CAEP 2021 Academic Symposium: recommendations for addressing racism and colonialism in emergency medicine

Purpose: Racism and colonialism impact health, physician advancement, professional development and medical education in Canada. The Canadian Association of Emergency Physicians (CAEP) has committed to addressing inequities in health in their recent statement on racism. The objective of this project was to develop recommendations for addressing racism and colonialism in emergency medicine. Methods: The authors, in collaboration with a 40 member working group, conducted a literature search, held a community consultation, solicited input from expert medical, academic and community advisors, conducted a national survey of emergency physicians, and presented draft recommendations at the 2021 CAEP Academic Symposium on Equity, Diversity and Inclusion for a live facilitated discussion with a post-session survey. Results: Sixteen recommendations were generated in the areas of patient care, hospital and departmental commitment to Equity, Diversity, and Inclusion, physician advancement, and professional development and medical education. Conclusion: Emergency physicians are uniquely positioned to promote equity at each encounter with patients, peers and learners. The 16 recommendations presented here are practical steps to countering racism and colonialism everyday in emergency medicine

Investigating the Role of TRPV4 as a Mechanoreceptor in the Intervertebral Disc

Transient Receptor Potential Cation Channel Subfamily V Member 4 (TRPV4) is a cell membrane Ca2+ channel that regulates intracellular calcium levels in response to mechanical stimuli. Recent studies have demonstrated that TRPV4 is required for the induction of extracellular gene expression in murine intervertebral disc (IVD) cells in response to mechanical load. We investigated the role of TRPV4 in age associated IVD degeneration and spine development using novel knockout mice. Spine samples were harvested from NotoCre;Trpv4fl/fl and WT mice at embryonic day 13.5 (E13.5) as well as postnatal day 1 and postnatal day 21 samples using histological analysis. NotoCre;Trpv4fl/fl mice demonstrated no difference in IVD structure compared to WT mice at each of the observed timepoints. In Col2Cre;Trpv4fl/fl (Trpv4-/-) mice used to asses age-associated disc degeneration, 24-month-old male Trpv4-/-mice showed gross changes in IVD structure at the L4/5 and L5/6 spinal levels compared to WT. Conversely, in 24-month female mice TRPV4 loss appeared to have a protective effect against IVD degeneration. This suggests that the loss of TRPV4 within the IVD may have a sex-specific effect in age-associated disc degeneration. Furthermore, 24-month-old female WT mice demonstrated significantly increased Trpv4 gene expression compared to male WT mice of the same age. Gene expression analysis of 24-month-old male mice, demonstrated a trend of increased expression of inflammatory markers Mmp-13, IL-1beta and IL-6 in Trpv4-/-samples compared to WT. Altogether, these results further support the role of TRPV4 as an important mechanoreceptor within the IVD, that contributes to the adaptive response of the disc to mechanical load

Implementation of the YEARS algorithm to optimise pulmonary embolism diagnostic workup in the emergency department

Background Excessive use of CT pulmonary angiography (CTPA) to investigate pulmonary embolism (PE) in the emergency department (ED) contributes to adverse patient outcomes. Non-invasive D-dimer testing, in the context of a clinical algorithm, may help decrease unnecessary imaging but this has not been widely implemented in Canadian EDs.Aim To improve the diagnostic yield of CTPA for PE by 5% (absolute) within 12 months of implementing the YEARS algorithm.Measures and design Single centre study of all ED patients >18 years investigated for PE with D-dimer and/or CTPA between February 2021 and January 2022. Primary and secondary outcomes were the diagnostic yield of CTPA and frequency of CTPA ordered compared with baseline. Process measures included the percentage of D-dimer tests ordered with CTPA and CTPAs ordered with D-dimers <500 µg/L Fibrinogen Equivalent Units (FEU). The balancing measure was the number of PEs identified on CTPA within 30 days of index visit. Multidisciplinary stakeholders developed plan- do-study-act cycles based on the YEARS algorithm.Results Over 12 months, 2695 patients were investigated for PE, of which 942 had a CTPA. Compared with baseline, the CTPA yield increased by 2.9% (12.6% vs 15.5%, 95% CI −0.06% to 5.9%) and the proportion of patients that underwent CTPA decreased by 11.4% (46.4% vs 35%, 95% CI −14.1% to −8.8%). The percentage of CTPAs ordered with a D-dimer increased by 26.3% (30.7% vs 57%, 95% CI 22.2% 30.3%) and there were two missed PE (2/2695, 0.07%).Impact Implementing the YEARS criteria may safely improve the diagnostic yield of CTPAs and reduce the number of CTPAs completed without an associated increase in missed clinically significant PEs. This project provides a model for optimising the use of CTPA in the ED