Skill retention following simulation learning in acute coronary syndrome versus cardiac arrest.

BACKGROUND: The acquisition skills in pathologies involving life prognosis is often problematic for young family medicine (MF). Simulation learning seems to be the technique of choice. Few studies have studied the maintenance of skills acquired in simulation. AIM: Study the retention of skills acquired in simulation learning from a distance of simulation learning. METHODS: Prospective randomized study. Inclusion of MF working in emergency departments. Theoretical training on the management of cardiac arrest (ACR) and acute coronary syndrome with ST segment elevation (ACS). Randomization into 2 groups to receive simulation training to manage ACR (ACR group) or ACS (ACS group). Evaluation of the groups by a common scenario. at T0 (the day of the simulation) and at T1 (1 month after). Study of the evolution of grades between T0 and T1. RESULTS: Inclusion ACR group: T0 (n = 19), T1 (n = 13), ACS group: T0 (n = 14), T1 (n = 9). At T0, the participants trained on a simulator had significantly better results than those of the control group (14.92 ± 2 (ACR group) vs. 7.51± 3.37 (ACS group), p <0.001 for the ACR scenario and 11 ± 2 (ACR group) vs. 13± 2 (ACS group), p = 0.03 for the ACS scenario. The ACS group maintained its knowledge at T1 for the ACS scenario. For the ACR group, a significant drop in scores in T1 for the ACR scenario was noted. CONCLUSION: Our study confirms the educational benefit of simulator training. This benefit is maintained only for the ACS.

Predictors of repeat emergency department visits among patients aged over 65 years.

BACKGROUND: The objective of our study was to evaluate the predictors of repeat visits at Emergency Department (ED) in patients aged ≥ 65 years. METHODS: A prospective observational study was conducted over a month. Inclusion:  patients (age> = 65 year) seen in the ED and leaving the same day. The epidemiological and clinical characteristics at the first visit (index visit (IV)) were collected. The Identification of Senior At Risk (ISAR) score was used to assess our patients. The number of visits (n ≥ 2) to ED within 30 days of the IV was estimated by a phone contact. RESULTS: Inclusion of125 patients. Mean age = 76 +/- 7 years. The sex ratio was 0.85. Twenty five percent of our patients made repeat visits the following period. Univariate analysis identified: age> 75 years, mean ISAR score>2, history of renal failure, ED visit a month prior to the IV, hospitalization in the last 6 months, patients who depend on someone else help at home and those taking more than 3 medications daily. In multivariate analysis, ED visit a month prior to the IV, hospitalization in the last 6 months, and patients who depend on someone else help at home were independent factors of repeat visits to the ED. CONCLUSION:   Efforts to identify patients at high risk of repeat visits to the ED should be made.

Acute coronary syndrome without persistent ST segment elevation in the emergency department: Epidemiology, clinical features and prognosis.

BACKGROUND: Acute coronary syndrome without persistent ST segment elevation (NSTE-ACS) is a major public health problem. It has been the subject of numerous studies but little has been published from the emergency department (ED). OBJECTIVE: Describe the epidemiology, clinical features, management and prognosis of patients with NSTE-ACS presenting to ED. METHODS: Prospective, observational, over four years study (2011-2015). INCLUSION CRITERIA: patients (> 18 years of age) presenting consecutively to ED with the diagnosis of NSTE-ACS. Collection of epidemiological, clinical and therapeutic features. Calculation of ischemic risk (TIMI and GRACE) and bleeding risk (CRUSADE) score. Prognosis (death and ischemic events) was evaluated at six months.  Results: Inclusion of 390 patients. Mean age = 61 ± 11 years. Sex-ratio = 1.46. Cardio-vascular risk factors (%):  hypertension (60), Mellitus diabetes (47), dyslipidemia (29) and smoking (26).   The median TIMI and GRACE scores were equal to 3 and 112 respectively. The median CRUSADE score was 29. Electrocardiographic findings (%): ST segment depression (43), T wave depression (24) and no ischemic changes (26).Initial management in the ED (%):  anti-ischaemic agents (43), antiplatelet agents (Acetylsalicylic acid (90), Clopidogrel (70)) and anticoagulants (70). Coronary angiography was done in all patients: early in 71% of patients and elective in 29% of patients.Prognosis at 6 months (%): recurrence of angina (24), infraction (9) and mortality (5). CONCLUSION: Patients with NSTE-ACS are predominantly male. The main risk factors are hypertension, mellitus diabetes and dyslipidemia. The prognosis was good with a mortality rate of 5%.

Anaphylaxis in an emergency department: Epidemiology, clinical features and management.

INTRODUCTION: Studies report that anaphylaxis was under-diagnosed in emergency department (ED) and emergency management was often in disagreement with international recommendations. AIM OF THE STUDY: The aim of this study was to describe the epidemiology, clinical features, management and outcome of patients with anaphylaxis presenting to an ED. METHODS: Prospective, observational study over four years (June 2010 to May 2014). INCLUSION CRITERIA: patients (> 14 years of age) presenting consecutively to the ED with the diagnosis of anaphylaxis. Collection of epidemiological, clinical and therapeutic parameters Results: During the study, 239 patients were enrolled. Mean age = 40±15 years. Sex-ratio=0.8.  History of anaphylaxis was reported in 40% of cases. Clinical features n (%): cutaneous features 229 (96), cardiovascular features 124 (52), respiratory features 127 (53), gastrointestinal features 48 (20) and neurologic features 4 (10). Most common allergens: drugs 62%, food 24% and insects 4%. No causes were apparent in 8% of cases. An anaphylactic shock was recorded in 73 patients (31%). Adrenaline was used in 83%of patients, intravenously in 31%.  Corticosteroids and histamine H1 antagonist were prescribed in 98 and 51% respectively. Biphasic reactions were reported in three patients. There was no death cases registered. CONCLUSION: Our results showed that the prevalence of anaphylaxis was low.This demonstrates that anaphylaxis is a situation which remains underestimated. It is therefore imperative to conduct prospective multicenter studies in emergency services for better determination of its impact and its risk factors.

Evaluation of anticoagulation therapy in non-valvular atrial Fibrillation in the emergency department.

INTRODUCTION: The vitamin K antagonists (VKAs) are currently the most effective therapeutic class for the prevention of cerebrovascular eventsin atrial fibrillation (AF) patients. However, several studies showed an under-prescription of this therapy.The aim of the study was to assess the prescription of VKAs in non-valvular AF (NVAF) patients and factors influencing the non-prescription ofsuch treatment. METHODS: We conducted a prospective, observational study in an emergency department (ED). Patients with high thromboembolic risk NVAFand not receiving VKAs beforehand were included. Calculation of CHA2DS2-VASc and HAS-BLED scores was performed. An analytic study wasconducted in order to identify independent predictors of the under-prescription of VKAs. RESULTS: During study, 176 patients were enrolled, the mean age was 67±13 years and 66% were women. The mean CHA2DS2VASc andHASBLED scores were 2.88 ± 1.55 and 1.52 ± 1.05, respectively. Among our cohort, VKA was prescribed in 36% of cases. Age >70 years(OR=1.59, 95%CI[1.11-2.21],p<0.001), creatinine level ≥110 µmol/l (OR=2.54,95%CI[1.20-5.37],p=0.01) and aspirin use (OR =1.7,95%CI [1.08-2.67],p=0.02) were independently associated with under-prescription of VKAs. Bedside, the main causes reported by the emergency physicians(EP) were: factors related to patient characteristics (n=38,34%), factors related to emergency physician (n=62,55%), factors related to the patientenvironment (n=20,17%) and factors related to the drug (n=22,23%). CONCLUSIONS: Our results showed that the prescription of VKAs was low in ED. The reasons of VKA under-prescription are linked usually toseveral factors inherent to patient and to the adherence of EP to new recommendations.