The Kidney Transplant Program at the Toronto General Hospital uses numerous electronic health record platforms housing patient health information that is often not coded in a systematic manner to facilitate quality assurance and research. To address this, the comprehensive renal transplant research information system was conceived by a multidisciplinary healthcare team. Data analysis from comprehensive renal transplant research information system presented at programmatic retreats, scientific meetings, and peer-reviewed manuscripts contributes to quality improvement and knowledge in kidney transplantation.

Objective: The Kidney Transplant Program at the Toronto General Hospital utilizes numerous electronic health record (EHR) platforms housing patient health information that are often not coded in a systematic manner to facilitate quality assurance and research. To address this problem, the Comprehensive Renal Transplant Research and Information System (CoReTRIS) was developed. Methods/Approach: A team of multi-disciplinary professionals developed the framework and codebook for CoReTRIS, which comprises clinical outcomes, costs, and quality-of-life data elements. To create CoReTRIS, relational tables representing elements from pre-and posttransplant domains, and linked to a biological specimen repository, were developed using MS Access. Training manuals for data abstraction and entry from EHR platforms were created to ensure all procedures were performed systematically. To reduce human resource costs, trained personnel from the Multi-Organ Transplant Student Research Training Program (MOTSRTP) under healthcare staff supervision performed the majority of the data management exercises. Results: Currently, CoReTRIS comprises over 40 domains with 700 data elements. This includes data for all kidney patients transplanted since 1 Jan 2000, referred patients with end-stage renal disease since 1 Jan 2003, and biological specimen samples for all kidney transplant patients actively followed through our clinical trials unit. The training manuals have led to the development of training courses and e-learning tools. These e-learning tools provide an interactive environment with tests following each session to assess the readiness of trainees to initiate actual data abstraction exercises. A set of statistical codes developed utilizing the program Stata® were employed to perform data audits and validation checks to ensure maintenance of the quality of the databases and to produce standardized analytical datasets for ongoing and future research. Conclusion: Data analysis from CoReTRIS presented at programmatic retreats and scientific meetings is contributing to quality improvement and the knowledge base of kidney transplantation. CoReTRIS provides high quality data at minimal financial cost, thus a similar framework has wide applicability for chronic care management databases in other healthcare institutions.

Previous studies have shown that the 'BURP' maneuver improved glottic view, when applied to the thyroid cartilage. (1) We hypothesized that backward, upward and rightward pressure on the cricoid cartilage would combine benefits of both 'BURP' and Sellick's maneuver (2), improving glottic view and offer potential protection against passive regurgitation. M ME ET TH HO OD DS SWe analyzed glottic view data from 40 adults undergoing elective surgery, in this prospective, randomized, double blind and crossover study. Patients at risk for regurgitation or with difficult airways were excluded. Patients were induced with fentanyl, propofol and rocuronium. In a random sequence for each case, and blinded by a sheet to the laryngoscopist, an anesthetic technician applied 30 newtons of direct, 'BURP', or no pressure to the patients cricoid cartilage. A separate laryngscopy was conducted for each maneuver and the views were graded as being good (part of the glottis seen), poor (the arytenoids were seen) and no view (only the epiglottis was seen). After the third maneuver the airway was secured with an endotracheal tube. The same anesthetic technician applied the pressures and the same laryngoscopist assessed the glottic views through the study. Views were recorded and blinding was maintained until the conclusion of the study. Differences were analyzed using the Wilcoxon Signed Rank test. R RE ES SU UL LT TS SThe hypothesis was rejected and 12/40 (30%) of the patients having 'BURP' applied to the cricoid cartilage showed a worse view (p=0.007), while only 2/40 (5%) showed an improved view. Direct cricoid pressure made the view worse in 5/40 (12.5%) of the patients, which was not statistically significant (p=0.279) and only 1/40 (2.5%) showed an improved view. No difference was seen in 26/40 (65%) of the patients. D DI IS SC CU US SS SI IO ON NThe'BURP' maneuver worsens glottic view when applied to the cricoid cartilage. There would be no benefit in routinely applying 'BURP' to the cricoid cartilage, during rapid sequence inductions. Second, proper application of cricoid pressure is important to prevent an obstructed view of the glottis. Finally, there may be situations where cricoid pressure could be removed to get a better view. I IN NT TR RO OD DU UC CT TI IO ON N Morphine was the first opioid used intrathecally for pain relief purposes. 1 It is now held as the "gold standard" for pain relief in the post-operative setting. An alternative to morphine is lacking, however hydromorphone has been suggested for this role. 2 We designed a study to determine the dose of hydromorphone that would be acceptable as an alternative to morphine for pain relief after gynecologic surgery. R RE EF FE ER RE EN NC CE ES S M ME ET TH HO OD DS SWith ethics approval obtained, suitable participants were randomized in a double blind fashion to six groups and received one of the following, along with spinal bupivicaine anesthesia: hydromorphone (HM) 100,200,300,400 or 500 µg versus morphine (M) 100 µg. Outcomes measured were adequacy of analgesia a...