Telemedicine Monitoring System on PAP Adherence-Fox et al lenge is maximizing adherence with therapy. Many patients discontinue or do not use the device substantially. This is of clinical importance as increased adherence is associated with a reduced risk of motor vehicle crashes, improved cardiovascular outcomes, increased alertness, and improved quality of life. [3][4][5] Optimizing adherence is thus an important aspect of patient management.Adherence to PAP therapy is influenced by many factors, including severity of the disorder, side effects, therapeutic response, claustrophobia, patient's perception of disease seriousness, family support, and cost. Increased air leak with auto-PAP therapy is associated with reduced adherence, 6 and general management with interventions such as heated humidification, mask optimization, and topical nasal therapy improves adherence. 7 Adherence can also be significantly improved by a comprehensive support program and timely interventions by health professionals. This suggests that technical innovations that permit close monitoring of physiologic variables (such as air leak) during therapy and rapid troubleshooting of potential problems may improve adherence to PAP therapy. 8 Telemedicine can be defined as "the use of information and communication technology to deliver health services, exper-

Purpose Endotracheal intubation (ETI) of critically ill patients is a high-risk procedure that is commonly performed by resident physicians. Multiple attempts (C2) at intubation have previously been shown to be associated with severe complications. Our goal was to determine the association between year of training, type of residency, and multiple attempts at ETI. Methods This was a cohort study of 191 critically ill patients requiring urgent intubation at two tertiary care teaching hospitals in Vancouver, Canada. Multivariable logistic regression was used to model the association between postgraduate year (PGY) of training and multiple attempts at ETI. ResultsThe majority of ETIs were performed for respiratory failure (68.6%) from the hours of 07:00-19:00 (60.7%). Expert supervision was present for 78.5% of the intubations. Multiple attempts at ETI were required in 62%, 48%, and 34% of patients whose initial attempt was performed by PGY-1, PGY-2, and PGY-3 non-anesthesiology residents, respectively. Anesthesiology residents required multiple attempts at ETI in 15% of patients, regardless of the year of training. The multivariable model showed that both higher year of training (risk ratio [RR] 0.74; 95% confidence interval [CI] 0.54-0.93; P \ 0.01) and residency training in anesthesiology (RR 0.52; 95% CI 0.20-1.0; P = 0.05) were independently associated with a decreased risk of multiple intubation attempts. Finally, intubations performed at night were associated with an increased risk of multiple intubation attempts (RR 1.3; 95% CI 1.0-1.4; P = 0.03). Conclusion Year of training, type of residency, and time of day were significantly associated with multiple tracheal intubation attempts in the critical care setting. RésuméObjectif L'intubation endotrache´ale (IET) des patients en phase critique est une intervention a`haut risque qui est souvent re´alise´e par les me´decins re´sidents. Il a e´ted e´montre´par le passe´que des tentatives multiples (C2) d'intubation e´taient associe´es a`des complications graves. Notre objectif e´tait de de´terminer l'association entre l'anne´e de formation, le type de re´sidence et les tentatives multiples d'IET. Méthode Cette e´tude de cohorte a examine´191 patients en phase critique ne´cessitant une intubation d'urgence dans deux hôpitaux universitaires de soins tertiaires aV ancouver, au Canada. Une me´thode de re´gression logistique multivarie´e a éte´utilise´e pour illustrer

No abstract

No abstract

Patients’ perspectives on the impact of the COVID-19 pandemic on their access to asthma and COPD healthcare could inform better, more equitable care delivery. We demonstrate this topic using British Columbia (BC), Canada, where the impact of the pandemic has not been described. We co-designed a cross-sectional survey with patient partners and administered it to a convenience sample of people living with asthma and COPD in BC between September 2020 and March 2021. We aimed to understand how access to healthcare for these conditions was affected during the pandemic. The survey asked respondents to report their characteristics, access to healthcare for asthma and COPD, types of services they found disrupted and telehealth (telephone or video appointment) use during the pandemic. We analysed 433 responses and found that access to healthcare for asthma and COPD was lower during the pandemic than pre-pandemic ( p < 0.001). Specialty care services were most frequently reported as disrupted, while primary care, home care and diagnostics were least disrupted. Multivariable logistic regression revealed that access during the pandemic was positively associated with self-assessed financial ability (OR = 22.0, 95% CI: 7.0 – 84.0, p < 0.001, reference is disagreeing with having financial ability) and living in medium-sized urban areas (OR = 2.3, 95% CI: 1.0 – 5.2, p = 0.04, reference is rural areas). These disparities in access should be validated post-pandemic to confirm whether they still persist. They also indicate the continued relevance of exploring approaches for more equitable healthcare.