Initial presentation of lung cancer in the emergency department: a descriptive analysis.

BACKGROUND: Guidelines aimed at improving care for lung cancer, the leading cause of cancer-related death in Canada and worldwide, require accurate knowledge of the diagnostic setting or pathway. We sought to determine how often lung cancer is initially diagnosed through the emergency department. METHODS: We performed a descriptive study that included all cases of primary lung cancer diagnosed in residents of Nova Scotia in 2014. Cancer registry data included diagnostic data and date of death to Aug. 31, 2016. We reviewed linked hospital records, including laboratory and imaging results, to identify the first positive diagnostic study and the route of presentation (emergency department v. other). We evaluated time from diagnosis to death as a function of presentation route using Kaplan-Meier curves and Cox regression (hazard rate ratios [HRRs]). RESULTS: Sufficient data were available for 946 of 951 cases identified, of which 336 (35.5%) were diagnosed through the emergency department. Cases diagnosed via the emergency department were more likely to be at an advanced stage (stage IV, 59.5% v. 43.4%), with patients experiencing shorter survival (1-yr survival, 28.4% v. 49.5%), including stage-specific survival. Mortality for cases diagnosed in the emergency department was 54% higher than for the non-emergency department group after adjusting for age and stage (HRR 1.54, 95% confidence interval 1.32-1.81). Few patients (7.1%, n = 24) who presented to the emergency department reported having no family physician. INTERPRETATION: The emergency department is a common route of presentation for lung cancer and is associated with advanced stage at diagnosis and reduced survival time. Strategies are needed to encourage pre-emergent diagnosis and to ensure that emergency providers are supported in the initial care of patients with lung cancer.

Acute Lymphoblastic Leukemia Presenting Solely as Low Back Pain.

A 23-year-old man with acute lymphoblastic leukemia presented to the emergency department without any history of constitutional symptoms (fatigue, anorexia, or weight loss), dyspnea, bruising, or bleeding. Presentation of acute leukemia solely as musculoskeletal pathology is common in pediatric populations but rare among adult patients. Recognizing this presentation of acute leukemia in adult patients could help prevent delayed diagnoses.

CAEP 2014 Academic Symposium: "How to make research succeed in your department: Promoting excellence in Canadian emergency medicine resident research".

OBJECTIVES: To characterize the current state of Canadian emergency medicine (EM) resident research and develop recommendations to promote excellence in this area. METHODS: We performed a systematic review of MEDLINE, Embase, and ERIC using search terms relevant to EM resident research. We conducted an online survey of EM residency program directors from the Royal College of Physicians and Surgeons of Canada (RCPSC) and College of Family Physicians of Canada (CFPC). An expert panel reviewed these data, presented recommendations at the Canadian Association of Emergency Physicians 2014 Academic Symposium, and refined them based on feedback received. RESULTS: Of 654 potentially relevant citations, 35 articles were included. These were categorized into four themes: 1) expectations and requirements, 2) training and assessment, 3) infrastructure and support, and 4) dissemination. We received 31 responses from all 31 RCPSC-EM and CFPC-EM programs. The majority of EM programs reported requiring a resident scholarly project; however, we found wide-ranging expectations for the type of resident research performed and how results were disseminated, as well as the degree of completion expected. Although 93% of RCPSC-EM programs reported providing formal training on how to conduct research, only 53% of CFPC-EM programs reported doing so. Almost all programs (94%) reported having infrastructure in place to support resident research, but the nature of support was highly variable. Finally, there was marked variability regarding the number of resident-published abstracts and manuscripts. CONCLUSIONS: Based on the literature, our national survey, and discussions with stakeholders, we offer 14 recommendations encompassing goals, expectations, training, assessment, infrastructure, and dissemination in order to improve Canadian EM resident research.

Emergent presentation of decompensated mitral valve prolapse and atrial septal defect.

Mitral valve prolapse is not commonly on the list of differential diagnosis when a patient presents in the emergency department (ED) in severe distress, presenting with non-specific features such as abdominal pain, tachycardia and dyspnea. A healthy 55-year-old man without significant past medical history arrived in the ED with a unique presentation of a primary mitral valve prolapse with an atrial septal defect uncommon in cardiology literature. Early recognition of mitral valve prolapse in high-risk patients for severe mitral regurgitation or patients with underlying cardiovascular abnormalities such as an atrial septal defect is crucial to prevent morbid outcomes such as sudden cardiac death.

Ergonomics evaluation and redesign of a hospital meal cart.

The ergonomic, design and other problems of a conventional hospital meal cart were evaluated with a view to redesign a hospital meal cart by incorporating ergonomic principles and data. The operators encountered difficulty in setting the cart in motion, seeing over the cart, turning the cart and stopping the cart while in motion. The operators expressed postural discomfort in the shoulder, neck, back, lower back, knee and leg, and ankle and foot. The cart with meal trays and food was found to exceed the acceptable initial turning push force requirement of 5th percentile females. Recommendations were made for proper placement of cart handles and handle diameter, provision of large-diameter cart wheel made of hard rubber tire, reduction of cart height, use of plastic material for cart construction, provision of emergency brake, provision of individually (electrically) heated plates for soup and main meal, provision of thick air-tight transparent plastic doors, and reduction of the meal tray size. Several recommendations were adopted by the manufacturer in the new model.