In this study, we compared metronidazole (Mtz)-sensitive and -resistant strains of Helicobacter pylori for metabolic differences that might correlate with drug resistance. Included in this study was an isogenic Mtz

BackgroundLow back pain may be having a significant impact on emergency departments around the world. Research suggests low back pain is one of the leading causes of emergency department visits. However, in the peer-reviewed literature, there has been limited focus on the prevalence and management of back pain in the emergency department setting. The aim of the systematic review was to synthesize evidence about the prevalence of low back pain in emergency settings and explore the impact of study characteristics including type of emergency setting and how the study defined low back pain.MethodsStudies were identified from PubMed and EMBASE, grey literature search, and other sources. We selected studies that presented prevalence data for adults presenting to an emergency setting with low back pain. Critical appraisal was conducted using a modified tool developed to assess prevalence studies. Meta-analyses and a meta-regression explored the influence of study-level characteristics on prevalence.ResultsWe screened 1187 citations and included 21 studies, reported between 2000 and 2016 presenting prevalence data from 12 countries. The pooled prevalence estimate from studies of standard emergency settings was 4.39% (95% CI: 3.67-5.18). Prevalence estimates of the included studies ranged from 0.9% to 17.1% and varied with study definition of low back pain and the type of emergency setting. The overall quality of the evidence was judged to be moderate as there was limited generalizability and high heterogeneity in the results.ConclusionThis is the first systematic review to examine the prevalence of low back pain in emergency settings. Our results indicate that low back pain is consistently a top presenting complaint and that the prevalence of low back pain varies with definition of low back pain and emergency setting. Clinicians and policy decisions makers should be aware of the potential impact of low back pain in their emergency settings.Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-017-1511-7) contains supplementary material, which is available to authorized users.

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BackgroundAtrial fibrillation (AF) is the most common sustained cardiac arrhythmia resulting in mortality and morbidity. Gaps in oral anticoagulation and education of patients regarding AF have been identified as areas that require improvement.Methods and ResultsA before‐and‐after study of 433 patients with newly diagnosed AF in the 3 emergency departments in Nova Scotia from January 1, 2011 until January 31, 2014 was performed. The “before” phase underwent the usual‐care pathway for AF management; the “after” phase was enrolled in a nurse‐run, physician‐supervised AF clinic. The primary outcome was a composite of death, cardiovascular hospitalization, and AF‐related emergency department visits. A propensity analysis was performed to account for differences in baseline characteristics.ResultsA total of 185 patients were enrolled into the usual‐care group, and 228 patients were enrolled in the AF clinic group. The mean age was 64±15 years and 44% were women. In a propensity‐matched analysis, the primary outcome occurred in 44 (26.2%) patients in the usual‐care group and 29 (17.3%) patients in the AF clinic group (odds ratio 0.71; 95% CI [0.59, 1]; P=0.049) at 12 months. Prescription of oral anticoagulation was increased in the CHADS 2 ≥2 group (88.4% in the AF clinic versus 58.5% in the usual‐care group, P<0.01).ConclusionsAdoption of this integrated management approach for the burgeoning population of AF may provide an overall benefit to cardiovascular morbidity and mortality.

BackgroundLow back pain (LBP) is one of the leading causes of disability. Presentations to the emergency department (ED) are common and consume significant healthcare resources. However, treatment of patients with LBP is variable and highly physician dependent. Our study objective was to describe the demographic and clinical characteristics of patients presenting to the ED with LBP, the diagnostic strategies employed by ED physicians, and the subsequent management.MethodsWe conducted a retrospective study using clinical and electronic health data at the Queen Elizabeth II Health Science Center’s Charles V. Keating Emergency and Trauma Centre. We selected a simple random sample of 325 adult participants who presented to the ED with non-urgent LBP over a six-year period. Data for all participants, including demographic characteristics, diagnostic testing, and interventions received, was retrieved from the Emergency Department Information System database and from patient charts.ResultsParticipants had a median age of 43 years and 55% were female. The majority (92.9%) were acute presentations of LBP (less than 4 weeks of duration), with an assigned Canadian Triage Acuity Scale score of 3-4 (92.4%). A range of pain intensity scores were reported, mostly without associated neurological symptoms (81%) or sciatica (68%). At triage, pain score was most commonly reported as moderate intensity (57.6%), followed by severe (32.6%) and mild (9.9%). Documentation of pain rating during assessment was similar (moderate 68.6%; severe 25.9%; mild 5.6%). Laboratory investigations were conducted on 22.5% of participants and 30% received an imaging study. Medications were delivered to 59.4% of participants during their stay in the ED. Of the medications administered, ibuprofen (28.3%), hydromorphone (24.9%), and acetaminophen (21.5%) were the most frequent. Almost all (94%) had a record of having a primary care provider in EDIS and referrals back to the participant’s family physician were recorded for 41.2% of non-urgent LBP encounters.ConclusionsWe presented a complete description of patient characteristics, LBP descriptors, and health service use for a random sample of non-urgent LBP patients presenting to the ED. This has allowed for a better understanding of patients who seek care in the ED for their non-urgent LBP.

Canadian specialist emergency medicine (EM) residency training is undergoing the most significant transformation in its history. This article describes the rationale, process, and redesign of EM competency-based medical education. The rationale for this evolution in residency education includes 1) improved public trust by increasing transparency of the quality and rigour of residency education, 2) improved fiscal accountability to government and institutions regarding specialist EM training, 3) improved assessment systems to replace poor functioning end-of-rotation assessment reports and overemphasis on high-stakes, end-of-training examinations, and 4) and tailored learning for residents to address individualized needs. A working group with geographic and stakeholder representation convened over a 2-year period. A consensus process for decision-making was used. Four key design features of the new residency education design include 1) specialty EM-specific outcomes to be achieved in residency; 2) designation of four progressive stages of training, linked to required learning experiences and entrustable professional activities to be achieved at each stage; 3) tailored learning that provides residency programs and learner flexibility to adapt to local resources and learner needs; and 4) programmatic assessment that emphasizes systematic, longitudinal assessments from multiple sources, and sampling sentinel abilities. Required future study includes a program evaluation of this complex education intervention to ensure that intended outcomes are achieved and unintended outcomes are identified.

Objectives:To examine the safety of emergency department (ED) procedural sedation and analgesia (PSA) and the patterns of use of pharmacologic agents at a Canadian adult teaching hospital. Methods: Retrospective analysis of the PSA records of 979 patients, treated between Aug. 1, 2004, and July 31, 2005, with descriptive statistical analysis. This represents an inclusive consecutive case series of all PSAs performed during the study period. Results: Hypotension (systolic blood pressure ≤ 85 mm Hg) was documented during PSA in 13 of 979 patients (1.3%; 95% confidence interval [CI] 0.3%-2.3%), and desaturation (SaO 2 ≤ 90) in 14 of 979 (1.4%; CI 0.1%-2.7%). No cases of aspiration, endotracheal intubation or death were recorded. The most common medication used was fentanyl (94.0% of cases), followed by propofol (61.2%), midazolam (42.5%) and then ketamine (2.7%). The most frequently used 2-medication combinations were propofol and fentanyl (P/F) followed by midazolam and fentanyl (M/F), used with similar frequencies 58.1% (569/979) and 41.0% (401/979) respectively. There was no significant difference in the incidence of hypotension or desaturation between the P/F and M/F treated groups. In these patients, 9.1% (90/979) of patients received more than 2 different drugs. Conclusions: Adverse events during ED PSA are rare and of doubtful clinical significance. Propofol/fentanyl and midazolam/fentanyl are used safely, and at similar frequencies for ED PSA in this tertiary hospital case series. The use of ketamine for adult PSA is unusual in our facility.

BackgroundWhile low back pain is a common presenting complaint in the emergency department, current estimates from Canada are limited. Furthermore, existing estimates do not clearly define low back pain. As such, our main objective was to estimate prevalence rates of low back pain in a large Nova Scotian emergency department using various definitions, and to describe characteristics of individuals included in these groups. An additional objective was to explore trends in low back pain prevalence in our emergency department over time.MethodsWe conducted a cross sectional analysis using six years of administrative data from our local emergency setting. We first calculated the prevalence and patient characteristics for individuals presenting with any complaint of back pain, and for groups diagnosed with different types of low back pain. We explored prevalence over time by analyzing presentation trends by month, day of the week and hour of the day.ResultsThe prevalence of patients presenting to the emergency department with a complaint of back pain was 3.17%. Individuals diagnosed with non-specific/mechanical low back pain with no potential nerve root involvement made up 60.8% of all back pain presentations. Persons diagnosed with non-specific/mechanical low back pain with potential nerve root involvement made up 6.7% of presentation and the low back pain attributed to secondary factors accounted for 9.9% of back pain presentations. We found a linear increase in presentations for low back pain over the study period.ConclusionThis is the first multi-year analysis assessing the prevalence of low back pain in a Canadian emergency department. Back pain is a common presenting complaint in our local emergency department, with most of these persons receiving a diagnosis of non-specific/mechanical low back pain with no potential nerve root involvement. Future research should concentrate on understanding the management of low back pain in this setting, to ensure this is the proper setting to manage this common condition.Electronic supplementary materialThe online version of this article (10.1186/s12891-018-2237-x) contains supplementary material, which is available to authorized users.