19 results
LO20: The characteristics, clinical course and disposition of long-term care patients treated by paramedics during an emergency call: Exploring the potential impact of community paramedicine
- S. Leduc, G. Wells, V. Thiruganasambandamoorthy, Z. Cantor, P. Kelly, M. Rietschlin, C. Vaillancourt
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 22 / Issue S1 / May 2020
- Published online by Cambridge University Press:
- 13 May 2020, p. S14
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- May 2020
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Introduction: An increasing number of Canadian paramedic services are creating Community Paramedic programs targeting treatment of long-term care (LTC) patients on-site. We explored the characteristics, clinical course and disposition of LTC patients cared for by paramedics during an emergency call, and the possible impact of Community Paramedic programs. Methods: We completed a health records review of paramedic call reports and emergency department (ED) records between April 1, 2016 and March 31, 2017. We utilized paramedic dispatch data to identify emergency calls originating from LTC centers resulting in transport to one of the two EDs of the Ottawa Hospital. We excluded patients with absent vital signs, a Canadian Triage and Acuity Scale (CTAS) score of 1, and whose transfer to hospital were deferrable or scheduled. We stratified remaining cases by month and selected cases using a random number generator to meet our apriori sample size. We collected data using a piloted standardized form. We used descriptive statistics and categorized patients into groups based on the ED care received and if the treatment received fit into current paramedic medical directives. Results: Characteristics of the 381 included patients were mean age 82.5 years, 58.5% female, 59.7% hypertension, 52.6% dementia and 52.1% cardiovascular disease. On arrival at hospital, 57.7% of patients waited in offload delay for a median time of 45 minutes (IQR 33.5-78.0). We could identify 4 groups: 1) Patients requiring no treatment or diagnostics in the ED (7.9%); 2) Patients receiving ED treatment within current paramedic medical directives and no diagnostics (3.2%); 3) Patients requiring diagnostics or ED care outside current paramedic directives (54.9%); and 4) patients requiring admission (34.1%). Most patients were discharged from the ED (65.6%), and 1.1% died. The main ED diagnoses were infection (18.6%) and musculoskeletal injury (17.9%). Of the patients that required ED care but were discharged, 64.1% required x-rays, 42.1% CT, and 3.4% ultrasound. ED care included intravenous fluids (35.7%), medication (67.5%), antibiotics (29.4%), non-opioid analgesics (29.4%) and opioids (20.7%). Overall, 11.1% of patients didn't need management beyond current paramedic capabilities. Conclusion: Many LTC patients could receive care by paramedics on-site within current medical directives and avoid a transfer to the ED. This group could potentially grow using Community Paramedics with an expanded scope of practice.
LO63: Evaluation of epinephrine secondary effects in a Canadian emergency department anaphylaxis adult cohort
- S. Gabrielli, M. Ben-Shoshan, A. Lachance, M. Rhéaume, L. Londei-Leduc, R. Goldman, E. Chan, J. Upton, E. Hochstadter, A. Bretholz, A. O'Keefe, D. Chu, J. Morris
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 22 / Issue S1 / May 2020
- Published online by Cambridge University Press:
- 13 May 2020, p. S30
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- May 2020
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Introduction: There are few large-scale studies assessing the true risk of epinephrine use during anaphylaxis in adults. We aimed to assess the demographics, clinical characteristics, and secondary effects of epinephrine treatment and to determine factors associated with major and minor secondary effects associated with epinephrine use among adults with anaphylaxis. Methods: From May 2012 to February 2018, adults presenting to the Hôpital du Sacré-Coeur de Montréal (HSCM) emergency department (ED) with anaphylaxis were recruited prospectively as part of the Cross-Canada Anaphylaxis Registry (C-CARE). Missed cases were identified through a previously validated algorithm. Data were collected on demographics, clinical characteristics, and management of anaphylaxis using a structured chart review. Multivariate logistic regression models were compared to estimate factors associated with side effects of epinephrine administration. Results: Over a 6-year period, 402 adult patients presented to the ED at HSCM with anaphylaxis. The median age was 38 years (Interquartile Range [IQR]: 27, 52) and 40.4% were males. The main trigger for anaphylaxis was food (53.0%). A total of 286 patients (71.1%) received epinephrine treatment, of which 23.9% were treated in the pre-hospital setting, 47.0% received treatment in the ED, and 5.0% received epinephrine in both settings. Among patients treated with epinephrine, major secondary effects were rare (1.4% of patients), including new changes to electrocardiogram, arrhythmia, and neurological symptoms. Minor secondary effects due to epinephrine were reported in 50.0% of patients, mainly inappropriate sinus tachycardia (defined as a rate over 100 beats/minute in 30.1%). Major cardiovascular secondary effects were associated with regular use of beta-blockers (aOR 1.10 [95%CI, 1.02, 1.18]), regular use of ACE-inhibitors (aOR 1.16 [95%CI, 1.07, 1.27]), and receiving more than two doses of epinephrine (aOR 1.09 [95%CI, 1.00, 1.18]). The model was adjusted for age, history of ischemic heart disease, trigger of anaphylaxis, presence of asthma, sex, and reaction severity. Inappropriate sinus tachycardia was more likely in females (aOR 1.18 [95%CI, 1.04, 1.33]) and palpitations, tremors, and psychomotor agitation were more likely in females (aOR 1.09 [95%CI, 1.00, 1.19]) and among those receiving more than two doses of epinephrine (aOR 1.49 [95%CI, 1.14, 1.96]). The models were adjusted for age, regular use of medications, history of ischemic heart disease, triggers of anaphylaxis, presence of asthma, reaction severity, and IV administration of epinephrine. Conclusion: The low rate of occurrence of major secondary effects of epinephrine in the treatment of anaphylaxis in our study demonstrates the overall safety of epinephrine use.
LO15: Paramedic and allied health professional interventions at long-term care facilities to reduce emergency department visits: systematic review
- S. Leduc, Z. Cantor, P. Kelly, V. Thiruganasambandamoorthy, G. Wells, C. Vaillancourt
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 22 / Issue S1 / May 2020
- Published online by Cambridge University Press:
- 13 May 2020, p. S12
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- May 2020
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Introduction: Emergency department (ED) crowding, long waits for care, and paramedic offload delay are of increasing concern. Older adults living in long-term care (LTC) are more likely to utilize the ED and are vulnerable to adverse events. We sought to identify existing programs that seek to avoid ED visits from LTC facilities where allied health professionals are the primary providers of the intervention and, to evaluate their efficacy and safety. Methods: We completed this systematic review based on a protocol we published apriori and following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. We systematically searched Medline, CINAHL and EMBASE with terms relating to long-term care, emergency services, hospitalization and allied health personnel. Two investigators independently selected studies and extracted data using a piloted standardized form and evaluated the risk of bias of included studies. We report a narrative synthesis grouped by intervention categories. Results: We reviewed 11,176 abstracts and included 22 studies. Most studies were observational and few assessed patient safety. We found five categories of interventions including: 1) use of advanced practice nursing; 2) a program called Interventions to Reduce Acute Care Transfers (INTERACT); 3) end-of-life care; 4) condition specific interventions; and 5) use of extended care paramedics. Of the 13 studies that reported ED visits, all (100%) reported a decrease, and of the 16/17 that reported hospitalization, 94.1% reported a decrease. Patient adverse events such as functional status and relapse were seldom reported (6/22) as were measures of emergency system function such as crowding/inability of paramedics to transfer care to the ED (1/22). Only 4/22 studies evaluated patient mortality and 3/4 found a non-statistically significant worsening. When measured, studies reported decreased hospital length of stay, more time spent with patients by allied health professionals and cost savings. Conclusion: We found five types of programs/interventions which all demonstrated a decrease in ED visits or hospitalization. Many identified programs focused on improved primary care for patients. Interventions addressing acute care issues such as those provided by community paramedics, patient preferences, and quality of life indicators all deserve more study.
P136: What happens to bypassed trauma patients meeting Field Trauma Triage standards?
- M. Austin, J. Sinclair, S. Leduc, S. Duncan, J. Rouleau, P. Price, C. Evans, C. Vaillancourt
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 22 / Issue S1 / May 2020
- Published online by Cambridge University Press:
- 13 May 2020, p. S113
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- May 2020
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Introduction: Prehospital field trauma triage (FTT) standards were reviewed and revised in 2014 based on the recommendations of the Centers for Disease Control and Prevention. The FTT standard allows a hospital bypass and direct transport, within 30 min, to a lead trauma hospital (LTH). Our objectives were to assess the impact of the newly introduced prehospital FTT standard and to describe the emergency department (ED) management and outcomes of patients that had bypassed closer hospitals. Methods: We conducted a 12-month multi-centred health record review of paramedic and ED records following the implementation of the 4 step FTT standard (step 1: vital signs and level of consciousness (physiologic), step 2: anatomical injury, step 3: mechanism and step 4: special considerations) in nine paramedic services across Eastern Ontario. We included adult trauma patients transported as urgent that met FTT standard, regardless of transport time. We developed and piloted a data collection tool and obtained consensus on all definitions. The primary outcome was the rate of appropriate triage to a LTH which was defined as: ISS ≥12, admitted to intensive care unit (ICU), non-orthopedic surgery, or death. We have reported descriptive statistics. Results: 570 patients were included: mean age 48.8, male 68.9%, falls 29.6%, motor vehicle collisions 20.2%, stab wounds 10.5%, transported to a LTH 76.5% (n = 436). 72.2% (n = 315) of patients transported to a LTH had bypassed a closer hospital and 126/306 (41.2%) of those were determined to be an appropriate triage to LTH (9 patients had missing outcomes). ED management included: CT head/cervical spine 69.9%, ultrasound 53.6%, xray 51.6%, intubation 15.0%, sedation 11.1%, tranexamic acid 9.8%, blood transfusion 8.2%, fracture reduction 6.9%, tube thoracostomy 5.9%. Outcomes included: ISS ≥ 12 32.7%, admitted to ICU 15.0%, non-orthopedic surgery 11.1%, death 8.8%. Others included: admission to hospital 57.5%, mean LOS 12.8 days, orthopedic surgery 16.3% and discharged from ED 37.3%. Conclusion: Despite a high number of admissions, the majority of trauma patients bypassed to a LTH were considered over-triaged, with a low number of ED procedures and non-orthopedic surgeries. Continued work is needed to appropriately identify patients requiring transport to a LTH.
LO09: Variation entre les taux de retour de circulation spontané préhospitalier et les délais de réanimation avant ceux-ci en fonction du rythme initial chez les patients souffrant d'un arrêt cardiaque extrahospitalier
- A. Cournoyer, S. Cossette, R. Daoust, J. Chauny, B. Potter, M. Marquis, J. Morris, L. de Montigny, D. Ross, Y. Lamarche, L. Londei-Leduc, J. Paquet, É. Notebaert, M. Albert, F. Bernard, É. Piette, Y. Cavayas, A. Denault
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 21 / Issue S1 / May 2019
- Published online by Cambridge University Press:
- 02 May 2019, pp. S9-S10
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- May 2019
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Introduction: Les patients ayant un retour de circulation spontanée (RCS) durant la phase préhospitalière de leur réanimation suite à un arrêt cardiaque extrahospitalier (ACEH) ont un meilleur taux de survie que ceux n'en ayant pas. La durée des efforts de réanimation avant l'initiation d'un transport ne varie généralement pas en fonction du rythme initial observé. Cette étude vise à comparer la durée des manœuvres de réanimation nécessaire afin de générer la majorité des RCS préhospitaliers et des RCS préhospitaliers menant à une survie en fonction du rythme initial. Methods: La présente étude de cohorte a été réalisée à partir des bases de données collectées de la Corporation d'Urgences-santé dans la région de Montréal entre 2010 et 2015. Les patients avec un ACEH d'origine médicale ont été inclus. Les patients dont l'ACEH était témoigné par les paramédics ont été exclus, tout comme ceux dont le rythme initial était inconnu. Nous avons comparé entre les groupes (rythme défibrillable [RD], activité électrique sans pouls [AESP] et asystolie) les taux de RCS préhospitalier et le temps nécessaires pour obtenir une majorité des RCS préhospitaliers et des RCS préhospitaliers menant à une survie. Results: Un total de 6002 patients (3851 hommes et 2151 femmes) d'un âge moyen de 52 ans ( ±10) ont été inclus dans l’étude, parmi lesquels 563 (9%) ont survécu jusqu’à leur congé hospitalier et 1310 (22%) ont obtenu un RCS préhospitalier. Un total de 1545 (26%) patients avaient un RD, 1654 (28%) une AESP et 2803 (47%) une asystolie. Les patients avec un RD ont obtenu plus fréquemment un RCS préhospitalier et un RCS préhospitalier menant à une survie que les patients avec une AESP qui eux même avaient un meilleur pronostic que ceux avec une asystolie initial (777 patients [55%] vs 385 [23%] vs 148 [5%], p < 0,001; 431 [28%] vs 85 [5%] vs 7 [0,2%], p < 0,001, respectivement). Les RCS survenaient également plus rapidement lorsque le rythme initial était un RD (13 minutes [ ±12] vs 18 [ ±13] vs 25 [ ±12], p < 0,001). Cependant, une période de réanimation plus longue était nécessaire afin d'obtenir 95% des RCS préhospitaliers menant à une survie pour les patients avec un RD (26 minutes vs 21 minutes vs 21 minutes). Conclusion: Les patients avec un rythme initial défibrillable suite à leur ACEH sont à meilleur pronostic. Il serait envisageable de transporter plus rapidement vers l'hôpital les patients avec une AESP ou une asystolie que ceux avec un rythme défibrillable si l'arrêt des manœuvres n'est pas envisagé.
LO06: Évolution du rythme en fonction du délai avant l'initiation des manœuvres de réanimation chez des patients souffrant d'un arrêt cardiaque extrahospitalier
- A. Cournoyer, S. Cossette, R. Daoust, J. Morris, J. Chauny, B. Potter, L. de Montigny, D. Ross, L. Londei-Leduc, Y. Lamarche, J. Paquet, M. Marquis, É. Notebaert, F. Bernard, M. Albert, É. Piette, Y. Cavayas, A. Denault
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 21 / Issue S1 / May 2019
- Published online by Cambridge University Press:
- 02 May 2019, pp. S8-S9
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- May 2019
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Introduction: Les patients dont l'arrêt cardiaque extrahospitalier (ACEH) n'a pas été témoigné sont généralement exclus des protocoles de réanimation par circulation extracorporelle puisque le délai avant l'initiation de leur réanimation est inconnu. Il a été proposé que la présence d'un rythme initial défibrillable (RD) est fortement suggestif une très courte période avant l'initiation des manœuvres de réanimation. La présente étude vise à décrire l'association entre la durée avant l'initiation de la réanimation et la présence d'un RD chez des patients souffrant d'un ACEH. Methods: Cette étude de cohorte a été réalisée à partir des bases de données collectées de la Corporation d'Urgences-santé dans la région de Montréal entre 2010 et 2015. Les patients dont l'arrêt était témoigné, mais dont les témoins n'ont pas entamé de manœuvres de réanimation, ont été inclus. Nous avons également inclus les patients dont l'arrêt était témoigné par les paramédics comme groupe contrôle (durée avant l'initiation de la réanimation = 0 minute). Les patients avec un retour de circulation spontanée avant l'arrivée des services préhospitaliers ont été exclus, tout comme ceux dont le rythme initial était inconnu. Nous avons décrit l’évolution de la proportion de chacun des rythmes et construit une régression logistique multivariée ajustant pour les variables sociodémographiques et cliniques pertinentes. Results: Un total de 1751 patients (1173 hommes et 578 femmes) d'un âge moyen de 69 ans (±16) ont été inclus dans l'analyse principale, parmi lesquels 603 (34%) avaient un RD. Un total de 663 autres patients ont vu leur ACEH témoigné directement par les paramédics. Un plus court délai avant l'initiation des manœuvres est associé à la présence d'un RD (rapport de cotes ajusté = 0,97 [intervalle de confiance à 95% 0,94-0,99], p = 0,016). Cependant, cette relation n'est pas linéaire et la proportion de RD ne diminue pas avant notablement jusqu’à ce que 15 minutes s’écoulent avant le début de la réanimation (0 min = 35%, 1-5 min = 37%, 5-10 min = 35%, 10-15 min = 34%, +de 15 min = 16%). Conclusion: Bien que la proportion de patients avec un RD diminue lorsque le délai augmente avant l'initiation des manœuvres, cette relation ne semble pas linéaire. La baisse principale de la proportion de patients avec RD semble se produire suite à la quinzième minute de délai avant le début de la réanimation.
P028: Quel est le meilleur moment de départ vers le centre hospitalier pour les patients souffrant d'un arrêt cardiaque extrahospitalier potentiellement éligible à une réanimation par circulation extracorporelle?
- A. Cournoyer, S. Cossette, R. Daoust, J. Chauny, B. Potter, M. Marquis, J. Morris, L. de Montigny, D. Ross, Y. Lamarche, L. Londei-Leduc, J. Paquet, É. Notebaert, M. Albert, F. Bernard, É. Piette, Y. Cavayas, A. Denault
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 21 / Issue S1 / May 2019
- Published online by Cambridge University Press:
- 02 May 2019, p. S73
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- May 2019
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Introduction: La réanimation par circulation extracorporelle (R-CEC) permet potentiellement d'améliorer la survie de patients souffrant d'un arrêt cardiaque extrahospitalier (ACEH) réfractaire aux traitements habituels. Cette technique, se pratiquant généralement en centre hospitalier (CH), doit être réalisée le plus précocement possible. Un transport vers le CH en temps opportun est donc nécessaire. Cette étude vise à décrire la durée nécessaire des manœuvres de réanimation préhospitalières afin d'optimiser le moment du départ vers le CH dans le but d'obtenir un maximum de retour de circulation spontanée (RCS) préhospitalier. Methods: La présente étude de cohorte a été réalisée à partir des bases de données collectées de la Corporation d'Urgences-santé dans la région de Montréal entre 2010 et 2015. Les patients éligibles à une R-CEC selon les critères locaux ont été inclus (<65 ans, rythme initial défibrillable, arrêt témoigné avec réanimation par un témoin). Les patients ayant eu un arrêt devant les paramédics ont été exclus, tout comme ceux avec un RCS avant l'arrivée des services préhospitaliers. Nous avons calculé la sensibilité et la spécificité à différents seuils afin de prédire un RCS préhospitalier et une survie au congé hospitalier. Une courbe ROC a également été construite. Results: Un total de 236 patients (207 hommes et 29 femmes) d'un âge moyen de 52 ans (±10) ont été inclus dans l’étude, parmi lesquels 93 (39%) ont survécu jusqu’à leur congé hospitalier et 136 (58%) ont obtenu un RCS préhospitalier. Le délai moyen avant leur RCS était de 13 minutes (±10). Plus de 50% des survivants avaient eu un RCS moins de 8 minutes après l'initiation des manœuvres de réanimation par les intervenants préhospitaliers, et plus de 90% avant 24 minutes. Plus de 50% de tous les RCS survenaient dans les 10 premières minutes de réanimation et plus de 90% dans les 31 premières minutes. La courbe ROC montrait visuellement que le délai avant le RCS maximisant la sensibilité et la spécificité pour prédire la survie chez ces patients était à 22 minutes (Sensibilité = 90%, spécificité = 78%; aire sous la courbe = 0,89 [intervalle de confiance à 95% 0,84-0,93]). Conclusion: Le départ vers le CH pourrait être considéré pour ces patients entre 8 et 24 minutes après l'initiation des manœuvres. Une période de réanimation de 22 minutes semble être le meilleur compromis à cet égard.
P008: Evaluation of outcomes after implementation of a provincial prehospital bypass standard for trauma patients – an Eastern Ontario experience
- M. Austin, J. Sinclair, S. Leduc, S. Duncan, J. Rouleau, P. Price, C. Evans, C. Vaillancourt
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 21 / Issue S1 / May 2019
- Published online by Cambridge University Press:
- 02 May 2019, pp. S65-S66
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- May 2019
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Introduction: Trauma and injury play a significant role in the population's burden of disease. Limited research exists evaluating the role of trauma bypass protocols. The objective of this study was to assess the impact and effectiveness of a newly introduced prehospital field trauma triage (FTT) standard, allowing paramedics to bypass a closer hospital and directly transport to a trauma centre (TC) provided transport times were within 30 minutes. Methods: We conducted a 12-month multi-centred health record review of paramedic call reports and emergency department health records following the implementation of the 4 step FTT standard (step 1: vital signs and level of consciousness, step 2: anatomical injury, step 3: mechanism and step 4: special considerations) in nine paramedic services across Eastern Ontario. We included adult trauma patients transported as an urgent transport to hospital, that met one of the 4 steps of the FTT standard and would allow for a bypass consideration. We developed and piloted a standardized data collection tool and obtained consensus on all data definitions. The primary outcome was the rate of appropriate triage to a TC, defined as any of the following: injury severity score ≥12, admitted to an intensive care unit, underwent non-orthopedic operation, or death. We report descriptive and univariate analysis where appropriate. Results: 570 adult patients were included with the following characteristics: mean age 48.8, male 68.9%, attended by Advanced Care Paramedic 71.8%, mechanisms of injury: MVC 20.2%, falls 29.6%, stab wounds 10.5%, median initial GCS 14, mean initial BP 132, prehospital fluid administered 26.8%, prehospital intubation 3.5%, transported to a TC 74.6%. Of those transported to a TC, 308 (72.5%) had bypassed a closer hospital prior to TC arrival. Of those that bypassed a closer hospital, 136 (44.2%) were determined to be “appropriate triage to TC”. Bypassed patients more often met the step 1 or step 2 of the standard (186, 66.9%) compared to the step 3 or step 4 (122, 39.6%). An appropriate triage to TC occurred in 104 (55.9%) patients who had met step 1 or 2 and 32 (26.2%) patients meeting step 3 or 4 of the FTT standard. Conclusion: The FTT standard can identify patients who should be bypassed and transported to a TC. However, this is at a cost of potentially burdening the system with poor sensitivity. More work is needed to develop a FTT standard that will assist paramedics in appropriately identifying patients who require a trauma centre.
LO05: Influence du délai avant le retour de circulation spontanée sur la survie des patients souffrant d'un arrêt cardiaque extrahospitalier
- A. Cournoyer, S. Cossette, R. Daoust, J. Morris, J. Chauny, B. Potter, L. de Montigny, D. Ross, L. Londei-Leduc, Y. Lamarche, J. Paquet, M. Marquis, É. Notebaert, M. Albert, É. Piette, Y. Cavayas, A. Denault
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 21 / Issue S1 / May 2019
- Published online by Cambridge University Press:
- 02 May 2019, p. S8
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- May 2019
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Introduction: Parmi les patients souffrant d'un arrêt cardiaque extrahospitalier (ACEH), ceux ayant un retour de circulation spontanée (RCS) durant la phase préhospitalière de leur réanimation ont un meilleur taux de survie. Il est plausible que les patients ayant un RCS plus précocement durant leur réanimation préhospitalière aient de meilleur taux de survie que les patients ayant un RCS plus tardif. Cette étude visait à décrire l'association entre la survie et la durée de la réanimation par les paramédics avant le RCS préhospitalier. Methods: La présente étude de cohorte a été réalisée à partir des bases de données collectées de la Corporation d'Urgences-santé dans la région de Montréal entre 2010 et 2015. Tous les patients adultes avec un RCS préhospitalier suite à un ACEH d'origine médicale ont été inclus. Les patients ayant eu un arrêt devant les paramédics ont été exclus, tout comme ceux avec un RCS avant l'arrivée des services préhospitaliers. L'association entre la survie et le temps de réanimation avant le RCS a été évaluée à l'aide d'une régression logistique multivariée ajustant pour les variables sociodémographiques et cliniques pertinentes (âge, sexe, rythme initial, heure de l'appel initial, arrêt témoigné, manœuvre par témoin, présence de premiers répondants ou de paramédics de soins avancés, délai avant l'arrivée des intervenants préhospitaliers). Results: Un total de 1194 patients (818 hommes et 376 femmes) d'un âge moyen de 64 ans ( ±17) ont été inclus dans l’étude, parmi lesquels 433 (36%) ont survécu jusqu’à leur congé hospitalier. Le délai moyen avant leur RCS était de 17 minutes ( ±12). Nous avons observé une association indépendante entre la survie au congé hospitalier et le délai avant le RCS préhospitalier (rapport de cotes ajusté = 0,91 [intervalle de confiance à 95% 0,89-0,92], p < 0,001). Plus de 50% des survivants avaient obtenu un RCS moins de 9 minutes après l'initiation des manœuvres de réanimation par les intervenants préhospitaliers, et plus de 95% avant 26 minutes. Aucun (0%) des 17 patients ayant eu un RCS plus de 56 minutes après l'initiation de la réanimation préhospitalière n'a survécu. Conclusion: Un RCS précoce semble être un facteur de bon pronostic parmi les patients souffrant d'un ACEH. La majorité des patients avec un RCS préhospitalier allant survivre à leur hospitalisation ont obtenus leur RCS dans les 9 minutes suivant l'initiation des manœuvres de réanimation.
LO03: Impact of the conversion to a shockable rhythm from a non-shockable rhythm for patients suffering from out-of-hospital cardiac arrest
- A. Cournoyer, E. Notebaert, S. Cossette, J. Morris, L. de Montigny, D. Ross, L. Londei-Leduc, M. Iseppon, J. Chauny, R. Daoust, C. Sokoloff, E. Piette, J. Paquet, Y. Lamarche, M. Albert, A. Denault
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 20 / Issue S1 / May 2018
- Published online by Cambridge University Press:
- 11 May 2018, p. S7
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- May 2018
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Introduction: Patients suffering from out-of-hospital cardiac arrest (OHCA) with an initial shockable rhythm (ventricular tachycardia or ventricular fibrillation) have higher odds of survival than those suffering from non-shockable rhythm (asystole or pulseless electrical activity). Because of that prognostic significance, patients with an initial non-shockable rhythm are often not considered for advanced resuscitation therapies such as extracorporeal resuscitation. However, the prognostic significance of the conversion to a shockable rhythm from an initially non-shockable rhythm remains uncertain. This study aimed to determine the degree of association between the conversion (or not) of a non-shockable rhythm to a shockable rhythm and resuscitation outcomes in patients with OHCA. It was hypothesized that such a conversion would be associated with a higher survival to discharge. Methods: The present study used a registry of adult OHCA between 2010 and 2015 in Montreal, Canada. Adult patients with non-traumatic OHCA and an initial non-shockable rhythm were included. The primary outcome measure was survival to hospital discharge, and the secondary outcome measure was prehospital return of spontaneous circulation (ROSC). The associations of interest were evaluated with univariate logistic regressions and multivariate models controlling for demographic and clinical variables (e.g. age, gender, type of initial non-shockable rhythm, witnessed arrest, bystander cardiopulmonary resuscitation). Assuming a survival rate of 3% and 25% of the variability explained by the control variables, including more than 4580 patients would allow to detect an absolute difference of 4% in survival between both groups with a power of more than 90%. Results: A total of 4893 patients (2869 men and 2024 women) with a mean age of 70 years (standard deviation 17) were included, of whom 450 (9.2%) experienced a conversion to a shockable rhythm during the course of their prehospital resuscitation. Among all patients, 146 patients (3.0%) survived to discharge and 633 (12.9%) experienced prehospital ROSC. In the univariate models, there was no association between the conversion to a shockable rhythm and survival (odds ratio [OR] 1.14 [95% confidence interval {CI} 0.66-1.95]), but a significant assocation was observed with ROSC (OR 2.00 [95% CI 1.57-2.55], p<0.001). However, there was no independent association between the conversion to a shockable rhythm and survival (adjusted OR [AOR] 0.92 [95% CI 0.51-1.66], p=0.78) and prehospital ROSC (AOR 1.30 [95% CI 0.98-1.72], p=0.073). Conclusion: There is no clinically significant association between the conversion to a shockable rhythm and resuscitation outcomes in patients suffering from OHCA. The initial rhythm remains a much better outcome predictor than subsequent rhythms and should be preferred when evaluating the eligibility for advanced resuscitation procedures.
PL04: Effectiveness of hospital avoidance interventions among elderly patients: a systematic review
- A. Ness, N. Symonds, M. Siarkowski, M. Broadfoot, K. McBrien, E. S. Lang, J. Holroyd-Leduc, P. Ronksley
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 20 / Issue S1 / May 2018
- Published online by Cambridge University Press:
- 11 May 2018, p. S6
- Print publication:
- May 2018
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Introduction: Overuse of acute care services, particularly emergency department (ED) use, is an important topic for healthcare providers and policy makers within Canada and abroad. Prior work has shown that frail elderly patients with complex medical needs and limited personal and social resources are heavy users of ED services and are often admitted when they present to the ED. Updated information on the most effective strategies to avert ED presentation and hospital admission focused specifically on elderly patients is needed. Methods: This systematic review addressed the question: what interventions have demonstrated effectiveness in decreasing ED use and hospital admissions in elderly patients? Comprehensive literature searches were conducted in databases including Ovid Medline, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials with no language or date restrictions. Citations were limited to interventional studies. Grey literature and reference list searches, as well as communication with experts in the field were performed. Consensus or a third reviewer resolved any disagreements. Original research regarding interventions conducted in populations 65 years or older with acute illness, either living in community or facility-living were included. Primary outcomes were ED visits and hospital admissions. Secondary outcomes included: mortality, cost, and patient-reported outcomes such as health-related quality of life and functional status. Results: Forty-three relevant studies were identified including 22 randomized controlled trials (RCT), 2 cluster-RCT, 2 trials with non-random allocation, 4 before-after studies, 6 quasi-experimental studies, and 7 cohort studies. Intervention settings included: home visits (22), long-term care (7), outpatient or primary care clinics (8), and ED (3) or inpatient (3). Data characterization revealed that home-based, outpatient and/or primary care-based strategies reduced ED visits and hospitalizations, particularly those which included comprehensive geriatric assessments, home visits or regular face-to-face contact and interdisciplinary teams. Hospital-based models generally showed no difference in ED or inpatient service utilization. There was, however, considerable variability across individual studies with respect to reporting of outcomes, statistical analyses performed, and overall risk of bias. Conclusion: Various interventional strategies have been studied to avert ED presentation and hospital admission for frail elderly patients. More rigorous methodology and standardization of outcome measures is needed to quantitatively assess the effects of these programs.
MP30: Impact des bicarbonates sur le devenir des patients souffrant dun arrêt cardiaque préhospitalier
- A. Cournoyer, E. Notebaert, S. Cossette, L. Londei-Leduc, J. Chauny, R. Daoust, J. Morris, M. Iseppon, Y. Lamarche, A. Vadeboncoeur, C. Sokoloff, E. Piette, D. Larose, F. de Champlain, J. Paquet, M. Albert, F. Bernard, A. Denault
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 20 / Issue S1 / May 2018
- Published online by Cambridge University Press:
- 11 May 2018, p. S51
- Print publication:
- May 2018
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Introduction: Les patients souffrant dun arrêt cardiaque extra hospitalier (ACEH) sont fréquemment traités à laide de soins avancés en réanimation cardiovasculaire (SARC). Dans ce contexte, des bicarbonates de sodium sont parfois administrés à des patients en arrêt cardiaque réfractaire chez qui une acidose métabolique importante, une hyperkaliémie ou une intoxication est suspectée. Puisquil ny a que peu dévidences quant à cet usage, lobjectif de la présente étude est dévaluer lassociation entre le traitement à laide de bicarbonate de sodium (une dose ou plus) et le devenir (retour de circulation spontané et survie au congé) chez les patients souffrant dun ACEH. Methods: La présente étude de cohorte a été réalisée à partir des bases de données de la Corporation dUrgences-santé dans la région de Montréal entre 2010 et 2015. Les patients adultes ayant souffert dun ACEH dorigine médicale traités en préhospitalier par des paramédics de soins avancés prodiguant des SARC ont été inclus. Les associations dintérêt ont été évaluées initialement à laide de régressions logistiques univariées, puis à laide de régressions logistiques multivariées ajustant pour les variables sociodémographiques et cliniques pertinentes. Results: Un total de 1973 patients (1349 hommes et 683 femmes) dun âge moyen de 66 ans (±17) ont été inclus dans cette étude, parmi lesquels 77 (3,8%) ont reçu une dose de bicarbonate, 763 (37,5%) ont retrouvés un pouls en préhospitalier et 222 (10,9%) ont survécu jusquà leur congé de lhôpital. Sans ajustement, il y avait une association négative entre le traitement à laide de bicarbonates et le retour de circulation spontané (rapport de cotes [RC]=0,46 [intervalle de confiance {IC} 95% 0,27-0,79], p=0,005) et la survie au congé (RC=0,21 [IC 95% 0,05-0,86], p=0,030). Cependant, ces associations nétaient plus significatives suite à lajustement pour les autres covariables (RC ajusté=0,63 [IC 95% 0,34-1,18], p=0,15 et RC ajusté=1,69 [95% IC 0,29-10,01], p=0,56). Conclusion: Il ny a pas dassociation indépendante entre le traitement à laide de bicarbonates et le devenir chez les patients souffrant dun ACEH. Dans ce contexte, il serait adéquat de réaliser un essai clinique afin de trancher définitivement sur cette question.
P039: Potential impact on receiving hospital of a prehospital triage system for refractory cardiac arrest: a simulation study
- A. Cournoyer, E. Notebaert, E. Segal, L. De Montigny, M. Iseppon, S. Cossette, L. Londei-Leduc, Y. Lamarche, J. Morris, E. Piette, R. Daoust, J. Chauny, C. Sokoloff, D. Ross, Y. Cavayas, D. Lafrance, J. Paquet, A. Denault
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 19 / Issue S1 / May 2017
- Published online by Cambridge University Press:
- 15 May 2017, p. S91
- Print publication:
- May 2017
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Introduction: Extracorporeal cardiopulmonary resuscitation (E-CPR) has been used successfully to increase survival in patients suffering from out-of-hospital cardiac arrest (OHCA). However, few OHCA patients can benefit from E-CPR since this procedure is only performed in dedicated centers. Prehospital triage systems have helped decrease mortality from other acute conditions, by directly transporting patients to dedicated centers, often bypassing primary care centers. Our study aimed to quantify the possible impact of a prehospital triage system on the proportion of E-CPR eligible patients transported to E-CPR centers. Methods: We used a registry of adult OHCA collected between 2010 and 2015 from the city of Montréal, Canada. Included patients were adults with non-traumatic witnessed OHCA refractory to 15 minutes of resuscitation. Using this cohort, we created 3 scenarios in which potential E-CPR candidates could be redirected to E-CPR centers. We used strict eligibility criteria in our first pair (e.g. age <60 years old, initial shockable rhythm), intermediate criteria in our second pair (e.g. age <65 years old, at least one shock given) and inclusive criteria in our third pair (e.g. age <70 years old, initial rhythm ≠ asystole). These 3 scenarios were compared to their counterpart in which patients would be transported to the closest hospital. The proportions of patients who would have been transported to an E-CPR centers were compared using McNemar’s test. To obtain a power of 99%, expecting 1% of discordant pairs and using a unilateral alpha of 0.83% (after Bonferroni correction), we needed to include at least 1000 patients. Results: A total of 3136 patients (2054 men and 982 women) with a mean age of 69 years (standard deviation 15) were included. In each simulation, prehospital redirection would have significantly increased the proportion of patients transported to an E-CPR center (pair 1: 1.3% vs 3.8%, p<0.001; pair 2: 2.6% vs 7.3%, p<0.001; pair 3: 7.6% vs 29.8%, p<0.001). Conclusion: In an urban setting, a prehospital triage system could triple the number of patients with refractory OHCA who would have an access to E-CPR. This implies that centers with E-CPR capability should prepare themselves accordingly for such a system to effectively improve survival following OHCA.
LO71: For patients suffering from out-of-hospital cardiac arrest, is survival influenced by the capabilities of the receiving hospital?
- A. Cournoyer, E. Notebaert, L. De Montigny, M. Iseppon, S. Cossette, L. Londei-Leduc, Y. Lamarche, D. Larose, F. de Champlain, J. Morris, A. Vadeboncoeur, E. Piette, R. Daoust, J. Chauny, C. Sokoloff, D. Ross, Y. Cavayas, J. Paquet, A. Denault
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 19 / Issue S1 / May 2017
- Published online by Cambridge University Press:
- 15 May 2017, p. S52
- Print publication:
- May 2017
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Introduction: Patients suffering from out-of-hospital cardiac arrest (OHCA) are frequently transported to the closest hospital after return of spontaneous circulation (ROSC). Percutaneous coronary intervention (PCI) is often indicated as a diagnostic and therapeutic procedure following OHCA. This study aimed to determine the association between the type of destination hospital (PCI-capable or not) and survival to discharge for patients with OHCA and prehospital ROSC. We hypothesized that being transported to a PCI-capable hospital would be associated with a higher survival to discharge. Methods: The present study used a registry of adult OHCA between 2010 and 2015 in Montréal, Canada. We included adult patients with non-traumatic OHCA and prehospital ROSC. The association of interest was evaluated with a multivariate logistic regression model to control for demographic and clinical variables (age, gender, time of day, initial rhythm, witnessed arrest, bystander CPR, presence of first responders or advanced care paramedics, prehospital supraglottic airway placement, delay before paramedics’ arrival). Assuming a survival rate of 40% and 75% of the variability explained by other factors included in the model, more than 1200 patients needed to be included to detect an absolute difference of 10% in survival between both groups with a power of more than 90%. Results: A total of 1691 patients (1140 men and 551 women) with a mean age of 64 years (standard deviation 17) were included, of which 1071 (63%) were transported to a PCI-capable hospital. Among all patients, 704 patients (42%) survived to hospital discharge. We observed a significant independent association between survival to discharge and being transported to a PCI-capable hospital (adjusted odds ratio [AOR] 1.46 [95% confidence interval 1.09-1.96]) after controlling for confounding variables. Having an initial shockable rhythm and presence of first responders also increased survival to discharge (AORs 3.67 [95% confidence interval 2.75-4.88] and 1.53 [95% confidence interval 1.12-2.09], respectively). Conclusion: Patients experiencing ROSC after OHCA could benefit from a direct transport to a PCI-capable hospital. This benefit might also be related to unmeasured interventions other than PCI these hospitals can provide (e.g. high-level intensive care or cardiovascular surgery).
P.131 Lumbar fusion for degenerative disease: a systematic review and meta-analysis
- D Yavin, AM Isaacs, S Casha, S Wiebe, TE Feasby, C Atta, J Holroyd-Leduc, RJ Hurlbert, H Quan, A Nataraj, GR Sutherland, N Jette
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- Journal:
- Canadian Journal of Neurological Sciences / Volume 43 / Issue S2 / June 2016
- Published online by Cambridge University Press:
- 17 June 2016, p. S50
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Background: Lumbar fusion for degenerative indications is associated with a great degree of practice variation. We summarize the current evidence on the comparative safety and efficacy of lumbar fusion, decompression alone, or non-operative care for degenerative indications. Methods: Literature search of electronic bibliographic databases was conducted. Comparative studies reporting validated measures of safety or efficacy were included. Treatments effects were calculated through DerSimonian and Laird random effects models. Results: We retrieved 62 studies (17 randomized controlled, 15 prospective, 15 retrospective, and 15 registries), enrolling a total 302,347 adult patients. Disability, pain, and patient satisfaction following fusion, decompression alone, or non-operative care were dependent on surgical indications and study methodology. Relative to decompression alone, the risk of reoperation following fusion was increased for spinal stenosis (relative risk [RR] 1.17, 95% CI 1.06 to 1.30, p<0.004) and decreased for spondylolisthesis (RR 0.71, 95% CI 0.59 to 0.84, p<0.001). In all indications, complications were more frequent following fusion (RR 1.88, 95% CI 1.37 to 2.58, p<0.001). Mortality and treatment modality were not associated. Conclusions: Improvements were greatest in patients undergoing fusion for spondylolisthesis while complications limited the role of fusion for spinal stenosis. The relative safety and efficacy of fusion for chronic low back pain suggested careful patient selection is required.
Television viewing and food intake during television viewing in normal-weight, overweight and obese 9- to 11-year-old Canadian children: a cross-sectional analysis
- Michael M. Borghese, Mark S. Tremblay, Genevieve Leduc, Charles Boyer, Priscilla Bélanger, Allana G. LeBlanc, Claire Francis, Jean-Philippe Chaput
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- Journal:
- Journal of Nutritional Science / Volume 4 / 2015
- Published online by Cambridge University Press:
- 27 February 2015, e8
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It is unclear if children of different weight status differ in their nutritional habits while watching television. The objective of the present paper was to determine if children who are overweight or obese differ in their frequency of consumption of six food items while watching television compared with their normal-weight counterparts. A cross-sectional study of 550 children (57·1 % female; mean age = 10 years) from Ottawa, Canada was conducted. Children's weight status was categorised using the Centers for Disease Control and Prevention cut-points. Questionnaires were used to determine the number of hours of television watching per day and the frequency of consumption of six types of foods while watching television. Overweight/obese children watched more television per day than normal-weight children (3·3 v. 2·7 h, respectively; P = 0·001). Obese children consumed fast food and fruits/vegetables more frequently while watching television than normal-weight or overweight children (P < 0·05). Children who watched more than 4 h of television per d had higher odds (OR 3·21; 95% CI 1·14, 9·03; P = 0·03) of being obese, independent of several covariates, but not independent of moderate-to-vigorous physical activity. The finding that both television watching and the frequency of consumption of some food items during television watching are higher in children who are obese is concerning. While the nature of the present study does not allow for the determination of causal pathways, future research should investigate these weight-status differences to identify potential areas of intervention.
Contributors
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- By Aakash Agarwala, Linda S. Aglio, Rae M. Allain, Paul D. Allen, Houman Amirfarzan, Yasodananda Kumar Areti, Amit Asopa, Edwin G. Avery, Patricia R. Bachiller, Angela M. Bader, Rana Badr, Sibinka Bajic, David J. Baker, Sheila R. Barnett, Rena Beckerly, Lorenzo Berra, Walter Bethune, Sascha S. Beutler, Tarun Bhalla, Edward A. Bittner, Jonathan D. Bloom, Alina V. Bodas, Lina M. Bolanos-Diaz, Ruma R. Bose, Jan Boublik, John P. Broadnax, Jason C. Brookman, Meredith R. Brooks, Roland Brusseau, Ethan O. Bryson, Linda A. Bulich, Kenji Butterfield, William R. Camann, Denise M. Chan, Theresa S. Chang, Jonathan E. Charnin, Mark Chrostowski, Fred Cobey, Adam B. Collins, Mercedes A. Concepcion, Christopher W. Connor, Bronwyn Cooper, Jeffrey B. Cooper, Martha Cordoba-Amorocho, Stephen B. Corn, Darin J. Correll, Gregory J. Crosby, Lisa J. Crossley, Deborah J. Culley, Tomas Cvrk, Michael N. D'Ambra, Michael Decker, Daniel F. Dedrick, Mark Dershwitz, Francis X. Dillon, Pradeep Dinakar, Alimorad G. Djalali, D. John Doyle, Lambertus Drop, Ian F. Dunn, Theodore E. Dushane, Sunil Eappen, Thomas Edrich, Jesse M. Ehrenfeld, Jason M. Erlich, Lucinda L. Everett, Elliott S. Farber, Khaldoun Faris, Eddy M. Feliz, Massimo Ferrigno, Richard S. Field, Michael G. Fitzsimons, Hugh L. Flanagan Jr., Vladimir Formanek, Amanda A. Fox, John A. Fox, Gyorgy Frendl, Tanja S. Frey, Samuel M. Galvagno Jr., Edward R. Garcia, Jonathan D. Gates, Cosmin Gauran, Brian J. Gelfand, Simon Gelman, Alexander C. Gerhart, Peter Gerner, Omid Ghalambor, Christopher J. Gilligan, Christian D. Gonzalez, Noah E. Gordon, William B. Gormley, Thomas J. Graetz, Wendy L. Gross, Amit Gupta, James P. Hardy, Seetharaman Hariharan, Miriam Harnett, Philip M. Hartigan, Joaquim M. Havens, Bishr Haydar, Stephen O. Heard, James L. Helstrom, David L. Hepner, McCallum R. Hoyt, Robert N. Jamison, Karinne Jervis, Stephanie B. Jones, Swaminathan Karthik, Richard M. Kaufman, Shubjeet Kaur, Lee A. Kearse Jr., John C. Keel, Scott D. Kelley, Albert H. Kim, Amy L. Kim, Grace Y. Kim, Robert J. Klickovich, Robert M. Knapp, Bhavani S. Kodali, Rahul Koka, Alina Lazar, Laura H. Leduc, Stanley Leeson, Lisa R. Leffert, Scott A. LeGrand, Patricio Leyton, J. Lance Lichtor, John Lin, Alvaro A. Macias, Karan Madan, Sohail K. Mahboobi, Devi Mahendran, Christine Mai, Sayeed Malek, S. Rao Mallampati, Thomas J. Mancuso, Ramon Martin, Matthew C. Martinez, J. A. Jeevendra Martyn, Kai Matthes, Tommaso Mauri, Mary Ellen McCann, Shannon S. McKenna, Dennis J. McNicholl, Abdel-Kader Mehio, Thor C. Milland, Tonya L. K. Miller, John D. Mitchell, K. Annette Mizuguchi, Naila Moghul, David R. Moss, Ross J. Musumeci, Naveen Nathan, Ju-Mei Ng, Liem C. Nguyen, Ervant Nishanian, Martina Nowak, Ala Nozari, Michael Nurok, Arti Ori, Rafael A. Ortega, Amy J. Ortman, David Oxman, Arvind Palanisamy, Carlo Pancaro, Lisbeth Lopez Pappas, Benjamin Parish, Samuel Park, Deborah S. Pederson, Beverly K. Philip, James H. Philip, Silvia Pivi, Stephen D. Pratt, Douglas E. Raines, Stephen L. Ratcliff, James P. Rathmell, J. Taylor Reed, Elizabeth M. Rickerson, Selwyn O. Rogers Jr., Thomas M. Romanelli, William H. Rosenblatt, Carl E. Rosow, Edgar L. Ross, J. Victor Ryckman, Mônica M. Sá Rêgo, Nicholas Sadovnikoff, Warren S. Sandberg, Annette Y. Schure, B. Scott Segal, Navil F. Sethna, Swapneel K. Shah, Shaheen F. Shaikh, Fred E. Shapiro, Torin D. Shear, Prem S. Shekar, Stanton K. Shernan, Naomi Shimizu, Douglas C. Shook, Kamal K. Sikka, Pankaj K. Sikka, David A. Silver, Jeffrey H. Silverstein, Emily A. Singer, Ken Solt, Spiro G. Spanakis, Wolfgang Steudel, Matthias Stopfkuchen-Evans, Michael P. Storey, Gary R. Strichartz, Balachundhar Subramaniam, Wariya Sukhupragarn, John Summers, Shine Sun, Eswar Sundar, Sugantha Sundar, Neelakantan Sunder, Faraz Syed, Usha B. Tedrow, Nelson L. Thaemert, George P. Topulos, Lawrence C. Tsen, Richard D. Urman, Charles A. Vacanti, Francis X. Vacanti, Joshua C. Vacanti, Assia Valovska, Ivan T. Valovski, Mary Ann Vann, Susan Vassallo, Anasuya Vasudevan, Kamen V. Vlassakov, Gian Paolo Volpato, Essi M. Vulli, J. Matthias Walz, Jingping Wang, James F. Watkins, Maxwell Weinmann, Sharon L. Wetherall, Mallory Williams, Sarah H. Wiser, Zhiling Xiong, Warren M. Zapol, Jie Zhou
- Edited by Charles Vacanti, Scott Segal, Pankaj Sikka, Richard Urman
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- Book:
- Essential Clinical Anesthesia
- Published online:
- 05 January 2012
- Print publication:
- 11 July 2011, pp xv-xxviii
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Strained Silicon On Insulator wafers made by the Smart Cut™ technology
- B. Ghyselen, Y. Bogumilowicz, C. Aulnette, A. Abbadie, B. Osternaud, P. Besson, N. Daval, F. Andrieu, I. Cayrefourq, H. Moriceau, T. Ernst, A. Tiberj, O. Rayssac, B. Blondeau, C. Mazure, C. Lagahe-Blanchard, S. Pocas, A.-M. Cartier, J.-M. Hartmann, P. Leduc, C. Di Nardo, J.-F. Lugand, F. Fournel, M.-N. Semeria, N. Kernevez, Y. Campidelli, O. Kermarrec, Y. Morand, M. Rivoire, D. Bensahel, V. Paillard, L. Vincent, A. Claverie, P. Boucaud
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- Journal:
- MRS Online Proceedings Library Archive / Volume 809 / 2004
- Published online by Cambridge University Press:
- 17 March 2011, B2.3
- Print publication:
- 2004
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Strained Silicon On Insulator wafers are today envisioned as a natural and powerfulenhancement to standard SOI and/or bulk-like strained Si layers. For MOSFETs applications, thisnew technology potentially combines enhanced devices scalability allowed by thin films andenhanced electron and hole mobility in strained silicon. This paper is intended to demonstrate byexperimental results how a layer transfer technique such as the Smart Cut™ technology can be usedto obtain good quality tensile Strained Silicon On insulator wafers. Detailed experiments andcharacterizations will be used to characterize these engineered substrates and show that they arecompatible with the applications.
Efficient magneto-optical trapping of a metastable helium gas
- F. Pereira Dos Santos, F. Perales, J. Léonard, A. Sinatra, J. Wang, F. S. Pavone, E. Rasel, C. S. Unnikrishnan, M. Leduc
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- Journal:
- The European Physical Journal - Applied Physics / Volume 14 / Issue 1 / April 2001
- Published online by Cambridge University Press:
- 15 April 2001, pp. 69-76
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- April 2001
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This article presents a new experiment aiming at BEC of metastable helium atoms. It describes the design of a high flux discharge source of atoms and a robust laser system using a DBR diode coupled with a high power Yb doped fiber amplifier for manipulating the beam of metastable atoms. The atoms are trapped in a small quartz cell in an extreme high vacuum. The trapping design uses an additional laser (repumper) and allows the capture of a large number of metastable helium atoms (approximately 109) in a geometry favorable for loading a tight magnetostatic trap.