This is the official blog for the Department of Emergency Medicine at the University of Ottawa. Our main goal is to share the results of our monthly Journal Club for people to view and for our staff/residents to have as a resource if the need arises to review the content. The scores and analysis of each article are derived from an initial critical review of the literature by a single reviewer, followed by a group discussion.
What is Quality Improvement (QI)? You have all heard the latest buzzword in healthcare: “quality improvement”, or QI. Yet many healthcare professionals still only have a vague idea of what that truly means, and likely an even poorer understanding of how it might apply to their frontline practice. Conceptually, QI can be defined as the “combined and unceasing efforts of everyone - healthcare professionals, patients and their families, researchers, payers, planners and educators - to make the changes that will lead to better patient outcomes (health), better system performance (care) and better professional development (learning)”1.
Journal Club Summary Methodology Score:4/5Usefulness Score:4/5 Stanley AJ, et al. BMJ.
2017 Jan 4;356:i6432. Full Article This multicentre, multinational study assessed the ability
of five upper gastrointestinal bleeding scores to predict outcomes including
death, re-bleeding, need for endoscopy, transfusion, surgery or interventional
radiology, and length of hospital stay, finding that the Glasgow Blatchford
score is best at predicting the composite outcome of intervention or death,
although AIMS65 was best at predicting mortality. While applying the scores as
recommended may result in missing a small number of significant outcomes, they
are easy to apply and can help expedite disposition planning, whether
outpatient management or hospital-based intervention. By: Dr. Daniel James Epi lessonComposite OutcomesIt is not unusual for studies to select a composite outcome as their
primary outcome measure. The necessity to do so is often justified by the rare
occurrence of the primary outcome of t…
The Zika Virus exploded onto the
international health scene in the last several months. It was first discovered
in humans in 1951 and remained limited to Africa and Asia until the first major
outbreak in Micronesia in 2007. Since then the virus has continued to evolve
and spread from the Pacific Islands and French Polynesia to the main major
outbreak in South America in early 2015 and finally to the US in January 2016.
Pediatric endotracheal intubation is an uncommon procedure in the Emergency Department (ED); even in high volume tertiary pediatric centres the incidence has been reported at 8-10/10,000 patients. While infrequent, pediatric airway management is an essential and life-saving skill that all ER physicians must be prepared for. Much of the knowledge and skill set from the adult world is applicable here, however there are several important differences that are unique to the pediatric population.
This single-centre, non-blinded RCT of ICU ARDS patients, found that NIV delivered by a novel helmet, as compared to a standard NIV facemask, reduced intubations (18.2% vs. 61.5%; P <0.001) and hospital mortality (27.3% vs. 48.7%; P= 0.04). Despite its few methodological flaws, this study supports the existing literature on the advantage of oxygen delivered via helmet over facemask in avoiding intubation in ARDS, and future studies should focus on its impact in heart failure or hypercapneic respiratory failure. By: Dr. Shannon Fernando Epi lesson: Interim Analyses and Stopping Rules In clinical trials, an interim analysis is one that is conducted before data collection has been completed to determin…