CAEP 2018 Academic Symposium: Recommendations for developing and supporting Global Emergency Medicine in Canadian academic emergency departments and divisions.

OBJECTIVES: The objective of the CAEP Global Emergency Medicine (EM) panel was to identify successes, challenges, and barriers to engaging in global health in Canadian academic emergency departments, formulate recommendations for increasing engagement of faculty, and guide departments in developing a Global EM program. METHODS: A panel of academic Global EM practitioners and residents met regularly via teleconference in the year leading up to the CAEP 2018 Academic Symposium. Recommendations were drafted based on a literature review, three mixed methods surveys (CAEP general members, Canadian Global EM practitioners, and Canadian academic emergency department leaders), and panel members' experience. Recommendations were presented at the CAEP 2018 Academic Symposium in Calgary and further refined based on feedback from the Academic Section. RESULTS: A total of nine recommendations are presented here. Seven of these are directed towards Canadian academic departments and divisions and intend to increase their engagement in Global EM by recognizing it as an integral part of the practice of emergency medicine, deliberately incorporating it into strategic plans, identifying local leaders, providing tangible supports (i.e., research, administration or financial support, shift flexibility), mitigating barriers, encouraging collaboration, and promoting academic deliverables. The final two recommendations pertain to CAEP increasing its own engagement and support of Global EM. CONCLUSIONS: These recommendations serve as guidance for Canadian academic emergency departments and divisions to increase their engagement in Global EM.

Defining and Using Preoperative Predictors of Diabetic Remission Following Bariatric Surgery.

BACKGROUND: Diabetes remission is defined as the return of glycemic control in the absence of medication or insulin use after bariatric surgery. We sought to identify and assess the clinical utility of a predictive model for remission of type 2 diabetes mellitus in a population seeking bariatric surgery. METHOD: A retrospective cohort design was applied to presurgical data on patients referred for Roux-en-Y gastric bypass (RYGB) or vertical sleeve gastrectomy (VSG). The model developed from logistic regression was compared with a published model through receiver operating characteristic analyses. RESULTS: At 12 months postoperatively, 59.7% of the cohort was remitted, with no differences between RYGB and VSG. Logistic regression analyses yielded a model in which 4 preoperative variables reliably predicted remission. A Hosmer-Lemeshow goodness-of-fit test result of 0.204 indicated good fit of the developed prediction model to our outcome data. The predictive accuracy of this prediction model was compared with a published model, and an associated variation with diabetes years was substituted for age in our patient population. Our model was the most accurate. CONCLUSIONS: Using these predictors, healthcare providers may be able to better counsel patients who are living with diabetes and considering bariatric surgery on the likelihood of achieving remission from the intervention. This refined prediction model requires further testing in a larger sample to evaluate its external validity.