RESUMEN
Patients who wander as one of their psychological and behavioural symptoms of dementia are often unable to follow or recall Infection Prevention and Control precautions, putting them at risk of contracting or spreading COVID-19. Physical and chemical restraints have been used to limit the risk of transmission to wandering patients and their care providers, but restraints are not the standard of care for wandering behaviour in non-pandemic scenarios. Although provincial policies on restraint use are available, their guidance may not provide the context-dependent information necessary for individual patient decisions. To address this knowledge gap, we reviewed the medical, ethical, and legal considerations through an interdisciplinary approach including nurses, physicians, ethicists, hospital leadership, risk management, and legal counsel. We present an ethical framework that front-line health-care workers can use to create a balanced patient-centred care plan for incapable wandering patients who are at risk of contracting or spreading COVID-19.
RESUMEN
PURPOSE: Though prior literature has shown that virtual conferences improve accessibility and provide a comparable educational experience, further research is required to characterize their educational value. METHODS: In this repeated cross-sectional study, demographic and survey data were compared between attendance perspectives for the in-person student-led internal medicine conference held in 2019 and subsequent virtual conference held in 2020. RESULTS: There were 146 attendees at the in-person conference and 200 attendees at the online conference, in which 32 (22% response rate) and 52 responses (26% response rate) were gathered, respectively. Comparison of Likert Scale data via Mann-Whitney U Test revealed that learning objectives were better met in-person for the overall conference (p < 0.01) and didactic sessions (p < .05), but not for workshops, in which there was no significant difference. Survey takers noted the virtual conference to be more accessible on multiple factors, but felt as though their potential for interaction with other participants was more limited. CONCLUSIONS: Results indicate that though the virtual conference appeared more accessible to attendees, overall learning objectives for the conference and didactic sessions were better met in-person. Interestingly however, there was no observed difference in perceived educational value for small group workshops.
OBJECTIF: Bien que la littérature existante montre que les conférences virtuelles améliorent l'accessibilité et offrent une expérience éducative comparable à celles qui sont tenues en personne, des recherches plus approfondies s'imposent pour mieux qualifier leur valeur éducative. MÉTHODES: Dans cette étude transversale répétée, on compare les données démographiques et les données d'enquête concernant la perception des participants à une conférence en médecine interne tenue par des étudiants dans un lieu physique en 2019 et les données analogues concernant une conférence virtuelle qui s'est tenue en 2020. RÉSULTATS: Des 146 participants à la conférence en personne, 32 ont répondu au sondage (taux de réponse de 22 %); parmi les 200 participants à la conférence en ligne, les répondants étaient au nombre de 52 (taux de réponse de 26 %). Les données recueillies selon une échelle de Likert ont été comparées par le biais du test U de Mann-Whitney. Le résultat montre que tandis que les objectifs d'apprentissage étaient mieux atteints lors de la participation en personne pour la conférence en général (p <0,01) et les séances didactiques (p <0,05), pour les ateliers, il n'y avait pas de différence significative. Les participants à l'enquête ont noté que la conférence virtuelle était plus accessible à divers niveaux, mais ils ont trouvé que la possibilité d'interagir avec les autres participants y était plus limitée qu'à la conférence tenue en personne. CONCLUSIONS: D'après les résultats, bien que la conférence virtuelle ait semblé plus accessible aux participants, les objectifs d'apprentissage généraux pour la conférence et les séances didactiques ont été mieux atteints en personne. Il est toutefois intéressant de noter qu'aucune différence n'a été relevée en ce qui concerne la valeur éducative perçue des ateliers en petits groupes.
RESUMEN
OBJECTIVES: To synthesize quantitative and qualitative data on pharmacologic interventions of pediatric cyclic vomiting syndrome and their effectiveness in disease management in the acute care setting. STUDY DESIGN: Using keywords, 799 studies published up from December 1954 to February 2018 were extracted from MEDLINE via Pubmed, Embase via OVID, CINAHL via EBSCO, and Cochrane Controlled Trials Registry. Studies were evaluated for inclusion and exclusion by 2 independent reviewers using predetermined inclusion and exclusion criteria. RESULTS: The search yielded 84 studies for full review, of which 54 were included in the systematic review. Studies were subsequently separated into 1 group of 6 case series studies containing quantitative data on sumatriptan, ondansetron, phenothiazines, prokinetic agents, carbohydrate, isometheptene, and aprepitant; 1 one group consisting only of qualitative studies containing expert recommendations. CONCLUSIONS: Ondansetron has the most quantitative and qualitative evidence to support its inclusion in pediatric emergency department protocols as a rescue therapy. Sumatriptan and aprepitant are potential candidates for inclusion as abortive therapies. Qualitative data from retrospective studies and case reports are not applicable to a larger patient population. This report informs a need for controlled, prospective cohort studies and randomized, controlled trials to optimize current management protocols and to develop new medical interventions.