bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementation of an automated, real-time public health surveillance system linking emergency departments and health units: rationale and methodology
Authors: Moore Kieran M. , Edgar Bronwen L. , McGuinness Donald 
Published: July 2016

ABSTRACTIn September 2004, Kingston, Frontenac, Lennox and Addington (KFL&amp;A) Public Health, in collaboration with the Public Health Division of the Ontario Ministry of Health and Long-Term Care, Queen's University, the Public Health Agency of Canada, Kingston General Hospital and Hotel Dieu Hospital, began a 2-year pilot project to implement and evaluate an emergency department (ED) chief complaint syndromic surveillance system. Our objective was to evaluate a comprehensive and readily deployable real-time regional syndromic surveillance program and to determine its ability to detect gastrointestinal or respiratory outbreaks well in advance of traditional reporting systems. In order to implement the system, modifications were made to the University of Pittsburgh's Real-time Outbreak and Disease Surveillance (RODS) system, which has been successfully integrated into public health systems, and has enhanced communication and collaboration between them and EDs. This paper provides an overview of a RODS-based syndromic surveillance system as adapted for use at a public health unit in Kingston, Ontario. We summarize the technical specifications, privacy and security considerations, data capture, classification and management of the data streams, alerting and public health response. We hope that the modifications described here, including the addition of unique data streams, will provide a benchmark for future Canadian syndromic surveillance systems.
Énoncé de position de l’ACMU sur le contrôle des armes à feu
Authors: Snider Carolyn E. , Ovens Howard , Drummond Alan , Kapur Atul K. 
Published: July 2016

RÉSUMÉLes blessures et les décès par armes à feu continuent d'être un problème important au Canada. Depuis les années 90, les médecins d'urgence du Canada ont milité en faveur du contrôle des armes à feu. Cet article actualise la position de l'Association canadienne des médecins d'urgence (ACMU) à l'égard du contrôle des armes à feu.Même si la couverture des médias porte généralement sur les homicides, la majorité des décès par balle est en réalité le résultat de suicides. Moins de 40 % des blessures par armes à feu sont infligées intentionnellement par une autre personne. Depuis la mise en application du Registre des armes à feu en 1995 au Canada, on a constaté une réduction importante des suicides par balle et des homicides par un conjoint. La proposition d'assouplir la législation sur les armes à feu au Canada aura des répercussions importantes sur les décès et les blessures par balle. Il faut plutôt élargir les programmes axés sur la prévention du suicide, de la violence conjugale et de la violence liée aux gangs de rue.La majorité des blessures par armes à feu intentionnelles ou non intentionnelles impliquent une infraction aux règles d'entreposage ou de maniement sécuritaire de ces armes. Le potentiel de préjudice futur en raison de l'entreposage ou du maniement non sécuritaire des armes à feu ou d'actes de vengeance perpétrés par des gangs de rue corrobore notre position voulant que les établissements de soins de santé déclarent obligatoirement à la police les blessures par balle (BPB). Par ailleurs, il faut mettre en application un système de surveillance national pour appuyer la recherche et orienter les futures politiques publiques et la législation.En tant que médecins d'urgence, nous devons plaider en faveur du contrôle des blessures. Toutes les blessures et tous les décès par balle sont évitables, et nous devons préconiser une stratégie multidimensionnelle afin de réduire au minimum ce risque pour nos patients.
Physician workload and the Canadian Emergency Department Triage and Acuity Scale: the Predictors of Workload in the Emergency Room (POWER) Study
Authors: Dreyer Jonathan F. , McLeod Shelley L. , Anderson Chris K. , Carter Michael W. , Zaric Gregory S. 
Published: July 2016

ABSTRACTIntroduction:The Canadian Emergency Department Triage and Acuity Scale (CTAS) is a 5-level triage tool used to determine the priority by which patients should be treated in Canadian emergency departments (EDs). To determine emergency physician (EP) workload and staffing needs, many hospitals in Ontario use a case-mix formula based solely on patient volume at each triage level. The purpose of our study was to describe the distribution of EP time by activity during a shift in order to estimate the amount of time required by an EP to assess and treat patients in each triage category and to determine the variability in the distribution of CTAS scoring between hospital sites.Methods:Research assistants directly observed EPs for 592 shifts and electronically recorded their activities on a moment-by-moment basis. The duration of all activities associated with a given patient were summed to derive a directly observed estimate of the amount of EP time required to treat the patient.Results:We observed treatment times for 11 716 patients in 11 hospital-based EDs. The mean time for physicians to treat patients was 73.6 minutes (95% confidence interval [CI] 63.6–83.7) for CTAS level 1, 38.9 minutes (95% CI 36.0–41.8) for CTAS-2, 26.3 minutes (95% CI 25.4–27.2) for CTAS-3, 15.0 minutes (95% CI 14.6–15.4) for CTAS-4 and 10.9 minutes (95% CI 10.1–11.6) for CTAS-5. Physician time related to patient care activities accounted for 84.2% of physicians' ED shifts.Conclusion:In our study, EPs had very limited downtime. There was significant variability in the distribution of CTAS scores between sites and also marked variation in EP time related to each triage category. This brings into question the appropriateness of using CTAS alone to determine physician staffing levels in EDs.
Saddle pulmonary emboli: an unusual presentation
Authors: Kothari Truptesh H. , Kothari Shivangi , Pandey Mahima , Khara Harshit , Dhungel Nishant 
Published: July 2016

A 38-year-old man with a history of polyposis syndrome diagnosed 3 years previously, with poor compliance for follow-up, presented to the emergency department with symptoms of retrosternal chest pain associated with dizziness and shortness of breath. His blood pressure was 94/43 mm Hg, his pulse was 123 beats/min and he had an oxygen saturation of 84% on room air. The patient’s initial laboratory results showed a hemoglobin of 80 g/L and blood gas with a pH of 7.23. He had a normal chest radiograph and electrocardiogram, but had an elevated troponin I at 0.12	μg/L. He was given acetylsalicylic acid for suspicion of acute coronary syndrome. On physical examination, the patient was found to have right calf tenderness. With this finding and the presenting symptoms, he underwent computed tomography angiography (CTA) of the chest. The chest CTA showed a massive saddle embolus with a filling defect completely occluding the right pulmonary artery and extending through the main pulmonary artery segment to involve the left pulmonary artery. There were also diffuse filling defects involving bilateral pulmonary segmental arteries (Fig. 1 and Fig. 2). The patient received alteplase and underwent a workup for a hypercoagulable state. His workup revealed positive anticardiolipin antibodies and factor V Leiden. The Doppler ultrasound of his lower extremities showed an extensive thrombus measuring more than 6 cm extending in the right superficial femoral vein. The patient was then referred for placement of an inferior vena cava filter.
Presentations to emergency departments for chronic obstructive pulmonary disease in Alberta: a population-based study
Authors: Rosychuk Rhonda J. , Voaklander Donald C. , Senthilselvan Ambikaipakan , Klassen Terry P. , Marrie Thomas J. , Rowe Brian H. 
Published: July 2016

ABSTRACTObjective:Chronic obstructive pulmonary disease (COPD) is a widespread illness with an increasing prevalence in older adults; exacerbations resulting in visits to the emergency department (ED) are common. We sought to determine the epidemiology of COPD presentations to EDs by older adults in Alberta.Methods:Administrative databases were used to examine all ED encounters for COPD from April 1999 to March 2005 in Alberta. Data included demographics of patients and timing of ED visits. Data analysis included descriptive summaries and age–sex directly standardized visit rates (DSVRs).Results:There were 85 330 ED visits for acute COPD made by 38 638 patients 55 years of age or older during the study period. More men (53.2%) presented, and the mean age at presentation was 72 years. The age–sex DSVRs remained stable from 2000/01 (24.4/1000) to 2004/05 (25.6/1000). Presentation rates differed among population subgroups. Overall, 67% of visits resulted in discharge from the ED.Conclusion:Chronic obstructive pulmonary disease is a common presentation in Alberta EDs; however, the rates of presentation were stable during the study period, and monthly and hourly trends exhibited similar patterns for each year. Disparities based on age, sex, and socio-economic and cultural statuses were identified. Targeted interventions could be implemented to reduce future ED visits for COPD.
Treatment variability and outcome differences in the emergency department management of alcohol withdrawal
Authors: Kahan Meldon , Borgundvaag Bjug , Midmer Deana , Borsoi Diane , Edwards Carol , Ladhani Noor 
Published: July 2016

ABSTRACTObjective:Evidence suggests that symptom-triggered benzodiazepine treatment for patients with alcohol withdrawal reduces complication rates and emergency department lengths of stay. Our objective was to describe the management of alcohol withdrawal in 2 urban emergency departments.Methods:A structured chart audit was performed for patients with alcohol-related problems who presented to 2 Toronto hospitals over a 2-year period.Results:A total of 209 emergency department charts were audited. Patient characteristics were similar in both hospitals. None of the patients had been assessed using the Clinical Institute Withdrawal Assessment for Alcohol (CIWA-Ar) scale. Patients at one hospital received substantially higher mean diazepam doses (64 mg v. 26 mg;p&lt; 0.001) than did the patients at the other hospital, and the patients at the first hospital had fewer seizures during their emergency department stay (1% v. 9%;p= 0.012). Patients spent an average of 9 hours and 40 minutes in the emergency department.Conclusion:There is significant variability in the documentation and treatment of alcohol withdrawal. Lower benzodiazepine doses are associated with higher rate of withdrawal seizures and prolonged emergency department length of stay. A standardized approach using symptom-triggered management is likely to improve outcomes for patients presenting with alcohol withdrawal.
Patient Expectations of Emergency Department Care: Phase II – A Cross-Sectional Survey
Authors: Cooke Timothy , Watt Denise , Wertzler William , Quan Hude 
Published: July 2016

ABSTRACTObjectives:To explore emergency department (ED) patient expectations regarding staff communication with patients, wait times, the triage process and information management.Methods:We conducted a cross-sectional English-language telephone survey among patients aged 18 years or older who visited the EDs in the Calgary Health Region in 2002. Survey items were based on a preceding qualitative study.Results:Of the 941 surveys, 837 were analyzed. Patients placed the highest importance on the explanation of test results (96.5%), a description of circumstances that would require the patient to return to the ED (94.4%), the use of plain language (92.1%) and the reason for the tests (90.8%). Seventy-six percent of patients felt that ED staff should update patients every 30 minutes or less, 51.3% expected patients with non-life threatening problems should wait &lt;1 hour, and 58.3% expected that the tests should be done within 1 hour. Almost two-thirds of the patients (64.4%) believed that the most serious patients should be seen first; 59.3% felt that the seriousness of medical concern should be determined by a triage nurse, and 63.9% thought that their personal health records should be immediately available to the emergency physician without their consent. The actual length of stay was significantly longer than expected length of stay for all patient groups, withCanadian Emergency Department Triage and Acuity ScaleLevels IV and V patients expecting a shorter wait than patients in more urgent triage groups. Triage level effects on other expectations were not observed.Conclusions:ED patient expectations appear to be similar across all triage levels. Patients value effective communication and short wait times over many other aspects of care. They have expectations for short wait times that are met infrequently and are currently unattainable in many Canadian EDs. Although it may be neither feasible nor desirable to meet all patient expectations, increased focus on wait times and staff communication may increase both ED efficiency and patient satisfaction.
Systematic review of randomized controlled trials of therapeutic hypothermia as a neuroprotectant in post cardiac arrest patients
Authors: Cheung Ka Wai , Green Robert S. , Magee Kirk D. 
Published: July 2016

ABSTRACTObjective:Several randomized controlled trials have suggested that mild induced hypothermia may improve neurologic outcome in comatose cardiac arrest survivors. This systematic review of randomized controlled trials was designed to determine if mild induced hypothermia improves neurologic outcome, decreases mortality, or is associated with an increased incidence of adverse events.Data sources:The following databases were reviewed: Cochrane Controlled Trials Register (Issue 4, 2005), MEDLINE (January 1966 to November 2005), EMBASE (1980 to November 2005), CINAHL (1982 to November 2005) and Web of Science (1989 to November 2005). For each included study, references were reviewed and the primary author contacted to identify any additional studies.Study selection:Studies that met inclusion criteria were randomized controlled trials of adult patients (&gt;18 years of age) with primary cardiac arrest who remained comatose after return of spontaneous circulation. Patients had to be randomized to mild induced hypothermia (32°C-34°C) or normothermia within 24 hours of presentation. Only studies reporting pre-determined outcomes including discharge neurologic outcome, mortality or significant treatment-related adverse events were included. There were no language or publication restrictions.Data synthesis:Four studies involving 436 patients, with 232 cooled to a core temperature of 32°C-34°C met inclusion criteria. Pooled data demonstrated that mild hypothermia decreased inhospital mortality (relative ratio [RR] 0.75; 95% confidence interval [CI], 0.62-0.92) and reduced the incidence of poor neurologic outcome (RR 0.74; 95% CI, 0.62-0.84). Numbers needed to treat were 7 patients to save 1 life, and 5 patients to improve neurologic outcome. There was no evidence of treatment-limiting side effects.Conclusions:Therapeutically induced mild hypothermia decreases in-hospital mortality and improves neurologic outcome in comatose cardiac arrest survivors. The possibility of treatment-limiting side effects cannot be excluded.
A survey of one CCFP-EM program’s graduates: their background, intended type of practice and actual practice
Authors: Shepherd Lisa G. , Burden Julia K. 
Published: July 2016

ABSTRACT

Objectives:
Our primary objective was to survey the graduates of one residency program with respect to anticipated versus actual medical practice.

Methods:
Using a modified Dillman technique, we surveyed all 83 physicians who had completed one year of residency training that led to certification of special competency in Emergency Medicine (CCFP-EM) at the University of Western Ontario (UWO) from 1982–2004. Respondents were asked what type of medicine they had thought they would practise before beginning their emergency medicine training. They were then asked to describe their employment from graduation to present time. Additional demographic information was collected. Correlation between demographic factors and other selected factors of influence upon career decisions was analyzed.

Results:
Our response rate was 87% (72/83), with 71% (51/72) respondents being male. At the start of their CCFP-EM residency training, 50% of respondents intended to practise emergency medicine exclusively and 47% intended to blend family and emergency medicine. For each of the respondents' first 4 positions of employment, the greatest percentage were practising emergency medicine only (ranging from 72% in position 1 to 53% in position 4), while the number engaging in a blended family/emergency medicine practice never exceeded 20%. No demographic factors surveyed had significant correlation with intended or actual practice. In all positions of employment, “type of practice” was ranked as the most influential factor in choosing that position.

Conclusion:
Most graduates of the UWO CCFP-EM program practise in emergency medicine only positions. Less than 20% are engaged in a blended family/emergency medicine practice. At training onset, one-half of the residents intended to practise emergency medicine exclusively. None of the demographic factors surveyed significantly correlated with intended or actual practice. Further examination of the practice patterns of all emergency medicine residency program graduates is an essential part of future planning for the specialty of Emergency Medicine in Canada.
Impact of a standardized communication system on continuity of care between family physicians and the emergency department
Authors: Afilalo Marc , Lang Eddy , Léger Ruth , Xue Xiaoqing , Colacone Antoinette , Soucy Nathalie , Vandal Alain , Boivin Jean-François , Unger Bernard 
Published: July 2016

ABSTRACTObjective:It has been suggested that continuity of care is hampered because of the lack of communication between emergency departments (EDs) and primary care providers. A web-based, standardized communication system (SCS) that enables family physicians (FPs) to visualize information regarding their patients' ED visits was developed. This paper aims to evaluate the impact of this SCS on continuity of care.Methods:We conducted an open, 4-period crossover, cluster-randomized controlled trial of 23 FP practices. During the intervention phase, FPs received detailed reports via SCS, while in the control phase they received mailed copies of the ED notes. Continuity of care was evaluated with a web questionnaire completed by FPs 21 days after the ED visit. The primary measures of continuity of care were knowledge of ED visit (quality and quantity), patient management and follow-up rate.Results:We analyzed a total of 2022 ED visits (1048 intervention and 974 control). The intervention group received information regarding the ED visit more often (odds ratio [OR] 3.14, 95% confidence interval [CI] 2.6–3.79), found the information more useful (OR 5.1, 95% CI 3.49–7.46), possessed a better knowledge of the ED visit (OR 6.28, 95% CI 5.12–7.71), felt they could better manage patients (OR 2.46, 95% CI 2.02–2.99) and initiated actions more often following receipt of information (OR 1.62, 95% CI 1.36–1.93). However, there was no significant difference in the follow-up rate at FPs offices (OR 1.25, 95% CI 0.97–1.61).Conclusion:The use of SCS between an ED and FPs led to significant improvements in continuity of care by increasing the usefulness of transferred information and by improving FPs' perceived patient knowledge and patient management.
Prevalence of pneumonia in children under 12 years of age who undergo abdominal radiography in the emergency department
Authors: Homier Valérie , Bellavance Colette , Xhignesse Marianne 
Published: July 2016

ABSTRACTObjective:Pneumonia is a well-known cause of acute abdominal pain in children. However, the utility of chest radiography in this setting is controversial. We sought to determine the prevalence of pneumonia in children under 12 years of age who had abdominal pain and underwent abdominal radiography when visiting an emergency department (ED). We also aimed to describe the signs and symptoms of children diagnosed with pneumonia in this context.Methods:We conducted a retrospective analysis of electronic data from ED visits to a tertiary care centre by children 12 years of age and under who were seen between June 1, 2001, and June 30, 2003, and who underwent both an abdominal and a chest radiograph during the same visit, or an abdominal x-ray at a first visit as well as a chest x-ray in the 10 days following the initial visit.Results:Of 1584 visits studied, 30 cases of pneumonia were identified, for a prevalence of 1.89% (95% confidence interval 1.22%–1.56%). If chest radiography had been limited to children who presented with fever, cough and symptoms of an upper respiratory tract infection (URTI), the diagnosis of pneumonia would have been missed in only 2/1584 visits (0.13%).Conclusion:Children aged 12 years and under presenting to the ED with acute abdominal pain and in whom an abdominal radiograph is requested need only undergo a chest radiograph in the presence of cough, fever or other symptoms of a URTI.
Factors associated with delay to emergency department presentation, antibiotic usage and admission for human bite injuries
Authors: Merchant Roland C. , Zabbo Christopher P. , Mayer Kenneth H. , Becker Bruce M. 
Published: July 2016

ABSTRACTObjectives:Evidence and consensus on best practices on the management of human bite injuries is lacking. Our objective was to identify factors that are associated with delay to emergency department (ED) presentation, antibiotic usage and patient admission.Methods:We present a retrospective chart review of adults treated for human bites. Multivariable logistic regression models used demographic characteristics and bite circumstances and characteristics as factors associated with ED presentation more than 24 hours after the bite, antibiotic usage and hospital admission.Results:Of the 388 patients evaluated for a human bite, 66.5% were bitten during an altercation; 23.8% presented more than 24 hours after the bite; 50.3% were bitten on the hands or fingers, 23.5% on an extremity and 17.8% on the head or neck. Only 7.7% of all patients sustained closed-fist injuries; the majority had occlusional or other kinds of bites. The majority of patients (77.3%) received antibiotics and 11.1% were admitted to hospital. Patients who had greater odds of presenting more than 24 hours after the bite were black (odds ratio [OR] 1.79, 95% confidence interval [CI] 1.02–3.13), Hispanic (OR 2.68, 95% CI 1.22–5.89) and those who had a non-occupational bite (OR 3.87, 95% CI, 1.68–8.90). Patients had a greater chance of receiving antibiotics if they were bitten during an altercation (OR 1.87, 95% CI, 1.09–3.20) and were bitten on the hands or fingers (OR 2.23, 95% CI 1.31-3.80). Patients had a greater chance of being admitted to the hospital if they were bitten during an altercation (OR 4.91, 95% CI 1.65–14.64), bitten on the hands or fingers (OR 5.26, 95% CI, 1.74–15.87) and if they presented ≥ 24 hours after the bite.Conclusion:Most patients presented to the ED within 24 hours of their injury and received antibiotics. The circumstances surrounding the bite appeared to be associated with delay to ED presentation, receipt of antibiotics and admission to the hospital. There are ethnic background differences in delay to ED presentation. ED clinicians in our study favour antibiotic usage and admission based on the body location of the bite, despite little evidence to support these practices.