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https://www.readbyqxmd.com/read/30460885/outcomes-and-emergency-medical-services-resource-utilization-among-patients-with-syncope-arriving-to-the-emergency-department-by-ambulance
#1
Lawrence Yau, Muhammad A Mukarram, Soo-Min Kim, Kirtana Arcot, Kednapa Thavorn, Ian G Stiell, Monica Taljaard, Brian H Rowe, Marco L A Sivilotti, Venkatesh Thiruganasambandamoorthy
CLINICIAN'S CAPSULEWhat is known about the topic?A majority of syncope patients are transported to the emergency department by emergency medical services (EMS), yet only a small proportion are admitted or suffer serious adverse events (SAE).What did this study ask?What proportion of EMS syncope patient transports are at low risk (i.e., absence of EMS interventions, hospitalization, and SAE)?What did this study find?This prospective cohort study found that 40% of syncope transports are at low risk.Why does this study matter to clinicians?This group of patients represents potentially avoidable transports once a clinical decision tool is developed with a substantial opportunity cost for EMS systems...
November 21, 2018: CJEM
https://www.readbyqxmd.com/read/30457087/new-canadian-guideline-provides-evidence-based-approach-to-non-occupational-hiv-prophylaxis
#2
Shannon O'Donnell, Darrell H S Tan, Mark W Hull
The incidence of HIV infections in Canada has increased yearly since 2014. New cases of HIV have resulted almost exclusively from non-occupational exposures, including sexual contact and needle sharing. Appropriate HIV post-exposure prophylaxis is under-prescribed to patients who present to the emergency department after a high-risk exposure. In November of 2017, a Canadian guideline on HIV pre-exposure prophylaxis (PrEP) and non-occupational post-exposure prophylaxis (nPEP) was published. The guideline presents a standardized, evidence-based approach to assessing risk for HIV transmission and prescribing HIV prophylaxis...
November 20, 2018: CJEM
https://www.readbyqxmd.com/read/30419990/the-promotion-dilemma-for-clinician-teachers
#3
Rick Penciner
No abstract text is available yet for this article.
November 13, 2018: CJEM
https://www.readbyqxmd.com/read/30411698/implementing-electronic-medical-records-in-canadian-emergency-departments
#4
Daniel Rosenfield, Gregory Harvey, Karim Jessa
No abstract text is available yet for this article.
November 9, 2018: CJEM
https://www.readbyqxmd.com/read/30411696/-nous-sommes-forts-un-po%C3%A3-me-sur-la-r%C3%A3-silience-en-m%C3%A3-decine-d-urgence
#5
Valérie Langlois-Carbonneau
No abstract text is available yet for this article.
November 9, 2018: CJEM
https://www.readbyqxmd.com/read/30404680/emergency-overcrowding-and-access-block-a-smaller-problem-than-we-think
#6
Grant D Innes, Marco L A Sivilotti, Howard Ovens, Kirstie McLelland, Adam Dukelow, Edmund Kwok, Anil Chopra, Ivy Cheng, Dan Kalla, David Mackinnon, Chad Kim Sing, Neil Barclay, Terry Ross, Alecs Chochinov
CLINICIAN'S CAPSULE What is known about the topic? Emergency access block is the number one emergency department (ED) safety concern; many believe it cannot be solved without increased hospital capacity. What did this study ask? The objective was to measure emergency access blocks (problem) as a fraction of inpatient capacity (potential solution). What did this study find? Delays to care space averaged 46,000 hours per ED per year - large, but only 1% of inpatient capacity. Why does this study matter to clinicians? Emergency access gaps are small relative to hospital capacity; if viewed as a hospital problem, small improvements could eliminate them...
November 8, 2018: CJEM
https://www.readbyqxmd.com/read/30404678/the-prognostic-significance-of-repeated-prehospital-shocks-for-out-of-hospital-cardiac-arrest-survival
#7
Alexis Cournoyer, Éric Notebaert, Sylvie Cossette, Luc Londei-Leduc, Luc de Montigny, Dave Ross, Yoan Lamarche, Brian J Potter, Alain Vadeboncoeur, Raoul Daoust, Catalina Sokoloff, Martin Albert, Francis Bernard, Judy Morris, Jean Paquet, Jean-Marc Chauny, Massimiliano Iseppon, Martin Marquis, François de Champlain, Yiorgos Alexandros Cavayas, André Denault
For a French translation of the original research, please see the Supplementary Material at DOI: 10.1017/cem.2018.437 CLINICIAN'S CAPSULE What is known about the topic? The prognostic implications of repeated shocks for out-of-hospital cardiac arrest are uncertain. What did this study ask? What is the association between the number of prehospital shocks and survival in patients suffering from an out-of-hospital cardiac arrest? What did this study find? Survival remains possible even after a high number of shocks for patients suffering from an OHCA...
November 8, 2018: CJEM
https://www.readbyqxmd.com/read/30404670/cognitive-load-theory-as-a-framework-for-simulation-based-ultrasound-guided-internal-jugular-catheterization-training-once-is-not-enough
#8
Robert McGraw, Tim Chaplin, Nicole Rocca, Louise Rang, Melanie Jaeger, Matthew Holden, Zsuzsanna Keri, Gabor Fichtinger
CLINICIAN'S CAPSULE What is known about the topic? Cognitive load theory can be used to guide simulation-based training for procedural skills. What did this study ask? How can cognitive load theory be used to overcome the challenges of learning ultrasound-guided internal jugular catheterization? What did this study find? All trainees approached or exceeded expert benchmarks, with evidence of retention over time. Why does this study matter to clinicians? This curriculum may better prepare trainees for performing this important procedure in the clinical setting...
November 8, 2018: CJEM
https://www.readbyqxmd.com/read/30404669/managing-the-opioid-epidemic-back-to-the-basics-with-resuscitation
#9
Orlando Hung, Ronald D Stewart, Gemma Malpas, Sarah Phipps, David Hung
No abstract text is available yet for this article.
November 8, 2018: CJEM
https://www.readbyqxmd.com/read/30404667/blood-on-board-the-development-of-a-prehospital-blood-transfusion-program-in-a-canadian-helicopter-emergency-medical-service
#10
Chase Krook, Domhnall O'Dochartaigh, Doug Martin, Zoë Piggott, Ryan Deedo, Sarah Painter, Gennifer van Werkhoven, Darcy McKay, Dennis Nesdoly, J N Armstrong
CLINICIAN'S CAPSULE What is known about the topic? Emerging evidence regarding prehospital blood transfusions for patients in hemorrhagic shock is positive. What did this study ask? Describe the implementation and stewardship of a prehospital blood transfusion program, as well as basic demographics and blood traceability. What did this study find? We provided blood transfusion to 274 mainly male trauma patients, and just 1.2% of units were wasted. Why does this study matter to clinicians? Implementation of a similar program at other prehospital organizations can be sustainably achieved...
November 8, 2018: CJEM
https://www.readbyqxmd.com/read/30343675/cjem-debate-series-choosingwisely-the-choosing-wisely-campaign-will-not-impact-physician-behaviour-and-choices-corrigendum
#11
Paul Atkinson, Eddy Lang, Meaghan Mackenzie, Rashi Hiranandani, Rebecca Lys, Megan Laupacis, Heather Murray
No abstract text is available yet for this article.
October 22, 2018: CJEM
https://www.readbyqxmd.com/read/30303054/wwgd-what-would-gwyneth-do
#12
Deepa Soni
No abstract text is available yet for this article.
October 10, 2018: CJEM
https://www.readbyqxmd.com/read/30295590/effects-of-a-reminder-to-initiate-oral-anticoagulation-in-patients-with-atrial-fibrillation-atrial-flutter-discharged-from-the-emergency-department-reminder-study
#13
Saman Rezazadeh, Derek S Chew, Robert J H Miller, Sheila Klassen, Payam Pournazari, Graham Bennett, Eddy Lang, F Russell Quinn
CLINICIAN'S CAPSULE What is known about the topic? Oral anticoagulation (OAC) reduces stroke risk in patients with atrial fibrillation or flutter; however, initiation rates in patients discharged from the ED are low. What did this study ask? Can a simple quality improvement intervention increase the initiation of appropriate OAC in the ED? What did this study find? The rate of OAC initiation was increased by 8.5%. Why does this study matter to clinicians? This simple intervention is transferrable and therefore can improve patient care...
October 8, 2018: CJEM
https://www.readbyqxmd.com/read/30295219/analysis-of-eye-tracking-behaviours-in-a-pediatric-trauma-simulation
#14
Omar Damji, Patricia Lee-Nobbee, David Borkenhagen, Adam Cheng
ABSTRACTEye-tracking devices are able to capture eye movements, which are further characterized by fixations. The application of eye tracking in a trauma setting has not been explored. Visual fixation can be utilized as a surrogate measure of attention during the management of a trauma patient. We aimed to determine the feasibility of using eye tracking and to characterize eye tracking behaviours of pediatric emergency medicine physicians during management of a simulated pediatric trauma patient. Each participant was equipped with a head-mounted eye-tracking device during a standardized simulated pediatric trauma scenario...
October 8, 2018: CJEM
https://www.readbyqxmd.com/read/30295218/methotrexate-for-the-treatment-of-unruptured-tubal-ectopic-pregnancy
#15
K Hawrylyshyn, S L McLeod, J Thomas, Catherine Varner
CLINICIAN'S CAPSULE What is known about the topic? Methotrexate is widely accepted as first-line treatment of non-ruptured ectopic pregnancy and may be considered for women with a suspected ectopic pregnancy. What did this study ask? What are the outcomes of pregnant women with suspected ectopic pregnancy who received methotrexate as first-line treatment? What did this study find? Of patients treated with methotrexate, 18% went on to require surgical management, with 11.2% having ruptured on surgical evaluation...
October 8, 2018: CJEM
https://www.readbyqxmd.com/read/30289098/the-effect-of-an-infographic-promotion-on-research-dissemination-and-readership-a-randomized-controlled-trial
#16
Simon Huang, Lynsey J Martin, Calvin H Yeh, Alvin Chin, Heather Murray, William B Sanderson, Rohit Mohindra, Teresa M Chan, Brent Thoma
CLINICIAN'S CAPSULE What is known about the topic? Infographics are graphical illustrations of complex ideas that are broadly shared on social media platforms. What did this study ask? What is the effect of a social media strategy using infographics on the readership and dissemination of research articles? What did this study find? Infographic articles were associated with increased Altmetric scores and abstract views, but not full-text views. Why does this study matter to clinicians? The promotion of articles with infographics may increase awareness and dissemination of research findings among clinicians...
October 5, 2018: CJEM
https://www.readbyqxmd.com/read/30277194/comparison-of-pecarn-catch-and-chalice-clinical-decision-rules-for-pediatric-head-injury-in-the-emergency-department
#17
Mark McGraw, Todd Way
Clinical questionWhat is the diagnostic accuracy of the PECARN, CATCH, and CHALICE clinical decision rules for pediatric head injury, and are the clinical decision rules valid when applied to a novel data set?Article chosenBabl FE, Borland ML, Phillips N, et al. Accuracy of PECARN, CATCH, and CHALICE head injury decision rules in children: a prospective cohort study. Lancet (London, England) 2017;389(10087):2393-402. OBJECTIVES: The primary objective of the study was to determine the diagnostic accuracy and provide external validation for the PECARN, CATCH, and CHALICE clinical decision rules in a clinically homogeneous cohort of children...
October 2, 2018: CJEM
https://www.readbyqxmd.com/read/30277177/evaluation-of-emergency-department-ultrasound-machines-for-the-presence-of-occult-blood
#18
Zafrina Poonja, Jasmene Uppal, Stuart J Netherton, Rhonda Bryce, Andrew W Lyon, Bruce Cload
CLINICIAN'S CAPSULE What is known about the topic? Bedside ultrasound is a frequently used tool in the emergency department (ED), with no standard cleaning protocols in place. What did this study ask? Is there visible and occult contamination of the ED ultrasound machine after daily use and in trauma? What did this study find? This study found that the ultrasound machine tested positive for occult blood contamination on 10% of daily tests and on 43% of assessments after use in trauma. Why does this study matter to clinicians? Standard cleaning practices should be implemented to reduce contamination rates...
October 2, 2018: CJEM
https://www.readbyqxmd.com/read/30277176/retrospective-evaluation-of-a-clinical-decision-support-tool-for-effective-computed-tomography-angiography-utilization-in-urgent-brain-imaging-of-suspected-tia-minor-stroke-in-the-emergency-department
#19
Maximilian B Bibok, Kristine Votova, Robert F Balshaw, Melanie Penn, Mary L Lesperance, Devin R Harris, Colin Sedgwick, Madeline Nealis, Brian Farrell, John R Mathieson, Andrew M Penn
CLINICIAN'S CAPSULE What is known about the topic? Canadian guidelines recommend that suspected transient ischemic attack (TIA) patients receive brain imaging in the emergency department; yet, high requisition rates for non-cerebrovascular patients exist. What did this study ask? What is the hypothetical impact that a clinical decision support tool (CDST) would have on computed tomography angiography (CTA) requisitions for suspected TIA patients. What did this study find? CDST use would have resulted in more TIA patients receiving CTA, while imaging fewer non-cerebrovascular patients...
October 2, 2018: CJEM
https://www.readbyqxmd.com/read/30261938/sex-specific-high-sensitivity-cardiac-troponin-t-cut-off-concentrations-for-ruling-out-acute-myocardial-infarction-with-a-single-measurement
#20
Andrew McRae, Michelle Graham, Tasnima Abedin, Yunqi Ji, Hong Yang, Dongmei Wang, Danielle Southern, James Andruchow, Eddy Lang, Grant Innes, Isolde Seiden-Long, Lawrence DeKoning, Peter Kavsak
CLINICIAN'S CAPSULE What is known about the topic? Sex-specific, high-sensitivity cardiac troponin T (hs-cTnT) cut-offs increase the specificity of a myocardial infarction (MI) diagnosis. What did this study ask? Do sex-specific, hs-cTnT rule-out cut-offs enable ruling out MI in more patients while maintaining sensitivity? What did this study find? Sex-specific, hs-cTnT cut-offs ruled out MI in more patients than universal cut-offs; however, differences between sex-specific and universal cut-offs are small...
September 28, 2018: CJEM
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