bluuebunny/crossref_metadata_2025_split huggingface dataset:
Flu vaccine and the ED: Administering influenza vaccine in a Canadian emergency department: Is there a role?
Authors: Chiasson Ann Marie , Rowe Patrick 
Published: July 2016

ABSTRACT

Objectives:
To determine the prevalence of influenza vaccination in patients who present to the emergency department (ED) who meet current guidelines for its use. To evaluate the feasibility of an ED-based program to provide influenza vaccine to at-risk patients.

Methods:
A survey of ED patients and their family physicians, using a convenience sample.

Participants and setting:
Consecutive patients presenting to the emergency department of Prince George Regional Hospital, Prince George, BC, a regional hospital in Northern British Columbia, during designated shifts between Nov. 6, 1997, and Dec. 10, 1997.

Outcome measures:
Age, gender, family physician (FP), eligibility for influenza vaccine, vaccination status, willingness to receive vaccine in the ED, and FP methods for ensuring use of influenza vaccine.

Results:
935 patients were interviewed; 816 met study eligibility criteria. Of 214 patients eligible for influenza vaccine, 113 (52.8%) had not been vaccinated. Fifty-three (46.9%) agreed to vaccination, and 49 were vaccinated in the ED. A survey of the patients’ FPs revealed that 85% used callback lists, but that only 49% of vaccine-eligible patients identified in the study were on a callback list. Positive associations were found between the presence of an FP and the likelihood of having been vaccinated (odds ratio [OR] = 8.8), being on a callback list and having been vaccinated (OR = 4.1), and age &gt;64 and being on a callback list (OR = 2.1).

Conclusions:
Up to 50% of patients eligible for influenza vaccine are not adequately immunized. Administering influenza vaccine in the ED is acceptable to patients and should reduce influenza rates in at-risk populations. There is a role for administering influenza vaccine in the ED.
Do emergency physicians know the costs of medical care?
Authors: Innes Grant , Grafstein Eric , McGrogan Jonathan 
Published: July 2016

ABSTRACT

Objectives:
To estimate the level of knowledge that Canadian emergency physicians have of the costs of common diagnostic tests and interventions in the emergency department (ED).

Methods:
In a cross-sectional survey, 75 emergency physicians from 7 community and academic EDs were asked to estimate the cost of 60 of the most commonly ordered imaging modalities, laboratory tests and pharmaceuticals. Their estimates were compared to actual costs obtained from hospital finance departments. For each test or pharmaceutical, physician error was calculated as a percentage of the actual value, using the formula [(actual – estimated) / actual] × 100. For each item, the proportion of responses that were underestimates, the proportion that were overestimates and the proportion that were accurate within 25% were reported.

Results:
Mean error of the physicians’ estimates was 40% (95% confidence interval [CI], 35%–45%) for imaging studies, 153% (95% CI, 128%–178%) for lab investigations, and 218% (95% CI, 179%–257%) for pharmaceutical costs. Rates of underestimation vs. overestimation were 68% vs. 16% for imaging modalities, 23% vs. 56% for laboratory tests, and 21% vs. 64% for pharmaceuticals.

Conclusions:
Emergency physicians have a limited knowledge of the costs of the tests and interventions they use on a daily basis. They tend to overestimate lab and pharmaceutical costs but underestimate imaging costs. Cost-awareness programs for emergency physicians are most likely to be beneficial if they focus on imaging modalities.
Infantile glaucoma presenting as a case of “red eye”
Authors: James David M. 
Published: July 2016

RÉSUMÉ
Le glaucome infantile est une forme de glaucome congénital qui se manifeste au cours de la première année de vie. Les enfants, comme les adultes, peuvent développer une forme de glaucome aigu pouvant conduire à la cécité chez l’enfant. L’identification et le traitement rapides sont essentiels afin d’éviter ce dénouement tragique. L’enfant dont le cas est discuté dans le présent article présentait une rougeur à l’œil qui fut diagnostiquée par la suite comme étant un glaucome. Cet article passe en revue la physiopathologie du glaucome infantile, les techniques d’examen et les stratégies de traitement.
Pericardial tamponade presenting as abdominal pain in a patient with systemic lupus erythematosis
Authors: Muñiz Antonio E. 
Published: July 2016

ABSTRACT:Abdominal pain is a common complaint in children presenting to the emergency department. Patients with systemic lupus erythematosus (SLE) are at increased risk of infection, bowel necrosis and perforation, especially if they are taking nonsteroidal anti-inflammatory drugs, corticosteroids or immunosuppresive agents, which may mask the signs and symptoms of the underlying condition, hence delay diagnosis and treatment. This article presents the case of an adolescent girl whose abdominal pain was related to cardiac tamponade and provides an overview of the cardiac and gastrointestinal manifestations of SLE.
Motivations for a career in emergency medicine: a profile of the 1996 US applicant pool
Authors: Kazzi Amin Antoine , Langdorf Mark I. , Ghadishah Delaram , Handly Neal 
Published: July 2016

ABSTRACTIntroduction:Although some studies have tried to assess the factors leading to choice of specialty, none have been specific to emergency medicine (EM). With a doubling of the number of EM residency programs in the past decade, an assessment of the career motivations of residents is in order.Objectives:To identify and rank the factors that lead candidates to choose EM as a career. Methods: Fifty-four participating EM programs returned a total of 393 anonymous surveys completed by their 1996 National Residency Matching Program (NRMP) interviewees. The survey asked respondents to rank 12 factors on a 5-point (0–4) Likert scale.Results:Respondents ranked the 12 motivating factors in the following descending order of importance: diversity in clinical pathology, emphasis on acute care, flexibility in choice of practice location, flexibility of EM work schedules, previous work experience in EM, greater availability of EM faculty for bedside teaching, strong influence of an EM faculty advisor or mentor, relatively shorter length of training, better salaries for EM than for primary care specialties, the presence of an EM residency at the student’s medical school, perception that EM residents have more time to moonlight and popularity of EM among medical students.Conclusion:US applicants appear to choose a career in EM largely because of clinical factors (diversity of clinical pathology and emphasis on acute care) and practice-related factors (flexibility in practice location and schedule).
Delayed presentation of cauda equina syndrome secondary to lumbar disc herniation: functional outcomes and health-related quality of life
Authors: Busse Jason W. , Bhandari Mohit , Schnittker Joseph B. , Reddy Kesava , Dunlop R. Brett 
Published: July 2016

ABSTRACTObjective:Cauda equina syndrome (CES) is a feared complication of lumbar disc herniation. It is generally accepted that CES requires decompression within 6 hours of symptom onset, but this time goal is rarely met, and the relative benefit of delayed decompression on functional status and quality of life (QOL) remains unknown. The study objective was to describe the functional status and quality of life outcomes for patients who undergo delayed surgical decompression for CES.Methods:Patients with CES who underwent decompression of a herniated lumbar disc during a 10-year period were assessed at hospital discharge and at least 4 months after the procedure. Evaluation of functional outcomes was based on a previously validated scale and QOL outcomes on the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) questionnaire.Results:During the study period, 1100 patients with herniated discs were identified, and 14 underwent surgical decompression for CES. All 14 had had symptoms for more than 38 hours before surgery. Ten patients were available for long-term follow-up. There was a strong correlation between long CES symptom duration and poor functional outcome: of 8 patients with symptoms for less than 10 days before decompression (range, 1.6–7.5 d), all had good functional outcomes. The 2 patients with more prolonged symptoms (10.6 and 14.2 d) had poor outcomes. SF-36 scores demonstrated declines in physical roles (p= 0.03), social function (p= 0.03) and increased pain (p= 0.003) compared with population norms. Correlation between SF-36 domain scores and CES symptom duration failed to achieve statistical significance, perhaps because of small sample size.Conclusions:Patients who undergo delayed decompression for CES have increased pain and impaired social and physical function. Longer delays correlate with worse functional outcomes. Beyond 24 hours, decompression delay may be associated with a poorer quality of life but, because of the rarity of CES, the sample size in this study was too small to provide definitive conclusions. Since no patients underwent surgery within 38.4 hours of symptoms, it is not possible to comment on the importance of emergent decompression in early presenters.
Accuracy and speed of urine pregnancy tests done in the emergency department: a prospective study
Authors: Lazarenko Gerald C. , Dobson Cathy , Enokson Rosemarie , Brant Rollin 
Published: July 2016

Abstract

Objectives:
Our primary objective was to assess the agreement between urine pregnancy tests done in the emergency department (ED) and those done by the Calgary Laboratory Services (CLS). Our secondary objective was to compare turnaround times for tests done in the ED and those done in the laboratory.

Methods:
This prospective study enrolled a convenience sample of ED patients who required a pregnancy test at 1 of 3 urban Calgary EDs. Using the same urine sample from each patient, testing was done in both the ED and by the CLS using the Abbott TestPak Plus (Abbott Laboratories, Mississauga, Ont.) urine pregnancy kit. The ED data included time of urine collection, β-hCG (human chorionic gonadotropin) result, urine specific gravity, and the time the ED nurse reported the result. The CLS data included the time sample was sent to the laboratory, time of laboratory reporting, time ED nurse was aware of the result, the urine β-hCG result and uring specific gravity. When the ED result and CLS result differed, a serum β-hCG assay was performed and used as the diagnostic “gold standard.”

Results:
There was a high level of agreement between the CLS and the ED, as indicated by a kappa value of 0.97 (95% confidence interval [CI], 0.95–0.98). The ED was significantly faster in time to initial report and time to availability on the chart, with mean differences of 25 minutes (95% CI, 22–27) and 60 minutes (95% CI, 56–64), respectively.

Conclusions:
ED nurses can perform urine pregnancy tests as accurately as laboratory technicians, and can provide results on which to base care much faster than the laboratory can. Point-of-care urine pregnancy testing may expedite the ED management of patients who require pregnancy tests.
Emergency patient transfers from rural hospitals: a regional study
Authors: Rourke James T.B. , Kennard MaryAnn 
Published: July 2016

AbstractObjective:To clarify case mix, mode of transport and reasons for interfacility transfer from rural emergency departments (EDs) and to make recommendations for improved emergency health care delivery in rural settings.Methods:This was a multi-centre descriptive study, based in 5 rural Ontario EDs. Over a 1-year period, all ED patients who required transfer to another hospital were studied. Data collection forms were completed prospectively by the most responsible nurse involved in the transfer. Main measurements included patient age, gender, place of residence, circumstances and reason for transfer, primary diagnosis, mode of transport and receiving hospital.Results:Of 53 796 patients who presented to the 5 participating EDs, 98.4% were managed locally and 836 (1.6%) were transferred to referral centres. Most patients (86%) were transferred because they required treatment beyond the scope of the local hospital. The need for orthopedic care, CT and pediatric care accounted for 23.6%, 14.1% and 8.7% of transfers respectively.Conclusions:These data suggest that rural family physicians may benefit from increased orthopedic and pediatric training and support. The study also identified a need for increased specialist availability in our rural setting. The high number of transfers for CT scans suggests that some rural health regions should consider acquiring a “regional” CT scanner. The development of a regional hospital, with a CT scanner and specialist resources, especially a general surgery on-call system, would reduce the need for transfer outside the region.
Food-dependent exercise-induced anaphylaxis
Authors: Woo Michael Y. , Cwinn A. Adam , Dickinson Garth , Yang William H. 
Published: July 2016

ABSTRACTFood-dependent exercise-induced anaphylaxis (FDEIA) is a specific variant of exercise-induced anaphylaxis that requires both vigorous physical activity and the ingestion of specific foods within the preceding several hours. When patients present to the emergency department (ED) with allergic reactions, careful history regarding these 2 factors is required to establish the correct diagnosis. Correct diagnosis of FDEIA will allow patients to take control of their lifestyles and avert repeated events and ED visits. Two cases of FDEIA are presented, and the diagnosis, pathophysiology and therapy of food-dependent exercise-induced anaphylaxis are reviewed.
Ethics in the trenches: preparing for ethical challenges in the emergency department
Authors: Pauls Merril , LeBlanc Connie , Campbell Sam 
Published: July 2016

ABSTRACTEthical issues can be more difficult to address in the emergency department than in other settings. We present two cases, with the goal of stimulating moral reflection and encouraging emergency physicians to gain a better understanding of two important ethical issues: advance directives and resource allocation decisions.Understanding the legal and ethical basis for advance directives allows emergency physicians to determine when the directives should be followed and when they should be questioned. Resource allocation decisions are among the toughest decisions emergency physicians make. Although patients or substitute decision-makers define the value of a treatment goal, emergency physicians must ensure that this goal does indeed represent the patient’s wishes, that it is achievable, and that competing claims for the same resource are considered.Learning from others’ experiences and preparing for ethical problems in advance will help physicians feel more comfortable in dealing with ethical issues.
Urban emergency department overcrowding: defining the problem and eliminating misconceptions
Authors: Schull Michael J. , Slaughter Pamela M. , Redelmeier Donald A. 
Published: July 2016

ABSTRACTStudy objective:To develop an operational definition and a parsimonious list of postulated determinants for urban emergency department (ED) overcrowding.Methods:A panel was formed from clinical and administrative experts in pre-hospital, ED and hospital domains. Key studies and reports were reviewed in advance by panel members, an experienced health services researcher facilitated the panel’s discussions, and a formal content analysis of audiotaped recordings was conducted.Results:The panel considered community, patient, ED and hospital determinants of overcrowding. Of 46 factors postulated in the literature, 21 were not retained by the experts as potentially important determinants of overcrowding. Factors not retained included access to primary care services and seasonal influenza outbreaks. Key determinants retained included admitted patients awaiting beds and patient characteristics. Ambulance diversion was considered to be an appropriate operational definition and proxy measure of ED overcrowding.Conclusion:These results help to clarify the conceptual framework around ED overcrowding, and may provide a guide for future research. The relative importance of the determinants must be assessed by prospective studies.
Canadian C-Spine Rule study for alert and stable trauma patients: I. Background and rationale
Authors: Stiell Ian G. , Wells George A. , McKnight R. Douglas , Brison Robert , Lesiuk Howard , Clement Catherine M. , Eisenhauer Mary A. , Greenberg Gary H. , MacPhail Iain , Reardon Mark , Worthington James , Verbeek Richard , Dreyer Jonathan , Cass Daniel , Schull Michael , Morrison Laurie , Rowe Brian , Holroyd Brian , Bandiera Glen , Laupacis Andreas ,   Canadian CT Head and C-Spine (CCC) Study Group
Published: July 2016

ABSTRACTThis paper is Part I of a 2-part series to describe the background and methodology for the Canadian C-Spine Rule study to develop a clinical decision rule for rational imaging in alert and stable trauma patients. Current use of radiography is inefficient and variable, in part because there has been a lack of evidence-based guidelines to assist emergency physicians. Clinical decision rules are research-based decision-making tools that incorporate 3 or more variables from the history, physical examination or simple tests. The Canadian CT Head and C-Spine (CCC) Study is a large collaborative effort to develop clinical decision rules for the use of CT head in minor head injury and for the use of cervical spine radiography in alert and stable trauma victims. Part I details the background and rationale for the development of the Canadian C-Spine Rule. Part II will describe in detail the objectives and methods of the Canadian C-Spine Rule study.
Helping at Ground Zero: the experience of four Canadian emergency medicine residents and an emergency department nurse
Authors: Carvalho Anna-Maria , Delvin Marie-Elaine , Rosenczweig Carolyn , Sivarman Sujit , Venugopal Raghu 
Published: July 2016

SOMMAIRE
Le 11 septembre 2001, le monde a été témoin d’une des pires attaques terroristes de l’histoire de l’humanité dirigée contre les deux Tours du World Trade Center à New York, et contre le Pentagone à Washington, DC. En tant que contingent canadien non officiel formé de quatre résidents en médecine d’urgence et d’une infirmière d’urgence, nous nous sommes joints au personnel médical américain pour offrir notre aide au cours de la phase de sauvetage à New York. Nous présentons un compte-rendu de notre expérience en tant que bénévoles au centre principal de triage de «Ground Zero.» Nous dressons le bilan des leçons que nous avons tirées de l’expérience et discutons du rôle du résident dans une situation de désastre.
Can nurses apply the Canadian C-Spine Rule? A pilot study
Authors: Kelly Anne-Maree , Bradshaw Luke , Kerr Debra 
Published: July 2016

ABSTRACTObjective:The aim of this study was to determine the inter-rater agreement between physicians and nurses regarding eligibility for application of the Canadian C-Spine Rule (CCR) and assessment of the criteria of the CCR.Methods:In this observational study, nurses and physicians independently assessed the CCR criteria in a convenience sample of patients with potential C-spine injury. Data were entered onto separate data sheets. The outcomes of interest were the inter-rater agreement between nurse and physician regarding eligibility for application of the rule, for assessment of each component of the rule and for interpretation of the rule overall, assessed by kappa analysis.Results:In total, 88 cases were eligible for analysis. Physicians and nurses agreed on which patients were eligible for CCR application in 96.6% of cases. Inter-rater agreement for most CCR criteria was good (κ &gt; 0.61), with the exception of midline tenderness (κ = 0.58) and range of motion, which most nurses did not test.Conclusion:This study shows that nurses have the potential to reliably apply the Canadian C-Spine Rule but require further training in the assessment of midline tenderness and range of motion.
Prospective evaluation of a guideline for the selective elimination of pre-reduction radiographs in clinically obvious anterior shoulder dislocation
Authors: Shuster Michael , Abu-Laban Riyad B. , Boyd Jeff , Gauthier Charles , Shepherd Lance , Turner Chris 
Published: July 2016

ABSTRACT:

Objective:
Research has demonstrated that experienced emergency physicians can identify a subgroup of patients with shoulder dislocation for whom pre-reduction radiographs do not alter patient management. Based on that research, a treatment guideline for the selective elimination of pre-reduction radiographs in clinically evident cases of anterior shoulder dislocation was developed and implemented. The primary objective of this study was to prospectively determine whether the treatment guideline safely eliminates unnecessary radiographs.

Methods:
We enrolled a convenience sample of patients who presented to our rural emergency department with possible shoulder dislocation between November 2000 and April 2001. Physicians scored their level of clinical diagnostic certainty on a 10-cm visual analogue scale prior to viewing pre-reduction radiographs (if obtained). Data were collected on clinical scoring and evaluation, compliance with the guideline, and outcomes.

Results:
A total of 63 patients were enrolled, ranging in age from 17 to 79 years (mean = 33); 87.3% were male. Emergency physicians were certain of shoulder dislocation in 59 (93.7%) patients (95% CI, 84.5%–98.2%) and complied with the treatment guideline in 52 patients (82.5%). Most deviations from the treatment guideline involved the elimination of post-reduction radiographs (which the guideline recommends for all patients). The treatment guideline eliminated 56 (88.9%, 95% CI, 78.4%–95.4%) pre-reduction radiographs, as compared to the standard practice of obtaining pre-reduction films for all cases of suspected shoulder dislocation (p &lt; 0.0001)

Conclusions:
Experienced emergency physicians are frequently certain of the diagnosis of anterior shoulder dislocation on clinical grounds alone and can comfortably and safely use this guideline for the selective elimination of pre-reduction radiographs. Compliance with the guideline substantially decreases pre-reduction radiographs. Validation of the guideline in other settings is warranted.
Intravenous amiodarone for acute pharmacological conversion of atrial fibrillation in the emergency department
Authors: Slavik Richard S. 
Published: July 2016

ABSTRACTAtrial fibrillation (AF) is the most common arrhythmia seen in patients presenting to the emergency department (ED). Pharmacological conversion of atrial fibrillation to normal sinus rhythm (NSR) may be a feasible management strategy in selected patients. Recent guidelines have recommended intravenous amiodarone, a class III antiarrhythmic agent, for the conversion of AF to NSR. The purpose of this review is to examine the published evidence for the efficacy of IV amiodarone for the acute conversion of AF to NSR in the ED. Currently available data from 11 randomized, controlled trials and 3 meta analyses do not support the use of conventional doses of IV amiodarone for acute conversion in the ED. High dose IV or combined IV and oral administration may be effective as early as 8 hours in patients with recent-onset AF of ≤48 hour duration in patients without contraindications to these high dose regimens. There are no data to support the use of IV amiodarone for acute conversion in patients with an ejection fraction of &lt;40% or clinical heart failure, so its use in these scenarios should be limited to symptomatic patients who are refractory to electrical conversion. More well-designed studies are required to determine the role of IV amiodarone for the acute conversion of AF in the ED.