Canadian journal of rural medicine : the official journal of the Society of Rural Physicians of Canada = Journal canadien de la médecine rurale : le journal officiel de la Société de médecine rurale du Canada
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Aboriginal people are substantially more likely to be injured or die in motor vehicle crashes (MVCs) than the general population. However, research examining MVCs among Canadian Aboriginal populations is limited. We examine trends and gaps in the Canadian literature and suggest priorities for future research. ⋯ This review indicates that rates of death, hospital admission and injury related to MVCs are twice as high among Aboriginal populations than the general Canadian population, which highlights a major public health concern. Priorities for future research should include examination of the social environment, more rigorous methods and collaborative research in partnership with Aboriginal communities.
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Case Reports
Patient advocacy by rural emergency physicians after major service cuts: the case of Nelson, BC.
Efforts at cost containment through regionalization have led to reduced services in several rural emergency departments (EDs) in Canada. As a result, questions have been raised about patient safety and equitable access to care, compelling physicians to advocate for their patients. ⋯ We describe our experience of patient advocacy after major service cuts at Kootenay Lake Hospital in Nelson, BC. Despite mixed results, we suggest increased physician involvement in patient advocacy.
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Pulmonary embolism (PE) is a serious condition with mortality estimates of up to 10%. We sought to investigate the diagnosis of PE, time to access imaging and diagnostic utility of each modality in a rural emergency department (Ed). ⋯ In this ED there may be over reliance on the D-dimer test, irrespective of Wells score. Access to V/Q and CT were similar to that of an urban centre. Empiric anticoagulation was started in most patients.
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Epidural steroid injections (ESIs) are a safe and accessible therapy for chronic low back pain, one of the most common and challenging chronic conditions seen in primary care. However, the indications for and effectiveness of ESI remain controversial. In rural settings with limited public transportation infrastructure, such a mobility-limiting condition can have even more negative effects on quality of life and function. Furthermore, diagnostic and specialist services are often limited. A paucity of safe, effective and accessible treatments leads to heavy reliance on oral analgesics, especially opioids, which have well-known complications. ⋯ Some patients with neurologic compromise from LDH or LSS have improvement in symptoms after ESI. A prospective study is underway to more rigorously assess the effectiveness of this treatment.