bluuebunny/crossref_metadata_2025_split huggingface dataset:
P100: Une activité de simulation de table à des fins de formation interprofessionnelle pour enseigner une nouvelle procédure intrahospitalière de code rose : une étude pilote exploratoire et rétrospective sur la perception des apprenants
Authors: Frégeau A. , Cournoyer A. , Soucy N. , Fortier D. , Desaulniers P. , Castonguay V. , Fleet R. 
Published: May 2020

Introduction: Les erreurs médicales sont causées par des failles de système plutôt qu'un seul individu. Dans ce contexte, de multiples designs pédagogiques de formation interprofessionnelle (FIP) ont été proposés pour développer une meilleure collaboration interprofessionnelle. L'une des initiatives pédagogiques proposées en médecine de désastre est la simulation de table (TTX). La TTX consiste à simuler une situation de code orange dans un environnement informel où les participants doivent discuter de la suite logique des actions à prendre. Le protocole d'arrêt cardiaque intra-hospitalier chez le nourrisson de moins de 30 jours (code rose) ayant été mis à jour au Centre hospitalier de l'Université de Montréal (CHUM), cela a généré un besoin de FIP au sein des équipes. Ainsi, nous avons développé une FIP innovante en utilisant la TTX pour enseigner un nouveau protocole de code rose. L'objectif primaire de la présente étude est d'évaluer la perception des apprenants à propos de cette FIP. Methods: La présente étude rétrospective de cohorte s'est déroulée en mars 2019 au centre de simulation du Centre hospitalier de l'Université de Montréal. Un groupe interprofessionnel (médecins, infirmières, inhalothérapeutes, préposés aux bénéficiaires, etc.) a été recruté. Un sondage de satisfaction des participants leur a été remis immédiatement après la TTX. Des statistiques descriptives (n, %) ont été réalisées. Les commentaires recueillis lors du débreffage ont permis de nuancer les résultats et d'apporter des changements à la nouvelle procédure de code rose. Results: Un total de 13 participants ont participé à la TTX, dont 10 ont répondu au sondage (10/13 : 77%). 3 observateurs ont participé à la TTX et ont tous répondu à certaines questions du sondage (3/3 : 100%). Suite à la TTX, 80% (n = 8) des participants ont eu l'impression de mieux comprendre leur propre rôle et 90% (n = 9) des participants ont eu l'impression de mieux comprendre le rôle des autres professionnels. Tous (100%, n = 13) ont apprécié la TTX et ont affirmé qu'il était probable ou très probable qu'ils participent à nouveau à une telle activité de FIP s'ils y étaient invités et qu'ils recommanderaient à un collègue d'y participer. Conclusion: Il est possible de réaliser une TTX pour une autre procédure d'urgence que le code orange, c'est-à-dire pour le code rose et cela est apprécié des participants. Ces derniers se sont sentis plus confiants dans leur rôle et dans leur connaissance du rôle des autres professionnels.
P121: A quality improvement project to improve medical imaging ordering workflow in the emergency department
Authors: Choi J. , Bhayana R. , Wang D. , Bartlett E. , Menezes R. 
Published: May 2020

Background: Many computerized tomography (CT) scans ordered after-hours from the emergency department (ED) at our institution required a discussion between the emergency physician (EP) and radiology resident (RR), leading to workflow inefficiency. Aim Statement: The aim was to improve workflow efficiency and provider satisfaction, and reduce CT turnaround time, without significantly affecting CT utilization within six months. Measures & Design: We created a new workflow by creating an electronic list of ED CT requests that RRs monitor. RRs protocolled all requests and only called the ED physician for more details when required. The intervention was implemented in a stepwise fashion via plan-do-study-act cycles. An electronic survey measured qualitative outcomes, and quantitative outcomes were analyzed via statistical process control (SPC) charts and other statistical methods. Evaluation/Results: Survey response was high (76% EP, 79% RR). Most EPs and RRs felt more efficient (96.3%, 73.3%), RRs felt fewer disruptions (83.3%), and most EPs felt that scans were done faster (84.1%). We analyzed CT turnaround times and utilization using SPC charts and segmented regression analyses. Turnaround time trended to improvement (33 mins vs 29 mins on weekdays [WD], 37 mins vs 33 on weekends [WE]), but was not statistically significant. There was background rising CT utilization over time (+0.7 and + 1.9 CT/100 ED visits/year on WD and WE, respectively, p < 0.0005), but the intervention itself did not cause a significant change. The total number of pages to RR (a measure of workflow disruption) decreased significantly on the WDs (23 vs 19 pages, p = 0.0011), but not on WE (79 vs 75 pages, p = 0.1663). However when adjusting for number of scans ordered, there was a decrease in paging rates (0.73 vs 0.54 pages per scan ordered on WD [p < 0.00005], 3.24 vs 2.63 pages per scan ordered on WE [p = 0.0012]). Discussion/Impact: Our intervention led to improved work satisfaction and perceived efficiency experienced by both EPs and RRs. It did not statistically significantly affect imaging turnaround times or utilization rates. Our project shows that calling for preapproval of imaging studies does not seem to provide any benefit in our setting.
P129: A phase IV real world study on the use of low dose methoxyflurane (PENTHROX™) for the treatment of moderate to severe trauma pain in the Canadian emergency department (ADVANCE-ED): an interim report on secondary outcomes
Authors: Campbell S. , Simard E. , Arcand A. , Blagrove L. , Piraino P. , Dhani S. 
Published: May 2020

Introduction: Inhaled low dose methoxyflurane (MEOF) was recently approved in Canada for the short-term relief of moderate to severe acute pain associated with trauma or interventional medical procedures in conscious adult patients. ADVANCE-ED is an ongoing phase IV, prospective open label study undertaken to generate real-world evidence to complement the global clinical development program through evaluation of the effectiveness of low dose MEOF in Canadian emergency departments (EDs). Methods: This multi-centre study is enrolling adult (≥18 yrs) patients with moderate to severe acute pain (NRS0-10 ≥ 4) associated with minor trauma. To address limitations from the pivotal study, this study allows patients who were excluded in the pivotal trials: namely, those with severe (≥7) pain, and those using OTC or stably dosed analgesics for other conditions, including chronic pain. Eligible patients receive a single treatment of up to 2 x 3 mL MEOF (2nd 3 mL to be provided only upon request), self-administered by the patient under medical supervision. Rescue medication is permitted at any time, if required. Results: Here we describe the patient demographics and treatment satisfaction (Global Medication Performance, GMP) at 50% enrolment (n = 49). Mean (SD) patient age is 48.0 (17.1) yrs and 55.1% are female. Mean pain (SD) reported at enrolment is 8.3 (1.5), with 73.4% of patients with NRS0-10 ≥ 8. Injuries are overwhelmingly limb trauma (87.8%). The most common type is sprain/strain (40.8%), followed by fracture (32.7%). At 5 minutes post-start of administration (STA) of MEOF, 80.4% of patients reported pain relief; this increased to 91.3% at 15 minutes, and 100% of patients reported pain relief by 30 minutes post-STA. GMP was assessed as “good”, “very good” or “excellent” by ≥80% of patients both 20 minutes post-start of administration (STA) of MEOF (83.3%) and at discharge (85.8%). When asked to what extent their expectation of pain relief had been met, 32.7% responded good, 26.5% responded “very good” and 22.4% responded “excellent”. Three quarters of enrolled patients (75.5%) did not require rescue medication. The most common (≥5%) treatment-related adverse events were dizziness (n = 14, 28.6%) and euphoric mood (n = 4, 8.2%). No serious adverse events have been reported. Conclusion: Based on 50% of the patients enrolled in this prospective, open label study, responses to inhaled low-dose MEOF are within expectation for both effectiveness and tolerability.
PL04: A randomized controlled trial comparing prescribed light exercise to standard management for emergency department patients with acute mild traumatic brain injury
Authors: Varner C. , Thompson C. , de Wit K. , Borgundvaag B. , Houston R. , McLeod S. 
Published: May 2020

Introduction: The emergency department (ED) is often the first point of health care contact for patients with mild traumatic brain injury (MTBI). Spontaneous resolution occurs in most patients within 7 days, yet 15-30% will develop post-concussion syndrome (PCS). Given the paucity of effective management strategies to prevent PCS and emerging evidence supporting exercise, the objective of this study was to evaluate the impact of prescribed early light exercise compared to standard discharge instructions for acute MTBI patients in the ED. Methods: This was a randomized controlled trial conducted in three Canadian EDs. Consecutive, adult (18-64 years) ED patients with a MTBI sustained within the preceding 48 hours were eligible for enrollment. The intervention group received discharge instructions prescribing 30 minutes of daily light exercise (e.g., walking), and the control group was given standard MTBI instructions advising gradual return to exercise following symptom resolution. Participants documented their daily physical activities and completed follow-up questionnaires at 7, 14, and 30 days. The primary outcome was the proportion of patients with PCS at 30 days, defined as the presence of ≥ 3 symptoms on the Rivermead Post-concussion Symptoms Questionnaire (RPQ) at 30 days. Results: 367 patients were enrolled (control n = 184; intervention n = 183). Median age was 32 years and 201 (57.6%) were female. There was no difference in the proportion of patients with PCS at 30 days (control 13.4 vs intervention 14.6; Δ1.2, 95% CI: -6.2 to 8.5). There were no differences in median change of RPQ scores (control 14 vs intervention 13; Δ1, 95% CI: -1 to 4), median number of return health care provider visits (control 1 vs intervention 1; Δ0, 95% CI: 0 to 0), or median number of missed school or work days (control 2 vs intervention 2; Δ0, 95% CI: 0 to 1) at 30 days. There was a nonsignificant difference in unplanned return ED visits within 30 days (control 9.9% vs intervention 5.6%; Δ1, 95% CI: -1.4 to 10.3). Participants in the control group reported fewer minutes of light exercise at 7 days (30 vs 35; Δ5, 95% CI: 2 to 15). Conclusion: To our knowledge, this is the first randomized trial of prescribed early light exercise for adults with acute MTBI. There were no differences in recovery or healthcare utilization outcomes. Results suggest prescribed early light exercise should be encouraged as tolerated at ED discharge following MTBI, but exercise prescription alone is not sufficient to prevent PCS.
LO44: Birth cohort hepatitis C screening in an academic emergency department in Canada: preliminary results
Authors: Friedman S. , Capraru C. , Bates K. , Porplycia D. , Mazzulli T. , Vanderhoff A. , Hansen B. , Shah H. , Janssen H. , Feld J. 
Published: May 2020

Introduction: Epidemiologic and modeling studies suggest that between 45 and 70% of individuals with chronic hepatitis C virus (HCV) infection in Canada remain undiagnosed. The Canadian Association for the Study of the Liver (CASL) recommends one-time screening of baby boomers (1945-1975). Screening programs in the US have shown a very high prevalence of previously undiagnosed HCV among patients seen in the emergency department (ED). We sought to assess the feasibility of implementing a targeted birth-cohort HCV screening program in a Canadian ED setting. Methods: Patients born from 1945 to 1975 presenting to the ED of a downtown Toronto hospital were offered HCV testing. Patients with life-threatening conditions, unable to provide verbal consent in English or intoxication were excluded. Blood samples were collected by finger prick on Dried Blood Spot (DBS) collection cards and tested for anti-HCV antibody with reflex to HCV RNA. Patients with positive HCV RNA were referred to a liver specialist. Results: During a 27-month period (July 2017 - Sept 2019), 8363 patients in the birth cohort presented to the ED during daytime hours. 80% (6714) met eligibility criteria, and 48.4% (3247) were offered testing. Screening was performed by non-medical staff (mean 8/day, median spots on DBS 4). 345 (10.6%) had been previously tested, and 639 (19.7%) declined. 2136 (65.8%) patients underwent testing: median age 58.4 years (40-82), 1117 male (52.3%). Of these, 45 patients (2.1%; 95% CI 1.5%-2.7%) were anti-HCV positive: 32 (76.2%) were HCV RNA positive, 10 (23.8%) negative and 3 not done due to inadequate DBS sample. 26 patients (81.3%) were linked to care and 3 (9.4%) lost to follow-up. HCV prevalence in the ED was significantly higher than the general Canadian population (2.1% vs 0.7%; p < 0.0001) but much lower than reported rates in American EDs (2.1% vs 10.3%; p < 0.0001). Conclusion: Acceptance of HCV screening in the ED birth cohort was high and easily performed using DBS to ensure the majority of positive samples were tested for HCV RNA. Challenges included implementation that limited number of people tested, and linkage to care for HCV positive patients. HCV prevalence among this ED birth cohort was higher than the general population but lower than seen in the ED in the US. This may in part be due to exclusion of individuals with more severe medical issues, refusal by higher risk subgroups, or population and healthcare system differences between countries.
Bulk tank milk quality data is unlikely to give useful information about dairy cow welfare at herd level
Authors: Ginestreti Jessica , Strano Rosa Maria , Lorenzi Valentina , Fusi Francesca , Angelucci Alessandra , Ferrara Giandomenico , Galletti Giorgio , Bergagna Stefania , Bolzoni Giuseppe , Zanardi Giorgio , Buffoli Elena , Marcolini Antonio , Bertocchi Luigi 
Published: May 2020

AbstractThis research communication explores the value of routinely collected bulk tank milk quality data for estimating dairy cattle welfare at herd level. Selected bulk tank milk quality parameters (somatic cell count, total bacterial count, urea, protein and fat contents) recorded during the years 2014–2016 in 287 Italian dairy farms were compared with the animal welfare data of each farm. The welfare assessment data were extracted from the database of the Italian Reference Centre for Animal Welfare (CReNBA), which includes the outputs of the application of the CReNBA welfare assessment protocol for dairy cows, used at national level for on-farm controls. The statistical analysis was carried out using the correlation coefficient for Kendall's Tau ranks, in order to investigate the presence of a categoric relationship between the selected bulk tank milk quality parameters and the overall animal welfare score or the scores of the single areas A (farm management and staff training), B (housing) and C (animal-based measures). Somatic cell count, total bacterial count, urea and proteins demonstrated only a few statistically significant and very weak correlations with farm animal welfare data, while no significant correlations were obtained for milk fat content. Given the weak correlations found, the selected bulk tank milk parameters seems to be able to provide only limited information about the welfare level of the herd, thus it could be difficult to use them for drawing up a pre-screening model for identifying herds at risk of poor welfare.
Chronic subclinical mastitis reduces milk and components yield at the cow level
Authors: Martins Larissa , Barcelos Melina Melo , Cue Roger I. , Anderson Kevin L. , Santos Marcos Veiga dos , Gonçalves Juliano Leonel 
Published: May 2020

AbstractWe evaluated the effects of chronic subclinical mastitis (CSM) caused by different types of pathogens on milk yield and milk components at the cow level. A total of 388 Holstein cows had milk yield measured and were milk sampled three times at intervals of two weeks for determination of SCC and milk composition, and microbiological culture was performed. Cows were considered healthy if all three samples of SCC were ≤200 000 cells/ml and were culture-negative at the third milk sampling. Cows with one result of SCC > 200 000 cells/ml were considered to suffer non-chronic subclinical mastitis whereas cows with at least 2 out of 3 results of SCC > 200 000 cells/ml had CSM. These latter cows were further sorted according to culture results into chronic negative-culture or chronic positive-culture. This resulted in four udder health statuses: healthy, non-chronic, chronicNC or chronicPC. The milk and components yields were evaluated according to the udder health status and by pathogen using a linear mixed effects model. A total of 134 out of 388 cows (34.5%) were chronicPC, 57 cows (14.7%) were chronicNC, 78 cows (20.1%) were non-chronic and 119 cows (30.7%) were considered healthy, which resulted in a grand total of 1164 cow records included in the statistical model. The healthy cows produced more milk than each of the other groups (+2.1 to +5.7 kg/cow/day) and produced higher milk component yields than the chronicPC cows. The healthy cows produced more milk than cows with chronicPC caused by minor (+5.2 kg/cow/day) and major pathogens (+7.1 kg/cow/day) and losses varied from 5.8 to 11.8 kg/cow/day depending on the pathogen causing chronicPC mastitis. Chronic positive-culture cows had a reduction of at least 24.5% of milk yield and 22.4% of total solids yield.
Unsustainable harvest of water frogs in southern Turkey for the European market
Authors: Çiçek Kerim , Ayaz Dinçer , Afsar Murat , Bayrakcı Yusuf , Pekşen Çiğdem Akın , Cumhuriyet Oğuzkan , İsmail İlhan Bayram , Yenmiş Melodi , Üstündağ Erdal , Tok Cemal Varol , Bilgin C. Can , Akçakaya H. Reşit 
Published: May 2020

AbstractFrogs have been harvested from the wild for the last 40 years in Turkey. We analysed the population dynamics of Anatolian water frogs (Pelophylax spp.) in the Seyhan and Ceyhan Deltas during 2013–2015. We marked a total of 13,811 individuals during 3 years, estimated population sizes, simulated the dynamics of a harvested population over 50 years, and collated frog harvest and export statistics from the region and for Turkey as a whole. Our capture estimates indicated a population reduction of c. 20% per year, and our population modelling showed that, if overharvesting continues at current rates, the harvested populations will decline rapidly. Simulations with a model of harvested population dynamics resulted in a risk of extinction of > 90% within 50 years, with extinction likely in c. 2032. Our interviews with harvesters revealed their economic dependence on the frog harvest. However, our results also showed that reducing harvest rates would not only ensure the viability of these frog populations but would also provide a source of income that is sustainable in the long term. Our study provides insights into the position of Turkey in the ‘extinction domino’ line, in which harvest pressure shifts among countries as frog populations are depleted and harvest bans are effected. We recommend that harvesting of wild frogs should be banned during the mating season, hunting and exporting of frogs < 30 g should be banned, and harvesters should be trained on species knowledge and awareness of regulations.
Presidential Nominating Conventions and Elections
Authors: Levitt Morris J . , James Ronald 
Published: May 2020

Teaching through simulation is one of the most innovative and interesting methods available. Many educators, however, are reluctant to utilize this technique. Some of the reasons for this are understandable. Setting up a simulation is somewhat time consuming and involves more than the usual amount of paperwork. Secondly, the educator may be unfamiliar with organizing a flexible, people- integrating simulation. Third, grading criteria may be a bit more difficult to develop. In spite of these facts, the strengths of using simulation far outweigh the difficulties, and it is the intention of this article to help overcome such problems.Although setting up a simulation is time consuming, once accomplished, the teacher's job becomes easier because the students will begin to “learn by doing”.
Teaching Ethics in a Not-So-Ivory Tower of Babel
Authors: Brandon William P. , Bluhm William T. 
Published: May 2020

Our course differs from most comparable courses in ethics and public policy because we attract students from widely disparate programs. at the university of rochester, we put into the same small seminar master's students in a very quantitative public policy program dominated by microeconomics, community medicine students from the preventive medicine department's master's program in the medical school, selected undergraduate upperclassmen, and nursing students in nurse-clinician master's programs.The faculty also have different backgrounds. One has taught politica philosophy in the Political Science Department for many years; the other (who had a primary appointment in the Preventive Medicine Department and a joint appointment in Political Science) taught health politics and policy, but had previously completed considerable training in philosophy and political theory.
Political Scientists and Journalists Watch Congress
Authors: Ornstein Norman J. 
Published: May 2020

When the House of Representatives began to allow television cameras in to cover its floor proceedings in early 1979, it was not widely noticed in the country or the academic community. As C-SPAN's Susan Swain notes, the initial cable coverage was from 10 a.m. to 6 p.m. weekdays, with only three-and-one- half million homes wired to receive the service. It was rare in the first year or two of television coverage for other television outlets, especially the commercial networks, to use any of the floor footage extensively either.But within a couple of years, the television coverage of the House began to penetrate the media and the country more widely. C-SPAN, under Brian Lamb's astute tutelage expanded dramatically; network evening and weekend news shows, growing comfortable at monitoring the floor debate, began to use both ten-second “sound bites” and more extended excerpts on their shows; public television, through the Mac-Neil/Lehrer NewsHour and The Lawmakers, made the televised floor proceedings staples of their news coverage.
Confessions of a Professor
Authors: Joyner Conrad 
Published: May 2020

This is an essay and a confession. It is an essay, because I deal with teaching from a personal point of view. It is a confession in the dual sense of revealing a few “sins,” and stating my beliefs about teaching. My aim is didactic. I hope others, including professors, students, administrators, college and university trustees, and legislators, discover something useful in what I say.A number of factors affect how and what people teach. Performance is shaped by the professor's personality, experience, subject matter, research interests, publications, general prominence within the university or college, type of students, and the value placed on teaching by peers and the administration.
Teaching Policy Evaluation
Authors: Nagel Stuart S. 
Published: May 2020

An instructor needs to resolve several issues in teaching a course on policy evaluation. Those issues include matters of course content such as what books to use, what evaluation methods to present, the role of statistical analysis in determining relations, the role of legal analysis in determining values, the role of political and administrative feasibility, and how to combine policy analysis and program evaluation.Back in 1958, the economist Roland McKean, working for the Rand Corporation, wrote a book entitled Efficiency in Government Through Systems Analysis: With Emphasis on Water Resources Development (Wiley, 1958). That may have been the first book that attempted to provide a survey, of methods involved in systematically evaluating alternative public policies, although only the first 100 pages are general in nature.