System Configuration Evaluation for a Province-Wide Clinical Information System Using the eSafety Checklist.

Background: According to Digital Health Canada 2013 eSafety Guidelines, an estimated one-third of patient safety incidents following implementation of clinical information systems (CISs) are technology-related. An eSafety checklist was previously developed to improve CIS safety by providing a comprehensive listing of system-agnostic, evidence-based configuration recommendations.

Objectives: We sought to use the checklist to support safe initial configuration of a provincial system-wide CIS (Alberta, Canada), referred to as Connect Care.

Medication-Facilitated Advanced Airway Management with First-Line Use of a Supraglottic Device - A One-Year Quality Assurance Review.

Introduction: Airway management is a controversial topic in modern Emergency Medical Services (EMS) systems. Among many concerns regarding endotracheal intubation (ETI), unrecognized esophageal intubation and observations of unfavorable neurologic outcomes in some studies raise the question of whether alternative airway techniques should be first-line in EMS airway management protocols. Supraglottic airway devices (SADs) are simpler to use, provide reliable oxygenation and ventilation, and may thus be an alternative first-line airway device for paramedics.

Appropriate Air Medical Services Utilization and Recommendations for Integration of Air Medical Services Resources into the EMS System of Care: A Joint Position Statement and Resource Document of NAEMSP, ACEP, and AMPA.

This update to the 2013 joint position statement, , provides guidance for air medical services utilization based on currently available evidence. Air medical services utilization considerations fall into three major categories: clinical considerations, safety considerations, and system integration and quality assurance.Clinically, air medical services should accomplish one or more of three primary patient-centered goals: initiation or continuation of locally unavailable advanced or specialty care; expedited delivery to definitive care for time-sensitive interventions; and/or extraction from physically remote or otherwise inaccessible locations that limit timely access to necessary care.

External Validation of the qSOFA Score in Emergency Department Patients With Pneumonia.

Background: Pneumonia is the leading cause of sepsis. In 2016, the 3 International Consensus Conference for Sepsis released the Quick Sepsis-Related Organ Failure Assessment (qSOFA) to identify risk for poor outcomes in sepsis.

Objective: We sought to externally validate qSOFA in emergency department (ED) patients with pneumonia and compare the accuracy of qSOFA to systemic inflammatory response syndrome score (SIRS), Confusion, Respiratory Rate and Blood Pressure (CRB), Confusion, Respiratory Rate, Blood Pressure and Age (CRB-65), and DS CRB-65, which is based on the CRB-65 score and includes two additional items-presence of underlying comorbid disease and blood oxygen saturation.

The Efficacy of Antivenin Latrodectus (Black Widow) Equine Immune F(ab') Versus Placebo in the Treatment of Latrodectism: A Randomized, Double-Blind, Placebo-Controlled, Clinical Trial.

Study Objective: The antivenom currently available for treatment of systemic black widow envenomation (latrodectism) is composed of equine whole immunoglobin. Although considered effective, it has been associated with anaphylaxis and 2 reported fatalities. We test the efficacy and safety of new equine antivenom composed of purified F(ab') antibody fragments.

Severe Decompression Illness: Case Report, Prehospital Recognition, and Regional Transport Considerations.

A 46-year-old male presented to our tertiary care emergency department (ED) with shortness of breath and chest pain following an uneventful four-hour SCUBA dive at 100 feet. His prehospital emergency medical services (EMS) assessment revealed transient hypotension and hypoxia. He later developed progressive skin mottling.

Trauma Simulation Training Increases Confidence Levels in Prehospital Personnel Performing Life-Saving Interventions in Trauma Patients.

Introduction. Limited evidence is available on simulation training of prehospital care providers, specifically the use of tourniquets and needle decompression. This study focused on whether the confidence level of prehospital personnel performing these skills improved through simulation training.

Influenza-like illness-related emergency department visits: Christmas and New Year holiday peaks and relationships with laboratory-confirmed respiratory virus detections, Edmonton, Alberta, 2004-2014.

Background: Emergency department (ED) visit volumes can be especially high during the Christmas-New Year holidays, a period occurring during the influenza season in Canada.

Methods: Using daily data, we examined the relationship between ED visits for the chief complaint "cough" (for Edmonton, Alberta residents) and laboratory detections for influenza A and respiratory syncytial virus (RSV) (for Edmonton and surrounding areas), lagged 0-5 days ahead, for non-pandemic years (2004-2008 and 2010-2014) using multivariable linear regression adjusting for temporal variables. We defined these cough-related visits as influenza-like illness (ILI)-related ED visits and, for 2004-2014, compared Christmas-New Year holiday (December 24-January 3) and non-holiday volumes during the influenza season (October-April).

[Aspiration in a specialised weaning unit--an underestimated problem].

This retrospective case series shows that 45 % of patients aspirated straight after removal of the tracheal cannula. The present case series includes 82 patients with long-term mechanical ventilation (LTMV) admitted to a specialised weaning unit. Aspiration was proven after patients sipped water coloured with patent blue V.

Expanding prevertebral soft tissue swelling subsequent to a motor vehicle collision.

Cervical acceleration/deceleration or whiplash injuries are a common cause of cervical spine trauma. Cervical acceleration/deceleration can result in vertebral fractures, subluxations, and ligamentous and other soft tissue injuries. Severe injuries are often evidenced by increased prevertebral swelling on lateral X-ray.

Pilot study comparing sepsis management with and without electronic clinical practice guidelines in an academic emergency department.

Background: Sepsis is a potentially life-threatening condition that requires urgent management in an Emergency Department (ED). Evidence-based guidelines for managing sepsis have been developed; however, their integration into routine practice is often incomplete. Care maps may help clinicians meet guideline targets more often.

A multi-function public health surveillance system and the lessons learned in its development: the Alberta Real Time Syndromic Surveillance Net.

Objective: We describe a centralized automated multi-function detection and reporting system for public health surveillance--the Alberta Real Time Syndromic Surveillance Net (ARTSSN). This improves upon traditional paper-based systems which are often fragmented, limited by incomplete data collection and inadequate analytical capacity, and incapable of providing timely information for public health action.

Methods: ARTSSN concurrently analyzes multiple electronic data sources in real time to describe results in tables, charts and maps.

Febrile neutropenia in EDs: the role of an electronic clinical practice guideline.

Purpose: Evidence-based clinical practice guidelines (CPGs) for managing febrile neutropenia (FN) are widely available; however, the integration of guidelines into routine practice is often incomplete. This study evaluated the uptake and clinical impact of implementing an electronic CPG on the management and outcomes of patients presenting with FN at 4 urban emergency departments (ED).

Methods: A retrospective chart review over a 3-year period at 4 hospitals in Edmonton, Alberta, was performed.

Development of a flexible healthcare form builder using Ruby on Rails.

A collaboratively maintained, centralized web-based clinical decision support system (CDSS) repository could lead to improved quality and standardization of care and decrease duplication of resources. Ruby on Rails (RoR) is an open source web application framework that enables rapid iterative development of database backed applications. We have created a prototype form building application in RoR that has the potential to create and maintain such a CDSS repository.

How usability of a web-based clinical decision support system has the potential to contribute to adverse medical events.

Introduction: Clinical decision support systems (CDSS) have the potential to reduce adverse medical events, but improper design can introduce new forms of error. CDSS pertaining to community acquired pneumonia and neutropenic fever were studied to determine whether usability of the graphical user interface might contribute to potential adverse medical events.

Methods: Automated screen capture of 4 CDSS being used by volunteer emergency physicians was analyzed using structured methods.

Does a waiting room video about what to expect during an emergency department visit improve patient satisfaction?

Objective: We created an instructional waiting room video that explained what patients should expect during their emergency department (ED) visit and sought to determine whether preparing patients using this video would 1) improve satisfaction, 2) decrease perceived waiting room times and 3) increase calls to an outpatient referral line in an ambulatory population.

Methods: This serial cross-sectional study took place over a period of 2 months before (control) and 2 months after the introduction of an educational waiting room video that described a typical patient visit to our ED. We enrolled a convenience sample of adult patients or parents of pediatric patients who were triaged to the ED waiting room; a research assistant distributed and collected the surveys as patients were being discharged after treatment.

The effect of training on nurse agreement using an electronic triage system.

Objectives: Emergency department (ED) triage prioritizes patients based on urgency of care, and the Canadian Triage and Acuity Scale (CTAS) is the national standard. We describe the inter-rater agreement and manual overrides of nurses using a CTAS-compliant web-based triage tool (eTRIAGE) for 2 different intensities of staff training.

Methods: This prospective study was conducted in an urban tertiary care ED.

Predictive validity of a computerized emergency triage tool.

Background: Emergency department (ED) triage prioritizes patients on the basis of the urgency of need for care. eTRIAGE is a Web-based triage decision support tool that is based on the Canadian Triage and Acuity Scale (CTAS), a five level triage system (CTAS 1 = resuscitation, CTAS 5 = nonurgent).

Objectives: To examine the validity of eTRIAGE on the basis of resource utilization and cost as measures of acuity.

Reliability of computerized emergency triage.

Objectives: Emergency department (ED) triage prioritizes patients based on urgency of care. This study compared agreement between two blinded, independent users of a Web-based triage tool (eTRIAGE) and examined the effects of ED crowding on triage reliability.

Methods: Consecutive patients presenting to a large, urban, tertiary care ED were assessed by the duty triage nurse and an independent study nurse, both using eTRIAGE.

Emergency triage: comparing a novel computer triage program with standard triage.

Background: Emergency department (ED) triage prioritizes patients based on urgency of care; however, little previous testing of triage tools in a live ED environment has been performed.

Objectives: To determine the agreement between a computer decision tool and memory-based triage.

Methods: Consecutive patients presenting to a large, urban, tertiary care ED were assessed in the usual fashion and by a blinded study nurse using a computerized decision support tool.

Supporting clinical practice at the bedside using wireless technology.

Objectives: Despite studies that show improvements in both standards of care and outcomes with the judicious application of clinical practice guidelines (CPGs), their clinical utilization remains low. This randomized controlled trial examined the use of a wirelessly networked mobile computer (MC) by physicians at the bedside with access to an emergency department information system, decision support tools (DSTs), and other software options.

Methods: Each of ten volunteer emergency physicians was randomized using a matched-pair design to work five shifts in standard fashion (desktop computer [DC] access) and five shifts with a wirelessly networked MC.

Blood plasma concentrations of oestradiol-17beta, testosterone and testosterone/oestradiol ratio in dogs with neoplastic and degenerative testicular diseases.

Oestradiol-17beta and testosterone blood plasma concentrations were measured in dogs with Leydig-cell tumours (n=20), Sertoli-cell tumours (n=6), seminomas (n=9), unilateral inguinal cryptorchidism (n=7), abdominal cryptorchidism (n=9, one bilateral), degenerate scrotal testicles (n=6, two bilateral), and animals with normal scrotal testicles (n=20). The testosterone/oestradiol ratio (testosterone concentration [ng/mL]x100/oestradiol concentration [pg/mL]) was calculated.A considerably higher oestradiol concentration was found in dogs with Sertoli-cell tumours (29.

Patterns of failure in anorectal melanoma. A guide to surgical therapy.

Anorectal melanoma is an aggressive tumor with a reported 5-year survival rate of 6%. Recommendations for local surgical therapy vary from local excision to abdominoperineal resection. Therapy, patterns of failure, and survival were retrospectively examined in 32 patients with anorectal melanoma.