The impact of social media promotion with infographics and podcasts on research dissemination and readership.

OBJECTIVE: In 2015 and 2016, the Canadian Journal of Emergency Medicine (CJEM) Social Media (SoMe) Team collaborated with established medical websites to promote CJEM articles using podcasts and infographics while tracking dissemination and readership. METHODS: CJEM publications in the "Original Research" and "State of the Art" sections were selected by the SoMe Team for podcast and infographic promotion based on their perceived interest to emergency physicians. A control group was composed retrospectively of articles from the 2015 and 2016 issues with the highest Altmetric score that received standard Facebook and Twitter promotions. Studies on SoMe topics were excluded. Dissemination was quantified by January 1, 2017 Altmetric scores. Readership was measured by abstract and full-text views over a 3-month period. The number needed to view (NNV) was calculated by dividing abstract views by full-text views. RESULTS: Twenty-nine of 88 articles that met inclusion were included in the podcast (6), infographic (11), and control (12) groups. Descriptive statistics (mean, 95% confidence interval) were calculated for podcast (Altmetric: 61, 42-80; Abstract: 1795, 1135-2455; Full-text: 431, 0-1031), infographic (Altmetric: 31.5, 19-43; Abstract: 590, 361-819; Full-text: 65, 33-98), and control (Altmetric: 12, 8-15; Abstract: 257, 159-354; Full-Text: 73, 38-109) articles. The NNV was 4.2 for podcast, 9.0 for infographic, and 3.5 for control articles. Discussion Limitations included selection bias, the influence of SoMe promotion on the Altmetric scores, and a lack of generalizability to other journals. CONCLUSION: Collaboration with established SoMe websites using podcasts and infographics was associated with increased Altmetric scores and abstract views but not full-text article views.

Leveraging a Virtual Community of Practice to Participate in a Survey-based Study: A Description of the METRIQ Study Methodology.

OBJECTIVES: To power the METRIQ (Medical Education Translational Resources: Impact and Quality) Study adequately, we aimed to recruit > 200 medical students, residents, and attendings to complete a 90- to 120-minute survey by leveraging a virtual community of practice (vCoP). METHODS: Participants were recruited using personal (conference campaign and e-mails) and online (a study website and social media campaign utilizing Twitter, Facebook, blogs, podcasts, an infographic, and a YouTube video) techniques that leveraged relationships within a virtual community or practice. Participants received weekly survey reminders for 4 weeks and at the end of the rating period. Survey completion rates were calculated. RESULTS: A total of 380 potential participants completed an intake form (139 medical students, 120 residents, 121 attendings), 330 consented to participate, and 309 (81.3% of interested and 93.9% of consenting participants) completed the full survey (121, 88, and 100, respectively). The required sample size was achieved. CONCLUSIONS: The METRIQ Study utilized a multimodal recruitment campaign that targeted a vCoP. It recruited large numbers of participants with high completion rates. Response rates could not be calculated given the uncertainty surrounding the number of individuals invited to participate.

Diagnostic accuracy of the iCare rebound tonometer compared to the Perkins applanation tonometer in assessing intraocular pressure in rural patients.

BACKGROUND: Vision health is recognized as a critical unmet need in North America. The ocular morbidity associated with glaucoma results from increased intraocular pressure (IOP) and early detection is crucial for the management of glaucoma. Our objective was to find a diagnostically accurate screening tool for intraocular hypertension that can be used in rural communities. We sought to validate the diagnostic accuracy of the iCare rebound tonometer against the gold standard Perkins applanation tonometer (PAT) in measuring IOP. METHODS: Patients from two rural communities in Ontario, Canada visiting their optometrists for routine appointments had their IOP measured by a non-contact tonometer (NCT), an iCare rebound tonometer, and a Perkins applanation tonometer (PAT). Values of sensitivity, specificity, and likelihood ratios for a positive and negative result were calculated for the iCare and the NCT. RESULTS: Complete data was collected from 209 patients. Overall, the iCare tonometer had high levels of validity, as compared to the gold standard PAT. The iCare tonometer displayed excellent sensitivity of 98.3% (90-99%, 95% CI) and excellent negative likelihood ratio of 0.024 (0.0088-0.066, 95% CI) which is useful for ruling out intraocular hypertension. CONCLUSIONS: The iCare tonometer is a reasonably valid tool for detecting elevated IOP. Its ease of use, simplicity, and accessibility makes it a good screening tool to improve eye health in rural areas.

Procedural sedation and analgesia in rural and regional emergency departments.

INTRODUCTION: Several agents can be administered during procedural sedation and analgesia (PSA) in the emergency department (ED). The purpose of this study was to determine the PSA agents commonly used by physicians working in nontertiary EDs, and to assess the physicians' comfort level administering the agents as well as their knowledge of adverse effects of the agents. METHODS: We distributed a confidential electronic survey to physicians working in nontertiary EDs in southwestern Ontario. Using a 5-point Likert scale, ED physicians were asked to rate their use of older and newer agents used for PSA in the ED, as well as their familiarity with the agents. RESULTS: A total of 55 physicians completed the survey. The most frequently used drugs were fentanyl (66.0% often or always) and propofol with fentanyl (59.2% often or always). Most respondents stated that they rarely used ketofol (54.2% rarely or never) or etomidate (77.1% rarely or never). Respondents were most comfortable using midazolam or fentanyl (96.1% somewhat or very comfortable), and least comfortable administering etomidate and ketofol (36.5% and 23.1% somewhat or very uncomfortable). These differences were magnified with comparison of physicians with CCFP (Certification in The College of Family Physicians) and CCFP(EM) (emergency medicine) designations. Additionally, etomidate's adverse effects were the least astutely recognized (19%), compared with midazolam combined with fentanyl (63%). CONCLUSION: Physicians practising in nontertiary EDs used more often, remained more comfortable with and were more familiar with older sedation agents than newer agents.

INTRODUCTION: On peut administrer plusieurs agents pour la sédation et l'analgésie en cours d'intervention dans les services d'urgence. Le but de cette étude était de déterminer quels sont les agents les plus couramment utilisés par les urgentologues d'établissements de soins non tertiaires, de vérifier dans quelle mesure ils se sentent à l'aise de les administrer et de mesurer leur degré de connaissances au sujet des effets indésirables de ces agents. MÉTHODES: Nous avons envoyé un sondage électronique confidentiel aux urgentologues des établissements de soins non tertiaires du Sud-Ouest de l'Ontario. En utilisant une échelle de Likert en 5 points, nous les avons invités à classer leur utilisation des agents anciens et récents pour la sédation et l'analgésie en cours d'interventionà l'urgence, de même que leur degré de connaissance de ces agents. RÉSULTATS: En tout, 55 médecins ont répondu au sondage. Les médicaments les plus souvent utilisés ont été le fentanyl (66,0 %, souvent ou toujours) et le propofol avec fentanyl (59,2 %, souvent ou toujours). La plupart des répondants ont affirmé utiliser rarement le kétofol (54,2 % rarement ou jamais) ou l'étomidate (77,1 % rarement ou jamais). Les répondants étaient le plus à l'aise avec le midazolam ou le fentanyl (96,1 % relativement ou très à l'aise) et le moins à l'aise avec l'étomidate et le kétofol (36,5 % et 23,1 % relativement ou très à l'aise). Ces différences étaient amplifiées lorsqu'on comparait les médecins détenteurs d'un CCFM (certificat du Collège des médecins de famille) et d'un CCFM(MU) (médecine d'urgence). De plus, les effets indésirables de l'étomidate étaient les moins bien reconnus (19 %), comparativement à ceux du midazolam allié au fentanyl (63 %). CONCLUSION: Les médecins qui exercent dans les services d'urgence des établissements de soins non tertiaires ont utilisé plus souvent des sédatifs plus anciens; ils se sentaient plus à l'aise d'utiliser ce type d'agents et les connaissaient mieux que les agents plus récents.

Ontario children have outgrown the Broselow tape.

OBJECTIVE: The Broselow Pediatric Emergency Tape (Armstrong Medical Industries, Inc., Lincolnshire, IL) (BT) is a well-established length-based tool for estimation of body weight for children during resuscitation. In view of pandemic childhood obesity, the BT may no longer accurately estimate weight. We therefore studied the BT in children from Ontario in a large recent patient cohort. METHODS: Actual height and weight were obtained from an urban and a rural setting. Children were prospectively recruited between April 2007 and July 2008 from the emergency department and outpatient clinics at the London Health Science Centre. Rural children from junior kindergarten to grade 4 were also recruited in the spring of 2008 from the Avon Maitland District School Board. Data for preschool children were obtained from three daycare centres and the electronic medical record from the Maitland Valley Medical Centre. The predicted weight from the BT was compared to the actual weight using Spearman rank correlation; agreement and percent error (PE) were also calculated. RESULTS: A total of 6,361 children (46.2% female) were included in the study. The median age was 3.9 years (interquartile range [IQR] 1.56-7.67 years), weight was 17.2 kg (IQR 11.6-25.4 kg), and height was 103.5 cm (IQR 82-124.4 cm). Although the BT weight estimate correlated with the actual weight (r  =  0.95577, p < 0.0001), the BT underestimated the actual weight by 1.62 kg (7.1% ± 16.9% SD, 95% CI -26.0-40.2). The BT had an ≥ 10% PE 43.7% of the time. CONCLUSIONS: Although the BT remains an effective method for estimating pediatric weight, it was not accurate and tended to underestimate the weight of Ontario children. Until more accurate measurement tools for emergency departments are developed, physicians should be aware of this discrepancy.

A door-to-needle time of 30 minutes or less for myocardial infarction thrombolysis is possible in rural emergency departments.

OBJECTIVE: The Canadian Emergency Cardiac Care Coalition, the American Heart Association and similar groups have established a benchmark for the administration of thrombolytics in acute myocardial infarction (AMI) care as a door-to-needle (DTN) time of 30 minutes or less. Previous research suggests that this goal is not being achieved in Canada. The purpose of this study was to determine whether the target DTN time of 30 minutes or less for thrombolysis could be met in 2 rural Ontario emergency departments (EDs). METHODS: We conducted a retrospective chart review and obtained descriptive data for each case, including demographic information and the Canadian Emergency Department Triage and Acuity Scale (CTAS) score. Visit timeline data were also collected and included the time during which patients saw a physician, had an electrocardiogram (ECG), received thrombolytic therapy and were discharged from the ED. Relevant time intervals, such as the median DTN time, were calculated. RESULTS: A total of 454 charts were reviewed for patients with a diagnosis of AMI who were seen between 1996 and 2007. The final sample consisted of 101 patients who received thrombolytics (63% men) whose median age was 67 years and median CTAS score was Level II (Emergent). The median door-to-ECG time was 6 minutes, door-to-physician time was 8 minutes and DTN time was 27 minutes; 58% of patients received thrombolytics within 30 minutes. CONCLUSION: A DTN time of 30 minutes or less is achievable in rural EDs.