CJEM
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Multicenter Study
Predictors of delirium in older patients at the emergency department: a prospective multicentre derivation study.
The objective of this study was to identify the predictors of incident delirium in this high-risk population. ⋯ More work is needed to determine which tool(s) are most appropriate for the ED use to increase delirium screening compliance among health professionals working in this department. It is really the first step to be able to suggest interventions to decrease delirium incidence.
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Randomized Controlled Trial
Predictors of persistent concussion symptoms in adults with acute mild traumatic brain injury presenting to the emergency department.
To identify risk factors associated with persistent concussion symptoms in adults presenting to the emergency department (ED) with acute mild traumatic brain injury (TBI). ⋯ Five variables were found to be significant predictors of persistent concussion symptoms. Although mild TBI is mostly a self-limited condition, patients with these risk factors should be considered high risk for developing persistent concussion symptoms and flagged for early outpatient follow-up.
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Acute atrial flutter has one-tenth the prevalence of acute atrial fibrillation in the emergency department (ED) but shares many management strategies. Our aim was to compare conversion from acute atrial flutter to sinus rhythm between pharmacological cardioversion followed by electrical cardioversion (Drug-Shock), and electrical cardioversion alone (Shock-Only). ⋯ This trial found that the Drug-Shock strategy is potentially superior but that either approach to immediate rhythm control in the ED for patients with acute acute atrial flutter is highly effective, rapid, and safe in restoring sinus rhythm and allowing patients to go home and return to normal activities. Unlike the case of atrial fibrillation, we found that IV procainamide alone was infrequently effective.
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We sought to compare the ability of the prehospital Canadian C-Spine Rule to selectively recommend immobilization in sport-related versus non-sport-related injuries and describe sport-related mechanisms of injury. ⋯ Although equal proportions of sport and non-sport-related injuries were immobilized, a dangerous mechanism was most often responsible for immobilization in sport-related cases. These findings do not address the potential impact of using the Canadian C-Spine Rule to evaluate collegiate or pro athletes assessed by sport medicine physicians. It does support using the Canadian C-Spine Rule as a tool in sport-injured patients assessed by paramedics.
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We implemented a novel transition-to-practice curriculum incorporating four new processes to prepare CCFP(EM) residents for independent practice. These elements were: 1) explicit sequencing of competency progression; 2) establishment of coaching teams; 3) establishment of independent shifts; and 4) implementation of a transition-to-practice seminar series. ⋯ All residents rated competency progression, coaching teams, independent shifts and transition-to-practice series favourably. This framework can be used by other 1-year enhanced skills or other fellowship programs to prepare their residents for independent practice.