CURRENT PROJECTS

 

ADJUST DVT

The primary objective of this study is to assess the efficacy & safety of a progressive cut-off of D-dimer to rule out DVT. This age-adjusted cut-off is defined as age x 10 in patients 50 years or older. UHN Site Investigators: Jennifer Hulme, Edward Xie

ADVOCACY WRITING AS RESIDENT EDUCATION (AWARE)

This workshop will provide participants with knowledge and skills required to produce a short opinion editorial piece. The project will consist of three parts: a didactic session reviewing the purpose and mechanism of opinion editorial writing, resident independent work in which they complete an opinion editorial, and a workshop.This will help residents to improve their systems-level advocacy skills, which fulfills a core CANMEDS competency. Investigators: Kate Hayman, Jennifer Hulme, Connor Lavelle

BUILDING A COMPREHENSIVE ADDICTION MEDICINE PROGRAM OF RESEARCH AT THE UNIVERSITY HEALTH NETWORK

We aim to understand current Emergency Department (ED) policies and practices in the area of addictions both locally and nationally. We will explore the uptake, effectiveness, and impact of various addiction medicine initiatives in caring for people with substance use disorders, and feed this back into the quality improvement loop to modify our practice. Investigators: Jennifer Hulme, Hasan Sheikh, David Wiercigroch, Edward Xie, Patricia Hoyeck

DETERMINING EVIDENCE BASE AND KNOWLEDGE TRANSLATION OPPORTUNITIES FOR HEALTH EQUITY IN THE EMERGENCY DEPARTMENT

We aim to understand current Emergency Department (ED) policies and practices for key vulnerable groups. We seek to identify and consolidate best practice interventions in the ED to improve access to care and social services, as well as long term outcomes for the homeless, under housed, and people who use drugs and alcohol. We also seek to identify major unmet needs that exist for these patient populations in the GTA. Investigators: Jennifer Hulme, Kate Hayman, Megan Landes

CHEST X-RAY FOR CHEST PAIN IN THE ED

The primary objective of this study is to reinvestigate the viability of the Poku rule (a clinical decision rule to safely decrease the need for chest x-rays in patients with chest pain) using the original criteria in addition to vital signs not included in the original study. 600 charts were randomly selected and audited for patients with a primary complaint of chest pain or an equivalent from two academic emergency departments over a period of 1 year. The aim was to analyze what factors could predict clinically significant chest x-rays. Investigators: Jennifer Bryan, Scott McGilvray

Head injury is a major cause of bicycling-related death,  and more likely to occur in unhelmeted riders. In Canada, legislation regarding helmet use varies by province. In Ontario, helmet use is not mandatory for cyclists >= age 18, and approximately 50 % of adult cyclists do not routinely wear helmets. Non-legislative approaches to increase helmet use have included education, public health campaigns, and helmet giveaways, but sustained effect is typically limited.


The goal of the HEADSTRONG Behaviour Study is to identify injured adult cyclists who do not regularly wear helmets, and enrol them in a program that will effect sustained helmet use. The strategy incorporates evidence-based elements of health behaviour change, including:  a) reducing barriers, b) education and modeling, c) providing necessary materials, and d) social support. Investigators: Steven Friedman, Danielle Porplycia, Brenda Varriano

MANAGEMENT OF CLOSED DISTAL RADIUS FRACTURES IN THE ED

Wrist fracture from a fall on an outstretched hand is among the commonest orthopaedic injuries seen in the emergency department. The primary objective of this study is to determine rates of reduction in orthopaedic follow up at six weeks for patients who are discharged from the ED with Closed Distal Radius Fracture CDRF in two cohorts: i) patients who were reduced on the index visit, and ii) patients who were not reduced on the index visit. Investigators: Telisha Smith-Gorvie, Shaun Mehta

Subcutaneous abscesses are a frequent presentation in the emergency department, but some elements of their management are based more on dogma than evidence. The primary objective of this study was to characterize the management of uncomplicated subcutaneous abscesses (SA) by Canadian emergency physicians (EPs). Results identified practice variability and deviations from practice guidelines (i.e. IDSA, Choosing Wisely Canada). A knowledge translation exercise based on the guidelines for Canadian EPs is planned. Investigators: Steven Friedman Ahmed Al-Den

OCULOMOTOR FUNCTION TESTING IN PATIENTS WHO SUFFERED CONCUSSION

Concussion or mild traumatic brain injury (mTBI) is a major cause of morbidity and mortality worldwide and may lead to brain function changes. These subtle brain changes may present as a physical, cognitive, and/or behavioural symptoms. The concussion symptoms resolve in most individuals within days to weeks, however, 10-15% of patients suffer these symptoms for a prolonged time which is referred to as the post-concussion syndrome (PCS). Given that concussions may have devastating short- and long-term effects, tools that improve assessments and managements are critical. Visual complaints such as double vision and eye fatigue as well as impairment in vergence, accommodation, and saccades are commonly seen in patients after concussion. The primary objective of this study is to identify differences in oculomotor function and visual scanning behaviour (VSB) between participant with and without acute concussion. The aim is also to investigate patterns of change and recovery in oculomotor function and VSB in participants who suffered a concussion. Investigators: Carmela Tartaglia, Moshe Eizenman, Steven Friedman (EM Lead and Co-I). 

PALLIATIVE CARE IN THE ED

The primary objective of this study is to allow for improvement in quality of care for patients at UHN with advanced, life-limiting illness. If patients with unmet palliative needs can be identified quickly in the Emergency Department setting, then these patients can have their symptom management and psychosocial needs met. The results of this study will provide insight into the palliative care needs of ED patients and may allow for improvement in the delivery of palliative care services at UHN. Investigators: Erin O’Connor, Juliana Duffy

RAPID ACCESS ADDICTIONS MEDICINE IN THE ED

The primary objective of this study is to understand current Emergency Department (ED) policies and practices in the area of addictions both locally and nationally. We aim to understand the uptake, effectiveness, and impact of various addiction medicine initiatives in caring for people with substance use disorders, and feed this back into the quality improvement loop to modify our practice.  Investigators: Jennifer Hulme

SCOPE (Seamless Care Optimizing the Patient Experience) is a multifaceted primary care practice-based intervention to reduce ED visits and hospitalization for complex patients. A virtual interprofessional health team supports primary care providers through a single point of access. Family physicians and nurse practitioners registered with SCOPE can connect to local specialists, imaging, and community services, to serve their patients with complex care needs. ​ Investigators: Gillian Hawker, Noah Ivers, Pauline Pariser, Tara O'Brien, Onil Bhattacharyya, Steven Friedman (EM Lead and Co-I),

USE OF REGIONAL ANESTHESIA IN THE EMERGENCY DEPARTMENT: SURVEY OF LOCAL PRACTICES

Current attitudes and practices with respect to regional anesthesia in emergency departments across Canada have not been documented. This study aims to describe current practice patterns of emergency physicians across Canada. Furthermore, the study aims to understand facilitators and barriers to using regional anesthetic techniques in the ED setting. Investigators: Maxim Ben-Yakov, Steven Friedman, David Wiercigroch

The UHN Hepatology clinic is completing Hepatitis C screening tests to eligible patients born between 1945-1975 in the emergency department. Objectives include testing the feasibility of a targeted birth cohort screening program for HCV in the ED, as well as in an ambulatory care and community outreach settings. The VIRCAN team is offering follow up and treatment to all patients with a positive test. Investigators: Jordan Feld, Camelia Capraru, Steven Friedman (EM Lead and Co-I).

VIRUNGA RANGER TRAINING, HANDBOOK & PROGRAM EVALUATION

We aim to create a sustainable wilderness medical training programme for the park rangers of

Virunga National Park in the Democratic Republic of Congo. These rangers have a very high

mortality rate from accidents, violence, infections, and environmental hazards. Our goal is to train a subset of rangers in wilderness first responder techniques, and teaching methods, to reduce morbidity and mortality in the field. Investigators: Margaret Salmon, Michael Galvin

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