Can J Emerg Med
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Meta Analysis
Risk factors for adverse outcomes in older adults with blunt chest trauma: A systematic review.
The objective of this study was to systematically review the published literature for risk factors associated with adverse outcomes in older adults sustaining blunt chest trauma. ⋯ While blunt chest wall trauma in older adults is relatively common, the literature on prognostic factors for adverse outcomes in this patient population remains inadequate due to a paucity of high quality studies and lack of consistent reporting standards.
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Multicenter Study
Uncomplicated urinary tract infections in the emergency department: a review of local practice patterns.
To determine the number of urine cultures ordered for women who presented to the emergency department (ED) with symptoms of uncomplicated UTI, and whether a culture result impacted subsequent management. ⋯ For the majority of young female patients with an uncomplicated UTI, urine cultures did not change management in the ED setting. However, when the diagnosis is uncertain based on symptomology and urinalyses alone, a urine culture may be warranted. Greater efforts should be directed towards educating emergency physicians on accurately diagnosing uncomplicated cystitis and the limited impact of urine cultures on treatment once a diagnosis has been made.
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Reviews help scholars consolidate evidence and guide their educational practice. However, few papers describe how to effectively publish review papers. We completed a scoping review to develop a set of quality indicators that will assist junior authors to publish reviews and integrative scholarship. ⋯ In emergency medicine education, review articles can help synthesize educational research so that educators can engage in evidence-based scholarly teaching. We hope that this work will act as an introduction to those interested in engaging in integrative scholarship by providing them with a guide to key quality markers and important checklists for improving their research.
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Health care costs are on the rise in Canada and the sustainability of our health care system is at risk. As gatekeepers to patient care, emergency department (ED) physicians have a direct impact on health care costs. We aimed to identify current levels of cost awareness among ED physicians. By understanding the current level of physician cost awareness, we hope to identify areas where cost education would provide the greatest benefit in reducing ordering costs. ⋯ The average percentage of correct cost estimates among ED physicians was 14% across the four ordering categories. Where cost-effective alternatives exist, ED physicians overestimated the cost of the more cost-effective item. They also underestimated the cost of low-yield tests.InterpretationED physicians demonstrated limited cost awareness of common health care costs. Further studies that characterize utilization of hospital resources based on ED physician awareness of cost-effective alternatives and cost of "low yield" tests are needed.
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Case Reports
Octreotide for the treatment of intentional insulin aspart overdose in a non-diabetic patient.
Intentional insulin overdose may lead to severe and refractory hypoglycemia. Exogenous dextrose administration is the mainstay of therapy for these patients and is effective in most cases. However, in patients with a functional pancreas, exogenous dextrose administration may precipitate endogenous insulin release leading to rebound hypoglycemia. ⋯ Our patient experienced complications, including peripheral edema, related to the large volumes of intravenous dextrose required to attempt to maintain euglycemia. Octreotide, a somatostatin analogue, may help prevent dextrose-induced hypoglycemia and improve the management in select insulin overdose patients; large infusion volumes resulted in significant peripheral edema. Treatment with octreotide was initiated 12.5 hours post-injection and was followed by a stabilization of blood glucose concentration in this non-diabetic patient.