scholarly journals P.079 Factors influencing HINTS exam usage by Canadian Emergency Medicine Physicians

2021 ◽  
Vol 48 (s3) ◽  
pp. S42-S42
Author(s):  
M Byworth ◽  
P Johns ◽  
A Pardhan ◽  
K Srivastava ◽  
M Sharma
Keyword(s):  
Emergency Medicine ◽  
Residency Training ◽  
Older Age ◽  
Head Impulse Test ◽  
Emergency Physicians ◽  
Academic Practice ◽  
Head Impulse ◽  
Factors Influencing ◽  
Canadian Association ◽  
Acute Vestibular Syndrome

Background: The HINTS examination is a sensitive and specific tool for determining whether a patient presenting with an acute vestibular syndrome has had a stroke. Despite its efficacy, it is often not used by Emergency Medicine (EM) physicians when assessing patients with vertigo. Methods: To ascertain why, we surveyed, by email, physicians registered with the Canadian Association of Emergency Physicians, to gather information on their practices when assessing patients with vertigo, and their utilization and perspectives concerning the HINTS examination. Results: 185 participants responded to our survey, demographically representative of Canadian EM physicians. The majority regularly use the HINTS exam in the appropriate setting, but significant minorities employ the exam inappropriately, such as in patients without nystagmus, with other neurological findings, or alongside tests for intermittent vertigo. Misapplication was associated with older age, years of practice, non-academic practice settings, and less residency training (p<0.05). The predominant reasons for not using this examination are lack of confidence in recalling and performing component exam techniques, particularly the head-impulse test, and doubts about the necessity, safety, or validity of this examination. Conclusions: HINTS examination use is limited by lack of provider skill, safety concerns, and doubts on its validity in excluding stroke when employed by EM physicians.

scholarly journals Building and strengthening relationships between academic departments/divisions of emergency medicine and rural and regional emergency departments

CJEM ◽  
2019 ◽  
Vol 21 (5) ◽  
pp. 595-599 ◽  
Author(s):  
Aaron Johnston ◽  
Kylie Booth ◽  
Jim Christenson ◽  
David Fu ◽  
Shirley Lee ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Emergency Departments ◽  
Academic Departments ◽  
List Type ◽  
Emergency Physicians ◽  
Common Value ◽  
Rural And Urban ◽  
Canadian Association ◽  
Rural Physicians ◽  
Training Opportunities

ABSTRACTObjectivesMake recommendations on approaches to building and strengthening relationships between academic departments or divisions of Emergency Medicine and rural and regional emergency departments.MethodsA panel of leaders from both rural and urban/academic practice environments met over 8 months. Draft recommendations were developed from panel expertise as well as survey data and presented at the 2018 Canadian Association of Emergency Physicians (CAEP) Academic Symposium. Symposium feedback was incorporated into final recommendations.ResultsSeven recommendations emerged and are summarized below: 1)CAEP should ensure engagement with other rural stakeholder organizations such as the College of Family Physicians of Canada and the Society of Rural Physicians of Canada.2)Engagement efforts require adequate financial and manpower resources.3)Training opportunities should be promoted.4)The current operational interface between the academic department of Emergency Medicine and the emergency departments in the catchment area must be examined and gaps addressed as part of building and strengthening relationships.5)Initial engagement efforts should be around projects with common value.6)Academic Departments should partner with and support rural scholars.7)Academic departments seeking to build or strengthen relationships should consider successful examples from elsewhere in the country as well as considering local culture and challenges.ConclusionThese recommendations serve as guidance for building and strengthening mutually beneficial relationships between academic departments or divisions of Emergency Medicine and rural and regional emergency departments.

scholarly journals Important returns on investment: an evaluation of a national research grants competition in emergency medicine

CJEM ◽  
2010 ◽  
Vol 12 (01) ◽  
pp. 33-38 ◽  
Author(s):  
Jaime Bawden ◽  
Namdar Manouchehri ◽  
Cristina Villa-Roel ◽  
Eric Grafstein ◽  
Brian H. Rowe
Keyword(s):  
Emergency Medicine ◽  
Research Funding ◽  
Emergency Physicians ◽  
Research Grants ◽  
Annual Basis ◽  
Canadian Association ◽  
Additional Funding ◽  
Study Completion ◽  
Returns On Investment ◽  
Median Amount

ABSTRACTObjective:We sought to examine scholarly outcomes of the projects receiving research grants from the Canadian Association of Emergency Physicians (CAEP) during the first 10 years of national funding (i.e., between 1996 and 2005).Methods:We sent email surveys to 62 emergency medicine (EM) researchers who received funding from CAEP. We focused our data collection on grant deliverables and opinions using a 1–7 Likert scale with regard to the value of the award.Results:Fifty-eight recipients responded to our survey. Grants were most commonly awarded to residents (21 [36%]), followed by senior (16 [28%]) and junior (13 [22%]) emergency staff. Twenty-six applicants from Ontario and 11 from Quebec received the majority of the grants. Overall, 51 projects were completed at the time of contact and, from these, 39 manuscripts were published or in press. Abstract presentations were more common, with a median of 2 abstracts presented per completed project. Abstract presentations for the completed projects were documented locally (23), nationally (39) and internationally (37). Overall, 19 projects received additional funding. The median amount funded was Can$4700 with an interquartile range of $3250–$5000. Respondents felt CAEP funding was critical to completing their projects and felt strongly that dedicated EM research funding should be continued to stimulate productivity.Conclusion:Overall, the CAEP Research Grants Competition has produced impressive results. Despite the small sums available, the grants have been important for ensuring study completion and for securing additional funding. CAEP and similar EM organizations need to develop a more robust funding approach so that larger grant awards and more researchers can be supported on an annual basis.

scholarly journals The core emergency ultrasound curriculum project: A report from the Curriculum Working Group of the CAEP Emergency Ultrasound Committee

CJEM ◽  
2017 ◽  
Vol 20 (2) ◽  
pp. 176-182 ◽  
Author(s):  
Paul Olszynski ◽  
Dan Kim ◽  
Jordan Chenkin ◽  
Louise Rang
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Working Group ◽  
Focused Ultrasound ◽  
Position Statement ◽  
Emergency Ultrasound ◽  
Emergency Physicians ◽  
The Core ◽  
Canadian Association ◽  
Curriculum Project

Emergency ultrasound (EUS) is now widely considered to be a “skill integral to the practice of emergency medicine.”1The Canadian Association of Emergency Physicians (CAEP) initially issued a position statement in 1999 supporting the availability of focused ultrasound 24 hours per day in the emergency department (ED).2

scholarly journals “The Future of Emergency Medicine” Inaugural address to the First Canadian EM Residents Workshop

CJEM ◽  
2000 ◽  
Vol 2 (04) ◽  
pp. 262-264 ◽  
Author(s):  
Isser Dubinsky
Keyword(s):  
Emergency Medicine ◽  
Emergency Services ◽  
Emergency Physicians ◽  
Inaugural Address ◽  
Health Network ◽  
Canadian Association ◽  
The Future ◽  
National Forum ◽  
The University

On June 10 to 11 this year, the Residents’ Section of the Canadian Association of Emergency Physicians (CAEP-RS) held its first official national forum for future emergency physicians — the First Canadian EM Residents Workshop, in conjunction with CAEP 2000. To celebrate the event, the RS decided to invite a nationally recognized emergency medicine leader, advocate, and teacher to be the first to address the Annual Residents’ Dinner. We were grateful for the privilege of having Dr. Isser Dubinsky be that person. Dr. Dubinsky, currently Chief of Emergency Services at the University Health Network in Toronto, was asked to speak about “The Future of Emergency Medicine.” Dr. Dubinsky's speech, filled with warmth, wisdom, and humanity, is transcribed below. — Jason Frank, MD, Chair CAEP-RS

scholarly journals Quantifying the Vestibulo-Ocular Reflex with Video-Oculography: Nature and Frequency of Artifacts

2014 ◽  
Vol 20 (1) ◽  
pp. 39-50 ◽  
Author(s):  
Georgios Mantokoudis ◽  
Ali S. Saber Tehrani ◽  
Jorge C. Kattah ◽  
Karin Eibenberger ◽  
Cynthia I. Guede ◽  
...  
Keyword(s):  
Head Impulse Test ◽  
Head Impulse ◽  
Video Oculography ◽  
Ocular Reflex ◽  
Acute Vestibular Syndrome ◽  
Vestibulo Ocular Reflex ◽  
Corrective Saccades ◽  
Coding Manual ◽  
A Prospective Study ◽  
The Impact

Video-oculography devices are now used to quantify the vestibulo-ocular reflex (VOR) at the bedside using the head impulse test (HIT). Little is known about the impact of disruptive phenomena (e.g. corrective saccades, nystagmus, fixation losses, eye-blink artifacts) on quantitative VOR assessment in acute vertigo. This study systematically characterized the frequency, nature, and impact of artifacts on HIT VOR measures. From a prospective study of 26 patients with acute vestibular syndrome (16 vestibular neuritis, 10 stroke), we classified findings using a structured coding manual. Of 1,358 individual HIT traces, 72% had abnormal disruptive saccades, 44% had at least one artifact, and 42% were uninterpretable. Physicians using quantitative recording devices to measure head impulse VOR responses for clinical diagnosis should be aware of the potential impact of disruptive eye movements and measurement artifacts. i 2014 S. Karger AG, Basel

scholarly journals CAEP 2015 Academic Symposium: Recommendations for University Governance and Administration for Emergency Medicine

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S18-S25 ◽  
Author(s):  
David Petrie ◽  
Anil Chopra ◽  
Alecs Chochinov ◽  
Jennifer D. Artz ◽  
Michael Schull ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Good Governance ◽  
Local Environment ◽  
Essential Elements ◽  
Current Status ◽  
Emergency Physicians ◽  
Canadian Association ◽  
Academic Units ◽  
Research And Education ◽  
Exceptional Patient

AbstractObjective1) To identify the strengths and challenges of governance structures in academic emergency medicine (EM), and 2) to make recommendations on principles and approaches that may guide improvements.MethodsOver the course of 9 months, eight established EM leaders met by teleconference, reviewed the literature, and discussed their findings and experiences to arrive at recommendations on governance in academic units of EM. The results and recommendations were presented at the annual Canadian Association of Emergency Physicians (CAEP) Academic Symposium, where attendees provided feedback. The updated recommendations were subsequently distributed to the CAEP Academic Section for further input, and the final recommendations were decided by consensus.ResultsThe panel identified four governance areas of interest: 1) the elements of governance; 2) the relationships between emergency physicians and academic units of EM, and between the academic units of EM and faculty of medicine; 3) current status of governance in Canadian academic units of EM; and 4) essential elements of good governance. Six recommendations were developed around three themes, including 1) the importance of good governance; 2) the purposes of an academic unit of EM; and 3) essential elements for better governance for academic units of EM. Recommendations included identifying the importance of good governance, recognizing the need to adapt to the different models depending on the local environment; seeking full departmental status, provided it is mutually beneficial to EM and the faculty of medicine (and health authority); using a consultation service to learn from the experience of other academic units of EM; and establishing an annual forum for EM leaders.ConclusionAlthough governance of academic EM is complex, there are ways to iteratively improve the mission of academic units of EM: providing exceptional patient care through research and education. Although there is no one-size-fits-all guide, there are practical recommended steps for academic units of EM to consider.

scholarly journals Emergency medicine training in Canada: a survey of medical students' knowledge, attitudes, and preferences

CJEM ◽  
2011 ◽  
Vol 13 (04) ◽  
pp. 251-258 ◽  
Author(s):  
Morgan Hillier ◽  
Shelley McLeod ◽  
Danny Mendelsohn ◽  
Bradley Moffat ◽  
Audra Smallfield ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Medical Students ◽  
Family Medicine ◽  
Training Program ◽  
Residency Training ◽  
Residency Training Program ◽  
Factors Affecting ◽  
Factors Influencing ◽  
The University ◽  
And Control

ABSTRACTObjectives:The objective of this study was to assess medical students' knowledge of and attitudes toward the two Canadian emergency medicine (EM) residency programs (Fellow of the Royal College of Physicians of Canada [FRCPC] and Certificant of the College of Family Physicians-Emergency Medicine [CCFP-EM]). Additionally, medical students interested in EM were asked to select factors affecting their preferred choice of residency training program and their intended future practice.Methods:Medical students enrolled at The University of Western Ontario for the 2008–2009 academic year were invited to complete an online 47-item questionnaire pertaining to their knowledge, opinions, and attitudes toward EM residency training.Results:Of the 563 students invited to participate, 406 (72.1%) completed the survey. Of the respondents, 178 (43.8%) expressed an interest in applying to an EM residency training program, with 85 (47.8%) most interested in applying to the CCFP-EM program.The majority of respondents (54.1%) interested in EM believed that there should be two streams to EM certification, whereas 18.0% disagreed. Family life and control over work schedule appeared to be common priorities seen as benefits of any career in EM. Other high-ranking factors influencing career choice differed between the groups interested in CCFP-EM and FRCPC. The majority of students interested in the CCFP-EM residency program (78%) reported that they intend to blend their EM with their family medicine practice. Only 2% of students planned to practice only EM with no family medicine.Conclusions:This is the first survey of Canadian medical students to describe disparities in factors influencing choice of EM residency stream, perceptions of postgraduate work life, and anticipated practice environment.

Misleading signs in acute vertigo

2017 ◽  
Vol 18 (2) ◽  
pp. 162-165 ◽  
Author(s):  
Sean Lance ◽  
Stuart Scott Mossman
Keyword(s):  
Benign Paroxysmal Positional Vertigo ◽  
Correct Diagnosis ◽  
Clinical Findings ◽  
Head Impulse Test ◽  
Head Impulse ◽  
Positional Vertigo ◽  
Acute Vestibular Syndrome ◽  
Horizontal Head ◽  
Fourth Nerve Palsy ◽  
Paroxysmal Positional Vertigo

The acute vestibular syndrome is common and usually has a benign cause. Sometimes, however, even experienced neurologists can find it difficult to determine the cause clinically. Furthermore, neuroimaging is known to be insensitive.We describe two cases of acute vestibular syndrome where conflicting clinical findings contributed to a delay in making the correct diagnosis. The first patient with symptomatic vertigo had signs consistent with horizontal benign paroxysmal positional vertigo but also had an abnormal horizontal head impulse test, superficially suggesting acute vestibular neuritis but later accounted for by the finding of a vestibular schwannoma (acoustic neuroma). The second patient also had an abnormal horizontal head impulse test, with skew deviation suggesting stroke as the cause. However, later assessment identified that a long-standing fourth nerve palsy was the true cause for her apparent skew. We discuss potential errors that can arise when assessing such patients and highlight ways to avoid them.

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