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Leeies M, Mohindra R, Hrymak C, McColl T, Ratana P, Hayward J, Davis P, Primavesi R, Archambault P, Meyer T, LeBlanc C, Sibley A, Mcilveen-Brown E, Henderson B, D'Cunha G, Bryan J, Grunau B. Enhanced sociodemographic variable collection in emergency departments. CAN J EMERG MED 2024:10.1007/s43678-024-00689-1. [PMID: 38691216 DOI: 10.1007/s43678-024-00689-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 03/27/2024] [Indexed: 05/03/2024]
Affiliation(s)
- Murdoch Leeies
- Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada.
- Section of Critical Care, Department of Medicine, University of Manitoba, Winnipeg, MB, Canada.
| | - Rohit Mohindra
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Carmen Hrymak
- Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada
- Section of Critical Care, Department of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Tamara McColl
- Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Paul Ratana
- Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Jake Hayward
- Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada
| | - Philip Davis
- Department of Emergency Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Rob Primavesi
- Department of Emergency Medicine, McGill University, Montreal, QC, Canada
| | - Patrick Archambault
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec City, QC, Canada
- Department of Anesthesiology and Intensive Care, Université Laval, Québec City, QC, Canada
| | - Tracy Meyer
- Department of Emergency Medicine, Dalhousie University, Saint John, NB, Canada
| | - Constance LeBlanc
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
| | - Aaron Sibley
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
- University of Prince Edward Island, Charlottetown, PE, Canada
| | - Emma Mcilveen-Brown
- Department of Emergency Medicine, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Beth Henderson
- Health Records, Yukon Hospital Corporation, Whitehorse, YT, Canada
| | | | - Jennifer Bryan
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Brian Grunau
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
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Marx T, Moore L, Talbot D, Guertin JR, Lachapelle P, Blais S, Singbo N, Simonyan D, Lavallée J, Zada N, Shahrigharahkoshan S, Huard B, Olivier P, Mallet M, Létourneau M, Lafrenière M, Archambault P, Berthelot S. Value-based comparison of ambulatory children with respiratory diseases in an emergency department and a walk-in clinic: a retrospective cohort study in Québec, Canada. BMJ Open 2024; 14:e078566. [PMID: 38670620 PMCID: PMC11057281 DOI: 10.1136/bmjopen-2023-078566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 02/21/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVE To compare health outcomes and costs given in the emergency department (ED) and walk-in clinics for ambulatory children presenting with acute respiratory diseases. DESIGN A retrospective cohort study. SETTING This study was conducted from April 2016 to March 2017 in one ED and one walk-in clinic. The ED is a paediatric tertiary care centre, and the clinic has access to lab tests and X-rays. PARTICIPANTS Inclusion criteria were children: (1) aged from 2 to 17 years old and (2) discharged home with a diagnosis of upper respiratory tract infection (URTI), pneumonia or acute asthma. MAIN OUTCOME MEASURES The primary outcome measure was the proportion of patients returning to any ED or clinic within 3 and 7 days of the index visit. The secondary outcome measures were the mean cost of care estimated using time-driven activity-based costing and the incidence of antibiotic prescription for URTI patients. RESULTS We included 532 children seen in the ED and 201 seen in the walk-in clinic. The incidence of return visits at 3 and 7 days was 20.7% and 27.3% in the ED vs 6.5% and 11.4% in the clinic (adjusted relative risk at 3 days (aRR) (95% CI) 3.17 (1.77 to 5.66) and aRR at 7 days 2.24 (1.46 to 3.44)). The mean cost (95% CI) of care (CAD) at the index visit was $C96.68 (92.62 to 100.74) in the ED vs $C48.82 (45.47 to 52.16) in the clinic (mean difference (95% CI): 46.15 (41.29 to 51.02)). Antibiotic prescription for URTI was less common in the ED than in the clinic (1.5% vs 16.4%; aRR 0.10 (95% CI 0.03 to 0.32)). CONCLUSIONS The incidence of return visits and cost of care were significantly higher in the ED, while antibiotic use for URTI was more frequent in the walk-in clinic. These data may help determine which setting offers the highest value to ambulatory children with acute respiratory conditions.
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Affiliation(s)
- Tania Marx
- Axe Santé des populations et Pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Lynne Moore
- Axe Santé des populations et Pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
- Département de médecine sociale et préventive, Université Laval, Québec, Québec, Canada
| | - Denis Talbot
- Axe Santé des populations et Pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
- Département de médecine sociale et préventive, Université Laval, Québec, Québec, Canada
| | - Jason Robert Guertin
- Axe Santé des populations et Pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
- Département de médecine sociale et préventive, Université Laval, Québec, Québec, Canada
| | - Philippe Lachapelle
- Direction de la performance clinique et organisationnelle, CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Sébastien Blais
- Direction de la performance clinique et organisationnelle, CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Narcisse Singbo
- Axe Santé des populations et Pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
| | - David Simonyan
- Axe Santé des populations et Pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Jeanne Lavallée
- Axe Santé des populations et Pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Nawid Zada
- Axe Santé des populations et Pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Shaghayegh Shahrigharahkoshan
- Axe Santé des populations et Pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Benoit Huard
- Axe Santé des populations et Pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Pascale Olivier
- Axe Santé des populations et Pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Myriam Mallet
- Axe Santé des populations et Pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
| | - Mélanie Létourneau
- Direction de la performance clinique et organisationnelle, CHU de Québec-Université Laval, Québec, Québec, Canada
| | | | - Patrick Archambault
- Département de médecine de famille et de médecine d'urgence, Université Laval, Québec, Québec, Canada
- Centre de recherche du Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, Québec, Canada
- VITAM - Centre de recherche en santé durable, Université Laval, Québec, Québec, Canada
| | - Simon Berthelot
- Axe Santé des populations et Pratiques optimales en santé, Centre de recherche du CHU de Québec-Université Laval, Québec, Québec, Canada
- Département de médecine de famille et de médecine d'urgence, Université Laval, Québec, Québec, Canada
- VITAM - Centre de recherche en santé durable, Université Laval, Québec, Québec, Canada
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Conombo B, Guertin JR, Hoch JS, Grimshaw J, Bérubé M, Malo C, Berthelot S, Lauzier F, Stelfox HT, Turgeon AF, Archambault P, Belcaid A, Moore L. Implementation of an audit and feedback module targeting low-value clinical practices in a provincial trauma quality assurance program: a cost-effectiveness study. BMC Health Serv Res 2024; 24:479. [PMID: 38632593 PMCID: PMC11025277 DOI: 10.1186/s12913-024-10969-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 04/09/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Audit and Feedback (A&F) interventions based on quality indicators have been shown to lead to significant improvements in compliance with evidence-based care including de-adoption of low-value practices (LVPs). Our primary aim was to evaluate the cost-effectiveness of adding a hypothetical A&F module targeting LVPs for trauma admissions to an existing quality assurance intervention targeting high-value care and risk-adjusted outcomes. A secondary aim was to assess how certain A&F characteristics might influence its cost-effectiveness. METHODS We conducted a cost-effectiveness analysis using a probabilistic static decision analytic model in the Québec trauma care continuum. We considered the Québec Ministry of Health perspective. Our economic evaluation compared a hypothetical scenario in which the A&F module targeting LVPs is implemented in a Canadian provincial trauma quality assurance program to a status quo scenario in which the A&F module is not implemented. In scenarios analyses we assessed the impact of A&F characteristics on its cost-effectiveness. Results are presented in terms of incremental costs per LVP avoided. RESULTS Results suggest that the implementation of A&F module (Cost = $1,480,850; Number of LVPs = 6,005) is associated with higher costs and higher effectiveness compared to status quo (Cost = $1,124,661; Number of LVPs = 8,228). The A&F module would cost $160 per LVP avoided compared to status quo. The A&F module becomes more cost-effective with the addition of facilitation visits; more frequent evaluation; and when only high-volume trauma centers are considered. CONCLUSION A&F module targeting LVPs is associated with higher costs and higher effectiveness than status quo and has the potential to be cost-effective if the decision-makers' willingness-to-pay is at least $160 per LVP avoided. This likely represents an underestimate of true ICER due to underestimated costs or missed opportunity costs. Results suggest that virtual facilitation visits, frequent evaluation, and implementing the module in high-volume centers can improve cost-effectiveness.
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Affiliation(s)
- Blanchard Conombo
- Department of Social and Preventative Medicine, Université Laval, Québec City, Québec, Canada
- Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Quebec University Hospital, Centre de Recherche du CHU de Québec-Université Laval, 18E Rue, Local H-012a, Québec City, Québec, 1401G1J 1Z4, Canada
| | - Jason R Guertin
- Department of Social and Preventative Medicine, Université Laval, Québec City, Québec, Canada
| | - Jeffrey S Hoch
- Division of Health Policy and Management, Department of Public Health Sciences, University of California at Davis, Davis, CA, USA
| | - Jeremy Grimshaw
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Mélanie Bérubé
- Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Quebec University Hospital, Centre de Recherche du CHU de Québec-Université Laval, 18E Rue, Local H-012a, Québec City, Québec, 1401G1J 1Z4, Canada
- Faculty of Nursing, Université Laval, Québec City, Québec, Canada
| | - Christian Malo
- Faculty of Nursing, Université Laval, Québec City, Québec, Canada
| | - Simon Berthelot
- Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Quebec University Hospital, Centre de Recherche du CHU de Québec-Université Laval, 18E Rue, Local H-012a, Québec City, Québec, 1401G1J 1Z4, Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec City, Québec, Canada
- Centre de Recherche Intégrée Pour Un Système Apprenant en Santé Et Services Sociaux, Centre Intégré de Santé Et de Services Sociaux de Chaudière-Appalaches, Lévis, Québec, Canada
| | - François Lauzier
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec City, Québec, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, Medicine and Community Health Sciences, O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Alexis F Turgeon
- Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Quebec University Hospital, Centre de Recherche du CHU de Québec-Université Laval, 18E Rue, Local H-012a, Québec City, Québec, 1401G1J 1Z4, Canada
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec City, Québec, Canada
| | - Patrick Archambault
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec City, Québec, Canada
- VITAM-Centre de Recherche en Santé Durable, Québec City, Québec, Canada
| | - Amina Belcaid
- Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Quebec University Hospital, Centre de Recherche du CHU de Québec-Université Laval, 18E Rue, Local H-012a, Québec City, Québec, 1401G1J 1Z4, Canada
| | - Lynne Moore
- Department of Social and Preventative Medicine, Université Laval, Québec City, Québec, Canada.
- Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Quebec University Hospital, Centre de Recherche du CHU de Québec-Université Laval, 18E Rue, Local H-012a, Québec City, Québec, 1401G1J 1Z4, Canada.
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4
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Wtorek P, Weiss MJ, Singh JM, Hrymak C, Chochinov A, Grunau B, Paunovic B, Shemie SD, Lalani J, Piggott B, Stempien J, Archambault P, Seleseh P, Fowler R, Leeies M. Beliefs of physician directors on the management of devastating brain injuries at the Canadian emergency department and intensive care unit interface: a national site-level survey. Can J Anaesth 2024:10.1007/s12630-024-02749-7. [PMID: 38570415 DOI: 10.1007/s12630-024-02749-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 01/24/2024] [Accepted: 01/29/2024] [Indexed: 04/05/2024] Open
Abstract
PURPOSE Insufficient evidence-based recommendations to guide care for patients with devastating brain injuries (DBIs) leave patients vulnerable to inconsistent practice at the emergency department (ED) and intensive care unit (ICU) interface. We sought to characterize the beliefs of Canadian emergency medicine (EM) and critical care medicine (CCM) physician site directors regarding current management practices for patients with DBI. METHODS We conducted a cross-sectional survey of EM and CCM physician directors of adult EDs and ICUs across Canada (December 2022 to March 2023). Our primary outcome was the proportion of respondents who manage (or consult on) patients with DBI in the ED. We conducted subgroup analyses to compare beliefs of EM and CCM physicians. RESULTS Of 303 eligible respondents, we received 98 (32%) completed surveys (EM physician directors, 46; CCM physician directors, 52). Most physician directors reported participating in the decision to withdraw life-sustaining measures (WLSM) for patients with DBI in the ED (80%, n = 78), but 63% of these (n = 62) said this was infrequent. Physician directors reported that existing neuroprognostication methods are rarely sufficient to support WLSM in the ED (49%, n = 48) and believed that an ICU stay is required to improve confidence (99%, n = 97). Most (96%, n = 94) felt that providing caregiver visitation time prior to WLSM was a valid reason for ICU admission. CONCLUSION In our survey of Canadian EM and CCM physician directors, 80% participated in WLSM in the ED for patients with DBI. Despite this, most supported ICU admission to optimize neuroprognostication and patient-centred end-of-life care, including organ donation.
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Affiliation(s)
- Piotr Wtorek
- Section of Critical Care Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
- Health Sciences Centre, JJ399-820 Sherbrook St., Ann Thomas Building, Winnipeg, MB, R3A 1R9, Canada.
| | - Matthew J Weiss
- Transplant Québec, Montreal, QC, Canada
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
- Division of Critical Care, Department of Pediatrics, Centre Mère-Enfant Soleil du CHU de Québec, Quebec City, QC, Canada
| | - Jeffrey M Singh
- Interdepartmental Division of Critical Care Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Carmen Hrymak
- Section of Critical Care Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada
- Transplant Manitoba, Gift of Life Program, Shared Health Manitoba, Winnipeg, MB, Canada
| | - Alecs Chochinov
- Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Brian Grunau
- Department of Emergency Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Bojan Paunovic
- Section of Critical Care Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Sam D Shemie
- McGill University, Montreal Children's Hospital, Montreal, QC, Canada
| | | | | | - James Stempien
- Department of Emergency Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Patrick Archambault
- Department of Anesthesiology and Critical Care, Université Laval, Laval, QC, Canada
| | - Parisa Seleseh
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Rob Fowler
- Department of Critical Care Medicine, Sunnybrook Hospital, Toronto, ON, Canada
| | - Murdoch Leeies
- Section of Critical Care Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
- Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada
- Transplant Manitoba, Gift of Life Program, Shared Health Manitoba, Winnipeg, MB, Canada
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5
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Mullie L, Afilalo J, Archambault P, Bouchakri R, Brown K, Buckeridge DL, Cavayas YA, Turgeon AF, Martineau D, Lamontagne F, Lebrasseur M, Lemieux R, Li J, Sauthier M, St-Onge P, Tang A, Witteman W, Chassé M. CODA: an open-source platform for federated analysis and machine learning on distributed healthcare data. J Am Med Inform Assoc 2024; 31:651-665. [PMID: 38128123 PMCID: PMC10873779 DOI: 10.1093/jamia/ocad235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/28/2023] [Accepted: 12/02/2023] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVES Distributed computations facilitate multi-institutional data analysis while avoiding the costs and complexity of data pooling. Existing approaches lack crucial features, such as built-in medical standards and terminologies, no-code data visualizations, explicit disclosure control mechanisms, and support for basic statistical computations, in addition to gradient-based optimization capabilities. MATERIALS AND METHODS We describe the development of the Collaborative Data Analysis (CODA) platform, and the design choices undertaken to address the key needs identified during our survey of stakeholders. We use a public dataset (MIMIC-IV) to demonstrate end-to-end multi-modal FL using CODA. We assessed the technical feasibility of deploying the CODA platform at 9 hospitals in Canada, describe implementation challenges, and evaluate its scalability on large patient populations. RESULTS The CODA platform was designed, developed, and deployed between January 2020 and January 2023. Software code, documentation, and technical documents were released under an open-source license. Multi-modal federated averaging is illustrated using the MIMIC-IV and MIMIC-CXR datasets. To date, 8 out of the 9 participating sites have successfully deployed the platform, with a total enrolment of >1M patients. Mapping data from legacy systems to FHIR was the biggest barrier to implementation. DISCUSSION AND CONCLUSION The CODA platform was developed and successfully deployed in a public healthcare setting in Canada, with heterogeneous information technology systems and capabilities. Ongoing efforts will use the platform to develop and prospectively validate models for risk assessment, proactive monitoring, and resource usage. Further work will also make tools available to facilitate migration from legacy formats to FHIR and DICOM.
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Affiliation(s)
- Louis Mullie
- Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, H2X 3E4, Canada
- Faculty of Medicine, Université de Montréal, Montréal, H3C 3J7, Canada
- Mila Quebec Artificial Intelligence Institute, Montréal, H2S 3H1, Canada
| | - Jonathan Afilalo
- Department of Medicine, Jewish General Hospital, Montréal, H3T 1E4, Canada
| | - Patrick Archambault
- Department of Emergency Medicine and Family Medicine, Université Laval, Québec, G1V 0A6, Canada
- Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec, G1V 0A6, Canada
- Centre de Recherche Intégré pour un Système Apprenant en santé et Services Sociaux, Centre intégré de santé et de Services Sociaux de Chaudière-Appalaches, Lévis, G6V 3Z1, Canada
| | - Rima Bouchakri
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montréal, H2X 0A9, Canada
| | - Kip Brown
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montréal, H2X 0A9, Canada
| | - David L Buckeridge
- Mila Quebec Artificial Intelligence Institute, Montréal, H2S 3H1, Canada
- Department of Epidemiology and Biostatistics, School of Population and Global Health, McGill University Health Centre, Montréal, H3A 1G1, Canada
| | | | - Alexis F Turgeon
- Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec, G1V 0A6, Canada
- Centre de recherche du CHU de Québec-Université Laval, Université Laval, Québec, G1V 4G2, Canada
| | - Denis Martineau
- Centre de recherche du CHU de Québec-Université Laval, Université Laval, Québec, G1V 4G2, Canada
| | - François Lamontagne
- Centre de recherche du CHUS, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, J1G 2E8, Canada
| | - Martine Lebrasseur
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montréal, H2X 0A9, Canada
| | - Renald Lemieux
- Centre de recherche du CHUS, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, J1G 2E8, Canada
| | - Jeffrey Li
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montréal, H2X 0A9, Canada
| | - Michaël Sauthier
- Faculty of Medicine, Université de Montréal, Montréal, H3C 3J7, Canada
- Department of Pediatrics, Université de Montréal and CHU Sainte-Justine Research Centre, Montréal, H3C 3J7, Canada
| | - Pascal St-Onge
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, Montréal, H2X 0A9, Canada
| | - An Tang
- Faculty of Medicine, Université de Montréal, Montréal, H3C 3J7, Canada
- Department of Radiology, Centre Hospitalier de l’Université de Montréal, Montréal, H2X 3E4, Canada
| | - William Witteman
- Centre de Recherche Intégré pour un Système Apprenant en santé et Services Sociaux, Centre intégré de santé et de Services Sociaux de Chaudière-Appalaches, Lévis, G6V 3Z1, Canada
| | - Michaël Chassé
- Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montréal, H2X 3E4, Canada
- Faculty of Medicine, Université de Montréal, Montréal, H3C 3J7, Canada
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6
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Mikolić A, Brasher PMA, Brubacher JR, Panenka W, Scheuermeyer FX, Archambault P, Khazei A, Silverberg ND. External Validation of the Post-Concussion Symptoms Rule for Predicting Mild Traumatic Brain Injury Outcome. J Neurotrauma 2024. [PMID: 38226635 DOI: 10.1089/neu.2023.0484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2024] Open
Abstract
Persistent symptoms are common after a mild traumatic brain injury (mTBI). The Post-Concussion Symptoms (PoCS) Rule is a newly developed clinical decision rule for the prediction of persistent post-concussion symptoms (PPCS) 3 months after an mTBI. The PoCS Rule includes assessment of demographic and clinical characteristics and headache presence in the emergency department (ED), and follow-up assessment of symptoms at 7 days post-injury using two thresholds (lower/higher) for symptom scoring. We examined the PoCS Rule in an independent sample. We analyzed a clinical trial that recruited participants with mTBI from EDs in Greater Vancouver, Canada. The primary analysis used data from 236 participants, who were randomized to a usual care control group, and completed the Rivermead Postconcussion Symptoms Questionnaire at 3 months. The primary outcome was PPCS, as defined by the PoCS authors. We assessed the overall performance of the PoCS rule (area under the receiver operating characteristic curve [AUC]), sensitivity, and specificity. More than 40% of participants (median age 38 years, 59% female) reported PPCS at 3 months. Most participants (88%) were categorized as being at medium risk based on the ED assessment, and a majority were considered as being at high risk according to the final PoCS Rule (81% using a lower threshold and 72% using a higher threshold). The PoCS Rule showed a sensitivity of 93% (95% confidence interval [CI], 88-98; lower threshold) and 85% (95% CI, 78-92; higher threshold), and a specificity of 28% (95% CI, 21-36) and 37% (95% CI, 29-46), respectively. The overall performance was modest (AUC 0.61, 95% CI 0.59, 0.65). In conclusion, the PoCS Rule was sensitive for PPCS, but had a low specificity in our sample. Follow-up assessment of symptoms can improve risk stratification after mTBI.
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Affiliation(s)
- Ana Mikolić
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
- Rehabilitation Research Program, Centre for Aging SMART at Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Penelope M A Brasher
- Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Jeffrey R Brubacher
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - William Panenka
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Provincial Neuropsychiatry Program, Vancouver, British Columbia, Canada
- Department of Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Frank X Scheuermeyer
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Patrick Archambault
- Department of Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Afshin Khazei
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Noah D Silverberg
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
- Rehabilitation Research Program, Centre for Aging SMART at Vancouver Coastal Health, Vancouver, British Columbia, Canada
- Department of Family and Emergency Medicine, Université Laval, Québec, Québec, Canada
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7
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Gomes Souza L, Bouba DA, Corôa RDC, Dofara SG, Robitaille V, Blanchette V, Kastner K, Bergeron F, Guay-Bélanger S, Izumi SS, Totten AM, Archambault P, Légaré F. The Impact of Advance Care Planning on Healthcare Professionals' Well-being: A Systematic Review. J Pain Symptom Manage 2024; 67:173-187. [PMID: 37827454 DOI: 10.1016/j.jpainsymman.2023.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/08/2023] [Accepted: 09/16/2023] [Indexed: 10/14/2023]
Abstract
CONTEXT Advance care planning (ACP) improves care for patients with chronic illnesses and reduces family stress. However, the impact of ACP interventions on healthcare professionals' well-being remains unknown. OBJECTIVE To systematically review the literature evaluating the impact of ACP interventions on healthcare professionals' well-being. METHODS We followed the Joanna Briggs Institute methodology for systematic reviews and registered the protocol in PROSPERO (CRD42022346354). We included primary studies in all languages that assessed the well-being of healthcare professionals in ACP interventions. We excluded any studies on ACP in psychiatric care and in palliative care that did not address goals of care. Searches were conducted on April 4, 2022, and March 6, 2023 in Embase, CINAHL, Web of Science, and PubMed. We used the Mixed Methods Appraisal Tool for quality analysis. We present results as a narrative synthesis because of their heterogeneity. RESULTS We included 21 articles published in English between 1997 and 2021 with 17 published after 2019. All were conducted in high-income countries, and they involved a total of 1278 participants. Three reported an interprofessional intervention and two included patient partners. Studies had significant methodological flaws but most reported that ACP had a possible positive impact on healthcare professionals' well-being. CONCLUSION This review is the first to explore the impact of ACP interventions on healthcare professionals' well-being. ACP interventions appear to have a positive impact, but high-quality studies are scarce. Further research is needed, particularly using more rigorous and systematic methods to implement interventions and report results.
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Affiliation(s)
- Lucas Gomes Souza
- Department of Social and Preventive Medicine (L.G.S., D.A.B.), Faculty of Medicine, Université Laval, Québec, Canada, and VITAM, Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, QC, Canada
| | - Dalil Asmaou Bouba
- Department of Social and Preventive Medicine (L.G.S., D.A.B.), Faculty of Medicine, Université Laval, Québec, Canada, and VITAM, Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, QC, Canada
| | - Roberta de Carvalho Corôa
- Department of Family Medicine and Emergency Medicine (R.C.C.), VITAM, Centre de recherche en santé durable, Unité de soutien au système de santé apprenant, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Faculty of Medicine, Université Laval, Québec, QC, Canada
| | - Suélène Georgina Dofara
- VITAM, Centre de recherche en santé durable (S.G.B., S.G.D.), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, QC, Canada
| | - Vincent Robitaille
- Faculty of Medicine, Université Laval (V.R.), VITAM, Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
| | - Virginie Blanchette
- Department of Human Kinetics and Podiatric Medicine (V.B.), Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | | | | | - Sabrina Guay-Bélanger
- VITAM, Centre de recherche en santé durable (S.G.B., S.G.D.), Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, QC, Canada
| | | | - Annette M Totten
- Department of Medical Informatics and Clinical Epidemiology (A.M.T.), School of Medicine, Oregon Health & Science University, Portland, OR
| | - Patrick Archambault
- Department of Family Medicine and Emergency Medicine (P.A.), Faculty of Medicine, Université Laval, VITAM, Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Québec, QC, Canada
| | - France Légaré
- Department of Family Medicine and Emergency Medicine (F.L.), Faculty of Medicine, Université Laval, VITAM, Centre de recherche en santé durable, Researcher, Centre de recherche du CHU de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, QC, Canada.
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8
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Boucher V, Frenette J, Neveu X, Tardif PA, Mercier É, Chauny JM, Berthelot S, Archambault P, Lee J, Perry JJ, McRae A, Lang E, Moore L, Cameron P, Ouellet MC, de Guise E, Swaine B, Émond M, Le Sage N. Lack of association between four biomarkers and persistent post-concussion symptoms after a mild traumatic brain injury. J Clin Neurosci 2023; 118:34-43. [PMID: 37857062 DOI: 10.1016/j.jocn.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 08/07/2023] [Accepted: 10/10/2023] [Indexed: 10/21/2023]
Abstract
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. We conducted a prospective cohort study in seven Canadian EDs. Patients aged ≥ 14 years presenting to the ED within 24 h of a mild TBI who were discharged were eligible. Clinical data and blood samples were collected in the ED, and a standardized questionnaire was administered 90 days later to assess the presence of symptoms. The following biomarkers were analyzed: S100B protein, Neuron Specific Enolase (NSE), cleaved-Tau (c-Tau) and Glial Fibrillary Acidic Protein (GFAP). The primary outcome measure was the presence of PPCS at 90 days after trauma. Relative risks and Areas Under the Curve (AUC) were computed. A total of 595 patients were included, and 13.8 % suffered from PPCS at 90 days. The relative risk of PPCS was 0.9 (95 % CI: 0.5-1.8) for S100B ≥ 20 pg/mL, 1.0 (95 % CI: 0.6-1.5) for NSE ≥ 200 pg/mL, 3.4 (95 % CI: 0.5-23.4) for GFAP ≥ 100 pg/mL, and 1.0 (95 % CI: 0.6-1.8) for C-Tau ≥ 1500 pg/mL. AUC were 0.50, 0.50, 0.51 and 0.54, respectively. Among mild TBI patients, S100B protein, NSE, c-Tau or GFAP do not seem to predict PPCS. Future research testing of other biomarkers is needed to determine their usefulness in predicting PPCS.
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Affiliation(s)
- Valérie Boucher
- CHU de Québec-Université Laval Research Centre, 1401, 18e rue, Québec, Québec G1J 1Z4, Canada
| | - Jérôme Frenette
- CHU de Québec-Université Laval Research Centre, 1401, 18e rue, Québec, Québec G1J 1Z4, Canada; Faculté de médecine, Université Laval, 1050 Av. de la Médecine, Québec, Québec G1V 0A6, Canada
| | - Xavier Neveu
- CHU de Québec-Université Laval Research Centre, 1401, 18e rue, Québec, Québec G1J 1Z4, Canada
| | - Pier-Alexandre Tardif
- CHU de Québec-Université Laval Research Centre, 1401, 18e rue, Québec, Québec G1J 1Z4, Canada
| | - Éric Mercier
- CHU de Québec-Université Laval Research Centre, 1401, 18e rue, Québec, Québec G1J 1Z4, Canada; Faculté de médecine, Université Laval, 1050 Av. de la Médecine, Québec, Québec G1V 0A6, Canada; VITAM-Centre de recherche en santé durable, 2480 Chem. de la Canardière, Québec, Québec G1J 2G1, Canada
| | - Jean-Marc Chauny
- Faculté de médecine, Université de Montréal, 2900 Edouard Montpetit Blvd, Montréal, Québec H3T 1J4, Canada
| | - Simon Berthelot
- CHU de Québec-Université Laval Research Centre, 1401, 18e rue, Québec, Québec G1J 1Z4, Canada; Faculté de médecine, Université Laval, 1050 Av. de la Médecine, Québec, Québec G1V 0A6, Canada
| | - Patrick Archambault
- Faculté de médecine, Université Laval, 1050 Av. de la Médecine, Québec, Québec G1V 0A6, Canada; VITAM-Centre de recherche en santé durable, 2480 Chem. de la Canardière, Québec, Québec G1J 2G1, Canada; Centre de recherche du CISSS de Chaudière-Appalaches, 143 Rue Wolfe, Lévis, Québec, QC G6V 3Z1, Canada
| | - Jacques Lee
- Sunnybrook Health Science Center, 2075 Bayview Ave, Toronto, Ontario M4N 3M5, Canada; Schwartz-Reisman Emergency Medicine Institute, Mount Sinai Hospital, 600 University Ave, Toronto, Ontario M5G 1X5, Canada
| | - Jeffrey J Perry
- The Ottawa Hospital Research Institute, 501 Smyth Box 511, Ottawa, Ontario K1H 8L6, Canada; Department of Emergency Medicine, University of Ottawa, 75 Laurier Ave E, Ottawa, Ontario K1N 6N5, Canada
| | - Andrew McRae
- Department of Emergency Medicine, University of Calgary, 2500 University Dr NW, Calgary, Alberta T2N 1N4, Canada; Foothills Medical Centre, 1403 29 St NW, Calgary, Alberta T2N 2T9, Canada
| | - Eddy Lang
- Department of Emergency Medicine, University of Calgary, 2500 University Dr NW, Calgary, Alberta T2N 1N4, Canada; Foothills Medical Centre, 1403 29 St NW, Calgary, Alberta T2N 2T9, Canada
| | - Lynne Moore
- CHU de Québec-Université Laval Research Centre, 1401, 18e rue, Québec, Québec G1J 1Z4, Canada; Faculté de médecine, Université Laval, 1050 Av. de la Médecine, Québec, Québec G1V 0A6, Canada
| | - Peter Cameron
- Alfred Emergency and Trauma Centre, Monash University, 55 Commercial Rd, Melbourne, VIC 3004, Australia
| | - Marie-Christine Ouellet
- Faculté de médecine, Université Laval, 1050 Av. de la Médecine, Québec, Québec G1V 0A6, Canada; Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), 525 Bd Wilfrid-Hamel, Québec, Québec G1M 2S8, Canada
| | - Elaine de Guise
- Département de psychologie, Université de Montréal, 2900, boul. Édouard-Montpetit, Montréal, Québec H3T 1J4, Canada; Centre de recherche interdisciplinaire en réadaptation (CRIR) du Montréal métropolitain, 6363, chemin Hudson, Montréal, Québec H3S 1M9, Canada
| | - Bonnie Swaine
- Faculté de médecine, Université de Montréal, 2900 Edouard Montpetit Blvd, Montréal, Québec H3T 1J4, Canada; Centre de recherche interdisciplinaire en réadaptation (CRIR) du Montréal métropolitain, 6363, chemin Hudson, Montréal, Québec H3S 1M9, Canada
| | - Marcel Émond
- CHU de Québec-Université Laval Research Centre, 1401, 18e rue, Québec, Québec G1J 1Z4, Canada; Faculté de médecine, Université Laval, 1050 Av. de la Médecine, Québec, Québec G1V 0A6, Canada; VITAM-Centre de recherche en santé durable, 2480 Chem. de la Canardière, Québec, Québec G1J 2G1, Canada
| | - Natalie Le Sage
- CHU de Québec-Université Laval Research Centre, 1401, 18e rue, Québec, Québec G1J 1Z4, Canada; Faculté de médecine, Université Laval, 1050 Av. de la Médecine, Québec, Québec G1V 0A6, Canada; VITAM-Centre de recherche en santé durable, 2480 Chem. de la Canardière, Québec, Québec G1J 2G1, Canada.
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9
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Ghandour EK, Leblond S, Binette S, Rivard J, Joanisse J, Carreau L, Bert L, Boutier V, Fortin JP, Denis JL, Sinha S, Archambault P. Implementation of the Acute Care for Elders Strategy to Improve the Quality of Care Transitions in Quebec and Ontario: a Retrospective Multiple Case Study. Can Geriatr J 2023; 26:444-477. [PMID: 38045881 PMCID: PMC10684303 DOI: 10.5770/cgj.26.679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023] Open
Abstract
Background In 2016, two Canadian hospitals participated in a quality improvement (QI) program, the International Acute Care for Elders (ACE) Collaborative, and sought to adapt and implement a transition coach intervention (TCI). Both hospitals were challenged to provide optimal continuity of care for an increasing number of older adults. The two hospitals received initial funding, coaching, educational materials, and tools to adapt the TCI to their local contexts, but the QI project teams achieved different results. We aimed to compare the implementation of the ACE TCI in these two Canadian hospitals to identify the factors influencing the adaptation of the intervention to the local contexts and to understand their different results. Methods We conducted a retrospective multiple case study, including documentary analysis, 21 semi-structured individual interviews, and two focus groups. We performed thematic analysis using a hybrid inductive-deductive approach. Results Both hospitals met initial organizational goals to varying degrees. Our qualitative analysis highlighted certain factors that were critical to the effective implementation and achievement of the QI project goals: the magnitude of changes and adaptations to the initial intervention; the organizational approaches to the QI project implementation, management, and monitoring; the organizational context; the change management strategies; the ongoing health system reform and organizational restructuring. Our study also identified other key factors for successful care transition QI projects: minimal adaptation to the original evidence-based intervention; use of a collaborative, bottom-up approach; use of a theoretical model to support sustainability; support from clinical and organizational leadership; a strong organizational culture for QI; access to timely quality measures; financial support; use of a knowledge management platform; and involvement of an integrated research team and expert guidance. Conclusion Many of the lessons learned and strategies identified from our analysis will help clinicians, managers, and policymakers better address the issues and challenges of adapting evidence-based innovations in care transitions for older adults to local contexts.
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Affiliation(s)
- El Kebir Ghandour
- Institut national d'excellence en santé et en services sociaux (INESSS), Québec, QC, Canada
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux-SASSS du CISSS de Chaudière-Appalaches, Lévis, QC, Canada
| | - Sara Leblond
- Hôpital Montfort, Ottawa, ON, Canada
- Institut du Savoir Montfort, Ottawa, ON, Canada
| | - Sébastien Binette
- VITAM-Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Québec, QC, Canada
| | - Josée Rivard
- Centre intégré de santé et de services sociaux de la Montérégie-Centre, Greenfield Park, QC, Canada
| | - John Joanisse
- Hôpital Montfort, Ottawa, ON, Canada
- Institut du Savoir Montfort, Ottawa, ON, Canada
| | | | - Laetitia Bert
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux-SASSS du CISSS de Chaudière-Appalaches, Lévis, QC, Canada
- Université Laval, Québec, QC, Canada
| | - Véronique Boutier
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux-SASSS du CISSS de Chaudière-Appalaches, Lévis, QC, Canada
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - Jean-Paul Fortin
- VITAM-Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Québec, QC, Canada
- Université Laval, Québec, QC, Canada
| | - Jean-Louis Denis
- Département de gestion, d'évaluation et de politique de santé (DGEPS), École de santé publique-Université de Montréal, Montréal, QC, Canada
| | - Samir Sinha
- Sinai Health, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Department of Institute of Health Policy and Management, University of Toronto, Toronto, ON, Canada
- Division of Geriatric Medicine and Gerontology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Patrick Archambault
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux-SASSS du CISSS de Chaudière-Appalaches, Lévis, QC, Canada
- Institut du Savoir Montfort, Ottawa, ON, Canada
- VITAM-Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux (CIUSSS) de la Capitale-Nationale, Québec, QC, Canada
- Université Laval, Québec, QC, Canada
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada
- Department of Anesthesiology and Intensive Care Medicine, Université Laval, Québec, QC, Canada
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10
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Ismath M, Black H, Hrymak C, Rosychuk RJ, Archambault P, Fok PT, Audet T, Dufault B, Hohl C, Leeies M. Characterizing intubation practices in response to the COVID-19 pandemic: a survey of the Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN) sites. BMC Emerg Med 2023; 23:139. [PMID: 38001415 PMCID: PMC10675858 DOI: 10.1186/s12873-023-00911-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 11/20/2023] [Indexed: 11/26/2023] Open
Abstract
OBJECTIVE The risk of occupational exposure during endotracheal intubation has required the global Emergency Medicine (EM), Anesthesia, and Critical Care communities to institute new COVID- protected intubation guidelines, checklists, and protocols. This survey aimed to deepen the understanding of the changes in intubation practices across Canada by evaluating the pre-COVID-19, early-COVID-19, and present-day periods, elucidating facilitators and barriers to implementation, and understanding provider impressions of the effectiveness and safety of the changes made. METHODS We conducted an electronic, self-administered, cross-sectional survey of EM physician site leads within the Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN) to characterize and compare airway management practices in the pre-COVID-19, early-COVID-19, and present-day periods. Ethics approval for this study was obtained from the University of Manitoba Health Research Ethics Board. The electronic platform SurveyMonkey ( www.surveymonkey.com ) was used to collect and store survey tool responses. Categorical item responses, including the primary outcome, are reported as numbers and proportions. Variations in intubation practices over time were evaluated through mixed-effects logistic regression models. RESULTS Invitations were sent to 33 emergency department (ED) physician site leads in the CCEDRRN. We collected 27 survey responses, 4 were excluded, and 23 analysed. Responses were collected in English (87%) and French (13%), from across Canada and included mainly physicians practicing in mainly Academic and tertiary sites (83%). All respondents reported that the intubation protocols used in their EDs changed in response to the COVID-19 pandemic (100%, n = 23, 95% CI 0.86-1.00). CONCLUSIONS This study provides a novel summary of changes to airway management practices in response to the evolving COVID-19 pandemic in Canada. Information from this study could help inform a consensus on safe and effective emergent intubation of persons with communicable respiratory infections in the future.
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Affiliation(s)
- Muzeen Ismath
- Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Holly Black
- Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Carmen Hrymak
- Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
| | - Rhonda J Rosychuk
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Patrick Archambault
- Department of Family Medicine and Emergency Medicine, Department of Anesthesiology and Intensive Care, Université Laval, Québec, QC, Canada
| | - Patrick T Fok
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
| | - Thomas Audet
- Department of Internal Medicine, Université Laval, Québec, QC, Canada
| | - Brenden Dufault
- George & Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Corinne Hohl
- Deparment of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Murdoch Leeies
- Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada.
- Rady Faculty of Health Sciences, Section of Critical Care Medicine, University of Manitoba, Winnipeg, MB, Canada.
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11
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Siegal DM, Belley-Côté EP, Lee SF, Hill S, D’Aragon F, Zarychanski R, Rochwerg B, Chassé M, Binnie A, Honarmand K, Lauzier F, Ball I, Al-Hazzani W, Archambault P, Duan E, Khwaja K, Lellouche F, Lysecki P, Marquis F, Naud JF, Shahin J, Shea J, Tsang JL, Wang HT, Crowther M, Arnold DM, Di Sante E, Marfo G, Kovalova T, Fonguh S, Vincent J, Connolly SJ. Small-Volume Blood Collection Tubes to Reduce Transfusions in Intensive Care: The STRATUS Randomized Clinical Trial. JAMA 2023; 330:1872-1881. [PMID: 37824152 PMCID: PMC10570918 DOI: 10.1001/jama.2023.20820] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 09/22/2023] [Indexed: 10/13/2023]
Abstract
Importance Blood collection for laboratory testing in intensive care unit (ICU) patients is a modifiable contributor to anemia and red blood cell (RBC) transfusion. Most blood withdrawn is not required for analysis and is discarded. Objective To determine whether transitioning from standard-volume to small-volume vacuum tubes for blood collection in ICUs reduces RBC transfusion without compromising laboratory testing procedures. Design, Setting, and Participants Stepped-wedge cluster randomized trial in 25 adult medical-surgical ICUs in Canada (February 5, 2019 to January 21, 2021). Interventions ICUs were randomized to transition from standard-volume (n = 10 940) to small-volume tubes (n = 10 261) for laboratory testing. Main Outcomes and Measures The primary outcome was RBC transfusion (units per patient per ICU stay). Secondary outcomes were patients receiving at least 1 RBC transfusion, hemoglobin decrease during ICU stay (adjusted for RBC transfusion), specimens with insufficient volume for testing, length of stay in the ICU and hospital, and mortality in the ICU and hospital. The primary analysis included patients admitted for 48 hours or more, excluding those admitted during a 5.5-month COVID-19-related trial hiatus. Results In the primary analysis of 21 201 patients (mean age, 63.5 years; 39.9% female), which excluded 6210 patients admitted during the early COVID-19 pandemic, there was no significant difference in RBC units per patient per ICU stay (relative risk [RR], 0.91 [95% CI, 0.79 to 1.05]; P = .19; absolute reduction of 7.24 RBC units/100 patients per ICU stay [95% CI, -3.28 to 19.44]). In a prespecified secondary analysis (n = 27 411 patients), RBC units per patient per ICU stay decreased after transition from standard-volume to small-volume tubes (RR, 0.88 [95% CI, 0.77 to 1.00]; P = .04; absolute reduction of 9.84 RBC units/100 patients per ICU stay [95% CI, 0.24 to 20.76]). Median decrease in transfusion-adjusted hemoglobin was not statistically different in the primary population (mean difference, 0.10 g/dL [95% CI, -0.04 to 0.23]) and lower in the secondary population (mean difference, 0.17 g/dL [95% CI, 0.05 to 0.29]). Specimens with insufficient quantity for analysis were rare (≤0.03%) before and after transition. Conclusions and Relevance Use of small-volume blood collection tubes in the ICU may decrease RBC transfusions without affecting laboratory analysis. Trial Registration ClinicalTrials.gov Identifier: NCT03578419.
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Affiliation(s)
- Deborah M. Siegal
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Emilie P. Belley-Côté
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Shun Fu Lee
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Stephen Hill
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Frédérick D’Aragon
- Department of Anesthesiology, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Ryan Zarychanski
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Bram Rochwerg
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Michaël Chassé
- Centre Hospitalier de l’Université de Montréal, Department of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Alexandra Binnie
- William Osler Health System – Brampton Civic and Etobicoke General, Brampton, Ontario, Canada
| | - Kimia Honarmand
- London Health Sciences Centre – CCTC and University Hospital, Department of Medicine, Western University, London, Ontario, Canada
| | - François Lauzier
- Centre Hospitalier Universitaire de Québec - Enfant-Jésus and Hôtel-Dieu, Department of Medicine, Department of Anesthesiology, Université Laval, Québec, Canada
| | - Ian Ball
- London Health Sciences Centre – CCTC and University Hospital, Department of Medicine, Western University, London, Ontario, Canada
| | - Waleed Al-Hazzani
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Patrick Archambault
- Hôtel-Dieu de Lévis, Department of Family Medicine and Urgent Care, Université Laval, Québec, Canada
| | - Erick Duan
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Niagara Health – St. Catharine’s General Hospital, St. Catharine’s, Ontario, Canada
| | - Kosar Khwaja
- Montreal General Hospital, Departments of Surgery and Critical Care Medicine, McGill University, Montréal, Québec, Canada
| | - François Lellouche
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Department of Medicine, Université Laval, Québec, Canada
| | - Paul Lysecki
- Joseph Brant Hospital, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - François Marquis
- Maisonneuve-Rosemont, Department of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Jean-François Naud
- Centre intégré universitaire de santé et de services sociaux de la Mauricie-et-du-Centre-du-Québec-CHAUR, Trois-Rivières, Québec, Canada
| | - Jason Shahin
- Royal Victoria Hospital, Department of Critical Care, McGill University, Montréal, Québec, Canada
| | - Jennifer Shea
- Saint John Regional Hospital, Department of Medicine, Memorial University, St. John, New Brunswick, Canada
| | - Jennifer L.Y. Tsang
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Niagara Health – St. Catharine’s General Hospital, St. Catharine’s, Ontario, Canada
| | - Han Ting Wang
- Maisonneuve-Rosemont, Department of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Mark Crowther
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Donald M. Arnold
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Emily Di Sante
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Gladys Marfo
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Tanya Kovalova
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Sylvanus Fonguh
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Jessica Vincent
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Stuart J. Connolly
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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12
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Guay-Bélanger S, Aubin E, Cimon M, Archambault P, Blanchette V, Giguere A, Gogovor A, Morin M, Ben Charif A, Ben Gaied N, Bickerstaff J, Chénard N, Emond J, Gilbert J, Violet I, Légaré F. Engagement of Older Adults Receiving Home Care Services and Their Caregivers in Health Decisions in Partnership With Clinical Teams: Protocol for a Multimethod Study to Prioritize and Culturally Adapt Decision Aids for Home Care. JMIR Res Protoc 2023; 12:e53150. [PMID: 37889512 PMCID: PMC10696497 DOI: 10.2196/53150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/20/2023] [Accepted: 10/23/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Older adults (people aged 65 years and older) face many difficult decisions. Patient decision aids (PtDAs) can help them and their families make informed value-congruent decisions. Some PtDAs have been developed for the home care context, but little is known about scaling them for use with older adults in a different culture. OBJECTIVE This study aims to (1) assess the scalability of existing PtDAs for older adults in the home care context; (2) prioritize those that best match the decisional needs of older adults in home care; and (3) culturally adapt the prioritized PtDAs so they can be scaled successfully to the Quebec health care system. METHODS This multimethod study includes 3 phases. All phases will be overseen by a steering committee of older adults, caregivers, health professionals, decision makers, community organization representatives, and researchers with the needed expertise. In phase 1, we will use the Innovation Scalability Self-administered Questionnaire, a validated scalability self-assessment tool, to assess the scalability of 33 PtDAs previously identified in a systematic review. Based on their scalability, their quality (based on the International Patient Decision Aids Standards), and the importance of the decision point, we will retain approximately a third of these. In phase 2, we will conduct a 2-round web-based Delphi to prioritize the PtDAs selected in phase 1. Using a snowball recruitment strategy, we aim to recruit 60 Delphi participants in the province of Quebec, including older adults, caregivers, health professionals, decision makers involved in home care services, and PtDA experts. In the first round, we will ask participants to rate the importance of several PtDA decision points according to various criteria such as prevalence and difficulty on a 5-point Likert scale (1=not important to 5=very important). Approximately 6 of the highest-rated PtDAs will be retained for presentation in the second round, and we will select up to 3 PtDAs judged as having the highest priority for cultural adaptation. In phase 3, using the Chenel framework and user-centered design methods, we will update and adapt the PtDAs to the Quebec health care system and integrate these PtDAs into an interprofessional shared decision-making training program for home care teams. The adapted PtDAs will respect the International Patient Decision Aids Standards criteria. RESULTS This study was funded in March 2022 by the Canadian Institutes of Health Research. Data collection for the web-based Delphi began in October 2023. Results are expected to be published in May 2024. CONCLUSIONS This project will provide relevant and culturally appropriate decision support tools for older adults making difficult decisions and their home care teams that will be ready for scaling across the province of Quebec. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/53150.
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Affiliation(s)
- Sabrina Guay-Bélanger
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
| | - Emmanuelle Aubin
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
| | - Marie Cimon
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
| | - Patrick Archambault
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
- Department of Anesthesiology and Intensive Care, Université Laval, Quebec, QC, Canada
| | - Virginie Blanchette
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Department of Human Kinetics and Podiatric Medicine, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Anik Giguere
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - Amédé Gogovor
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - Michèle Morin
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
- Department of Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | | | | | | | - Nancy Chénard
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - Julie Emond
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - Julie Gilbert
- Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
| | - Isabelle Violet
- Ministère de la santé et des services sociaux du Québec, Quebec, QC, Canada
| | - France Légaré
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Quebec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
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13
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Izumi SS, Caron D, Guay-Bélanger S, Archambault P, Michaels L, Heinlein J, Dorr DA, Totten A, Légaré F. Development and Evaluation of Serious Illness Conversation Training for Interprofessional Primary Care Teams. J Palliat Med 2023; 26:1198-1206. [PMID: 37040304 DOI: 10.1089/jpm.2022.0268] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023] Open
Abstract
Background: Early advance care planning (ACP) conversations are essential to deliver patient-centered care. While primary care is an ideal setting to initiate ACP, such as Serious Illness Conversations (SICs), many barriers exist to implement such conversations in routine practice. An interprofessional team approach holds promises to address barriers. Objective: To develop and evaluate SIC training for interprofessional primary care teams (IP-SIC). Design: An existing SIC training was adapted for IP-SIC and then implemented and evaluated for acceptability and effectiveness. Setting/Context: Interprofessional teams in 15 primary care clinics in five US states. Measures: Acceptability of the IP-SIC training and participants' self-reported likelihood to engage in ACP after the training. Results: The 156 participants were a mix of physicians and advanced practice providers (APPs) (44%), nurses and social workers (31%), and others (25%). More than 90% of all participants rated the IP-SIC training positively. While nurse/social worker and other groups were less likely than physician and APP group to engage in ACP before training (4.4, 3.7, and 6.4 on a 1-10 scale, respectively), all groups showed significant increase in likelihood to engage in ACP after the IP-SIC training (8.5, 7.7, and 9.2, respectively). Both physician/APP and nurse/social worker groups showed significant increase in likelihood to use the SIC Guide after the IP-SIC training, whereas an increase in likelihood to use SIC Guide among other groups was not statistically significant. Conclusion: The new IP-SIC training was well accepted by interprofessional team members and effective to improve their likelihood to engage in ACP. Further research exploring how to facilitate collaboration among interprofessional team members to maximize opportunities for more and better ACP is warranted. ClinicalTrials.gov ID: NCT03577002.
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Affiliation(s)
- Shigeko Seiko Izumi
- School of Nursing, Oregon Health and Science University, Portland, Oregon, USA
| | - Danielle Caron
- VITAM-Centre de Recherche en Santé Durable, Centre Intégré Universitaire de Santé et Services Sociaux de la Capitale-Nationale, Quebec City, Quebec, Canada
| | - Sabrina Guay-Bélanger
- VITAM-Centre de Recherche en Santé Durable, Centre Intégré Universitaire de Santé et Services Sociaux de la Capitale-Nationale, Quebec City, Quebec, Canada
| | - Patrick Archambault
- VITAM-Centre de Recherche en Santé Durable, Centre Intégré Universitaire de Santé et Services Sociaux de la Capitale-Nationale, Quebec City, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
- Centre de Recherche, Centre Intégré en Santé et Services Sociaux de Chaudière-Appalaches, Lévis, Quebec, Canada
| | - LeAnn Michaels
- Oregon Rural Practice-Based Research Network, Oregon Health and Science University, Portland, Oregon, USA
| | - Julia Heinlein
- Oregon Rural Practice-Based Research Network, Oregon Health and Science University, Portland, Oregon, USA
| | - David A Dorr
- Oregon Rural Practice-Based Research Network, Oregon Health and Science University, Portland, Oregon, USA
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, USA
| | - Annette Totten
- Oregon Rural Practice-Based Research Network, Oregon Health and Science University, Portland, Oregon, USA
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, USA
| | - France Légaré
- VITAM-Centre de Recherche en Santé Durable, Centre Intégré Universitaire de Santé et Services Sociaux de la Capitale-Nationale, Quebec City, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
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14
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Menear M, Duhoux A, Bédard M, Paquette JS, Baron M, Breton M, Courtemanche S, Dubé S, Dufour S, Fortin M, Girard A, Larouche-Côté É, L'Espérance A, LeBlanc A, Poitras ME, Rivet S, Sasseville M, Achim A, Archambault P, Bajurny V, Brown JB, Carrier JD, Côté N, Couturier Y, Dogba MJ, Gagnon MP, Ghio SC, Marshall EG, Kothari A, Lussier MT, Mair FS, Smith S, Vachon B, Wong S. Understanding the impacts of the COVID-19 pandemic on the care experiences of people with mental-physical multimorbidity: protocol for a mixed methods study. BMC Prim Care 2023; 24:154. [PMID: 37488515 PMCID: PMC10364355 DOI: 10.1186/s12875-023-02106-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 07/06/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Primary care and other health services have been disrupted during the COVID-19 pandemic, yet the consequences of these service disruptions on patients' care experiences remain largely unstudied. People with mental-physical multimorbidity are vulnerable to the effects of the pandemic, and to sudden service disruptions. It is thus essential to better understand how their care experiences have been impacted by the current pandemic. This study aims to improve understanding of the care experiences of people with mental-physical multimorbidity during the pandemic and identify strategies to enhance these experiences. METHODS We will conduct a mixed-methods study with multi-phase approach involving four distinct phases. Phase 1 will be a qualitative descriptive study in which we interview individuals with mental-physical multimorbidity and health professionals in order to explore the impacts of the pandemic on care experiences, as well as their perspectives on how care can be improved. The results of this phase will inform the design of study phases 2 and 3. Phase 2 will involve journey mapping exercises with a sub-group of participants with mental-physical multimorbidity to visually map out their care interactions and experiences over time and the critical moments that shaped their experiences. Phase 3 will involve an online, cross-sectional survey of care experiences administered to a larger group of people with mental disorders and/or chronic physical conditions. In phase 4, deliberative dialogues will be held with key partners to discuss and plan strategies for improving the delivery of care to people with mental-physical multimorbidity. Pre-dialogue workshops will enable us to synthesize an prepare the results from the previous three study phases. DISCUSSION Our study results will generate much needed evidence of the positive and negative impacts of the COVID-19 pandemic on the care experiences of people with mental-physical multimorbidity and shed light on strategies that could improve care quality and experiences.
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Affiliation(s)
- Matthew Menear
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Canada.
- VITAM Centre de recherche en santé durable, Quebec City, Canada.
| | - Arnaud Duhoux
- Faculty of Nursing, Université de Montréal, Montreal, Canada
- Centre de Recherche Charles-Le Moyne, Montreal, Canada
| | - Myreille Bédard
- Person With Lived Experience (Patient Partner), Montreal, Canada
| | - Jean-Sébastien Paquette
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Canada
- VITAM Centre de recherche en santé durable, Quebec City, Canada
| | - Marie Baron
- VITAM Centre de recherche en santé durable, Quebec City, Canada
| | - Mylaine Breton
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | | | - Savannah Dubé
- VITAM Centre de recherche en santé durable, Quebec City, Canada
| | - Stefany Dufour
- VITAM Centre de recherche en santé durable, Quebec City, Canada
| | - Martin Fortin
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Ariane Girard
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | | | | | - Annie LeBlanc
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Canada
- VITAM Centre de recherche en santé durable, Quebec City, Canada
| | - Marie-Eve Poitras
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Sophie Rivet
- VITAM Centre de recherche en santé durable, Quebec City, Canada
| | - Maxime Sasseville
- VITAM Centre de recherche en santé durable, Quebec City, Canada
- Faculty of Nursing, Université Laval, Quebec, Canada
| | - Amélie Achim
- VITAM Centre de recherche en santé durable, Quebec City, Canada
- Department of Psychiatry, Université Laval, Quebec, Canada
| | - Patrick Archambault
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Canada
- VITAM Centre de recherche en santé durable, Quebec City, Canada
| | - Virtue Bajurny
- Person with Lived Experience (Patient Partner), Toronto, Canada
| | | | - Jean-Daniel Carrier
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Nancy Côté
- VITAM Centre de recherche en santé durable, Quebec City, Canada
- Faculty of Social Sciences, Université Laval, Quebec, Canada
| | - Yves Couturier
- School of Social Work, Université de Sherbrooke, Sherbrooke, Canada
| | - Maman Joyce Dogba
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Canada
- VITAM Centre de recherche en santé durable, Quebec City, Canada
| | - Marie-Pierre Gagnon
- VITAM Centre de recherche en santé durable, Quebec City, Canada
- Faculty of Nursing, Université Laval, Quebec, Canada
| | | | | | - Anita Kothari
- Department of Health Studies, Western University, London, Canada
| | - Marie-Thérèse Lussier
- Department of Family Medicine and Emergency Medicine, Université de Montréal, Montreal, Canada
| | - Frances S Mair
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Susan Smith
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, UK
| | - Brigitte Vachon
- School of Rehabilitation, Université de Montréal, Montreal, Canada
| | - Sabrina Wong
- Faculty of Applied Science, University of British Colombia, Vancouver, Canada
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15
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Moore L, Bérubé M, Belcaid A, Turgeon AF, Taljaard M, Fowler R, Yanchar N, Mercier É, Paquet J, Stelfox HT, Archambault P, Berthelot S, Guertin JR, Haas B, Ivers N, Grimshaw J, Lapierre A, Ouyang Y, Sykes M, Witteman H, Lessard-Bonaventure P, Gabbe B, Lauzier F. Evaluating the effectiveness of a multifaceted intervention to reduce low-value care in adults hospitalized following trauma: a protocol for a pragmatic cluster randomized controlled trial. Implement Sci 2023; 18:27. [PMID: 37420284 DOI: 10.1186/s13012-023-01279-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/28/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND While simple Audit & Feedback (A&F) has shown modest effectiveness in reducing low-value care, there is a knowledge gap on the effectiveness of multifaceted interventions to support de-implementation efforts. Given the need to make rapid decisions in a context of multiple diagnostic and therapeutic options, trauma is a high-risk setting for low-value care. Furthermore, trauma systems are a favorable setting for de-implementation interventions as they have quality improvement teams with medical leadership, routinely collected clinical data, and performance-linked to accreditation. We aim to evaluate the effectiveness of a multifaceted intervention for reducing low-value clinical practices in acute adult trauma care. METHODS We will conduct a pragmatic cluster randomized controlled trial (cRCT) embedded in a Canadian provincial quality assurance program. Level I-III trauma centers (n = 30) will be randomized (1:1) to receive simple A&F (control) or a multifaceted intervention (intervention). The intervention, developed using extensive background work and UK Medical Research Council guidelines, includes an A&F report, educational meetings, and facilitation visits. The primary outcome will be the use of low-value initial diagnostic imaging, assessed at the patient level using routinely collected trauma registry data. Secondary outcomes will be low-value specialist consultation, low-value repeat imaging after a patient transfer, unintended consequences, determinants for successful implementation, and incremental cost-effectiveness ratios. DISCUSSION On completion of the cRCT, if the intervention is effective and cost-effective, the multifaceted intervention will be integrated into trauma systems across Canada. Medium and long-term benefits may include a reduction in adverse events for patients and an increase in resource availability. The proposed intervention targets a problem identified by stakeholders, is based on extensive background work, was developed using a partnership approach, is low-cost, and is linked to accreditation. There will be no attrition, identification, or recruitment bias as the intervention is mandatory in line with trauma center designation requirements, and all outcomes will be assessed with routinely collected data. However, investigators cannot be blinded to group allocation and there is a possibility of contamination bias that will be minimized by conducting intervention refinement only with participants in the intervention arm. TRIAL REGISTRATION This protocol has been registered on ClinicalTrials.gov (February 24, 2023, # NCT05744154 ).
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Affiliation(s)
- Lynne Moore
- Department of Social and Preventive Medicine, Université Laval, 1050 Av. de La Médecine, Québec, Qc, Canada
- Population Health and Optimal Health Practices Research Unit, Centre de Recherche du CHU de Québec (Hôpital de L'Enfant-Jésus), Université Laval, 1050 Av. de La Médecine, Québec, Qc, Canada
| | - Mélanie Bérubé
- Population Health and Optimal Health Practices Research Unit, Centre de Recherche du CHU de Québec (Hôpital de L'Enfant-Jésus), Université Laval, 1050 Av. de La Médecine, Québec, Qc, Canada
- Faculty of Nursing, Université Laval, 1050 Av. de La Médecine, Québec, Qc, Canada
| | - Amina Belcaid
- Institut national d'excellence en santé et services sociaux, Bd Laurier, Québec, Qc, 2535, Canada
| | - Alexis F Turgeon
- Population Health and Optimal Health Practices Research Unit, Centre de Recherche du CHU de Québec (Hôpital de L'Enfant-Jésus), Université Laval, 1050 Av. de La Médecine, Québec, Qc, Canada
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, 1050 Av. de La Médecine, Québec, Qc, Canada
| | - Monica Taljaard
- Ottawa Hospital Research Institute, 725 Parkdale Ave, Ottawa, On, Canada
| | - Robert Fowler
- Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, On, Canada
| | - Natalie Yanchar
- Department of Surgery, University of Calgary, 3280 Hospital Dr. NW, Calgary, Ab, Canada
| | - Éric Mercier
- Population Health and Optimal Health Practices Research Unit, Centre de Recherche du CHU de Québec (Hôpital de L'Enfant-Jésus), Université Laval, 1050 Av. de La Médecine, Québec, Qc, Canada
| | - Jérôme Paquet
- Department of Surgery, Université Laval, 1050 Av. de La Médecine, Québec, Qc, Canada
| | - Henry Thomas Stelfox
- Department of Critical Care Medicine, Medicine and Community Health Sciences, O'Brien Institute for Public Health, University of Calgary, 3280 Hospital Dr. NW, Calgary, Al, Canada
| | - Patrick Archambault
- Population Health and Optimal Health Practices Research Unit, Centre de Recherche du CHU de Québec (Hôpital de L'Enfant-Jésus), Université Laval, 1050 Av. de La Médecine, Québec, Qc, Canada
| | - Simon Berthelot
- Population Health and Optimal Health Practices Research Unit, Centre de Recherche du CHU de Québec (Hôpital de L'Enfant-Jésus), Université Laval, 1050 Av. de La Médecine, Québec, Qc, Canada
| | - Jason R Guertin
- Population Health and Optimal Health Practices Research Unit, Centre de Recherche du CHU de Québec (Hôpital de L'Enfant-Jésus), Université Laval, 1050 Av. de La Médecine, Québec, Qc, Canada
| | - Barbara Haas
- Department of Surgery, University of Toronto, 149 College St, Toronto, On, Canada
| | - Noah Ivers
- Department of Family and Community Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St 4Th Floor, Toronto, On, Canada
| | - Jeremy Grimshaw
- Ottawa Hospital Research Institute, 725 Parkdale Ave, Ottawa, On, Canada
| | - Alexandra Lapierre
- Faculty of Nursing, Université de Montréal, Chem. de La Côte-Sainte-Catherine, Montréal, Qc, 2375, Canada
| | - Yongdong Ouyang
- Ottawa Hospital Research Institute, 725 Parkdale Ave, Ottawa, On, Canada
| | - Michael Sykes
- Department of Nursing, Midwifery, and Health, Northumbria University, Ellison PI, Newcastle, UK
| | - Holly Witteman
- Department of Family and Emergency Medicine, Université Laval, 1050 Av. de La Médecine, Québec, Qc, Canada
| | - Paule Lessard-Bonaventure
- Department of Surgery, Division of Neurosurgery, Université Laval, 1050 Av. de La Médecine, Québec, Canada
| | - Belinda Gabbe
- School of Public Health and Preventive Medicine, Monash University, 553 St. Kilda Rd, Melbourne, Victoria, VIC 3004, Australia
| | - François Lauzier
- Population Health and Optimal Health Practices Research Unit, Centre de Recherche du CHU de Québec (Hôpital de L'Enfant-Jésus), Université Laval, 1050 Av. de La Médecine, Québec, Qc, Canada
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, 1050 Av. de La Médecine, Québec, Qc, Canada
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16
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Kho ME, Reid J, Molloy AJ, Herridge MS, Seely AJ, Rudkowski JC, Buckingham L, Heels-Ansdell D, Karachi T, Fox-Robichaud A, Ball IM, Burns KEA, Pellizzari JR, Farley C, Berney S, Pastva AM, Rochwerg B, D'Aragon F, Lamontagne F, Duan EH, Tsang JLY, Archambault P, English SW, Muscedere J, Serri K, Tarride JE, Mehta S, Verceles AC, Reeve B, O'Grady H, Kelly L, Strong G, Hurd AH, Thabane L, Cook DJ. Critical Care C ycling to Improve Lower Extremity Strength (CYCLE): protocol for an international, multicentre randomised clinical trial of early in-bed cycling for mechanically ventilated patients. BMJ Open 2023; 13:e075685. [PMID: 37355270 PMCID: PMC10314658 DOI: 10.1136/bmjopen-2023-075685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 05/18/2023] [Indexed: 06/26/2023] Open
Abstract
INTRODUCTION In-bed leg cycling with critically ill patients is a promising intervention aimed at minimising immobility, thus improving physical function following intensive care unit (ICU) discharge. We previously completed a pilot randomised controlled trial (RCT) which supported the feasibility of a large RCT. In this report, we describe the protocol for an international, multicentre RCT to determine the effectiveness of early in-bed cycling versus routine physiotherapy (PT) in critically ill, mechanically ventilated adults. METHODS AND ANALYSIS We report a parallel group RCT of 360 patients in 17 medical-surgical ICUs and three countries. We include adults (≥18 years old), who could ambulate independently before their critical illness (with or without a gait aid), ≤4 days of invasive mechanical ventilation and ≤7 days ICU length of stay, and an expected additional 2-day ICU stay, and who do not fulfil any of the exclusion criteria. After obtaining informed consent, patients are randomised using a web-based, centralised system to either 30 min of in-bed cycling in addition to routine PT, 5 days per week, up to 28 days maximum, or routine PT alone. The primary outcome is the Physical Function ICU Test-scored (PFIT-s) at 3 days post-ICU discharge measured by assessors blinded to treatment allocation. Participants, ICU clinicians and research coordinators are not blinded to group assignment. Our sample size estimate was based on the identification of a 1-point mean difference in PFIT-s between groups. ETHICS AND DISSEMINATION Critical Care Cycling to improve Lower Extremity (CYCLE) is approved by the Research Ethics Boards of all participating centres and Clinical Trials Ontario (Project 1345). We will disseminate trial results through publications and conference presentations. TRIAL REGISTRATION NUMBER NCT03471247 (Full RCT); NCT02377830 (CYCLE Vanguard 46 patient internal pilot).
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Affiliation(s)
- Michelle E Kho
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
- Physiotherapy, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Research Institute of St. Joe's, Hamilton, Ontario, Canada
| | - Julie Reid
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Alexander J Molloy
- Physiotherapy, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Research Institute of St. Joe's, Hamilton, Ontario, Canada
| | - Margaret S Herridge
- University Health Network, Toronto General Research Institute, Toronto, Ontario, Canada
| | - Andrew J Seely
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Jill C Rudkowski
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Medicine, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Lisa Buckingham
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Diane Heels-Ansdell
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Tim Karachi
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | | | - Ian M Ball
- Department of Medicine, Western University, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Karen E A Burns
- Li Sha King Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care, Unity Health Toronto, Toronto, Ontario, Canada
| | - Joseph R Pellizzari
- Consultation-Liaison Psychiatry Service, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Christopher Farley
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Sue Berney
- Department of Physiotherapy, Austin Health, Heidelberg, Victoria, Australia
- Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - Amy M Pastva
- Departments of Medicine and Orthopedic Surgery, Duke University, Durham, North Carolina, USA
| | - Bram Rochwerg
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Frédérick D'Aragon
- Department of Anesthesiology, Universite de Sherbrooke Faculte de medecine et des sciences de la sante, Sherbrooke, Quebec, Canada
- Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
| | - Francois Lamontagne
- Centre de recherche du CHUS, Sherbrooke, Quebec, Canada
- Medicine, Universite de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Erick H Duan
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Medicine, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
- Division of Critical Care Medicine, Niagara Health System, St Catharines, Ontario, Canada
| | - Jennifer L Y Tsang
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Division of Critical Care Medicine, Niagara Health System, St Catharines, Ontario, Canada
| | - Patrick Archambault
- Anesthesiology and Intensive Care, Faculty of Medicine, Université Laval, Quebec, Québec, Canada
- Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Quebec, Québec, Canada
| | - Shane W English
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine (Critical Care), University of Ottawa, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - John Muscedere
- Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada
| | - Karim Serri
- Critical Care Division, Department of Medicine, Hôpital du Sacré-Coeur de Montréal, Montreal, Québec, Canada
| | - Jean-Eric Tarride
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Programs for the Assessment of Technology in Health, Research Institute of St. Joe's Hamilton, Hamilton, Ontario, Canada
| | - Sangeeta Mehta
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada
- Sinai Health System, Toronto, Ontario, Canada
| | - Avelino C Verceles
- Department of Medicine, University of Maryland Medical Center, Baltimore, Maryland, USA
- Division of Pulmonary and Critical Care Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Brenda Reeve
- Medicine, Brantford General Hospital, Brantford, Ontario, Canada
| | - Heather O'Grady
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Laurel Kelly
- Physiotherapy, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Geoff Strong
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Abby H Hurd
- Physiotherapy, St Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Lehana Thabane
- Research Institute of St. Joe's, Hamilton, Ontario, Canada
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Deborah J Cook
- Research Institute of St. Joe's, Hamilton, Ontario, Canada
- Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- Medicine, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
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17
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Kiss A, Zhang Q, Carley M, Smith M, Légaré F, Archambault P, Stacey D. Quality of patient decision aids to support the public making COVID-19 decisions: An online environmental scan. Patient Educ Couns 2023; 114:107797. [PMID: 37244134 PMCID: PMC10197540 DOI: 10.1016/j.pec.2023.107797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/03/2023] [Accepted: 05/16/2023] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To identify and appraise the quality of COVID-19 patient decision aids (PtDAs). METHODS We conducted an environmental scan of online publicly available COVID-19 PtDAs. Two reviewers independently searched and extracted data. We calculated median International Patient Decision Aid Standards (IPDAS) scores and proportion scoring > 70% on Patient Education Materials Information Tool (PEMAT) adequate for understandability and actionability. RESULTS Of 876 resources identified, 12 were PtDAs. Decisions focused on initial COVID-19 vaccination series (n = 9), location of care for elderly (n = 2), and social distancing (n = 1). All 12 PtDAs were written materials and two had accompanying videos. The median IPDAS score minimizing risk of biased decisions was 4 of 6 items (IQR 1, range 2-4). For PEMAT, 92% had adequate for understandability and none for actionability. CONCLUSIONS We identified few online publicly available COVID-19 PtDAs and none were about COVID-19 vaccination boosters or treatment. PtDAs scored poorly on actionability and none met all IPDAS criteria for minimizing risk of biased decisions. PRACTICE IMPLICATIONS PtDA developers for COVID-19 and future pandemics should ensure their PtDAs meet all IPDAS criteria for minimizing risk of bias, have adequate scores for actionability, and are disseminated in the A to Z inventory.
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Affiliation(s)
- Alda Kiss
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Canada
| | - Qian Zhang
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Canada
| | - Meg Carley
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Maureen Smith
- Patient Partner and Cochrane Consumer Network Executive, Ottawa, Canada
| | - France Légaré
- VITAM-Centre de recherche en santé durable, Pavillon Landry-Poulin, Québec, Canada; Department of Family Medicine and Emergency Medicine, Université Laval, Québec, Canada; Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Université Laval, Québec, Canada
| | - Patrick Archambault
- Centre de Recherche Intégrée Pour un Système Apprenant en Santé et Services Sociaux, Lévis, Canada; Department of Family Medicine and Emergency Medicine, Université Laval, Lévis, Canada; VITAM - Centre de Recherche en Santé Durable, Québec, Canada
| | - Dawn Stacey
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Canada; Ottawa Hospital Research Institute, Ottawa, Canada.
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18
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Leeies M, Rosychuk RJ, Ismath M, Xu K, Archambault P, Fok PT, Audet T, Jelic T, Hayward J, Daoust R, Chandra K, Davis P, Yan JW, Hau JP, Welsford M, Brooks SC, Hohl CM. Intubation practices and outcomes for patients with suspected or confirmed COVID-19: a national observational study by the Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN). CAN J EMERG MED 2023; 25:335-343. [PMID: 37017802 PMCID: PMC10075161 DOI: 10.1007/s43678-023-00487-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 03/09/2023] [Indexed: 04/06/2023]
Abstract
OBJECTIVE Intubation practices changed during the COVID-19 pandemic to protect healthcare workers from transmission of disease. Our objectives were to describe intubation characteristics and outcomes for patients tested for SARS CoV-2 infection. We compared outcomes between patients testing SARS COV-2 positive with those testing negative. METHODS We conducted a health records review using the Canadian COVID-19 Emergency Department Rapid Response Network (CCEDRRN) registry. We included consecutive eligible patients who presented to one of 47 EDs across Canada between March 1, 2020 and June 20, 2021, were tested for SARS-CoV-2 and intubated in the ED. The primary outcome was the proportion of patients experiencing a post-intubation adverse event during the ED stay. Secondary outcomes included first-pass success, intubation practices, and hospital mortality. We used descriptive statistics to summarize variables with subgroup differences examined using t tests, z tests, or chi-squared tests where appropriate with 95% CIs. RESULTS Of 1720 patients with suspected COVID-19 who were intubated in the ED during the study period, 337 (19.6%) tested SARS-CoV-2 positive and 1383 (80.4%) SARS-CoV-2 negative. SARS-CoV-2 positive patients presented to hospital with lower oxygen levels than SARS-CoV-2 negative patients (mean pulse oximeter SaO2 86 vs 94%, p < 0.001). In total, 8.5% of patients experienced an adverse event post-intubation. More patients in the SARS-CoV-2 positive subgroup experienced post-intubation hypoxemia (4.5 vs 2.2%, p = 0.019). In-hospital mortality was greater for patients who experienced intubation-related adverse events (43.2 vs 33.2%, p = 0.018). There was no significant difference in adverse event-associated mortality by SARS-CoV-2 status. First-pass success was achieved in 92.4% of all intubations, with no difference by SARS-CoV-2 status. CONCLUSIONS During the COVID-19 pandemic, we observed a low risk of adverse events associated with intubation, even though hypoxemia was common in patients with confirmed SARS-CoV-2. We observed high rates of first-pass success and low rates of inability to intubate. The limited number of adverse events precluded multivariate adjustments. Study findings should reassure emergency medicine practitioners that system modifications made to intubation processes in response to the COVID-19 pandemic do not appear to be associated with worse outcomes compared to pre-COVID-19 practices.
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Affiliation(s)
- Murdoch Leeies
- Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada.
- Rady Faculty of Health Sciences, Section of Critical Care Medicine, University of Manitoba, Winnipeg, MB, Canada.
| | - Rhonda J Rosychuk
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Muzeen Ismath
- Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Ke Xu
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Patrick Archambault
- Department of Family Medicine and Emergency Medicine and Department of Anesthesiology and Intensive Care, Université Laval, Québec, QC, Canada
| | - Patrick T Fok
- Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
| | - Thomas Audet
- Department of Internal Medicine, Université Laval, Québec, QC, Canada
| | - Tomislav Jelic
- Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Jake Hayward
- Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada
| | - Raoul Daoust
- Department of Family and Emergency Medicine, University of Montreal, Montreal, QC, Canada
| | - Kavish Chandra
- Department of Emergency Medicine, Dalhousie University, Saint John, NB, Canada
| | - Phil Davis
- Department of Emergency Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Justin W Yan
- Division of Emergency Medicine, Department of Medicine, Schulich School of Medicine and Dentistry, Western University and Lawson Health Research Institute, London Health Sciences Centre, London, ON, Canada
| | - Jeffrey P Hau
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Michelle Welsford
- Division of Emergency Medicine, McMaster University, Hamilton, ON, Canada
| | - Steven C Brooks
- Department of Emergency Medicine, Queen's University, Kingston, ON, Canada
| | - Corinne M Hohl
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
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19
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Stacey D, Ludwig C, Archambault P, Smith M, Taljaard M, Carley M, Plourde K, Boland L, Gogovor A, Graham I, Kobewka D, McLean RKD, Nelson MLA, Vanderspank-Wright B, Légaré F. Decisions and Decisional Needs of Canadians From all Provinces and Territories During the COVID-19 Pandemic: Population-Based Cross-sectional Surveys. JMIR Public Health Surveill 2023; 9:e43652. [PMID: 36688986 PMCID: PMC10131685 DOI: 10.2196/43652] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/21/2022] [Accepted: 01/20/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Never before COVID-19 had Canadians faced making health-related decisions in a context of significant uncertainty. However, little is known about which type of decisions and the types of difficulties that they faced. OBJECTIVE We sought to identify the health-related decisions and decisional needs of Canadians. METHODS Our study was codesigned by researchers and knowledge users (eg, patients, clinicians). Informed by the CHERRIES (the Checklist for Reporting Results of Internet E-Surveys) reporting guideline, we conducted 2 online surveys of random samples drawn from the Leger consumer panel of 400,000 Canadians. Eligible participants were adults (≥18 years) who received or were receiving any health services in the past 12 months for themselves (adults) or for their child (parent) or senior with cognitive impairment (caregiver). We assessed decisions and decisional needs using questions informed by the Ottawa Decision Support Framework, including decisional conflict and decision regret using the Decision Conflict Scale (DCS) and the Decision Regret Scale (DRS), respectively. Descriptive statistics were conducted for adults who had decided for themselves or on behalf of someone else. Significant decisional conflict (SDC) was defined as a total DCS score of >37.5 out of 100, and significant decision regret was defined as a total DRS score of >25 out of 100. RESULTS From May 18 to June 4, 2021, 14,459 adults and 6542 parents/caregivers were invited to participate. The invitation view rate was 15.5% (2236/14,459) and 28.3% (1850/6542); participation rate, 69.3% (1549/2236) and 28.7% (531/1850); and completion rate, 97.3% (1507/1549) and 95.1% (505/531), respectively. The survey was completed by 1454 (97.3%) adults and 438 (95.1%) parents/caregivers in English (1598/1892, 84.5%) or French (294/1892, 15.5%). Respondents from all 10 Canadian provinces and the northern territories represented a range of ages, education levels, civil statuses, ethnicities, and annual household income. Of 1892 respondents, 541 (28.6%) self-identified as members of marginalized groups. The most frequent decisions were (adults vs parents/caregivers) as follows: COVID-19 vaccination (490/1454, 33.7%, vs 87/438, 19.9%), managing a health condition (253/1454, 17.4%, vs 47/438, 10.7%), other COVID-19 decisions (158/1454, 10.9%, vs 85/438, 19.4%), mental health care (128/1454, 8.8%, vs 27/438, 6.2%), and medication treatments (115/1454, 7.9%, vs 23/438, 5.3%). Caregivers also reported decisions about moving family members to/from nursing or retirement homes (48/438, 11.0%). Adults (323/1454, 22.2%) and parents/caregivers (95/438, 21.7%) had SDC. Factors making decisions difficult were worrying about choosing the wrong option (557/1454, 38.3%, vs 184/438, 42.0%), worrying about getting COVID-19 (506/1454, 34.8%, vs 173/438, 39.5%), public health restrictions (427/1454, 29.4%, vs 158/438, 36.1%), information overload (300/1454, 20.6%, vs 77/438, 17.6%), difficulty separating misinformation from scientific evidence (297/1454, 20.4%, vs 77/438, 17.6%), and difficulty discussing decisions with clinicians (224/1454, 15.4%, vs 51/438, 11.6%). For 1318 (90.6%) adults and 366 (83.6%) parents/caregivers who had decided, 353 (26.8%) and 125 (34.2%) had significant decision regret, respectively. In addition, 1028 (50%) respondents made their decision alone without considering the opinions of clinicians. CONCLUSIONS During COVID-19, Canadians who responded to the survey faced several new health-related decisions. Many reported unmet decision-making needs, resulting in SDC and decision regret. Interventions can be designed to address their decisional needs and support patients facing new health-related decisions.
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Affiliation(s)
- Dawn Stacey
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | - Patrick Archambault
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, QC, Canada
- Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Université Laval, Lévis, QC, Canada
- VITAM - Centre de recherche en santé durable, Université Laval, Quebec City, QC, Canada
| | - Maureen Smith
- Patient Partner, Ottawa, ON, Canada
- Cochrane Consumer Network Executive, Ottawa, ON, Canada
| | - Monica Taljaard
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Meg Carley
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Karine Plourde
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, QC, Canada
| | - Laura Boland
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Amédé Gogovor
- VITAM - Centre de recherche en santé durable, Université Laval, Quebec City, QC, Canada
| | - Ian Graham
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Daniel Kobewka
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- General Internal Medicine, The Ottawa Hospital, Ottawa, ON, Canada
| | | | - Michelle L A Nelson
- Sinai Health System, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Brandi Vanderspank-Wright
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, QC, Canada
- VITAM - Centre de recherche en santé durable, Université Laval, Quebec City, QC, Canada
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20
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Mowbray FI, Heckman G, Hirdes JP, Costa AP, Beauchet O, Archambault P, Eagles D, Wang HT, Perry JJ, Sinha SK, Jantzi M, Hebert P. Agreement and prognostic accuracy of three ED vulnerability screeners: findings from a prospective multi-site cohort study. CAN J EMERG MED 2023; 25:209-217. [PMID: 36857018 PMCID: PMC10014815 DOI: 10.1007/s43678-023-00458-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 01/13/2023] [Indexed: 03/02/2023]
Abstract
OBJECTIVES To evaluate the agreement between three emergency department (ED) vulnerability screeners, including the InterRAI ED Screener, ER2, and PRISMA-7. Our secondary objective was to evaluate the discriminative accuracy of screeners in predicting discharge home and extended ED lengths-of-stay (> 24 h). METHODS We conducted a nested sub-group study using data from a prospective multi-site cohort study evaluating frailty in older ED patients presenting to four Quebec hospitals. Research nurses assessed patients consecutively with the three screeners. We employed Cohen's Kappa to determine agreement, with high-risk cut-offs of three and four for the PRISMA-7, six for the ER2, and five for the interRAI ED Screener. We used logistic regression to evaluate the discriminative accuracy of instruments, testing them in their dichotomous, full, and adjusted forms (adjusting for age, sex, and hospital academic status). RESULTS We evaluated 1855 older ED patients across the four hospital sites. The mean age of our sample was 84 years. Agreement between the interRAI ED Screener and the ER2 was fair (K = 0.37; 95% CI 0.33-0.40); agreement between the PRISMA-7 and ER2 was also fair (K = 0.39; 95% CI = 0.36-0.43). Agreement between interRAI ED Screener and PRISMA-7 was poor (K = 0.19; 95% CI 0.16-0.22). Using a cut-off of four for PRISMA-7 improved agreement with the ER2 (K = 0.55; 95% CI 0.51-0.59) and the ED Screener (K = 0.32; 95% CI 0.2-0.36). When predicting discharge home, the concordance statistics among models were similar in their dichotomous (c = 0.57-0.61), full (c = 0.61-0.64), and adjusted forms (c = 0.63-0.65), and poor for all models when predicting extended length-of-stay. CONCLUSION ED vulnerability scores from the three instruments had a fair agreement and were associated with important patient outcomes. The interRAI ED Screener best identifies older ED patients at greatest risk, while the PRISMA-7 and ER2 are more sensitive instruments.
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Affiliation(s)
- Fabrice I Mowbray
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - George Heckman
- School of Public Health Science, University of Waterloo, Waterloo, ON, Canada
- Schlegel Research Institute for Aging, Waterloo, ON, Canada
| | - John P Hirdes
- School of Public Health Science, University of Waterloo, Waterloo, ON, Canada
| | - Andrew P Costa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Olivier Beauchet
- Department of Medicine and Research Center of the Geriatric University Institute of Montreal, University of Montreal, Montreal, QC, Canada
- Division of Geriatric Medicine, Department of Medicine, Sir Mortimer B. Davis Jewish General Hospital and Lady Davis Institute for Medical Research, McGill University, Montreal, QC, Canada
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Patrick Archambault
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec, QC, Canada
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Sainte-Marie, QC, Canada
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec City, QC, Canada
| | - Debra Eagles
- Department of Emergency Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Han Ting Wang
- Division of Critical Care Medicine, Department of Medicine, Universite de Montreal, Montreal, QC, Canada
| | - Jeffrey J Perry
- Department of Emergency Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Samir K Sinha
- Division of Geriatric Medicine, Department of Medicine, Sinai Health and University Health Network, Toronto, ON, Canada
- Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Micaela Jantzi
- School of Public Health Science, University of Waterloo, Waterloo, ON, Canada
| | - Paul Hebert
- Division of Palliative Care, Department of Medicine, Bruyere Research Institute, University of Ottawa, Ottawa, ON, Canada.
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21
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Tran A, Wallner C, de Wit K, Gérin-Lajoie C, Ritchie K, Mercuri M, Clayton N, Boulos M, Archambault P, Schwartz L, Gray S, Chan TMY. Humans not heroes: Canadian emergency physician experiences during the early COVID-19 pandemic. J Accid Emerg Med 2023; 40:86-91. [PMID: 36253075 DOI: 10.1136/emermed-2022-212466] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 09/29/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND The pandemic has upended much clinical care, irrevocably changing our health systems and thrusting emergency physicians into a time of great uncertainty and change. This study is a follow-up to a survey that examined the early pandemic experience among Canadian emergency physicians and aimed to qualitatively describe the experiences of these physicians during the global pandemic. The study was conducted at a time when Canadian COVID-19 case numbers were low. METHODS The investigators engaged in an interview-based study that used an interpretive description analytic technique, sensitised by the principles of phenomenology. One-to-one interviews were conducted, transcribed and then analysed to establish a codebook, which was subsequently grouped into key themes. Results underwent source triangulation (with survey data from a similar period) and investigator-driven audit trail analysis. RESULTS A total of 16 interviews (11 female, 5 male) were conducted between May and September 2020. The isolated themes on emergency physicians' experiences during the early pandemic included: (1) disruption and loss of emergency department shift work; (2) stress of COVID-19 uncertainty and information bombardment; (3) increased team bonding; (4) greater personal life stress; (5) concern for patients' isolation, miscommunication and disconnection from care; (6) emotional distress. CONCLUSIONS Canadian emergency physicians experienced emotional and psychological distress during the early COVID-19 pandemic, at a time when COVID-19 prevalence was low. This study's findings could guide future interventions to protect emergency physicians against pandemic-related distress.
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Affiliation(s)
- Anna Tran
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,School of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Clare Wallner
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,Emergency Department, Hamilton Health Sciences, Hamilton, Ontario, Canada.,Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kerstin de Wit
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada .,Health research methodology, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada.,Emergency Medicine, Queen's University, Kingston, Ontario, Canada
| | | | - Kerri Ritchie
- Department of Obstetrics and Gynecology, Ottawa Hospital, Ottawa, Ontario, Canada.,Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada
| | - Mathew Mercuri
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,University of Toronto, Toronto, Ontario, Canada
| | - Natasha Clayton
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,Emergency Department, Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Mary Boulos
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Patrick Archambault
- Department of Anesthesiology and Critical Care Medicine, Universite Laval Faculte de medecine, Quebec, Quebec, Canada.,Centre integre de sante et de services sociaux de Chaudiere-Appalaches, Lévis, Quebec, Canada
| | - Lisa Schwartz
- Health research methodology, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
| | - Sara Gray
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Teresa Man-Yee Chan
- Emergency Department, Hamilton Health Sciences, Hamilton, Ontario, Canada.,Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.,Health research methodology, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada.,Division of Education & Innovation, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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22
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Bola R, Sutherland J, Murphy RA, Leeies M, Grant L, Hayward J, Archambault P, Graves L, Rose T, Hohl C. Patient-reported health outcomes of SARS-CoV-2-tested patients presenting to emergency departments: a propensity score-matched prospective cohort study. Public Health 2023; 215:1-11. [PMID: 36587446 PMCID: PMC9712064 DOI: 10.1016/j.puhe.2022.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/21/2022] [Accepted: 11/23/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVE This study aimed to compare the long-term physical and mental health outcomes of matched severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive and SARS-CoV-2-negative patients controlling for seasonal effects. STUDY DESIGN This was a retrospective cohort study. METHODS This study enrolled patients presenting to emergency departments participating in the Canadian COVID-19 Emergency Department Rapid Response Network. We enrolled consecutive eligible consenting patients who presented between March 1, 2020, and July 14, 2021, and were tested for SARS-CoV-2. Research assistants randomly selected four site and date-matched SARS-CoV-2-negative controls for every SARS-CoV-2-positive patient and interviewed them at least 30 days after discharge. We used propensity scores to match patients by baseline characteristics and used linear regression to compare Veterans RAND 12-item physical health component score (PCS) and mental health component scores (MCS), with higher scores indicating better self-reported health. RESULTS We included 1170 SARS-CoV-2-positive patients and 3716 test-negative controls. The adjusted mean difference for PCS was 0.50 (95% confidence interval [CI]: -0.36, 1.36) and -1.01 (95% CI: -1.91, -0.11) for MCS. Severe disease was strongly associated with worse PCS (β = -7.4; 95% CI: -9.8, -5.1), whereas prior mental health illness was strongly associated with worse MCS (β = -5.4; 95% CI: -6.3, -4.5). CONCLUSION Physical health, assessed by PCS, was similar between matched SARS-CoV-2-positive and SARS-CoV-2-negative patients, whereas mental health, assessed by MCS, was worse during a time when the public experienced barriers to care. These results may inform the development and prioritization of support programs for patients.
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Affiliation(s)
- R Bola
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - J Sutherland
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada
| | - R A Murphy
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; Cancer Control Research, BC Cancer, Vancouver, BC, Canada
| | - M Leeies
- Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada; Section of Critical Care Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - L Grant
- Department of Emergency Medicine, McGill University, Montreal, QC, Canada; Emergency Department, Jewish General Hospital, Montreal, QC, Canada
| | - J Hayward
- Department of Emergency Medicine, University of Alberta, AB, Canada
| | - P Archambault
- Université Laval, Department of Family Medicine and Emergency Medicine, QC, Canada
| | - L Graves
- Patient Partner, Canadian COVID-19 Emergency Department Rapid Response Network Patient Engagement Committee, Canada
| | - T Rose
- Patient Partner, Canadian COVID-19 Emergency Department Rapid Response Network Patient Engagement Committee, Canada
| | - C Hohl
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada; Emergency Department, Vancouver General Hospital, Vancouver, BC, Canada.
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Mowbray FI, Heckman G, Hirdes JP, Costa AP, Beauchet O, Eagles D, Perry JJ, Sinha S, Archambault P, Wang H, Jantzi M, Hebert P. Examining the utility and accuracy of the interRAI Emergency Department Screener in identifying high-risk older emergency department patients: A Canadian multiprovince prospective cohort study. J Am Coll Emerg Physicians Open 2023; 4:e12876. [PMID: 36660313 PMCID: PMC9838565 DOI: 10.1002/emp2.12876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 11/08/2022] [Accepted: 11/30/2022] [Indexed: 01/15/2023] Open
Abstract
Objectives We set out to determine the accuracy of the interRAI Emergency Department (ED) Screener in predicting the need for detailed geriatric assessment in the ED. Our secondary objective was to determine the discriminative ability of the interRAI ED Screener for predicting the odds of discharge home and extended ED length of stay (>24 hours). Methods We conducted a multiprovince prospective cohort study in Canada. The need for detailed geriatric assessment was determined using the interRAI ED Screener and the interRAI ED Contact Assessment as the reference standard. A score of ≥5 was used to classify high-risk patients. Assessments were conducted by emergency and research nurses. We calculated the sensitivity, positive predictive value, and false discovery rate of the interRAI ED Screener. We employed logistic regression to predict ED outcomes while adjusting for age, sex, academic status, and the province of care. Results A total of 5629 older ED patients across 11 ED sites were evaluated using the interRAI ED Screener and 1061 were evaluated with the interRAI ED Contact Assessment. Approximately one-third of patients were discharged home or experienced an extended ED length of stay. The interRAI ED Screener had a sensitivity of 93%, a positive predictive value of 82%, and a false discovery rate of 18%. The interRAI ED Screener predicted discharge home and extended ED length of stay with fair accuracy. Conclusion The interRAI ED Screener is able to accurately and rapidly identify individuals with medical complexity. The interRAI ED Screener predicts patient-important health outcomes in older ED patients, highlighting its value for vulnerability screening.
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Affiliation(s)
- Fabrice I. Mowbray
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
| | - George Heckman
- School of Public Health ScienceUniversity of WaterlooWaterlooOntarioCanada,Schlegel Research Institute for AgingWaterlooOntarioCanada
| | - John P. Hirdes
- School of Public Health ScienceUniversity of WaterlooWaterlooOntarioCanada
| | - Andrew P. Costa
- Department of Health Research Methods, Evidence, and ImpactMcMaster UniversityHamiltonOntarioCanada
| | - Olivier Beauchet
- Departments of Medicine and Research Center of the Geriatric University Institute of MontrealUniversity of MontrealMontrealQuebecCanada,Department of MedicineDivision of Geriatric MedicineSir Mortimer B. Davis Jewish General Hospital and Lady Davis Institute for Medical ResearchMcGill UniversityMontrealQuebecCanada,Lee Kong Chian School of MedicineNanyang Technological UniversitySingaporeSingapore
| | - Debra Eagles
- Department of Emergency MedicineSchool of Epidemiology and Public HealthUniversity of OttawaOttawaOntarioCanada,Ottawa Hospital Research InstituteOttawaOntarioCanada
| | - Jeffrey J. Perry
- Department of Emergency MedicineSchool of Epidemiology and Public HealthUniversity of OttawaOttawaOntarioCanada,Ottawa Hospital Research InstituteOttawaOntarioCanada
| | - Samir Sinha
- Department of MedicineDivision of Geriatric MedicineSinai Health and University Health NetworkTorontoOntarioCanada,Department of MedicineDivision of Geriatric MedicineUniversity of TorontoTorontoOntarioCanada
| | - Patrick Archambault
- Department of Family Medicine and Emergency MedicineUniversité LavalQuébec CityOntarioCanada,Centre intégré de santé et de services sociaux de Chaudière‐AppalachesSainte‐MarieOntarioCanada,Department of Anesthesiology and Critical Care MedicineDivision of Critical Care MedicineUniversité LavalQuébec CityOntarioCanada
| | - Hanting Wang
- Department of MedicineDivision of Critical Care MedicineUniversite de MontrealMontrealQuebecCanada
| | - Michaela Jantzi
- School of Public Health ScienceUniversity of WaterlooWaterlooOntarioCanada
| | - Paul Hebert
- Department of MedicineDivision of Palliative CareBruyere Research InstituteUniversity of OttawaOttawaOntarioCanada
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24
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Sourial N, Develay E, Quesnel-Vallee A, Holyoke P, Dassieu L, Archambault P, Godard-Sebillotte C, Karunananthan S, Puzhko S. The Importance of Proximity in the Social Network of Older Persons Living Alone During the Pandemic. Geriatrics (Basel) 2023. [DOI: 10.1370/afm.21.s1.4006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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25
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Sourial N, Kaczorowski J, Quesnel-Vallee A, Lussier MT, Khanassov V, Develay E, Layani G, Godard-Sebillotte C, Adams A, Authier M, Beauchet O, Motulsky A, Archambault P. Evaluation of a Virtual Pre-Consultation Tool for Older Adults in Primary Care: Results from a Randomized Trial. Clinical trial 2023. [PMID: 37023251 DOI: 10.1370/afm.21.s1.3887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Context: Virtual pre-consultation screening of patient needs may offer opportunities to improve the care and health outcomes of older patients in primary care, especially those with multiple care needs. Objective: We sought to implement and evaluate the effectiveness of a multidimensional virtual pre-consultation tool in the primary care setting to support rapid and standardized needs assessment for older persons. Study Design and Analysis: Pragmatic, multi-center, 1:1 individually randomized trial design. Implementation was conducted using a participatory approach over a 3-month period. Baseline and 3-month follow-up data were collected through phone-based questionnaires. An intention-to-treat analysis was carried out. Setting: Four university-affiliated interprofessional primary care clinics, two clinics in one urban region (Montreal) and two in one rural region (Abitibi) in Quebec, Canada. Population Studied: Patients 65 years and older with a consultation with a primary care provider (physician, nurse, social worker, other) during the implementation period in one of the participating clinics. Intervention: A virtual pre-consultation tool, ESOGER, was administered as a phone-based questionnaire by a member of the clinic staff to eligible patients prior to their consultation with the primary care provider. The ESOGER tool provides a general assessment of the physical, social, mental and cognitive health needs of older adults and produces a summary report available to clinicians at the time of consultation. Outcome Measures: The primary endpoint consisted of the EQ-5D quality of life score at 3-month follow-up. Secondary endpoints were unplanned primary care visits, visits to the ED and hospital admissions in last 3 months. Results: Of the 659 eligible patients contacted to date, 345 (52.3%) agreed to participate and have been randomized. Follow-up assessments are ongoing with a loss to follow-up of 22.8% and will be completed by August 2022. Final results of the intention-to-treat analysis will be presented overall and stratified by urban and rural sites. Conclusions: Intended consequences of this intervention include an increased responsiveness of consultations for providers resulting in improved care of older patients. Overall, we hope results will support the implementation of evidence-based, multidimensional and virtual pre-consultation tools for older persons in the primary care setting.
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Ouellet S, Galliani MC, Gélinas C, Fontaine G, Archambault P, Mercier É, Severino F, Bérubé M. Strategies to improve the quality of nurse triage in emergency departments: A realist review protocol. Nurs Open 2022; 10:2770-2779. [PMID: 36527423 PMCID: PMC10077397 DOI: 10.1002/nop2.1550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 11/21/2022] [Accepted: 11/25/2022] [Indexed: 12/23/2022] Open
Abstract
AIM The purpose of this realist review was to assess what works, for whom and in what context, regarding strategies that influence nurses' behaviour to improve triage quality in emergency departments (ED). DESIGN Realist review protocol. METHODS This protocol follows the PRISMA-P statement and will include any type of study on strategies to improve the triage process in the ED (using recognized and validated triage scales). The included studies were examined for scientific quality using the Mixed Methods Appraisal Tool. The framework for this realist review is based on the Behaviour Change Wheel (BCW) and the context-mechanism-outcome (CMO) models. DISCUSSION Nurses and ED decision makers will be informed on the evidence regarding strategies to improve the quality of triage and the factors required to maximize their effectiveness. Research gaps may also be identified to guide future research projects on the adoption of best practices in ED nursing triage.
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Affiliation(s)
- Simon Ouellet
- Faculty of Nursing Université Laval Québec City Quebec Canada
- Department of Health Sciences Université du Québec à Rimouski (UQAR) Rimouski Québec Canada
- Emergency Department Rimouski Hospital Rimouski Québec Canada
| | - Maria Cécilia Galliani
- Faculty of Nursing Université Laval Québec City Quebec Canada
- Quebec Network on Nursing Intervention Research (RRISIQ) Montréal Québec Canada
| | - Céline Gélinas
- Quebec Network on Nursing Intervention Research (RRISIQ) Montréal Québec Canada
- Ingram School of Nursing McGill University Montreal Quebec Canada
- Centre for Nursing Research and Lady Davis Institute, Jewish General Hospital Montréal Québec Canada
| | - Guillaume Fontaine
- Clinical Epidemiology Program Ottawa Hospital Research Institute Ottawa Ontario Canada
- Faculty of Medicine University of Ottawa Ottawa Ontario Canada
- Centre for Nursing Research Jewish General Hospital Montréal Québec Canada
| | - Patrick Archambault
- Department of Family Medicine, Emergency Medicine, Anesthesiology and Critical Care Université Laval Québec City Quebec Canada
- Research Center CISSS de Chaudière‐Appalaches Lévis Québec Canada
- VITAM ‐ Center for Sustainable Health Research Québec City Québec Canada
| | - Éric Mercier
- VITAM ‐ Center for Sustainable Health Research Québec City Québec Canada
- CHU de Québec‐University Laval Research Centre Population Health and Optimal Practices Research Unit Research Unit (Trauma – Emergency – Critical Care Medicine) Québec City Quebec Canada
| | - Fabian Severino
- Faculty of Nursing Université Laval Québec City Quebec Canada
- CHU de Québec‐University Laval Research Centre Population Health and Optimal Practices Research Unit Research Unit (Trauma – Emergency – Critical Care Medicine) Québec City Quebec Canada
| | - Mélanie Bérubé
- Faculty of Nursing Université Laval Québec City Quebec Canada
- Quebec Network on Nursing Intervention Research (RRISIQ) Montréal Québec Canada
- CHU de Québec‐University Laval Research Centre Population Health and Optimal Practices Research Unit Research Unit (Trauma – Emergency – Critical Care Medicine) Québec City Quebec Canada
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27
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Le Sage N, Chauny JM, Berthelot S, Archambault P, Neveu X, Moore L, Boucher V, Frenette J, De Guise É, Ouellet MC, Lee J, McRae AD, Lang E, Émond M, Mercier É, Tardif PA, Swaine B, Cameron P, Perry JJ. Post-Concussion Symptoms Rule: Derivation and Validation of a Clinical Decision Rule for Early Prediction of Persistent Symptoms after a Mild Traumatic Brain Injury. J Neurotrauma 2022; 39:1349-1362. [PMID: 35765917 PMCID: PMC9529302 DOI: 10.1089/neu.2022.0026] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Mild traumatic brain injury (mTBI) is a common problem. Depending on diagnostic criteria, 13 to 62% of those patients develop persistent post-concussion symptoms (PPCS). The main objective of this prospective multi-center study is to derive and validate a clinical decision rule (CDR) for the early prediction of PPCS. Patients aged ≥14 years were included if they presented to one of our seven participating emergency departments (EDs) within 24 h of an mTBI. Clinical data were collected in the ED, and symptom evolution was assessed at 7, 30 and 90 days post-injury using the Rivermead Post-Concussion Questionnaire (RPQ). The primary outcome was PPCS at 90 days after mTBI. A predictive model called the Post-Concussion Symptoms Rule (PoCS Rule) was developed using the methodological standards for CDR. Of the 1083 analyzed patients (471 and 612 for the derivation and validation cohorts, respectively), 15.6% had PPCS. The final model included the following factors assessed in the ED: age, sex, history of prior TBI or mental health disorder, headache in ED, cervical sprain and hemorrhage on computed tomography. The 7-day follow-up identified additional risk factors: headaches, sleep disturbance, fatigue, sensitivity to light, and RPQ ≥21. The PoCS Rule had a sensitivity of 91.4% and 89.6%, a specificity of 53.8% and 44.7% and a negative predictive value of 97.2% and 95.8% in the derivation and validation cohorts, respectively. The PoCS Rule will help emergency physicians quickly stratify the risk of PPCS in mTBI patients and better plan post-discharge resources.
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Affiliation(s)
- Natalie Le Sage
- CHU de Québec-Université Laval Research Centre, Université Laval, Québec, Canada
- VITAM-Centre de recherche en santé durable, Université Laval, Québec, Canada
| | - Jean-Marc Chauny
- Department of Emergency Medicine, Université de Montréal, Quebec, Canada
| | - Simon Berthelot
- CHU de Québec-Université Laval Research Centre, Université Laval, Québec, Canada
| | - Patrick Archambault
- CHU de Québec-Université Laval Research Centre, Université Laval, Québec, Canada
| | - Xavier Neveu
- CHU de Québec-Université Laval Research Centre, Université Laval, Québec, Canada
| | - Lynne Moore
- CHU de Québec-Université Laval Research Centre, Université Laval, Québec, Canada
| | - Valérie Boucher
- CHU de Québec-Université Laval Research Centre, Université Laval, Québec, Canada
| | - Jérôme Frenette
- CHU de Québec-Université Laval Research Centre, Université Laval, Québec, Canada
| | - Élaine De Guise
- Department of Emergency Medicine, McGill University, Québec, Canada
| | | | - Jacques Lee
- Department of Emergency Medicine, University of Toronto, Ontario, Canada
| | - Andrew D. McRae
- Department of Emergency Medicine, University of Calgary, Alberta, Canada
| | - Eddy Lang
- Department of Emergency Medicine, University of Calgary, Alberta, Canada
| | - Marcel Émond
- CHU de Québec-Université Laval Research Centre, Université Laval, Québec, Canada
| | - Éric Mercier
- CHU de Québec-Université Laval Research Centre, Université Laval, Québec, Canada
| | | | - Bonnie Swaine
- Department of Emergency Medicine, Université de Montréal, Quebec, Canada
| | - Peter Cameron
- Department of Epidemiology and Preventive Medicine, Monash University Melbourne, Victoria, Australia
| | - Jeffrey J. Perry
- Department of Emergency Medicine, Ottawa Hospital Research Institute, Ontario, Canada
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28
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Moore L, Bérubé M, Tardif PA, Lauzier F, Turgeon A, Cameron P, Champion H, Yanchar N, Lecky F, Kortbeek J, Evans D, Mercier É, Archambault P, Lamontagne F, Gabbe B, Paquet J, Razek T, Belcaid A, Berthelot S, Malo C, Lang E, Stelfox HT. Validation of Quality Indicators Targeting Low-Value Trauma Care. JAMA Surg 2022; 157:2796291. [PMID: 36103195 PMCID: PMC9475433 DOI: 10.1001/jamasurg.2022.3912] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/18/2022] [Indexed: 09/16/2023]
Abstract
Importance Reducing low-value care has the potential to improve patient experiences and outcomes and free up health care resources. Sixteen quality indicators were recently developed targeting reductions in low-value trauma care based on a synthesis of the best available evidence, expert consensus, and patient preferences. Objective To assess the validity of quality indicators on low-value trauma care using trauma registry data. Design, Setting, and Participants Data from an inclusive Canadian provincial trauma system were used in this analysis. Included were all admissions for injury to any of the 57 provincial adult trauma centers between April 1, 2013, and March 31, 2020. Metrics for quality indicators were developed iteratively with clinical experts. Main Outcomes and Measures Validity was assessed using a priori criteria based on 5 parameters: frequency (incidence and case volume), discrimination (interhospital variation), construct validity (correlation with quality indicators on high-value care), predictive validity (correlation with quality indicators on risk-adjusted outcomes), and forecasting (correlation over time). Results The study sample included 136 783 patient admissions (mean [SD] age, 63 [22] years; 68 428 men [50%]). Metrics were developed for 12 of the 16 quality indicators. Six quality indicators showed moderate or high validity on all measurable parameters: initial head, cervical spine, or whole-body computed tomography for low-risk patients; posttransfer repeated computed tomography; neurosurgical consultation for mild complicated traumatic brain injury; and spine service consultation for isolated thoracolumbar process fractures. Red blood cell transfusion in low-risk patients had low frequency but had moderate or high validity on all other parameters. Five quality indicators had low validity on at least 2 parameters: repeated head CT and intensive care unit admission for mild complicated traumatic brain injury, hospital admission for minor blunt abdominal trauma, orthosis for thoracolumbar burst fractures, and surgical exploration in penetrating neck injury without hard signs. Conclusions and Relevance This cohort study shows the feasibility of assessing low-value trauma care using routinely collected data. It provided data on quality indicators properties that can be used to decide which quality indicators are most appropriate in a given system. Results suggest that 6 quality indicators have moderate to high validity. Their implementation now needs to be tested.
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Affiliation(s)
- Lynne Moore
- Department of Social and Preventative Medicine, Université Laval, Québec City, Québec, Canada
- Population Health and Optimal Health Practices Research Unit, Trauma–Emergency–Critical Care Medicine, Centre de Recherche du CHU de Québec, Hôpital de l’Enfant-Jésus, Université Laval, Québec City, Québec, Canada
| | - Mélanie Bérubé
- Department of Social and Preventative Medicine, Université Laval, Québec City, Québec, Canada
- Population Health and Optimal Health Practices Research Unit, Trauma–Emergency–Critical Care Medicine, Centre de Recherche du CHU de Québec, Hôpital de l’Enfant-Jésus, Université Laval, Québec City, Québec, Canada
- Faculty of Nursing, Université Laval, Québec City, Québec, Canada
| | - Pier-Alexandre Tardif
- Population Health and Optimal Health Practices Research Unit, Trauma–Emergency–Critical Care Medicine, Centre de Recherche du CHU de Québec, Hôpital de l’Enfant-Jésus, Université Laval, Québec City, Québec, Canada
| | - François Lauzier
- Department of Social and Preventative Medicine, Université Laval, Québec City, Québec, Canada
- Population Health and Optimal Health Practices Research Unit, Trauma–Emergency–Critical Care Medicine, Centre de Recherche du CHU de Québec, Hôpital de l’Enfant-Jésus, Université Laval, Québec City, Québec, Canada
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec City, Québec, Canada
| | - Alexis Turgeon
- Department of Social and Preventative Medicine, Université Laval, Québec City, Québec, Canada
- Population Health and Optimal Health Practices Research Unit, Trauma–Emergency–Critical Care Medicine, Centre de Recherche du CHU de Québec, Hôpital de l’Enfant-Jésus, Université Laval, Québec City, Québec, Canada
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec City, Québec, Canada
| | - Peter Cameron
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Howard Champion
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Natalie Yanchar
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Fiona Lecky
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
- Trauma Audit and Research Network, Salford, United Kingdom
| | - John Kortbeek
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - David Evans
- Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Éric Mercier
- Population Health and Optimal Health Practices Research Unit, Trauma–Emergency–Critical Care Medicine, Centre de Recherche du CHU de Québec, Hôpital de l’Enfant-Jésus, Université Laval, Québec City, Québec, Canada
| | - Patrick Archambault
- Population Health and Optimal Health Practices Research Unit, Transfert des Connaissances et Évaluation des Technologies et Modes d’Intervention en Santé, Centre de Recherche du CHU de Québec, Hôpital St François d’Assise, Université Laval, Québec City, Québec, Canada
| | - François Lamontagne
- Department of Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Belinda Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jérôme Paquet
- Department of Surgery, Division of Neurosurgery, Université Laval, Québec City, Québec, Canada
| | - Tarek Razek
- Department of Trauma Surgery, Montreal General Hospital, McGill University Health Center, Montreal, Québec, Canada
| | - Amina Belcaid
- Institut National d’Excellence en Santé et Services Sociaux, Québec City, Québec, Canada
| | - Simon Berthelot
- Population Health and Optimal Health Practices Research Unit, Trauma–Emergency–Critical Care Medicine, Centre de Recherche du CHU de Québec, Hôpital de l’Enfant-Jésus, Université Laval, Québec City, Québec, Canada
| | - Christian Malo
- Département de Médicine Familiale et de Médicine d’urgence, Faculté de Médecine, Université Laval, Québec City, Québec, Canada
| | - Eddy Lang
- University of Calgary, Calgary, Alberta, Canada
| | - Henry Thomas Stelfox
- Department of Critical Care Medicine, O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
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29
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Abiala G, Bérubé M, Mercier É, Yanchar N, Stelfox HT, Archambault P, Bourgeois G, Belcaid A, Neveu X, Isaac CJ, Clément J, Lamontagne F, Moore L. Pre- and posttransfer computed tomography imaging in Canadian trauma centers: A multicenter retrospective cohort study. Acad Emerg Med 2022; 29:1084-1095. [PMID: 35612384 DOI: 10.1111/acem.14536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 05/03/2022] [Accepted: 05/21/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Multiple clinical practice guidelines recommend minimizing radiation in trauma patients but there is a knowledge gap on the importance of this problem for trauma transfers. We aimed to estimate the incidence of pretransfer and repeat posttransfer computed tomography (CT) overall and in patients with an indication for immediate transfer, to assess interhospital practice variation, to identify predictors, and to quantify the influence of pretransfer CT on time to transfer. Methods We conducted a retrospective multicenter cohort study on patients transferred to major trauma centers from 2013 to 2019. Multilevel generalized linear regression was used to generate intraclass correlation coefficients (ICCs) to assess interhospital variation, multilevel logistic regression to generate odds ratios for each predictor, and geometric mean ratios to quantify the influence of CT on time to transfer. Results Of 18,244 patients included, 8501 (47%) had a pretransfer CT and one-quarter (26%) had a repeat posttransfer CT. Interhospital variation was moderate for pretransfer CT (5%-66%, ICC 12.5%) and for repeat posttransfer CT (7%-44%, ICC 14.7%). Pretransfer imaging was more frequent in elders and in males and repeat posttransfer imaging decreased over the study period but was more frequent in patients transferred in from Level III/IV centers than nondesignated hospitals. Time to transfer was doubled in patients who had a pretransfer CT. CONCLUSIONS Results suggest that pretransfer CT and repeat posttransfer CT are frequent and are subject to significant practice variation. In addition, pretransfer CT is associated with increased times to transfer though additional studies are needed to demonstrate causation. These results highlight potential opportunities to reduce low-value imaging for trauma transfers.
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Affiliation(s)
- Godwill Abiala
- Population Health and Optimal Health Practices Research Unit, Trauma, Emergency, Critical Care Medicine, Centre de Recherche du CHU de Québec, Laval University (Hôpital de l'Enfant-Jésus), Laval University, Québec, Québec, Canada.,Department of Social and Preventive Medicine, Laval University, Québec, Québec, Canada
| | - Mélanie Bérubé
- Population Health and Optimal Health Practices Research Unit, Trauma, Emergency, Critical Care Medicine, Centre de Recherche du CHU de Québec, Laval University (Hôpital de l'Enfant-Jésus), Laval University, Québec, Québec, Canada
| | - Éric Mercier
- Department of Family Medicine and Emergency Medicine, Laval University, Québec City, Québec, Canada
| | - Natalie Yanchar
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - H Thomas Stelfox
- Department of Critical Care Medicine, Medicine and Community Health Sciences (HTS), Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Patrick Archambault
- Department of Family Medicine and Emergency Medicine, Laval University, Québec City, Québec, Canada.,Centre de recherche intégré pour un système apprenant en santé et en services sociaux Lévis, Lévis, Québec, Canada.,VITAM-Centre de recherche en santé durable, Québec City, Québec, Canada
| | - Gilles Bourgeois
- Institut National d'Excellence en Santé et en Services Sociaux, Québec City, Québec, Canada
| | - Amina Belcaid
- Institut National d'Excellence en Santé et en Services Sociaux, Québec City, Québec, Canada
| | - Xavier Neveu
- Population Health and Optimal Health Practices Research Unit, Trauma, Emergency, Critical Care Medicine, Centre de Recherche du CHU de Québec, Laval University (Hôpital de l'Enfant-Jésus), Laval University, Québec, Québec, Canada
| | - Chartelin J Isaac
- Population Health and Optimal Health Practices Research Unit, Trauma, Emergency, Critical Care Medicine, Centre de Recherche du CHU de Québec, Laval University (Hôpital de l'Enfant-Jésus), Laval University, Québec, Québec, Canada.,Department of Social and Preventive Medicine, Laval University, Québec, Québec, Canada
| | - Julien Clément
- Department of Surgery, University Laval, Québec City, Québec, Canada
| | - François Lamontagne
- Department of Medicine, Centre de recherche du CHU de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Lynne Moore
- Population Health and Optimal Health Practices Research Unit, Trauma, Emergency, Critical Care Medicine, Centre de Recherche du CHU de Québec, Laval University (Hôpital de l'Enfant-Jésus), Laval University, Québec, Québec, Canada.,Department of Social and Preventive Medicine, Laval University, Québec, Québec, Canada
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Dassieu L, Develay E, Beauchet O, Quesnel-Vallée A, Godard-Sebillotte C, Tchouaket E, Puzhko S, Karunananthan S, Archambault P, Launay C, Holyoke P, Sauriol C, Galery K, Sourial N. Implementing a Telehealth Support Tool for Community-Dwelling Older Adults During the COVID-19 Pandemic: A Qualitative Investigation of Provider Experiences. J Aging Soc Policy 2022:1-18. [PMID: 35994512 DOI: 10.1080/08959420.2022.2111166] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 01/19/2022] [Indexed: 10/15/2022]
Abstract
During the COVID-19 pandemic, policymakers had to quickly offer telehealth services to address older adults' needs. This study aimed to understand the experiences of providers who implemented a telephone-based telehealth tool named Socio-Geriatric Evaluation (ESOGER), which assessed health and social isolation risks in community-dwelling older adults in Quebec (Canada). This qualitative study used 20 semi-structured online/phone interviews with health and social service providers coming from publicly-funded healthcare facilities and community organizations. We included adopters and non-adopters of the telehealth tool. Interviews were audio-recorded and transcribed verbatim. We used reflexive thematic analysis to interpret the data. Three dimensions of providers' practice influenced the tool's implementation: service organization, working conditions, and interactions with older adults. Participants reported that the tool fostered continuity of care, provided guidance for their pandemic-related new tasks, and helped identify and support socially isolated older adults. Challenges to implementation included limited appropriateness of the telehealth tool for diverse services, feasibility barriers to adopting a new tool amid the health crisis, and acceptability challenges with some older adults. Despite relevance of the telehealth tool for providers, organizational, professional, and interactional barriers could hinder implementation success. Participatory approaches to telehealth may be promising avenues for future policies in this field.
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Affiliation(s)
- Lise Dassieu
- Senior Postdoctoral Researcher, Department of Biomedical Sciences, Université de Montréal, and Research Center of the Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Elise Develay
- Research Professional, Research Centre, Research Center of the Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Olivier Beauchet
- Professor, Department of Medicine, Université de Montréal, and Research Center of the Institut Universitaire en Gériatrie de Montréal, Montreal, Quebec, Canada
| | - Amélie Quesnel-Vallée
- Professor, Department of Sociology and Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Claire Godard-Sebillotte
- Assistant Professor, Division of Geriatrics, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Eric Tchouaket
- Professor, Department of Nursing Sciences, Université du Quebec en Outaouais, Saint-Jérôme, Quebec, Canada
| | - Svetlana Puzhko
- Postdoral Researcher, Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | | | - Patrick Archambault
- Associate Professor, Department of Family and Emergency Medicine, Université Laval, Quebec City, Quebec, Canada
| | - Cyrille Launay
- Geriatrician, Clinical Researcher, Department of Medicine, Division of Geriatric Medicine, Sir Mortimer B. Davis - Jewish General Hospital and Lady Davis Institute for Medical Research, McGill University, Montreal, Quebec, Canada
| | - Paul Holyoke
- Executive Director, SE Research Centre, SE Health, Markham, Ontario, Canada
| | - Caroline Sauriol
- Director, Little Brothers Organization, Montreal, Quebec, Canada
| | - Kevin Galery
- Assistant Director, Research Centre, Research Center of the Institut Universitaire en Gériatrie de Montréal, Montreal, Quebec, Canada
| | - Nadia Sourial
- Assistant Professor, Department of Health Management, Evaluation and Policy, School of Public Health, Université de Montreal, Université de Montréal, and Research Center of the Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
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McRae AD, Archambault P, Fok P, Wiemer H, Morrison LJ, Herder M. Reducing barriers to accessing administrative data on SARS-CoV-2 vaccination for research. CMAJ 2022; 194:E943-E947. [PMID: 35851526 PMCID: PMC9299746 DOI: 10.1503/cmaj.211712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Andrew D McRae
- Departments of Emergency Medicine and Community Health Sciences (McRae), University of Calgary, Calgary, Alta.; Departments of Family Medicine, Emergency Medicine, Anesthesiology and Intensive Care Medicine (Archambault), Université Laval, Québec, Que.; Department of Emergency Medicine (Fok, Wiemer), Dalhousie University, Halifax, NS; Division of Emergency Medicine (Morrison), Department of Medicine, University of Toronto; Health Law Institute (Herder), Schulich School of Law; Department of Pharmacology (Herder), Faculty of Medicine, Dalhousie University, Halifax, NS.
| | - Patrick Archambault
- Departments of Emergency Medicine and Community Health Sciences (McRae), University of Calgary, Calgary, Alta.; Departments of Family Medicine, Emergency Medicine, Anesthesiology and Intensive Care Medicine (Archambault), Université Laval, Québec, Que.; Department of Emergency Medicine (Fok, Wiemer), Dalhousie University, Halifax, NS; Division of Emergency Medicine (Morrison), Department of Medicine, University of Toronto; Health Law Institute (Herder), Schulich School of Law; Department of Pharmacology (Herder), Faculty of Medicine, Dalhousie University, Halifax, NS
| | - Patrick Fok
- Departments of Emergency Medicine and Community Health Sciences (McRae), University of Calgary, Calgary, Alta.; Departments of Family Medicine, Emergency Medicine, Anesthesiology and Intensive Care Medicine (Archambault), Université Laval, Québec, Que.; Department of Emergency Medicine (Fok, Wiemer), Dalhousie University, Halifax, NS; Division of Emergency Medicine (Morrison), Department of Medicine, University of Toronto; Health Law Institute (Herder), Schulich School of Law; Department of Pharmacology (Herder), Faculty of Medicine, Dalhousie University, Halifax, NS
| | - Hana Wiemer
- Departments of Emergency Medicine and Community Health Sciences (McRae), University of Calgary, Calgary, Alta.; Departments of Family Medicine, Emergency Medicine, Anesthesiology and Intensive Care Medicine (Archambault), Université Laval, Québec, Que.; Department of Emergency Medicine (Fok, Wiemer), Dalhousie University, Halifax, NS; Division of Emergency Medicine (Morrison), Department of Medicine, University of Toronto; Health Law Institute (Herder), Schulich School of Law; Department of Pharmacology (Herder), Faculty of Medicine, Dalhousie University, Halifax, NS
| | - Laurie J Morrison
- Departments of Emergency Medicine and Community Health Sciences (McRae), University of Calgary, Calgary, Alta.; Departments of Family Medicine, Emergency Medicine, Anesthesiology and Intensive Care Medicine (Archambault), Université Laval, Québec, Que.; Department of Emergency Medicine (Fok, Wiemer), Dalhousie University, Halifax, NS; Division of Emergency Medicine (Morrison), Department of Medicine, University of Toronto; Health Law Institute (Herder), Schulich School of Law; Department of Pharmacology (Herder), Faculty of Medicine, Dalhousie University, Halifax, NS
| | - Matthew Herder
- Departments of Emergency Medicine and Community Health Sciences (McRae), University of Calgary, Calgary, Alta.; Departments of Family Medicine, Emergency Medicine, Anesthesiology and Intensive Care Medicine (Archambault), Université Laval, Québec, Que.; Department of Emergency Medicine (Fok, Wiemer), Dalhousie University, Halifax, NS; Division of Emergency Medicine (Morrison), Department of Medicine, University of Toronto; Health Law Institute (Herder), Schulich School of Law; Department of Pharmacology (Herder), Faculty of Medicine, Dalhousie University, Halifax, NS
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Moore L, Guertin JR, Tardif PA, Ivers NM, Hoch J, Conombo B, Antony J, Stelfox HT, Berthelot S, Archambault P, Turgeon A, Gandhi R, Grimshaw JM. Economic evaluations of audit and feedback interventions: a systematic review. BMJ Qual Saf 2022; 31:754-767. [PMID: 35750494 DOI: 10.1136/bmjqs-2022-014727] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 05/15/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND The effectiveness of audit and feedback (A&F) interventions to improve compliance to healthcare guidelines is supported by randomised controlled trials (RCTs) and meta-analyses of RCTs. However, there is currently a knowledge gap on their cost-effectiveness. OBJECTIVE We aimed to assess whether A&F interventions targeting improvements in compliance to recommended care are economically favourable. METHODS We conducted a systematic review including experimental, observational and simulation-based economic evaluation studies of A&F interventions targeting healthcare providers. Comparators were a 'do nothing' strategy, or any other intervention not involving A&F or involving a subset of A&F intervention components. We searched MEDLINE, CINAHL, CENTRAL, Econlit, EMBASE, Health Technology Assessment Database, MEDLINE, NHS Economic Evaluation Database, ABI/INFORM, Web of Science, ProQuest and websites of healthcare quality associations to December 2021. Outcomes were incremental cost-effectiveness ratios, incremental cost-utility ratios, incremental net benefit and incremental cost-benefit ratios. Pairs of reviewers independently selected eligible studies and extracted relevant data. Reporting quality was evaluated using CHEERS (Consolidated Health Economic Evaluation Reporting Standards). Results were synthesised using permutation matrices for all studies and predefined subgroups. RESULTS Of 13 221 unique citations, 35 studies met our inclusion criteria. The A&F intervention was dominant (ie, at least as effective with lower cost) in 7 studies, potentially cost-effective in 26 and was dominated (ie, the same or less effectiveness and higher costs) in 2 studies. A&F interventions were more likely to be economically favourable in studies based on health outcomes rather than compliance to recommended practice, considering medical costs in addition to intervention costs, published since 2010, and with high reporting quality. DISCUSSION Results suggest that A&F interventions may have a high potential to be cost-effective. However, as is common in systematic reviews of economic evaluations, publication bias could have led to an overestimation of their economic value.
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Affiliation(s)
- Lynne Moore
- Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, CHU de Québec-Université Laval, Quebec, Quebec, Canada
| | - Jason Robert Guertin
- Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, CHU de Québec-Université Laval, Quebec, Quebec, Canada
| | - Pier-Alexandre Tardif
- Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, CHU de Québec-Université Laval, Quebec, Quebec, Canada
| | - Noah Michael Ivers
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jeffrey Hoch
- Department of Public Health Sciences, University of California San Francisco, San Francisco, California, USA
| | - Blanchard Conombo
- Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, CHU de Québec-Université Laval, Quebec, Quebec, Canada
| | - Jesmin Antony
- Women's College Hospital Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada
| | | | - Simon Berthelot
- Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, CHU de Québec-Université Laval, Quebec, Quebec, Canada
| | - Patrick Archambault
- Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, CHU de Québec-Université Laval, Quebec, Quebec, Canada
| | - Alexis Turgeon
- Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, CHU de Québec-Université Laval, Quebec, Quebec, Canada
| | - Rohit Gandhi
- Department of Pediatric Neurology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - J M Grimshaw
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Wozney L, Curran J, Archambault P, Cassidy C, Jabbour M, Mackay R, Newton A, Plint AC, Somerville M. Electronic Discharge Communication Tools Used in Pediatric Emergency Departments: Systematic Review. JMIR Pediatr Parent 2022; 5:e36878. [PMID: 35608929 PMCID: PMC9270703 DOI: 10.2196/36878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Electronic discharge communication tools (EDCTs) are increasingly common in pediatric emergency departments (EDs). These tools have been shown to improve patient-centered communication, support postdischarge care at home, and reduce unnecessary return visits to the ED. OBJECTIVE This study aimed to map and assess the evidence base for EDCTs used in pediatric EDs according to their functionalities, intended purpose, implementation context features, and outcomes. METHODS A systematic review was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) procedures for identification, screening, and eligibility. A total of 7 databases (EBSCO, MEDLINE, CINAHL, PsycINFO, EMBASE Scopus, and Web of Science) were searched for studies published between 1989 and 2021. Studies evaluating discharge communication-related outcomes using electronic tools (eg, text messages, videos, and kiosks) in pediatric EDs were included. In all, 2 researchers independently assessed the eligibility. Extracted data related to study identification, methodology, settings and demographics, intervention features, outcome implementation features, and practice, policy, and research implications. The Mixed Method Appraisal Tool was used to assess methodological quality. The synthesis of results involved structured tabulation, vote counting, recoding into common metrics, inductive thematic analysis, descriptive statistics, and heat mapping. RESULTS In total, 231 full-text articles and abstracts were screened for review inclusion with 49 reports (representing 55 unique tools) included. In all, 70% (26/37) of the studies met at least three of five Mixed Method Appraisal Tool criteria. The most common EDCTs were videos, text messages, kiosks, and phone calls. The time required to use the tools ranged from 120 seconds to 80 minutes. The EDCTs were evaluated for numerous presenting conditions (eg, asthma, fracture, head injury, fever, and otitis media) that required a range of at-home care needs after the ED visit. The most frequently measured outcomes were knowledge acquisition, caregiver and patient beliefs and attitudes, and health service use. Unvalidated self-report measures were typically used for measurement. Health care provider satisfaction or system-level impacts were infrequently measured in studies. The directionality of primary outcomes pointed to positive effects for the primary measure (44/55, 80%) or no significant difference (10/55, 18%). Only one study reported negative findings, with an increase in return visits to the ED after receiving the intervention compared with the control group. CONCLUSIONS This review is the first to map the broad literature of EDCTs used in pediatric EDs. The findings suggest a promising evidence base, demonstrating that EDCTs have been successfully integrated across clinical contexts and deployed via diverse technological modalities. Although caregiver and patient satisfaction with EDCTs is high, future research should use robust trials using consistent measures of communication quality, clinician experience, cost-effectiveness, and health service use to accumulate evidence regarding these outcomes. TRIAL REGISTRATION PROSPERO CRD42020157500; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=157500.
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Affiliation(s)
- Lori Wozney
- Mental Health and Addictions, Nova Scotia Health, Dartmouth, NS, Canada
| | - Janet Curran
- IWK Health, Strengthening Transitions in Care Lab, Halifax, NS, Canada
- School of Nursing, Dalhousie University, Halifax, NS, Canada
| | - Patrick Archambault
- Département de médecine d'urgence, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Levis, QC, Canada
| | | | - Mona Jabbour
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Rebecca Mackay
- IWK Health, Strengthening Transitions in Care Lab, Halifax, NS, Canada
| | - Amanda Newton
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Amy C Plint
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- Department of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Mari Somerville
- IWK Health, Strengthening Transitions in Care Lab, Halifax, NS, Canada
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Silverberg ND, Otamendi T, Brasher PM, Brubacher JR, Li LC, Lizotte PP, Panenka WJ, Scheuermeyer FX, Archambault P. Effectiveness of a guideline implementation tool for supporting management of mental health complications after mild traumatic brain injury in primary care: protocol for a randomised controlled trial. BMJ Open 2022; 12:e062527. [PMID: 35728892 PMCID: PMC9214410 DOI: 10.1136/bmjopen-2022-062527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Mental health problems frequently interfere with recovery from mild traumatic brain injury (mTBI) but are under-recognised and undertreated. Consistent implementation of clinical practice guidelines for proactive detection and treatment of mental health complications after mTBI will require evidence-based knowledge translation strategies. This study aims to determine if a guideline implementation tool can reduce the risk of mental health complications following mTBI. If effective, our guideline implementation tool could be readily scaled up and/or adapted to other healthcare settings. METHODS AND ANALYSIS We will conduct a triple-blind cluster randomised trial to evaluate a clinical practice guideline implementation tool designed to support proactive management of mental health complications after mTBI in primary care. We will recruit 535 adults (aged 18-69 years) with mTBI from six emergency departments and two urgent care centres in the Greater Vancouver Area, Canada. Upon enrolment at 2 weeks post-injury, they will complete mental health symptom screening tools and designate a general practitioner (GP) or primary care clinic where they plan to seek follow-up care. Primary care clinics will be randomised into one of two arms. In the guideline implementation tool arm, GPs will receive actionable mental health screening test results tailored to their patient and their patients will receive written education about mental health problems after mTBI and treatment options. In the usual care control arm, GPs and their patients will receive generic information about mTBI. Patient participants will complete outcome measures remotely at 2, 12 and 26 weeks post-injury. The primary outcome is rate of new or worsened mood, anxiety or trauma-related disorder on the Mini International Neuropsychiatric Interview at 26 weeks. ETHICS AND DISSEMINATION Study procedures were approved by the University of British Columbia's research ethics board (H20-00562). The primary report for the trial results will be published in a peer-reviewed journal. Our knowledge user team members (patients, GPs, policymakers) will co-create a plan for public dissemination. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT04704037).
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Affiliation(s)
- Noah D Silverberg
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Thalia Otamendi
- Rehabilitation Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Penelope Ma Brasher
- Centre for Clinical Epidemiology & Evaluation, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Jeffrey R Brubacher
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Linda C Li
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Pierre-Paul Lizotte
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - William J Panenka
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Frank X Scheuermeyer
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Emergency Medicine, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Patrick Archambault
- Department of Family and Emergency Medicine, Université Laval, Québec, Québec, Canada
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Said Abasse K, Toulouse Fournier A, Paquet C, Côté A, Smith PY, Bergeron F, Archambault P. Collaborative Writing Applications in Support of Knowledge Translation and Management during Pandemics: A Scoping Review. Int J Med Inform 2022; 165:104814. [DOI: 10.1016/j.ijmedinf.2022.104814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 04/17/2022] [Accepted: 06/05/2022] [Indexed: 11/28/2022]
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Légaré F, Stacey D, Forest PG, Archambault P, Boland L, Coutu MF, Giguère AMC, LeBlanc A, Lewis KB, Witteman HO. Shared decision-making in Canada: Update on integration of evidence in health decisions and patient-centred care government mandates. Z Evid Fortbild Qual Gesundhwes 2022; 171:22-29. [PMID: 35606312 DOI: 10.1016/j.zefq.2022.04.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 06/15/2023]
Abstract
In Canada, government mandates for patient-centred care (PCC) vary across the 10 provinces and three territories. Although basic medical and hospital services are provided for all, health care options for patients also depend on having private insurance. Thus, the current design of the Canadian healthcare system has several implications for PCC and shared decision-making (SDM). Since 2007, this is our fourth update on SDM in Canada. The aim of this paper is to provide an update on the current state of SDM and patient and public involvement in Canada. Overall, we still observed the difficulty of implementing any sort of national strategy partly because of the decentralized nature of the healthcare system. Second, national professional education programs are complicated by licensure and scope of practice variations across jurisdictions. Third, there are variations in the availability of different options covered by universal healthcare. Canada has experienced some favorable development as PCC is now explicitly articulated in the policies of most provinces and territories and there are increased efforts to give patients more access to their electronic health records. However, patient and public engagement (PPE) reform in health programs and governance remains an exception, and continuing centralization of governance structures may reduce their responsiveness to patient priorities. In a 2018 survey, 47.2% of respondents reported that they were not told by their health professional that they had a choice about treatment. Nonetheless, decision aids and decision coaching are increasingly available for health-related decisions and the Ottawa Hospital Research Institute's decision aid inventory has ensured continued leadership in this area. Diverse jurisdictions are starting to embed decision aids into care pathways, with some decision aids being included in clinical practice guidelines. The COVID-19 pandemic may have had a negative impact on SDM by removing decision choices due to emergency public health mandates, but stimulated new research and decision aids. Canada continues to assign health research funding to SDM and PCC, and a program dedicated to patient-oriented research is central to this effort. Guides and frameworks are increasingly available for planning and evaluating PPE. Finally, various initiatives are attempting to involve and empower Indigenous peoples through PPE and SDM.
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Affiliation(s)
- France Légaré
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux (CIUSSS) de la Capitale-Nationale, Quebec City, Canada; Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry, Quebec City, Canada; Research Centre of the Centre Hospitalier Universitaire de Québec, Quebec City, Canada.
| | - Dawn Stacey
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada; Ottawa Hospital Research Institute, Ottawa, Canada
| | | | - Patrick Archambault
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux (CIUSSS) de la Capitale-Nationale, Quebec City, Canada; Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry, Quebec City, Canada; Research Centre of the Centre Hospitalier Universitaire de Québec, Quebec City, Canada; Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Centre intégré de santé et services sociaux de Chaudière-Appalaches, Lévis, Canada; Department of Anesthesiology and Intensive Care Medicine, Université Laval, Pavillon Ferdinand-Vandry, Quebec City, Canada
| | - Laura Boland
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada; Ottawa Hospital Research Institute, Ottawa, Canada
| | - Marie-France Coutu
- Centre for Action in Work Disability Prevention and Rehabilitation affiliated with Hôpital Charles-Lemoyne Research Center, Rehabilitation School, Longueuil Campus - Université de Sherbrooke, Longueuil, Canada
| | - Anik M C Giguère
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux (CIUSSS) de la Capitale-Nationale, Quebec City, Canada; Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry, Quebec City, Canada; Office of Education and Continuing Development, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry, Quebec City, Canada
| | - Annie LeBlanc
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux (CIUSSS) de la Capitale-Nationale, Quebec City, Canada; Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry, Quebec City, Canada
| | - Krystina B Lewis
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada; University of Ottawa Heart Institute, Ottawa, Canada
| | - Holly O Witteman
- VITAM - Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux (CIUSSS) de la Capitale-Nationale, Quebec City, Canada; Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry, Quebec City, Canada; Research Centre of the Centre Hospitalier Universitaire de Québec, Quebec City, Canada; Ottawa Hospital Research Institute, Ottawa, Canada; Office of Education and Continuing Development, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry, Quebec City, Canada
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Baldeo N, D'Souza A, Haag HL, Hanafy S, Quilico E, Archambault P, Colquhoun H, Lewko J, Riopelle R, Colantonio A, Mollayeva T. A thematic analysis of patients' and their informal caregivers' gendered experiences in traumatic brain injury. Disabil Rehabil 2022; 45:1636-1645. [PMID: 35575401 DOI: 10.1080/09638288.2022.2071483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE Research shows that patients' perceptions of themselves and others, in addition to their understanding of the concept of gender, changes after traumatic brain injury (TBI). Little is known about gendered experiences in TBI and care delivery. This study aims to explore perceptions of gender through life experiences and interactions between adult patients with TBI and their informal caregivers. MATERIALS AND METHODS Seven patients with mild and moderate-severe TBI and eight informal caregivers were interviewed. Transcripts were coded and analysed according to Braun and Clarke's thematic analysis. The Consolidated Criteria for Reporting Qualitative Research guidelines were followed in reporting results. RESULTS The participants described a transformation of their understanding and experiences of gender following the TBI event. Three themes were identified: (1) Gender designations of "man" and "woman";( 2) Post-injury performativity of gender; and (3) Gender in giving and receiving care. CONCLUSIONS The findings emphasize the importance of raising awareness among researchers and practitioners on gender as a transformative process for patients with TBI and informal caregivers after the injury. The diversity of patient-caregiver experiences and critical needs based on gender call for intervention approaches that mitigate gender disparities in giving and receiving care. Implications for RehabilitationHistorically, rehabilitation of persons with traumatic brain injury has targeted physical and cognitive impairments, with little attention to their gendered demands in the lived environment.Gender prevails in the lived experiences of persons with traumatic brain injury, and their informal caregivers, and in giving and receiving quality care.A major challenge for clinicians is identifying harmful gendered roles, norms, and relations and the affective/behavioral problems they produce to alleviate enduring distress and reduce disability.Rehabilitation interventions focusing on flexible and adaptive responses to gendered demands in the lived environment of persons with traumatic brain injury are timely.
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Affiliation(s)
- Navindra Baldeo
- Acquired Brain Injury Research Lab, University of Toronto, Toronto, Canada.,Toronto Rehabilitation Institute (KITE), University Health Network, Toronto, Canada
| | - Andrea D'Souza
- Acquired Brain Injury Research Lab, University of Toronto, Toronto, Canada
| | - Halina Lin Haag
- Acquired Brain Injury Research Lab, University of Toronto, Toronto, Canada.,Faculty of Social Work, Wilfrid Laurier University, Waterloo, Canada
| | - Sara Hanafy
- Acquired Brain Injury Research Lab, University of Toronto, Toronto, Canada.,Toronto Rehabilitation Institute (KITE), University Health Network, Toronto, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Enrico Quilico
- Acquired Brain Injury Research Lab, University of Toronto, Toronto, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Patrick Archambault
- Department of Family and Emergency Medicine, Unviersite Laval, Quebec, Canada
| | - Heather Colquhoun
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - John Lewko
- School of Rural and Northern Health, Laurentian University, Sudbury, Canada
| | - Richard Riopelle
- Department of Neurology and Neurosurgery, McGill University, Montreal, Canada
| | - Angela Colantonio
- Acquired Brain Injury Research Lab, University of Toronto, Toronto, Canada.,Toronto Rehabilitation Institute (KITE), University Health Network, Toronto, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada
| | - Tatyana Mollayeva
- Acquired Brain Injury Research Lab, University of Toronto, Toronto, Canada.,Toronto Rehabilitation Institute (KITE), University Health Network, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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Conombo B, Guertin JR, Tardif PA, Gagnon MA, Duval C, Archambault P, Berthelot S, Lauzier F, Turgeon AF, Stelfox HT, Chassé M, Hoch JS, Gabbe B, Champion H, Lecky F, Cameron P, Moore L. Economic Evaluation of In-Hospital Clinical Practices in Acute Injury Care: A Systematic Review. Value Health 2022; 25:844-854. [PMID: 35500953 DOI: 10.1016/j.jval.2021.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 08/27/2021] [Accepted: 10/31/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Underuse of high-value clinical practices and overuse of low-value practices are major sources of inefficiencies in modern healthcare systems. To achieve value-based care, guidelines and recommendations should target both underuse and overuse and be supported by evidence from economic evaluations. We aimed to conduct a systematic review of the economic value of in-hospital clinical practices in acute injury care to advance knowledge on value-based care in this patient population. METHODS Pairs of independent reviewers systematically searched MEDLINE, Embase, Web of Science, and Cochrane Central Register for full economic evaluations of in-hospital clinical practices in acute trauma care published from 2009 to 2019 (last updated on June 17, 2020). Results were converted into incremental net monetary benefit and were summarized with forest plots. The protocol was registered with PROSPERO (CRD42020164494). RESULTS Of 33 910 unique citations, 75 studies met our inclusion criteria. We identified 62 cost-utility, 8 cost-effectiveness, and 5 cost-minimization studies. Values of incremental net monetary benefit ranged from international dollars -467 000 to international dollars 194 000. Of 114 clinical interventions evaluated (vs comparators), 56 were cost-effective. We identified 15 cost-effective interventions in emergency medicine, 6 in critical care medicine, and 35 in orthopedic medicine. A total of 58 studies were classified as high quality and 17 as moderate quality. From studies with a high level of evidence (randomized controlled trials), 4 interventions were clearly dominant and 8 were dominated. CONCLUSIONS This research advances knowledge on value-based care for injury admissions. Results suggest that almost half of clinical interventions in acute injury care that have been studied may not be cost-effective.
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Affiliation(s)
- Blanchard Conombo
- Department of Social and Preventative Medicine, Université Laval, Québec City, Québec, Canada; Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec City, Québec, Canada
| | - Jason R Guertin
- Department of Social and Preventative Medicine, Université Laval, Québec City, Québec, Canada
| | - Pier-Alexandre Tardif
- Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec City, Québec, Canada
| | - Marc-Aurèle Gagnon
- Department of Social and Preventative Medicine, Université Laval, Québec City, Québec, Canada; Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec City, Québec, Canada
| | - Cécile Duval
- Department of Social and Preventative Medicine, Université Laval, Québec City, Québec, Canada; Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec City, Québec, Canada
| | - Patrick Archambault
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec City, Québec, Canada; VITAM-Centre de recherche en santé durable, Université Laval, Québec City, Québec, Canada; Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Université Laval, Québec City, Québec, Canada
| | - Simon Berthelot
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec City, Québec, Canada
| | - François Lauzier
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec City, Québec, Canada
| | - Alexis F Turgeon
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec City, Québec, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, Medicine and Community Health Sciences, O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Michaël Chassé
- Department of Medicine, Université de Montréal, Québec City, Québec, Canada
| | - Jeffrey S Hoch
- Division of Health Policy and Management, Department of Public Health Sciences, University of California, Davis, Davis, CA, USA
| | - Belinda Gabbe
- School of Public Health and Preventive Medicine at Monash University, Melbourne, Victoria, Australia
| | - Howard Champion
- Uniformed Services University of the Health Sciences Annapolis, Bethesda, MD, USA
| | - Fiona Lecky
- School of Health and Related Research, Sheffield, England, UK
| | - Peter Cameron
- School of Public Health and Preventive Medicine at Monash University, Melbourne, Victoria, Australia
| | - Lynne Moore
- Department of Social and Preventative Medicine, Université Laval, Québec City, Québec, Canada; Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec City, Québec, Canada.
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Moore L, Bérubé M, Tardif PA, Lauzier F, Turgeon A, Cameron P, Champion H, Yanchar N, Lecky F, Kortbeek J, Evans D, Mercier É, Archambault P, Lamontagne F, Gabbe B, Paquet J, Razek T, Stelfox HT. Quality Indicators Targeting Low-Value Clinical Practices in Trauma Care. JAMA Surg 2022; 157:507-514. [PMID: 35476055 PMCID: PMC9047751 DOI: 10.1001/jamasurg.2022.0812] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Importance The use of quality indicators has been shown to improve injury care processes and outcomes. However, trauma quality indicators proposed to date exclusively target the underuse of recommended practices. Initiatives such as Choosing Wisely publish lists of practices to be questioned, but few apply to trauma care, and most have not successfully been translated to quality indicators. Objective To develop a set of evidence and patient-informed, consensus-based quality indicators targeting reductions in low-value clinical practices in acute, in-hospital trauma care. Design, Setting, and Participants This 2-round Research and Development/University of California at Los Angeles (RAND/UCLA) consensus study, conducted from April 20 to June 9, 2021, comprised an online questionnaire and a virtual workshop led by 2 independent moderators. Two panels of international experts from Canada, Australia, the US, and the UK, and local stakeholders from Québec, Canada, represented key clinical expertise involved in trauma care and included 3 patient partners. Main Outcomes and Measures Panelists were asked to rate 50 practices on a 7-point Likert scale according to 4 quality indicator criteria: importance, supporting evidence, actionability, and measurability. Results Of 49 eligible experts approached, 46 (94%; 18 experts [39%] aged ≥50 years; 37 men [80%]) completed at least 1 round and 36 (73%) completed both rounds. Eleven quality indicators were selected overall, 2 more were selected by the international panel and a further 3 by the local stakeholder panel. Selected indicators targeted low-value clinical practices in the following aspects of trauma care: (1) initial diagnostic imaging (head, cervical spine, ankle, and pelvis), (2) repeated diagnostic imaging (posttransfer computed tomography [CT] and repeated head CT), (3) consultation (neurosurgical and spine), (4) surgery (penetrating neck injury), (5) blood product administration, (6) medication (antibiotic prophylaxis and late seizure prophylaxis), (7) trauma service admission (blunt abdominal trauma), (8) intensive care unit admission (mild complicated traumatic brain injury), and (9) routine blood work (minor orthopedic surgery). Conclusions and Relevance In this consensus study, a set of consensus-based quality indicators were developed that were informed by the best available evidence and patient priorities, targeting low-value trauma care. Selected indicators represented a trauma-specific list of practices, the use of which should be questioned. Trauma quality programs in high-income countries may use these study results as a basis to select context-specific quality indicators to measure and reduce low-value care.
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Affiliation(s)
- Lynne Moore
- Department of Social and Preventative Medicine, Université Laval, Québec City, Québec, Canada.,Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec City, Québec, Canada
| | - Mélanie Bérubé
- Department of Social and Preventative Medicine, Université Laval, Québec City, Québec, Canada.,Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec City, Québec, Canada.,Faculty of Nursing, Université Laval, Québec City, Québec, Canada
| | - Pier-Alexandre Tardif
- Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec City, Québec, Canada
| | - François Lauzier
- Department of Social and Preventative Medicine, Université Laval, Québec City, Québec, Canada.,Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec City, Québec, Canada.,Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec City, Québec, Canada
| | - Alexis Turgeon
- Department of Social and Preventative Medicine, Université Laval, Québec City, Québec, Canada.,Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec City, Québec, Canada.,Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec City, Québec, Canada
| | - Peter Cameron
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Howard Champion
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Natalie Yanchar
- Department of Surgery, University of Calgary, Calgary, Canada
| | - Fiona Lecky
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom.,Trauma Audit and Research Network, Salford, United Kingdom
| | - John Kortbeek
- Department of Surgery, University of Calgary, Calgary, Canada
| | - David Evans
- Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Éric Mercier
- Population Health and Optimal Health Practices Research Unit, Trauma-Emergency-Critical Care Medicine, Centre de Recherche du CHU de Québec (Hôpital de l'Enfant-Jésus), Université Laval, Québec City, Québec, Canada
| | - Patrick Archambault
- Population Health and Optimal Health Practices Research Unit, Transfert des Connaissances et Évaluation des Technologies et Modes d'Intervention en Santé, Centre de Recherche du CHU de Québec - Université Laval (Hôpital St François d'Assise), Université Laval, Québec City, Québec, Canada
| | - François Lamontagne
- Department of Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Belinda Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jérôme Paquet
- Division of Neurosurgery, Department of Surgery, Université Laval, Québec, Québec, Canada
| | - Tarek Razek
- Department of Trauma Surgery, Montreal General Hospital, McGill University Health Center, Montreal, Canada
| | - Henry Thomas Stelfox
- Departments of Critical Care Medicine, Medicine and Community Health Sciences, O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
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Hamel S, Denis I, Turcotte S, Fleet R, Archambault P, Dionne CE, Foldes-Busque G. Anxiety disorders in patients with noncardiac chest pain: association with health-related quality of life and chest pain severity. Health Qual Life Outcomes 2022; 20:7. [PMID: 35012545 PMCID: PMC8751105 DOI: 10.1186/s12955-021-01912-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 12/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with noncardiac chest pain (NCCP) report more severe symptoms and lowered health-related quality of life when they present with comorbid panic disorder (PD). Although generalized anxiety disorder (GAD) is the second most common psychiatric disorder in these patients, its impact on NCCP and health-related quality of life remains understudied. This study describes and prospectively compares patients with NCCP with or without PD or GAD in terms of (1) NCCP severity; and (2) the physical and mental components of health-related quality of life. METHODS A total of 915 patients with NCCP were consecutively recruited in two emergency departments. The presence of comorbid PD or GAD was assessed at baseline with the Anxiety Disorder Schedule for DSM-IV. NCCP severity at baseline and at the six-month follow-up was assessed with a structured telephone interview, and the patients completed the 12-item Short-Form Health Survey Version 2 (SF-12v2) to assess health-related quality of life at both time points. RESULTS Average NCCP severity decreased between baseline and the six-month follow-up (p < .001) and was higher in the patients with comorbid PD or GAD (p < .001) at both time points compared to those with NCCP only. However, average NCCP severity did not differ between patients with PD and those with GAD (p = 0.901). The physical component of quality of life improved over time (p = 0.016) and was significantly lower in the subset of patients with PD with or without comorbid GAD compared to the other groups (p < .001). A significant time x group interaction was found for the mental component of quality of life (p = 0.0499). GAD with or without comorbid PD was associated with a lower mental quality of life, and this effect increased at the six-month follow-up. CONCLUSIONS Comorbid PD or GAD are prospectively associated with increased chest pain severity and lowered health-related quality of life in patients with NCCP. PD appears to be mainly associated with the physical component of quality of life, while GAD has a greater association with the mental component. Knowledge of these differences could help in the management of patients with NCCP and these comorbidities.
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Affiliation(s)
- Stéphanie Hamel
- School of Psychology, Université Laval, Pavillon Félix-Antoine-Savard, 2325 rue des Bibliothèques, Quebec, QC G1V 0A6 Canada
- Research Centre of the Centre Hospitalier Affilié Universitaire de Lévis of the Centre Intégré de Santé Et de Services Sociaux de Chaudière-Appalaches, 143 Rue Wolfe, Lévis, QC G6V 3Z1 Canada
| | - Isabelle Denis
- School of Psychology, Université Laval, Pavillon Félix-Antoine-Savard, 2325 rue des Bibliothèques, Quebec, QC G1V 0A6 Canada
- Research Centre of the Centre Hospitalier Affilié Universitaire de Lévis of the Centre Intégré de Santé Et de Services Sociaux de Chaudière-Appalaches, 143 Rue Wolfe, Lévis, QC G6V 3Z1 Canada
- Centre de Recherche Universitaire Sur Les Jeunes Et Les Familles (CRUJeF), 2915 avenue du Bourg-Royal, Quebec, QC G1C 3S2 Canada
| | - Stéphane Turcotte
- Research Centre of the Centre Hospitalier Affilié Universitaire de Lévis of the Centre Intégré de Santé Et de Services Sociaux de Chaudière-Appalaches, 143 Rue Wolfe, Lévis, QC G6V 3Z1 Canada
| | - Richard Fleet
- Research Centre of the Centre Hospitalier Affilié Universitaire de Lévis of the Centre Intégré de Santé Et de Services Sociaux de Chaudière-Appalaches, 143 Rue Wolfe, Lévis, QC G6V 3Z1 Canada
- Department of Family and Emergency Medicine, Université Laval, Pavillon Ferdinand-Vandry, 1050 Avenue de la Médecine, Quebec, QC G1V 0A6 Canada
| | - Patrick Archambault
- Research Centre of the Centre Hospitalier Affilié Universitaire de Lévis of the Centre Intégré de Santé Et de Services Sociaux de Chaudière-Appalaches, 143 Rue Wolfe, Lévis, QC G6V 3Z1 Canada
- Department of Family and Emergency Medicine, Université Laval, Pavillon Ferdinand-Vandry, 1050 Avenue de la Médecine, Quebec, QC G1V 0A6 Canada
| | - Clermont E. Dionne
- CHU de Quebec Research Centre, Saint-Sacrement Hospital, 1050, Chemin Sainte-Foy, Quebec, QC G1S 4L8 Canada
| | - Guillaume Foldes-Busque
- School of Psychology, Université Laval, Pavillon Félix-Antoine-Savard, 2325 rue des Bibliothèques, Quebec, QC G1V 0A6 Canada
- Research Centre of the Centre Hospitalier Affilié Universitaire de Lévis of the Centre Intégré de Santé Et de Services Sociaux de Chaudière-Appalaches, 143 Rue Wolfe, Lévis, QC G6V 3Z1 Canada
- Quebec Heart and Lung Institute Research Centre, 2725 chemin Sainte-Foy, Quebec, QC G1V 4G5 Canada
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Abbas A, Abdukahil SA, Abdulkadir NN, Abe R, Abel L, Absil L, Acharya S, Acker A, Adachi S, Adam E, Adrião D, Ageel SA, Ahmed S, Ain Q, Ainscough K, Aisa T, Ait Hssain A, Ait Tamlihat Y, Akimoto T, Akmal E, Al Qasim E, Alalqam R, Alam T, Al-dabbous T, Alegesan S, Alegre C, Alessi M, Alex B, Alexandre K, Al-Fares A, Alfoudri H, Ali I, Ali Shah N, Alidjnou KE, Aliudin J, Alkhafajee Q, Allavena C, Allou N, Altaf A, Alves J, Alves JM, Alves R, Amaral M, Amira N, Ammerlaan H, Ampaw P, Andini R, Andrejak C, Angheben A, Angoulvant F, Ansart S, Anthonidass S, Antonelli M, Antunes de Brito CA, Anwar KR, Apriyana A, Arabi Y, Aragao I, Arali R, Arancibia F, Araujo C, Arcadipane A, Archambault P, Arenz L, Arlet JB, Arnold-Day C, Aroca A, Arora L, Arora R, Artaud-Macari E, Aryal D, Asaki M, Asensio A, Ashley E, Ashraf M, Ashraf S, Asim M, Assie JB, Asyraf A, Atique A, Attanyake AMUL, Auchabie J, Aumaitre H, Auvet A, Azemar L, Azoulay C, Bach B, Bachelet D, Badr C, Baig N, Baillie JK, Baird JK, Bak E, Bakakos A, Bakar NA, Bal A, Balakrishnan M, Balan V, Bani-Sadr F, Barbalho R, Barbosa NY, Barclay WS, Barnett SU, Barnikel M, Barrasa H, Barrelet A, Barrigoto C, Bartoli M, Bartone C, Baruch J, Bashir M, Basmaci R, Basri MFH, Bastos D, Battaglini D, Bauer J, Bautista Rincon DF, Bazan Dow D, Bedossa A, Bee KH, Behilill S, Beishuizen A, Beljantsev A, Bellemare D, Beltrame A, Beltrão BA, Beluze M, Benech N, Benjiman LE, Benkerrou D, Bennett S, Bento L, Berdal JE, Bergeaud D, Bergin H, Bernal Sobrino JL, Bertoli G, Bertolino L, Bessis S, Betz A, Bevilcaqua S, Bezulier K, Bhatt A, Bhavsar K, Bianchi I, Bianco C, Bidin FN, Bikram Singh M, Bin Humaid F, Bin Kamarudin MN, Bissuel F, Biston P, Bitker L, Blanco-Schweizer P, Blier C, Bloos F, Blot M, Blumberg L, Boccia F, Bodenes L, Bogaarts A, Bogaert D, Boivin AH, Bolze PA, Bompart F, Bonfasius A, Borges D, Borie R, Bosse HM, Botelho-Nevers E, Bouadma L, Bouchaud O, Bouchez S, Bouhmani D, Bouhour D, Bouiller K, Bouillet L, Bouisse C, Boureau AS, Bourke J, Bouscambert M, Bousquet A, Bouziotis J, Boxma B, Boyer-Besseyre M, Boylan M, Bozza FA, Brack M, Braconnier A, Braga C, Brandenburger T, Brás Monteiro F, Brazzi L, Breen D, Breen P, Breen P, Brett S, Brickell K, Broadley T, Browne A, Browne S, Brozzi N, Brusse-Keizer M, Buchtele N, Buesaquillo C, Bugaeva P, Buisson M, Burhan E, Burrell A, Bustos IG, Butnaru D, Cabie A, Cabral S, Caceres E, Cadoz C, Callahan M, Calligy K, Calvache JA, Cam J, Campana V, Campbell P, Campisi J, Canepa C, Cantero M, Caraux-Paz P, Cárcel S, Cardellino CS, Cardoso F, Cardoso F, Cardoso N, Cardoso S, Carelli S, Carlier N, Carmoi T, Carney G, Carpenter C, Carqueja I, Carret MC, Carrier FM, Carroll I, Carson G, Carton E, Casanova ML, Cascão M, Casey S, Casimiro J, Cassandra B, Castañeda S, Castanheira N, Castor-Alexandre G, Castrillón H, Castro I, Catarino A, Catherine FX, Cattaneo P, Cavalin R, Cavalli GG, Cavayas A, Ceccato A, Cervantes-Gonzalez M, Chair A, Chakveatze C, Chan A, Chand M, Chantalat Auger C, Chapplain JM, Chas J, Chaudary M, Chávez Iñiguez JS, Chen A, Chen YS, Cheng MP, Cheret A, Chiarabini T, Chica J, Chidambaram SK, Chin-Tho L, Chirouze C, Chiumello D, Cho HJ, Cho SM, Cholley B, Chopin MC, Chow TS, Chow YP, Chua HJ, Chua J, Cidade JP, Cisneros Herreros JM, Citarella BW, Ciullo A, Clarke E, Clarke J, Claure Del Granado R, Clohisey S, Cobb JP, Coca N, Codan C, Cody C, Coelho A, Coles M, Colin G, Collins M, Colombo SM, Combs P, Connolly J, Connor M, Conrad A, Contreras S, Conway E, Cooke GS, Copland M, Cordel H, Corley A, Cormican S, Cornelis S, Cornet AD, Corpuz AJ, Cortegiani A, Corvaisier G, Costigan E, Couffignal C, Couffin-Cadiergues S, Courtois R, Cousse S, Cregan R, Crepy D'Orleans C, Croonen S, Crowl G, Crump J, Cruz C, Cruz Berm JL, Cruz Rojo J, Csete M, Cucino A, Cullen A, Cullen C, Cummings M, Curley G, Curlier E, Curran C, Custodio P, da Silva Filipe A, Da Silveira C, Dabaliz AA, Dagens A, Dahly D, Dalton H, Dalton J, Daly S, D'Amico F, Daneman N, Daniel C, Dankwa EA, Dantas J, D’Aragon F, de Boer M, de Loughry G, de Mendoza D, De Montmollin E, de Oliveira França RF, de Pinho Oliveira AI, De Rosa R, de Silva T, de Vries P, Deacon J, Dean D, Debard A, DeBenedictis B, Debray MP, DeCastro N, Dechert W, Deconninck L, Decours R, Defous E, Delacroix I, Delaveuve E, Delavigne K, Delfos NM, Deligiannis I, Dell'Amore A, Delmas C, Delobel P, Delsing C, Demonchy E, Denis E, Deplanque D, Depuydt P, Desai M, Descamps D, Desvallée M, Dewayanti S, Diallo A, Diamantis S, Dias A, Diaz P, Diaz R, Diaz Diaz JJ, Didier K, Diehl JL, Dieperink W, Dimet J, Dinot V, Diop F, Diouf A, Dishon Y, Dixit D, Djossou F, Docherty AB, Doherty H, Dondorp AM, Dong A, Donnelly CA, Donnelly M, Donohue C, Donohue S, Donohue Y, Doran C, Doran P, Dorival C, D'Ortenzio E, Douglas JJ, Douma R, Dournon N, Downer T, Downey J, Downing M, Drake T, Driscoll A, Dryden M, Duarte Fonseca C, Dubee V, Dubos F, Ducancelle A, Duculan T, Dudman S, Duggal A, Dunand P, Dunning J, Duplaix M, Durante-Mangoni E, Durham III L, Dussol B, Duthoit J, Duval X, Dyrhol-Riise AM, Ean SC, Echeverria-Villalobos M, Egan S, Eira C, El Sanharawi M, Elapavaluru S, Elharrar B, Ellerbroek J, Eloy P, Elshazly T, Elyazar I, Enderle I, Endo T, Eng CC, Engelmann I, Enouf V, Epaulard O, Escher M, Esperatti M, Esperou H, Esposito-Farese M, Estevão J, Etienne M, Ettalhaoui N, Everding AG, Evers M, Fabre I, Fabre M, Faheem A, Fahy A, Fairfield CJ, Fakar Z, Faria P, Farooq A, Farrar JJ, Farshait N, Fateena H, Fatoni AZ, Faure K, Favory R, Fayed M, Feely N, Feeney L, Fernandes J, Fernandes M, Fernandes S, Ferrand FX, Ferrand Devouge E, Ferrão J, Ferraz M, Ferreira B, Ferreira S, Ferrer-Roca R, Ferriere N, Ficko C, Figueiredo-Mello C, Fiorda J, Flament T, Flateau C, Fletcher T, Florio LL, Flynn B, Flynn D, Foley C, Foley J, Fomin V, Fonseca T, Fontela P, Forsyth S, Foster D, Foti G, Fourn E, Fowler RA, Fraher DM, Franch-Llasat D, Fraser C, Fraser JF, Freire MV, Freitas Ribeiro A, Friedrich 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The value of open-source clinical science in pandemic response: lessons from ISARIC. Lancet Infect Dis 2021; 21:1623-1624. [PMID: 34619109 PMCID: PMC8489876 DOI: 10.1016/s1473-3099(21)00565-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/16/2021] [Indexed: 12/31/2022]
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Soltana K, Moore L, Bouderba S, Lauzier F, Clément J, Mercier É, Krouchev R, Tardif PA, Belcaid A, Stelfox T, Lamontagne F, Archambault P, Turgeon A. Adherence to Clinical Practice Guideline Recommendations on Low-Value Injury Care: A Multicenter Retrospective Cohort Study. Value Health 2021; 24:1728-1736. [PMID: 34838270 DOI: 10.1016/j.jval.2021.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/08/2021] [Accepted: 06/14/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Low-value clinical practices have been identified as one of the most important areas of excess healthcare spending. Nevertheless, there is a knowledge gap on the scale of this problem in injury care. We aimed to identify clinical practice guideline (CPG) recommendations pertaining to low-value injury care, estimate how frequently they are used in practice, and evaluate interhospital variations in their use. METHODS We identified low-value clinical practices from internationally recognized CPGs. We conducted a retrospective cohort study using data from a Canadian trauma system (2014-2019) to calculate frequencies and assess interhospital variations. RESULTS We identified 29 low-value practices. Fourteen could be measured using trauma registry data. The 3 low-value clinical practices with the highest absolute and relative frequencies were computed tomography (CT) in adults with minor head injury (n = 5591, 24%), cervical spine CT (n = 2742, 31%), and whole-body CT in minor or single-system trauma (n = 530, 32%). We observed high interhospital variation for decompressive craniectomy in diffuse traumatic brain injury. Frequencies and interhospital variations were low for magnetic resonance imaging, intracranial pressure monitoring, inferior vena cava filter use, and surgical management of blunt abdominal injuries. CONCLUSIONS We observed evidence of poor adherence to CPG recommendations on low-value CT imaging and high practice variation for decompressive craniectomy. Results suggest that adherence to recommendations for the 10 other low-value practices is high. These data can be used to advance the research agenda on low-value injury care and inform the development of interventions targeting reductions in healthcare overuse in this population.
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Affiliation(s)
- Kahina Soltana
- Canada Research Chair in Critical Care Neurology and Trauma, CHU de Québec - Laval University, Québec City, QC, Canada; Cochrane Canada Francophone, CHU de Québec - Laval University, Québec City, QC, Canada; CHU de Québec Research Center, Hôpital de l'Enfant-Jésus, CHU de Québec - Laval University, Québec City, QC, Canada; Population Health and Optimal Health Practice Research Unit, Trauma - Emergency - Critical Care Medicine, CHU de Québec Research Center, Laval University, Québec City, QC, Canada
| | - Lynne Moore
- CHU de Québec Research Center, Hôpital de l'Enfant-Jésus, CHU de Québec - Laval University, Québec City, QC, Canada; Population Health and Optimal Health Practice Research Unit, Trauma - Emergency - Critical Care Medicine, CHU de Québec Research Center, Laval University, Québec City, QC, Canada; Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Québec City, QC, Canada.
| | - Samy Bouderba
- CHU de Québec Research Center, Hôpital de l'Enfant-Jésus, CHU de Québec - Laval University, Québec City, QC, Canada; Population Health and Optimal Health Practice Research Unit, Trauma - Emergency - Critical Care Medicine, CHU de Québec Research Center, Laval University, Québec City, QC, Canada
| | - François Lauzier
- Canada Research Chair in Critical Care Neurology and Trauma, CHU de Québec - Laval University, Québec City, QC, Canada; CHU de Québec Research Center, Hôpital de l'Enfant-Jésus, CHU de Québec - Laval University, Québec City, QC, Canada; Division of Critical Care, Department of Medicine and Anesthesiology and Research Center, CHU de Québec - Laval University, Québec City, QC, Canada
| | - Julien Clément
- Institut national d'excellence en santé et en services sociaux (INESSS), Québec, QC, Canada; Department of Surgery, Université Laval, Québec, QC, Canada
| | - Éric Mercier
- CHU de Québec Research Center, Hôpital de l'Enfant-Jésus, CHU de Québec - Laval University, Québec City, QC, Canada; Population Health and Optimal Health Practice Research Unit, Trauma - Emergency - Critical Care Medicine, CHU de Québec Research Center, Laval University, Québec City, QC, Canada; Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Laval University, Québec City, QC, Canada
| | | | - Pier-Alexandre Tardif
- CHU de Québec Research Center, Hôpital de l'Enfant-Jésus, CHU de Québec - Laval University, Québec City, QC, Canada; Population Health and Optimal Health Practice Research Unit, Trauma - Emergency - Critical Care Medicine, CHU de Québec Research Center, Laval University, Québec City, QC, Canada
| | - Amina Belcaid
- CHU de Québec Research Center, Hôpital de l'Enfant-Jésus, CHU de Québec - Laval University, Québec City, QC, Canada; Population Health and Optimal Health Practice Research Unit, Trauma - Emergency - Critical Care Medicine, CHU de Québec Research Center, Laval University, Québec City, QC, Canada; Institut national d'excellence en santé et en services sociaux (INESSS), Québec, QC, Canada
| | - Thomas Stelfox
- Department of Critical Care Medicine - Calgary Zone, University of Calgary and Alberta Health Services, University of Calgary, Calgary, AB, Canada
| | - François Lamontagne
- Internal Medicine Department, Department of Medicine, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Patrick Archambault
- Department of Family Medicine and Emergency Medicine, Division of Critical Care, Department of Anesthesia, CISSS Chaudière-Appalaches (Secteur Alphonse-Desjardins), Sainte-Marie, QC, Canada
| | - Alexis Turgeon
- Canada Research Chair in Critical Care Neurology and Trauma, CHU de Québec - Laval University, Québec City, QC, Canada; Cochrane Canada Francophone, CHU de Québec - Laval University, Québec City, QC, Canada; CHU de Québec Research Center, Hôpital de l'Enfant-Jésus, CHU de Québec - Laval University, Québec City, QC, Canada; Population Health and Optimal Health Practice Research Unit, Trauma - Emergency - Critical Care Medicine, CHU de Québec Research Center, Laval University, Québec City, QC, Canada; Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Université Laval, Québec City, QC, on behalf of the Canadian Traumatic Brain Research Consortium
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Johnstone J, Meade M, Lauzier F, Marshall J, Duan E, Dionne J, Arabi YM, Heels-Ansdell D, Thabane L, Lamarche D, Surette M, Zytaruk N, Mehta S, Dodek P, McIntyre L, English S, Rochwerg B, Karachi T, Henderson W, Wood G, Ovakim D, Herridge M, Granton J, Wilcox ME, Goffi A, Stelfox HT, Niven D, Muscedere J, Lamontagne F, D’Aragon F, St.-Arnaud C, Ball I, Nagpal D, Girard M, Aslanian P, Charbonney E, Williamson D, Sligl W, Friedrich J, Adhikari NK, Marquis F, Archambault P, Khwaja K, Kristof A, Kutsogiannis J, Zarychanski R, Paunovic B, Reeve B, Lellouche F, Hosek P, Tsang J, Binnie A, Trop S, Loubani O, Hall R, Cirone R, Reynolds S, Lysecki P, Golan E, Cartin-Ceba R, Taylor R, Cook D. Effect of Probiotics on Incident Ventilator-Associated Pneumonia in Critically Ill Patients: A Randomized Clinical Trial. JAMA 2021; 326:1024-1033. [PMID: 34546300 PMCID: PMC8456390 DOI: 10.1001/jama.2021.13355] [Citation(s) in RCA: 80] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
IMPORTANCE Growing interest in microbial dysbiosis during critical illness has raised questions about the therapeutic potential of microbiome modification with probiotics. Prior randomized trials in this population suggest that probiotics reduce infection, particularly ventilator-associated pneumonia (VAP), although probiotic-associated infections have also been reported. OBJECTIVE To evaluate the effect of Lactobacillus rhamnosus GG on preventing VAP, additional infections, and other clinically important outcomes in the intensive care unit (ICU). DESIGN, SETTING, AND PARTICIPANTS Randomized placebo-controlled trial in 44 ICUs in Canada, the United States, and Saudi Arabia enrolling adults predicted to require mechanical ventilation for at least 72 hours. A total of 2653 patients were enrolled from October 2013 to March 2019 (final follow-up, October 2020). INTERVENTIONS Enteral L rhamnosus GG (1 × 1010 colony-forming units) (n = 1321) or placebo (n = 1332) twice daily in the ICU. MAIN OUTCOMES AND MEASURES The primary outcome was VAP determined by duplicate blinded central adjudication. Secondary outcomes were other ICU-acquired infections including Clostridioides difficile infection, diarrhea, antimicrobial use, ICU and hospital length of stay, and mortality. RESULTS Among 2653 randomized patients (mean age, 59.8 years [SD], 16.5 years), 2650 (99.9%) completed the trial (mean age, 59.8 years [SD], 16.5 years; 1063 women [40.1%.] with a mean Acute Physiology and Chronic Health Evaluation II score of 22.0 (SD, 7.8) and received the study product for a median of 9 days (IQR, 5-15 days). VAP developed among 289 of 1318 patients (21.9%) receiving probiotics vs 284 of 1332 controls (21.3%; hazard ratio [HR], 1.03 (95% CI, 0.87-1.22; P = .73, absolute difference, 0.6%, 95% CI, -2.5% to 3.7%). None of the 20 prespecified secondary outcomes, including other ICU-acquired infections, diarrhea, antimicrobial use, mortality, or length of stay showed a significant difference. Fifteen patients (1.1%) receiving probiotics vs 1 (0.1%) in the control group experienced the adverse event of L rhamnosus in a sterile site or the sole or predominant organism in a nonsterile site (odds ratio, 14.02; 95% CI, 1.79-109.58; P < .001). CONCLUSIONS AND RELEVANCE Among critically ill patients requiring mechanical ventilation, administration of the probiotic L rhamnosus GG compared with placebo, resulted in no significant difference in the development of ventilator-associated pneumonia. These findings do not support the use of L rhamnosus GG in critically ill patients. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02462590.
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Affiliation(s)
| | | | | | | | | | | | - Yaseen M. Arabi
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | | | | | | | | | | | | | - Peter Dodek
- University of British Columbia, Vancouver, Canada
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ian Ball
- Western University, London, Canada
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Abbasgholizadeh Rahimi S, Légaré F, Sharma G, Archambault P, Zomahoun HTV, Chandavong S, Rheault N, T Wong S, Langlois L, Couturier Y, Salmeron JL, Gagnon MP, Légaré J. Application of Artificial Intelligence in Community-Based Primary Health Care: Systematic Scoping Review and Critical Appraisal. J Med Internet Res 2021; 23:e29839. [PMID: 34477556 PMCID: PMC8449300 DOI: 10.2196/29839] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/29/2021] [Accepted: 05/31/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Research on the integration of artificial intelligence (AI) into community-based primary health care (CBPHC) has highlighted several advantages and disadvantages in practice regarding, for example, facilitating diagnosis and disease management, as well as doubts concerning the unintended harmful effects of this integration. However, there is a lack of evidence about a comprehensive knowledge synthesis that could shed light on AI systems tested or implemented in CBPHC. OBJECTIVE We intended to identify and evaluate published studies that have tested or implemented AI in CBPHC settings. METHODS We conducted a systematic scoping review informed by an earlier study and the Joanna Briggs Institute (JBI) scoping review framework and reported the findings according to PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analysis-Scoping Reviews) reporting guidelines. An information specialist performed a comprehensive search from the date of inception until February 2020, in seven bibliographic databases: Cochrane Library, MEDLINE, EMBASE, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), ScienceDirect, and IEEE Xplore. The selected studies considered all populations who provide and receive care in CBPHC settings, AI interventions that had been implemented, tested, or both, and assessed outcomes related to patients, health care providers, or CBPHC systems. Risk of bias was assessed using the Prediction Model Risk of Bias Assessment Tool (PROBAST). Two authors independently screened the titles and abstracts of the identified records, read the selected full texts, and extracted data from the included studies using a validated extraction form. Disagreements were resolved by consensus, and if this was not possible, the opinion of a third reviewer was sought. A third reviewer also validated all the extracted data. RESULTS We retrieved 22,113 documents. After the removal of duplicates, 16,870 documents were screened, and 90 peer-reviewed publications met our inclusion criteria. Machine learning (ML) (41/90, 45%), natural language processing (NLP) (24/90, 27%), and expert systems (17/90, 19%) were the most commonly studied AI interventions. These were primarily implemented for diagnosis, detection, or surveillance purposes. Neural networks (ie, convolutional neural networks and abductive networks) demonstrated the highest accuracy, considering the given database for the given clinical task. The risk of bias in diagnosis or prognosis studies was the lowest in the participant category (4/49, 4%) and the highest in the outcome category (22/49, 45%). CONCLUSIONS We observed variabilities in reporting the participants, types of AI methods, analyses, and outcomes, and highlighted the large gap in the effective development and implementation of AI in CBPHC. Further studies are needed to efficiently guide the development and implementation of AI interventions in CBPHC settings.
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Affiliation(s)
- Samira Abbasgholizadeh Rahimi
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.,Mila-Quebec AI Institute, Montreal, QC, Canada
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, QC, Canada.,VITAM - Centre de recherche en santé durable, Université Laval, Quebec City, QC, Canada
| | - Gauri Sharma
- Faculty of Engineering, Dayalbagh Educational Institute, Agra, India
| | - Patrick Archambault
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, QC, Canada.,VITAM - Centre de recherche en santé durable, Université Laval, Quebec City, QC, Canada
| | - Herve Tchala Vignon Zomahoun
- VITAM - Centre de recherche en santé durable, Université Laval, Quebec City, QC, Canada.,Quebec SPOR-Support Unit, Quebec City, QC, Canada
| | - Sam Chandavong
- Faculty of Science and Engineering, Université Laval, Quebec City, QC, Canada
| | - Nathalie Rheault
- VITAM - Centre de recherche en santé durable, Université Laval, Quebec City, QC, Canada.,Quebec SPOR-Support Unit, Quebec City, QC, Canada
| | - Sabrina T Wong
- School of Nursing, University of British Columbia, Vancouver, BC, Canada.,Center for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada
| | - Lyse Langlois
- Department of Industrial Relations, Université Laval, Quebec City, QC, Canada.,OBVIA - Quebec International Observatory on the social impacts of AI and digital technology, Quebec City, QC, Canada
| | - Yves Couturier
- School of Social Work, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Jose L Salmeron
- Department of Data Science, University Pablo de Olavide, Seville, Spain
| | | | - Jean Légaré
- Arthritis Alliance of Canada, Montreal, QC, Canada
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Ouellet V, Boucher V, Beauchamp F, Neveu X, Archambault P, Berthelot S, Chauny JM, De Guise E, Émond M, Frenette J, Lang E, Lee J, Mercier, Moore L, Ouellet MC, Perry J, Le Sage N. Influence of concomitant injuries on post-concussion symptoms after a mild traumatic brain injury - a prospective multicentre cohort study. Brain Inj 2021; 35:1028-1034. [PMID: 34224275 DOI: 10.1080/02699052.2021.1945145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objectives: To compare post-concussion symptoms (PCS) and return to normal activities between mild Traumatic Brain Injury (mTBI) patients with or without concomitant injuries at 7-and 90 days post-mTBI.Methods: Design: Sub-analysis of a multicentre prospective cohort study. PARTICIPANTS AND SETTING patients with mTBI from 7 Canadian Emergency Departments. PROCEDURE Research assistants conducted telephone follow-ups using the Rivermead Postconcussion Symptoms Questionnaire (RPQ) at 7-, 30- and 90 days post-mTBI. MAIN OUTCOME Presence of PCS (RPQ: ≥3 symptoms) at 90 days. SECONDARY OUTCOMES RPQ score ≥21, prevalence of individual RPQ symptoms and patients' return to normal activities, at 7- and 90-days. Adjusted risk ratios (RR) were calculated.Results: 1725 mTBI patients were included and 1055 (61.1%) had concomitant injuries. Patients with concomitant injuries were at higher risk of having ≥3 symptoms on the RPQ (RR:1.26 [95% CI 1.01-1.58]) at 90 days. They were also at higher risk of experiencing specific symptoms (dizziness, fatigue, headaches and taking longer to think) and of non-return to their normal activities (RR:2.11 [95% CI 1.30-3.45]).Conclusion: Patients with concomitant injuries have slightly more PCS and seemed to be at higher risk of non-return to their normal activities 90 days, compared to patients without concomitant injuries.
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Affiliation(s)
- V Ouellet
- CHU De Québec-Université Laval Research Center, Quebec, Canada.,Centre De Recherche Sur Les Soins Et Les Services De Première Ligne De l'Université Laval (CERSSPL-UL), Canada.,Département De Médecine Familiale Et De Médecine D'urgence, Faculté De Médecine, Université Laval Québec Canada
| | - V Boucher
- CHU De Québec-Université Laval Research Center, Quebec, Canada.,Centre De Recherche Sur Les Soins Et Les Services De Première Ligne De l'Université Laval (CERSSPL-UL), Canada
| | - F Beauchamp
- CHU De Québec-Université Laval Research Center, Quebec, Canada.,Centre De Recherche Sur Les Soins Et Les Services De Première Ligne De l'Université Laval (CERSSPL-UL), Canada.,Département De Médecine Familiale Et De Médecine D'urgence, Faculté De Médecine, Université Laval Québec Canada
| | - X Neveu
- CHU De Québec-Université Laval Research Center, Quebec, Canada.,Centre De Recherche Sur Les Soins Et Les Services De Première Ligne De l'Université Laval (CERSSPL-UL), Canada
| | - P Archambault
- Département De Médecine Familiale Et De Médecine D'urgence, Faculté De Médecine, Université Laval Québec Canada.,Centre Intégré De Santé Et De Services Sociaux De Chaudière-Appalaches, Centre Hospitalier Affilié Universitaire Hôtel-Dieu De Lévis, Lévis (Quebec) Canada
| | - S Berthelot
- CHU De Québec-Université Laval Research Center, Quebec, Canada.,Centre De Recherche Sur Les Soins Et Les Services De Première Ligne De l'Université Laval (CERSSPL-UL), Canada.,Département De Médecine Familiale Et De Médecine D'urgence, Faculté De Médecine, Université Laval Québec Canada
| | - J M Chauny
- Université De Montréal, Montréal, Québec, Canada
| | - E De Guise
- Université De Montréal, Montréal, Québec, Canada.,Research-Institute, McGill University Health CentreMontreal, Quebec, Canada.,Centre De Recherche Interdisciplinaire En Réadaptation Du Montréal Métropolitain (CRIR), Montreal, Quebec, Canada
| | - M Émond
- CHU De Québec-Université Laval Research Center, Quebec, Canada.,Centre De Recherche Sur Les Soins Et Les Services De Première Ligne De l'Université Laval (CERSSPL-UL), Canada.,Département De Médecine Familiale Et De Médecine D'urgence, Faculté De Médecine, Université Laval Québec Canada
| | - J Frenette
- Centre De Recherche Sur Les Soins Et Les Services De Première Ligne De l'Université Laval (CERSSPL-UL), Canada
| | - E Lang
- University of Calgary, Calgary, Alberta, Canada
| | - J Lee
- Schwartz/Reisman Emergency Medicine Institute, Toronto, Ontario, Canada
| | - Mercier
- CHU De Québec-Université Laval Research Center, Quebec, Canada.,Centre De Recherche Sur Les Soins Et Les Services De Première Ligne De l'Université Laval (CERSSPL-UL), Canada.,Département De Médecine Familiale Et De Médecine D'urgence, Faculté De Médecine, Université Laval Québec Canada
| | - L Moore
- Department of Social and Preventive Medicine, Faculté De Médecine, Université Laval Québec Canada
| | - M C Ouellet
- Département De Psychologie, Université Laval Québec Canada.,Centre Interdisciplinaire De Recherche En Réadaptation Et Intégration Sociale CIRRIS, Quebec, Canada
| | - J Perry
- Department of Emergency Medicine, Ottawa Hospital Research Institute, University of Ottawa Ottawa Canada
| | - N Le Sage
- CHU De Québec-Université Laval Research Center, Quebec, Canada.,Centre De Recherche Sur Les Soins Et Les Services De Première Ligne De l'Université Laval (CERSSPL-UL), Canada.,Département De Médecine Familiale Et De Médecine D'urgence, Faculté De Médecine, Université Laval Québec Canada
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Archambault P, Turcotte S, Smith PY, Said Abasse K, Paquet C, Côté A, Gomez D, Khechine H, Gagnon MP, Tremblay M, Elazhary N, Légaré F. Intention to Use Wiki-Based Knowledge Tools: Survey of Quebec Emergency Health Professionals. JMIR Med Inform 2021; 9:e24649. [PMID: 34142977 PMCID: PMC8277401 DOI: 10.2196/24649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 02/16/2021] [Accepted: 05/07/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Clinical decision support systems are information technologies that assist clinicians in making better decisions. Their adoption has been limited because their content is difficult to adapt to local contexts and slow to adapt to emerging evidence. Collaborative writing applications such as wikis have the potential to increase access to existing and emerging evidence-based knowledge at the point of care, standardize emergency clinical decision making, and quickly adapt this knowledge to local contexts. However, little is known about the factors influencing health professionals' use of wiki-based knowledge tools. OBJECTIVE This study aims to measure emergency physicians' (EPs) and other acute care health professionals' (ACHPs) intentions to use wiki-based knowledge tools in trauma care and identify determinants of this intention that can be used in future theory-based interventions for promoting the use of wiki-based knowledge tools in trauma care. METHODS In total, 266 EPs and 907 ACHPs (nurses, respiratory therapists, and pharmacists) from 12 Quebec trauma centers were asked to answer a survey based on the theory of planned behavior (TPB). The TPB constructs were measured using a 7-point Likert scale. Descriptive statistics and Pearson correlations between the TPB constructs and intention were calculated. Multiple linear regression analysis was conducted to identify the salient beliefs. RESULTS Among the eligible participants, 57.1% (152/266) of EPs and 31.9% (290/907) of ACHPs completed the questionnaire. For EPs, we found that attitude, perceived behavioral control (PBC), and subjective norm (SN) were significant determinants of the intention to use wiki-based knowledge tools and explained 62% of its variance. None of the sociodemographic variables were related to EPs' intentions to use wiki-based knowledge tools. The regression model identified two normative beliefs ("approval by physicians" and "approval by patients") and two behavioral beliefs ("refreshes my memory" and "reduces errors"). For ACHPs, attitude, PBC, SN, and two sociodemographic variables (profession and the previous personal use of a wiki) were significantly related to the intention to use wiki-based knowledge tools and explained 60% of the variance in behavioral intention. The final regression model for ACHPs included two normative beliefs ("approval by the hospital trauma team" and "people less comfortable with information technology"), one control belief ("time constraints"), and one behavioral belief ("access to evidence"). CONCLUSIONS The intentions of EPs and ACHPs to use wiki-based knowledge tools to promote best practices in trauma care can be predicted in part by attitude, SN, and PBC. We also identified salient beliefs that future theory-based interventions should promote for the use of wiki-based knowledge tools in trauma care. These interventions will address the barriers to using wiki-based knowledge tools, find ways to ensure the quality of their content, foster contributions, and support the exploration of wiki-based knowledge tools as potential effective knowledge translation tools in trauma care.
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Affiliation(s)
- Patrick Archambault
- Département de médecine d'urgence, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada
- VITAM - Centre de recherche en santé durable, Université Laval, Québec, QC, Canada
| | - Stéphane Turcotte
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - Pascal Y Smith
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - Kassim Said Abasse
- Département de management, Faculté des sciences de l'administration, Université Laval, Québec, QC, Canada
| | - Catherine Paquet
- Département de marketing, Faculté des sciences de l'administration, Université Laval, Québec, QC, Canada
| | - André Côté
- Département de management, Faculté des sciences de l'administration, Université Laval, Québec, QC, Canada
| | - Dario Gomez
- Département de systèmes d'information organisationnels, Faculté des sciences de l'administration, Université Laval, Québec, QC, Canada
| | - Hager Khechine
- Département de systèmes d'information organisationnels, Faculté des sciences de l'administration, Université Laval, Québec, QC, Canada
| | - Marie-Pierre Gagnon
- VITAM - Centre de recherche en santé durable, Université Laval, Québec, QC, Canada
- Faculté des sciences infirmières, Université Laval, Québec, QC, Canada
| | - Melissa Tremblay
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Nicolas Elazhary
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada
- VITAM - Centre de recherche en santé durable, Université Laval, Québec, QC, Canada
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Silverberg ND, Otamendi T, Panenka WJ, Archambault P, Babul S, MacLellan A, Li LC. De-implementing Prolonged Rest Advice for Concussion in Primary Care Settings: A Pilot Stepped Wedge Cluster Randomized Trial. J Head Trauma Rehabil 2021; 36:79-86. [PMID: 32898029 DOI: 10.1097/htr.0000000000000609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the feasibility and preliminary efficacy of a de-implementation intervention to support return-to-activity guideline use after concussion. SETTING Community. PARTICIPANTS Family physicians in community practice (n = 21 at 5 clinics). DESIGN Pilot stepped wedge cluster randomized trial with qualitative interviews. Training on new guidelines for return to activity after concussion was provided in education outreach visits. MAIN MEASURES The primary feasibility outcomes were recruitment, retention, and postencounter form completion (physicians prospectively recorded what they did for each new patient with concussion). Efficacy indicators included a knowledge test and guideline compliance based on postencounter form data. Qualitative interviews covered Theoretical Domains Framework elements. RESULTS Recruitment, retention, and postencounter form completion rates all fell below feasibility benchmarks. Family physicians demonstrated increased knowledge about the return-to-activity guideline (M = 8.8 true-false items correct out of 10 after vs 6.3 before) and improved guideline adherence (86% after vs 25% before) after the training. Qualitative interviews revealed important barriers (eg, beliefs about contraindications) and facilitators (eg, patient handouts) to behavior change. CONCLUSIONS Education outreach visits might facilitate de-implementation of prolonged rest advice after concussion, but methodological changes will be necessary to improve the feasibility of a larger trial. The qualitative findings highlight opportunities for refining the intervention.
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Affiliation(s)
- Noah D Silverberg
- Division of Physical Medicine & Rehabilitation (Dr Silverberg), Rehabilitation Sciences (Ms Otamendi), and Departments of Psychiatry (Dr Panenka), Pediatrics (Dr Babul), and Physical Therapy (Dr Li), The University of British Columbia, Vancouver, Canada; Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada (Dr Silverberg and Ms MacLellan); BC Mental Health & Substance Use Services Research Institute, Vancouver, British Columbia, Canada (Dr Panenka); British Columbia Provincial Neuropsychiatry Program, Vancouver, British Columbia, Canada (Dr Panenka); Department of Family Medicine and Emergency Medicine, Université Laval, Québec City, Quebec, Canada (Dr Archambault); Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Ste-Marie, Ontario, Canada (Dr Archambault); Centre de recherche intégrée pour un système apprenant en santé et services sociaux, Lévis, Quebec, Canada (Dr Archambault); Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Québec City, Quebec, Canada (Dr Archambault); Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec City, Quebec, Canada (Dr Archambault); BC Injury Research and Prevention Unit, BC Children's Hospital, Vancouver, British Columbia, Canada (Dr Babul); and Arthritis Research Canada, Richmond, British Columbia, Canada (Dr Li); on behalf of the Canadian TBI Research Consortium
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48
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Stacey D, Ludwig C, Archambault P, Babulic K, Edwards N, Lavoie J, Sinha S, O’Connor AM. Feasibility of Rapidly Developing and Widely Disseminating Patient Decision Aids to Respond to Urgent Decisional Needs due to the COVID-19 Pandemic. Med Decis Making 2021; 41:233-239. [PMID: 33300438 PMCID: PMC7879222 DOI: 10.1177/0272989x20979693] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 11/17/2020] [Indexed: 11/16/2022]
Abstract
To meet urgent decisional needs of retirement/nursing home residents and their families, our interdisciplinary stakeholder team rapidly developed and disseminated patient decision aids (PtDAs) regarding leaving one's residence during the COVID-19 pandemic. The development steps were as follows: identify urgent decisional needs, develop PtDAs using the Ottawa Decision Support Framework template and minimal International PtDA Standards, obtain stakeholder feedback, broadly disseminate, and incorporate user feedback. Within 2 wk, we developed 2 PtDAs for retirement and nursing home living environments that were informed by decisional needs (identified from public responses to related media reports), current pandemic regulations/guidance, and recent systematic reviews. Within 3 wk of their dissemination (websites, international PtDA inventory, Twitter, Facebook, media interviews), the PtDAs were downloaded 10,000 times, and user feedback was positive. Our expert team showed feasible rapid development and wide dissemination of PtDAs to respond to urgent decisional needs. Development efficiencies included access to a well-tested theory-based PtDA template, recent evidence syntheses, and values-based public responses to media reports. Future research includes methods for rapidly collecting user feedback, facilitating implementation, and measuring use and outcomes.
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Affiliation(s)
- Dawn Stacey
- University of Ottawa, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Claire Ludwig
- />University of Ottawa, Ottawa, ON, Canada
- />Champlain LHIN, Ottawa, ON, Canada
| | - Patrick Archambault
- Centre de recherche du Centre intégré de santé et de services de santé de Chaudiére-Appalaches and Université Laval
| | | | | | - Josée Lavoie
- Royal Ottawa Mental Health Centre, Ottawa, ON, Canada
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Hohl CM, Rosychuk RJ, McRae AD, Brooks SC, Archambault P, Fok PT, Davis P, Jelic T, Turner JP, Rowe BH, Mercier É, Cheng I, Taylor J, Daoust R, Ohle R, Andolfatto G, Atzema C, Hayward J, Khangura JK, Landes M, Lang E, Martin I, Mohindra R, Ting DK, Vaillancourt S, Welsford M, Brar B, Dahn T, Wiemer H, Yadav K, Yan JW, Stachura M, McGavin C, Perry JJ, Morrison LJ. Development of the Canadian COVID-19 Emergency Department Rapid Response Network population-based registry: a methodology study. CMAJ Open 2021; 9:E261-E270. [PMID: 33731427 PMCID: PMC8096396 DOI: 10.9778/cmajo.20200290] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Emergency physicians lack high-quality evidence for many diagnostic and treatment decisions made for patients with suspected or confirmed coronavirus disease 2019 (COVID-19). Our objective is to describe the methods used to collect and ensure the data quality of a multicentre registry of patients presenting to the emergency department with suspected or confirmed COVID-19. METHODS This methodology study describes a population-based registry that has been enrolling consecutive patients presenting to the emergency department with suspected or confirmed COVID-19 since Mar. 1, 2020. Most data are collected from retrospective chart review. Phone follow-up with patients at 30 days captures the World Health Organization clinical improvement scale and contextual, social and cultural variables. Phone follow-up also captures patient-reported quality of life using the Veterans Rand 12-Item Health Survey at 30 days, 60 days, 6 months and 12 months. Fifty participating emergency departments from 8 provinces in Canada currently enrol patients into the registry. INTERPRETATION Data from the registry of the Canadian COVID-19 Emergency Department Rapid Response Network will be used to derive and validate clinical decision rules to inform clinical decision-making, describe the natural history of the disease, evaluate COVID-19 diagnostic tests and establish the real-world effectiveness of treatments and vaccines, including in populations that are excluded or underrepresented in clinical trials. This registry has the potential to generate scientific evidence to inform our pandemic response, and to serve as a model for the rapid implementation of population-based data collection protocols for future public health emergencies. TRIAL REGISTRATION Clinicaltrials.gov, no. NCT04702945.
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Affiliation(s)
- Corinne M Hohl
- Department of Emergency Medicine (Hohl, Taylor, Andolfatto, Ting, Brar, Stachura), University of British Columbia; Centre for Clinical Epidemiology & Evaluation (Hohl), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Emergency Medicine (McRae), Foothills Medical Center, Calgary, Alta.; Department of Emergency Medicine (Brooks), School of Medicine, Queen's University; Kingston Health Sciences Centre (Brooks), Kingston, Ont.; Department of Family Medicine and Emergency Medicine (Archambault), Faculty of Medicine, Université Laval; VITAM (Centre de recherche en santé durable) (Archambault, Mercier), Québec, Que.; Division of EMS (Fok, Dahn, Wiemer), Department of Emergency Medicine, Dalhousie University; Charles V. Keating Emergency and Trauma Centre (Fok, Dahn, Wiemer), QEII Health Sciences Centre, Halifax, NS; Department of Emergency Medicine (Davis), College of Medicine, University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Jelic), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Emergency Department (Turner), Jewish General Hospital; Department of Emergency Medicine (Turner), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; Department of Emergency Medicine (Rowe, Hayward, Khangura), Faculty of Medicine & Dentistry, and School of Public Health (Rowe), University of Alberta, Edmonton, Alta.; Centre de recherche (Mercier), CHU de Québec, Université Laval, Québec, Que.; Sunnybrook Health Sciences Centre (Cheng, Atzema); Division of Emergency Medicine (Cheng, Landes, Vaillancourt, Morrison), Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ont.; Emergency Department (Taylor), Royal Columbian Hospital, New Westminster, BC; Départements de médecine de famille et de médecine d'urgence (Daoust), Faculté de médecine, Université de Montréal; Hôpital du Sacré-Coeur-de-Montréal (Daoust), CIUSSS Nord-de-l'ile-de-Montréal, Montréal, Que.; Department of Emergency Medicine (Ohle), Health Sciences North; Northern Ontario School of Medicine (Ohle), Sudbury, Ont.; Lions Gate Hospital (Andolfatto, Stachura), North Vancouver, BC; ICES Central (Atzema); University Health Network (Landes), Toronto, Ont.; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary; Rockyview General Hospital (Lang), Calgary, Alta.; Department of Family Practice (Martin), Faculty of Medicine, University of British Columbia, Vancouver, BC; Abbotsford Regional Hospital & Cancer Agency (Martin), Abbotsford, BC; Department of Emergency Medicine (Mohindra), North York General Hospital, North York, Ont.; Department of Emergency Medicine (Vaillancourt, Morrison), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Division of Emergency Medicine (Welsford), Department of Medicine, McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Surrey Memorial Hospital (Brar), Surrey, BC; Department of Emergency Medicine (Yadav, Perry), University of Ottawa; Ottawa Hospital Research Institute (Yadav, Perry), Ottawa, Ont.; Division of Emergency Medicine (Yan), Department of Medicine, London Health Sciences Centre; Schulich School of Medicine and Dentistry (Yan), Western University, London, Ont.; BC SUPPORT Unit (McGavin), Vancouver, BC
| | - Rhonda J Rosychuk
- Department of Emergency Medicine (Hohl, Taylor, Andolfatto, Ting, Brar, Stachura), University of British Columbia; Centre for Clinical Epidemiology & Evaluation (Hohl), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Emergency Medicine (McRae), Foothills Medical Center, Calgary, Alta.; Department of Emergency Medicine (Brooks), School of Medicine, Queen's University; Kingston Health Sciences Centre (Brooks), Kingston, Ont.; Department of Family Medicine and Emergency Medicine (Archambault), Faculty of Medicine, Université Laval; VITAM (Centre de recherche en santé durable) (Archambault, Mercier), Québec, Que.; Division of EMS (Fok, Dahn, Wiemer), Department of Emergency Medicine, Dalhousie University; Charles V. Keating Emergency and Trauma Centre (Fok, Dahn, Wiemer), QEII Health Sciences Centre, Halifax, NS; Department of Emergency Medicine (Davis), College of Medicine, University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Jelic), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Emergency Department (Turner), Jewish General Hospital; Department of Emergency Medicine (Turner), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; Department of Emergency Medicine (Rowe, Hayward, Khangura), Faculty of Medicine & Dentistry, and School of Public Health (Rowe), University of Alberta, Edmonton, Alta.; Centre de recherche (Mercier), CHU de Québec, Université Laval, Québec, Que.; Sunnybrook Health Sciences Centre (Cheng, Atzema); Division of Emergency Medicine (Cheng, Landes, Vaillancourt, Morrison), Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ont.; Emergency Department (Taylor), Royal Columbian Hospital, New Westminster, BC; Départements de médecine de famille et de médecine d'urgence (Daoust), Faculté de médecine, Université de Montréal; Hôpital du Sacré-Coeur-de-Montréal (Daoust), CIUSSS Nord-de-l'ile-de-Montréal, Montréal, Que.; Department of Emergency Medicine (Ohle), Health Sciences North; Northern Ontario School of Medicine (Ohle), Sudbury, Ont.; Lions Gate Hospital (Andolfatto, Stachura), North Vancouver, BC; ICES Central (Atzema); University Health Network (Landes), Toronto, Ont.; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary; Rockyview General Hospital (Lang), Calgary, Alta.; Department of Family Practice (Martin), Faculty of Medicine, University of British Columbia, Vancouver, BC; Abbotsford Regional Hospital & Cancer Agency (Martin), Abbotsford, BC; Department of Emergency Medicine (Mohindra), North York General Hospital, North York, Ont.; Department of Emergency Medicine (Vaillancourt, Morrison), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Division of Emergency Medicine (Welsford), Department of Medicine, McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Surrey Memorial Hospital (Brar), Surrey, BC; Department of Emergency Medicine (Yadav, Perry), University of Ottawa; Ottawa Hospital Research Institute (Yadav, Perry), Ottawa, Ont.; Division of Emergency Medicine (Yan), Department of Medicine, London Health Sciences Centre; Schulich School of Medicine and Dentistry (Yan), Western University, London, Ont.; BC SUPPORT Unit (McGavin), Vancouver, BC
| | - Andrew D McRae
- Department of Emergency Medicine (Hohl, Taylor, Andolfatto, Ting, Brar, Stachura), University of British Columbia; Centre for Clinical Epidemiology & Evaluation (Hohl), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Emergency Medicine (McRae), Foothills Medical Center, Calgary, Alta.; Department of Emergency Medicine (Brooks), School of Medicine, Queen's University; Kingston Health Sciences Centre (Brooks), Kingston, Ont.; Department of Family Medicine and Emergency Medicine (Archambault), Faculty of Medicine, Université Laval; VITAM (Centre de recherche en santé durable) (Archambault, Mercier), Québec, Que.; Division of EMS (Fok, Dahn, Wiemer), Department of Emergency Medicine, Dalhousie University; Charles V. Keating Emergency and Trauma Centre (Fok, Dahn, Wiemer), QEII Health Sciences Centre, Halifax, NS; Department of Emergency Medicine (Davis), College of Medicine, University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Jelic), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Emergency Department (Turner), Jewish General Hospital; Department of Emergency Medicine (Turner), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; Department of Emergency Medicine (Rowe, Hayward, Khangura), Faculty of Medicine & Dentistry, and School of Public Health (Rowe), University of Alberta, Edmonton, Alta.; Centre de recherche (Mercier), CHU de Québec, Université Laval, Québec, Que.; Sunnybrook Health Sciences Centre (Cheng, Atzema); Division of Emergency Medicine (Cheng, Landes, Vaillancourt, Morrison), Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ont.; Emergency Department (Taylor), Royal Columbian Hospital, New Westminster, BC; Départements de médecine de famille et de médecine d'urgence (Daoust), Faculté de médecine, Université de Montréal; Hôpital du Sacré-Coeur-de-Montréal (Daoust), CIUSSS Nord-de-l'ile-de-Montréal, Montréal, Que.; Department of Emergency Medicine (Ohle), Health Sciences North; Northern Ontario School of Medicine (Ohle), Sudbury, Ont.; Lions Gate Hospital (Andolfatto, Stachura), North Vancouver, BC; ICES Central (Atzema); University Health Network (Landes), Toronto, Ont.; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary; Rockyview General Hospital (Lang), Calgary, Alta.; Department of Family Practice (Martin), Faculty of Medicine, University of British Columbia, Vancouver, BC; Abbotsford Regional Hospital & Cancer Agency (Martin), Abbotsford, BC; Department of Emergency Medicine (Mohindra), North York General Hospital, North York, Ont.; Department of Emergency Medicine (Vaillancourt, Morrison), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Division of Emergency Medicine (Welsford), Department of Medicine, McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Surrey Memorial Hospital (Brar), Surrey, BC; Department of Emergency Medicine (Yadav, Perry), University of Ottawa; Ottawa Hospital Research Institute (Yadav, Perry), Ottawa, Ont.; Division of Emergency Medicine (Yan), Department of Medicine, London Health Sciences Centre; Schulich School of Medicine and Dentistry (Yan), Western University, London, Ont.; BC SUPPORT Unit (McGavin), Vancouver, BC
| | - Steven C Brooks
- Department of Emergency Medicine (Hohl, Taylor, Andolfatto, Ting, Brar, Stachura), University of British Columbia; Centre for Clinical Epidemiology & Evaluation (Hohl), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Emergency Medicine (McRae), Foothills Medical Center, Calgary, Alta.; Department of Emergency Medicine (Brooks), School of Medicine, Queen's University; Kingston Health Sciences Centre (Brooks), Kingston, Ont.; Department of Family Medicine and Emergency Medicine (Archambault), Faculty of Medicine, Université Laval; VITAM (Centre de recherche en santé durable) (Archambault, Mercier), Québec, Que.; Division of EMS (Fok, Dahn, Wiemer), Department of Emergency Medicine, Dalhousie University; Charles V. Keating Emergency and Trauma Centre (Fok, Dahn, Wiemer), QEII Health Sciences Centre, Halifax, NS; Department of Emergency Medicine (Davis), College of Medicine, University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Jelic), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Emergency Department (Turner), Jewish General Hospital; Department of Emergency Medicine (Turner), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; Department of Emergency Medicine (Rowe, Hayward, Khangura), Faculty of Medicine & Dentistry, and School of Public Health (Rowe), University of Alberta, Edmonton, Alta.; Centre de recherche (Mercier), CHU de Québec, Université Laval, Québec, Que.; Sunnybrook Health Sciences Centre (Cheng, Atzema); Division of Emergency Medicine (Cheng, Landes, Vaillancourt, Morrison), Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ont.; Emergency Department (Taylor), Royal Columbian Hospital, New Westminster, BC; Départements de médecine de famille et de médecine d'urgence (Daoust), Faculté de médecine, Université de Montréal; Hôpital du Sacré-Coeur-de-Montréal (Daoust), CIUSSS Nord-de-l'ile-de-Montréal, Montréal, Que.; Department of Emergency Medicine (Ohle), Health Sciences North; Northern Ontario School of Medicine (Ohle), Sudbury, Ont.; Lions Gate Hospital (Andolfatto, Stachura), North Vancouver, BC; ICES Central (Atzema); University Health Network (Landes), Toronto, Ont.; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary; Rockyview General Hospital (Lang), Calgary, Alta.; Department of Family Practice (Martin), Faculty of Medicine, University of British Columbia, Vancouver, BC; Abbotsford Regional Hospital & Cancer Agency (Martin), Abbotsford, BC; Department of Emergency Medicine (Mohindra), North York General Hospital, North York, Ont.; Department of Emergency Medicine (Vaillancourt, Morrison), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Division of Emergency Medicine (Welsford), Department of Medicine, McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Surrey Memorial Hospital (Brar), Surrey, BC; Department of Emergency Medicine (Yadav, Perry), University of Ottawa; Ottawa Hospital Research Institute (Yadav, Perry), Ottawa, Ont.; Division of Emergency Medicine (Yan), Department of Medicine, London Health Sciences Centre; Schulich School of Medicine and Dentistry (Yan), Western University, London, Ont.; BC SUPPORT Unit (McGavin), Vancouver, BC
| | - Patrick Archambault
- Department of Emergency Medicine (Hohl, Taylor, Andolfatto, Ting, Brar, Stachura), University of British Columbia; Centre for Clinical Epidemiology & Evaluation (Hohl), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Emergency Medicine (McRae), Foothills Medical Center, Calgary, Alta.; Department of Emergency Medicine (Brooks), School of Medicine, Queen's University; Kingston Health Sciences Centre (Brooks), Kingston, Ont.; Department of Family Medicine and Emergency Medicine (Archambault), Faculty of Medicine, Université Laval; VITAM (Centre de recherche en santé durable) (Archambault, Mercier), Québec, Que.; Division of EMS (Fok, Dahn, Wiemer), Department of Emergency Medicine, Dalhousie University; Charles V. Keating Emergency and Trauma Centre (Fok, Dahn, Wiemer), QEII Health Sciences Centre, Halifax, NS; Department of Emergency Medicine (Davis), College of Medicine, University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Jelic), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Emergency Department (Turner), Jewish General Hospital; Department of Emergency Medicine (Turner), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; Department of Emergency Medicine (Rowe, Hayward, Khangura), Faculty of Medicine & Dentistry, and School of Public Health (Rowe), University of Alberta, Edmonton, Alta.; Centre de recherche (Mercier), CHU de Québec, Université Laval, Québec, Que.; Sunnybrook Health Sciences Centre (Cheng, Atzema); Division of Emergency Medicine (Cheng, Landes, Vaillancourt, Morrison), Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ont.; Emergency Department (Taylor), Royal Columbian Hospital, New Westminster, BC; Départements de médecine de famille et de médecine d'urgence (Daoust), Faculté de médecine, Université de Montréal; Hôpital du Sacré-Coeur-de-Montréal (Daoust), CIUSSS Nord-de-l'ile-de-Montréal, Montréal, Que.; Department of Emergency Medicine (Ohle), Health Sciences North; Northern Ontario School of Medicine (Ohle), Sudbury, Ont.; Lions Gate Hospital (Andolfatto, Stachura), North Vancouver, BC; ICES Central (Atzema); University Health Network (Landes), Toronto, Ont.; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary; Rockyview General Hospital (Lang), Calgary, Alta.; Department of Family Practice (Martin), Faculty of Medicine, University of British Columbia, Vancouver, BC; Abbotsford Regional Hospital & Cancer Agency (Martin), Abbotsford, BC; Department of Emergency Medicine (Mohindra), North York General Hospital, North York, Ont.; Department of Emergency Medicine (Vaillancourt, Morrison), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Division of Emergency Medicine (Welsford), Department of Medicine, McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Surrey Memorial Hospital (Brar), Surrey, BC; Department of Emergency Medicine (Yadav, Perry), University of Ottawa; Ottawa Hospital Research Institute (Yadav, Perry), Ottawa, Ont.; Division of Emergency Medicine (Yan), Department of Medicine, London Health Sciences Centre; Schulich School of Medicine and Dentistry (Yan), Western University, London, Ont.; BC SUPPORT Unit (McGavin), Vancouver, BC
| | - Patrick T Fok
- Department of Emergency Medicine (Hohl, Taylor, Andolfatto, Ting, Brar, Stachura), University of British Columbia; Centre for Clinical Epidemiology & Evaluation (Hohl), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Emergency Medicine (McRae), Foothills Medical Center, Calgary, Alta.; Department of Emergency Medicine (Brooks), School of Medicine, Queen's University; Kingston Health Sciences Centre (Brooks), Kingston, Ont.; Department of Family Medicine and Emergency Medicine (Archambault), Faculty of Medicine, Université Laval; VITAM (Centre de recherche en santé durable) (Archambault, Mercier), Québec, Que.; Division of EMS (Fok, Dahn, Wiemer), Department of Emergency Medicine, Dalhousie University; Charles V. Keating Emergency and Trauma Centre (Fok, Dahn, Wiemer), QEII Health Sciences Centre, Halifax, NS; Department of Emergency Medicine (Davis), College of Medicine, University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Jelic), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Emergency Department (Turner), Jewish General Hospital; Department of Emergency Medicine (Turner), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; Department of Emergency Medicine (Rowe, Hayward, Khangura), Faculty of Medicine & Dentistry, and School of Public Health (Rowe), University of Alberta, Edmonton, Alta.; Centre de recherche (Mercier), CHU de Québec, Université Laval, Québec, Que.; Sunnybrook Health Sciences Centre (Cheng, Atzema); Division of Emergency Medicine (Cheng, Landes, Vaillancourt, Morrison), Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ont.; Emergency Department (Taylor), Royal Columbian Hospital, New Westminster, BC; Départements de médecine de famille et de médecine d'urgence (Daoust), Faculté de médecine, Université de Montréal; Hôpital du Sacré-Coeur-de-Montréal (Daoust), CIUSSS Nord-de-l'ile-de-Montréal, Montréal, Que.; Department of Emergency Medicine (Ohle), Health Sciences North; Northern Ontario School of Medicine (Ohle), Sudbury, Ont.; Lions Gate Hospital (Andolfatto, Stachura), North Vancouver, BC; ICES Central (Atzema); University Health Network (Landes), Toronto, Ont.; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary; Rockyview General Hospital (Lang), Calgary, Alta.; Department of Family Practice (Martin), Faculty of Medicine, University of British Columbia, Vancouver, BC; Abbotsford Regional Hospital & Cancer Agency (Martin), Abbotsford, BC; Department of Emergency Medicine (Mohindra), North York General Hospital, North York, Ont.; Department of Emergency Medicine (Vaillancourt, Morrison), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Division of Emergency Medicine (Welsford), Department of Medicine, McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Surrey Memorial Hospital (Brar), Surrey, BC; Department of Emergency Medicine (Yadav, Perry), University of Ottawa; Ottawa Hospital Research Institute (Yadav, Perry), Ottawa, Ont.; Division of Emergency Medicine (Yan), Department of Medicine, London Health Sciences Centre; Schulich School of Medicine and Dentistry (Yan), Western University, London, Ont.; BC SUPPORT Unit (McGavin), Vancouver, BC
| | - Philip Davis
- Department of Emergency Medicine (Hohl, Taylor, Andolfatto, Ting, Brar, Stachura), University of British Columbia; Centre for Clinical Epidemiology & Evaluation (Hohl), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Emergency Medicine (McRae), Foothills Medical Center, Calgary, Alta.; Department of Emergency Medicine (Brooks), School of Medicine, Queen's University; Kingston Health Sciences Centre (Brooks), Kingston, Ont.; Department of Family Medicine and Emergency Medicine (Archambault), Faculty of Medicine, Université Laval; VITAM (Centre de recherche en santé durable) (Archambault, Mercier), Québec, Que.; Division of EMS (Fok, Dahn, Wiemer), Department of Emergency Medicine, Dalhousie University; Charles V. Keating Emergency and Trauma Centre (Fok, Dahn, Wiemer), QEII Health Sciences Centre, Halifax, NS; Department of Emergency Medicine (Davis), College of Medicine, University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Jelic), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Emergency Department (Turner), Jewish General Hospital; Department of Emergency Medicine (Turner), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; Department of Emergency Medicine (Rowe, Hayward, Khangura), Faculty of Medicine & Dentistry, and School of Public Health (Rowe), University of Alberta, Edmonton, Alta.; Centre de recherche (Mercier), CHU de Québec, Université Laval, Québec, Que.; Sunnybrook Health Sciences Centre (Cheng, Atzema); Division of Emergency Medicine (Cheng, Landes, Vaillancourt, Morrison), Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ont.; Emergency Department (Taylor), Royal Columbian Hospital, New Westminster, BC; Départements de médecine de famille et de médecine d'urgence (Daoust), Faculté de médecine, Université de Montréal; Hôpital du Sacré-Coeur-de-Montréal (Daoust), CIUSSS Nord-de-l'ile-de-Montréal, Montréal, Que.; Department of Emergency Medicine (Ohle), Health Sciences North; Northern Ontario School of Medicine (Ohle), Sudbury, Ont.; Lions Gate Hospital (Andolfatto, Stachura), North Vancouver, BC; ICES Central (Atzema); University Health Network (Landes), Toronto, Ont.; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary; Rockyview General Hospital (Lang), Calgary, Alta.; Department of Family Practice (Martin), Faculty of Medicine, University of British Columbia, Vancouver, BC; Abbotsford Regional Hospital & Cancer Agency (Martin), Abbotsford, BC; Department of Emergency Medicine (Mohindra), North York General Hospital, North York, Ont.; Department of Emergency Medicine (Vaillancourt, Morrison), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Division of Emergency Medicine (Welsford), Department of Medicine, McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Surrey Memorial Hospital (Brar), Surrey, BC; Department of Emergency Medicine (Yadav, Perry), University of Ottawa; Ottawa Hospital Research Institute (Yadav, Perry), Ottawa, Ont.; Division of Emergency Medicine (Yan), Department of Medicine, London Health Sciences Centre; Schulich School of Medicine and Dentistry (Yan), Western University, London, Ont.; BC SUPPORT Unit (McGavin), Vancouver, BC
| | - Tomislav Jelic
- Department of Emergency Medicine (Hohl, Taylor, Andolfatto, Ting, Brar, Stachura), University of British Columbia; Centre for Clinical Epidemiology & Evaluation (Hohl), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Emergency Medicine (McRae), Foothills Medical Center, Calgary, Alta.; Department of Emergency Medicine (Brooks), School of Medicine, Queen's University; Kingston Health Sciences Centre (Brooks), Kingston, Ont.; Department of Family Medicine and Emergency Medicine (Archambault), Faculty of Medicine, Université Laval; VITAM (Centre de recherche en santé durable) (Archambault, Mercier), Québec, Que.; Division of EMS (Fok, Dahn, Wiemer), Department of Emergency Medicine, Dalhousie University; Charles V. Keating Emergency and Trauma Centre (Fok, Dahn, Wiemer), QEII Health Sciences Centre, Halifax, NS; Department of Emergency Medicine (Davis), College of Medicine, University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Jelic), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Emergency Department (Turner), Jewish General Hospital; Department of Emergency Medicine (Turner), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; Department of Emergency Medicine (Rowe, Hayward, Khangura), Faculty of Medicine & Dentistry, and School of Public Health (Rowe), University of Alberta, Edmonton, Alta.; Centre de recherche (Mercier), CHU de Québec, Université Laval, Québec, Que.; Sunnybrook Health Sciences Centre (Cheng, Atzema); Division of Emergency Medicine (Cheng, Landes, Vaillancourt, Morrison), Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ont.; Emergency Department (Taylor), Royal Columbian Hospital, New Westminster, BC; Départements de médecine de famille et de médecine d'urgence (Daoust), Faculté de médecine, Université de Montréal; Hôpital du Sacré-Coeur-de-Montréal (Daoust), CIUSSS Nord-de-l'ile-de-Montréal, Montréal, Que.; Department of Emergency Medicine (Ohle), Health Sciences North; Northern Ontario School of Medicine (Ohle), Sudbury, Ont.; Lions Gate Hospital (Andolfatto, Stachura), North Vancouver, BC; ICES Central (Atzema); University Health Network (Landes), Toronto, Ont.; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary; Rockyview General Hospital (Lang), Calgary, Alta.; Department of Family Practice (Martin), Faculty of Medicine, University of British Columbia, Vancouver, BC; Abbotsford Regional Hospital & Cancer Agency (Martin), Abbotsford, BC; Department of Emergency Medicine (Mohindra), North York General Hospital, North York, Ont.; Department of Emergency Medicine (Vaillancourt, Morrison), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Division of Emergency Medicine (Welsford), Department of Medicine, McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Surrey Memorial Hospital (Brar), Surrey, BC; Department of Emergency Medicine (Yadav, Perry), University of Ottawa; Ottawa Hospital Research Institute (Yadav, Perry), Ottawa, Ont.; Division of Emergency Medicine (Yan), Department of Medicine, London Health Sciences Centre; Schulich School of Medicine and Dentistry (Yan), Western University, London, Ont.; BC SUPPORT Unit (McGavin), Vancouver, BC
| | - Joel P Turner
- Department of Emergency Medicine (Hohl, Taylor, Andolfatto, Ting, Brar, Stachura), University of British Columbia; Centre for Clinical Epidemiology & Evaluation (Hohl), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Emergency Medicine (McRae), Foothills Medical Center, Calgary, Alta.; Department of Emergency Medicine (Brooks), School of Medicine, Queen's University; Kingston Health Sciences Centre (Brooks), Kingston, Ont.; Department of Family Medicine and Emergency Medicine (Archambault), Faculty of Medicine, Université Laval; VITAM (Centre de recherche en santé durable) (Archambault, Mercier), Québec, Que.; Division of EMS (Fok, Dahn, Wiemer), Department of Emergency Medicine, Dalhousie University; Charles V. Keating Emergency and Trauma Centre (Fok, Dahn, Wiemer), QEII Health Sciences Centre, Halifax, NS; Department of Emergency Medicine (Davis), College of Medicine, University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Jelic), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Emergency Department (Turner), Jewish General Hospital; Department of Emergency Medicine (Turner), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; Department of Emergency Medicine (Rowe, Hayward, Khangura), Faculty of Medicine & Dentistry, and School of Public Health (Rowe), University of Alberta, Edmonton, Alta.; Centre de recherche (Mercier), CHU de Québec, Université Laval, Québec, Que.; Sunnybrook Health Sciences Centre (Cheng, Atzema); Division of Emergency Medicine (Cheng, Landes, Vaillancourt, Morrison), Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ont.; Emergency Department (Taylor), Royal Columbian Hospital, New Westminster, BC; Départements de médecine de famille et de médecine d'urgence (Daoust), Faculté de médecine, Université de Montréal; Hôpital du Sacré-Coeur-de-Montréal (Daoust), CIUSSS Nord-de-l'ile-de-Montréal, Montréal, Que.; Department of Emergency Medicine (Ohle), Health Sciences North; Northern Ontario School of Medicine (Ohle), Sudbury, Ont.; Lions Gate Hospital (Andolfatto, Stachura), North Vancouver, BC; ICES Central (Atzema); University Health Network (Landes), Toronto, Ont.; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary; Rockyview General Hospital (Lang), Calgary, Alta.; Department of Family Practice (Martin), Faculty of Medicine, University of British Columbia, Vancouver, BC; Abbotsford Regional Hospital & Cancer Agency (Martin), Abbotsford, BC; Department of Emergency Medicine (Mohindra), North York General Hospital, North York, Ont.; Department of Emergency Medicine (Vaillancourt, Morrison), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Division of Emergency Medicine (Welsford), Department of Medicine, McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Surrey Memorial Hospital (Brar), Surrey, BC; Department of Emergency Medicine (Yadav, Perry), University of Ottawa; Ottawa Hospital Research Institute (Yadav, Perry), Ottawa, Ont.; Division of Emergency Medicine (Yan), Department of Medicine, London Health Sciences Centre; Schulich School of Medicine and Dentistry (Yan), Western University, London, Ont.; BC SUPPORT Unit (McGavin), Vancouver, BC
| | - Brian H Rowe
- Department of Emergency Medicine (Hohl, Taylor, Andolfatto, Ting, Brar, Stachura), University of British Columbia; Centre for Clinical Epidemiology & Evaluation (Hohl), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Emergency Medicine (McRae), Foothills Medical Center, Calgary, Alta.; Department of Emergency Medicine (Brooks), School of Medicine, Queen's University; Kingston Health Sciences Centre (Brooks), Kingston, Ont.; Department of Family Medicine and Emergency Medicine (Archambault), Faculty of Medicine, Université Laval; VITAM (Centre de recherche en santé durable) (Archambault, Mercier), Québec, Que.; Division of EMS (Fok, Dahn, Wiemer), Department of Emergency Medicine, Dalhousie University; Charles V. Keating Emergency and Trauma Centre (Fok, Dahn, Wiemer), QEII Health Sciences Centre, Halifax, NS; Department of Emergency Medicine (Davis), College of Medicine, University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Jelic), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Emergency Department (Turner), Jewish General Hospital; Department of Emergency Medicine (Turner), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; Department of Emergency Medicine (Rowe, Hayward, Khangura), Faculty of Medicine & Dentistry, and School of Public Health (Rowe), University of Alberta, Edmonton, Alta.; Centre de recherche (Mercier), CHU de Québec, Université Laval, Québec, Que.; Sunnybrook Health Sciences Centre (Cheng, Atzema); Division of Emergency Medicine (Cheng, Landes, Vaillancourt, Morrison), Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ont.; Emergency Department (Taylor), Royal Columbian Hospital, New Westminster, BC; Départements de médecine de famille et de médecine d'urgence (Daoust), Faculté de médecine, Université de Montréal; Hôpital du Sacré-Coeur-de-Montréal (Daoust), CIUSSS Nord-de-l'ile-de-Montréal, Montréal, Que.; Department of Emergency Medicine (Ohle), Health Sciences North; Northern Ontario School of Medicine (Ohle), Sudbury, Ont.; Lions Gate Hospital (Andolfatto, Stachura), North Vancouver, BC; ICES Central (Atzema); University Health Network (Landes), Toronto, Ont.; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary; Rockyview General Hospital (Lang), Calgary, Alta.; Department of Family Practice (Martin), Faculty of Medicine, University of British Columbia, Vancouver, BC; Abbotsford Regional Hospital & Cancer Agency (Martin), Abbotsford, BC; Department of Emergency Medicine (Mohindra), North York General Hospital, North York, Ont.; Department of Emergency Medicine (Vaillancourt, Morrison), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Division of Emergency Medicine (Welsford), Department of Medicine, McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Surrey Memorial Hospital (Brar), Surrey, BC; Department of Emergency Medicine (Yadav, Perry), University of Ottawa; Ottawa Hospital Research Institute (Yadav, Perry), Ottawa, Ont.; Division of Emergency Medicine (Yan), Department of Medicine, London Health Sciences Centre; Schulich School of Medicine and Dentistry (Yan), Western University, London, Ont.; BC SUPPORT Unit (McGavin), Vancouver, BC
| | - Éric Mercier
- Department of Emergency Medicine (Hohl, Taylor, Andolfatto, Ting, Brar, Stachura), University of British Columbia; Centre for Clinical Epidemiology & Evaluation (Hohl), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Emergency Medicine (McRae), Foothills Medical Center, Calgary, Alta.; Department of Emergency Medicine (Brooks), School of Medicine, Queen's University; Kingston Health Sciences Centre (Brooks), Kingston, Ont.; Department of Family Medicine and Emergency Medicine (Archambault), Faculty of Medicine, Université Laval; VITAM (Centre de recherche en santé durable) (Archambault, Mercier), Québec, Que.; Division of EMS (Fok, Dahn, Wiemer), Department of Emergency Medicine, Dalhousie University; Charles V. Keating Emergency and Trauma Centre (Fok, Dahn, Wiemer), QEII Health Sciences Centre, Halifax, NS; Department of Emergency Medicine (Davis), College of Medicine, University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Jelic), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Emergency Department (Turner), Jewish General Hospital; Department of Emergency Medicine (Turner), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; Department of Emergency Medicine (Rowe, Hayward, Khangura), Faculty of Medicine & Dentistry, and School of Public Health (Rowe), University of Alberta, Edmonton, Alta.; Centre de recherche (Mercier), CHU de Québec, Université Laval, Québec, Que.; Sunnybrook Health Sciences Centre (Cheng, Atzema); Division of Emergency Medicine (Cheng, Landes, Vaillancourt, Morrison), Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ont.; Emergency Department (Taylor), Royal Columbian Hospital, New Westminster, BC; Départements de médecine de famille et de médecine d'urgence (Daoust), Faculté de médecine, Université de Montréal; Hôpital du Sacré-Coeur-de-Montréal (Daoust), CIUSSS Nord-de-l'ile-de-Montréal, Montréal, Que.; Department of Emergency Medicine (Ohle), Health Sciences North; Northern Ontario School of Medicine (Ohle), Sudbury, Ont.; Lions Gate Hospital (Andolfatto, Stachura), North Vancouver, BC; ICES Central (Atzema); University Health Network (Landes), Toronto, Ont.; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary; Rockyview General Hospital (Lang), Calgary, Alta.; Department of Family Practice (Martin), Faculty of Medicine, University of British Columbia, Vancouver, BC; Abbotsford Regional Hospital & Cancer Agency (Martin), Abbotsford, BC; Department of Emergency Medicine (Mohindra), North York General Hospital, North York, Ont.; Department of Emergency Medicine (Vaillancourt, Morrison), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Division of Emergency Medicine (Welsford), Department of Medicine, McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Surrey Memorial Hospital (Brar), Surrey, BC; Department of Emergency Medicine (Yadav, Perry), University of Ottawa; Ottawa Hospital Research Institute (Yadav, Perry), Ottawa, Ont.; Division of Emergency Medicine (Yan), Department of Medicine, London Health Sciences Centre; Schulich School of Medicine and Dentistry (Yan), Western University, London, Ont.; BC SUPPORT Unit (McGavin), Vancouver, BC
| | - Ivy Cheng
- Department of Emergency Medicine (Hohl, Taylor, Andolfatto, Ting, Brar, Stachura), University of British Columbia; Centre for Clinical Epidemiology & Evaluation (Hohl), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Emergency Medicine (McRae), Foothills Medical Center, Calgary, Alta.; Department of Emergency Medicine (Brooks), School of Medicine, Queen's University; Kingston Health Sciences Centre (Brooks), Kingston, Ont.; Department of Family Medicine and Emergency Medicine (Archambault), Faculty of Medicine, Université Laval; VITAM (Centre de recherche en santé durable) (Archambault, Mercier), Québec, Que.; Division of EMS (Fok, Dahn, Wiemer), Department of Emergency Medicine, Dalhousie University; Charles V. Keating Emergency and Trauma Centre (Fok, Dahn, Wiemer), QEII Health Sciences Centre, Halifax, NS; Department of Emergency Medicine (Davis), College of Medicine, University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Jelic), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Emergency Department (Turner), Jewish General Hospital; Department of Emergency Medicine (Turner), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; Department of Emergency Medicine (Rowe, Hayward, Khangura), Faculty of Medicine & Dentistry, and School of Public Health (Rowe), University of Alberta, Edmonton, Alta.; Centre de recherche (Mercier), CHU de Québec, Université Laval, Québec, Que.; Sunnybrook Health Sciences Centre (Cheng, Atzema); Division of Emergency Medicine (Cheng, Landes, Vaillancourt, Morrison), Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ont.; Emergency Department (Taylor), Royal Columbian Hospital, New Westminster, BC; Départements de médecine de famille et de médecine d'urgence (Daoust), Faculté de médecine, Université de Montréal; Hôpital du Sacré-Coeur-de-Montréal (Daoust), CIUSSS Nord-de-l'ile-de-Montréal, Montréal, Que.; Department of Emergency Medicine (Ohle), Health Sciences North; Northern Ontario School of Medicine (Ohle), Sudbury, Ont.; Lions Gate Hospital (Andolfatto, Stachura), North Vancouver, BC; ICES Central (Atzema); University Health Network (Landes), Toronto, Ont.; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary; Rockyview General Hospital (Lang), Calgary, Alta.; Department of Family Practice (Martin), Faculty of Medicine, University of British Columbia, Vancouver, BC; Abbotsford Regional Hospital & Cancer Agency (Martin), Abbotsford, BC; Department of Emergency Medicine (Mohindra), North York General Hospital, North York, Ont.; Department of Emergency Medicine (Vaillancourt, Morrison), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Division of Emergency Medicine (Welsford), Department of Medicine, McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Surrey Memorial Hospital (Brar), Surrey, BC; Department of Emergency Medicine (Yadav, Perry), University of Ottawa; Ottawa Hospital Research Institute (Yadav, Perry), Ottawa, Ont.; Division of Emergency Medicine (Yan), Department of Medicine, London Health Sciences Centre; Schulich School of Medicine and Dentistry (Yan), Western University, London, Ont.; BC SUPPORT Unit (McGavin), Vancouver, BC
| | - John Taylor
- Department of Emergency Medicine (Hohl, Taylor, Andolfatto, Ting, Brar, Stachura), University of British Columbia; Centre for Clinical Epidemiology & Evaluation (Hohl), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Emergency Medicine (McRae), Foothills Medical Center, Calgary, Alta.; Department of Emergency Medicine (Brooks), School of Medicine, Queen's University; Kingston Health Sciences Centre (Brooks), Kingston, Ont.; Department of Family Medicine and Emergency Medicine (Archambault), Faculty of Medicine, Université Laval; VITAM (Centre de recherche en santé durable) (Archambault, Mercier), Québec, Que.; Division of EMS (Fok, Dahn, Wiemer), Department of Emergency Medicine, Dalhousie University; Charles V. Keating Emergency and Trauma Centre (Fok, Dahn, Wiemer), QEII Health Sciences Centre, Halifax, NS; Department of Emergency Medicine (Davis), College of Medicine, University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Jelic), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Emergency Department (Turner), Jewish General Hospital; Department of Emergency Medicine (Turner), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; Department of Emergency Medicine (Rowe, Hayward, Khangura), Faculty of Medicine & Dentistry, and School of Public Health (Rowe), University of Alberta, Edmonton, Alta.; Centre de recherche (Mercier), CHU de Québec, Université Laval, Québec, Que.; Sunnybrook Health Sciences Centre (Cheng, Atzema); Division of Emergency Medicine (Cheng, Landes, Vaillancourt, Morrison), Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ont.; Emergency Department (Taylor), Royal Columbian Hospital, New Westminster, BC; Départements de médecine de famille et de médecine d'urgence (Daoust), Faculté de médecine, Université de Montréal; Hôpital du Sacré-Coeur-de-Montréal (Daoust), CIUSSS Nord-de-l'ile-de-Montréal, Montréal, Que.; Department of Emergency Medicine (Ohle), Health Sciences North; Northern Ontario School of Medicine (Ohle), Sudbury, Ont.; Lions Gate Hospital (Andolfatto, Stachura), North Vancouver, BC; ICES Central (Atzema); University Health Network (Landes), Toronto, Ont.; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary; Rockyview General Hospital (Lang), Calgary, Alta.; Department of Family Practice (Martin), Faculty of Medicine, University of British Columbia, Vancouver, BC; Abbotsford Regional Hospital & Cancer Agency (Martin), Abbotsford, BC; Department of Emergency Medicine (Mohindra), North York General Hospital, North York, Ont.; Department of Emergency Medicine (Vaillancourt, Morrison), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Division of Emergency Medicine (Welsford), Department of Medicine, McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Surrey Memorial Hospital (Brar), Surrey, BC; Department of Emergency Medicine (Yadav, Perry), University of Ottawa; Ottawa Hospital Research Institute (Yadav, Perry), Ottawa, Ont.; Division of Emergency Medicine (Yan), Department of Medicine, London Health Sciences Centre; Schulich School of Medicine and Dentistry (Yan), Western University, London, Ont.; BC SUPPORT Unit (McGavin), Vancouver, BC
| | - Raoul Daoust
- Department of Emergency Medicine (Hohl, Taylor, Andolfatto, Ting, Brar, Stachura), University of British Columbia; Centre for Clinical Epidemiology & Evaluation (Hohl), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Emergency Medicine (McRae), Foothills Medical Center, Calgary, Alta.; Department of Emergency Medicine (Brooks), School of Medicine, Queen's University; Kingston Health Sciences Centre (Brooks), Kingston, Ont.; Department of Family Medicine and Emergency Medicine (Archambault), Faculty of Medicine, Université Laval; VITAM (Centre de recherche en santé durable) (Archambault, Mercier), Québec, Que.; Division of EMS (Fok, Dahn, Wiemer), Department of Emergency Medicine, Dalhousie University; Charles V. Keating Emergency and Trauma Centre (Fok, Dahn, Wiemer), QEII Health Sciences Centre, Halifax, NS; Department of Emergency Medicine (Davis), College of Medicine, University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Jelic), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Emergency Department (Turner), Jewish General Hospital; Department of Emergency Medicine (Turner), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; Department of Emergency Medicine (Rowe, Hayward, Khangura), Faculty of Medicine & Dentistry, and School of Public Health (Rowe), University of Alberta, Edmonton, Alta.; Centre de recherche (Mercier), CHU de Québec, Université Laval, Québec, Que.; Sunnybrook Health Sciences Centre (Cheng, Atzema); Division of Emergency Medicine (Cheng, Landes, Vaillancourt, Morrison), Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ont.; Emergency Department (Taylor), Royal Columbian Hospital, New Westminster, BC; Départements de médecine de famille et de médecine d'urgence (Daoust), Faculté de médecine, Université de Montréal; Hôpital du Sacré-Coeur-de-Montréal (Daoust), CIUSSS Nord-de-l'ile-de-Montréal, Montréal, Que.; Department of Emergency Medicine (Ohle), Health Sciences North; Northern Ontario School of Medicine (Ohle), Sudbury, Ont.; Lions Gate Hospital (Andolfatto, Stachura), North Vancouver, BC; ICES Central (Atzema); University Health Network (Landes), Toronto, Ont.; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary; Rockyview General Hospital (Lang), Calgary, Alta.; Department of Family Practice (Martin), Faculty of Medicine, University of British Columbia, Vancouver, BC; Abbotsford Regional Hospital & Cancer Agency (Martin), Abbotsford, BC; Department of Emergency Medicine (Mohindra), North York General Hospital, North York, Ont.; Department of Emergency Medicine (Vaillancourt, Morrison), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Division of Emergency Medicine (Welsford), Department of Medicine, McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Surrey Memorial Hospital (Brar), Surrey, BC; Department of Emergency Medicine (Yadav, Perry), University of Ottawa; Ottawa Hospital Research Institute (Yadav, Perry), Ottawa, Ont.; Division of Emergency Medicine (Yan), Department of Medicine, London Health Sciences Centre; Schulich School of Medicine and Dentistry (Yan), Western University, London, Ont.; BC SUPPORT Unit (McGavin), Vancouver, BC
| | - Robert Ohle
- Department of Emergency Medicine (Hohl, Taylor, Andolfatto, Ting, Brar, Stachura), University of British Columbia; Centre for Clinical Epidemiology & Evaluation (Hohl), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Emergency Medicine (McRae), Foothills Medical Center, Calgary, Alta.; Department of Emergency Medicine (Brooks), School of Medicine, Queen's University; Kingston Health Sciences Centre (Brooks), Kingston, Ont.; Department of Family Medicine and Emergency Medicine (Archambault), Faculty of Medicine, Université Laval; VITAM (Centre de recherche en santé durable) (Archambault, Mercier), Québec, Que.; Division of EMS (Fok, Dahn, Wiemer), Department of Emergency Medicine, Dalhousie University; Charles V. Keating Emergency and Trauma Centre (Fok, Dahn, Wiemer), QEII Health Sciences Centre, Halifax, NS; Department of Emergency Medicine (Davis), College of Medicine, University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Jelic), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Emergency Department (Turner), Jewish General Hospital; Department of Emergency Medicine (Turner), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; Department of Emergency Medicine (Rowe, Hayward, Khangura), Faculty of Medicine & Dentistry, and School of Public Health (Rowe), University of Alberta, Edmonton, Alta.; Centre de recherche (Mercier), CHU de Québec, Université Laval, Québec, Que.; Sunnybrook Health Sciences Centre (Cheng, Atzema); Division of Emergency Medicine (Cheng, Landes, Vaillancourt, Morrison), Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ont.; Emergency Department (Taylor), Royal Columbian Hospital, New Westminster, BC; Départements de médecine de famille et de médecine d'urgence (Daoust), Faculté de médecine, Université de Montréal; Hôpital du Sacré-Coeur-de-Montréal (Daoust), CIUSSS Nord-de-l'ile-de-Montréal, Montréal, Que.; Department of Emergency Medicine (Ohle), Health Sciences North; Northern Ontario School of Medicine (Ohle), Sudbury, Ont.; Lions Gate Hospital (Andolfatto, Stachura), North Vancouver, BC; ICES Central (Atzema); University Health Network (Landes), Toronto, Ont.; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary; Rockyview General Hospital (Lang), Calgary, Alta.; Department of Family Practice (Martin), Faculty of Medicine, University of British Columbia, Vancouver, BC; Abbotsford Regional Hospital & Cancer Agency (Martin), Abbotsford, BC; Department of Emergency Medicine (Mohindra), North York General Hospital, North York, Ont.; Department of Emergency Medicine (Vaillancourt, Morrison), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Division of Emergency Medicine (Welsford), Department of Medicine, McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Surrey Memorial Hospital (Brar), Surrey, BC; Department of Emergency Medicine (Yadav, Perry), University of Ottawa; Ottawa Hospital Research Institute (Yadav, Perry), Ottawa, Ont.; Division of Emergency Medicine (Yan), Department of Medicine, London Health Sciences Centre; Schulich School of Medicine and Dentistry (Yan), Western University, London, Ont.; BC SUPPORT Unit (McGavin), Vancouver, BC
| | - Gary Andolfatto
- Department of Emergency Medicine (Hohl, Taylor, Andolfatto, Ting, Brar, Stachura), University of British Columbia; Centre for Clinical Epidemiology & Evaluation (Hohl), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Emergency Medicine (McRae), Foothills Medical Center, Calgary, Alta.; Department of Emergency Medicine (Brooks), School of Medicine, Queen's University; Kingston Health Sciences Centre (Brooks), Kingston, Ont.; Department of Family Medicine and Emergency Medicine (Archambault), Faculty of Medicine, Université Laval; VITAM (Centre de recherche en santé durable) (Archambault, Mercier), Québec, Que.; Division of EMS (Fok, Dahn, Wiemer), Department of Emergency Medicine, Dalhousie University; Charles V. Keating Emergency and Trauma Centre (Fok, Dahn, Wiemer), QEII Health Sciences Centre, Halifax, NS; Department of Emergency Medicine (Davis), College of Medicine, University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Jelic), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Emergency Department (Turner), Jewish General Hospital; Department of Emergency Medicine (Turner), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; Department of Emergency Medicine (Rowe, Hayward, Khangura), Faculty of Medicine & Dentistry, and School of Public Health (Rowe), University of Alberta, Edmonton, Alta.; Centre de recherche (Mercier), CHU de Québec, Université Laval, Québec, Que.; Sunnybrook Health Sciences Centre (Cheng, Atzema); Division of Emergency Medicine (Cheng, Landes, Vaillancourt, Morrison), Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ont.; Emergency Department (Taylor), Royal Columbian Hospital, New Westminster, BC; Départements de médecine de famille et de médecine d'urgence (Daoust), Faculté de médecine, Université de Montréal; Hôpital du Sacré-Coeur-de-Montréal (Daoust), CIUSSS Nord-de-l'ile-de-Montréal, Montréal, Que.; Department of Emergency Medicine (Ohle), Health Sciences North; Northern Ontario School of Medicine (Ohle), Sudbury, Ont.; Lions Gate Hospital (Andolfatto, Stachura), North Vancouver, BC; ICES Central (Atzema); University Health Network (Landes), Toronto, Ont.; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary; Rockyview General Hospital (Lang), Calgary, Alta.; Department of Family Practice (Martin), Faculty of Medicine, University of British Columbia, Vancouver, BC; Abbotsford Regional Hospital & Cancer Agency (Martin), Abbotsford, BC; Department of Emergency Medicine (Mohindra), North York General Hospital, North York, Ont.; Department of Emergency Medicine (Vaillancourt, Morrison), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Division of Emergency Medicine (Welsford), Department of Medicine, McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Surrey Memorial Hospital (Brar), Surrey, BC; Department of Emergency Medicine (Yadav, Perry), University of Ottawa; Ottawa Hospital Research Institute (Yadav, Perry), Ottawa, Ont.; Division of Emergency Medicine (Yan), Department of Medicine, London Health Sciences Centre; Schulich School of Medicine and Dentistry (Yan), Western University, London, Ont.; BC SUPPORT Unit (McGavin), Vancouver, BC
| | - Clare Atzema
- Department of Emergency Medicine (Hohl, Taylor, Andolfatto, Ting, Brar, Stachura), University of British Columbia; Centre for Clinical Epidemiology & Evaluation (Hohl), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Emergency Medicine (McRae), Foothills Medical Center, Calgary, Alta.; Department of Emergency Medicine (Brooks), School of Medicine, Queen's University; Kingston Health Sciences Centre (Brooks), Kingston, Ont.; Department of Family Medicine and Emergency Medicine (Archambault), Faculty of Medicine, Université Laval; VITAM (Centre de recherche en santé durable) (Archambault, Mercier), Québec, Que.; Division of EMS (Fok, Dahn, Wiemer), Department of Emergency Medicine, Dalhousie University; Charles V. Keating Emergency and Trauma Centre (Fok, Dahn, Wiemer), QEII Health Sciences Centre, Halifax, NS; Department of Emergency Medicine (Davis), College of Medicine, University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Jelic), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Emergency Department (Turner), Jewish General Hospital; Department of Emergency Medicine (Turner), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; Department of Emergency Medicine (Rowe, Hayward, Khangura), Faculty of Medicine & Dentistry, and School of Public Health (Rowe), University of Alberta, Edmonton, Alta.; Centre de recherche (Mercier), CHU de Québec, Université Laval, Québec, Que.; Sunnybrook Health Sciences Centre (Cheng, Atzema); Division of Emergency Medicine (Cheng, Landes, Vaillancourt, Morrison), Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ont.; Emergency Department (Taylor), Royal Columbian Hospital, New Westminster, BC; Départements de médecine de famille et de médecine d'urgence (Daoust), Faculté de médecine, Université de Montréal; Hôpital du Sacré-Coeur-de-Montréal (Daoust), CIUSSS Nord-de-l'ile-de-Montréal, Montréal, Que.; Department of Emergency Medicine (Ohle), Health Sciences North; Northern Ontario School of Medicine (Ohle), Sudbury, Ont.; Lions Gate Hospital (Andolfatto, Stachura), North Vancouver, BC; ICES Central (Atzema); University Health Network (Landes), Toronto, Ont.; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary; Rockyview General Hospital (Lang), Calgary, Alta.; Department of Family Practice (Martin), Faculty of Medicine, University of British Columbia, Vancouver, BC; Abbotsford Regional Hospital & Cancer Agency (Martin), Abbotsford, BC; Department of Emergency Medicine (Mohindra), North York General Hospital, North York, Ont.; Department of Emergency Medicine (Vaillancourt, Morrison), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Division of Emergency Medicine (Welsford), Department of Medicine, McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Surrey Memorial Hospital (Brar), Surrey, BC; Department of Emergency Medicine (Yadav, Perry), University of Ottawa; Ottawa Hospital Research Institute (Yadav, Perry), Ottawa, Ont.; Division of Emergency Medicine (Yan), Department of Medicine, London Health Sciences Centre; Schulich School of Medicine and Dentistry (Yan), Western University, London, Ont.; BC SUPPORT Unit (McGavin), Vancouver, BC
| | - Jake Hayward
- Department of Emergency Medicine (Hohl, Taylor, Andolfatto, Ting, Brar, Stachura), University of British Columbia; Centre for Clinical Epidemiology & Evaluation (Hohl), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Emergency Medicine (McRae), Foothills Medical Center, Calgary, Alta.; Department of Emergency Medicine (Brooks), School of Medicine, Queen's University; Kingston Health Sciences Centre (Brooks), Kingston, Ont.; Department of Family Medicine and Emergency Medicine (Archambault), Faculty of Medicine, Université Laval; VITAM (Centre de recherche en santé durable) (Archambault, Mercier), Québec, Que.; Division of EMS (Fok, Dahn, Wiemer), Department of Emergency Medicine, Dalhousie University; Charles V. Keating Emergency and Trauma Centre (Fok, Dahn, Wiemer), QEII Health Sciences Centre, Halifax, NS; Department of Emergency Medicine (Davis), College of Medicine, University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Jelic), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Emergency Department (Turner), Jewish General Hospital; Department of Emergency Medicine (Turner), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; Department of Emergency Medicine (Rowe, Hayward, Khangura), Faculty of Medicine & Dentistry, and School of Public Health (Rowe), University of Alberta, Edmonton, Alta.; Centre de recherche (Mercier), CHU de Québec, Université Laval, Québec, Que.; Sunnybrook Health Sciences Centre (Cheng, Atzema); Division of Emergency Medicine (Cheng, Landes, Vaillancourt, Morrison), Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ont.; Emergency Department (Taylor), Royal Columbian Hospital, New Westminster, BC; Départements de médecine de famille et de médecine d'urgence (Daoust), Faculté de médecine, Université de Montréal; Hôpital du Sacré-Coeur-de-Montréal (Daoust), CIUSSS Nord-de-l'ile-de-Montréal, Montréal, Que.; Department of Emergency Medicine (Ohle), Health Sciences North; Northern Ontario School of Medicine (Ohle), Sudbury, Ont.; Lions Gate Hospital (Andolfatto, Stachura), North Vancouver, BC; ICES Central (Atzema); University Health Network (Landes), Toronto, Ont.; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary; Rockyview General Hospital (Lang), Calgary, Alta.; Department of Family Practice (Martin), Faculty of Medicine, University of British Columbia, Vancouver, BC; Abbotsford Regional Hospital & Cancer Agency (Martin), Abbotsford, BC; Department of Emergency Medicine (Mohindra), North York General Hospital, North York, Ont.; Department of Emergency Medicine (Vaillancourt, Morrison), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Division of Emergency Medicine (Welsford), Department of Medicine, McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Surrey Memorial Hospital (Brar), Surrey, BC; Department of Emergency Medicine (Yadav, Perry), University of Ottawa; Ottawa Hospital Research Institute (Yadav, Perry), Ottawa, Ont.; Division of Emergency Medicine (Yan), Department of Medicine, London Health Sciences Centre; Schulich School of Medicine and Dentistry (Yan), Western University, London, Ont.; BC SUPPORT Unit (McGavin), Vancouver, BC
| | - Jaspreet K Khangura
- Department of Emergency Medicine (Hohl, Taylor, Andolfatto, Ting, Brar, Stachura), University of British Columbia; Centre for Clinical Epidemiology & Evaluation (Hohl), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Emergency Medicine (McRae), Foothills Medical Center, Calgary, Alta.; Department of Emergency Medicine (Brooks), School of Medicine, Queen's University; Kingston Health Sciences Centre (Brooks), Kingston, Ont.; Department of Family Medicine and Emergency Medicine (Archambault), Faculty of Medicine, Université Laval; VITAM (Centre de recherche en santé durable) (Archambault, Mercier), Québec, Que.; Division of EMS (Fok, Dahn, Wiemer), Department of Emergency Medicine, Dalhousie University; Charles V. Keating Emergency and Trauma Centre (Fok, Dahn, Wiemer), QEII Health Sciences Centre, Halifax, NS; Department of Emergency Medicine (Davis), College of Medicine, University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Jelic), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Emergency Department (Turner), Jewish General Hospital; Department of Emergency Medicine (Turner), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; Department of Emergency Medicine (Rowe, Hayward, Khangura), Faculty of Medicine & Dentistry, and School of Public Health (Rowe), University of Alberta, Edmonton, Alta.; Centre de recherche (Mercier), CHU de Québec, Université Laval, Québec, Que.; Sunnybrook Health Sciences Centre (Cheng, Atzema); Division of Emergency Medicine (Cheng, Landes, Vaillancourt, Morrison), Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ont.; Emergency Department (Taylor), Royal Columbian Hospital, New Westminster, BC; Départements de médecine de famille et de médecine d'urgence (Daoust), Faculté de médecine, Université de Montréal; Hôpital du Sacré-Coeur-de-Montréal (Daoust), CIUSSS Nord-de-l'ile-de-Montréal, Montréal, Que.; Department of Emergency Medicine (Ohle), Health Sciences North; Northern Ontario School of Medicine (Ohle), Sudbury, Ont.; Lions Gate Hospital (Andolfatto, Stachura), North Vancouver, BC; ICES Central (Atzema); University Health Network (Landes), Toronto, Ont.; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary; Rockyview General Hospital (Lang), Calgary, Alta.; Department of Family Practice (Martin), Faculty of Medicine, University of British Columbia, Vancouver, BC; Abbotsford Regional Hospital & Cancer Agency (Martin), Abbotsford, BC; Department of Emergency Medicine (Mohindra), North York General Hospital, North York, Ont.; Department of Emergency Medicine (Vaillancourt, Morrison), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Division of Emergency Medicine (Welsford), Department of Medicine, McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Surrey Memorial Hospital (Brar), Surrey, BC; Department of Emergency Medicine (Yadav, Perry), University of Ottawa; Ottawa Hospital Research Institute (Yadav, Perry), Ottawa, Ont.; Division of Emergency Medicine (Yan), Department of Medicine, London Health Sciences Centre; Schulich School of Medicine and Dentistry (Yan), Western University, London, Ont.; BC SUPPORT Unit (McGavin), Vancouver, BC
| | - Megan Landes
- Department of Emergency Medicine (Hohl, Taylor, Andolfatto, Ting, Brar, Stachura), University of British Columbia; Centre for Clinical Epidemiology & Evaluation (Hohl), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Emergency Medicine (McRae), Foothills Medical Center, Calgary, Alta.; Department of Emergency Medicine (Brooks), School of Medicine, Queen's University; Kingston Health Sciences Centre (Brooks), Kingston, Ont.; Department of Family Medicine and Emergency Medicine (Archambault), Faculty of Medicine, Université Laval; VITAM (Centre de recherche en santé durable) (Archambault, Mercier), Québec, Que.; Division of EMS (Fok, Dahn, Wiemer), Department of Emergency Medicine, Dalhousie University; Charles V. Keating Emergency and Trauma Centre (Fok, Dahn, Wiemer), QEII Health Sciences Centre, Halifax, NS; Department of Emergency Medicine (Davis), College of Medicine, University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Jelic), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Emergency Department (Turner), Jewish General Hospital; Department of Emergency Medicine (Turner), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; Department of Emergency Medicine (Rowe, Hayward, Khangura), Faculty of Medicine & Dentistry, and School of Public Health (Rowe), University of Alberta, Edmonton, Alta.; Centre de recherche (Mercier), CHU de Québec, Université Laval, Québec, Que.; Sunnybrook Health Sciences Centre (Cheng, Atzema); Division of Emergency Medicine (Cheng, Landes, Vaillancourt, Morrison), Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ont.; Emergency Department (Taylor), Royal Columbian Hospital, New Westminster, BC; Départements de médecine de famille et de médecine d'urgence (Daoust), Faculté de médecine, Université de Montréal; Hôpital du Sacré-Coeur-de-Montréal (Daoust), CIUSSS Nord-de-l'ile-de-Montréal, Montréal, Que.; Department of Emergency Medicine (Ohle), Health Sciences North; Northern Ontario School of Medicine (Ohle), Sudbury, Ont.; Lions Gate Hospital (Andolfatto, Stachura), North Vancouver, BC; ICES Central (Atzema); University Health Network (Landes), Toronto, Ont.; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary; Rockyview General Hospital (Lang), Calgary, Alta.; Department of Family Practice (Martin), Faculty of Medicine, University of British Columbia, Vancouver, BC; Abbotsford Regional Hospital & Cancer Agency (Martin), Abbotsford, BC; Department of Emergency Medicine (Mohindra), North York General Hospital, North York, Ont.; Department of Emergency Medicine (Vaillancourt, Morrison), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Division of Emergency Medicine (Welsford), Department of Medicine, McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Surrey Memorial Hospital (Brar), Surrey, BC; Department of Emergency Medicine (Yadav, Perry), University of Ottawa; Ottawa Hospital Research Institute (Yadav, Perry), Ottawa, Ont.; Division of Emergency Medicine (Yan), Department of Medicine, London Health Sciences Centre; Schulich School of Medicine and Dentistry (Yan), Western University, London, Ont.; BC SUPPORT Unit (McGavin), Vancouver, BC
| | - Eddy Lang
- Department of Emergency Medicine (Hohl, Taylor, Andolfatto, Ting, Brar, Stachura), University of British Columbia; Centre for Clinical Epidemiology & Evaluation (Hohl), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Emergency Medicine (McRae), Foothills Medical Center, Calgary, Alta.; Department of Emergency Medicine (Brooks), School of Medicine, Queen's University; Kingston Health Sciences Centre (Brooks), Kingston, Ont.; Department of Family Medicine and Emergency Medicine (Archambault), Faculty of Medicine, Université Laval; VITAM (Centre de recherche en santé durable) (Archambault, Mercier), Québec, Que.; Division of EMS (Fok, Dahn, Wiemer), Department of Emergency Medicine, Dalhousie University; Charles V. Keating Emergency and Trauma Centre (Fok, Dahn, Wiemer), QEII Health Sciences Centre, Halifax, NS; Department of Emergency Medicine (Davis), College of Medicine, University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Jelic), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Emergency Department (Turner), Jewish General Hospital; Department of Emergency Medicine (Turner), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; Department of Emergency Medicine (Rowe, Hayward, Khangura), Faculty of Medicine & Dentistry, and School of Public Health (Rowe), University of Alberta, Edmonton, Alta.; Centre de recherche (Mercier), CHU de Québec, Université Laval, Québec, Que.; Sunnybrook Health Sciences Centre (Cheng, Atzema); Division of Emergency Medicine (Cheng, Landes, Vaillancourt, Morrison), Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ont.; Emergency Department (Taylor), Royal Columbian Hospital, New Westminster, BC; Départements de médecine de famille et de médecine d'urgence (Daoust), Faculté de médecine, Université de Montréal; Hôpital du Sacré-Coeur-de-Montréal (Daoust), CIUSSS Nord-de-l'ile-de-Montréal, Montréal, Que.; Department of Emergency Medicine (Ohle), Health Sciences North; Northern Ontario School of Medicine (Ohle), Sudbury, Ont.; Lions Gate Hospital (Andolfatto, Stachura), North Vancouver, BC; ICES Central (Atzema); University Health Network (Landes), Toronto, Ont.; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary; Rockyview General Hospital (Lang), Calgary, Alta.; Department of Family Practice (Martin), Faculty of Medicine, University of British Columbia, Vancouver, BC; Abbotsford Regional Hospital & Cancer Agency (Martin), Abbotsford, BC; Department of Emergency Medicine (Mohindra), North York General Hospital, North York, Ont.; Department of Emergency Medicine (Vaillancourt, Morrison), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Division of Emergency Medicine (Welsford), Department of Medicine, McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Surrey Memorial Hospital (Brar), Surrey, BC; Department of Emergency Medicine (Yadav, Perry), University of Ottawa; Ottawa Hospital Research Institute (Yadav, Perry), Ottawa, Ont.; Division of Emergency Medicine (Yan), Department of Medicine, London Health Sciences Centre; Schulich School of Medicine and Dentistry (Yan), Western University, London, Ont.; BC SUPPORT Unit (McGavin), Vancouver, BC
| | - Ian Martin
- Department of Emergency Medicine (Hohl, Taylor, Andolfatto, Ting, Brar, Stachura), University of British Columbia; Centre for Clinical Epidemiology & Evaluation (Hohl), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Emergency Medicine (McRae), Foothills Medical Center, Calgary, Alta.; Department of Emergency Medicine (Brooks), School of Medicine, Queen's University; Kingston Health Sciences Centre (Brooks), Kingston, Ont.; Department of Family Medicine and Emergency Medicine (Archambault), Faculty of Medicine, Université Laval; VITAM (Centre de recherche en santé durable) (Archambault, Mercier), Québec, Que.; Division of EMS (Fok, Dahn, Wiemer), Department of Emergency Medicine, Dalhousie University; Charles V. Keating Emergency and Trauma Centre (Fok, Dahn, Wiemer), QEII Health Sciences Centre, Halifax, NS; Department of Emergency Medicine (Davis), College of Medicine, University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Jelic), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Emergency Department (Turner), Jewish General Hospital; Department of Emergency Medicine (Turner), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; Department of Emergency Medicine (Rowe, Hayward, Khangura), Faculty of Medicine & Dentistry, and School of Public Health (Rowe), University of Alberta, Edmonton, Alta.; Centre de recherche (Mercier), CHU de Québec, Université Laval, Québec, Que.; Sunnybrook Health Sciences Centre (Cheng, Atzema); Division of Emergency Medicine (Cheng, Landes, Vaillancourt, Morrison), Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ont.; Emergency Department (Taylor), Royal Columbian Hospital, New Westminster, BC; Départements de médecine de famille et de médecine d'urgence (Daoust), Faculté de médecine, Université de Montréal; Hôpital du Sacré-Coeur-de-Montréal (Daoust), CIUSSS Nord-de-l'ile-de-Montréal, Montréal, Que.; Department of Emergency Medicine (Ohle), Health Sciences North; Northern Ontario School of Medicine (Ohle), Sudbury, Ont.; Lions Gate Hospital (Andolfatto, Stachura), North Vancouver, BC; ICES Central (Atzema); University Health Network (Landes), Toronto, Ont.; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary; Rockyview General Hospital (Lang), Calgary, Alta.; Department of Family Practice (Martin), Faculty of Medicine, University of British Columbia, Vancouver, BC; Abbotsford Regional Hospital & Cancer Agency (Martin), Abbotsford, BC; Department of Emergency Medicine (Mohindra), North York General Hospital, North York, Ont.; Department of Emergency Medicine (Vaillancourt, Morrison), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Division of Emergency Medicine (Welsford), Department of Medicine, McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Surrey Memorial Hospital (Brar), Surrey, BC; Department of Emergency Medicine (Yadav, Perry), University of Ottawa; Ottawa Hospital Research Institute (Yadav, Perry), Ottawa, Ont.; Division of Emergency Medicine (Yan), Department of Medicine, London Health Sciences Centre; Schulich School of Medicine and Dentistry (Yan), Western University, London, Ont.; BC SUPPORT Unit (McGavin), Vancouver, BC
| | - Rohit Mohindra
- Department of Emergency Medicine (Hohl, Taylor, Andolfatto, Ting, Brar, Stachura), University of British Columbia; Centre for Clinical Epidemiology & Evaluation (Hohl), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Emergency Medicine (McRae), Foothills Medical Center, Calgary, Alta.; Department of Emergency Medicine (Brooks), School of Medicine, Queen's University; Kingston Health Sciences Centre (Brooks), Kingston, Ont.; Department of Family Medicine and Emergency Medicine (Archambault), Faculty of Medicine, Université Laval; VITAM (Centre de recherche en santé durable) (Archambault, Mercier), Québec, Que.; Division of EMS (Fok, Dahn, Wiemer), Department of Emergency Medicine, Dalhousie University; Charles V. Keating Emergency and Trauma Centre (Fok, Dahn, Wiemer), QEII Health Sciences Centre, Halifax, NS; Department of Emergency Medicine (Davis), College of Medicine, University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Jelic), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Emergency Department (Turner), Jewish General Hospital; Department of Emergency Medicine (Turner), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; Department of Emergency Medicine (Rowe, Hayward, Khangura), Faculty of Medicine & Dentistry, and School of Public Health (Rowe), University of Alberta, Edmonton, Alta.; Centre de recherche (Mercier), CHU de Québec, Université Laval, Québec, Que.; Sunnybrook Health Sciences Centre (Cheng, Atzema); Division of Emergency Medicine (Cheng, Landes, Vaillancourt, Morrison), Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ont.; Emergency Department (Taylor), Royal Columbian Hospital, New Westminster, BC; Départements de médecine de famille et de médecine d'urgence (Daoust), Faculté de médecine, Université de Montréal; Hôpital du Sacré-Coeur-de-Montréal (Daoust), CIUSSS Nord-de-l'ile-de-Montréal, Montréal, Que.; Department of Emergency Medicine (Ohle), Health Sciences North; Northern Ontario School of Medicine (Ohle), Sudbury, Ont.; Lions Gate Hospital (Andolfatto, Stachura), North Vancouver, BC; ICES Central (Atzema); University Health Network (Landes), Toronto, Ont.; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary; Rockyview General Hospital (Lang), Calgary, Alta.; Department of Family Practice (Martin), Faculty of Medicine, University of British Columbia, Vancouver, BC; Abbotsford Regional Hospital & Cancer Agency (Martin), Abbotsford, BC; Department of Emergency Medicine (Mohindra), North York General Hospital, North York, Ont.; Department of Emergency Medicine (Vaillancourt, Morrison), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Division of Emergency Medicine (Welsford), Department of Medicine, McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Surrey Memorial Hospital (Brar), Surrey, BC; Department of Emergency Medicine (Yadav, Perry), University of Ottawa; Ottawa Hospital Research Institute (Yadav, Perry), Ottawa, Ont.; Division of Emergency Medicine (Yan), Department of Medicine, London Health Sciences Centre; Schulich School of Medicine and Dentistry (Yan), Western University, London, Ont.; BC SUPPORT Unit (McGavin), Vancouver, BC
| | - Daniel K Ting
- Department of Emergency Medicine (Hohl, Taylor, Andolfatto, Ting, Brar, Stachura), University of British Columbia; Centre for Clinical Epidemiology & Evaluation (Hohl), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Emergency Medicine (McRae), Foothills Medical Center, Calgary, Alta.; Department of Emergency Medicine (Brooks), School of Medicine, Queen's University; Kingston Health Sciences Centre (Brooks), Kingston, Ont.; Department of Family Medicine and Emergency Medicine (Archambault), Faculty of Medicine, Université Laval; VITAM (Centre de recherche en santé durable) (Archambault, Mercier), Québec, Que.; Division of EMS (Fok, Dahn, Wiemer), Department of Emergency Medicine, Dalhousie University; Charles V. Keating Emergency and Trauma Centre (Fok, Dahn, Wiemer), QEII Health Sciences Centre, Halifax, NS; Department of Emergency Medicine (Davis), College of Medicine, University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Jelic), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Emergency Department (Turner), Jewish General Hospital; Department of Emergency Medicine (Turner), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; Department of Emergency Medicine (Rowe, Hayward, Khangura), Faculty of Medicine & Dentistry, and School of Public Health (Rowe), University of Alberta, Edmonton, Alta.; Centre de recherche (Mercier), CHU de Québec, Université Laval, Québec, Que.; Sunnybrook Health Sciences Centre (Cheng, Atzema); Division of Emergency Medicine (Cheng, Landes, Vaillancourt, Morrison), Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ont.; Emergency Department (Taylor), Royal Columbian Hospital, New Westminster, BC; Départements de médecine de famille et de médecine d'urgence (Daoust), Faculté de médecine, Université de Montréal; Hôpital du Sacré-Coeur-de-Montréal (Daoust), CIUSSS Nord-de-l'ile-de-Montréal, Montréal, Que.; Department of Emergency Medicine (Ohle), Health Sciences North; Northern Ontario School of Medicine (Ohle), Sudbury, Ont.; Lions Gate Hospital (Andolfatto, Stachura), North Vancouver, BC; ICES Central (Atzema); University Health Network (Landes), Toronto, Ont.; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary; Rockyview General Hospital (Lang), Calgary, Alta.; Department of Family Practice (Martin), Faculty of Medicine, University of British Columbia, Vancouver, BC; Abbotsford Regional Hospital & Cancer Agency (Martin), Abbotsford, BC; Department of Emergency Medicine (Mohindra), North York General Hospital, North York, Ont.; Department of Emergency Medicine (Vaillancourt, Morrison), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Division of Emergency Medicine (Welsford), Department of Medicine, McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Surrey Memorial Hospital (Brar), Surrey, BC; Department of Emergency Medicine (Yadav, Perry), University of Ottawa; Ottawa Hospital Research Institute (Yadav, Perry), Ottawa, Ont.; Division of Emergency Medicine (Yan), Department of Medicine, London Health Sciences Centre; Schulich School of Medicine and Dentistry (Yan), Western University, London, Ont.; BC SUPPORT Unit (McGavin), Vancouver, BC
| | - Samuel Vaillancourt
- Department of Emergency Medicine (Hohl, Taylor, Andolfatto, Ting, Brar, Stachura), University of British Columbia; Centre for Clinical Epidemiology & Evaluation (Hohl), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Emergency Medicine (McRae), Foothills Medical Center, Calgary, Alta.; Department of Emergency Medicine (Brooks), School of Medicine, Queen's University; Kingston Health Sciences Centre (Brooks), Kingston, Ont.; Department of Family Medicine and Emergency Medicine (Archambault), Faculty of Medicine, Université Laval; VITAM (Centre de recherche en santé durable) (Archambault, Mercier), Québec, Que.; Division of EMS (Fok, Dahn, Wiemer), Department of Emergency Medicine, Dalhousie University; Charles V. Keating Emergency and Trauma Centre (Fok, Dahn, Wiemer), QEII Health Sciences Centre, Halifax, NS; Department of Emergency Medicine (Davis), College of Medicine, University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Jelic), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Emergency Department (Turner), Jewish General Hospital; Department of Emergency Medicine (Turner), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; Department of Emergency Medicine (Rowe, Hayward, Khangura), Faculty of Medicine & Dentistry, and School of Public Health (Rowe), University of Alberta, Edmonton, Alta.; Centre de recherche (Mercier), CHU de Québec, Université Laval, Québec, Que.; Sunnybrook Health Sciences Centre (Cheng, Atzema); Division of Emergency Medicine (Cheng, Landes, Vaillancourt, Morrison), Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ont.; Emergency Department (Taylor), Royal Columbian Hospital, New Westminster, BC; Départements de médecine de famille et de médecine d'urgence (Daoust), Faculté de médecine, Université de Montréal; Hôpital du Sacré-Coeur-de-Montréal (Daoust), CIUSSS Nord-de-l'ile-de-Montréal, Montréal, Que.; Department of Emergency Medicine (Ohle), Health Sciences North; Northern Ontario School of Medicine (Ohle), Sudbury, Ont.; Lions Gate Hospital (Andolfatto, Stachura), North Vancouver, BC; ICES Central (Atzema); University Health Network (Landes), Toronto, Ont.; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary; Rockyview General Hospital (Lang), Calgary, Alta.; Department of Family Practice (Martin), Faculty of Medicine, University of British Columbia, Vancouver, BC; Abbotsford Regional Hospital & Cancer Agency (Martin), Abbotsford, BC; Department of Emergency Medicine (Mohindra), North York General Hospital, North York, Ont.; Department of Emergency Medicine (Vaillancourt, Morrison), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Division of Emergency Medicine (Welsford), Department of Medicine, McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Surrey Memorial Hospital (Brar), Surrey, BC; Department of Emergency Medicine (Yadav, Perry), University of Ottawa; Ottawa Hospital Research Institute (Yadav, Perry), Ottawa, Ont.; Division of Emergency Medicine (Yan), Department of Medicine, London Health Sciences Centre; Schulich School of Medicine and Dentistry (Yan), Western University, London, Ont.; BC SUPPORT Unit (McGavin), Vancouver, BC
| | - Michelle Welsford
- Department of Emergency Medicine (Hohl, Taylor, Andolfatto, Ting, Brar, Stachura), University of British Columbia; Centre for Clinical Epidemiology & Evaluation (Hohl), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Emergency Medicine (McRae), Foothills Medical Center, Calgary, Alta.; Department of Emergency Medicine (Brooks), School of Medicine, Queen's University; Kingston Health Sciences Centre (Brooks), Kingston, Ont.; Department of Family Medicine and Emergency Medicine (Archambault), Faculty of Medicine, Université Laval; VITAM (Centre de recherche en santé durable) (Archambault, Mercier), Québec, Que.; Division of EMS (Fok, Dahn, Wiemer), Department of Emergency Medicine, Dalhousie University; Charles V. Keating Emergency and Trauma Centre (Fok, Dahn, Wiemer), QEII Health Sciences Centre, Halifax, NS; Department of Emergency Medicine (Davis), College of Medicine, University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Jelic), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Emergency Department (Turner), Jewish General Hospital; Department of Emergency Medicine (Turner), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; Department of Emergency Medicine (Rowe, Hayward, Khangura), Faculty of Medicine & Dentistry, and School of Public Health (Rowe), University of Alberta, Edmonton, Alta.; Centre de recherche (Mercier), CHU de Québec, Université Laval, Québec, Que.; Sunnybrook Health Sciences Centre (Cheng, Atzema); Division of Emergency Medicine (Cheng, Landes, Vaillancourt, Morrison), Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ont.; Emergency Department (Taylor), Royal Columbian Hospital, New Westminster, BC; Départements de médecine de famille et de médecine d'urgence (Daoust), Faculté de médecine, Université de Montréal; Hôpital du Sacré-Coeur-de-Montréal (Daoust), CIUSSS Nord-de-l'ile-de-Montréal, Montréal, Que.; Department of Emergency Medicine (Ohle), Health Sciences North; Northern Ontario School of Medicine (Ohle), Sudbury, Ont.; Lions Gate Hospital (Andolfatto, Stachura), North Vancouver, BC; ICES Central (Atzema); University Health Network (Landes), Toronto, Ont.; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary; Rockyview General Hospital (Lang), Calgary, Alta.; Department of Family Practice (Martin), Faculty of Medicine, University of British Columbia, Vancouver, BC; Abbotsford Regional Hospital & Cancer Agency (Martin), Abbotsford, BC; Department of Emergency Medicine (Mohindra), North York General Hospital, North York, Ont.; Department of Emergency Medicine (Vaillancourt, Morrison), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Division of Emergency Medicine (Welsford), Department of Medicine, McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Surrey Memorial Hospital (Brar), Surrey, BC; Department of Emergency Medicine (Yadav, Perry), University of Ottawa; Ottawa Hospital Research Institute (Yadav, Perry), Ottawa, Ont.; Division of Emergency Medicine (Yan), Department of Medicine, London Health Sciences Centre; Schulich School of Medicine and Dentistry (Yan), Western University, London, Ont.; BC SUPPORT Unit (McGavin), Vancouver, BC
| | - Baljeet Brar
- Department of Emergency Medicine (Hohl, Taylor, Andolfatto, Ting, Brar, Stachura), University of British Columbia; Centre for Clinical Epidemiology & Evaluation (Hohl), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Emergency Medicine (McRae), Foothills Medical Center, Calgary, Alta.; Department of Emergency Medicine (Brooks), School of Medicine, Queen's University; Kingston Health Sciences Centre (Brooks), Kingston, Ont.; Department of Family Medicine and Emergency Medicine (Archambault), Faculty of Medicine, Université Laval; VITAM (Centre de recherche en santé durable) (Archambault, Mercier), Québec, Que.; Division of EMS (Fok, Dahn, Wiemer), Department of Emergency Medicine, Dalhousie University; Charles V. Keating Emergency and Trauma Centre (Fok, Dahn, Wiemer), QEII Health Sciences Centre, Halifax, NS; Department of Emergency Medicine (Davis), College of Medicine, University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Jelic), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Emergency Department (Turner), Jewish General Hospital; Department of Emergency Medicine (Turner), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; Department of Emergency Medicine (Rowe, Hayward, Khangura), Faculty of Medicine & Dentistry, and School of Public Health (Rowe), University of Alberta, Edmonton, Alta.; Centre de recherche (Mercier), CHU de Québec, Université Laval, Québec, Que.; Sunnybrook Health Sciences Centre (Cheng, Atzema); Division of Emergency Medicine (Cheng, Landes, Vaillancourt, Morrison), Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ont.; Emergency Department (Taylor), Royal Columbian Hospital, New Westminster, BC; Départements de médecine de famille et de médecine d'urgence (Daoust), Faculté de médecine, Université de Montréal; Hôpital du Sacré-Coeur-de-Montréal (Daoust), CIUSSS Nord-de-l'ile-de-Montréal, Montréal, Que.; Department of Emergency Medicine (Ohle), Health Sciences North; Northern Ontario School of Medicine (Ohle), Sudbury, Ont.; Lions Gate Hospital (Andolfatto, Stachura), North Vancouver, BC; ICES Central (Atzema); University Health Network (Landes), Toronto, Ont.; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary; Rockyview General Hospital (Lang), Calgary, Alta.; Department of Family Practice (Martin), Faculty of Medicine, University of British Columbia, Vancouver, BC; Abbotsford Regional Hospital & Cancer Agency (Martin), Abbotsford, BC; Department of Emergency Medicine (Mohindra), North York General Hospital, North York, Ont.; Department of Emergency Medicine (Vaillancourt, Morrison), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Division of Emergency Medicine (Welsford), Department of Medicine, McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Surrey Memorial Hospital (Brar), Surrey, BC; Department of Emergency Medicine (Yadav, Perry), University of Ottawa; Ottawa Hospital Research Institute (Yadav, Perry), Ottawa, Ont.; Division of Emergency Medicine (Yan), Department of Medicine, London Health Sciences Centre; Schulich School of Medicine and Dentistry (Yan), Western University, London, Ont.; BC SUPPORT Unit (McGavin), Vancouver, BC
| | - Tara Dahn
- Department of Emergency Medicine (Hohl, Taylor, Andolfatto, Ting, Brar, Stachura), University of British Columbia; Centre for Clinical Epidemiology & Evaluation (Hohl), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Emergency Medicine (McRae), Foothills Medical Center, Calgary, Alta.; Department of Emergency Medicine (Brooks), School of Medicine, Queen's University; Kingston Health Sciences Centre (Brooks), Kingston, Ont.; Department of Family Medicine and Emergency Medicine (Archambault), Faculty of Medicine, Université Laval; VITAM (Centre de recherche en santé durable) (Archambault, Mercier), Québec, Que.; Division of EMS (Fok, Dahn, Wiemer), Department of Emergency Medicine, Dalhousie University; Charles V. Keating Emergency and Trauma Centre (Fok, Dahn, Wiemer), QEII Health Sciences Centre, Halifax, NS; Department of Emergency Medicine (Davis), College of Medicine, University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Jelic), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Emergency Department (Turner), Jewish General Hospital; Department of Emergency Medicine (Turner), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; Department of Emergency Medicine (Rowe, Hayward, Khangura), Faculty of Medicine & Dentistry, and School of Public Health (Rowe), University of Alberta, Edmonton, Alta.; Centre de recherche (Mercier), CHU de Québec, Université Laval, Québec, Que.; Sunnybrook Health Sciences Centre (Cheng, Atzema); Division of Emergency Medicine (Cheng, Landes, Vaillancourt, Morrison), Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ont.; Emergency Department (Taylor), Royal Columbian Hospital, New Westminster, BC; Départements de médecine de famille et de médecine d'urgence (Daoust), Faculté de médecine, Université de Montréal; Hôpital du Sacré-Coeur-de-Montréal (Daoust), CIUSSS Nord-de-l'ile-de-Montréal, Montréal, Que.; Department of Emergency Medicine (Ohle), Health Sciences North; Northern Ontario School of Medicine (Ohle), Sudbury, Ont.; Lions Gate Hospital (Andolfatto, Stachura), North Vancouver, BC; ICES Central (Atzema); University Health Network (Landes), Toronto, Ont.; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary; Rockyview General Hospital (Lang), Calgary, Alta.; Department of Family Practice (Martin), Faculty of Medicine, University of British Columbia, Vancouver, BC; Abbotsford Regional Hospital & Cancer Agency (Martin), Abbotsford, BC; Department of Emergency Medicine (Mohindra), North York General Hospital, North York, Ont.; Department of Emergency Medicine (Vaillancourt, Morrison), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Division of Emergency Medicine (Welsford), Department of Medicine, McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Surrey Memorial Hospital (Brar), Surrey, BC; Department of Emergency Medicine (Yadav, Perry), University of Ottawa; Ottawa Hospital Research Institute (Yadav, Perry), Ottawa, Ont.; Division of Emergency Medicine (Yan), Department of Medicine, London Health Sciences Centre; Schulich School of Medicine and Dentistry (Yan), Western University, London, Ont.; BC SUPPORT Unit (McGavin), Vancouver, BC
| | - Hana Wiemer
- Department of Emergency Medicine (Hohl, Taylor, Andolfatto, Ting, Brar, Stachura), University of British Columbia; Centre for Clinical Epidemiology & Evaluation (Hohl), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Emergency Medicine (McRae), Foothills Medical Center, Calgary, Alta.; Department of Emergency Medicine (Brooks), School of Medicine, Queen's University; Kingston Health Sciences Centre (Brooks), Kingston, Ont.; Department of Family Medicine and Emergency Medicine (Archambault), Faculty of Medicine, Université Laval; VITAM (Centre de recherche en santé durable) (Archambault, Mercier), Québec, Que.; Division of EMS (Fok, Dahn, Wiemer), Department of Emergency Medicine, Dalhousie University; Charles V. Keating Emergency and Trauma Centre (Fok, Dahn, Wiemer), QEII Health Sciences Centre, Halifax, NS; Department of Emergency Medicine (Davis), College of Medicine, University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Jelic), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Emergency Department (Turner), Jewish General Hospital; Department of Emergency Medicine (Turner), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; Department of Emergency Medicine (Rowe, Hayward, Khangura), Faculty of Medicine & Dentistry, and School of Public Health (Rowe), University of Alberta, Edmonton, Alta.; Centre de recherche (Mercier), CHU de Québec, Université Laval, Québec, Que.; Sunnybrook Health Sciences Centre (Cheng, Atzema); Division of Emergency Medicine (Cheng, Landes, Vaillancourt, Morrison), Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ont.; Emergency Department (Taylor), Royal Columbian Hospital, New Westminster, BC; Départements de médecine de famille et de médecine d'urgence (Daoust), Faculté de médecine, Université de Montréal; Hôpital du Sacré-Coeur-de-Montréal (Daoust), CIUSSS Nord-de-l'ile-de-Montréal, Montréal, Que.; Department of Emergency Medicine (Ohle), Health Sciences North; Northern Ontario School of Medicine (Ohle), Sudbury, Ont.; Lions Gate Hospital (Andolfatto, Stachura), North Vancouver, BC; ICES Central (Atzema); University Health Network (Landes), Toronto, Ont.; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary; Rockyview General Hospital (Lang), Calgary, Alta.; Department of Family Practice (Martin), Faculty of Medicine, University of British Columbia, Vancouver, BC; Abbotsford Regional Hospital & Cancer Agency (Martin), Abbotsford, BC; Department of Emergency Medicine (Mohindra), North York General Hospital, North York, Ont.; Department of Emergency Medicine (Vaillancourt, Morrison), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Division of Emergency Medicine (Welsford), Department of Medicine, McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Surrey Memorial Hospital (Brar), Surrey, BC; Department of Emergency Medicine (Yadav, Perry), University of Ottawa; Ottawa Hospital Research Institute (Yadav, Perry), Ottawa, Ont.; Division of Emergency Medicine (Yan), Department of Medicine, London Health Sciences Centre; Schulich School of Medicine and Dentistry (Yan), Western University, London, Ont.; BC SUPPORT Unit (McGavin), Vancouver, BC
| | - Krishan Yadav
- Department of Emergency Medicine (Hohl, Taylor, Andolfatto, Ting, Brar, Stachura), University of British Columbia; Centre for Clinical Epidemiology & Evaluation (Hohl), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Emergency Medicine (McRae), Foothills Medical Center, Calgary, Alta.; Department of Emergency Medicine (Brooks), School of Medicine, Queen's University; Kingston Health Sciences Centre (Brooks), Kingston, Ont.; Department of Family Medicine and Emergency Medicine (Archambault), Faculty of Medicine, Université Laval; VITAM (Centre de recherche en santé durable) (Archambault, Mercier), Québec, Que.; Division of EMS (Fok, Dahn, Wiemer), Department of Emergency Medicine, Dalhousie University; Charles V. Keating Emergency and Trauma Centre (Fok, Dahn, Wiemer), QEII Health Sciences Centre, Halifax, NS; Department of Emergency Medicine (Davis), College of Medicine, University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Jelic), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Emergency Department (Turner), Jewish General Hospital; Department of Emergency Medicine (Turner), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; Department of Emergency Medicine (Rowe, Hayward, Khangura), Faculty of Medicine & Dentistry, and School of Public Health (Rowe), University of Alberta, Edmonton, Alta.; Centre de recherche (Mercier), CHU de Québec, Université Laval, Québec, Que.; Sunnybrook Health Sciences Centre (Cheng, Atzema); Division of Emergency Medicine (Cheng, Landes, Vaillancourt, Morrison), Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ont.; Emergency Department (Taylor), Royal Columbian Hospital, New Westminster, BC; Départements de médecine de famille et de médecine d'urgence (Daoust), Faculté de médecine, Université de Montréal; Hôpital du Sacré-Coeur-de-Montréal (Daoust), CIUSSS Nord-de-l'ile-de-Montréal, Montréal, Que.; Department of Emergency Medicine (Ohle), Health Sciences North; Northern Ontario School of Medicine (Ohle), Sudbury, Ont.; Lions Gate Hospital (Andolfatto, Stachura), North Vancouver, BC; ICES Central (Atzema); University Health Network (Landes), Toronto, Ont.; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary; Rockyview General Hospital (Lang), Calgary, Alta.; Department of Family Practice (Martin), Faculty of Medicine, University of British Columbia, Vancouver, BC; Abbotsford Regional Hospital & Cancer Agency (Martin), Abbotsford, BC; Department of Emergency Medicine (Mohindra), North York General Hospital, North York, Ont.; Department of Emergency Medicine (Vaillancourt, Morrison), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Division of Emergency Medicine (Welsford), Department of Medicine, McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Surrey Memorial Hospital (Brar), Surrey, BC; Department of Emergency Medicine (Yadav, Perry), University of Ottawa; Ottawa Hospital Research Institute (Yadav, Perry), Ottawa, Ont.; Division of Emergency Medicine (Yan), Department of Medicine, London Health Sciences Centre; Schulich School of Medicine and Dentistry (Yan), Western University, London, Ont.; BC SUPPORT Unit (McGavin), Vancouver, BC
| | - Justin W Yan
- Department of Emergency Medicine (Hohl, Taylor, Andolfatto, Ting, Brar, Stachura), University of British Columbia; Centre for Clinical Epidemiology & Evaluation (Hohl), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Emergency Medicine (McRae), Foothills Medical Center, Calgary, Alta.; Department of Emergency Medicine (Brooks), School of Medicine, Queen's University; Kingston Health Sciences Centre (Brooks), Kingston, Ont.; Department of Family Medicine and Emergency Medicine (Archambault), Faculty of Medicine, Université Laval; VITAM (Centre de recherche en santé durable) (Archambault, Mercier), Québec, Que.; Division of EMS (Fok, Dahn, Wiemer), Department of Emergency Medicine, Dalhousie University; Charles V. Keating Emergency and Trauma Centre (Fok, Dahn, Wiemer), QEII Health Sciences Centre, Halifax, NS; Department of Emergency Medicine (Davis), College of Medicine, University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Jelic), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Emergency Department (Turner), Jewish General Hospital; Department of Emergency Medicine (Turner), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; Department of Emergency Medicine (Rowe, Hayward, Khangura), Faculty of Medicine & Dentistry, and School of Public Health (Rowe), University of Alberta, Edmonton, Alta.; Centre de recherche (Mercier), CHU de Québec, Université Laval, Québec, Que.; Sunnybrook Health Sciences Centre (Cheng, Atzema); Division of Emergency Medicine (Cheng, Landes, Vaillancourt, Morrison), Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ont.; Emergency Department (Taylor), Royal Columbian Hospital, New Westminster, BC; Départements de médecine de famille et de médecine d'urgence (Daoust), Faculté de médecine, Université de Montréal; Hôpital du Sacré-Coeur-de-Montréal (Daoust), CIUSSS Nord-de-l'ile-de-Montréal, Montréal, Que.; Department of Emergency Medicine (Ohle), Health Sciences North; Northern Ontario School of Medicine (Ohle), Sudbury, Ont.; Lions Gate Hospital (Andolfatto, Stachura), North Vancouver, BC; ICES Central (Atzema); University Health Network (Landes), Toronto, Ont.; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary; Rockyview General Hospital (Lang), Calgary, Alta.; Department of Family Practice (Martin), Faculty of Medicine, University of British Columbia, Vancouver, BC; Abbotsford Regional Hospital & Cancer Agency (Martin), Abbotsford, BC; Department of Emergency Medicine (Mohindra), North York General Hospital, North York, Ont.; Department of Emergency Medicine (Vaillancourt, Morrison), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Division of Emergency Medicine (Welsford), Department of Medicine, McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Surrey Memorial Hospital (Brar), Surrey, BC; Department of Emergency Medicine (Yadav, Perry), University of Ottawa; Ottawa Hospital Research Institute (Yadav, Perry), Ottawa, Ont.; Division of Emergency Medicine (Yan), Department of Medicine, London Health Sciences Centre; Schulich School of Medicine and Dentistry (Yan), Western University, London, Ont.; BC SUPPORT Unit (McGavin), Vancouver, BC
| | - Maja Stachura
- Department of Emergency Medicine (Hohl, Taylor, Andolfatto, Ting, Brar, Stachura), University of British Columbia; Centre for Clinical Epidemiology & Evaluation (Hohl), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Emergency Medicine (McRae), Foothills Medical Center, Calgary, Alta.; Department of Emergency Medicine (Brooks), School of Medicine, Queen's University; Kingston Health Sciences Centre (Brooks), Kingston, Ont.; Department of Family Medicine and Emergency Medicine (Archambault), Faculty of Medicine, Université Laval; VITAM (Centre de recherche en santé durable) (Archambault, Mercier), Québec, Que.; Division of EMS (Fok, Dahn, Wiemer), Department of Emergency Medicine, Dalhousie University; Charles V. Keating Emergency and Trauma Centre (Fok, Dahn, Wiemer), QEII Health Sciences Centre, Halifax, NS; Department of Emergency Medicine (Davis), College of Medicine, University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Jelic), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Emergency Department (Turner), Jewish General Hospital; Department of Emergency Medicine (Turner), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; Department of Emergency Medicine (Rowe, Hayward, Khangura), Faculty of Medicine & Dentistry, and School of Public Health (Rowe), University of Alberta, Edmonton, Alta.; Centre de recherche (Mercier), CHU de Québec, Université Laval, Québec, Que.; Sunnybrook Health Sciences Centre (Cheng, Atzema); Division of Emergency Medicine (Cheng, Landes, Vaillancourt, Morrison), Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ont.; Emergency Department (Taylor), Royal Columbian Hospital, New Westminster, BC; Départements de médecine de famille et de médecine d'urgence (Daoust), Faculté de médecine, Université de Montréal; Hôpital du Sacré-Coeur-de-Montréal (Daoust), CIUSSS Nord-de-l'ile-de-Montréal, Montréal, Que.; Department of Emergency Medicine (Ohle), Health Sciences North; Northern Ontario School of Medicine (Ohle), Sudbury, Ont.; Lions Gate Hospital (Andolfatto, Stachura), North Vancouver, BC; ICES Central (Atzema); University Health Network (Landes), Toronto, Ont.; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary; Rockyview General Hospital (Lang), Calgary, Alta.; Department of Family Practice (Martin), Faculty of Medicine, University of British Columbia, Vancouver, BC; Abbotsford Regional Hospital & Cancer Agency (Martin), Abbotsford, BC; Department of Emergency Medicine (Mohindra), North York General Hospital, North York, Ont.; Department of Emergency Medicine (Vaillancourt, Morrison), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Division of Emergency Medicine (Welsford), Department of Medicine, McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Surrey Memorial Hospital (Brar), Surrey, BC; Department of Emergency Medicine (Yadav, Perry), University of Ottawa; Ottawa Hospital Research Institute (Yadav, Perry), Ottawa, Ont.; Division of Emergency Medicine (Yan), Department of Medicine, London Health Sciences Centre; Schulich School of Medicine and Dentistry (Yan), Western University, London, Ont.; BC SUPPORT Unit (McGavin), Vancouver, BC
| | - Colleen McGavin
- Department of Emergency Medicine (Hohl, Taylor, Andolfatto, Ting, Brar, Stachura), University of British Columbia; Centre for Clinical Epidemiology & Evaluation (Hohl), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Emergency Medicine (McRae), Foothills Medical Center, Calgary, Alta.; Department of Emergency Medicine (Brooks), School of Medicine, Queen's University; Kingston Health Sciences Centre (Brooks), Kingston, Ont.; Department of Family Medicine and Emergency Medicine (Archambault), Faculty of Medicine, Université Laval; VITAM (Centre de recherche en santé durable) (Archambault, Mercier), Québec, Que.; Division of EMS (Fok, Dahn, Wiemer), Department of Emergency Medicine, Dalhousie University; Charles V. Keating Emergency and Trauma Centre (Fok, Dahn, Wiemer), QEII Health Sciences Centre, Halifax, NS; Department of Emergency Medicine (Davis), College of Medicine, University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Jelic), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Emergency Department (Turner), Jewish General Hospital; Department of Emergency Medicine (Turner), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; Department of Emergency Medicine (Rowe, Hayward, Khangura), Faculty of Medicine & Dentistry, and School of Public Health (Rowe), University of Alberta, Edmonton, Alta.; Centre de recherche (Mercier), CHU de Québec, Université Laval, Québec, Que.; Sunnybrook Health Sciences Centre (Cheng, Atzema); Division of Emergency Medicine (Cheng, Landes, Vaillancourt, Morrison), Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ont.; Emergency Department (Taylor), Royal Columbian Hospital, New Westminster, BC; Départements de médecine de famille et de médecine d'urgence (Daoust), Faculté de médecine, Université de Montréal; Hôpital du Sacré-Coeur-de-Montréal (Daoust), CIUSSS Nord-de-l'ile-de-Montréal, Montréal, Que.; Department of Emergency Medicine (Ohle), Health Sciences North; Northern Ontario School of Medicine (Ohle), Sudbury, Ont.; Lions Gate Hospital (Andolfatto, Stachura), North Vancouver, BC; ICES Central (Atzema); University Health Network (Landes), Toronto, Ont.; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary; Rockyview General Hospital (Lang), Calgary, Alta.; Department of Family Practice (Martin), Faculty of Medicine, University of British Columbia, Vancouver, BC; Abbotsford Regional Hospital & Cancer Agency (Martin), Abbotsford, BC; Department of Emergency Medicine (Mohindra), North York General Hospital, North York, Ont.; Department of Emergency Medicine (Vaillancourt, Morrison), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Division of Emergency Medicine (Welsford), Department of Medicine, McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Surrey Memorial Hospital (Brar), Surrey, BC; Department of Emergency Medicine (Yadav, Perry), University of Ottawa; Ottawa Hospital Research Institute (Yadav, Perry), Ottawa, Ont.; Division of Emergency Medicine (Yan), Department of Medicine, London Health Sciences Centre; Schulich School of Medicine and Dentistry (Yan), Western University, London, Ont.; BC SUPPORT Unit (McGavin), Vancouver, BC
| | - Jeffrey J Perry
- Department of Emergency Medicine (Hohl, Taylor, Andolfatto, Ting, Brar, Stachura), University of British Columbia; Centre for Clinical Epidemiology & Evaluation (Hohl), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Emergency Medicine (McRae), Foothills Medical Center, Calgary, Alta.; Department of Emergency Medicine (Brooks), School of Medicine, Queen's University; Kingston Health Sciences Centre (Brooks), Kingston, Ont.; Department of Family Medicine and Emergency Medicine (Archambault), Faculty of Medicine, Université Laval; VITAM (Centre de recherche en santé durable) (Archambault, Mercier), Québec, Que.; Division of EMS (Fok, Dahn, Wiemer), Department of Emergency Medicine, Dalhousie University; Charles V. Keating Emergency and Trauma Centre (Fok, Dahn, Wiemer), QEII Health Sciences Centre, Halifax, NS; Department of Emergency Medicine (Davis), College of Medicine, University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Jelic), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Emergency Department (Turner), Jewish General Hospital; Department of Emergency Medicine (Turner), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; Department of Emergency Medicine (Rowe, Hayward, Khangura), Faculty of Medicine & Dentistry, and School of Public Health (Rowe), University of Alberta, Edmonton, Alta.; Centre de recherche (Mercier), CHU de Québec, Université Laval, Québec, Que.; Sunnybrook Health Sciences Centre (Cheng, Atzema); Division of Emergency Medicine (Cheng, Landes, Vaillancourt, Morrison), Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ont.; Emergency Department (Taylor), Royal Columbian Hospital, New Westminster, BC; Départements de médecine de famille et de médecine d'urgence (Daoust), Faculté de médecine, Université de Montréal; Hôpital du Sacré-Coeur-de-Montréal (Daoust), CIUSSS Nord-de-l'ile-de-Montréal, Montréal, Que.; Department of Emergency Medicine (Ohle), Health Sciences North; Northern Ontario School of Medicine (Ohle), Sudbury, Ont.; Lions Gate Hospital (Andolfatto, Stachura), North Vancouver, BC; ICES Central (Atzema); University Health Network (Landes), Toronto, Ont.; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary; Rockyview General Hospital (Lang), Calgary, Alta.; Department of Family Practice (Martin), Faculty of Medicine, University of British Columbia, Vancouver, BC; Abbotsford Regional Hospital & Cancer Agency (Martin), Abbotsford, BC; Department of Emergency Medicine (Mohindra), North York General Hospital, North York, Ont.; Department of Emergency Medicine (Vaillancourt, Morrison), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Division of Emergency Medicine (Welsford), Department of Medicine, McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Surrey Memorial Hospital (Brar), Surrey, BC; Department of Emergency Medicine (Yadav, Perry), University of Ottawa; Ottawa Hospital Research Institute (Yadav, Perry), Ottawa, Ont.; Division of Emergency Medicine (Yan), Department of Medicine, London Health Sciences Centre; Schulich School of Medicine and Dentistry (Yan), Western University, London, Ont.; BC SUPPORT Unit (McGavin), Vancouver, BC
| | - Laurie J Morrison
- Department of Emergency Medicine (Hohl, Taylor, Andolfatto, Ting, Brar, Stachura), University of British Columbia; Centre for Clinical Epidemiology & Evaluation (Hohl), Vancouver Coastal Health Research Institute, Vancouver, BC; Department of Pediatrics (Rosychuk), University of Alberta, Edmonton, Alta.; Department of Emergency Medicine (McRae), Foothills Medical Center, Calgary, Alta.; Department of Emergency Medicine (Brooks), School of Medicine, Queen's University; Kingston Health Sciences Centre (Brooks), Kingston, Ont.; Department of Family Medicine and Emergency Medicine (Archambault), Faculty of Medicine, Université Laval; VITAM (Centre de recherche en santé durable) (Archambault, Mercier), Québec, Que.; Division of EMS (Fok, Dahn, Wiemer), Department of Emergency Medicine, Dalhousie University; Charles V. Keating Emergency and Trauma Centre (Fok, Dahn, Wiemer), QEII Health Sciences Centre, Halifax, NS; Department of Emergency Medicine (Davis), College of Medicine, University of Saskatchewan, Saskatoon, Sask.; Department of Emergency Medicine (Jelic), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man.; Emergency Department (Turner), Jewish General Hospital; Department of Emergency Medicine (Turner), Faculty of Medicine and Health Sciences, McGill University, Montréal, Que.; Department of Emergency Medicine (Rowe, Hayward, Khangura), Faculty of Medicine & Dentistry, and School of Public Health (Rowe), University of Alberta, Edmonton, Alta.; Centre de recherche (Mercier), CHU de Québec, Université Laval, Québec, Que.; Sunnybrook Health Sciences Centre (Cheng, Atzema); Division of Emergency Medicine (Cheng, Landes, Vaillancourt, Morrison), Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ont.; Emergency Department (Taylor), Royal Columbian Hospital, New Westminster, BC; Départements de médecine de famille et de médecine d'urgence (Daoust), Faculté de médecine, Université de Montréal; Hôpital du Sacré-Coeur-de-Montréal (Daoust), CIUSSS Nord-de-l'ile-de-Montréal, Montréal, Que.; Department of Emergency Medicine (Ohle), Health Sciences North; Northern Ontario School of Medicine (Ohle), Sudbury, Ont.; Lions Gate Hospital (Andolfatto, Stachura), North Vancouver, BC; ICES Central (Atzema); University Health Network (Landes), Toronto, Ont.; Department of Emergency Medicine (Lang), Cumming School of Medicine, University of Calgary; Rockyview General Hospital (Lang), Calgary, Alta.; Department of Family Practice (Martin), Faculty of Medicine, University of British Columbia, Vancouver, BC; Abbotsford Regional Hospital & Cancer Agency (Martin), Abbotsford, BC; Department of Emergency Medicine (Mohindra), North York General Hospital, North York, Ont.; Department of Emergency Medicine (Vaillancourt, Morrison), St. Michael's Hospital, Unity Health Toronto, Toronto, Ont.; Division of Emergency Medicine (Welsford), Department of Medicine, McMaster University; Hamilton Health Sciences (Welsford), Hamilton, Ont.; Surrey Memorial Hospital (Brar), Surrey, BC; Department of Emergency Medicine (Yadav, Perry), University of Ottawa; Ottawa Hospital Research Institute (Yadav, Perry), Ottawa, Ont.; Division of Emergency Medicine (Yan), Department of Medicine, London Health Sciences Centre; Schulich School of Medicine and Dentistry (Yan), Western University, London, Ont.; BC SUPPORT Unit (McGavin), Vancouver, BC
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Moore L, Tardif PA, Lauzier F, Bérubé M, Archambault P, Lamontagne F, Chassé M, Stelfox HT, Gabbe B, Lecky F, Kortbeek J, Lessard Bonaventure P, Truchon C, Turgeon AF. Low-Value Clinical Practices in Adult Traumatic Brain Injury: An Umbrella Review. J Neurotrauma 2020; 37:2605-2615. [PMID: 32791886 DOI: 10.1089/neu.2020.7044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Despite numerous interventions and treatment options, the outcomes of traumatic brain injury (TBI) have improved little over the last 3 decades, which raises concern about the value of care in this patient population. We aimed to synthesize the evidence on 14 potentially low-value clinical practices in TBI care. Using umbrella review methodology, we identified systematic reviews evaluating the effectiveness of 14 potentially low-value practices in adults with acute TBI. We present data on methodological quality (Assessing the Methodological Quality of Systematic Reviews), reported effect sizes, and credibility of evidence (I to IV). The only clinical practice with evidence of benefit was therapeutic hypothermia (credibility of evidence II to IV). However, the most recent meta-analysis on hypothermia based on high-quality trials suggested harm (credibility of evidence IV). Meta-analyses on platelet transfusion for patients on antiplatelet therapy were all consistent with harm but were statistically non-significant. For the following practices, effect estimates were consistently close to the null: computed tomography (CT) in adults with mild TBI who are low-risk on a validated clinical decision rule; repeat CT in adults with mild TBI on anticoagulant therapy with no clinical deterioration; antibiotic prophylaxis for external ventricular drain placement; and decompressive craniectomy for refractory intracranial hypertension. We identified five clinical practices with evidence of lack of benefit or harm. However, evidence could not be considered to be strong for any clinical practice as effect measures were imprecise and heterogeneous, systematic reviews were often of low quality, and most included studies had a high risk of bias.
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Affiliation(s)
- Lynne Moore
- Department of Social and Preventative Medicine, Université Laval, Québec City, Québec, Canada.,Population Health and Optimal Health Practices Research Unit, Université Laval, Québec City, Québec, Canada
| | - Pier-Alexandre Tardif
- Population Health and Optimal Health Practices Research Unit, Université Laval, Québec City, Québec, Canada
| | - François Lauzier
- Department of Social and Preventative Medicine, Université Laval, Québec City, Québec, Canada.,Population Health and Optimal Health Practices Research Unit, Université Laval, Québec City, Québec, Canada
| | - Melanie Bérubé
- Department of Social and Preventative Medicine, Université Laval, Québec City, Québec, Canada.,Population Health and Optimal Health Practices Research Unit, Université Laval, Québec City, Québec, Canada
| | - Patrick Archambault
- Population Health and Optimal Health Practices Research Unit, Université Laval, Québec City, Québec, Canada
| | - François Lamontagne
- Department of Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Michael Chassé
- Department of Medicine, Université de Montréal CRCHUM, Montréal, Québec, Canada
| | - Henry T Stelfox
- Departments of Critical Care Medicine, Medicine, and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Belinda Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Swansea University Medical School, Swansea University, Swansea, United Kingdom
| | - Fiona Lecky
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - John Kortbeek
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - Paule Lessard Bonaventure
- Population Health and Optimal Health Practices Research Unit, Université Laval, Québec City, Québec, Canada.,Department of Surgery, Université Laval, Québec City, Québec, Canada
| | - Catherine Truchon
- Institut national d'excellence en santé et en services sociaux, Québec City, Québec, Canada
| | - Alexis F Turgeon
- Department of Social and Preventative Medicine, Université Laval, Québec City, Québec, Canada.,Population Health and Optimal Health Practices Research Unit, Université Laval, Québec City, Québec, Canada
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