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Featured researches published by Wael Haddara.


Academic Medicine | 2013

Are we all on the same page? A discourse analysis of interprofessional collaboration.

Wael Haddara; Lorelei Lingard

Purpose Interprofessional collaboration (IPC) has become a dominant idea in both medical education and clinical care as reflected in its incorporation into competency-based educational frameworks and hospital accreditation models. This study examined the published literature to explore whether a shared IPC discourse underpins these current efforts. Method Using a critical discourse analysis methodology informed by Michel Foucault’s approach, the authors analyzed an archive of 188 texts published from 1960 through 2011. The authors identified the texts through a search of PubMed and CINAHL. Results The authors identified two major discourses in IPC: utilitarian and emancipatory. The utilitarian discourse is characterized by a positivist, experimental approach to the question of whether IPC is useful in patient care and, if so, what features best promote successful outcomes. This discourse uses the language of “evidence” and “validity.” The emancipatory discourse is characterized by a constructivist approach concerned primarily with equalizing power relations among health practitioners; its language includes “power” and “dominance.” Conclusions This study suggests that IPC is not a single, coherent idea in medical education and health care. At least two different IPC discourses exist, each with its own distinctive truths, objects, and language. The extent to which educators and health care practitioners may tacitly align with one discourse or the other may explain the tensions that have accompanied the conceptualization, implementation, and assessment of IPC. Explicit acknowledgment of and attention to these discourses could improve the coherence and impact of IPC efforts in educational and clinical settings.


Aacn Clinical Issues: Advanced Practice in Acute and Critical Care | 2000

Pathophysiology and Implications for Treatment of Acute Respiratory Distress Syndrome

Mary van Soeren; William L. Diehl-Jones; Robert J. Maykut; Wael Haddara

Acute respiratory distress syndrome is a complex group of signs and symptoms caused by direct or indirect lung injury. In spite of decades of research, it is still associated with a high mortality rate. Pathogenesis of this disease is related to alveolar endothelial and epithelial cell injury and associated release and sequestration of inflammatory mediators and cells, including cytokines and neutrophils, respectively. Pharmacologic interventions have been largely unsuccessful, and ventilation strategies to support oxygenation while limiting ventilator associated lung injury have not demonstrated any significant reductions in the mortality rate. However, novel therapies are in development, based on the knowledge of the pathologic processes of acute respiratory distress syndrome. In this article an overview of the disease process and mediator involvement is presented, followed by a review of pharmacologic and ventilation treatments currently in use or under study.


Medical Education | 2018

Navigating complexity in team‐based clinical settings

Kori LaDonna; Emily Field; Christopher Watling; Lorelei Lingard; Wael Haddara; Sayra Cristancho

Educators must prepare learners to navigate the complexities of clinical care. Training programmes have, however, traditionally prioritised teaching around the biomedical and the technical, not the socio‐relational or systems issues that create complexity. If we are to transform medical education to meet the demands of 21st century practice, we need to understand how clinicians perceive and respond to complex situations.


Case reports in critical care | 2018

Unique ECG Findings in Acute Pulmonary Embolism: STE with Reciprocal Changes and Pathologic Q Wave

Amanda Grant-Orser; Brennan Ballantyne; Wael Haddara

A 68-year-old male presented to the emergency department with retrosternal chest pain, presyncope, and then a pulseless electrical activity cardiac arrest. An ECG prior to his arrest revealed ST elevations in leads V1–V3, Q waves in lead V2, and reciprocal ST depressions in the lateral and inferior leads. He received thrombolytic therapy for a presumptive diagnosis of ST elevation myocardial infarction. Return of spontaneous circulation was achieved and he underwent a coronary angiogram. No critical disease was found and his left ventriculogram showed normal contraction. His ongoing metabolic acidosis and dependence on an intra-aortic balloon pump, despite adequate cardiac output, prompted a CT pulmonary angiogram which showed multiple segmental filling defects. He was treated for a pulmonary embolism and was discharged 5 days later. Acute pulmonary embolism (APE) has variable clinical presentations. To our knowledge, this is the first case report of an APE presenting with these ECG findings suggestive of myocardial ischemia. In this case report, we discuss the underlying physiological mechanisms responsible and offer management suggestions for emergency department and critical care physicians to better expedite the treatment of APE mimicking acute coronary syndrome on ECG.


Advances in Health Sciences Education | 2017

Exploring the premise of lost altruism: content analysis of two codes of ethics

Wael Haddara; Lorelei Lingard

As an ideal, altruism has long enjoyed privileged status in medicine and medical education. As a practice, altruism is perceived to be in decline in the current generation. A number of educational efforts are underway to reclaim this “lost value” of medicine. In this paper we explore constructions of altruism over a defined period of time through a content analysis of the Canadian and Australian Medical Associations (CMA and AMA respectively) Codes of Ethics. We analyzed all editions of both Codes (1868–2004), using a content analysis approach, including thematic analysis. We coded as altruistic or non-altruistic, respectively, statements in which the interest of the patient is placed ahead of the physician’s and statements in which the interest of the physician is given primacy. We examined the pattern of appearance and disappearance of these statements over time. We identified 13 altruistic and 2 non-altruistic statements across all editions. There is a gradual and uneven loss of altruistic content over time. The CMA Codes of 1938, 1970 and 2004 and the AMA code of 1992 represent significant change points. The most recent versions of both Codes contain only 1 altruistic statement and both non-altruistic statements. We conclude that altruism appears to be a fluid and changing concept over time. Loss of altruism is not merely a current generational issue but extends through the past century and is likely due to political and social forces. These results call into question current educational attempts to reclaim altruism, and point to the social evolution of the ideal.


Journal of Critical Care | 2015

Soft tissue oxygenation and risk of mortality (STORM): an early marker of critical illness?

Biniam Kidane; Sami A. Chadi; Anthony Di Labio; Fran Priestap; Wael Haddara; Tina Mele; John M. Murkin

PURPOSE Tissue oxygen saturation (StO2) is a noninvasive measure that reflects changes in tissue perfusion. Rapid response teams (RRTs) assess sick inpatients to determine need for intensive care unit (ICU) admission. This determination is subjective based on parameters such as systolic blood pressure, heart rate, and pulse oximetry. Our objective was to determine if parameters readily available at RRT bedside assessment (vital signs and StO2) can predict ICU admission and inhospital mortality. MATERIALS AND METHODS All inpatients assessed by RRT at a tertiary Canadian hospital were consecutively sampled for 3 months. After clinical assessment, the RRT physician (blinded to StO2) made the ultimate ICU admission decision. RESULTS In 134 included patients, mean age was 65.5 ± 15.2 years, and 53% (n = 71) were males. There were 49 ICU admissions (36.6%) and 31 mortalities (23.1%). Two multivariable models significantly predicted ICU admission and inhospital mortality. The only independent predictor of ICU admission was pulse oximetry (adjusted odds ratio, 0.88; 95% confidence interval, 0.80-0.96; P = .007). Tissue oxygen saturation did not predict ICU admission but was the only independent predictor of mortality (adjusted odds ratio, 1.06; 95% confidence interval, 1.01-1.12; P = .04). CONCLUSIONS Tissue oxygen saturation may identify critical illness in patients who would not traditionally meet ICU admission criteria and thus may identify patients who benefit from closer monitoring.


Canadian Journal of Anaesthesia-journal Canadien D Anesthesie | 2013

Oral and intravenous thyroxine (T4) achieve comparable serum levels for hormonal resuscitation protocol in organ donors: a randomized double-blinded study

Michael D. Sharpe; Barbara van Rassel; Wael Haddara


PLOS ONE | 2009

Categorizing Patients in a Forced-Choice Triad Task: The Integration of Context in Patient Management

Sarah L. Devantier; John Paul Minda; Mark Goldszmidt; Wael Haddara


Canadian Journal of Anaesthesia-journal Canadien D Anesthesie | 2018

Triiodothyronine replacement in critically ill adults with non-thyroidal illness syndrome

Salmaan Kanji; Jonathan Neilipovitz; Benjamin Neilipovitz; John Kim; Wael Haddara; Michelle Pittman; Hilary Meggison; Rakesh Patel


Canadian Journal of Anaesthesia-journal Canadien D Anesthesie | 2018

The impact of delayed critical care outreach team activation on in-hospital mortality and other patient outcomes: a historical cohort study

Bourke W. Tillmann; Michelle Klingel; Shelley McLeod; Scott K. Anderson; Wael Haddara; Neil Parry

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Lorelei Lingard

University of Western Ontario

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Fran Priestap

University of Western Ontario

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John Paul Minda

University of Western Ontario

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Mark Goldszmidt

University of Western Ontario

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Sarah L. Devantier

University of Western Ontario

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Tina Mele

University of Western Ontario

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Amanda Grant-Orser

University of Western Ontario

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Anthony Di Labio

London Health Sciences Centre

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Barbara van Rassel

University of Western Ontario

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