Hospital policy of tranexamic acid to reduce transfusion in major non-cardiac surgery (TRACTION): protocol for a phase IV randomised controlled trial.

Introduction: Tranexamic acid (TXA) is an inexpensive and widely available medication that reduces blood loss and red blood cell (RBC) transfusion in cardiac and orthopaedic surgeries. While the use of TXA in these surgeries is routine, its efficacy and safety in other surgeries, including oncologic surgeries, with comparable rates of transfusion are uncertain. Our primary objective is to evaluate whether a hospital-level policy implementation of routine TXA use in patients undergoing major non-cardiac surgery reduces RBC transfusion without increasing thrombotic risk.

The One Pill Can Kill Myth.

"One Pill Can Kill" is a meme originating in the 1990s. This construct lists pharmaceuticals that have the alleged potential for fatality after the ingestion of a single pill by a toddler. However, its foundation is fundamentally flawed because it contravenes a basic principle of pediatric pharmacology, allometric scaling.

Simulation-based medical education in Canadian anesthesiology academic institutions: a national survey.

Purpose: Simulation-based medical education (SBME) is provided by all anesthesiology residency programs in Canada. The purpose of this study was to characterize SBME in Canadian anesthesiology residency training programs.

Methods: We administered a 21-question survey to the simulation director/coordinator for all 17 Canadian academic departments of anesthesiology from October 2019 to January 2020.

The role of whole bowel irrigation in the treatment of toxic ingestions.

There is no high-quality evidence regarding the benefit of any gastrointestinal decontamination procedure in the overdose patient. The original and twice reaffirmed position of the AACT and EAPCCT is based upon the best evidence and practical considerations. WBI was recommended as a treatment for the ingestion of modified release pharmaceuticals, iron salts and other substances not adsorbed by activated charcoal.

American Academy of Pediatrics Recommendations for the Prevention of Pediatric ATV-Related Deaths and Injuries.

Since all-terrain vehicles (ATVs) were introduced in the mid-1970s, regulatory agencies, injury prevention researchers, and pediatricians have documented their dangers to youth. Major risk factors, crash mechanisms, and injury patterns for children and adolescents have been well characterized. Despite this knowledge, preventing pediatric ATV-related deaths and injuries has proven difficult and has had limited success.

Prospective randomized trial of continuous femoral nerve block with posterior capsular injection versus periarticular injection for analgesia in primary total knee arthroplasty.

Background: Femoral nerve block (NB) and periarticular injection (PI) are 2 common options for pain control after total knee arthroplasty (TKA). We performed a prospective triple-blinded randomized trial comparing continuous femoral NB to PI, with follow-up to 1 year.

Methods: Patients younger than 70 years of age who were scheduled to undergo elective primary TKA under spinal anesthesia between 2009 and 2010 were randomly allocated to receive either continuous femoral NB or PI.

Key Findings and Implications of a Recent Systematic Review of the Potential Adverse Effects of Caffeine Consumption in Healthy Adults, Pregnant Women, Adolescents, and Children.

In 2016⁻2017, we conducted and published a systematic review on caffeine safety that set out to determine whether conclusions that were presented in the heavily cited Health Canada assessment, remain supported by more recent data. To that end, we reviewed data from 380 studies published between June 2001 and June 2015, which were identified from an initial batch of over 5000 articles through a stringent search and evaluation process. In the current paper, we use plain language to summarize our process and findings, with the intent of sharing additional context for broader reach to the general public.

Systematic review of the potential adverse effects of caffeine consumption in healthy adults, pregnant women, adolescents, and children.

To date, one of the most heavily cited assessments of caffeine safety in the peer-reviewed literature is that issued by Health Canada (Nawrot et al., 2003). Since then, >10,000 papers have been published related to caffeine, including hundreds of reviews on specific human health effects; however, to date, none have compared the wide range of topics evaluated by Nawrot et al.

Age and the risk of All-Terrain Vehicle-related injuries in children and adolescents: a cross sectional study.

Background: The study was designed to determine if youth <16 years are at a greater risk of serious injuries related to all-terrain vehicle (ATV) use compared to older adolescents and adults.

Methods: We performed cross sectional study of children and adults presenting to pediatric and adult emergency departments between 1990 and 2009 in Canada. The primary exposure variable was age <16 years and the primary outcome measure was moderate to serious injury determined from physician report of type and severity of injury.

Participation of Canadian anesthesiology departments in undergraduate medical education.

Purpose: Historically, anesthesiology departments have played a small role in teaching the pre-clerkship component of undergraduate medical education (UGME). The purpose of this study was to measure the current participation of Canadian anesthesiologists in UGME with a focus on pre-clerkship.

Methods: Three surveys were developed in collaboration with the Association of Canadian Departments of Anesthesia.

Simulation-based assessment of anesthesiology residents' competence: development and implementation of the Canadian National Anesthesiology Simulation Curriculum (CanNASC).

The specialty of anesthesiology will soon adopt the Competence By Design (CBD) approach to residency education developed by the Royal College of Physicians and Surgeons of Canada (RCPSC). A foundational component of CBD is frequent and contextualized assessment of trainees. In 2013, the RCPSC Anesthesiology Specialty Committee assembled a group of simulation educators, representing each of the 17 Canadian anesthesiology residency programs, to form the Canadian National Anesthesiology Simulation Curriculum (CanNASC) Task Force.

Severe vitamin D deficiency in 6 Canadian First Nation formula-fed infants.

Background: Rickets was first described in the 17th century and vitamin D deficiency was recognized as the underlying cause in the early 1900s. Despite this long history, vitamin D deficiency remains a significant health concern. Currently, vitamin D supplementation is recommended in Canada for breast fed infants.

Management of childhood intussusception after reduction by enema.

Objective: The objective of the study was to describe the utility of emergency department (ED)/outpatient management after enema reduction for childhood intussusception.

Methods: A retrospective medical record review of children aged 2 months to 6 years with confirmed intussusception who underwent enema reduction in a tertiary care academic children's hospital was performed. Subjects were analyzed with respect to location of care after reduction (ED/outpatient vs inpatient) and number, timing, and outcome of recurrences.

Do you really need that emergency drug screen?

Introduction: A drug screen is a frequent investigation in the emergency department. The purpose of ordering this test is to determine whether the patient's condition is due to a drug. The purpose of this review is to address the question - do you really need that emergency drug screen?

Background: A screening test is an investigation performed upon a defined population to identify subclinical disease.

Home safety measures and the risk of unintentional injury among young children: a multicentre case-control study.

Background: Young children may sustain injuries when exposed to certain hazards in the home. To better understand the relation between several childproofing strategies and the risk of injuries to children in the home, we undertook a multicentre case-control study in which we compared hazards in the homes of children with and without injuries.

Methods: We conducted this case-control study using records from 5 pediatric hospital emergency departments for the 2-year period 1995-1996.

Hepatotoxicity in acute iron poisoning.

Although liver injury is a recognized consequence of acute iron poisoning, its description is limited to several case reports. It appears to be dose-related, however, there are published reports of severe iron poisoning without liver injury. The purpose of this study is to examine the hypothesis that this is a dose-related phenomenon and to identify the serum iron concentration of risk for this outcome.

Acute pancreatitis due to erythromycin overdose.

Background: Antibiotic overdose is typically regarded as a benign event. We report a 15-year-old girl who developed pancreatitis after an overdose of erythromycin.

Case: A 15-year-old girl presented for care because of severe epigastric pain after an overdose of 5.

Early analgesia for children with acute abdominal pain.

Objectives: The objectives of this study were to determine whether the administration of morphine to children with acute abdominal pain would impede the diagnosis of appendicitis and to determine the efficacy of morphine in relieving the pain.

Methods: This was a double-blind, randomized, placebo-controlled trial involving 5- to 16-year-old children who presented to the emergency department of a children's hospital with a chief complaint of acute abdominal pain that was thought by the pediatric emergency attending physician to require a surgical consultation. Subjects were randomized to receive intravenously administered morphine or normal saline solution.

Unit-dose packaging of iron supplements and reduction of iron poisoning in young children.

Background: Iron poisoning is a major cause of unintentional poisoning death in young children. The US Food and Drug Administration proclaimed a regulation for unit-dose packaging of iron supplements in 1997.

Objective: To determine whether the requirement for unit-dose packaging of iron supplements decreases the incidence of iron ingestion and the incidence of deaths due to iron poisoning in children younger than 6 years.

Long term effects of a home visit to prevent childhood injury: three year follow up of a randomized trial.

Objective: To assess the long term effect of a home safety visit on the rate of home injury.

Design: Telephone survey conducted 36 months after participation in a randomized controlled trial of a home safety intervention. A structured interview assessed participant knowledge, beliefs, or practices around injury prevention and the number of injuries requiring medical attention.