BackgroundDiagnosis of influenza in older adults may be complicated by atypical presentations or when patients present with complications of an underlying illness. We aimed to identify clinical characteristics and epidemiological factors associated with influenza among community-dwelling adults aged ≥60 years presenting to emergency departments.MethodsWe identified patients with influenza-compatible chief complaints presenting to emergency departments of six acute care hospitals in Ontario, Canada during the 2011/12 and 2012/13 influenza seasons. Clinical characteristics, medical history and demographics were collected by patient interview, chart review and by contacting vaccine providers. Nasopharyngeal swabs were tested for influenza using polymerase chain reaction. We modeled predictors of influenza using multivariable logistic regression models that compared individuals with and without influenza.ResultsOf 1318 participants, 151 (11 %) had influenza (98 A/H3N2, 12 A/H1N1, 4 A [not sub-typed], 37 B). In the multivariable model, clinical symptoms associated with influenza were cough (OR 6.4, 95 % CI 3.2, 13.0), feverishness and/or triage temperature ≥37.2 °C (OR 3.0, 95 % CI 2.0, 4.7), 2–5 days from symptom onset to the emergency department visit (OR 2.2, 95 % CI 1.5, 3.2), and wheezing (OR 2.1, 95 % CI 1.3, 3.3). The effect of cough on influenza increased with older age. Epidemiological factors associated with increased odds for influenza included weeks when ≥10 % influenza tests from provincial laboratories were positive (OR 5.1, 95 % CI 1.2, 21.7) and exposure to a person with influenza-like illness (OR 1.9, 95 % CI 1.3, 2.8). Among participants with influenza, only 47 (31 %) met the U.S. Centers for Disease Control and Prevention criteria for influenza-like illness (temperature ≥37.8 °C and cough and/or sore throat).ConclusionsAs in younger adults, cough and feverishness are the two symptoms most predictive of influenza in the elderly. Current influenza-like illness definitions did not adequately capture influenza in older adults.

ObjectiveEncounters between patients and physicians who do not speak the same language are relatively common in Canada, particularly in urban settings; this trend is increasing worldwide. Language discordance has important effects on health outcomes, including mortality. This study sought to explore physicians’ experiences of care provision in situations of language discordance in depth.DesignQualitative study based on individual interviews. Interview guides elicited physicians’ perspectives on how they determined whether communication could proceed unaided. A descriptive qualitative approach was adopted, entailing inductive thematic analysis.Participants22 physicians experienced in treating patients in situations of language discordance were recruited from the emergency and internal medicine departments of an urban tertiary-care hospital.SettingLarge, inner-city teaching hospital in Toronto, Canada, one of the most linguistically diverse cities internationally.ResultsDetermining when to ‘get by’ or ‘get help’ in order to facilitate communication was described as a fluid and variable process. Deciding which strategy to use depended on three inter-related factors: time/time constraints, acuity of situation and ease of use/availability of translation aids. Participants reported at times feeling conflicted about their decisions, portraying some of these clinical encounters as a ‘troubling space’ in which they experienced one or more dilemmas related to real versus ideal practice, responsibility and informed consent.ConclusionsIn situations of language discordance, a physician's decision to ‘get by’ (vs ‘get help’) rests on a judgement of whether communication can be considered ‘good enough’ to proceed and depends on the circumstances of the specific encounter. The tension set up between what is ‘ideal’ and what is practically possible can be experienced as a dilemma by physicians. The study's findings have implications for practice and policy not only in Canada but in other multilingual settings, and indicate that physicians require greater support.

BackgroundHealth Science Research (HSR) is a pre-clerkship component of the University of Toronto (U of T) MD Program. Through online modules and tutorials, students learn to understand and apply research, and write an original research protocol. This study explored students' perceptions on how HSR prepared them to identify, critically appraise and consume research during clerkship. MethodsAn online 12-item questionnaire surveyed U of T medical students (Class of 2018) who completed HSR in 2016. Basic descriptive statistics were performed; free text responses were analysed via descriptive thematic analysis. ResultsTwenty six percent (67/262) of students participated. Approximately half either agreed/strongly agreed that HSR helped them to critically appraise research articles (50.7%, 32/63) and assess applicability of results to patient care (50.8%, 32/63). Three themes emerged: i) desire for increased critical appraisal, ii) producing research less important than consuming research, iii) developing a greater appreciation of research during clerkship. ConclusionsStudents' perceptions on HSR's value during clerkship were modest; they desired greater focus on learning to be consumers of research. These results will refine HS, and our observations may be useful to other educators, as this type of intervention is not represented in existing literature.