bluuebunny/crossref_metadata_2025_split huggingface dataset:
A kockázati tőke globális térnyerésének kérdése
Authors: Futó Judit Edit 
Published: July 2016

A 2008-as pénzügyi válság a kockázati tőke iparát is negatívan érintette világszerte, így az eddig megszokott befektetési körülmények megváltoztak. A tanulmány egyik célja, hogy áttekintést adjon a változásokról és az azokra való reagálásról. A globális trendek alapján látható, hogy az éves kockázatitőke-befektetések szintje 2013-ban is éppen csak eléri a 2008 előttit. Néhány ázsiai országban – például Kínában és Indiában – a visszaesés ugyan nem volt számottevő, az európai országokban viszont annál inkább. A tanulmány másik célja megvizsgálni, van-e realitása egy egységes globális kockázatitőke-modellnek, vagy minden országban más és más a helyzet, s ha fennáll a különbözőség, akkor ez milyen magyarázó tényezőkre vezethetők vissza. A kiterjedt nemzetközi irodalom alapján azt szűrtem le, hogy egy egységes modell kialakulását számos tényező befolyásolja; a pénzügyi rendszerek jellemzői, a jogi és intézményi akadályok, valamint a kultúra egyaránt ezek közé tartozik.
Journal of Economic Literature (JEL) kód: G24
Penetrating craniofacial trauma from a vice clamp: case report and discussion
Authors: Kjelland Colleen , Thirsk Warren 
Published: July 2016

ABSTRACTPenetrating craniofacial trauma, although uncommon, has a high potential for death or serious morbidity from injury to vital neurovascular structures. An in situ facial foreign body, particularly if large, presents significant challenges beyond safe and timely removal. Airway management, stabilization of the object, management of increased intracranial pressure, and identification of injuries to local structures are all issues that may require addressing. We present a case of penetrating facial trauma from a vice clamp, with an in situ foreign body, that illustrates several of these challenges and provides a forum for their discussion.
Esophageal coin removal by emergency physicians: a continuous quality improvement project incorporating rapid sequence intubation
Authors: Bhargava Rishi , Brown Lance 
Published: July 2016

ABSTRACTObjective:The objective of this study was to describe our experience removing esophageal coins from children in a tertiary care pediatric emergency department over a 4-year period.Methods:We retrospectively reviewed a continuous quality improvement data set spanning October 1, 2004, through September 30, 2008.Results:In 96 of 101 cases (95%), emergency physicians successfully retrieved the coin. The median age of the children was 19 months (interquartile range [IQR] 13–43 months; range 4 months–12.8 years). The median time to removal of coin from initiation of intubation was 8 minutes (IQR 4–14 minutes; range 1–60 minutes). Coins were extracted using forceps only in 56 cases, whereas forceps and a Foley catheter were used in the remainder. Succinylcholine and etomidate were used in almost all cases for rapid sequence intubation prior to coin removal. Complications were identified in 46 cases: minor bleeding (13), lip laceration (7), multiple attempts (5), hypoxia (3), accidental extubation (3), dental injuries (3), bradycardia (2), coin advanced (1), right main-stem bronchus intubation (1), and other (8).Conclusions:Emergency physicians successfully removed esophageal coins following rapid sequence intubation in most cases. Our approach may be considered for the management of pediatric esophageal coins, particularly in an academic pediatric emergency department.
Keeping an open mind about meningitis: a case report of carcinomatous meningitis
Authors: Walkty Andrew , Abbott Burton , Swirsky Neil , Safneck Janice , Embil John M. 
Published: July 2016

ABSTRACT:Carcinomatous meningitis is defined as leptomeningeal infiltration by malignant cells. A case of carcinomatous meningitis, originally diagnosed as viral meningitis, is presented here to highlight the importance of maintaining a broad differential diagnosis in patients with evidence of meningeal irritation. Clinical and laboratory clues that suggest a diagnosis of carcinomatous meningitis in a patient with meningeal irritation include the presence and type of underlying malignancy (more common with breast cancer, lung cancer, and melanoma), absence of fever, presence of radicular pain, evidence of both cranial and spinal involvement, consistent cerebrospinal fluid (CSF) findings (increased opening pressure, elevated protein concentration, decreased glucose, increased white cell count), and supportive neuroimaging. Diagnosis is based on positive CSF cytology results, which may require multiple lumbar puncture procedures to obtain. For patients with a known primary malignancy who present to the emergency department with symptoms and/or signs of meningeal irritation, carcinomatous meningitis should be included in the differential diagnosis.
Barriers and facilitators to the implementation of Ontario's emergency department clinical decision unit pilot program: a qualitative study
Authors: Salkeld Erin , Leaver Chad A. , Guttmann Astrid , Vermeulen Marian J. , Rowe Brian H. , Sales Anne , Schull Michael J. 
Published: July 2016

ABSTRACT:

Objective:
In Ontario, clinical decision units (CDUs) were implemented as a pilot project in 2008 by the Ministry of Health and Long-Term Care as part of its strategy to reduce emergency department (ED) waiting times. Our objective was to describe general characteristics of the program at each of the participating sites and to examine barriers and facilitators to integrating CDUs into practice.

Methods:
On-site small-group interviews were conducted in two phases with ED and hospital staff at participating sites, first at 8 to 12 weeks and again at 12 months postimplementation. Interview data were analyzed using the framework approach. Unstructured field notes and CDU clinical care protocols and documentation were also reviewed.

Results:
The qualitative analysis identified 10 key themes related to integrating CDUs into EDs: shift in clinical and operational practice; administrative aspects of implementation; team building and stakeholder involvement; use of clinical care protocols; physical or virtual model of care; responsive ancillary services; involvement of specialist services; coordination with hospital and community supports; appropriate use of the CDU; and ongoing evaluation and monitoring. Each theme represents an important insight from the perspective of clinical and administrative staff at participating sites.

Conclusion:
The implementation of CDUs is a complex process, with no single preferred clinical care or operational model. This study identifies a number of key considerations relevant to the future implementation of CDUs.
Canadian Association of Emergency Physicians sepsis treatment checklist: optimizing sepsis care in Canadian emergency departments
Authors: Djogovic Dennis , Green Robert , Keyes Robert , Gray Sara , Stenstrom Robert , Sweet David , Davidow Jonathan , Patterson Edward , Easton David , MacDonald Shavaun , Gaudet Jonathan , Kolber Michael R. , Lechelt David , Howes Daniel ,   the CAEP Critical Care Practice Committee
Published: July 2016

ABSTRACT

Objective:
The Canadian Association of Emergency Physicians (CAEP) sepsis guidelines created by the CAEP Critical Care Practice Committee (C4) and published in the Canadian Journal of Emergency Medicine (CJEM) form the most definitive publication on Canadian emergency department (ED) sepsis care to date. Our intention was to identify which of the care items in this document are specifically necessary in the ED and then to provide these items in a tiered checklist that can be used by any Canadian ED practitioner.

Methods:
Practice points from the CJEM sepsis publication were identified to create a practice point list. Members of C4 then used a Delphi technique consensus process over May to October 2009 via e-mail to create a tiered checklist of sepsis care items that can or could be completed in a Canadian ED when caring for the septic shock patient. This checklist was then assessed for use by a survey of ED practitioners from varying backgrounds (rural ED, community ED, tertiary ED) from July to October 2010.

Results:
Twenty sepsis care items were identified in the CAEP sepsis guidelines. Fifteen items were felt to be necessary for ED care. Two levels of checklists were then created that can be used in a Canadian ED. Most ED physicians in community and tertiary care centres could complete all parts of the level I sepsis checklist. Rural centres often struggle with the ability to obtain lactate values and central venous access. Many items of the level II sepsis checklist could not be completed outside the tertiary care centre ED.

Conclusion:
Sepsis care continues to be an integral and major part of the ED domain. Practice points for sepsis care that require specialized monitoring and invasive techniques are often limited to larger tertiary care EDs and, although heavily emphasized by many medical bodies, cannot be reasonably expected in all centres. When the resources of a centre limit patient care, transfer may be required.
Use of rate control medication before cardioversion of recent-onset atrial fibrillation or flutter in the emergency department is associated with reduced success rates
Authors: Blecher Gabriel E. , Stiell Ian G. , Rowe Brian H. , Lang Eddy , Brison Robert J. , Perry Jeffrey J. , Clement Catherine M. , Borgundvaag Bjug , Langhan Trevor , Magee Kirk , Stenstrom Rob , Birnie David , Wells George A. 
Published: July 2016

ABSTRACTObjective:It is believed that when patients present to the emergency department (ED) with recent-onset atrial fibrillation or flutter (RAFF), controlling the ventricular rate before cardioversion improves the success rate. We evaluated the influence of rate control medication and other variables on the success of cardioversion.Methods:This secondary analysis of a medical records review comprised 1,068 patients with RAFF who presented to eight Canadian EDs over 12 months. Univariate analysis was performed to find associations between predictors of conversion to sinus rhythm including use of rate control, rhythm control, and other variables. Predictive variables were incorporated into the multivariate model to calculate adjusted odds ratios (ORs) associated with successful cardioversion.Results:A total of 634 patients underwent attempted cardioversion: 428 electrical, 354 chemical, and 148 both. Adjusted ORs for factors associated with successful electrical cardioversion were use of rate control medication, 0.39 (95% confidence interval [CI] 0.21-0.74); rhythm control medication, 0.28 (95% CI 0.15-0.53); and CHADS2score &gt; 0, 0.43 (95% CI 0.15-0.83). ORs for factors associated with successful chemical cardioversion were use of rate control medication, 1.29 (95% CI 0.82-2.03); female sex, 2.37 (95% CI 1.50-3.72); and use of procainamide, 2.32 (95% CI 1.43-3.74).Conclusion:We demonstrated reduced successful electrical cardioversion of RAFF when patients were pretreated with either rate or rhythm control medication. Although rate control medication was not associated with increased success of chemical cardioversion, use of procainamide was. Slowing the ventricular rate prior to cardioversion should be avoided.
Effect of a preauthorization policy on the utilization rate of after-hours emergency department neuroradiology computed tomography
Authors: Dhanoa Deljit , Burton Kirsteen Rennie , de Tilly Lyne Noël , Menezes Ravi J. 
Published: July 2016

ABSTRACTObjective:To evaluate the impact of an emergency department (ED) automatic preauthorization policy on after-hours utilization of neuroradiology computed tomography (CT).Methods:All CT studies of the head with contrast facial bones, orbits, spine, and neck requested through the ED and performed between January 1, 2004, and December 31, 2010, were reviewed. The preauthorization policy was instituted on February 25, 2008. A control group of noncontrast CT head studies was used for comparison. Pre- and postpolicy implementation utilization rates were compared between the control group of noncontrast CT head studies and the study group neuroradiology CT studies.Results:During the study period, 408,501 ED patient visits occurred and 20,703 neuroradiology CT studies were carried out. The pre- and postimplementation groups of noncontrast CT head scans totalled 7,474 and 6,094, respectively, whereas the pre- and postimplementation groups of all other neuroradiology CT studies totalled 3,833 and 3,302, respectively. The CT utilization between the two groups did not differ significantly: the noncontrast head group pre- and postpolicy implementation increased by 0.31 to 3.41%, whereas the utilization of all other neuroradiology CT studies increased by 0.22 to 1.84% (pvalue = 0.061 for a difference between groups).Conclusion:Implementation of an automatic preauthorization policy for after-hours neuroradiology CT studies did not result in a statistically significant increase in CT utilization. This suggests that concerns regarding the negative effects of such policiesmay be unfounded, and further research in this area is warranted.
Influence of publicly available online wait time data on emergency department choice in patients with noncritical complaints
Authors: Yip Amelia , McLeod Shelley , McRae Andrew , Xie Bin 
Published: July 2016

ABSTRACTObjectives:Increased emergency department (ED) wait times lead to more patients who leave without being seen and decreased patient satisfaction. Many EDs post estimated wait times either online or in the ED to guide patient expectations. The objectives of this study were to assess patients' awareness of online wait time data and to investigate patients' willingness to use this information when choosing between two academic EDs in London, Ontario.Methods:A prospective study was conducted over a 2-month period in a tertiary ED with online available wait times. Patients over 18 years of age assigned a Canadian Triage and Acuity Scale (CTAS) score of 3, 4, or 5 were approached by trained research assistants to complete a 15-item paper-based questionnaire. Multivariable logistic regression models were used to determine factors independently associated with the outcomes.Results:A total of 1,211 patients completed the survey. Of these, 109 (9%) were aware that ED wait time information was available on the Internet; 544 (45%) reported that they would use the available data to make a decision on which ED to visit, and 536 (44%) indicated that they were more likely to go to the ED with a shorter wait time. Age, gender, household income, education, and Internet access were not associated with awareness of online ED wait times. Participants less than 40 years of age were more likely to use online wait time information.Conclusion:There is low awareness of the availability of ED wait time data published online in the study locaton. Future research may include the delivery of a public awareness strategy for ED wait time data and a re-evaluation of ED use and patient satisfaction following this.
Spontaneous rectus sheath hematoma diagnosed by point-of-care ultrasonography
Authors: Shokoohi Hamid , Boniface Keith , Taheri M. Reza , Pourmand Ali 
Published: July 2016

ABSTRACTSpontaneous rectus sheath hematoma is an uncommon condition that can mimic other conditions associated with an acute abdomen. We report the case of a patient with a spontaneous rectus sheath hematoma due to a ruptured inferior epigastric artery pseudoaneurysm who presented with hypotension and severe abdominal pain and was diagnosed using emergency department point-of-care ultrasonography. Point-of-care ultrasonography has been increasingly used in the evaluation of emergency department patients with acute abdomen and hypotension to expedite the diagnosis and management of aortic aneurysm and intraperitoneal bleeding. Resuscitation and urgent surgical and interventional radiology consultations resulted in the successful embolization of a branch of the inferior epigastric artery and a good outcome.
Photodocumentation as an emergency department documentation tool in soft tissue infection: a randomized trial
Authors: Lund Adam , Joo Daniel , Lewis Kerrie , Arikan Yasemin , Grunfeld Anton 
Published: July 2016

ABSTRACT:Objectives:Current documentation methods for patients with skin and soft tissue infections receiving outpatient parenteral anti-infective therapy (OPAT) include written descriptions and drawings of the infection that may inadequately communicate clinical status. We undertook a study to determine whether photodocumentation (PD) improves the duration of outpatient treatment of skin and soft tissue infections.Methods:A single-blinded, prospective, randomized trial was conducted in the emergency departments of a community hospital and an academic tertiary centre. Participants included consecutive patients age ≥ 14 years presenting with noninvasive skin and soft tissue infections requiring OPAT. Patients in the intervention arm were treated with standard of care plus PD at each emergency physician assessment. Control subjects received care provided at the discretion of the treating physician and non-photographic documentation. The primary outcome was duration of therapy measured in half-days. The required sample size to detect a difference of one half-day was 253 patients per group (α = 0.05). Secondary outcomes included (1) completion and therapeutic failure rates, (2) patient satisfaction, and (3) physician and nurse satisfaction.Results:Enrolment was slower and follow-up rates lower than anticipated, and the trial was terminated when funds were exhausted. A total of 468 subjects with similar age and gender characteristics were enrolled, with 244 receiving the intervention and 224 in the control arm. The mean OPAT duration was similar in the two groups (3.6 days v. 3.5 days,p= 0.73). No differences in the rate for completion and therapeutic failure were observed (71% v. 68% and &lt; 1% for both, respectively). Survey response rates varied significantly: patients, 65%; nurses, 17%; and physicians, 87%. Physicians endorsed more comfort with their assessment and OPAT judgment with PD (65% and 64%, respectively). Physicians cited too much time lost with technological challenges, which would affect implementation in a busy ED.Conclusions:PD as an intervention is acceptable to patients and has reasonable endorsement by the majority of physicians. This trial had significant limitations that threatened the integrity of the study, so the results are inconclusive.
Prevalence of methicillin-resistant Staphylococcus aureus in skin and soft tissue infections in patients presenting to Canadian emergency departments
Authors: Borgundvaag Bjug , Ng Wil , Rowe Brian , Katz Kevin ,   on the behalf of EMERGency Department Emerging Infectious Disease Surveillance NeTwork (EMERGENT) Working Group
Published: July 2016

ABSTRACTBackground:Community-associated methicillin-resistantStaphylococcus aureus(MRSA) is an increasingly common cause of skin and soft tissue infection (SSTI) worldwide. The prevalence of MRSA in SSTIs across Canada has not been well described. Studies in the United States have shown significant geographic variability in the prevalence of MRSA. This study characterizes the geographic prevalence and microbiology of MRSA in patients presenting to Canadian emergency departments with SSTIs.Methods:Using a prospective, observational design, we enrolled patients with acute purulent SSTIs presenting to 17 hospital emergency departments and 2 community health centres (spanning 6 Canadian provinces) between July 1, 2008, and April 30, 2009. Eligible patients were those whose wound cultures grewS. aureus. MRSA isolates were characterized by antimicrobial susceptibility testing and pulsed-field gel electrophoresis. All patients were subjected to a structured chart audit, and patients whose wound swabs grew MRSA were contacted by telephone to gather detailed information regarding risk factors for MRSA infection, history of illness, and outcomes.Results:Of the 1,353S. aureus–positive encounters recorded, 431 (32%) grew MRSA and 922 (68%) wounds grew methicillin-susceptibleS. aureus. We observed significant variation in both the prevalence of MRSA (11–100%) and the proportion of community-associated strains of MRSA (0– 100%) across our study sites, with a significantly higher prevalence of MRSA in western Canada.Interpretation:MRSA continues to emerge across Canada, and the prevalence of MRSA in SSTIs across Canada is variable and higher than previously expected.
Ineffectiveness of cognitive forcing strategies to reduce biases in diagnostic reasoning: a
controlled trial
Authors: Sherbino Jonathan , Kulasegaram Kulamakan , Howey Elizabeth , Norman Geoffrey 
Published: July 2016

ABSTRACT

Objectives:
Cognitive forcing strategies (CFS)may reduce error arising from cognitive biases. This is the first experimental test to determine the effect of CFS training in medical students.

Methods:
Students were allocated to CFS training or control during a 4-week emergency medicine rotation (n = 191). At the end of the rotation examination, students were tested using computer-based cases. Application of CFS could enable reduction of diagnostic error, as evidenced by identifying multiple correct diagnoses for the two cases prone to search satisficing bias (SSB) and uncommon diagnoses for the two cases prone to availability bias (AB). Two “false positive” cases were included to test for possible “oversearching.”

Results:
There were 145 students in the intervention and 46 in the control group. For the SSB cases, 52% of students with CFS training and 48% in the control group initiated a search for the second diagnosis (χ2 = 0.13, df = 1, p = 0.91). More than half (54%) correctly identified the second diagnosis in the CFS group, and 48% identified it in the control group. The difference was not significant (χ2 = 2.25, df = 1, p = 0.13). For the second diagnosis in the false positive cases, 64% of the CFS group and 77% of the control group incorrectly identified it. There were no significant differences between groups (χ2 = 2.38, df = 1, p = 0.12). In the AB cases, only 45% in each group identified the uncommon correct diagnosis (χ2 = 0.001, df = 1, p = 0.98).

Conclusions:
The educational interventions suggested by experts in clinical reasoning and employed in our study to teach CFS failed to show any reduction in diagnostic error by novices.