IFEM model curriculum: emergency medicine learning outcomes for undergraduate medical education.

Background: The International Federation for Emergency Medicine (IFEM) published its model curriculum for medical student education in emergency medicine in 2009. Because of the evolving principles of emergency medicine and medical education, driven by societal, professional, and educational developments, there was a need for an update on IFEM recommendations. The main objective of the update process was creating Intended Learning Outcomes (ILOs) and providing tier-based recommendations.

Mentorship and how to conduct research: A research primer for low- and middle-income countries.

Development of a successful research program can seem daunting when looked at from the starting line. It will take years if not decades to succeed and become sustainable. It requires local partnerships and mentoring; it mandates the establishment of review boards; it requires national health policies to allow for protected time for research in salaries and for fund granting agencies to be set up; it requires training of researchers and support staff as well as a change in the mindset of clinical staff on the floor.

A Multi-mRNA Host-Response Molecular Blood Test for the Diagnosis and Prognosis of Acute Infections and Sepsis: Proceedings from a Clinical Advisory Panel.

Current diagnostics are insufficient for diagnosis and prognosis of acute infections and sepsis. Clinical decisions including prescription and timing of antibiotics, ordering of additional diagnostics and level-of-care decisions rely on understanding etiology and implications of a clinical presentation. Host mRNA signatures can differentiate infectious from noninfectious etiologies, bacterial from viral infections, and predict 30-day mortality.

Assessment of Pain Management During Interfacility Air Medical Transport of Intubated Patients.

Objective: The management of pain is an important component of care in the prehospital and transport setting. However, recent evidence suggests that pain control is infrequently achieved in these settings. The objective of the current study was to determine the proportion and frequency of opioid analgesia provided to intubated patients during interfacility transport by an air medical transport system.

Opioid Use Disorder Assessment Tools and Drug Screening.

Opioid use disorder risk assessment tools cannot be used in isolation. In combination with standardized clinical examination, and, when indicated, urine drug screening, a validated risk assessment tool, improves the ability to detect opioid misuse. Even though no single tool has been shown to have both high interobserver reliability and high sensitivity, the standardized approach has still been shown to be superior to subjective care giver assessment.

Evaluation of pain management in medical transfer of trauma patients by air.

Objectives: With regionalized trauma care, medical transport times can be prolonged, requiring paramedics to manage patient care and symptoms. Our objective was to evaluate pain management during air transport of trauma patients.

Methods: We conducted a 12-month review of electronic paramedic records from a provincial critical care transport agency.

Acute Pain Management in the Year 2018-A Review.

This review article provides an overview of acute pain management. It highlights the need to provide balanced pain care while limiting harm from opioids as per the World Health Organization (WHO) recommendations for balanced pain care. Opiophobia and its impact on the use of opioids for acute severe pain are discussed.

Analysis of h-index and other bibliometric markers of productivity and repercussion of a selected sample of worldwide emergency medicine researchers.

Objective: To explore bibliometric markers in a worldwide sample of emergency physician investigators to define global, continental and individual patterns over time.

Methods: We evaluated the number of papers published, citations received, cumulative impact factor and h-index of editorial board members of six international emergency medicine journals. We calculated the individual values for every year of each author's career to evaluate their dynamic evolution.

An Environmental Scan of Academic Emergency Medicine at the 17 Canadian Medical Schools: Why Does this Matter to Emergency Physicians?

Objective: We sought to conduct a major objective of the CAEP Academic Section, an environmental scan of the academic emergency medicine programs across the 17 Canadian medical schools.

Methods: We developed an 84-question questionnaire, which was distributed to academic heads. The responses were validated by phone by the lead author to ensure that the questions were answered completely and consistently.

Relationship between category size and journals' impact factor: implications for emergency medicine journals and researchers.

Objective: We assessed the relationship between the size of the 39 Journal Citation Reports (JCR) medical categories and impact factor (IF) of journals in these categories, and the implications that it might have for emergency medicine (EM) journals.

Materials And Methods: Using the 2010 JCR database, we calculated the mean IF, 5-year IF (5y-IF), Eigenfactor (EF), and Article Influence (AI) scores including all journals for each category. We also calculated a 'weighted IF' for all journals by dividing each journal IF by the mean IF of its category.

Premedications for infliximab infusions do not impact the risk of acute adverse drug reactions.

Objective: The purpose of this study was to identify the association of premedication with the adverse drug reaction (ADR) rate in infliximab infusions.

Design: A retrospective chart review of 684 patients who received 4077 infusions in a network of community clinics over 16.5 months.

The safety of infliximab infusions in the community setting.

Background: Tumour necrosis factor-alpha (TNFalpha) has an important role in the pathogenesis of inflammatory conditions such as rheumatoid arthritis, Crohn's disease, ulcerative colitis and psoriasis. Infliximab, a chimeric anti-TNFalpha monoclonal antibody, has been shown to reduce the severity of symptoms or induces remission of active disease. Infusions have generally been limited to the hospital setting due to cost and concerns for patient safety.

The impact on patient flow after the integration of nurse practitioners and physician assistants in 6 Ontario emergency departments.

Objective: We sought to assess the impact of the integration of the new roles of primary health care nurse practitioners (NPs) and physician assistants (PAs) on patient flow, wait times and proportions of patients who left without being seen in 6 Ontario emergency departments (EDs).

Methods: We performed a retrospective review of health records data on patient arrival time, time of initial assessment by a physician, time of discharge from the ED and discharge status.

Results: Whether a PA or NP was directly involved in the care of patients or indirectly involved by being on duty, the wait times, lengths of stay and proportion of patients who left without being seen were significantly reduced.

The influence of triage systems and triage scores on timeliness of ED analgesic administration.

Objectives: The aim of the study was to examine the association between triage scoring systems and triage priority scores on time to initial emergency department (ED) analgesic administration.

Methods: An observational, multicenter, prospective, cohort study was conducted at 20 US and Canadian EDs. Centers from the United States used the Emergency Severity Index triage system or 1 of 3 unvalidated triage systems.

The utility of multiple imaging modalities to diagnose acute aortic dissection.

A 21-year-old man with Marfan syndrome and known aortic root aneurysm presented to our emergency department with symptoms suggestive of acute aortic dissection. The patient was hemodynamically stable and bilateral upper extremity blood pressures were similar. There was no mediastinal widening on portable chest radiograph.

The application of change management principles to facilitate the introduction of nurse practitioners and physician assistants into six Ontario emergency departments.

In a project funded by the Ontario Ministry of Health and Long-Term Care, MedEmerg facilitated the introduction of three new providers into six emergency departments. A managed change process that included team development was carried out. Increased team awareness and a higher acceptance of the provider roles were some of the key successes.

Inter-observer agreement using the Canadian Emergency Department Triage and Acuity Scale.

Objective: To determine the inter-observer agreement on triage assignment by first-time users with diverse training and background using the Canadian Emergency Department Triage and Acuity Scale (CTAS).

Methods: Twenty emergency care providers (5 physicians, 5 nurses, 5 Basic Life Support paramedics and 5 Advanced Life Support paramedics) at a large urban teaching hospital participated in the study. Observers used the 5-level CTAS to independently assign triage levels for 42 case scenarios abstracted from actual emergency department patient presentations.

Perceptual reasons for resistance to change in the emergency department use of holding chambers for children with asthma.

Study Objective: We explore perceptions surrounding use of portable inhalers and holding chambers (spacers) for delivery of beta-agonist respiratory medications to children in the emergency department (ED) and factors influencing practice change.

Methods: This was a qualitative study guided by principles of grounded theory. Data were collected through focus groups and individual interviews at 2 sites in eastern Canada: Hospital A, where inhalers and holding chambers are used routinely; and Hospital B, where prevailing practice is the use of nebulization.