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25 episodes with canadiem
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This week, Dr Libby Sampey interviews Ian Lee on impromptu teaching on the medical ward. Ian discusses the importance in facilitating teaching on the wards and how to recognise and overcome challenges, as both educators and learners, to provide good quality training in a clinical setting. Ian Lee is a Lecturer in Medical Education and Senior Fellow of the Higher Education Academy who works mainly on the University of Edinburgh's Clinical Educator Programme. With a background in nursing, Ian's past clinical teaching includes; teaching resuscitation and clinical skills; ALS instruction; roles in simulation based education and of course supporting medical and nursing students on clinical placement in patient facing clinical settings which is what forms the basis of today's Clinical Conversation. Now in full time academia, Ian continues to share his experiences of working with learners in clinical settings and augments this with evidence from the literature as well as insights developed from hosting workshops on similar topics. Recording Date: 31 March 2023 --Useful Links-- Clinical Educator Programme website - https://www.clinicaleducator.org/en-gb/ A five-step "microskills" model of clinical teaching, by Neher et al. (1992) - https://pubmed.ncbi.nlm.nih.gov/1496899/ Teaching That Counts: The One-Minute Preceptor Model from CanadiEM - https://canadiem.org/teaching-that-counts-the-one-minute-preceptor-model/ SNAPPS: a learner-centered model for outpatient education, by Wolpaw, Wolpaw & Papp (2003) - https://doi.org/10.1097/00001888-200309000-00010 Learning and teaching in the clinical environment, by Spencer (2003) - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1125480/ -- Follow us -- https://www.instagram.com/rcpedintrainees https://twitter.com/RCPEdinTrainees -- Upcoming RCPE Events -- https://events.rcpe.ac.uk/ Feedback: cme@rcpe.ac.uk
In the final episode of the series, Sam Savard interviews Dr. Kevin Wasko on the power packed panel he hosted. Additionally, we highlight a member of the CanadiEM team who was featured in the conference.
As the highly anticipated annual CAEP conference approaches, we are thrilled to announce our partnership with CanadiEM to bring you "The CAEP Capsule," a dynamic podcast series that will give you a brief overview of each conference day. Get ready for insightful interviews, succinct summaries, and thought-provoking discussions, all designed to capture the essence of this renowned conference. The first episode serves as a trailer to both the conference and the series. Stay tuned for more amazing summaries from CAEP 2023!
Overview: In this episode, Tiffany shares her transition from Resident to Med Staff during the COVID pandemic. She candidly shares her challenges balancing job uncertainty, family, kid zoom classes, finishing residency and a cross country move. Take a listen! Host: Tiffany Proffitt DO, Staff Emergency Medicine Physician Honor Health Short Bio: Dr. Tiffany Proffitt is an Emergency Medicine Physician in Scottsdale, Arizona, USA. I completed residency in Michigan, USA with Spectrum Health Lakeland. During my time I graduated from the Medical Education Track. I am honored to be one of the inaugural fellows of EMRACAST, the official resident run podcast of EMRA. In my Med Staff life I am the co-founder of the HonorHealth Women Physicians Leadership Council, advancing leadership opportunities for over 550 women physicians. In my spare time, I cart my twin eight-year-olds to various activities, laugh with my husband and podcast! I am a MedEd enthusiast and proud to be part of the CanadiEM team!
Welcome to Episode 38 of our MacEmerg podcast. In this episode: 1) Dr. James Leung explains what we can do to enhance pediatric preparedness. 2) Dr. Monika Bilic tells the story behind the CanadiEM Junior Learner Primer in this month's resident's corner. This is a free app that has been generously supported by the Government of Ontario's Virtual Learning Strategy program from eCampus Ontario. Apple store link: https://apps.apple.com/ca/app/canadiem/id1596525775 Google Play store link: https://apps.apple.com/ca/app/canadiem/id1596525775 ALSO, make sure to check out our new DIY Mentorship Playbook - on sale now! https://www.macpfd.ca/modalities/coaching-mentorship/1on1-diy-mentorship-playbook
In this episode, hosts Jayneel Limbachia, Dakoda Herman, and Jake Domm discuss ECMO and mature ECMO programs, appraise the ARREST trial and consider the future of cardiac arrest care with expert guest Dr. James Gould. References: Yannopoulos D, Bartos J, Raveendran G, Walser E, Connett J, Murray TA, Collins G, Zhang L, Kalra R, Kosmopoulos M, John R, Shaffer A, Frascone RJ, Wesley K, Conterato M, Biros M, Tolar J, Aufderheide TP. Advanced reperfusion strategies for patients with out-of-hospital cardiac arrest and refractory ventricular fibrillation (ARREST): a phase 2, single centre, open-label, randomised controlled trial. Lancet. 2020 Dec 5;396(10265):1807-1816. doi: 10.1016/S0140-6736(20)32338-2. Epub 2020 Nov 13. PMID: 33197396; PMCID: PMC7856571. Lamhaut L, Hutin A, Puymirat E, Jouan J, Raphalen JH, Jouffroy R, Jaffry M, Dagron C, An K, Dumas F, Marijon E, Bougouin W, Tourtier JP, Baud F, Jouven X, Danchin N, Spaulding C, Carli P. A Pre-Hospital Extracorporeal Cardio Pulmonary Resuscitation (ECPR) strategy for treatment of refractory out hospital cardiac arrest: An observational study and propensity analysis. Resuscitation. 2017 Aug;117:109-117. doi: 10.1016/j.resuscitation.2017.04.014. Epub 2017 Apr 14. PMID: 28414164. Matsuoka Y, Goto R, Atsumi T, Morimura N, Nagao K, Tahara Y, Asai Y, Yokota H, Ariyoshi K, Yamamoto Y, Sakamoto T; SAVE-J Study Group. Cost-effectiveness of extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest: A multi-centre prospective cohort study. Resuscitation. 2020 Dec;157:32-38. doi: 10.1016/j.resuscitation.2020.10.009. Epub 2020 Oct 17. PMID: 33080369. Grunau B, Shemie SD, Wilson LC, Dainty KN, Nagpal D, Hornby L, Lamarche Y, van Diepen S, Kanji HD, Gould J, Saczkowski R, Brooks SC. Current Use, Capacity, and Perceived Barriers to the Use of Extracorporeal Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrest in Canada. CJC Open. 2020 Nov 13;3(3):327-336. doi: 10.1016/j.cjco.2020.11.005. PMID: 33778449; PMCID: PMC7985000. Sun T, Guy A, Sidhu A, Finlayson G, Grunau B, Ding L, Harle S, Dewar L, Cook R, Kanji HD. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for emergency cardiac support. J Crit Care. 2018 Apr;44:31-38. doi: 10.1016/j.jcrc.2017.10.011. Epub 2017 Oct 12. PMID: 29040883. Hsu CH, Meurer WJ, Domeier R, Fowler J, Whitmore SP, Bassin BS, Gunnerson KJ, Haft JW, Lynch WR, Nallamothu BK, Havey RA, Kidwell KM, Stacey WC, Silbergleit R, Bartlett RH, Neumar RW. Extracorporeal Cardiopulmonary Resuscitation for Refractory Out-of-Hospital Cardiac Arrest (EROCA): Results of a Randomized Feasibility Trial of Expedited Out-of-Hospital Transport. Ann Emerg Med. 2021 Jul;78(1):92-101. doi: 10.1016/j.annemergmed.2020.11.011. Epub 2021 Feb 1. PMID: 33541748; PMCID: PMC8238799.
In this episode, Tiffany talks with Dr. Kevin Dong from Hamilton, Canada, and CanadiEM podcast extraordinaire! We reflect on two years of practicing medicine during the COVID pandemic and share our own unique challenges, lessons learned and motivation to continue to work in the department as we enter our third year of the pandemic. Take a listen! Short Bio: Dr. Kevin Dong. Kevin is an Emergency Medicine physician at the Hamilton Health Sciences in Hamilton, Canada. He is an assistant clinical professor at McMaster University and he is currently the Director of Continuing Professional Development with the Tri-Divisions of Emergency Medicine. He is a FOAMed enthusiast and is heavily involved in the CanadiEM world. Twitter: @kevinjdongMD
Welcome to Episode 13 of “The 2 View,” the podcast for EM and urgent care nurse practitioners and physician assistants! Show Notes for Episode 13 of “The 2 View” – Nystagmus, SCAD, Sotromivab, Paxlovid, Molnupivarvir, and more. Nystagmus Mehar A. CanadiEM Frontline Primer - Vertigo workup. CanadiEM. Published April 25, 2020. Accessed January 11, 2022. https://canadiem.org/canadiem-frontline-primer-vertigo/ Nystagmus. NeurologyNeeds.com. Accessed January 11, 2022. https://www.neurologyneeds.com/neurological-examination-tips-tricks/nystagmus/ Nystagmus. The Proceduralist. Published January 10, 2022. Accessed January 11, 2022. https://www.youtube.com/watch?v=fW3sVsNgJ2k Talmud JD, Coffey R, Edemekong PF. Dix Hallpike Maneuver. NCBI. StatPearls Publishing. Last Update December 19, 2021. Accessed January 11, 2022. https://www.ncbi.nlm.nih.gov/books/NBK459307/ SCAD Beardsell L. Preventing mid-life spontaneity becoming a crisis - SCAD as a serious cause of chest pain. St Emlyn's. St.Emlyn's Emergency Medicine. Published May 29, 2021. Accessed January 11, 2022. https://www.stemlynsblog.org/scad/ Durrani M. Spontaneous Coronary Artery Dissection (SCAD). REBEL EM - Emergency Medicine Blog. Published October 19, 2020. Accessed January 11, 2022. https://rebelem.com/spontaneous-coronary-artery-dissection-scad/ Hayes SN, Tweet MS, Adlam D, et al. Spontaneous Coronary Artery Dissection: JACC State-of-the-Art Review. J Am Coll Cardiol. Published August 2020. Accessed January 11, 2022. https://www.jacc.org/doi/abs/10.1016/j.jacc.2020.05.084 Johnson AK, Tweet MS, Rouleau SG, Sadosty AT, Raukar NP. 243 Spontaneous Coronary Artery Dissection in the Emergency Department: The Elusive Dissection. Ann Emerg Med. Published October 1, 2020. Accesseed January 11, 2022. https://www.annemergmed.com/article/S0196-0644(20)31003-9/fulltext#relatedArticles Kim ESH. Spontaneous Coronary-Artery Dissection. N Engl J Med. Published December 10, 2020. Accessed January 11, 2022. https://www.nejm.org/doi/full/10.1056/NEJMra2001524 Sotromivab, Paxlovid and Molnupivarvir Beigel JH, Tomashek KM, Dodd LE, et al. Remdesivir for the Treatment of Covid-19 - Final Report. N Engl J Med. Published November 5, 2020. Accessed January 11, 2022. https://www.nejm.org/doi/full/10.1056/nejmoa2007764 Jayk Bernal A, Gomes da Silva MM, Musungaie DB, et al. Molnupiravir for Oral Treatment of Covid-19 in Nonhospitalized Patients. N Engl J Med. Published online December 16, 2021. Accessed January 11, 2022. https://www.nejm.org/doi/full/10.1056/NEJMoa2116044 PAXLOVIDTM (nirmatrelvir tablets; ritonavir tablets): Now Authorized for Emergency Use. For Patients. Pfizer. Covid19oralrx-patient.com. Accessed January 11, 2022. https://www.covid19oralrx-patient.com/ Sotrovimab. Sotrovimab.com. GSK. Accessed January 11, 2022. https://www.sotrovimab.com/ Guest Interview: JIM ROBERTS - IVERMECTIN Bryant A, Lawrie T, Dowswell T, et al. Ivermectin for Prevention and Treatment of COVID-19 Infection: A Systematic Review, Meta-analysis, and Trial Sequential Analysis to Inform Clinical Guidelines. American Journal of Therapeutics. Lww.com. Published July/August 2021. Accessed January 11, 2022. https://journals.lww.com/americantherapeutics/fulltext/2021/08000/ivermectinforpreventionandtreatment_of.7.aspx Em-news.com. Accessed January 11, 2022. http://www.em-news.com Kory P MD, Meduri GU MD, Iglesias J, et al. Review of the Emerging Evidence Demonstrating the Efficacy of Ivermectin in the Prophylaxis and Treatment of COVID-19. Published online 2020. Updated January 16, 2021. Accessed January 11, 2022. https://covid19criticalcare.com/wp-content/uploads/2020/11/FLCCC-Ivermectin-in-the-prophylaxis-and-treatment-of-COVID-19.pdf Mike & Martha's Something Sweet: Safest Countries in the World in 2021 Safest Countries in the World 2021. Worldpopulationreview.com. Accessed January 11, 2022. https://worldpopulationreview.com/country-rankings/safest-countries-in-the-world Recurring Sources Center for Medical Education. Ccme.org. http://ccme.org The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com Trivia Question: Send answers to 2viewcast@gmail.com Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at 2viewcast@gmail.com and tell us who you want to give a shout-out to. Be sure to listen in – this month we are giving away 20% off of our July Bootcamp Course and lunch with the faculty! Win and join us in Vegas this summer – come and share your ER experiences with us over a good meal.
CanadiEM Journal Club E04 Systematic reviews and meta analyses show notes Welcome back to Journal Club by CanadiEM! In this episode we go over an approach to systematic reviews and meta analyses based on Oxford centre of EBM, and learn about diagnosing pneumothorax with ultrasound vs X-ray Using the Oxford centre of EBM tool, we will ask: What question(s) did the systematic review address? Is it likely that important, relevant studies were missed? Were the criteria used to select articles for inclusion appropriate? Were the included studies sufficiently valid for the type of question asked? Were the results similar from study to study? What were the results? What is the clinical significance of the results? and then a clinical pearl on pneumothorax!! Hosts: Dakoda Herman Jayneel Limbachia Jake Domm Paper: “Chest ultrasonography versus supine chest radiography for diagnosis of pneumothorax in trauma patients in the emergency department” Cochrane Database of Systematic Reviews by Chan KK, Joo DA, McRae AD, Takwoingi Y, Premji ZA, Lang E, Wakai A What question(s) did the systematic review address? P: Trauma patients in the ER I: chest ultrasonography by non rad physicians C: Chest xray O: diagnosis of pneumothorax, improved patient safety Secondary: investigate potential sources of hetero such as type of CUS operator, type of trauma, type of US probe on test accuracy T: inception to 10 April 2020 Is it unlikely that important, relevant studies were missed? This study included prospective, paired comparative accuracy studies in which patients were suspected of having pneumothorax. Patients must have undergone both CUS by a frontline non-radiologist and CXR, as well as CT of the chest or tube thoracostomy as the reference standard. The authors carried out systematic searches in the following electronic databases: Cochrane Database of Systematic Reviews; Cochrane Central Register of Controlled Trials; MEDLINE; Embase; Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus; Database of Abstracts of Reviews of EIects; Web of Science core collection (which includes: Science Citation Index Expanded; Social Sciences Citation Index; Arts & Humanities Citation Index; Conference Proceedings Citation Index - Science; Conference Proceedings Citation Index - Social Sciences & Humanities; and Emerging Sources Citation Index; and Clinicaltrials.gov from database creation to April 2020. The authors also handsearched reference lists of included articles and reviews, retrieved via electronic searching, for potentially eligible studies. Additionally, they carried out forward citation searching of relevant articles in Google Scholar and looked at the “Related articles” on PubMed. They did not limit the search to Englsih language only and included articles published in all languages. Their search strategy in volved the use of MeSH terms such as Pneumothorax, Radiography, Ultrasonography, and focused assessment with ultrasonography for trauma. They also used many text words. Using this search strategy 3473 records were identified. 1180 duplicated records were removed, leaving 2293 records to be screened. These records were screened by two of the authors for their relevance, when there was a discrepancy a third author decided whether to include the record or not. 2268 records were excluded, leaving 25 full-text articles that were assessed for eligibility. 12 studies were excluded - 5 missing CUS/CXR/CT chest/chest tube, 4 CUS not performed by frontline non-radiologist physicians, 2 wrong patient population, 1 wrong study design. A total of 13 studies were included in qualitative and quantitative analysis. 9 studies using patients as units of analysis included in primary analysis. 4 studies using lung fields as units of analysis included in secondary analysis. Authors provide a nice figure depicting this. Authors did not contact experts for unpublished data but were very thorough and transparent in their search strategy. I think it is unlikely that important, relevant studies were missed. Were the criteria used to select articles for inclusion appropriate? The authors of this study clearly outlined their study inclusion and exclusion criteria. They included prospective, comparative accuracy studies in which patients were suspected of having pneumothorax. They included trauma patients in the emergency department setting. Patients must have undergone both CUS by frontline non-radiologist physicians and CXR as index tests, as well as CT of the chest or tube thoracostomy as the reference standard. The two main index tests were CUS completed by a frontline nonradiologist physician and CXR, both being performed in the supine position. If data on specific CUS findings (such as the absence of lung sliding, absence of B-lines or comet-tail artefact, presence of lung point, and absence of lung pulse) were available, they planned to assess the diagnostic accuracy of these individual CUS findings. The target condition was traumatic pneumothorax of any severity. They defined a pneumothorax identified on CT scan of the chest or via clinical findings of a rush of air or bubbling in a chest drain after tube thoracostomy as the reference standard. The authors excluded studies involving participants with already diagnosed pneumothorax (i.e. case-control studies); studies involving participants with nontraumatic pneumothorax; studies involving participants who had already been treated with tube thoracostomy; and studies in which a frontline non-radiologist physician did not perform CUS. These criteria were appropriate for inclusion. However, many studies did differ in their units of measurement - lung fields vs. patients, which could introduce significant bias into the results of individual studies. Were the included studies sufficiently valid for the type of question asked? The authors used the QUADAS-2 tool to assess risk of bias and the applicability of each included study. This tool assesses risk of bias in four domains: patient selection; index tests; reference standard; and flow and timing. In addition, they examined concerns about applicability in the first three domains. They tailored the tool to their review question - one of the signalling questions in the patient selection domain was not applicable because they excluded case-control studies; therefore they deleted this question from the tool. Two review authors performed the assessments independently. They discussed and resolved any disagreements that arose through consultation with a third review author. They included a figure describing their assessments of study quality. Of the nine studies that we included in the primary analysis: One had a low risk of bias, two had an unclear risk, and six had high risk of bias in the patient selection domain, mostly due to convenience sampling or inappropriate exclusion criteria, such as excluding haemodynamically unstable patients, lack of access to CUS, chest wall injuries precluding CUS, or if CT was not indicated. The risk of bias in the interpretation of CUS results was low in five studies, unclear in two studies, and high in two studies; this was related to unclear blinding methodology of outcome assessors interpreting CUS and CXR results. The risk of bias in the interpretation of CXR results was low in two studies, unclear in six studies, and high in one study; this was largely due to unclear blinding methodology of outcome assessors interpreting CXR and CT results, as in some studies it was not clear whether radiologists had access to both imaging results or not. The risk of bias introduced in interpretation of the reference standard results was low in three studies but unclear in the remainder for similar concerns regarding blinding methodology. The risk of bias in the flow and timing domain was low in two studies, unclear in four studies, and high in three studies; this was due to the exclusion of patients based on missing CT data or unclear/inappropriate time intervals between CUS, CXR, and CT. They judged applicability concerns regarding patient selection as low for six studies but high for three studies; this was due to the exclusion of haemodynamically unstable patients or lack of access to CUS despite the study focusing on comparing CUS. They judged one included study to have unclear concern regarding applicability of the reference standard used as there was insuIicient reporting of the method of assessment. They deemed all other domains for applicability concerns as low risk for all studies. Studies that used lung fields as their unit of analysis had several limitations including missing CUS data for some lung fields and using two CUS tests (one for each lung field) compared to one CXR (for both lungs) on the same patient. Inherently, there would be an inability to blind the CUS operator during collection of CUS data while performing the two CUS tests (one on each side of the patient), as well as during the interpretation of the CXR and CT results between the two lung fields. By analysing lung fields separately, it is diIicult to ascertain whether patient characteristics, past medical history, or traumatic injury pattern could have affected one or both lungs and may have confounded the diagnostic accuracy. Out of the four studies included in the secondary analysis: The risk of bias in the patient selection domain was low in one study, unclear in two studies, and high in one study; this was due to inappropriate exclusion criteria, such as excluding haemodynamically unstable patients or chest wall injuries precluding CUS, or due to unclear sampling technique. The risk of bias introduced in interpreting CUS results was low in two studies and unclear in two studies due to lack of clarity about blinding of the outcome assessors interpreting CUS and CXR results. The risk of bias introduced in interpreting CXR and CT results to be low in one study, unclear in two studies, and high in one study; this was again due to definite unblinded interpretation of test results or unclear blinding methodology of outcome assessors interpreting CXR and CT results. The risk of bias in the flow and timing domain was low in two studies and high in two studies due to missing patient data. They judged applicability concerns in the patient selection domain as low for two studies, unclear for one study, and high for one study, due to unclear patient selection methods and exclusion of haemodynamically unstable patients or chest wall injuries precluding CUS. They judged one study to have unclear concern regarding applicability of the reference standard, as blinding of the outcome assessor interpreting the results of CUS, CXR, and CT was unclear. We deemed all other domains as 'low concern' for all studies. The authors were thorough in their assessment of each study's quality and discussed how this may have impacted the results. The most common area of bias seemed to be in patient selection where 11/13 studies were judged to be at unclear or high risk of bias. Were the results similar from study to study? Substantial heterogeneity in sensitivity analysis of supine CXR Based on Figure 4, Forest plot: Sensitivity ranged from 0.09 to 0.75 Wide and non overlapping confidence intervals are suggestive of high variability between studies Limits the evidence But they do not list the reasons for why such heterogeneity exists Some possibilities for the heterogeneity include the high or unclear risk of bias of included studies There is no I squared statistic shown - a statistical measure that confirms the presence of significant heterogeneity in a meta-analysis Results of the study: Included 13 studies, 1271 trauma patients with 410 who had a pneumothorax 9 studies used patients as unit of analysis 4 studies used lung field as unit of analysis Most studies were high or unclear risk of bias - 11/13 CUS sensitivity and specificity: 0.91 (95% CI: 0.85 - 0.94) and 0.99 (95% CI: 0.97 - 1.00) CXR sensitivity and specificity: 0.47 (95% CI: 0.31 - 0.63) and 1.00 (95% CI: 0.97 - 1.00) Difference in sensitivity: 0.44 (95% CI: 0.27 - 0.61) Practise Changing? This is an excellently executed Systematic Review that makes the most of the limited evidence available and presents such in a transparent way. The results of this study suggest that CUS has better sensitivity in detecting pneumothorax in the emergency department than CXR, and comparable specificity. This publication adds to the body of research that is building in support of US in the primary care setting, and promotes a change in culture as US adoption rates grow. Clinical pearl: Pneumothorax, or, air in the pleural space, is a fairly common complication of thoracic traumas, occurring 15-50% of the time. History: If you're able to get a history, and often you won't be able to, you'll hear about a Sudden, severe, chest pain, sometimes referred to shoulder and maybe associated pleuritic pain or SOB. On Exam: Exam findings range from nothing to respiratory distress and shock. May have decreased chest wall motion, subcutaneous emphysema, or poprock skin, hyperresonance, or decreased or absent breath sounds on the affected side. Imaging: traditionally via x-ray or US depending on physician. On xray: Absence of lung markings beyond the edge of the lung. The edge of the scapula or upper ribs are often mistaken for a pneumothorax. On US: Scan over the most upright part of the patient's chest. if supine go right over the top of their chest (third or fourth intercostal space in the midclavicular line and is repeated on both sides) and if upright scan the apices. Looking for lung sliding and the classic “seashore sign” in M-mode in normal lungs, or absence of lung sliding and “barcode sign” seen in pneumothorax. There are tons of good videos online to take a look at. CT is gold standard, but rarely necessary - Rush of air on thoracostomy is also diagnostic. - Treatment: varies based on severity, from no treatment if patient tolerating well, to drains and chest tubes, to needle or finger thoracostomy for immediate decompression if pneumothorax clinically indicated and hypotension.
CanadiEM Journal Club E04 Systematic reviews and meta analyses show notes Welcome back to Journal Club by CanadiEM! In this episode we go over an approach to systematic reviews and meta analyses based on Oxford centre of EBM, and learn about diagnosing pneumothorax with ultrasound vs X-ray Using the Oxford centre of EBM tool, we will ask: What question(s) did the systematic review address? Is it likely that important, relevant studies were missed? Were the criteria used to select articles for inclusion appropriate? Were the included studies sufficiently valid for the type of question asked? Were the results similar from study to study? What were the results? What is the clinical significance of the results? and then a clinical pearl on pneumothorax!! Hosts: Dakoda Herman Jayneel Limbachia Jake Domm Paper: “Chest ultrasonography versus supine chest radiography for diagnosis of pneumothorax in trauma patients in the emergency department” Cochrane Database of Systematic Reviews by Chan KK, Joo DA, McRae AD, Takwoingi Y, Premji ZA, Lang E, Wakai A What question(s) did the systematic review address? P: Trauma patients in the ER I: chest ultrasonography by non rad physicians C: Chest xray O: diagnosis of pneumothorax, improved patient safety Secondary: investigate potential sources of hetero such as type of CUS operator, type of trauma, type of US probe on test accuracy T: inception to 10 April 2020 Is it unlikely that important, relevant studies were missed? This study included prospective, paired comparative accuracy studies in which patients were suspected of having pneumothorax. Patients must have undergone both CUS by a frontline non-radiologist and CXR, as well as CT of the chest or tube thoracostomy as the reference standard. The authors carried out systematic searches in the following electronic databases: Cochrane Database of Systematic Reviews; Cochrane Central Register of Controlled Trials; MEDLINE; Embase; Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus; Database of Abstracts of Reviews of EIects; Web of Science core collection (which includes: Science Citation Index Expanded; Social Sciences Citation Index; Arts & Humanities Citation Index; Conference Proceedings Citation Index - Science; Conference Proceedings Citation Index - Social Sciences & Humanities; and Emerging Sources Citation Index; and Clinicaltrials.gov from database creation to April 2020. The authors also handsearched reference lists of included articles and reviews, retrieved via electronic searching, for potentially eligible studies. Additionally, they carried out forward citation searching of relevant articles in Google Scholar and looked at the “Related articles” on PubMed. They did not limit the search to Englsih language only and included articles published in all languages. Their search strategy in volved the use of MeSH terms such as Pneumothorax, Radiography, Ultrasonography, and focused assessment with ultrasonography for trauma. They also used many text words. Using this search strategy 3473 records were identified. 1180 duplicated records were removed, leaving 2293 records to be screened. These records were screened by two of the authors for their relevance, when there was a discrepancy a third author decided whether to include the record or not. 2268 records were excluded, leaving 25 full-text articles that were assessed for eligibility. 12 studies were excluded - 5 missing CUS/CXR/CT chest/chest tube, 4 CUS not performed by frontline non-radiologist physicians, 2 wrong patient population, 1 wrong study design. A total of 13 studies were included in qualitative and quantitative analysis. 9 studies using patients as units of analysis included in primary analysis. 4 studies using lung fields as units of analysis included in secondary analysis. Authors provide a nice figure depicting this. Authors did not contact experts for unpublished data but were very thorough and transparent in their search strategy. I think it is unlikely that important, relevant studies were missed. Were the criteria used to select articles for inclusion appropriate? The authors of this study clearly outlined their study inclusion and exclusion criteria. They included prospective, comparative accuracy studies in which patients were suspected of having pneumothorax. They included trauma patients in the emergency department setting. Patients must have undergone both CUS by frontline non-radiologist physicians and CXR as index tests, as well as CT of the chest or tube thoracostomy as the reference standard. The two main index tests were CUS completed by a frontline nonradiologist physician and CXR, both being performed in the supine position. If data on specific CUS findings (such as the absence of lung sliding, absence of B-lines or comet-tail artefact, presence of lung point, and absence of lung pulse) were available, they planned to assess the diagnostic accuracy of these individual CUS findings. The target condition was traumatic pneumothorax of any severity. They defined a pneumothorax identified on CT scan of the chest or via clinical findings of a rush of air or bubbling in a chest drain after tube thoracostomy as the reference standard. The authors excluded studies involving participants with already diagnosed pneumothorax (i.e. case-control studies); studies involving participants with nontraumatic pneumothorax; studies involving participants who had already been treated with tube thoracostomy; and studies in which a frontline non-radiologist physician did not perform CUS. These criteria were appropriate for inclusion. However, many studies did differ in their units of measurement - lung fields vs. patients, which could introduce significant bias into the results of individual studies. Were the included studies sufficiently valid for the type of question asked? The authors used the QUADAS-2 tool to assess risk of bias and the applicability of each included study. This tool assesses risk of bias in four domains: patient selection; index tests; reference standard; and flow and timing. In addition, they examined concerns about applicability in the first three domains. They tailored the tool to their review question - one of the signalling questions in the patient selection domain was not applicable because they excluded case-control studies; therefore they deleted this question from the tool. Two review authors performed the assessments independently. They discussed and resolved any disagreements that arose through consultation with a third review author. They included a figure describing their assessments of study quality. Of the nine studies that we included in the primary analysis: One had a low risk of bias, two had an unclear risk, and six had high risk of bias in the patient selection domain, mostly due to convenience sampling or inappropriate exclusion criteria, such as excluding haemodynamically unstable patients, lack of access to CUS, chest wall injuries precluding CUS, or if CT was not indicated. The risk of bias in the interpretation of CUS results was low in five studies, unclear in two studies, and high in two studies; this was related to unclear blinding methodology of outcome assessors interpreting CUS and CXR results. The risk of bias in the interpretation of CXR results was low in two studies, unclear in six studies, and high in one study; this was largely due to unclear blinding methodology of outcome assessors interpreting CXR and CT results, as in some studies it was not clear whether radiologists had access to both imaging results or not. The risk of bias introduced in interpretation of the reference standard results was low in three studies but unclear in the remainder for similar concerns regarding blinding methodology. The risk of bias in the flow and timing domain was low in two studies, unclear in four studies, and high in three studies; this was due to the exclusion of patients based on missing CT data or unclear/inappropriate time intervals between CUS, CXR, and CT. They judged applicability concerns regarding patient selection as low for six studies but high for three studies; this was due to the exclusion of haemodynamically unstable patients or lack of access to CUS despite the study focusing on comparing CUS. They judged one included study to have unclear concern regarding applicability of the reference standard used as there was insuIicient reporting of the method of assessment. They deemed all other domains for applicability concerns as low risk for all studies. Studies that used lung fields as their unit of analysis had several limitations including missing CUS data for some lung fields and using two CUS tests (one for each lung field) compared to one CXR (for both lungs) on the same patient. Inherently, there would be an inability to blind the CUS operator during collection of CUS data while performing the two CUS tests (one on each side of the patient), as well as during the interpretation of the CXR and CT results between the two lung fields. By analysing lung fields separately, it is diIicult to ascertain whether patient characteristics, past medical history, or traumatic injury pattern could have affected one or both lungs and may have confounded the diagnostic accuracy. Out of the four studies included in the secondary analysis: The risk of bias in the patient selection domain was low in one study, unclear in two studies, and high in one study; this was due to inappropriate exclusion criteria, such as excluding haemodynamically unstable patients or chest wall injuries precluding CUS, or due to unclear sampling technique. The risk of bias introduced in interpreting CUS results was low in two studies and unclear in two studies due to lack of clarity about blinding of the outcome assessors interpreting CUS and CXR results. The risk of bias introduced in interpreting CXR and CT results to be low in one study, unclear in two studies, and high in one study; this was again due to definite unblinded interpretation of test results or unclear blinding methodology of outcome assessors interpreting CXR and CT results. The risk of bias in the flow and timing domain was low in two studies and high in two studies due to missing patient data. They judged applicability concerns in the patient selection domain as low for two studies, unclear for one study, and high for one study, due to unclear patient selection methods and exclusion of haemodynamically unstable patients or chest wall injuries precluding CUS. They judged one study to have unclear concern regarding applicability of the reference standard, as blinding of the outcome assessor interpreting the results of CUS, CXR, and CT was unclear. We deemed all other domains as 'low concern' for all studies. The authors were thorough in their assessment of each study's quality and discussed how this may have impacted the results. The most common area of bias seemed to be in patient selection where 11/13 studies were judged to be at unclear or high risk of bias. Were the results similar from study to study? Substantial heterogeneity in sensitivity analysis of supine CXR Based on Figure 4, Forest plot: Sensitivity ranged from 0.09 to 0.75 Wide and non overlapping confidence intervals are suggestive of high variability between studies Limits the evidence But they do not list the reasons for why such heterogeneity exists Some possibilities for the heterogeneity include the high or unclear risk of bias of included studies There is no I squared statistic shown - a statistical measure that confirms the presence of significant heterogeneity in a meta-analysis Results of the study: Included 13 studies, 1271 trauma patients with 410 who had a pneumothorax 9 studies used patients as unit of analysis 4 studies used lung field as unit of analysis Most studies were high or unclear risk of bias - 11/13 CUS sensitivity and specificity: 0.91 (95% CI: 0.85 - 0.94) and 0.99 (95% CI: 0.97 - 1.00) CXR sensitivity and specificity: 0.47 (95% CI: 0.31 - 0.63) and 1.00 (95% CI: 0.97 - 1.00) Difference in sensitivity: 0.44 (95% CI: 0.27 - 0.61) Practise Changing? This is an excellently executed Systematic Review that makes the most of the limited evidence available and presents such in a transparent way. The results of this study suggest that CUS has better sensitivity in detecting pneumothorax in the emergency department than CXR, and comparable specificity. This publication adds to the body of research that is building in support of US in the primary care setting, and promotes a change in culture as US adoption rates grow. Clinical pearl: Pneumothorax, or, air in the pleural space, is a fairly common complication of thoracic traumas, occurring 15-50% of the time. History: If you're able to get a history, and often you won't be able to, you'll hear about a Sudden, severe, chest pain, sometimes referred to shoulder and maybe associated pleuritic pain or SOB. On Exam: Exam findings range from nothing to respiratory distress and shock. May have decreased chest wall motion, subcutaneous emphysema, or poprock skin, hyperresonance, or decreased or absent breath sounds on the affected side. Imaging: traditionally via x-ray or US depending on physician. On xray: Absence of lung markings beyond the edge of the lung. The edge of the scapula or upper ribs are often mistaken for a pneumothorax. On US: Scan over the most upright part of the patient's chest. if supine go right over the top of their chest (third or fourth intercostal space in the midclavicular line and is repeated on both sides) and if upright scan the apices. Looking for lung sliding and the classic “seashore sign” in M-mode in normal lungs, or absence of lung sliding and “barcode sign” seen in pneumothorax. There are tons of good videos online to take a look at. CT is gold standard, but rarely necessary - Rush of air on thoracostomy is also diagnostic. - Treatment: varies based on severity, from no treatment if patient tolerating well, to drains and chest tubes, to needle or finger thoracostomy for immediate decompression if pneumothorax clinically indicated and hypotension.
This year, CanadiEM has partnered with the Canadian Association of Emergency Physicians, EMOttawa, and the Skeptic's Guide to Emergency Medicine to help promote #CAEP21: CAEP at the Forks - Rising to the Challenge. From June 15-17, 2021 we will be publishing The CAEP Daily, a journalistic summary of highlights from the conference. Please join the discussion!
CanadiEM has partnered with the Canadian Association of Emergency Physicians, EMOttawa, and the Skeptic's Guide to Emergency Medicine to help promote CAEP at the Forks - Rising to the Challenge. From June 15-17, 2021 we will be publishing The CAEP Daily, a journalistic summary of highlights from the conference. Please join the discussion!
This year, CanadiEM has partnered with the Canadian Association of Emergency Physicians, EMOttawa, and the Skeptic's Guide to Emergency Medicine to help promote #CAEP21: CAEP at the Forks - Rising to the Challenge. From June 15-17, 2021 we will be publishing The CAEP Daily, a journalistic summary of highlights from the conference. Please join the discussion!
CanadiEM has partnered with the Canadian Association of Emergency Physicians, EMOttawa, and the Skeptic's Guide to Emergency Medicine to help promote CAEP at the Forks - Rising to the Challenge. From June 15-17, 2021 we will be publishing The CAEP Daily, a journalistic summary of highlights from the conference. Please join the discussion!
This is the third episode of our CanadiEM's podcast series in collaboration with CAEP 2021. In this episode, Dr. Hans Rosenberg is joined by two CAEP 2021 Track Chairs, who give a sneak peak about the great speakers lined up! First, we are joined by Dr. Ken Milne, who outlines the Recent Emergency Medicine Literature track. Afterwards, Dr. Caroline Kowal highlights the Global Emergency Medicine track.
This is the third episode of our CanadiEM's podcast series in collaboration with CAEP 2021. In this episode, Dr. Hans Rosenberg is joined by two CAEP 2021 Track Chairs, who give a sneak peak about the great speakers lined up! First, we are joined by Dr. Ken Milne, who outlines the Recent Emergency Medicine Literature track. Afterwards, Dr. Caroline Kowal highlights the Global Emergency Medicine track.
This is the third episode of our CanadiEM's podcast series in collaboration with CAEP 2021, with our guest host Ken Milne. You may recognize Ken Milne's voice from the popular podcast Skeptic's Guide to Emergency Medicine. In this series, Ken breaks down will tell you everything you need to know about the upcoming CAEP 2021 conference, CAEP at the Forks: Rising to the Challenge! In today's episode, Ken Milne meets with Dr. Tamara McColl to discuss everything you need to know about the upcoming CAEP conference tracks and plenary speakers. Dr. Tamara McColl breaks down why you should attend the CAEP conference, and what exciting tracks to look out for!
This is the third episode of our CanadiEM's podcast series in collaboration with CAEP 2021, with our guest host Ken Milne. You may recognize Ken Milne's voice from the popular podcast Skeptic's Guide to Emergency Medicine. In this series, Ken breaks down will tell you everything you need to know about the upcoming CAEP 2021 conference, CAEP at the Forks: Rising to the Challenge! In today's episode, Ken Milne meets with Dr. Tamara McColl to discuss everything you need to know about the upcoming CAEP conference tracks and plenary speakers. Dr. Tamara McColl breaks down why you should attend the CAEP conference, and what exciting tracks to look out for!
This is the second episode of our CanadiEM’s podcast series in collaboration with CAEP 2021, with our guest host Ken Milne. You may recognize Ken Milne’s voice from the popular podcast Skeptic’s Guide to Emergency Medicine. In this series, Ken breaks down will tell you everything you need to know about the upcoming CAEP 2021 conference, CAEP at the Forks: Rising to the Challenge! In today’s episode, Ken Milne meets with Dr. Tamara McColl to discuss everything you need to know about the upcoming CAEP pre-conference. Dr. Tamara McColl breaks down the meaning behind CAEP at the Forks, why you should attend the CAEP pre-conference!
This is the second episode of our CanadiEM’s podcast series in collaboration with CAEP 2021, with our guest host Ken Milne. You may recognize Ken Milne’s voice from the popular podcast Skeptic’s Guide to Emergency Medicine. In this series, Ken breaks down will tell you everything you need to know about the upcoming CAEP 2021 conference, CAEP at the Forks: Rising to the Challenge! In today’s episode, Ken Milne meets with Dr. Tamara McColl to discuss everything you need to know about the upcoming CAEP pre-conference. Dr. Tamara McColl breaks down the meaning behind CAEP at the Forks, why you should attend the CAEP pre-conference!
This is the first episode of our CanadiEM's podcast series in collaboration with CAEP 2021, with our guest host Kevin Milne. You may recognize Kevin Milne's voice from the popular podcast Skeptic's Guide to Emergency Medicine. In this series, Kevin breaks down will tell you everything you need to know about the upcoming CAEP 2021 conference, CAEP at the Forks: Rising to the Challenge! In today's episode, Kevin Milne meets with Dr. Tamara McColl to discuss everything you need to about the upcoming CAEP Conference. Dr. Tamara McColl breaks down the meaning behind CAEP at the Forks, why you should attend the CAEP conference and all the details you need to know before attending!
This is the first episode of our CanadiEM's podcast series in collaboration with CAEP 2021, with our guest host Kevin Milne. You may recognize Kevin Milne's voice from the popular podcast Skeptic's Guide to Emergency Medicine. In this series, Kevin breaks down will tell you everything you need to know about the upcoming CAEP 2021 conference, CAEP at the Forks: Rising to the Challenge! In today's episode, Kevin Milne meets with Dr. Tamara McColl to discuss everything you need to about the upcoming CAEP Conference. Dr. Tamara McColl breaks down the meaning behind CAEP at the Forks, why you should attend the CAEP conference and all the details you need to know before attending!
In this collaboration CAEP Conference + CanadiEM promotions podcast episode - We introduce some of our amazing track chairs from the conference. They discuss their guest speakers and some of the awesome content they will be hosting at their respective tracks! Track Chairs - Tracks: Dr. Brandon Ritcey - Procedures Dr. Hasan Sheikh - Advocacy and Public Affairs: Leading System-Wide Change as an Emergency Physician Dr. Lisa Thurgur - CORE-EM Dr. Eddy Lang - Leadership and Admin (LeAd) and Flow Check out the podcast and register for the conference at CAEP Conference website at www.caepconference.ca
In this collaboration CAEP Conference + CanadiEM promotions podcast episode - We introduce some of our amazing track chairs from the conference. They discuss their guest speakers and some of the awesome content they will be hosting at their respective tracks! Track Chairs - Tracks: Dr. Brandon Ritcey - Procedures Dr. Hasan Sheikh - Advocacy and Public Affairs: Leading System-Wide Change as an Emergency Physician Dr. Lisa Thurgur - CORE-EM Dr. Eddy Lang - Leadership and Admin (LeAd) and Flow Check out the podcast and register for the conference at CAEP Conference website at www.caepconference.ca
Purpose: Learn the importance of treatment studies (RCTs) in EBM Understand and interpret methods and results of treatment based studies Become familiar with critically appraising treatment based studies Hosts: Dylan Collins Levi Johnston Dakoda Herman Jayneel Limbachia Jake Domm Paper: Warren, Jaimee, et al. "Antacid Monotherapy Is More Effective in Relieving Epigastric Pain Than in Combination With Lidocaine: A Randomized Double‐blind Clinical Trial." Academic Emergency Medicine 27.9 (2020): 905-909. https://onlinelibrary.wiley.com/doi/epdf/10.1111/acem.14069 EBM Checklist for therapy studies (University of Oxford: https://www.cebm.net/wp-content/uploads/2018/11/RCT.pdf Episode takeaway RCTs are considered gold standard in terms of evidence since the randomization process controls for both known and unknown confounding variables Understanding how to quickly and efficiently appraise studies by assessing its methods is an important skill that can help you assess its utility to your practice and whether the authors adequately answered the question Use a validated critical appraisal tool. We used the CEBM tool, but there are others. The GATE from by Rod Jackson is another great method to learn. Know that sometimes people use publishing guidelines as critical appraisal tools, like the CONSORT for RCTs, but these are just work arounds. Be skeptical and curious. If there is a published protocol, check it. Look at who funded the study. Read the COI and method to mitigate bias.
Purpose: Learn the importance of treatment studies (RCTs) in EBM Understand and interpret methods and results of treatment based studies Become familiar with critically appraising treatment based studies Hosts: Dylan Collins Levi Johnston Dakoda Herman Jayneel Limbachia Jake Domm Paper: Warren, Jaimee, et al. "Antacid Monotherapy Is More Effective in Relieving Epigastric Pain Than in Combination With Lidocaine: A Randomized Double‐blind Clinical Trial." Academic Emergency Medicine 27.9 (2020): 905-909. https://onlinelibrary.wiley.com/doi/epdf/10.1111/acem.14069 EBM Checklist for therapy studies (University of Oxford: https://www.cebm.net/wp-content/uploads/2018/11/RCT.pdf Episode takeaway RCTs are considered gold standard in terms of evidence since the randomization process controls for both known and unknown confounding variables Understanding how to quickly and efficiently appraise studies by assessing its methods is an important skill that can help you assess its utility to your practice and whether the authors adequately answered the question Use a validated critical appraisal tool. We used the CEBM tool, but there are others. The GATE from by Rod Jackson is another great method to learn. Know that sometimes people use publishing guidelines as critical appraisal tools, like the CONSORT for RCTs, but these are just work arounds. Be skeptical and curious. If there is a published protocol, check it. Look at who funded the study. Read the COI and method to mitigate bias.
CAEP and CanadiEM are collaborating to help promote the Virtual CAEP Conference 2021! Did you know Canadian Association of Emergency Physicians (CAEP) is hosting a virtual CAEP Conference in 2021? CAEP at the Forks: Rising to the Challenge When is it? June 15-17, 2021 Where is it? It's virtual but its hosted by the organizers at University of Manitoba, Winnipeg in collaboration with educators from all over Canada. How can I register? caepconference.ca #CAEP2021 The CAEP Conference 2021 Social Media and Promotions team consists of many members of the CanadiEM Leadership as well as some of the most well-known educators in the country. Our goal is to help CAEP promote their amazing annual conference and bring awareness to some of the highlights from the upcoming event. Some of the promotional items coming at you: Pre and In-Conference Podcasts and Videocasts - highlighting our key plenaries, speakers, and providing quick summaries of each day's events. Social Media updates will come regularly, highlighting some of the best from the conference. Infographic summaries and reviews of the day's events and clinical, med-ed, research concepts/pearls. Newsletter updates using our various channels (CAEP Connects, CanadiEM Newsletter, etc.) More to come! If you have ideas, feel free to let us know! Introducing the CAEP Conference Social Media / Promotions Committee Members: Dr. Daniel Ting Dr. Kevin Junghwan Dong Dr. Ken Milne Dr. Hans Rosenberg Dr. Shahbaz Sayed Dr. Fareen Zaver Dr. Alkarim Velji Dr. Sonja Wakeling Dr. Patrick Boreskie Evan Formosa Follow @caepconference on Twitter and stay tuned for more content!
CAEP and CanadiEM are collaborating to help promote the Virtual CAEP Conference 2021! Did you know Canadian Association of Emergency Physicians (CAEP) is hosting a virtual CAEP Conference in 2021? CAEP at the Forks: Rising to the Challenge When is it? June 15-17, 2021 Where is it? It's virtual but its hosted by the organizers at University of Manitoba, Winnipeg in collaboration with educators from all over Canada. How can I register? caepconference.ca #CAEP2021 The CAEP Conference 2021 Social Media and Promotions team consists of many members of the CanadiEM Leadership as well as some of the most well-known educators in the country. Our goal is to help CAEP promote their amazing annual conference and bring awareness to some of the highlights from the upcoming event. Some of the promotional items coming at you: Pre and In-Conference Podcasts and Videocasts - highlighting our key plenaries, speakers, and providing quick summaries of each day's events. Social Media updates will come regularly, highlighting some of the best from the conference. Infographic summaries and reviews of the day's events and clinical, med-ed, research concepts/pearls. Newsletter updates using our various channels (CAEP Connects, CanadiEM Newsletter, etc.) More to come! If you have ideas, feel free to let us know! Introducing the CAEP Conference Social Media / Promotions Committee Members: Dr. Daniel Ting Dr. Kevin Junghwan Dong Dr. Ken Milne Dr. Hans Rosenberg Dr. Shahbaz Sayed Dr. Fareen Zaver Dr. Alkarim Velji Dr. Sonja Wakeling Dr. Patrick Boreskie Evan Formosa Follow @caepconference on Twitter and stay tuned for more content!
Purpose: 1. Learn the importance of treatment studies (RCTs) in EBM 2. Understand and interpret methods and results of treatment based studies 3. Become familiar with critically appraising treatment based studies Hosts: Dylan Collins Levi Johnston Dakoda Herman Jayneel Limbachia Jake Domm Paper: Warren, Jaimee, et al. "Antacid Monotherapy Is More Effective in Relieving Epigastric Pain Than in Combination With Lidocaine: A Randomized Double‐blind Clinical Trial." Academic Emergency Medicine 27.9 (2020): 905-909. https://onlinelibrary.wiley.com/doi/epdf/10.1111/acem.14069EBM Checklist for therapy studies (University of Oxford: https://www.cebm.net/wp-content/uploads/2018/11/RCT.pdf Episode takeaway 1. RCTs are considered gold standard in terms of evidence since the randomization process controls for both known and unknown confounding variables 2. Understanding how to quickly and efficiently appraise studies by assessing its methods is an important skill that can help you assess its utility to your practice and whether the authors adequately answered the question 3. Use a validated critical appraisal tool. We used the CEBM tool, but there are others. The GATE from by Rod Jackson is another great method to learn. Know that sometimes people use publishing guidelines as critical appraisal tools, like the CONSORT for RCTs, but these are just work arounds. 4. Be skeptical and curious. If there is a published protocol, check it. Look at who funded the study. Read the COI and method to mitigate bias.
Purpose: 1. Learn the importance of treatment studies (RCTs) in EBM 2. Understand and interpret methods and results of treatment based studies 3. Become familiar with critically appraising treatment based studies Hosts: Dylan Collins Levi Johnston Dakoda Herman Jayneel Limbachia Jake Domm Paper: Warren, Jaimee, et al. "Antacid Monotherapy Is More Effective in Relieving Epigastric Pain Than in Combination With Lidocaine: A Randomized Double‐blind Clinical Trial." Academic Emergency Medicine 27.9 (2020): 905-909. https://onlinelibrary.wiley.com/doi/epdf/10.1111/acem.14069EBM Checklist for therapy studies (University of Oxford: https://www.cebm.net/wp-content/uploads/2018/11/RCT.pdf Episode takeaway 1. RCTs are considered gold standard in terms of evidence since the randomization process controls for both known and unknown confounding variables 2. Understanding how to quickly and efficiently appraise studies by assessing its methods is an important skill that can help you assess its utility to your practice and whether the authors adequately answered the question 3. Use a validated critical appraisal tool. We used the CEBM tool, but there are others. The GATE from by Rod Jackson is another great method to learn. Know that sometimes people use publishing guidelines as critical appraisal tools, like the CONSORT for RCTs, but these are just work arounds. 4. Be skeptical and curious. If there is a published protocol, check it. Look at who funded the study. Read the COI and method to mitigate bias.
Journal Club by CanadiEM is a podcast designed to help medical learners at all stages of training develop the skills necessary to properly appraise, interpret, and apply medical research to the practice of Emergency Medicine, all in the spirit of evidence based medicine.
Journal Club by CanadiEM is a podcast designed to help medical learners at all stages of training develop the skills necessary to properly appraise, interpret, and apply medical research to the practice of Emergency Medicine, all in the spirit of evidence based medicine.
In this week’s episode, we are covering how to best prepare for your all-important interviews! From what questions to expect to how to leave a positive impression, we cover it all! Helping break this all down for us is a panel of resident guests from diverse programs across Canada: Dr. Larissa Hattin, Dr. Dillan Radomske, and Dr. Ben Forestell. Dr. Larissa Hattin is a 4th-year emergency medicine resident at UBC and co-chief resident of the Victoria site. She completed medical school at McMaster and quickly moved out to the island to escape the snow. This year she is completing her fellowship in Medical Education through Oxford University. Dr. Dillan Radomske went to medical school in Calgary at the Cumming School of Medicine and is now in his third year of emergency medicine resident at the University of Saskatchewan. He is interested in medical education, and some of our listeners may recognize his voice from the CanadiEM CrackCast series. Dr. Ben Forestell is a graduate of McMaster medical school and he is now in his first year of emergency medicine residency, also at McMaster. He is passionate about medical education and has been lucky to be involved with projects like ClerkCast at CanadiEM. Click Here for more information about today's episode.
In this week’s episode, we are covering how to best prepare for your all-important interviews! From what questions to expect to how to leave a positive impression, we cover it all! Helping break this all down for us is a panel of resident guests from diverse programs across Canada: Dr. Larissa Hattin, Dr. Dillan Radomske, and Dr. Ben Forestell. Dr. Larissa Hattin is a 4th-year emergency medicine resident at UBC and co-chief resident of the Victoria site. She completed medical school at McMaster and quickly moved out to the island to escape the snow. This year she is completing her fellowship in Medical Education through Oxford University. Dr. Dillan Radomske went to medical school in Calgary at the Cumming School of Medicine and is now in his third year of emergency medicine resident at the University of Saskatchewan. He is interested in medical education, and some of our listeners may recognize his voice from the CanadiEM CrackCast series. Dr. Ben Forestell is a graduate of McMaster medical school and he is now in his first year of emergency medicine residency, also at McMaster. He is passionate about medical education and has been lucky to be involved with projects like ClerkCast at CanadiEM. Click Here for more information about today's episode.
This new CanadiEM series features Emergency Medicine figures from around Canada while they participate in some sort of ice-breaking activity. First up, how can Dr. Brent Thoma from the University of Saskatchewan manage increasingly spicy chicken wings while talking about his academic interests? This podcast is the audio-only version of a video that you can watch on www.canadiem.org.
This new CanadiEM series features Emergency Medicine figures from around Canada while they participate in some sort of ice-breaking activity. First up, how can Dr. Brent Thoma from the University of Saskatchewan manage increasingly spicy chicken wings while talking about his academic interests? This podcast is the audio-only version of a video that you can watch on www.canadiem.org.
Whether it's a blog, a podcast, a wiki, a tweet, or an infographic, a growing number of doctors now turn online when they need answers. For the past five years, Dr. Brent Thoma has led research supporting the use of free, open-access, and high-quality resources for medical education. “I think we're really elevating our game in medical education, because these resources are available from such exceptional educators and researchers," said Thoma, who specializes in emergency medicine and trauma. He's also the CEO and founder of CanadiEM.org. In this episode, Thoma lays out the risks and rewards of moving medical education from textbooks to the online world. He also explains how to spot false and misleading information. Thoma said the Covid-19 pandemic gives clinicians and researchers a sense of urgency in debunking the proliferation of false and misleading medical statements on social media. “If we're not at the table and having some of these conversations and sharing high quality resources and work, we're just going to get drowned out," he said.
In today’s episode, we cover how to prepare for your upcoming emergency medicine elective and how best to ask for that coveted reference letter. Helping us navigate this subject is our expert guest Dr. Brent Thoma. Dr. Thoma works clinically as a trauma and emergency medicine physician. Academically, he studies technology-enhanced medical education and works for the Royal College of Physicians and Surgeons of Canada as a Clinician Educator. He is also the CEO of CanadiEM. Click here for resources mentioned in today's episode.
In today’s episode, we cover how to prepare for your upcoming emergency medicine elective and how best to ask for that coveted reference letter. Helping us navigate this subject is our expert guest Dr. Brent Thoma. Dr. Thoma works clinically as a trauma and emergency medicine physician. Academically, he studies technology-enhanced medical education and works for the Royal College of Physicians and Surgeons of Canada as a Clinician Educator. He is also the CEO of CanadiEM. Click here for resources mentioned in today's episode.
Welcome to Episode 19 of our MacEmerg podcast. Please take a moment to complete our survey, sharing with us your thoughts on our podcast! This will help us continue to make quality content best suited for our listeners! Click on this link below to complete the survey: https://surveys.mcmaster.ca/limesurvey/index.php/732233 In this episode: 1) Dr. Teresa Chan interviews Tim O'Shea about his work within health advocacy for his patients in Hamilton via the HAMSMaRT (Hamilton Social Medicine Response Team) program. This program is comprised of a team of dedicated health care providers seeking to ensure quality health care to Hamiltonians wherever and whoever they may be. 2)Guest star Dr. Krista Dowhos (PGY-3, CCFP-EM) is back again for another edition of Teaching that Counts with co-hosts Alim Nagji and Teresa Chan. 3) Resident's Corner section features Dr. Joana Dida interviewing Drs. Ben Forestell and Lauren Beals (new PGY1s in the RCPSC program) who are the co-founders of ClerkCast - a limited series that they designed for CanadiEM.org. Find out more about what these talented trainees have to say about the origins of this series. p.s. Don't forget to take our survey: https://surveys.mcmaster.ca/limesurvey/index.php/732233
Welcome to ClerkCast! A podcast for medical students by medical students, focusing on cognitive approaches to common EM presentations. This episode covers how to succeed in the Emergency Department as a medical student with our guest co-host Dr. Teresa Chan, staff EM doc at Hamilton Health Sciences, CanadiEM co-founder, and medical educator extraordinaire We cover: 1. How to structure your differential diagnosis in the ED 2. Eye-balling a patient - edits have been made clarifying the ABCs 3. How to prioritize management in the ED using the RAPID mnemonic 4. How to present a case in the ED 5. Feedback at the end of a shift Enjoy!
An intro to the latest CanadiEM podcast, ClerkCast! Hosted by two McMaster medical students, Lauren Beals and Ben Forestell, ClerkCast is your one stop shop for approaches to common EM presentations... enjoy!
An intro to the latest CanadiEM podcast, ClerkCast! Hosted by two McMaster medical students, Lauren Beals and Ben Forestell, ClerkCast is your one stop shop for approaches to common EM presentations... enjoy!
Welcome to ClerkCast! A podcast for medical students by medical students, focusing on cognitive approaches to common EM presentations. This episode covers how to succeed in the Emergency Department as a medical student with our guest co-host Dr. Teresa Chan, staff EM doc at Hamilton Health Sciences, CanadiEM co-founder, and medical educator extraordinaire We cover: 1. How to structure your differential diagnosis in the ED 2. Eye-balling a patient - edits have been made clarifying the ABCs 3. How to prioritize management in the ED using the RAPID mnemonic 4. How to present a case in the ED 5. Feedback at the end of a shift Enjoy!
Welcome to the MacEmerg podcast. This podcast aims to connect all the faculty members in the MacEmerg family from across the region. From Niagara to Brampton...from Kitchener-Waterloo to Hamilton... we are going to feature the awesome talent from our region and highlight awesome things that are going on. This fifth episode features two guests: 1) Dr. Jonathan Sherbino (Full Professor/Trauma Team Leader) who has a few tips and tricks before we head into the high season of trauma; 2)Dr. Paula Sneath (PGY1) who is the lead editor for a series called "Sirens to Scrubs" at the #FOAMed blog CanadiEM.org. Want to join in? Email us at MacEmergPodcast@gmail.com. We welcome feedback and suggestions! Also, please let us know if you would like to contribute or edit for our volunteer team!
05:05 no canadiem full crackcast.org@gmail.com (CCteam)CCteamCRACKCast (Core Rosen's and Clinical Knowledge) helps residents to "Turn on their learn on" through podcasts that assist with exam prep by covering essential core content. Physicians as Humans explores the struggles t
In the fourth episode of the Physicians as Humans project, I speak with Dr. Kevin Dueck, a family medicine resident at McMaster, about his decision to take parental leave during residency. Also check out his blog https://abootmedicine.wordpress.com/! This is an ongoing project, so if you or anyone you know have a story about managing personal struggles while in medicine, please contact velmurug@ualberta.ca. If you are unfamiliar with the project, please read this post for more information on the origin of this podcast series. The CanadiEM podcast can be added to your podcast application from the iTunes store or by entering the podcast RSS feed. If you would prefer to download it, click here. It can also be streamed above. Thanks for listening and please refer your colleagues! Music for Episode 04 (All songs have been modified for the project) ambient by strange day. Music provided by Music for Creators under a Creative Commons Attribution 3.0 Unported— CC BY 3.0 license. NOWË - Burning (Vlog No Copyright Music). Music provided by Vlog No Copyright Music. Video Link: https://youtu.be/AWv6Cr-RJaM Jorm - Broken (Vlog No Copyright Music). Music provided by Vlog No Copyright Music. Video Link: https://youtu.be/sl-o3ywNTV4 Skander Music - Back Home (Vlog No Copyright Music). Music promoted by Vlog No Copyright Music. Video Link: https://youtu.be/uwXmBL1kQT4 Pressure - Riot https://youtu.be/ELksuZkgQsQ Joakim Karud - Waves. Song/Free Download - https://youtu.be/xG8AWZSnFgI. Support Joakim Karud - http://smarturl.it/joakimkarud LAKEY INSPIRED - In My Dreams (Vlog No Copyright Music). Music provided by Vlog No Copyright Music. Video Link: https://youtu.be/PiKks_6yC8Q
In the fourth episode of the Physicians as Humans project, I speak with Dr. Kevin Dueck, a family medicine resident at McMaster, about his decision to take parental leave during residency. Also check out his blog https://abootmedicine.wordpress.com/! This is an ongoing project, so if you or anyone you know have a story about managing personal struggles while in medicine, please contact velmurug@ualberta.ca. If you are unfamiliar with the project, please read this post for more information on the origin of this podcast series. The CanadiEM podcast can be added to your podcast application from the iTunes store or by entering the podcast RSS feed. If you would prefer to download it, click here. It can also be streamed above. Thanks for listening and please refer your colleagues! Music for Episode 04 (All songs have been modified for the project) ambient by strange day. Music provided by Music for Creators under a Creative Commons Attribution 3.0 Unported— CC BY 3.0 license. NOWË - Burning (Vlog No Copyright Music). Music provided by Vlog No Copyright Music. Video Link: https://youtu.be/AWv6Cr-RJaM Jorm - Broken (Vlog No Copyright Music). Music provided by Vlog No Copyright Music. Video Link: https://youtu.be/sl-o3ywNTV4 Skander Music - Back Home (Vlog No Copyright Music). Music promoted by Vlog No Copyright Music. Video Link: https://youtu.be/uwXmBL1kQT4 Pressure - Riot https://youtu.be/ELksuZkgQsQ Joakim Karud - Waves. Song/Free Download - https://youtu.be/xG8AWZSnFgI. Support Joakim Karud - http://smarturl.it/joakimkarud LAKEY INSPIRED - In My Dreams (Vlog No Copyright Music). Music provided by Vlog No Copyright Music. Video Link: https://youtu.be/PiKks_6yC8Q
What can we learn from social media in the more traditional medical education? Listen to Teresa Chan talk about lessons learned through the years and what is around the corner.Social medias role in Medical Educationwebpage: http://bit.ly/2tD3uwHIn the interview Dr Chan explain how she uses social media herself as personal continuous medical education (CME). Both in her practice area and in the medical education fieldIt is a way to connect with other medical educators and get different perspectives on things. It works well for asynchronous contacts when you work shifts or are in different time zones as well as synchronous discussions when you don’t share the same physical place. It is a way to get the “Water cooler talk” to expand to have it on Twitter. She has cowritten an article with some tips for the novice and sceptic (Choo et al., 2015).“It has opened my eyes up to different and varied practices both in medical education and emergency medicine. “According to Dr Chan we see three forms of new scholars that exist now since social media (Chan et al., 2017): Critical clinicians – maybe not researchers themselves, but active and engage with science and get the scientists feedback on clinical implications. Good resource for sciences and can help Interactive investigator – scientists that are online to disseminate discuss their work. Engagement with Translational teachers – taking the latest studies and discuss it with peers and learners online on podcasts, blogs, chats.You can read more about it in the article:Evidence-based medicine in the era of social media: Scholarly engagement through participation and online interaction. Chan T, Trueger N, Roland D, Thoma B CJEM 2017 Jan;():1-6What transformative ideas has Web 2.0 brought to Medical Education?Furthermore we discussed FOAM, Free Open Access Medical Education as a disruptive innovation in Medical Education FOAM (Twitter hashtag #FOAMed) For more information about what it is and how to use it read the blogpost by Cadogan: Creating the FOAMed Network andFree Open Access Meducation (FOAM): the rise of emergency medicine and critical care blogs and podcasts (2002-2013). Cadogan M, Thoma B, Chan T, Lin M Emerg Med J 2014 Oct;31(e1):e76-7Disruptive innovation comes from Clayton Christensen’s work and can be described as “innovation that transforms a product or service that historically has been very complicated and expensive into something that is affordable and simple to use.” (“Clay Christensen on Disrupting Health Care,” 2009)A recommended read: Harvard Business Review: A disruptive solution for healthcare (Christensen, 2011) and “What is a disruptive innovation” (Christensen, Raynor, & McDonald, 2015)With all these resources, how do we assess quality of the resources we use in education?Quality is a tricky thing and often in the eye of the beholder. We need to think about to educate our learners as well as ourselves to not only critique the primary resources as the scientific work, but also the secondary resources. We can now learn from how we critique online resources and bring that knowledge and frameworks to practice when we look at textbooks.We need to educate our learners how to critique and look at different resources, no matter the sender. “Just because it looks like a New England Journal doesn’t mean it is.”There is a lot of research that has been done and are still ongoing in The Metriq Study.What would be our next steps?Dr Chan mentioned a lot of different opportunities and challenges for Health care end Medical Education. We are already co-creating things with our learners, readers, participants and even patients. What is on in the frontline is how we can use gamification more, not only for learning as students but also as a patient. Furthermore we need to look at how we can be better at communicating with our patients. Some people have accessed a lot of material already, some of them has accessed contractional resources than you.Good example of how to use digital media in your profession is how Dr Mike Evans have used videos to create information accessable for everyone.Dr Teresa Chan is an Assistant Professor at the Division of Emergency Medicine, Department of Medicine in McMaster UniversityShe is an emergency physician, base hospital physician, and clinician educator in Hamilton, Ontario, Canada. Since 2014, she has also been the Director of Continuing Professional Development for the Division of Emergency Medicine. Nationally, she has held positions with the Canadian Journal of Emergency Medicine as the journal’s inaugural Social Media Editor. Dr Chan is involved in several online educational resources as ALiEM (Academic Life in Medical Education), CanadiEM and International Clinician Educator’s blog.
What can we learn from social media in the more traditional medical education? Listen to Teresa Chan talk about lessons learned through the years and what is around the corner.Social medias role in Medical Educationwebpage: http://bit.ly/2tD3uwHIn the interview Dr Chan explain how she uses social media herself as personal continuous medical education (CME). Both in her practice area and in the medical education fieldIt is a way to connect with other medical educators and get different perspectives on things. It works well for asynchronous contacts when you work shifts or are in different time zones as well as synchronous discussions when you don’t share the same physical place. It is a way to get the “Water cooler talk” to expand to have it on Twitter. She has cowritten an article with some tips for the novice and sceptic (Choo et al., 2015).“It has opened my eyes up to different and varied practices both in medical education and emergency medicine. “According to Dr Chan we see three forms of new scholars that exist now since social media (Chan et al., 2017): Critical clinicians – maybe not researchers themselves, but active and engage with science and get the scientists feedback on clinical implications. Good resource for sciences and can help Interactive investigator – scientists that are online to disseminate discuss their work. Engagement with Translational teachers – taking the latest studies and discuss it with peers and learners online on podcasts, blogs, chats.You can read more about it in the article:Evidence-based medicine in the era of social media: Scholarly engagement through participation and online interaction. Chan T, Trueger N, Roland D, Thoma B CJEM 2017 Jan;():1-6What transformative ideas has Web 2.0 brought to Medical Education?Furthermore we discussed FOAM, Free Open Access Medical Education as a disruptive innovation in Medical Education FOAM (Twitter hashtag #FOAMed) For more information about what it is and how to use it read the blogpost by Cadogan: Creating the FOAMed Network andFree Open Access Meducation (FOAM): the rise of emergency medicine and critical care blogs and podcasts (2002-2013). Cadogan M, Thoma B, Chan T, Lin M Emerg Med J 2014 Oct;31(e1):e76-7Disruptive innovation comes from Clayton Christensen’s work and can be described as “innovation that transforms a product or service that historically has been very complicated and expensive into something that is affordable and simple to use.” (“Clay Christensen on Disrupting Health Care,” 2009)A recommended read: Harvard Business Review: A disruptive solution for healthcare (Christensen, 2011) and “What is a disruptive innovation” (Christensen, Raynor, & McDonald, 2015)With all these resources, how do we assess quality of the resources we use in education?Quality is a tricky thing and often in the eye of the beholder. We need to think about to educate our learners as well as ourselves to not only critique the primary resources as the scientific work, but also the secondary resources. We can now learn from how we critique online resources and bring that knowledge and frameworks to practice when we look at textbooks.We need to educate our learners how to critique and look at different resources, no matter the sender. “Just because it looks like a New England Journal doesn’t mean it is.”There is a lot of research that has been done and are still ongoing in The Metriq Study.What would be our next steps?Dr Chan mentioned a lot of different opportunities and challenges for Health care end Medical Education. We are already co-creating things with our learners, readers, participants and even patients. What is on in the frontline is how we can use gamification more, not only for learning as students but also as a patient. Furthermore we need to look at how we can be better at communicating with our patients. Some people have accessed a lot of material already, some of them has accessed contractional resources than you.Good example of how to use digital media in your profession is how Dr Mike Evans have used videos to create information accessable for everyone.Dr Teresa Chan is an Assistant Professor at the Division of Emergency Medicine, Department of Medicine in McMaster UniversityShe is an emergency physician, base hospital physician, and clinician educator in Hamilton, Ontario, Canada. Since 2014, she has also been the Director of Continuing Professional Development for the Division of Emergency Medicine. Nationally, she has held positions with the Canadian Journal of Emergency Medicine as the journal’s inaugural Social Media Editor. Dr Chan is involved in several online educational resources as ALiEM (Academic Life in Medical Education), CanadiEM and International Clinician Educator’s blog.
In the second episode of the Physicians as Humans project, I speak with Dr. Rob Rogers (@EM_Educator), a leading educator in emergency medicine and director of The Teaching Course. He shares his experiences of dealing with a devastating illness in his own family and the effect it had on his career as an emergency physician. This is an ongoing project, so if you or anyone you know have a story about managing personal struggles while in medicine, please contact velmurug@ualberta.ca. If you are unfamiliar with the project, please read this post for more information on the origin of this podcast series. The CanadiEM podcast can be added to your podcast application from the iTunes store or by entering the podcast RSS feed. If you would prefer to download it, click here. It can also be streamed above. Thanks for listening and please refer your colleagues! Music for Episode 02 (All songs have been modified for the project) ambient by strange day. Music provided by Music for Creators under a Creative Commons Attribution 3.0 Unported— CC BY 3.0 license. Moon by LEMMiNO. Music provided by Music for Creators under a Creative Commons Attribution-ShareAlike 3.0 Unported— CC BY-SA 3.0 license. Icy Vindur by A Himitsu. Music provided by Music for Creators under a Creative Commons Attribution 3.0 Unported— CC BY 3.0 license. Flourish, Wither, Bye by A Himitsu Music provided by Music for Creators under a Creative Commons — Attribution 3.0 Unported— CC BY 3.0 license. Where Silence is Nonexistent by A Himitsu Music provided by Music for Creators under a Creative Commons — Attribution 3.0 Unported— CC BY 3.0 license. Tomorrow by Bensound Pressure by Riot
In the second episode of the Physicians as Humans project, I speak with Dr. Rob Rogers (@EM_Educator), a leading educator in emergency medicine and director of The Teaching Course. He shares his experiences of dealing with a devastating illness in his own family and the effect it had on his career as an emergency physician. This is an ongoing project, so if you or anyone you know have a story about managing personal struggles while in medicine, please contact velmurug@ualberta.ca. If you are unfamiliar with the project, please read this post for more information on the origin of this podcast series. The CanadiEM podcast can be added to your podcast application from the iTunes store or by entering the podcast RSS feed. If you would prefer to download it, click here. It can also be streamed above. Thanks for listening and please refer your colleagues! Music for Episode 02 (All songs have been modified for the project) ambient by strange day. Music provided by Music for Creators under a Creative Commons Attribution 3.0 Unported— CC BY 3.0 license. Moon by LEMMiNO. Music provided by Music for Creators under a Creative Commons Attribution-ShareAlike 3.0 Unported— CC BY-SA 3.0 license. Icy Vindur by A Himitsu. Music provided by Music for Creators under a Creative Commons Attribution 3.0 Unported— CC BY 3.0 license. Flourish, Wither, Bye by A Himitsu Music provided by Music for Creators under a Creative Commons — Attribution 3.0 Unported— CC BY 3.0 license. Where Silence is Nonexistent by A Himitsu Music provided by Music for Creators under a Creative Commons — Attribution 3.0 Unported— CC BY 3.0 license. Tomorrow by Bensound Pressure by Riot
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