Background and ObjectivesRare but potentially life‐threatening hypersensitivity reactions can occur during the administration of intravenous iron. To provide guidance to healthcare professionals caring for adults receiving intravenous iron, a panel of 10 Canadian clinical experts developed a practical algorithm for the identification and management of hypersensitivity reactions to intravenous iron.Materials and methodsA systematic search of PubMed to February 2018 was performed. Articles related to hypersensitivity reactions were selected for review. The algorithm was developed during a 1‐day live meeting based on the literature review and clinical expertise where evidence was lacking. The algorithm was then refined through an iterative process involving a web‐based platform and virtual meetings.ResultsThe algorithm provides guidance to healthcare professionals in preparing for and administering IV iron, as well as recognizing and managing hypersensitivity reactions to intravenous iron. Considerations for re‐challenging patients who have experienced prior reactions are provided.ConclusionHealthcare professionals who are involved in the care of patients receiving intravenous iron should be trained to anticipate, recognize and manage hypersensitivity reactions to intravenous iron to optimize patient care.

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The factors influencing anticoagulation management after gastrointestinal bleeding are unclear. Focus groups and a discrete choice experiments survey of health‐care providers were conducted. Re‐bleeding risk and thrombosis risk were the most important factors influencing decision making. Preference variability exists with a minority most sensitive to the anticoagulation indication. Abstract BackgroundOral anticoagulants (OACs) are permanently discontinued in up to 50% of patients after gastrointestinal (GI) bleeding despite evidence of benefit to restarting. ObjectivesWe aimed to identify factors influencing health‐care provider decision making regarding resuming OAC after GI bleeding and to identify preference groups. Patients/MethodsWe conducted focus group discussions (FGDs) with health‐care providers. Themes identified and ranked through a dot voting exercise became the attributes for a discrete choice experiment survey of health‐care providers developed using Sawtooth (Sawtooth Software, Provo, UT, USA). Hierarchical Bayes analysis was used to estimate preference coefficients (utilities) for each attribute. Preference groups were identified using latent class analysis. ResultsWe conducted four FGDs involving 29 participants. The five most important factors identified in the FGDs were included in the survey. There were 250 survey respondents (mean age 45 years, 53% male). The most important factor was re‐bleeding risk followed by thrombosis risk, index bleed severity, indication for OAC, and patient characteristics. Two preference groups were identified, a majority group (87% of respondents) placed the highest utility on re‐bleeding risk followed by thrombosis risk, while a minority group (13% of respondents) placed the highest utility on OAC indication. ConclusionsOverall, the most important factor influencing provider decision making was re‐bleeding risk followed closely by thrombosis risk, although the indication for OAC was most important for a minority of respondents. This highlights variability among providers in an area lacking high‐quality data to guide practice. Further research is needed to determine absolute rates of outcomes and patient values and preferences.

The null findings in the present study are inconsistent with previous research showing the pedagogical benefits of testing relative to studying. Given that most TEL research focuses on novice learners, who lack strong associative memory networks, it is possible that TEL is specific to novices and not generalizable to experts. Alternative explanations focus on the importance of repeated, distributed testing with feedback.

Both general and specific health status instruments can be utilised in evaluating health-related quality of life (HR-QOL) deficits resulting from osteoporotic fractures. Osteoporotic hip, vertebral and wrist fractures significantly decrease HR-QOL in most HR-QOL domains investigated. The presence of multiple vertebral fractures leads to larger decrements in HR-QOL. More research needs to be completed with these HR-QOL tools to better assess the true burden of osteoporotic fractures, particularly in the case of hip fractures, as the burden is surely being underestimated without recognition of HR-QOL. Only when the burden of fragility fractures is understood, inclusive of HR-QOL, will the value of proven antifracture prevention and treatment therapies be appreciated. Information collected by HR-QOL instruments may provide new insight as to how to improve quality of life for patients with fractures and how to properly allocate healthcare spending.

Background. In 2012, Health Canada released a warning regarding domperidone use, based on associations with life-threatening arrhythmias and death. Objective. This study aimed to compare the appropriateness of domperidone prescribing patterns before the advisory to those afterward. Methods. Two retrospective reviews were conducted for patients prescribed domperidone during quarters in 2005 and 2012. Outcomes included appropriateness of indication, dosing regimens, monitoring of electrolytes, baseline electrocardiogram performance and characteristics, presence of left ventricular dysfunction, and coprescription of QT-prolonging medications. Univariable and multivariable logistic regression analyses were performed. p values < 0.05 were considered significant. Results. 290 and 287 patients were analyzed in 2005 and 2012, respectively. Domperidone initiation in hospital decreased from 2005 to 2012 (71.4% versus 39.4%, p < 0.0001) as did prescriptions for nonapproved indications (84.8% versus 58.2%, p < 0.0001). In-hospital initiation predicted prescription for nonapproved indications (OR = 7.01, 95% CI 4.52–10.87, p < 0.0001). Use of domperidone as the sole GI drug predicted nonapproved indications (OR = 2.51, 95% CI 1.38–4.55, p = 0.002). Conclusions. The advisory was associated with more appropriate domperidone initiation and compliance with recommended dosages. Our study suggests the need for increased awareness of the dosing and monitoring of domperidone to ensure patient safety.

Background: The Resident Practice Audit in Gastroenterology (RPAGE) captures assessments of knowledge, professionalism, and technical skills, in real time. This brief report describes this innovative instrument and aspects of its utility. Methods: Assessment data on colonoscopy, endoscopy, and sigmoidoscopy procedures in 2016 were submitted to a repeated measures ANOVA with six within subjects’ assessments and one between subjects’ factor of year of specialization to evaluate construct validity. The validity hypothesis tested was that more experienced residents would be rated higher than less experienced residents. Reliability was assessed using Cronbach’s alpha. Results: The proportion of completed assessments was relatively low (9 to 22%). Overall reliability was high (α >0.8). There was evidence of validity as global ratings indicated higher competence for senior residents at colonoscopy (1.6) and upper endoscopy (1.4) than for more junior residents (1.9 and 2.1 respectively). These differences were significant for both colonoscopy, (F (1, 282) = 14.8, p <0.001) and endoscopy, F (1, 136) = 56.9, p <0.001. Conclusion: These findings suggest RPAGE is an acceptable electronic log of practice data, but may not be acceptable for workplace based assessment. A key next step will be to evaluate how information collected through RPAGE can help inform resident competency committees.