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Despite the fact that topical anesthetics provide superb analgesia to the painful eye, they are not prescribed routinely to patients when they are discharged from the emergency department because of concerns for delayed healing and... more
Despite the fact that topical anesthetics provide superb analgesia to the painful eye, they are not prescribed routinely to patients when they are discharged from the emergency department because of concerns for delayed healing and corneal erosion. To summarize the evidence for the safety of topical proparacaine and tetracaine for pain relief in patients with corneal abrasions. This is a systematic review looking at the use of topical anesthetic agents in the treatment of corneal abrasions in the emergency department. Our literature search produced two emergency department-based, randomized, double blind, placebo-controlled studies on human patients with corneal abrasions. Additionally, we found four studies that investigated the application of topical anesthetics in patients who underwent photorefractive keratectomy. All six studies demonstrated that a short course of dilute topical anesthetic provided efficacious analgesia without adverse effects or delayed epithelial healing. Limited available data suggests that the use of dilute topical ophthalmologic proparacaine or tetracaine for a short duration of time is effective, though their safety for outpatient use is inconclusive.
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ObjectivesAlteplase is commonly recommended for acute ischaemic stroke within 4.5 hours after stroke onset. The Third European Cooperative Acute Stroke Study (ECASS III) is the only trial reporting statistically significant efficacy for... more
ObjectivesAlteplase is commonly recommended for acute ischaemic stroke within 4.5 hours after stroke onset. The Third European Cooperative Acute Stroke Study (ECASS III) is the only trial reporting statistically significant efficacy for clinical outcomes for alteplase use 3–4.5 hours after stroke onset. However, baseline imbalances in history of prior stroke and stroke severity score may confound this apparent finding of efficacy. We reanalysed the ECASS III trial data adjusting for baseline imbalances to determine the robustness or sensitivity of the efficacy estimates.DesignReanalysis of randomised placebo-controlled trial. We obtained access to the ECASS III trial data and replicated the previously reported analyses to confirm our understanding of the data. We adjusted for baseline imbalances using multivariable analyses and stratified analyses and performed sensitivity analysis for missing data.SettingEmergency care.Participants821 adults with acute ischaemic stroke who could be...
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Introduction: A rapid and accurate weight of a child can be of critical importance during pediatric emergencies. The Broselow Tape (BT) is the gold standard for estimating a child’s weight based on their length. It separates children into... more
Introduction: A rapid and accurate weight of a child can be of critical importance during pediatric emergencies. The Broselow Tape (BT) is the gold standard for estimating a child’s weight based on their length. It separates children into incremental weight categories. Studies have shown that the BT is not accurate. We created a new pediatric spine board (PedEBoard) that weighs the child. The objective of this study was to compare the agreement between the actual weight vs. the PedEBoard weight and BT estimated weight of children presenting to a pediatric emergency department (ED). Methods: Ethics approval was obtained from McMaster University. A power calculation was done for sample size to detect 10% error. Consecutive children were recruited who presented to McMaster University’s Children’s ED on two days in March 2015. Children were excluded if their length was outside the BT range, non-English speaking or critically ill. Children had their weight taken by the triage nurse eithe...
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Dear Editor We read with interest the article by Grundlingh, Harris and Carley on #FOAM in the October issue of EMJ .1 The authors did a good job covering the subject and providing a list of FOAMed resources. Social media is turning... more
Dear Editor We read with interest the article by Grundlingh, Harris and Carley on #FOAM in the October issue of EMJ .1 The authors did a good job covering the subject and providing a list of FOAMed resources. Social media is turning medical education on its head. The top down, 20th century, didactic method of knowledge translation is being replaced by online resources that are timely, articulate, interactive and widely distributed. The …
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Research Interests: Emergency Medicine, Evidence Based Medicine, Social Media, Survival Analysis, Risk assessment, and 13 moreMedicine, Canada, Humans, Female, Male, Glasgow Coma Scale, Systematic review, Clinical Sciences, Risk Assessment, Hospital Mortality, Injury Severity Score, Randomized Controlled Trials as Topic, and Outcome assessment (Health care)
Introduction: The CJEM Social Media Team was created in 2014 to assist the journal with the dissemination of its research online. It consists of two Social Media Editors (Junior and Senior) and a team of volunteer medical students and... more
Introduction: The CJEM Social Media Team was created in 2014 to assist the journal with the dissemination of its research online. It consists of two Social Media Editors (Junior and Senior) and a team of volunteer medical students and residents to assist their work. Collaborative promotional agreements were developed to promote CJEM articles on the Skeptics’ Guide to Emergency Medicine (SGEM) podcast through the ‘Hot off the Press’ (HOP) series and the CanadiEM blog through an infographic series. Methods: CJEM papers were selected for promotion by the Team based on their perceived interest to the online community of emergency physicians. Altmetric scores, which are a measure of online dissemination derived from a weighted algorithm of social media metrics, were collated for articles promoted using the SGEM HOP or CanadiEM blogs. A control group was created using the articles with the top two Altmetric scores in each CJEM issue in 2015 and 2016. Erratum, Letters, and articles written...
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This study identified the most important quality indicators for online educational resources such as blogs and podcasts. A modified Delphi process that included 2 iterative surveys was used to build expert consensus on a previously... more
This study identified the most important quality indicators for online educational resources such as blogs and podcasts. A modified Delphi process that included 2 iterative surveys was used to build expert consensus on a previously defined list of 151 quality indicators divided into 3 themes: credibility, content, and design. Aggregate social media indicators were used to identify an expert population of editors from a defined list of emergency medicine and critical care blogs and podcasts. Survey 1 consisted of the quality indicators and a 7-point Likert scale. The mean score for each quality indicator was included in survey 2, which asked participants whether to "include" or "not include" each quality indicator. The cut point for consensus was defined at greater than 70% "include." Eighty-three percent (20/24) of bloggers and 90.9% (20/22) of podcasters completed survey 1 and 90% (18/20) of bloggers and podcasters completed survey 2. The 70% inclusion...
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Dear Editor We read with interest the article by Grundlingh, Harris and Carley on #FOAM in the October issue of EMJ .1 The authors did a good job covering the subject and providing a list of FOAMed resources. Social media is turning... more
Dear Editor We read with interest the article by Grundlingh, Harris and Carley on #FOAM in the October issue of EMJ .1 The authors did a good job covering the subject and providing a list of FOAMed resources. Social media is turning medical education on its head. The top down, 20th century, didactic method of knowledge translation is being replaced by online resources that are timely, articulate, interactive and widely distributed. The …
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Objective: The Canadian Emergency Cardiac Care Coalition, the American Heart Association and similar groups have established a benchmark for the administration of thrombolytics in acute myocardial infarction (AMI) care as a door-to-needle... more
Objective: The Canadian Emergency Cardiac Care Coalition, the American Heart Association and similar groups have established a benchmark for the administration of thrombolytics in acute myocardial infarction (AMI) care as a door-to-needle (DTN) time of 30 minutes or less. Previous research suggests that this goal is not being achieved in Canada. The purpose of this study was to determine whether the target DTN time of 30 minutes or less for thrombolysis could be met in 2 rural Ontario emergency departments (EDs). Methods: We conducted a retrospective chart review and obtained descriptive data for each case, including demographic information and the Canadian Emergency Department Triage and Acuity Scale (CTAS) score. Visit timeline data were also collected and included the time during which patients saw a physician, had an electrocardiogram (ECG), received thrombolytic therapy and were discharged from the ED. Relevant time intervals, such as the median DTN time, were calculated. Resul...
Research Interests: Emergency Medicine, Medicine, Electrocardiography, Humans, Female, and 14 moreMale, Ontario, Clinical Sciences, Aged, Middle Aged, Myocardial Infarction, Adult, Time Factors, Retrospective Studies, Time and Motion Studies, Emergency Department, Thrombolytic Therapy, Patient discharge, and Thrombolysis
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1. Am J Obstet Gynecol. 1988 Dec;159(6):1418-24. Circulatory responses to prolonged hypoxemia in fetal sheep. Bocking AD, Gagnon R, White SE, Homan J, Milne KM, Richardson BS. Department of Obstetrics/Gynaecology, University of Western... more
1. Am J Obstet Gynecol. 1988 Dec;159(6):1418-24. Circulatory responses to prolonged hypoxemia in fetal sheep. Bocking AD, Gagnon R, White SE, Homan J, Milne KM, Richardson BS. Department of Obstetrics/Gynaecology, University of Western Ontario, London, Canada. ...
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Online educational resources such as blogs are increasingly used for education by emergency medicine clinicians. The Social Media Index was developed to quantify their relative impact. The Medical Education Translational Resources:... more
Online educational resources such as blogs are increasingly used for education by emergency medicine clinicians. The Social Media Index was developed to quantify their relative impact. The Medical Education Translational Resources: Indicators of Quality (METRIQ) study was conducted in part to determine the association between the Social Media Index score and quality as measured by gestalt and previously derived quality instruments. Ten blogs were randomly selected from a list of emergency medicine and critical care Web sites. The 2 most recent clinically oriented blog posts published on these blogs were evaluated with gestalt, the Academic Life in Emergency Medicine Approved Instructional Resources (ALiEM AIR) score, and the METRIQ-8 score. Volunteer raters (including medical students, emergency medicine residents, and emergency medicine attending physicians) were identified with a multimodal recruitment methodology. The Social Media Index was calculated in February 2016, November 2...
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In 2015 and 2016, the Canadian Journal of Emergency Medicine (CJEM) Social Media (SoMe) Team collaborated with established medical websites to promote CJEM articles using podcasts and infographics while tracking dissemination and... more
In 2015 and 2016, the Canadian Journal of Emergency Medicine (CJEM) Social Media (SoMe) Team collaborated with established medical websites to promote CJEM articles using podcasts and infographics while tracking dissemination and readership. CJEM publications in the "Original Research" and "State of the Art" sections were selected by the SoMe Team for podcast and infographic promotion based on their perceived interest to emergency physicians. A control group was composed retrospectively of articles from the 2015 and 2016 issues with the highest Altmetric score that received standard Facebook and Twitter promotions. Studies on SoMe topics were excluded. Dissemination was quantified by January 1, 2017 Altmetric scores. Readership was measured by abstract and full-text views over a 3-month period. The number needed to view (NNV) was calculated by dividing abstract views by full-text views. Twenty-nine of 88 articles that met inclusion were included in the podcast (6...
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Open educational resources such as blogs are increasingly used for medical education. Gestalt is generally the evaluation method used for these resources; however, little information has been published on it. We aim to evaluate the... more
Open educational resources such as blogs are increasingly used for medical education. Gestalt is generally the evaluation method used for these resources; however, little information has been published on it. We aim to evaluate the reliability of gestalt in the assessment of emergency medicine blogs. We identified 60 English-language emergency medicine Web sites that posted clinically oriented blogs between January 1, 2016, and February 24, 2016. Ten Web sites were selected with a random-number generator. Medical students, emergency medicine residents, and emergency medicine attending physicians evaluated the 2 most recent clinical blog posts from each site for quality, using a 7-point Likert scale. The mean gestalt scores of each blog post were compared between groups with Pearson's correlations. Single and average measure intraclass correlation coefficients were calculated within groups. A generalizability study evaluated variance within gestalt and a decision study calculated the number of raters required to reliably (>0.8) estimate quality. One hundred twenty-one medical students, 88 residents, and 100 attending physicians (93.6% of enrolled participants) evaluated all 20 blog posts. Single-measure intraclass correlation coefficients within groups were fair to poor (0.36 to 0.40). Average-measure intraclass correlation coefficients were more reliable (0.811 to 0.840). Mean gestalt ratings by attending physicians correlated strongly with those by medical students (r=0.92) and residents (r=0.99). The generalizability coefficient was 0.91 for the complete data set. The decision study found that 42 gestalt ratings were required to reliably evaluate quality (>0.8). The mean gestalt quality ratings of blog posts between medical students, residents, and attending physicians correlate strongly, but individual ratings are unreliable. With sufficient raters, mean gestalt ratings provide a community standard for assessment.
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As part of the Canadian Journal of Emergency Medicine's (CJEM) developing social media strategy, 1 we are collaborating with the Skeptics' Guide to Emergency Medicine (SGEM) to summarize and critically appraise the current... more
As part of the Canadian Journal of Emergency Medicine's (CJEM) developing social media strategy, 1 we are collaborating with the Skeptics' Guide to Emergency Medicine (SGEM) to summarize and critically appraise the current emergency medicine (EM) literature using evidence-based medicine principles. In the "Hot Off the Press" series, we select original research manuscripts published in CJEM to be featured on the SGEM website/podcast 2 and discussed by the study authors and the online EM community. A similar collaboration is underway between the SGEM and Academic Emergency Medicine. What follows is a summary of the selected article the immediate post-publication synthesis from the SGEM podcast, commentary by the first author, and the subsequent discussion from the SGEM blog and other social media. Through this series, we hope to enhance the value, accessibility, and application of important, clinically relevant EM research. In this, the third SGEM HOP hosted collabor...
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The Canadian Association of Emergency Physicians (CAEP) published a position statement in 2006 encouraging immediate access to emergency medicine ultrasonography (EMUS) 24 hours a day, 7 days a week. However, barriers to advanced imaging... more
The Canadian Association of Emergency Physicians (CAEP) published a position statement in 2006 encouraging immediate access to emergency medicine ultrasonography (EMUS) 24 hours a day, 7 days a week. However, barriers to advanced imaging care still exist in many rural hospitals. Our study investigated the current availability of EMUS in rural communities and physicians' ability to use this technology. A literature review and interviews with rural physicians were conducted in the summer of 2010 to design a questionnaire focusing on EMUS. The survey was then sent electronically or via regular mail in November 2010 to all Ontario physicians self-identified as "rural." Descriptive statistics and the Fisher exact test were used to analyze the data. A total of 207 rural physicians responded to the survey (response rate 28.6%). Of the respondents, 70.9% were male, median age was 49 years and median year of graduation was 1988. The respondents had been in practice for a median of 20 years and had been in their present community for a median of 15 years. More than two-thirds of physicians (69.5%) practised in communities with populations of less than 10 000. Nearly three-quarters (72.6%) worked in a rural emergency department (ED). Almost all (96.9%) reported having access to ultrasonography in the hospital. However, only 60.6% had access to ultrasonography in the ED. Less than half (44.4%) knew how to perform ultrasonography, with 77.3% citing lack of training. Of those using EMUS, 32.5% were using it at least once per shift. The most common reason to use EMUS was to rule out abdominal aortic aneurysm (58.3%). Most respondents (71.5%) agreed or strongly agreed that EMUS is a skill that all rural ED physicians should have. Patients in many rural EDs do not have immediate access to EMUS, as advocated by CAEP. This gap in care needs to be addressed to ensure that all patients, no matter where they live, have access to this proven imaging modality.
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Vision health is recognized as a critical unmet need in North America. The ocular morbidity associated with glaucoma results from increased intraocular pressure (IOP) and early detection is crucial for the management of glaucoma. Our... more
Vision health is recognized as a critical unmet need in North America. The ocular morbidity associated with glaucoma results from increased intraocular pressure (IOP) and early detection is crucial for the management of glaucoma. Our objective was to find a diagnostically accurate screening tool for intraocular hypertension that can be used in rural communities. We sought to validate the diagnostic accuracy of the iCare rebound tonometer against the gold standard Perkins applanation tonometer (PAT) in measuring IOP.Patients from two rural communities in Ontario, Canada visiting their optometrists for routine appointments had their IOP measured by a non-contact tonometer (NCT), an iCare rebound tonometer, and a Perkins applanation tonometer (PAT). Values of sensitivity, specificity, and likelihood ratios for a positive and negative result were calculated for the iCare and the NCT.Complete data was collected from 209 patients. Overall, the iCare tonometer had high levels of validity, ...
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Despite the fact that topical anesthetics provide superb analgesia to the painful eye, they are not prescribed routinely to patients when they are discharged from the emergency department because of concerns for delayed healing and... more
Despite the fact that topical anesthetics provide superb analgesia to the painful eye, they are not prescribed routinely to patients when they are discharged from the emergency department because of concerns for delayed healing and corneal erosion. To summarize the evidence for the safety of topical proparacaine and tetracaine for pain relief in patients with corneal abrasions. This is a systematic review looking at the use of topical anesthetic agents in the treatment of corneal abrasions in the emergency department. Our literature search produced two emergency department-based, randomized, double blind, placebo-controlled studies on human patients with corneal abrasions. Additionally, we found four studies that investigated the application of topical anesthetics in patients who underwent photorefractive keratectomy. All six studies demonstrated that a short course of dilute topical anesthetic provided efficacious analgesia without adverse effects or delayed epithelial healing. Limited available data suggests that the use of dilute topical ophthalmologic proparacaine or tetracaine for a short duration of time is effective, though their safety for outpatient use is inconclusive.
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The World Health Organization declared an influenza H1N1 global pandemic in June 2009, which resulted in a great deal of research. However, no studies have been published on incidence, characteristics and impact in rural emergency... more
The World Health Organization declared an influenza H1N1 global pandemic in June 2009, which resulted in a great deal of research. However, no studies have been published on incidence, characteristics and impact in rural emergency departments (EDs). Data were gathered from two rural EDs located in Southwestern Ontario. A retrospective chart review was performed on all visits to the hospitals' EDs with ICD-10 codes relating to influenza-like illnesses (ILI). The chart review periods were 1 September 2009 to 1 January 2010 for the H1N1 study group and 1 September 2008 to 1 January 2009 for the control group. There were 546 cases of ILI during the H1N1 pandemic period out of 8339 total ED visits (6.5%). This was a 4.1 fold increase from the previous year when 132 cases of ILI were identified out of 8125 ED visits (1.6%). Half the cases of ILI that presented during the H1N1 pandemic occurred in patients aged 1 to 20 years, a proportion significantly larger during the pandemic compar...
Research Interests: Nursing, Rural & Remote Health, Adolescent, Humans, Child, and 15 moreInfant, Incidence, Ontario, Patient Admission, Length of Stay, Aged, Middle Aged, International Classification of Diseases, Adult, Time Factors, Pandemics, Hospital Mortality, Rural Health Services, Severity of Illness Index, and Child preschool
To assess the change in frequency and methods with which a pilot group of rural physicians consulted on-line medical resources before and after an educational intervention. Physicians were randomly assigned to an educational intervention... more
To assess the change in frequency and methods with which a pilot group of rural physicians consulted on-line medical resources before and after an educational intervention. Physicians were randomly assigned to an educational intervention or control group. Self-administered questionnaires were completed before and 3 months after the intervention. Rural practices in southwestern Ontario. Eighty rural (defined as a population of 15000 or less) physicians in southwestern Ontario, with a computer with Internet access. Individualized 3-hour training session on using the World Wide Web to research patient-related questions. Frequency of access and comfort with on-line medical information were compared after intervention with baseline data using the Wilcoxon two-sample test. At follow up, the intervention group showed a significant improvement over the control group in their frequency of accessing the World Wide Web to address patient-related questions (P = .009), in their comfort level in ...
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This guideline defines the standards pertaining to the application and documentation of fetal surveillance in labour that will decrease the incidence of birth asphyxia while maintaining the lowest possible rate of obstetrical... more
This guideline defines the standards pertaining to the application and documentation of fetal surveillance in labour that will decrease the incidence of birth asphyxia while maintaining the lowest possible rate of obstetrical intervention. Both high- and low-risk obstetrical populations are considered. It is intended that this guideline could be used by all persons providing intrapartum care in Canada, including nurses, physicians, and midwives. Consideration has been given to methods of fetal surveillance currently available in Canada, including intermittent auscultation, electronic fetal monitoring (alone and when paired with vibro-acoustic or scalp stimulation and fetal scalp blood sampling), the "admission strip," computerized heart rate analysis, fetal oxygen saturation monitoring, fetal electrocardiogram analysis, and near-infrared spectroscopy. Short- and long-term outcomes were considered that may indicate the presence of birth asphyxia. The associated rates of ope...
Research Interests: Algorithms, Obstetrics, Research Design, Evidence Based Medicine, Forecasting, and 15 moreElectrocardiography, Decision Trees, Pregnancy, Humans, Near Infrared Spectroscopy, Female, Newborn Infant, Oximetry, Blood gas analysis, Asphyxia neonatorum, Fetal Distress, auscultation, Fetal Monitoring, Patient selection, and Paediatrics and reproductive medicine
As part of the Canadian Journal of Emergency Medicine’s (CJEM) developing social media strategy,1 we are collaborating with the Skeptics’ Guide to Emergency Medicine (SGEM) to summarize and critically appraise the current emergency... more
As part of the Canadian Journal of Emergency Medicine’s (CJEM) developing social media strategy,1 we are collaborating with the Skeptics’ Guide to Emergency Medicine (SGEM) to summarize and critically appraise the current emergency medicine (EM) literature using evidence-based medicine principles. In the “Hot Off the Press” series, we select original research manuscripts published in CJEM to be featured on the SGEM website/podcast and discussed by the study authors and the online EM community. A similar collaboration is under way between the SGEM and Academic Emergency Medicine. What follows is a summary of the selected article, the immediate post-publication synthesis from the SGEM podcast, commentary by the first author, and the subsequent discussion from the SGEM blog and other social media. Through this series, we hope to enhance the value, accessibility, and application of important, clinically relevant EM research. In this, the second SGEM HOP hosted collaboratively with CJEM,...
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INTRODUCTION: Pulmonary embolism (PE) is a serious condition with mortality estimates of up to 10%. We sought to investigate the diagnosis of PE, time to access imaging and diagnostic utility of each modality in a rural emergency... more
INTRODUCTION: Pulmonary embolism (PE) is a serious condition with mortality estimates of up to 10%. We sought to investigate the diagnosis of PE, time to access imaging and diagnostic utility of each modality in a rural emergency department (Ed).METHODS: We completed a retrospective chart review to determine the investigations performed and treatments initiated in the management of suspected PE in a rural hospital.RESULTS: A total of 47 charts from a 5-year period were reviewed. Of these, 83.0% indicated a D-dimer test was ordered, and 31.9% and 40.4% indicated either ventilation-perfusion (V/Q) or computed tomography (CT) were ordered during the ED visit. Computed tomography diagnosed 11 of the 12 instances of confirmed PE. Mean time to patients undergoing V/Q or CT was 1.58 and 1.59 days, respectively. Low-molecular-weight heparin was started in 83.0% of patients.CONCLUSION: In this ED there may be over reliance on the D-dimer test, irrespective of Wells score. Access to V/Q and CT were similar to that of an urban centre. Empiric anticoagulation was started in most patients.© 2012 Society of Rural Physicians of Canada
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This Committee Opinion outlines the guiding principles and a format for the physician who is requested to provide a peer opinion for a medico-legal case. The format allows for completeness, uniformity, and consistency in the preparation... more
This Committee Opinion outlines the guiding principles and a format for the physician who is requested to provide a peer opinion for a medico-legal case. The format allows for completeness, uniformity, and consistency in the preparation of expert opinions given in medico-legal cases. This Committee Opinion outlines the different elements that should enable lawyers and the courts to assess the
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Several agents can be administered during procedural sedation and analgesia (PSA) in the emergency department (ED). The purpose of this study was to determine the PSA agents commonly used by physicians working in nontertiary EDs, and to... more
Several agents can be administered during procedural sedation and analgesia (PSA) in the emergency department (ED). The purpose of this study was to determine the PSA agents commonly used by physicians working in nontertiary EDs, and to assess the physicians' comfort level administering the agents as well as their knowledge of adverse effects of the agents. We distributed a confidential electronic survey to physicians working in nontertiary EDs in southwestern Ontario. Using a 5-point Likert scale, ED physicians were asked to rate their use of older and newer agents used for PSA in the ED, as well as their familiarity with the agents. A total of 55 physicians completed the survey. The most frequently used drugs were fentanyl (66.0% often or always) and propofol with fentanyl (59.2% often or always). Most respondents stated that they rarely used ketofol (54.2% rarely or never) or etomidate (77.1% rarely or never). Respondents were most comfortable using midazolam or fentanyl (96....
Research Interests: Humans, Female, Male, Analgesia, Ontario, and 4 moreQuestionnaires, Adult, Analgesics, and Conscious Sedation
The Canadian Association of Emergency Physicians (CAEP) published a position statement in 2006 encouraging immediate access to emergency medicine ultrasonography (EMUS) 24 hours a day, 7 days a week. However, barriers to advanced imaging... more
The Canadian Association of Emergency Physicians (CAEP) published a position statement in 2006 encouraging immediate access to emergency medicine ultrasonography (EMUS) 24 hours a day, 7 days a week. However, barriers to advanced imaging care still exist in many rural hospitals. Our study investigated the current availability of EMUS in rural communities and physicians' ability to use this technology. A literature review and interviews with rural physicians were conducted in the summer of 2010 to design a questionnaire focusing on EMUS. The survey was then sent electronically or via regular mail in November 2010 to all Ontario physicians self-identified as "rural." Descriptive statistics and the Fisher exact test were used to analyze the data. A total of 207 rural physicians responded to the survey (response rate 28.6%). Of the respondents, 70.9% were male, median age was 49 years and median year of graduation was 1988. The respondents had been in practice for a median...
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The Broselow Pediatric Emergency Tape (Armstrong Medical Industries, Inc., Lincolnshire, IL) (BT) is a well-established length-based tool for estimation of body weight for children during resuscitation. In view of pandemic childhood... more
The Broselow Pediatric Emergency Tape (Armstrong Medical Industries, Inc., Lincolnshire, IL) (BT) is a well-established length-based tool for estimation of body weight for children during resuscitation. In view of pandemic childhood obesity, the BT may no longer accurately estimate weight. We therefore studied the BT in children from Ontario in a large recent patient cohort. Actual height and weight were obtained from an urban and a rural setting. Children were prospectively recruited between April 2007 and July 2008 from the emergency department and outpatient clinics at the London Health Science Centre. Rural children from junior kindergarten to grade 4 were also recruited in the spring of 2008 from the Avon Maitland District School Board. Data for preschool children were obtained from three daycare centres and the electronic medical record from the Maitland Valley Medical Centre. The predicted weight from the BT was compared to the actual weight using Spearman rank correlation; a...
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Pulmonary embolism (PE) is a serious condition with mortality estimates of up to 10%. We sought to investigate the diagnosis of PE, time to access imaging and diagnostic utility of each modality in a rural emergency department (Ed). We... more
Pulmonary embolism (PE) is a serious condition with mortality estimates of up to 10%. We sought to investigate the diagnosis of PE, time to access imaging and diagnostic utility of each modality in a rural emergency department (Ed). We completed a retrospective chart review to determine the investigations performed and treatments initiated in the management of suspected PE in a rural hospital. A total of 47 charts from a 5-year period were reviewed. Of these, 83.0% indicated a D-dimer test was ordered, and 31.9% and 40.4% indicated either ventilation-perfusion (V/Q) or computed tomography (CT) were ordered during the ED visit. Computed tomography diagnosed 11 of the 12 instances of confirmed PE. Mean time to patients undergoing V/Q or CT was 1.58 and 1.59 days, respectively. Low-molecular-weight heparin was started in 83.0% of patients. In this ED there may be over reliance on the D-dimer test, irrespective of Wells score. Access to V/Q and CT were similar to that of an urban centre...