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. RÉSUMÉObjectifs: L'étude visait à caractériser l'état actuel de la recherche menée par les résidents en médecine d'urgence (MU) au Canada et à élaborer des recommandations afin de favoriser l'excellence dans le domaine. Méthode: Les auteurs ont procédé à une revue systématique dans MEDLINE, Embase et ERIC à l'aide de termes d'interrogation concernant la recherche menée par les résidents en MU. Une enquête en ligne a également été réalisée parmi les directeurs de programme de résidence en MU du Collège royal des médecins et chirurgiens du Canada (CRMCC) et du Collège des médecins de famille du Canada (CMFC). Un groupe d'experts a examiné les données recueillies, a présenté des recommandations à l'occasion du Symposium sur les affaires universitaires de l'Association canadienne des médecins d'urgence de 2014 et les a reformulées en tenant compte des observations reçues. Résultats: La recherche a permis de relever 654 mentions potentiellement pertinentes et de sélectionner 35 articles. Ceux-ci ont été divisés en quatre grands thèmes: 1) les attentes et les exigences; 2) la formation et l'évaluation; 3) l'infrastructure et le soutien; 4) la diffusion. Tous les directeurs de programme ...
Asplenia may refer to the spleen's surgical removal, functional impairment, or congenital absence. It is a risk factor for the development of severe bacterial infection. Functional asplenia is likely the most common presentation of this entity and has many etiologies. Those that are previously undiagnosed may present completely well until an episode of overt sepsis develops. The true incidence of mortality secondary to functional asplenia remains elusive. As lifetime mortality remains exceedingly high in the asplenic population regardless of etiology, markers of hyposplenism are important to detect. The present report describes an infant with trisomy 21 and previously undiagnosed functional asplenia who ultimately experienced overwhelming pneumococcal sepsis with features of Waterhouse-Friderichsen syndrome and died within 12 hours of initial presentation. It is a poignant reminder of what features to be cognizant of on peripheral blood smear in a previously well child, who may be at risk for a devastating consequence.
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