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Background: The Toronto-Addis Ababa Academic Collaboration in Emergency Medicine (TAAAC-EM) deploys teaching teams of Canadian EM faculty to Addis Ababa to deliver a longitudinal residency curriculum. Canadian trainees participate in these teams as a formally structured and supervised elective in global health (GH) and EM, which has been designed to enhance the strength of GH electives and address key challenges highlighted in the literature., Methods: The purpose of this qualitative study was to identify, describe, and evaluate strengths and weaknesses of this elective in relation to its purposeful structure. Residents who completed the elective were invited to participate in face-to-face interviews to discuss their experiences., Results: The findings show that the residents both chose this elective because of its purposefully designed features, and that these same features increased their enjoyment and the educational benefit of the elective. Supervised bedside teaching, relationships shared with Ethiopian residents, and the positive impact the experience had on their clinical practice in Canada were identified as the primary strengths., Conclusion: Purposeful and thoughtful design of global health electives can enhance the resident learning experience and mitigate challenges for trainees seeking global health training opportunities., Competing Interests: Conflicts of interest: The authors declare they have no conflicts of interest. This study was completed without funding.

Objectives: Alternative-level metrics (Altmetrics) are a new method to assess the sharing and spread of scientific knowledge. The primary objective of this study was to describe the traditional metrics and Altmetric scores of the 50 most frequently cited articles published in emergency medicine (EM) journals. Since many articles related to EM are published in other journals, the secondary aim of this study was to describe the Altmetric scores of the most frequently cited articles relevant to EM in other biomedical journals., Methods: A structured search of the Institute for Scientific Information Web of Science version of the Science Citation Index Expanded was conducted. The 200 most frequently cited articles in the top 10 EM journals (2011 Journal Citation Report) were identified. The 200 most frequently cited articles from the rest of the medical literature, matching a predefined list of keywords relevant to the specialty of EM, were identified. Two authors reviewed the lists of citations for relevance to EM and a consensus approach was used to arrive at the final lists of the top 50 cited articles. The Altmetric scores for the top 50 cited articles in EM and other journals were determined. Descriptive statistics and Spearman correlation were performed., Results: The highest Altmetric score for EM articles was 25.0; the mean (±SD) was 1.9 (±5.0). The EM journal with the highest mean article Altmetric score was Resuscitation. The main clinical areas shared for articles from EM articles were trauma (mean ± SD = 11.0 ± 15.6, median = 11.0) and cardiac arrest (mean ± SD = 2.7 ± 5.8, median = 0). The highest Altmetric score for other journals was 176.0 (mean ± SD = 23.3 ± 40.8). The other journal with the highest mean article Altmetric score was the New England Journal of Medicine. The main clinical areas shared for articles were critical care (mean ± SD score = 36.5 ± 47.4, median = 36.5), sepsis (mean ± SD = 24.6 ± 48.8, median = 12.0), cardiology (mean ± SD = 19.2 ± 35.6, median = 7.0), and infectious diseases (mean ± SD = 17.0 ± 12.7, median = 17.0). Spearman correlation demonstrated weakly positive correlation between citation counts and Altmetric scores for EM articles and other journals., Conclusions: This study is the first analysis of Altmetric scores for the top cited articles in EM. We demonstrated that there is a mild correlation between citation counts and Altmetric scores for the top papers in EM and other biomedical journals. We also demonstrated that there is a gap between the sharing of the top articles in EM journals and those related to EM in other biomedical journals. Future research to explore this relationship and its temporal trends will benefit the understanding of the reach and dissemination of EM research within the scientific community and society in general., (© 2016 by the Society for Academic Emergency Medicine.)

In early April 2014, two South Sudanese refugees in the Gambella region of western Ethiopia experienced acute onset of jaundice, accompanied by fever. One patient was a pregnant woman aged 24 years evaluated at a routine prenatal clinic visit in Leitchour refugee camp. The second patient was a malnourished boy aged 1 year who resided in Tierkidi refugee camp. The boy died despite hospitalization. During the last 2 weeks of May, four more cases of acute jaundice syndrome (AJS), defined as yellow discoloration of the eyes, were detected in Leitchuor. By mid-June, an additional 50 AJS cases were reported across three large camps in the region, Kule, Leitchuor, and Tierkidi, with 45 (90%) of these cases reported in Leitchuor. Sera collected from a convenience sample of 21 AJS cases were sent to Addis Ababa and Nairobi for real-time polymerase chain reaction testing; 12 (57%) were positive for hepatitis E virus (HEV) RNA. By January 2015, a total of 1,117 suspected cases of hepatitis E meeting the case definition of AJS were reported among refugees in camps across Gambella.

Background: Intravenous immune globulin (IVIG) is an expensive and sometimes scarce blood product that carries some risk. It may often be used inappropriately. We evaluated the appropriateness of IVIG use before and after the introduction of an utilization control program to reduce inappropriate use., Methods: We used the RAND/UCLA Appropriateness Method to measure the appropriateness of IVIG use in the province of British Columbia (BC) in 2001 and 2003, before and after the introduction of a utilization control program designed to reduce inappropriate use. For comparison, we measured the appropriateness of use during the same periods in the province of Alberta, which had no control program., Results: Of 2256 instances of IVIG use, 54.1% were deemed to be appropriate, 17.4% were of uncertain benefit, and 28.5% were deemed inappropriate. The frequency of inappropriate use in BC after the introduction of the utilization control program did not differ significantly from the frequency before the program or the frequency in Alberta., Interpretation: Almost half of IVIG use in BC and Alberta was judged to be inappropriate or of uncertain benefit, and the frequency of inappropriate use did not decrease after implementation of a utilization control program in BC. More effective utilization controls are necessary to prevent wasted resources and unnecessary risk to patients.

Excessive wait times for magnetic resonance imaging (MRI) studies are a major problem in the Canadian healthcare system. To determine how requests for MRI studies are managed, the authors performed a survey of public MRI facilities in Canada. Ninety-six per cent had some method to triage MRI requests. However, only 42% had documented guidelines for prioritization, and none employed quality assurance methods to ensure that guidelines were followed. Target timelines for each prioritization category varied widely. Sixteen per cent of centres were not able to meet their target timelines for any prioritization category, and 45% of centres met target times only for some prioritization categories. Strategies for dealing with wait lists primarily involved attempts to increase capacity. No centres attempted to reduce wait times by decreasing inappropriate requests. There appears to be a need to standardize MRI wait list management given the variation in management practices and wait times observed., (Copyright © 2009 Longwoods Publishing.)

Background: Hypnotics have a role in the management of acute insomnia; however, the efficacy and safety of pharmacological interventions in the management of chronic insomnia is unclear., Objective: The objective of this paper is to conduct a systematic review of the efficacy and safety of drug treatments for chronic insomnia in adults., Data Sources: Twenty-one electronic databases were searched, up to July 2006., Study Selection: Randomized double-blind, placebo-controlled trials were eligible. Quality was assessed using the Jadad scale. Data were pooled using the random effects model., Data Synthesis: One hundred and five studies were included in the review. Sleep onset latency, as measured by polysomnography, was significantly decreased for benzodiazepines (BDZ), (weighted mean difference: -10.0 minutes; 95% CI: -16.6, -3.4), non-benzodiazepines (non-BDZ) (-12.8 minutes; 95% CI: -16.9, -8.8) and antidepressants (ADP) (-7.0 minutes; 95% CI: -10.7, -3.3). Sleep onset latency assessed by sleep diaries was also improved (BDZ: -19.6 minutes; 95% CI: -23.9, -15.3; non-BDZ: -17.0 minutes; 95% CI: -20.0, -14.0; ADP: -12.2 minutes; 95% CI: -22.3, -2.2). Indirect comparisons between drug categories suggest BDZ and non-BDZ have a similar effect. All drug groups had a statistically significant higher risk of harm compared to placebo (BDZ: risk difference [RD]: 0.15; non-BDZ RD: 0.07; and ADP RD: 0.09), although the most commonly reported adverse events were minor. Indirect comparisons suggest that non-BDZ are safer than BDZ., Conclusions: Benzodiazepines and non-benzodiazepines are effective treatments in the management of chronic insomnia, although they pose a risk of harm. There is also some evidence that antidepressants are effective and that they pose a risk of harm.