P065: The history of emergency medicine in Ottawa

Introduction/Innovation Concept: There is a paucity of peer-reviewed works investigating the History of Emergency Medicine (EM) in Canada, and none examining a single centre. This study analyzed the academic and clinical evolution of EM in the City of Ottawa from its origins to present. Methods: The study comprised primary and secondary historical research and an oral history methodology. A literature review was performed on the following databases: PubMed, Medline, EMBASE, JSTOR, Web of Science, Historical Abstracts; five medical history journals were also searched. Data were collected from City of Ottawa Archives, Archives of the Sisters of Charity of Ottawa, The Ottawa Hospital Libraries, University of Ottawa Libraries, RCPSC and CFPC Archives, Historical Society of Ottawa documents, Ottawa newspaper archives, and professional correspondences. The oral history component consisted of formal interviews with seven practicing and retired Emergency Physicians in Ottawa. Ethics approval was not required though consent was obtained from respondents. Curriculum, Tool, or Material: The literature review yielded the following: PubMed: 218 results, 180 excluded for non-relevance, 3 papers included in analysis. Historical Abstracts: 1 result, overlap with PubMed. Other databases and medical history journals yielded no papers. Along with extensive archival data, these results were used to construct a detailed timeline of EM history in Ottawa and Canada more broadly. Residency training in EM in Ottawa was initiated in 1972 at the impetus of the Board of the Ottawa Civic Hospital. Two main themes recurred in the interviews: resistance from existing specialties to EM becoming a specialty, and early Emergency Rooms staffed by the least trained people treating the least differentiated patients. Early EM physicians were not viewed positively by other specialists. Conclusion: Pioneering EM physicians were forced to validate the specialty as distinct, rigorous, and credible. In Ottawa this was achieved by developing strong core academics and research. Nationally, this has been instrumental in establishing EM as a viable standalone academic specialty. Modern consult pushback may have evolved from existing specialists fighting against the creation of EM combined with their negative perception of EM physicians. These data could be incorporated into learning modules for EM residency academic programs, and the methods applied to other centres.

“Body Work”: Nurses and the Delegation of Medical Technology at the Ottawa Civic Hospital, 1947-1972

The absence of ordinary women from histories of science and technology may be partially explained by what has been excluded as science, as well as who have been excluded as women of science. Although the delegation of medical technology to Ontario nurses increased rapidly during the mid-twentieth century, we know very little regarding how these ordinary women engaged in science and medical technology through the everyday practice of "body work." Gender structured the working relationships between predominantly-male physicians and predominantly-female nurses, shaping the process of delegation and generating significant changes in nurses' work as well as who provided bedside care. Trained nurses parlayed these new technological skills to their advantage, enabling the extension of technological care at the bedside and assuring their roles as essential for the functioning of the hospital system.

Predicting the probability of meningioma recurrence based on the quantity of peritumoral brain edema on computerized tomography scanning

Object The goal of this study was to determine whether the quantity of peritumoral brain edema displayed on computerized tomography (CT) scanning could be correlated with brain invasion and subsequent recurrence of meningiomas. Methods One hundred thirty-five patients who underwent resection of intracranial meningiomas at the Ottawa Civic Hospital were followed during the period 1980 to 1998. A complete resection was defined as one in which tumor, invaded bone, and involved dura were removed. Tumors were examined microscopically for evidence of brain invasion. The mean follow-up period was 9 years (± 4 years, standard deviation [SD]) and the mean time to recurrence was 5 years (± 4 years, SD). The authors used a simple grading system based on the average thickness (in centimeters) of edema seen on an axial CT slice showing the most tumor. Edema grade was linearly related to edema volume determined by digitizing the scans (r = 0.96; 29 cases). The chance of brain invasion increased by 20% for each centimeter of edema (rs = 1, p < 0.0001; 124 cases). The presence of brain invasion was predictive of recurrence after complete resection with an accuracy of 83%, a sensitivity of 89%, and a specificity of 82%. The chance of recurrence within 10 years after complete resection was given by the equation: percentage chance of recurrence = (centimeter of edema)3 X 0.7, which can be used to predict the chance of recurrence based on findings on CT scans (rs = 1.00, p < 0.0001; 86 patients). Statistical significance was confirmed using Kaplan-Meier and univariate and multivariate analyses. Completeness of resection was the most powerful predictor of recurrence (p < 0.00001, r = 0.6), followed by edema grade and brain invasion (both p = 0.02, r = 0.1). Patient age and gender and tumor location, size, and histological subtype were nonsignificant factors. Conclusions Brain invasion causes peritumoral edema. Invaded brain tissue is also the source of residual cells in cases of tumor recurrence after gross-total resection.

Modernism and Medicine: The Hospitals of Stevens and Lee, 1916-1932

This paper considers the work of Bostonand Toronto-based architects Edward Stevens and Frederick Lee during a critical period in North American hospital expansion. Without exception, their hospitals represented state-of-the-art planning wrapped in conservative exteriors. The firm's work thus offers a rich case study from which to consider the notion of historicist design as a mechanism for coping with change. This paper focuses on five Stevens-and-Lee projects: Notre Dame Hospital and two additions to the Royal Victoria Hospital in Montreal, the Kingston General Hospital, and the Ottawa Civic Hospital. Their buildings can be considered typical of the period, since Stevens and Lee designed prominent hospitals across North America. An interpretation of the hospitals is further enriched by the prospect of comparing what was built to the architects' own words. Edward Stevens's The American Hospital of the Twentieth Century (1918) is a classic in the field of hospital architecture, and he published extensively in the architectural and medical professional presses. The study of Steven's words and his hospitals illuminates the inherent danger of regarding historicist building types as antimodern or necessarily conventional. It also reveals the paucity of stylistic interpretations of all architecture. This approach has resulted in the widespread misinterpretation of interwar hospitals as reactionary, or at best antimodern. For this reason, hospitals of the 1920s are generally omitted from studies of the building type and are seen, mistakenly, as simple reverberations of the nineteenth-century model. Generic hospital architecture of the interwar years was modern in its spatial attitudes-not necessarily its look, but rather in its structure, its endorsement of aseptic medical practice, its sanctioning of expert knowledge, its appeal to new patrons, its encouragement of new ways of working, its response to urbanization, its use of zoning, its acceptance of modern social structures, its resemblance to other modern building types, its embrace of internationalism, and its endorsement of standardization.

Reflecting the Model of Human Occupation in Occupational Therapy Documentation

This paper describes an innovative Screening Assessment Form developed at the Ottawa Civic Hospital. The development of the form was prompted by the need for a concise, time efficient guide that could be easily applied to a culturally diverse clientele presenting with various bio-psychosocial difficulties. The department had adopted the Model of Human Occupation as its frame of reference, however it was difficult to consistently covey the structure of the model in report writing. The challenge was to create an assessment tool which incorporated not only essential clinical information but also occupational therapy's unique holistic perspective of function.