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CJEM

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https://www.readbyqxmd.com/read/29925456/ascertaining-top-evidence-in-emergency-medicine-a-modified-delphi-study
#1
Stephanie J Bazak, Jonathan Sherbino, Suneel Upadhye, Teresa Chan
CLINICIAN'S CAPSULE What is known about the topic? EM is a specialty with a broad knowledge base making it daunting for a junior resident to know where to begin the acquisition of evidence-based knowledge. What did the study ask? What list of "top papers" was formulated in the field of EM using a national Canadian Delphi approach to achieve an expert consensus? What did the study find? A list was produced of top studies relevant for Canadian EM physicians in training. Why does this study matter to clinicians? The list produced can be used as an educational resource for junior residents...
June 21, 2018: CJEM
https://www.readbyqxmd.com/read/29925452/quality-improvement-primer-part-3-evaluating-and-sustaining-a-quality-improvement-project-in-the-emergency-department
#2
Lucas B Chartier, Samuel Vaillancourt, Amy H Y Cheng, Antonia S Stang
CLINICIAN'S CAPSULE What is known about the topic? The first two articles of this quality improvement (QI) Primer Series for emergency medicine (EM) clinicians reviewed foundational steps to prepare for and execute a QI project. What did this study ask? This article focused on the measurement, evaluation, and sustainability of QI projects. What did this study find? Run charts are used to represent the temporal relationship visually between interventions and the measures of interest. Sustainability of projects can be achieved through the use of specific frameworks, tools, and cultural change...
June 21, 2018: CJEM
https://www.readbyqxmd.com/read/29925451/a-new-way-to-look-at-simulation-based-assessment-the-relationship-between-gaze-tracking-and-exam-performance
#3
Adam Szulewski, Rylan Egan, Andreas Gegenfurtner, Daniel Howes, Gerhard Dashi, Nick C J McGraw, Andrew K Hall, Damon Dagnone, Jeroen J G van Merrienboer
CLINICIAN'S CAPSULE What is known about this topic? Gathering visual information effectively is an important task of a physician leader when managing a resuscitation case. What did this study ask? Are there particular visual information-gathering patterns associated with performance in simulated resuscitation scenarios? What did this study find? Certain visual patterns (e.g., focusing on case-specific clinically relevant stimuli) are associated with better performance in a simulated resuscitation setting. Why does this study matter to clinicians? The ability to characterize physician visual patterns across a competence continuum has implications for trainee assessment and medical education...
June 21, 2018: CJEM
https://www.readbyqxmd.com/read/29909815/-anchors
#4
Conor Lavelle
No abstract text is available yet for this article.
June 18, 2018: CJEM
https://www.readbyqxmd.com/read/29898800/screening-brief-intervention-and-referral-to-treatment-for-adolescent-alcohol-use-in-canadian-pediatric-emergency-departments-a-national-survey-of-pediatric-emergency-physicians
#5
Shelly Jun, Amy C Plint, Sarah Curtis, Amanda S Newton
CLINICIAN'S CAPSULE What is known about the topic? Emergency department (ED) visits for adolescent alcohol-related concerns offer the opportunity for early intervention; however, the underlying alcohol problem generally remains unaddressed. What did this study ask? What are ED physicians' perceptions regarding adolescent alcohol use and ED-based intervention? What are their current intervention practices? What did this study find? While the majority of ED physicians feel the responsibility to address problematic adolescent alcohol use, interventional practices are unstandardized and lacking...
June 14, 2018: CJEM
https://www.readbyqxmd.com/read/29898794/attitudes-of-emergency-department-physicians-and-nurses-toward-implementation-of-an-early-warning-score-to-identify-critically-ill-patients-qualitative-explanations-for-failed-implementation
#6
Blair L Bigham, Teresa Chan, Steven Skitch, Alison Fox-Robichaud
CLINICIAN'S CAPSULE What is known about the topic? Early warning scores reduce morbidity and mortality by identifying patients at risk for deterioration on the medical wards. What did this study ask? This study sought opinions from emergency department (ED) staff on the use of early warning scores in the ED. What did this study find? Emergency doctors and nurses did not value early warning scores despite quantitative data showing efficacy in the ED. Why does this study matter to clinicians? We gleaned insight into how to implement a computer-based early warning score into the ED to reduce morbidity and mortality from septic shock...
June 14, 2018: CJEM
https://www.readbyqxmd.com/read/29888689/describing-ccfp-em-programs-in-canada-a-national-survey-of-program-directors
#7
Avik Nath, Krishan Yadav, Jeffrey J Perry
CLINICIAN'S CAPSULE What is known about the topic? Little has been published on the structure and curricula of the Canadian College of Family Physicians Emergency Medicine [CCFP(EM)] programs across Canada. What did this study ask? Describe the major components of CCFP(EM) programs and how they are incorporated into curricula. What did this study find? Programs have similar clinical rotations, ultrasound, and simulation requirements. Variation exists in administrative structures, financial resources, academic projects, and competency-based curricula...
June 11, 2018: CJEM
https://www.readbyqxmd.com/read/29886848/subjective-sleep-quality-and-its-etiology-in-the-emergency-department
#8
Jean-Marc Chauny, Jean Paquet, Julie Carrier, Gilles Lavigne, Martin Marquis, Alexis Cournoyer, Christiane Manzini, Raoul Daoust
CLINICIAN'S CAPSULE What is known about the topic? Most hospital settings do not provide an optimal environment for sleep. What did this study ask? Assessed the subjective quality of nighttime sleep and its affecting factors in the emergency department (ED). What did this study find? Subjective sleep quality was lower in the ED, as compared with home sleep, and was affected by stress, noise, pain, and stretcher comfort. Why does this study matter to clinicians? ED sleep is not optimal but can be improved, as the factors disturbing it are potentially modifiable...
June 11, 2018: CJEM
https://www.readbyqxmd.com/read/29877168/association-between-ondansetron-use-and-symptom-persistence-in-children-with-concussions-a-5p-substudy
#9
Jocelyn Gravel, Kathy Boutis, Ken Tang, Miriam H Beauchamp, Stephen B Freedman, Alexander Sasha Dubrovsky, Isabelle Gagnon, Frank Momoli, Roger Zemek
CLINICIAN'S CAPSULE What is known about the topic? Most children who sustain a concussion suffer from post-concussion symptoms for many weeks following the accident. What did this study ask? Is there an association between ondansetron administration and the presence of persistent post-concussion symptoms at 1 week and 1 month in children? What did this study find? This observational study found that the use of ondansetron among children presenting to the emergency department with an acute concussion was associated with a higher risk of persistent symptoms at 1 month...
June 7, 2018: CJEM
https://www.readbyqxmd.com/read/29875027/regarding-co-payments
#10
Sarah Gander
No abstract text is available yet for this article.
June 7, 2018: CJEM
https://www.readbyqxmd.com/read/29866213/clinical-adverse-events-in-prehospital-patients-with-st-elevation-myocardial-infarction-transported-to-a-percutaneous-coronary-intervention-centre-by-basic-life-support-paramedics-in-a-rural-region
#11
Sylvain Bussières, François Bégin, Pierre-Alexandre Leblanc, Alain Tanguay, Jean-Michel Paradis, Denise Hébert, Richard Fleet
CLINICIAN'S CAPSULE What is known about the topic? ST-elevation myocardial infarction (STEMI) patients transported by ambulance are at risk for adverse events. What did this study ask? What is the impact of transport time on the occurrence of adverse events in the presence of basic life support paramedics? What did this study find? Transport time is not associated with a higher risk of adverse events. Why does this study matter to clinicians? Largest investigation of adverse events in a Canadian cohort of STEMI patients transported by ambulance...
June 5, 2018: CJEM
https://www.readbyqxmd.com/read/29866211/age-adjusted-d-dimer-thresholds-in-the-investigation-of-suspected-pulmonary-embolism-a-retrospective-evaluation-in-patients-ages-50-and-older-using-administrative-data
#12
Kevin Senior, Kristin Burles, Dongmei Wang, Daniel Grigat, Grant D Innes, James E Andruchow, Eddy S Lang, Andrew D McRae
CLINICIAN'S CAPSULE What is known about the topic? Age-adjusted D-dimer thresholds have been proposed to improve specificity of diagnostic testing for thromboembolism in patients ages 50 and over. What did this study ask? What is the diagnostic accuracy of an age-adjusted D-dimer threshold in a population of patients undergoing investigations for suspected pulmonary embolism (PE)? What did this study find? Age-adjusted D-dimer cut-offs improved specificity but at the expense of a slightly higher risk of missed PE...
June 5, 2018: CJEM
https://www.readbyqxmd.com/read/29852880/an-open-letter-to-the-emergency-medicine-community
#13
James Stempien
No abstract text is available yet for this article.
June 1, 2018: CJEM
https://www.readbyqxmd.com/read/29843841/ice-cream-rounds-the-adaptation-implementation-and-evaluation-of-a-peer-support-wellness-rounds-in-an-emergency-medicine-resident-training-program
#14
Samantha Calder-Sprackman, Thara Kumar, Caroline Gerin-Lajoie, Megan Kilvert, Kari Sampsel
Introduction/Innovation ConceptEmergency medicine (EM) requires physicians to deal with acutely ill patients in a fast-paced and dynamic environment, which creates a barrier to debriefing after critical events. These unique challenges can negatively impact wellness. We sought to adapt and implement a peer-support wellness program called 'Ice Cream Rounds' in an EM residency setting. METHODS: A needs assessment survey was conducted among EM residents at The University of Ottawa to gauge interest and obtain resident input regarding program design...
May 30, 2018: CJEM
https://www.readbyqxmd.com/read/29843840/understanding-why-older-adults-choose-to-seek-non-urgent-care-in-the-emergency-department-the-patient-s-perspective
#15
Donna Goodridge, James Stempien
CLINICIAN'S CAPSULE What is known about the topic? While EDs serve a critical role in the care of older adults, about 25% of visits made by older adults are classified as "non-urgent". What did this study ask? What are older adults' reasons for seeking non-urgent care in EDs? What did this study find? Comprehensiveness and convenience of diagnostic and treatment services in a single location were the primary motivations for older adults to seek treatment in the ED. Why does this study matter to clinicians? Novel partnerships between EDs, primary and community care are needed to better address the non-urgent care needs of older adults...
May 30, 2018: CJEM
https://www.readbyqxmd.com/read/29843837/application-of-quality-improvement-analytic-methodology-in-emergency-medicine-research-a-comparative-evaluation
#16
Bruce Harries, Lyne Filiatrault, Riyad B Abu-Laban
OBJECTIVE: Quality improvement (QI) analytic methodology is rarely encountered in the emergency medicine literature. We sought to comparatively apply QI design and analysis techniques to an existing data set, and discuss these techniques as an alternative to standard research methodology for evaluating a change in a process of care. METHODS: We used data from a previously published randomized controlled trial on triage-nurse initiated radiography using the Ottawa ankle rules (OAR)...
May 30, 2018: CJEM
https://www.readbyqxmd.com/read/29789038/pain-management-practices-surrounding-lumbar-punctures-in-children-a-survey-of-canadian-emergency-physicians
#17
Naveen Poonai, Victoria Brzozowski, Antonia S Stang, Amy L Drendel, Philippe Boisclair, Michael Miller, Stuart Harman, Samina Ali
CLINICIAN'S CAPSULE What is known about the topic? Few physicians adhere to recommendations surrounding analgesia for pediatric lumbar punctures (LPs). What did this study ask? How willing are emergency physicians to provide analgesia for pediatric LPs? What did this study find? Compared to older children, the willingness to provide analgesia was suboptimal in a young infant. Why does this study matter to clinicians? Knowledge translation should focus on dispelling misconceptions and emphasize the importance of analgesia for young infants undergoing LPs...
May 23, 2018: CJEM
https://www.readbyqxmd.com/read/29789030/yes-not-now-or-never-an-analysis-of-reasons-for-refusing-or-accepting-emergency-department-based-take-home-naloxone
#18
Andrew Kestler, Amanda Giesler, Jane Buxton, Gray Meckling, Michelle Lee, Garth Hunte, Jacob Wilkins, Dalya Marks, Frank Scheuermeyer
CLINICIAN'S CAPSULE What is known about the topic? Not all patients at risk of opioid overdose accept emergency department (ED)-based take-home naloxone (THN). What did this study ask? Why do at-risk ED patients refuse or accept THN? What did this study find? Those refusing THN felt: 1) not at risk of overdose; or 2) their ED visit was not the right time or place for THN. Those accepting THN wanted to save the lives of others. Why does this study matter to clinicians? Those refusing ED THN may accept THN elsewhere if referred to appropriate community services for overdose risk education and THN distribution...
May 23, 2018: CJEM
https://www.readbyqxmd.com/read/29769154/performance-of-the-french-version-of-the-4at-for-screening-the-elderly-for-delirium-in-the-emergency-department
#19
Anne-Julie Gagné, Philippe Voyer, Valérie Boucher, Alexandra Nadeau, Pierre-Hugues Carmichael, Mathieu Pelletier, Emilie Gouin, Simon Berthelot, Raoul Daoust, Machelle Wilchesky, Hélène Richard, Isabelle Pelletier, Stephanie Ballard, Antoine Laguë, Marcel Émond
CLINICIAN'S CAPSULE What is known about the topic? Delirium is frequent in older inpatients but often goes undetected. A short tool, the 4 A's Test (4AT), was created and validated for the detection of delirium. What did this study ask? This study compared the performance of the French version of the 4AT (4AT-F) with the Confusion Assessment Method (CAM) for the screening of delirium. What did this study find? The 4AT-F was a fast and reliable screening tool for delirium in the emergency department (ED). Why does this study matter to clinicians? Because of its quick administration time, it allows for systematic screening of patients at risk of delirium and cognitive impairment...
May 17, 2018: CJEM
https://www.readbyqxmd.com/read/29769153/point-of-care-ultrasound-to-diagnose-appendicitis-in-a-canadian-emergency-department
#20
Sameer Sharif, Steven Skitch, Dean Vlahaki, Andrew Healey
OBJECTIVES: Appendicitis is a common surgical condition that frequently requires diagnostic imaging. Abdominal computed tomography (CT) is the gold standard for diagnosing appendicitis. Ultrasound offers a radiation-free modality; however, its availability outside business hours is limited in many emergency departments (EDs). The purpose of this study is to evaluate the test characteristics of emergency physician-performed point-of-care ultrasound (POCUS) to diagnose appendicitis in a Canadian ED...
May 17, 2018: CJEM
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