Foot orthosis design for children with Charcot-Marie-Tooth and impact on gait.

Background: Charcot-Marie-Tooth (CMT) is a progressive disease resulting in distal sensory deficit and muscular weakness. As the disease progresses, most children develop a cavovarus foot deformity. Foot orthoses (FO) are widely prescribed in CMT to support the foot and improve gait, but there is a lack of guidelines for their conception.

Impact of vitamin C on the reduction of opioid consumption for acute musculoskeletal pain: A double-blind randomized control pilot study.

Introduction: Recent evidence has shown that vitamin C has analgesic and opioid sparing properties in immediate postoperative context. However, this has never been studied for acute musculoskeletal (MSK) emergency department (ED) injuries. The aim of this pilot study is to evaluate the feasibility of conducting a randomized placebo-controlled study to determine the opioid sparing and analgesic effect of vitamin C compared to placebo, in acute MSK injured ED patients.

Recommendations for the effective use of T-cell-redirecting therapies: a Canadian consensus statement.

Background: T-cell-redirecting therapies, such as bispecific antibodies and chimeric antigen receptor T-cells, exploit the cytotoxic capabilities of the immune system to destroy cells expressing specific surface antigens, including malignant cells. These therapies have demonstrated unprecedented rates, depth, and duration of responses in relapsed and refractory multiple myeloma. However, there are significant challenges in implementing these therapies into practice, which require multidisciplinary and multicenter coordination and significant healthcare resources to effectively manage these patients.

The mobile seniors' clinic - an innovative transition of care for frail older adults.

Background: This study aims to evaluate the impact of Quebec's first hospital-at-home-inspired mobile Seniors' Clinic, the "Clinique des Ainés (CDA)", on frail older adults' returns to the Emergency Department (ED), mortality, and hospital Length Of Stay (LOS) and rehospitalizations.

Methods: Design: Quasi-experimental pre-post implementation cohort study.

Population: Patients aged ≥ 75 years admitted to the short-term geriatric unit after an ED consultation (control) or included by the CDA (intervention).

A Multicentre Prospective Cohort Study to Identify High-Risk Transient Ischemic Attack/Minor Stroke Patients Benefitting from Echocardiography.

Background: We aimed to derive a clinical decision rule to identify patients with transient ischemic attack (TIA) or minor stroke most likely to benefit from echocardiography.

Methods: This multicentre prospective cohort study enrolled adults diagnosed with TIA/minor stroke in the emergency department who underwent echocardiograms within 90 days, from 13 Canadian academic emergency departments from October 2006 to May 2017. Our outcome was clinically significant echocardiogram findings.

Which adults aged 65 and older are at low-risk for cervical spine injuries after low-level falls?

Objectives: The population is aging and falls are a common reason for emergency department visits. Appropriate imaging in this population is important. The objectives of this study were to estimate the prevalence of cervical spine injury and identify factors associated with cervical spine injuries in adults ≥ 65 years after low-level falls.

Derivation of a clinical prediction score for the diagnosis of clinically significant symptomatic carotid artery disease.

Objectives: Emergent vascular imaging identifies a subset of patients requiring immediate specialized care (i.e. carotid stenosis > 50%, dissection or free-floating thrombus).

Nonmedical problems among older adults visiting the emergency department for low acuity conditions: A prospective multicentre cohort study.

Background: Data on the predictors of nonmedical problems (NMP) in older adults attending the emergency department (ED) for low acuity conditions is lacking and could help rapid identification of patients with NMP and integration of these needs into care planning.

Objectives: To determine the prevalence and predictors of NMP among older adults attending EDs for low acuity conditions.

Methods: Prospective cohort study in eight EDs (May-August 2021).

Opioid prescribing requirements to minimize unused medications after an emergency department visit for acute pain: a prospective cohort study.

Background: Unused opioid prescriptions can be a driver of opioid misuse. Our objective was to determine the optimal quantity of opioids to prescribe to patients with acute pain at emergency department discharge, in order to meet their analgesic needs while limiting the amount of unused opioids.

Methods: In a prospective, multicentre cohort study, we included consecutive patients aged 18 years and older with an acute pain condition present for less than 2 weeks who were discharged from emergency department with an opioid prescription.

Derivation of the Quebec Brain Injury Categories for complicated mild traumatic brain injuries.

Objective: Approximately 10% of patients with mild traumatic brain injury (TBI) present with intracranial bleeding, and only 3.5% eventually require neurosurgical intervention, which often necessitates interhospital transfer. Better guidelines and recommendations are needed to manage complicated mild TBI in the emergency department (ED).

Identification and Management of Pelvic Fractures in Prehospital and Emergency Department Settings.

Introduction: This study aims to describe the characteristics of patients with a pelvic fracture treated at a level 1 trauma center, the proportion of prehospital undertriage and the use of pelvic circumferential compression device (PCCD).

Methods: This is a retrospective cohort study. Prehospital and inhospital medical records of adults (≥16 y old) with a pelvic fracture who were treated at Hopital de l'Enfant-Jesus-CHU de Québec (Quebec City, Canada), a university-affiliated level 1 trauma center, between September 01, 2017 and September 01, 2021 were reviewed.

Association Between Frailty and Head Impact Location After Ground-Level Fall in Older Adults.

Background: Mild traumatic brain injuries (TBIs) are highly prevalent in older adults, and ground-level falls are the most frequent mechanism of injury.

Objective: This study aimed to assess whether frailty was associated with head impact location among older patients who sustained a ground-level fall-related, mild TBI. The secondary objective was to measure the association between frailty and intracranial hemorrhages.

Emergency physician gender and head computed tomography orders for older adults who have fallen.

Objective: Physicians vary in their computed tomography (CT) scan usage. It remains unclear how physician gender relates to clinical practice or patient outcomes. The aim of this study was to assess the association between physician gender and decision to order head CT scans for older emergency patients who had fallen.

Challenges and facilitators in the experience of caregiving for an older adult with traumatic brain injury: A longitudinal qualitative study in the first-year postinjury.

Purpose: To obtain a better understanding of the factors which complicate or facilitate the adjustment of caregivers after traumatic brain injury (TBI) in older adults.

Research Method: At 4, 8, and 12 months post-TBI (mild to severe), 65 caregivers answered two open-ended questions regarding facilitators and challenges linked to the injury of their loved one. A thematic analysis was performed.

Predictors of adverse outcomes in elders hospitalised for isolated orthopaedic trauma: a multicentre cohort study.

Background: Patients >64 years of age now represent more than 51% of injury hospitalisations in Canada. The tools used to identify older patients who could benefit the most from an interdisciplinary approach include complex parameters difficult to collect in the ED, which suggests that better tools with higher accuracy and using items that can be derived from routinely collected data are needed. We aimed to identify variables that are associated with adverse outcomes in older patients admitted to a trauma centre for an isolated orthopaedic injury.

Transitions of care for older adults discharged home from the emergency department: an inductive thematic content analysis of patient comments.

Objective: Improving care transitions for older adults can reduce emergency department (ED) visits, adverse events, and empower community autonomy. We conducted an inductive qualitative content analysis to identify themes emerging from comments to better understand ED care transitions.

Methods: The LEARNING WISDOM prospective longitudinal observational cohort includes older adults (≥ 65 years) who experienced a care transition after an ED visit from both before and during COVID-19.

Derivation of the Falls Decision Rule to exclude intracranial bleeding without head CT in older adults who have fallen.

Background: Ground-level falls are common among older adults and are the most frequent cause of traumatic intracranial bleeding. The aim of this study was to derive a clinical decision rule that safely excludes clinically important intracranial bleeding in older adults who present to the emergency department after a fall, without the need for a computed tomography (CT) scan of the head.

Methods: This prospective cohort study in 11 emergency departments in Canada and the United States enrolled patients aged 65 years or older who presented after falling from standing on level ground, off a chair or toilet seat, or out of bed.

Evaluation of physicians' current practices and awareness regarding the treatment of acute uncomplicated diverticulitis: results of a provincial survey.

Objective: International guidelines now recommend nonantibiotic treatment of uncomplicated diverticulitis. We assessed physicians' current management strategies for uncomplicated diverticulitis, their awareness of the updated recommendations, and barriers to practice change.

Methods: A 21-question web-based survey conducted between 09/2022 and 11/2022 was sent to participants through their respective Quebec provincial associations or working groups.

Lack of association between four biomarkers and persistent post-concussion symptoms after a mild traumatic brain injury.

Approximately 15 % of individuals who sustained a mild Traumatic Brain Injury (TBI) develop persistent post-concussion symptoms (PPCS). We hypothesized that blood biomarkers drawn in the Emergency Department (ED) could help predict PPCS. The main objective of this project was to measure the association between four biomarkers and PPCS at 90 days post mild TBI.

Level of implementation of pain management and early mobilization strategies to prevent delirium in geriatric trauma patients: A mixed-methods study.

Background: Pain management and early mobilization strategies are recommended in clinical practice guidelines for the prevention of delirium in older adults. However, available data on the implementation of these strategies in trauma are limited.

Aims: To describe the use of pain management and early mobilization strategies in older adults at a level I trauma center, as well as the facilitators and barriers to their implementation.