Saint John Regional Hospital

St. John's, Canada

Saint John Regional Hospital

St. John's, Canada

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Amit M.,St Marthas Regional Hospital | Gander S.,Saint John Regional Hospital | Grueger B.,Whitehorse General Hospital | Rowan-Legg A.,Childrens Hospital of Eastern Ontario
Paediatrics and Child Health | Year: 2011

The present statement reviews the evidence for universal newborn hearing screening (UNHS). A systematic review of the literature was conducted using Medline and using search dates from 1996 to the third week of August 2009. The following search terms were used: neonatal screening AND hearing loss AND hearing disorders. The key phrase "universal newborn hearing screening" was also searched. The Cochrane Central Register of Controlled Trials and systematic reviews was searched. Three systematic reviews, one controlled nonrandomized trial and multiple cohort studies were found. It was determined that there was satisfactory evidence to support UNHS. The results of the available literature are consistent and indicate clear evidence that without UNHS, delayed diagnosis leads to significant harm for children and their families; with UNHS, diagnosis and intervention occur earlier; earlier intervention translates to improved language outcomes; and in well-run programs, there is negligible harm from screening.

Chow E.,Odette Cancer Center | Hoskin P.,Mount Vernon Hospital | Mitera G.,Odette Cancer Center | Zeng L.,Odette Cancer Center | And 6 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2012

Purpose: To update the international consensus on palliative radiotherapy endpoints for future clinical trials in bone metastases by surveying international experts regarding previous uncertainties within the 2002 consensus, changes that may be necessary based on practice pattern changes and research findings since that time. Methods and Materials: A two-phase survey was used to determine revisions and new additions to the 2002 consensus. A total of 49 experts from the American Society for Radiation Oncology, the European Society for Therapeutic Radiology and Oncology, the Faculty of Radiation Oncology of the Royal Australian and New Zealand College of Radiologists, and the Canadian Association of Radiation Oncology who are directly involved in the care of patients with bone metastases participated in this survey. Results: Consensus was established in areas involving response definitions, eligibility criteria for future trials, reirradiation, changes in systemic therapy, radiation techniques, parameters at follow-up, and timing of assessments. Conclusion: An outline for trials in bone metastases was updated based on survey and consensus. Investigators leading trials in bone metastases are encouraged to adopt the revised guideline to promote consistent reporting. Areas for future research were identified. It is intended for the consensus to be re-examined in the future on a regular basis. © 2012 Elsevier Inc.

Buckley M.S.,Banner Good Samaritan Medical Center | Leblanc J.M.,Saint John Regional Hospital | Cawley M.J.,University of the Sciences in Philadelphia
Critical Care Medicine | Year: 2010

Electrolyte imbalances are common in critically ill patients. Although multiple disease states typically encountered in the intensive care unit may be responsible for the development of electrolyte disorders, medications may contribute to these disturbances as well. Medications can interfere with the absorption of electrolytes, alter hormonal responses affecting homeostasis, as well as directly impact organ function responsible for maintaining electrolyte balance. The focus on this review is to identify commonly prescribed medications in the intensive care unit and potential electrolyte disturbances that may occur as a result of their use. This review will also discuss the postulated mechanisms associated with these drug-induced disorders. The specific drug-induced electrolyte disorders discussed in this review involve abnormalities in sodium, potassium, calcium, phosphate, and magnesium. Clinicians encountering electrolyte disturbances should be vigilant in monitoring the patient's medications as a potential etiology. Insight into these drug-induced disorders should allow the clinician to provide optimal medical management for the critically ill patient, thus improving overall healthcare outcomes. Copyright © 2010 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins.

Li H.,University of New Brunswick | Webster D.,Saint John Regional Hospital | Johnson J.A.,University of New Brunswick | Gray C.A.,University of New Brunswick
Journal of Ethnopharmacology | Year: 2015

Ethnopharmacological relevance: Alnus incana, commonly known as the gray or speckled alder, is a medicinal plant used by some Canadian First Nations to treat symptoms associated with tuberculosis. The aim of this study was to assess the anti-mycobacterial activity of an Alnus incana bark extract and to identify the active constituents of the extract. Materials and Methods: Methanolic extracts of the bark of A. incana were subjected to bioassay guided fractionation using Mycobacterium tuberculosis (H37Ra). The active constituents were identified by NMR and MS. Results: Four pentacyclic lupane triterpenes were isolated and were identified as betulin, betulinic acid, betulone and lupenone. Betulin displayed a MIC of 12.5 μg/mL and an IC50 of 2.4 μg/mL against M. tuberculosis (H37Ra). Betulinic acid and betulone showed lower anti-mycobacterial activities with IC50 values of 84 and 57 μg/mL respectively. Lupenone was inactive against M. tuberculosis (H37Ra). Conclusions Betulin, betulinic acid and betulone were identified as the major anti-mycobacterial constituents in the bark of A. incana and the functionality at carbons 3 and 28 of the lupane skeleton would seem to be important in determining the anti-mycobacterial activity of the triterpenes. This work supports the ethnopharmacological use of A. incana by Canadian First Nations communities as a treatment for tuberculosis. © 2015 Elsevier Ireland Ltd. All rights reserved.

Cote C.,Dalhousie Medicine New Brunswick | MacLeod J.B.,Saint John Regional Hospital | Yip A.M.,Saint John Regional Hospital | Ouzounian M.,University of Toronto | And 5 more authors.
Journal of Thoracic and Cardiovascular Surgery | Year: 2015

Objectives: Rates of perioperative transfusion vary widely among patients undergoing cardiac surgery. Few studies have examined factors beyond the clinical characteristics of the patients that may be responsible for such variation. The purpose of this study was to determine whether differing practice patterns had an impact on variation in perioperative transfusion at a single center. Methods: Patients who underwent cardiac surgery at a single center between 2004 and 2011 were considered. Comparisons were made between patients who had received a perioperative transfusion and those who had not from the clinical factors at baseline, intraoperative variables, and differing practice patterns, as defined by the surgeon, anesthesiologist, perfusionist, and the year inwhich the procedure was performed. The risk-adjusted effect of these factors on perioperative transfusion rateswas determined usingmultivariable regressionmodeling techniques. Results: The study population comprised 4823 patients, of whom 1929 (40.0%) received a perioperative transfusion. Significant variation in perioperative transfusion rates was noted between surgeons (from 32.4% to 51.5%, P<.0001), anesthesiologists (from 34.4% to 51.9%, P<.0001) and across year (from 28.2% in 2004 to 48.8% in 2008, P<.0001). After adjustment for baseline and intraoperative variables, surgeon, anesthesiologist, and year of procedure were each found to be independent predictors of perioperative transfusion. Conclusions: Differing practice patterns contribute to significant variation in rates of perioperative transfusion within a single center. Strategies aimed at reducing overall transfusion rates must take into account such variability in practice patterns and account for nonclinical factors as well as known clinical predictors of blood transfusions. Copyright © 2015 by The American Association for Thoracic Surgery.

Chan E.K.,Saint John Regional Hospital | Woods R.,BC Cancer Agency | McBride M.L.,BC Cancer Agency | Virani S.,University of British Columbia | And 4 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2014

Purpose The risk of cardiac injury with hypofractionated whole-breast/chest wall radiation therapy (HF-WBI) compared with conventional whole-breast/chest wall radiation therapy (CF-WBI) in women with left-sided breast cancer remains a concern. The purpose of this study was to determine if there is an increase in hospital-related morbidity from cardiac causes with HF-WBI relative to CF-WBI. Methods and Materials Between 1990 and 1998, 5334 women ≤80 years of age with early-stage breast cancer were treated with postoperative radiation therapy to the breast or chest wall alone. A population-based database recorded baseline patient, tumor, and treatment factors. Hospital administrative records identified baseline cardiac risk factors and other comorbidities. Factors between radiation therapy groups were balanced using a propensity-score model. The first event of a hospital admission for cardiac causes after radiation therapy was determined from hospitalization records. Ten- and 15-year cumulative hospital-related cardiac morbidity after radiation therapy was estimated for left- and right-sided cases using a competing risk approach. Results The median follow-up was 13.2 years. For left-sided cases, 485 women were treated with CF-WBI, and 2221 women were treated with HF-WBI. Mastectomy was more common in the HF-WBI group, whereas boost was more common in the CF-WBI group. The CF-WBI group had a higher prevalence of diabetes. The 15-year cumulative hospital-related morbidity from cardiac causes (95% confidence interval) was not different between the 2 radiation therapy regimens after propensity-score adjustment: 21% (19-22) with HF-WBI and 21% (17-25) with CF-WBI (P=.93). For right-sided cases, the 15-year cumulative hospital-related morbidity from cardiac causes was also similar between the radiation therapy groups (P=.76). Conclusions There is no difference in morbidity leading to hospitalization from cardiac causes among women with left-sided early-stage breast cancer treated with HF-WBI or CF-WBI at 15-year follow-up. © 2014 Elsevier Inc. All rights reserved.

Butcher R.,University of Toronto | LeBlanc-Duchin D.,Saint John Regional Hospital
Medical Reference Services Quarterly | Year: 2015

The rapid development and updates of mobile medical resource applications (apps) highlight the need for an evaluation tool to assess the content of these resources. The purpose of the study was to develop and test a new evaluation rubric for medical resource apps. The evaluation rubric was designed using existing literature and through a collaborative effort between a hospital and an academic librarian. Testing found scores ranging from 23% to 88% for the apps. The evaluation rubric proved able to distinguish levels of quality within each content component of the apps, demonstrating potential for standardization of medical resource app evaluations. © , Published with license by Taylor & Francis.

Duplisea J.,Saint John Regional Hospital | Whelan T.,Dalhousie University
Journal of Urology | Year: 2013

Purpose: We calculated the compliance rate and determined which population of men would be more or less likely to be compliant with semen analysis followup based on demographic information and complication rates. Materials and Methods: We retrospectively reviewed the records of 946 consecutive patients who underwent vasectomy at an ambulatory clinic, as performed by 1 urologist. Standard followup consisted of a telephone call or prebooked appointment 2 months after vasectomy and 2 semen analyses 4 months after vasectomy. Results: Average ± SD patient age was 33.6 ± 5.4 years. Of the 946 study patients 47.9% did not submit a negative semen sample, 15.7% submitted 1 and 36.4% submitted the required 2 negative samples to confirm successful vasectomy according to the sampling protocol. Mean time to semen analysis was 4.53 ± 2.14 months. Complications included infection in 1.9% of cases, hematoma in 1% and sperm granuloma in 0.5%. Men 34 years or younger, men with 3 or more children and men without complications were more likely to be noncompliant with semen analysis. Conclusions: The number of men who provided samples for semen analysis in this study was low, although they were given written and verbal reminders. This poor patient compliance is similar to that in previous studies. We identified a subset of patients with poor compliance, which may allow urologists to target preprocedure counseling more appropriately. © 2013 American Urological Association Education and Research, Inc.

Connolly S.,Saint John Regional Hospital
The Journal of trauma | Year: 2010

BACKGROUND: The aim of this study was to assess the outcome of immediate plate osteosynthesis in the surgical treatment of open humeral shaft fractures. METHODS: In a Level I trauma center and teaching hospital, we reviewed 53 patients with open humeral diaphyseal fractures who were treated with immediate open reduction and plate fixation from April 1988 to August 1998. Forty-six patients were available for adequate follow-up and assessment. All fractures were treated with a standard protocol that included irrigation and debridement, intravenous antibiotics, and immediate open reduction and plate fixation. Patients were assessed to determine whether bone grafts were needed during surgery, whether bone union was achieved, the state of the radial nerve, and postoperative complications. No quantitative functional outcomes were assessed, because this was beyond the scope of the study. It was hypothesized that immediate plate osteosynthesis would achieve safe and acceptable clinical results. RESULTS: The 46 patients with adequate final follow-up were assessed at a mean time of 37.5 weeks (13-156 weeks). All fractures united primarily in satisfactory angulation <5 degrees in coronal and sagittal planes. There were 6 delayed unions with a mean time to union of 42.5 weeks (30-72 weeks). The remaining 40 patients united at a mean of 18.4 weeks (12-26 weeks). No patient required subsequent surgery to obtain union of the fracture. Complications were rare, with no deep infections, nonunions, or iatrogenic nerve injuries. Complications included amputation in three patients and dysesthesia in one patient. Two patients had implants removed because of discomfort. CONCLUSIONS: Immediate plate osteosynthesis for open humeral shaft fractures has been shown to produce excellent results regarding bone union and absence of deep infections and is a safe technique in the management of these injuries.

Obenson K.,Saint John Regional Hospital
Journal of Forensic and Legal Medicine | Year: 2015

Certain artifacts presenting on a fetus due to maceration or birth trauma, mimic inflicted head trauma (IHT) occurring post partum. In such cases, absent a thorough history and examination of the circumstances, the distinction may be impossible. This case report presents an unusual artifact occurring in a stillbirth delivered after the mother had complained of not feeling fetal movements for at least 24 hours. At autopsy, the macerated fetus presented with unusual widening of the sagittal suture and galeal/subgaleal hematomas. There were no other injuries. Review of the mothers antenatal, personal and social history combined with the absence of other injuries to the mother and fetus, helped distinguish the unusual birth-related diastatic separation from IHT. Consequently, in a case where the pathologist is presented with limited information for instance an abandoned fetus, a cautious approach to the determination of the cause and manner of death is strongly recommended. © 2014 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.

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