CAEP 2015 Academic Symposium: Leadership within the emergency medicine academic community and beyond

OBJECTIVES: A panel of emergency medicine (EM) leaders endeavoured to define the key elements of leadership and its models, as well as to formulate consensus recommendations to build and strengthen academic leadership in the Canadian EM community in the areas of mentorship, education, and resources

A case study of the patient wait experience in an emergency department with therapy dogs

The quality of patient healthcare is a growing concern in Canada’s hospital emergency departments (ED) due to increasing wait times and associated adverse outcomes. A developing body of literature indicates that therapy dogs can positively impact the patient experience. In 2016, members of our team partnered with the Royal University Hospital (RUH) in Saskatchewan to become the first ED in Canada to integrate a visiting therapy dog to positively impact the patient wait experience. The aim of this preliminary case study was to examine if and how this unique initiative impacted patients’ feelings during their ED wait. A brief questionnaire was completed with one-hundred and twenty-four patients pre and post-therapy dog visit and a research observer documented the encounters. Quantitative and qualitative analysis of the data revealed that visiting with a therapy dog in the ED appeared to improve patients’ feelings. Specifically, patients’ perceived comfort levels increased and their distress levels decreased, and the encounters were considered by patients to be a welcome distraction from the stressful ED environment. Our team, comprised of clinicians, researchers, therapy dog handlers and patient advocates documented the advantages and challenges of implementing the initiative. The outcomes support further study of patients’ wait time experiences in the ED and the utility of a visiting therapy dog

Prevalence of Cigarette Smoking Among Adult Emergency Department Patients in Canada

Introduction: Tobacco smoking is a priority public health concern, and a leading cause of deathand disability globally. While the daily smoking prevalence in Canada is approximately 9.7%,the proportion of smokers amongst emergency department (ED) patients has been found to besignificantly higher. The purpose of this survey study was to determine the smoking prevalence ofadult ED patients presenting to three urban Canadian hospitals, and to determine whether there wasan increased prevalence compared to the general public.Methods: A verbal questionnaire was administered to adult patients aged 18 years and olderpresenting to Royal University Hospital, St. Paul’s Hospital, and Saskatoon City Hospital inSaskatoon, Saskatchewan. We compared patients’ smoking habits to Fagerström tobaccodependence scores, readiness to quit smoking, chief complaints, Canadian Triage Acuity Scalescores, and willingness to partake in ED-specific cessation interventions.Results: A total of 1190 eligible patients were approached, and 1078 completed the questionnaire.Adult Saskatoon ED patients demonstrated a cigarette smoking prevalence of 19.6%, which issignificantly higher than the adult Saskatchewan public at 14.65% (P<0.0001). Out of the smokingcohort, 51.4% indicated they wanted to quit smoking and would partake in ED-specific cessationcounselling, if available. Of the proposed interventions, ED cessation counselling was most popularamongst patients (62.4%), followed by receiving a pamphlet (56.2%), and referral to a smokers’ quitline (49.5%).Conclusion: The higher smoking prevalence demonstrated amongst ED patients highlights theneed for a targeted intervention program that is feasible for the fast-paced ED environment. TrainingED staff to conduct brief cessation counselling and referral to community supports for follow-up couldprovide an initial point of contact for smokers not otherwise receiving cessation assistance

Patient Opinion of Visiting Therapy Dogs in a Hospital Emergency Department

To date there have been no studies examining whether patients want emergency department (ED) therapy dog programs. This patient-oriented study examined the opinions of patients about whether they would want to be visited by a therapy dog in the Royal University Hospital ED. Cross-sectional survey data were collected over a six week period from a convenience sample of 100 adult patients who had not been visited by a therapy dog in the ED. Most (80%) indicated they would want a visit by a therapy dog as an ED patient. A higher proportion of individuals who currently have a pet dog (95%) or identify as having lots of experience with dogs (71%) were more likely to indicate this want compared to those without a dog (90%) or little to no experience with dogs (62%). The majority were also of the opinion that patients may want to visit a therapy dog in the ED to reduce anxiety (92%) and frustration (87%) as well as to increase comfort (90%) and satisfaction (90%) and to a lesser extent to reduce pain (59%). There was no significant difference in findings by gender or age, other than a higher proportion of older adults and females identifying cultural background and tradition as a possible reason that patients may not want to be visited by a therapy dog. The findings of this study can help guide considerations for future ED therapy dog programs

Intramuscular Neurotrophin-3 normalizes low threshold spinal reflexes, reduces spasms and improves mobility after bilateral corticospinal tract injury in rats

Brain and spinal injury reduce mobility and often impair sensorimotor processing in the spinal cord leading to spasticity. Here, we establish that complete transection of corticospinal pathways in the pyramids impairs locomotion and leads to increased spasms and excessive mono- and polysynaptic low threshold spinal reflexes in rats. Treatment of affected forelimb muscles with an adeno-associated viral vector (AAV) encoding human Neurotrophin-3 at a clinically-feasible time-point after injury reduced spasticity. Neurotrophin-3 normalized the short latency Hoffmann reflex to a treated hand muscle as well as low threshold polysynaptic spinal reflexes involving afferents from other treated muscles. Neurotrophin-3 also enhanced locomotor recovery. Furthermore, the balance of inhibitory and excitatory boutons in the spinal cord and the level of an ion co-transporter in motor neuron membranes required for normal reflexes were normalized. Our findings pave the way for Neurotrophin-3 as a therapy that treats the underlying causes of spasticity and not only its symptoms. DOI: http://dx.doi.org/10.7554/eLife.18146.00

Sizes of the Largest Fossils in the Geological Record

This table contains taxonomic, size, and source information describing the largest known fossil plants, animals, protists, and prokaryotes in the fossil record. The prokaryote record covers only the Archaean and early Paleoproterozoic. The protist, animal, and vascular plant records cover all relevant geological periods from the Paleoproterozoic through the Neogene. See also http://bodysize.nescent.org

A VEGF/JAK2/STAT5 axis may partially mediate endothelial cell tolerance to hypoxia

Perturbation of oxygen flow occurs in disease states such as diabetic retinopathy and cancer. To maintain oxygen homoeostasis, the mammalian microvascular endothelium undergoes a dramatic reorganization to assist in bringing oxygen and nutrients to oxygen-starved tissues. This process is termed angiogenesis and is common in certain cancers with hypoxic foci and in areas of focal ischaemia in the diabetic retina. In the present study, we report on the activation of the JAK2/STAT5 pathway (where JAK stands for Janus kinase and STAT stands for signal transduction and activator of transcription) by low oxygen in microvascular endothelial cells. This activation appears to occur downstream of VEGF (vascular endothelial growth factor), a well-known proangiogenic factor, and is related to repression of proapoptotic FAS(CD95)/FASL(CD95L). These results indicate that the JAK/STAT pathway may play a pivotal role during tumour-associated or retinal angiogenesis in which endothelial cell survival during tissue hypoxia is critical for maintaining either the growth of neoplasms or the inappropriate retinal neovascularization common in diabetic retinopathy