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Objectives: To examine the rate of unplanned extubation (UE) after the introduction of NeoBar (endotracheal tube stabilization device) compared to the previous tapping method and to analyze the factors associated with UE in the neonatal intensive care unit (NICU).Methods: A quality improvement study was conducted in a tertiary NICU between October 2011 and December 2013. In October 2012, after many educational sessions NeoBar was introduced as a tool for securing endotracheal tube. The UE rate was compared one year before and one year after the introduction of NeoBar. The UE rate was reported as UE per 100 intubation days. Statistical process control charts were used for understanding the special cause variation. The authors used Standards for Quality Improvement Reporting Excellence (SQUIRE) method of reporting for this project.Results: The UE rate decreased from 1.47 per 100 intubation days to 1.17 per 100 intubation days following the introduction of NeoBar (p=0.91). The UE rate was consistently below/at the mean, showing a stable change following the introduction of NeoBar, despite no statistically significant difference in UE rate. The common factors associated with UE were retaping/adjustment of endotracheal tube, infant agitation and performance of other procedures in both time periods.Conclusions: Use of NeoBar as endotracheal tube securing device was associated with similar UE rates compared to taping method. Large prospective studies are required to assess whether NeoBar reduces the UE rate. [ABSTRACT FROM AUTHOR]

Purpose: Concerns have arisen regarding the use of retrievable inferior vena cava filters (rIVCFs) in trauma patients due to increasing reports of low retrieval rates. We hypothesized that complete follow-up with a dedicated trauma nurse practitioner would be associated with a higher rate of retrievability. This study was undertaken to determine the rate of retrievability of rIVCFs placed in a Canadian Lead Trauma Centre, and to compare the rate of retrievability in our trauma population to our non-trauma patients. Methods: We performed a retrospective cohort study of all patients with rIVCF placed between Jan 1 2000 and June 30 2014. Data were collected on demographics, indication for filter placement, retrieval status, and reasons for non-retrieval. Comparison was made between trauma patients and non-trauma patients. Results: A total of 374 rIVCFs were placed (61 in trauma patients and 313 in non-trauma patients) and follow-up was complete for the entire cohort. Filter retrieval was achieved in 86.9 % of trauma patients. Reasons for non-retrieval were technical in two patients, and death before retrieval in six patients. Retrieval was successful in 48.9 % of non-trauma patients. Conclusions: This study demonstrates that rIVCFs can be successfully retrieved amongst trauma patients. We demonstrated a higher rate of successful retrieval amongst trauma patients than non-trauma patients in our institution. Careful patient follow-up may play a role in successful retrieval of rIVCFs. [ABSTRACT FROM AUTHOR]

Waterpipe (WP) use has surged in popularity since the introduction of flavoured shisha. It is now an increasingly popular form of smoking among youth in North America. Health professionals/educators knowledge about the WP may well be inadequate. This study, using qualitative methods, sought to explore the knowledge and attitude of leaders in the community toward the WP. Family physicians, pharmacists, tobacco counsellors, social workers and educators were invited to participate in a one-one interview using open-ended questions. A total of 27 interviews were conducted. Individuals from Eastern Mediterranean backgrounds raised doubt about the overemphasised cultural significance of the WP and perceived this as a marketing strategy by industry. Most felt that WP smokers believed the WP to be less harmful than cigarettes and that the use of flavoured tobacco was motivating people to smoke. Participants believed that education should be directed at the general public and healthcare professionals, suggesting school programs and the use of social media to inform young smokers. Most thought that the current practices regarding packaging and second hand smoke exposure are confusing. They identified the lack of knowledge, poor enforcement procedures, 'so called cultural aspects' and the economic impact of banning the WP on small businesses as barriers to change. Despite the awareness of an increase in WP use, our participants recognized that little has been done to curb this problem. Our findings emphasize the need for further education and better legislation to regulate WP use and availability. [ABSTRACT FROM AUTHOR]

Summary: We describe the creation of a FRAX® model for the assessment of fracture probability in Canadian men and women, calibrated from national hip fracture and mortality data. This FRAX tool was used to examine possible thresholds for therapeutic intervention in Canada in two large complementary cohorts of women and men. Objective: To evaluate a Canadian World Health Organization (WHO) fracture risk assessment (FRAX®) tool for computing 10-year probabilities of osteoporotic fracture. Methods: Fracture probabilities were computed from national hip fracture data (2005) and death hazards (2004) for Canada. Probabilities took account of age, sex, clinical risk factors (CRFs), and femoral neck bone mineral density (BMD). Treatment implications were studied in two large cohorts of individuals age 50 years and older: the population-based Canadian Multicentre Osteoporosis Study (4,778 women and 1,919 men) and the clinically referred Manitoba BMD Cohort (36,730 women and 2,873 men). Results: Fracture probabilities increased with age, decreasing femoral neck T-score, and number of CRFs. Among women, 10.1-11.3% would be designated high risk based upon 10-year major osteoporotic fracture probability exceeding 20%. A much larger proportion would be designated high risk based upon 10-year hip fracture probability exceeding 3% (25.7-28.0%) or osteoporotic BMD (27.1-30.9%), and relatively few from prior hip or clinical spine fracture (1.6-4.2%). One or more criteria for intervention were met by 29.2-34.0% of women excluding hip fracture probability (35.3-41.0% including hip fracture probability). Lower intervention rates were seen among CaMos (Canadian Multicentre Osteoporosis Study) men (6.8-12.9%), but in clinically referred men from the Manitoba BMD Cohort, one or more criteria for high risk were seen for 26.4% excluding hip fracture probability (42.4% including hip fracture probability). Conclusions: The FRAX tool can be used to identify intervention thresholds in Canada. The FRAX model supports a shift from a dual X-ray absorptiometry (DXA)-based intervention strategy, towards a strategy based on fracture probability for a major osteoporotic fracture. [ABSTRACT FROM AUTHOR]

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