Can J Emerg Med
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Randomized Controlled Trial
Emergency physicians as human billboards for injury prevention: a randomized controlled trial.
The objective of this study was to evaluate the impact of a novel injury prevention intervention designed to prompt patients to initiate an injury prevention discussion with the ED physician, thus enabling injury prevention counselling and increasing bicycle helmet use among patients. ⋯ Our study showed that the intervention did not increase physician injury prevention counselling or self-reported bicycle helmet use rates among patients. Given the study limitations, replication and extension of the intervention is warranted.
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Comparative Study
Comparison of trimethoprim-sulfamethoxazole versus placebo for uncomplicated skin abscesses.
Clinical question In patients with uncomplicated abscesses receiving incision and drainage, does the addition of trimethoprim-sulfamethoxazole result in improved clinical resolution at 7 to 14 days after treatment when compared with placebo? Article chosen Talan DA, Mower WR, Krishnadasan A, et al. Trimethoprim-sulfamethoxazole versus placebo for uncomplicated skin abscess. N Engl J Med 2016;374(9):823-32.
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Choosing Wisely Canada (CWC) is an initiative to encourage patient-physician discussions about the appropriate, evidence based use of medical tests, procedures and treatments. We present the Canadian Association of Emergency Physicians' (CAEP) top five list of recommendations, and the process undertaken to generate them. ⋯ The CWC recommendations for emergency medicine were selected using a mixed methods approach. This top 5 list was released at the CAEP Conference in June 2015 and should form the basis for future implementation efforts.
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Approximately 4.3 million Canadians are without a primary care physician, of which 13% choose the emergency department (ED) as their regular access point to health care. We sought to identify factors associated with preferential ED use over other health services. We hypothesized that socioeconomic barriers (i.e., employment, health status, education) to primary care would also prevent access to ED alternatives. ⋯ Low socioeconomic status dictates preferential ED use in those without a primary care physician. Specific policy and system development targeting this at-risk population are indicated to alter ED use patterns in this population.
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Because abnormal vital signs indicate the potential for clinical deterioration, it is logical to make emergency physicians immediately aware of those patients who present with abnormal vital signs. ⋯ In our study, the implementation of an ED clinical triggers program did not result in a significant change in measured inpatient outcomes.