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MP51: The relationship between entrustment scores in the simulated and workplace environments among emergency medicine residents
- N. Prudhomme, M. O'Brien, M. McConnell, N. Dudek, W. Cheung
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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. S61
- Print publication:
- May 2020
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Introduction: The Emergency Medicine Specialty Committee of the Royal College of Physicians and Surgeons of Canada (RCPSC) has specified that resuscitation Entrustable Professional Activities (EPAs) can be assessed in either the workplace or simulation environments; however, there is minimal evidence that such clinical performance correlates. We sought to determine the relationship between assessments in the workplace versus simulation environments among junior emergency medicine residents. Methods: We conducted a prospective observational study to compare workplace and simulation resuscitation performance among all first-year residents (n = 9) enrolled in the RCPSC-Emergency Medicine program at the University of Ottawa. All scores from Foundations EPA #1 (F1) were collected during the 2018-2019 academic year; this EPA focuses on initiating and assisting in the resuscitation of critically ill patients. Workplace performance was assessed by clinical supervisors by direct observation during clinical shifts. Simulation performance was assessed by trained simulation educators during regularly-scheduled sessions. We present descriptive statistics and within-subjects analyses of variance. Results: We collected a total of 104 workplace and 36 simulation assessments. Interobserver reliability of simulation assessments was high (ICC = 0.863). We observed no correlation between mean EPA scores assigned in the workplace and simulation environments (Spearman's rho=−0.092, p = 0.813). Scores in both environments improved significantly over time (F(1,8) = 18.79, p < 0.001, ηp2 = 0.70), from 2.9(SD = 1.2) in months 1-4 to 3.5(0.2) in months 9-12 (p = 0.002). Workplace scores (3.4(0.1)) were consistently higher than simulation scores (2.9(0.2)) (F(1,8) = 7.16, p = 0.028, ηp2 = 0.47). Conclusion: We observed no correlation between EPA F1 ratings of resuscitation performance between the workplace and simulation environments. Further studies should seek to clarify this relationship to inform our ongoing use of simulation to assess clinical competence.
LO003: Outpatient referrals from the emergency department - a retrospective review
- N. Prudhomme, S. White, E.S. Kwok
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 18 / Issue S1 / May 2016
- Published online by Cambridge University Press:
- 02 June 2016, p. S31
- Print publication:
- May 2016
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Introduction: While a majority of patients presenting to the emergency department (ED) are discharged home without need for inpatient hospitalization, many require outpatient follow-up. Currently, outpatient referrals from our ED are made via a complex and error-prone series of manual steps which have the potential to be unreliable and negatively impact quality of care. We sought to perform a current state analysis of our outpatient referral processes across the hospital’s specialties. Methods: We conducted a retrospective health records review at a tertiary academic centre (>160,000 ED visits/year) from January 1 to January 7, 2015. All consecutive outpatient consultation requests triggered by an ED physician were identified and included for chart review. All cases were subsequently followed up to 11 months. A single reviewer extracted data on demographics, actual referral attendance rates, incomplete referrals, return ED visits, and time intervals. The top 3 and bottom 3 performing services were identified for further analysis of their outpatient referral mechanisms and processes. We present descriptive statistics. Results: A total of 251 outpatient referrals to a broad range of specialty services were identified during the study period. 216 (86.1%) of patients attended the intended appointment, while 35 (13.9%) of referrals were incomplete at 11 months post index ED visit. The overall median time to successful outpatient follow-up appointments was 8.5 days [IQR=3.8-24.2]. 8 (3.2%) patients had a return ED visit for a related complaint prior to being seen at their outpatient appointment. The top 3 performers were Ophthalmology [Median=1.0 day, IQR=0.0-1.0, Incomplete=2.8%], Plastic Surgery [Median=5.0 days, IQR=2.8-6.0, Incomplete=7.7%], and Orthopedics [Median=8.0 days, IQR=7.0-10.0, Incomplete=0.0%]. The bottom 3 performers were Dermatology [Median=52days, IQR=41.5-92.5, Incomplete=25.0%], Neurology [Median=40.0 days, IQR= 2.5-43.5, Incomplete=56.3%], and Urology [Median=14.0 days, IQR=10.5-48.0, Incomplete=33.3%]. Conclusion: We found a tremendous range of variability in both the waiting times and actual reliability of outpatient referral processes from the ED. Future phases of this project will focus on examining specific processes of the top and bottom performing specialties in order to improve and standardize all outpatient referrals.
Récepteurs sérotoninergiques 5-HT1D et antidépresseurs
- G. Fillion, C. Harel, I. Cloez, P. Barone, F. Atger, MP Fillion, N Prudhomme, JC Rousselle, E Zifa, F Haour, D Jordan, S Deluermoz, N Kopp
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- Journal:
- Psychiatry and Psychobiology / Volume 5 / Issue 3 / 1990
- Published online by Cambridge University Press:
- 28 April 2020, pp. 187-194
- Print publication:
- 1990
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Divers sous-types de récepteurs sérotoninergiques de type 5-HT1 ont été mis en évidence. Ils correspondent aux soustypes 5-HT1A (marqué sélectivement par le 8-OH-DPAT), 5-HT1B marqué par le propranolol et certains bêta-antagonistes et présent seulement chez le rat et la souris, absent chez l’homme) et 5-HT1C (marqué par la mésulergine et présent en particulier dans les plexus choroïdes). Un sous-type supplémentaire 5-HT1 non A, non B, non C a été mis en évidence; il est caractérisé par un site de liaison insensible aux concentrations de ligands inhibant sélectivement les sous-types 5-HT1A, 5-HT1B et 5-HT1C, il correspond à un système de transduction adénylcyclasique (activation ou inhibition) et apparaît enfin jouer un rôle important dans la modulation présynaptique de la libération de neurotransmetteurs - non sérotoninergiques - en particulier l’acétylcholine. Ces caractéristiques ont été mises en évidence sur des préparations membranaires de cortex de mammifères par des essais in vitro de liaison de [3H]5-HT, de mesure d’activité adénylcyclasique sur les mêmes préparations et par mesure de libération évoquée de [3H] acétylcholine à partir de préparations synaptosomales de diverses régions cérébrales de rat et de cobaye. Une analyse par autoradiographie quantitative a été réalisée chez l’homme sur des coupes fines de cortex frontal prélevées post-mortem chez des individus normaux et des individus déprimés; les résultats obtenus suggèrent une légère augmentation des sites 5-HT1 non A, non b, non c chez les individus déprimés versus les cerveaux normaux. Les antidépresseurs à faibles concentrations (10 à 100 nM) sont capables d’interagir in vitro avec le fonctionnement de ce récepteur: au niveau du site de reconnaissance en altérant les caractéristiques de liaison de la [3H]5-HT, à celui du système de transduction adénylcyclasique en inhibant l’activation induite par la 5-HT et enfin au niveau de l’effet cellulaire sérotoninergique en réversant partiellement l’effet inhibiteur du trilîuorophénylméthylpipérazine (TFMPP), un agoniste sérotoninergique, sur la libération évoquée d’acétylcholine. Cet effet est observé avec des antidépresseurs inhibiteurs d’uptake de la 5-HT mais aussi avec des inhibiteurs d’uptake de la noradrénaline et non pas avec des benzodiazépines ou des neuroleptiques. Ces résultats suggèrent I’hypothèse selon laquelle le système sérotoninergique fonctionnant à l’aide des récepteurs 5-HT1 non A, non B, non c pourrait réguler la libération de divers autres neurotransmetteurs entraînant par là une régulation du nombre des récepteurs correspondants à ceux-ci. Les antidépresseurs pourraient interagir avec cet effet modulateur sérotoninergique vraisemblablement altéré au cours de pathologies dépressives ou accompagnant celle-ci.