
Journal of Shoulder and Elbow Surgery | Year: 2012
Background: A critical component of evaluating the outcomes after surgery to restore lost elbow motion is the range of motion (ROM) of the elbow. This study examined if digital photography-based goniometry is as accurate and reliable as clinical goniometry for measuring elbow ROM. Materials and methods: Instrument validity and reliability for photography-based goniometry were evaluated for a consecutive series of 50 elbow contractures by 4 observers with different levels of elbow experience. Goniometric ROM measurements were taken with the elbows in full extension and full flexion directly in the clinic (once) and from digital photographs (twice in a blinded random manner). Results: Instrument validity for photography-based goniometry was extremely high (intraclass correlation coefficient: extension = 0.98, flexion = 0.96). For extension and flexion measurements by the expert surgeon, systematic error was negligible (0° and 1°, respectively). Limits of agreement were 7° (95% confidence interval [CI], 5° to 9°) and -7° (95% CI, -5° to -9°) for extension and 8° (95% CI, 6° to 10°) and -7° (95% CI, -5° to -9°) for flexion. Interobserver reliability for photography-based goniometry was better than that for clinical goniometry. The least experienced observer's photographic goniometry measurements were closer to the reference measurements than the clinical goniometry measurements. Conclusions: Photography-based goniometry is accurate and reliable for measuring elbow ROM. The photography-based method relied less on observer expertise than clinical goniometry. This validates an objective measure of patient outcome without requiring doctor-patient contact at a tertiary care center, where most contracture surgeries are done. © 2012 Journal of Shoulder and Elbow Surgery Board of Trustees.
Ruddick F.,Queen's University |
Sanders P.,University of British Columbia |
Bicknell S.G.,Lions Gate Hospital |
Crofts P.,Lions Gate Hospital
Journal of Ultrasound in Medicine | Year: 2011
Objectives-The purpose of this study was to determine whether the addition of disposable enemas and a 24-hour diet of clear fluids to the bowel preparation protocol before transrectal ultrasound-guided prostate biopsy decreases the rate of postbiopsy sepsis. Methods-Sepsis rates of patients who underwent transrectal ultrasound-guided prostate biopsies at a community hospital were analyzed before and after a new bowel preparation protocol was introduced in our department. All patients received the antibiotic ciprofloxacin both before and after the biopsy. The first group (190 patients) had a preparation protocol that only asked the patients to stop eating by midnight (clear fluids only) on the day before the biopsy. The second group involved 217 patients and followed a bowel-cleansing biopsy preparation protocol. This protocol included the use of 2 disposable enemas and a diet of clear fluids for 24 hours preceding the biopsy. A systematic chart review was then performed to determine which patients had required treatment for postbiopsy sepsis. Results-Sepsis occurred in 4 patients (2.11%) in group 1 and 1 patient (0.46%) in group 2. After performing a 2-sided Fisher exact test, it was found that there was no significant difference between the groups at a 95% confidence level (P = .189). Conclusions-The 24-hour clear-fluid diet and the use of disposable enemas combined with a regimen of ciprofloxacin decreased the rate of postbiopsy sepsis in patients who underwent transrectal ultrasound-guided prostate biopsy, but the results were not significantly different. © 2011 by the American Institute of Ultrasound in Medicine.
Dewar C.L.,Lions Gate Hospital |
Sigler L.,University of Alberta
Clinical Rheumatology | Year: 2010
Mycoleptodiscus indicus is a recognized plant pathogen which has very rarely been reported as a cause of human infection. It is a tropical or subtropical fungus which is difficult to culture and identify from clinical specimens. This is the first report of septic arthritis with this fungus in a healthy Canadian male. The fungal infection was contracted on a vacation in Costa Rica, probably through direct inoculation through injured skin. The fungus was isolated from synovial fluid and identification was confirmed by DNA sequencing. There has only been one previous case of septic arthritis of the knee and one skin infection reported with this fungus; both cases involved immunocompromised hosts. Both septic arthritis patients required joint surgery and lavage to eradicate the fungus, however, only the immunocompromised patient required antifungal medications. In the future, it is very likely that the number of patients identified with M. indicus infection will rise due to increasing awareness of this pathogen as well as increasing exposure. Many immunocompromised patients on anti-retroviral or biologic therapy are healthy enough to travel, thereby exposing themselves to exotic and infected plants which increase the risk of unusual fungal infections. © 2010 Clinical Rheumatology.
Tu A.,University of British Columbia |
Creedon K.,Lions Gate Hospital |
Sahjpaul R.,University of British Columbia
Journal of Neurosurgery: Spine | Year: 2014
Perineural cysts are common lesions of the sacral spine. They have rarely been reported in a presacral location, leading to their misdiagnosis as a gynecological lesion. The authors report the second such case, in a patient undergoing fenestration of what was presumed to be a benign pelvic cyst, and the resultant high-flow CSF leak that occurred. They describe the clinical presentation and manifestations of intracranial hypotension, as well as the pertinent investigations. They also review the literature for the best management options for this condition. Although they are uncommon, large perineural cysts should be included in the differential diagnosis when examining patients with a pelvic lesion. Appropriate imaging investigations should be performed to rule out a perineural cyst. The CSF leak that occurs from iatrogenic cyst fenestration may not respond to traditional first-line treatments for intracranial hypotension and may require early surgical intervention. The authors would recommend neurosurgical involvement prior to definitive treatment. © 2014 AANS.
Rezazadeh S.,University of British Columbia |
Co S.J.,University of British Columbia |
Bicknell S.,Lions Gate Hospital
Canadian Association of Radiologists Journal | Year: 2014
Purpose The purpose of this study was to determine whether low-kilovoltage (80 or 100 kV) computed tomography (CT)-guided interventions performed in a community-based hospital are feasible and to compare radiation exposure incurred with conventional 120 kV potential.Materials and Methods Effective doses (ED) received by patients who underwent CT-guided intervention were analysed before and after a low-dose kilovoltage protocol was instituted in our department. We performed CT-guided procedures of 93 consecutive patients by using conventional 120-kV tube voltage (50 patients) and a low voltage of 80 or 100 kV for the remainder of this cohort. Automatic tube current modulation was enabled to obtain the best image quality. Procedure details were prospectively recorded and included examination site and type, slice width, tube voltage and current, dose length product, volume CT dose index, and size-specific dose estimate. Dose length product was converted to ED to account for radiosensitivity of specific organs. Statistical comparisons with test differences in the ED, volume CT dose index, size-specific dose estimate, and effective diameter (patient size) were made by using the Student t test.Results All but 6 of the procedures performed at 80 kV were successful, for a success rate of 86%. At lower voltages, the ED was significantly (P <.01) reduced, on average, by 57%, 73%, and 65% for the pelvic, chest, and abdomen procedures, respectively.Conclusion A low-dose radiation technique by using 80 or 100 kV results in a high technical success rate for pelvic, chest, and abdomen CT-guided interventional procedures, although dramatically decreasing radiation exposure. There was no significant difference in effective diameter (patient size) between the conventional and the low-dose groups, which would suggest that dose reduction was indeed a result of kVp change and not patient size. © 2014 Canadian Association of Radiologists.
Andolfatto G.,Lions Gate Hospital |
Willman E.,University of British Columbia
Academic Emergency Medicine | Year: 2010
Objectives: This study evaluated the effectiveness, recovery time, and adverse event profile of intravenous (IV) ketofol (mixed 1:1 ketamine-propofol) for emergency department (ED) procedural sedation and analgesia (PSA) in children. Methods: Prospective data were collected on all PSA events in a trauma-receiving, community teaching hospital over a 3.5-year period, from which data on all patients under 21 years of age were studied. Patients receiving a single-syringe 1:1 mixture of 10 mg?mL ketamine and 10 mg?mL propofol (ketofol) were analyzed. Patients received ketofol in titrated aliquots at the discretion of the treating physician. Effectiveness, recovery time, caregiver and patient satisfaction, drug doses, physiologic data, and adverse events were recorded. Results: Ketofol PSA was performed in 219 patients with a median age of 13 years (range = 1 to 20 years; interquartile range [IQR] = 8 to 16 years) for primarily orthopedic procedures. The median dose of medication administered was 0.8 mg?kg each of ketamine and propofol (range = 0.2 to 3.0 mg?kg; IQR = 0.7 to 1.0 mg?kg). Sedation was effective in all patients. Three patients (1.4%; 95% confidence interval [CI] = 0.0% to 3.0%) had airway events requiring intervention, of which one (0.4%; 95% CI = 0.0% to 1.2%) required positive pressure ventilation. Two patients (0.9%; 95% CI = 0.0% to 2.2%) had unpleasant emergence requiring treatment. All other adverse events were minor. Median recovery time was 14 minutes (range = 3 to 41 minutes; IQR = 11 to 18 minutes). Median staff satisfaction was 10 on a 1-to-10 scale. Conclusions: Pediatric PSA using ketofol is highly effective. Recovery times were short; adverse events were few; and patients, caregivers, and staff were highly satisfied. © 2010 by the Society for Academic Emergency Medicine.
Andolfatto G.,Lions Gate Hospital |
Willman E.,University of British Columbia
Academic Emergency Medicine | Year: 2011
Objectives: The objective was to evaluate the effectiveness, recovery time, and adverse event profile of intravenous (IV) mixed 1:1 ketamine-propofol (ketofol) for adult procedural sedation and analgesia (PSA) in the emergency department (ED). Methods: Prospective data were collected on all PSA events over a 4.5-year period in a trauma-receiving suburban teaching hospital. PSAs using a 1:1 single-syringe mixture of 10 mg/mL ketamine and 10 mg/mL propofol in patients over 21 years of age were analyzed. Physiologic data, drug doses, adverse events, recovery time, patient satisfaction, and staff satisfaction were recorded. Results: Ketofol PSA was used in 728 patients for primarily orthopedic procedures. Median patient age was 53 years (range = 21 to 99 years, interquartile range [IQR] = 36-70 years). The median dose of ketamine and propofol was 0.7 mg/kg each (range = 0.2 to 2.7 mg/kg, IQR = 0.5-0.9 mg/kg), and median recovery time was 14 minutes (range = 3 to 50 minutes, IQR = 10-17 minutes). PSA was effective in 717 cases (98%). Bag-mask ventilation occurred in 15 patients (2.1%; 95% confidence interval [CI] = 1.0% to 3.1%). Recovery agitation occurred in 26 patients (3.6%; 95% CI = 2.2% to 4.9%), of whom 13 (1.8%; 95% CI = 0.8% to 2.7%) required treatment. One patient experienced vomiting and one patient was admitted to the hospital for monitoring of transient dysrhythmia and hypotension. No sequelae were identified. The median staff satisfaction scores were 10 (IQR = 9-10) on a scale of 1 to 10, and 97% of patients would have chosen the same method of PSA in the future. Conclusions: Ketofol is an effective PSA agent in adult ED patients. Recovery times are short and adverse events are few. Patients and ED staff were highly satisfied. © 2011 by the Society for Academic Emergency Medicine.