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      CAEP 2014 Academic symposium: “How to make research succeed in your department: How to fund your research program”

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          ABSTRACT

          Objective

          We sought to gather a comprehensive list of funding strategies and opportunities for emergency medicine (EM) centres across Canada, and make recommendations on how to successfully fund all levels of research activity, including research projects, staff salaries, infrastructure, and researcher stipends.

          Methods

          We formed an expert panel consisting of volunteers recognized nationally for their scholarly work in EM. First, we conducted interviews with academic leaders and researchers to obtain a description of their local funding strategies using a standardized open-ended questionnaire. Panelists then identified emerging funding models. Second, we listed funding opportunities and initiatives at the provincial, national, and international levels. Finally, we used an iterative consensus-based approach to derive pragmatic recommendations after incorporating comments and suggestions from participants at an academic symposium.

          Results

          Our review of funding strategies identified four funding models: 1) investigator dependent model, 2) practice plan, 3) generous benefactor, and 4) mixed funding. Recommendations in this document include approaches for research contributors and producers (seven recommendations), for local academic leaders (five recommendations), and for national organizations, such as the Canadian Association of Emergency Physicians (CAEP) (three recommendations).

          Conclusions

          Funding for research in EM varies across Canada and is largely insecure. We offer recommendations to help facilitate funding for large and small projects, for salary support, and for local and national leaders to advance EM research. We believe that these recommendations will increase funding for all levels of EM research activity, including research projects, staff salaries, infrastructure, and researcher stipends.

          RÉSUMÉ

          Objectifs

          Le groupe visait à dresser une liste exhaustive de stratégies et de possibilités de financement pour les centres de recherche en médecine d’urgence (MU) partout au Canada, et à faire des recommandations sur la manière d’assurer le financement de l’ensemble de l’activité de recherche, soit les projets de recherche comme tels, le salaire du personnel, l’infrastructure et les allocations aux chercheurs.

          Méthode

          Un groupe d’experts composé de bénévoles bien connus à l’échelle nationale pour leurs travaux savants en MU a été formé. Celui-ci a d’abord eu des entretiens avec des chefs de file en milieu universitaire et des chercheurs pour connaître leurs stratégies de financement local, et ce, à l’aide d’un questionnaire à réponses libres. Les membres du groupe ont dégagé de nouveaux modèles de financement. A ensuite été dressée une liste de possibilités et d’initiatives de financement aux niveaux provincial, national et international. Enfin, le groupe a formulé des recommandations pragmatiques selon un processus consensuel itératif après avoir tenu compte des observations et des suggestions faites par les participants à un symposium sur les affaires universitaires.

          Résultats

          L’examen des stratégies de financement a permis de relever quatre modèles de financement: 1) le modèle tributaire du chercheur; 2) le modèle du plan de pratique; 3) le modèle du généreux bienfaiteur; et 4) le modèle de financement mixte. Le présent document contient des recommandations qui s’adressent tant aux contributeurs à la recherche et aux producteurs (sept recommandations) qu’aux chefs de files locaux en milieu universitaire (cinq recommandations) et aux organisations nationales telles que l’ACMU (trois recommandations).

          Conclusions

          Le financement de la recherche en MU varie d’une région à l’autre au Canada et il est très précaire. Des recommandations ont été élaborées afin de faciliter le financement de petits et de gros projets de recherche ainsi que l’obtention d’aide salariale, en plus de soutenir les chefs de file locaux et nationaux dans leur tâche de faire progresser la recherche en MU. Le groupe est d’avis que ces recommandations auront pour effet d’accroître le financement de l’ensemble de l’activité de recherche en MU, soit les projets de recherche comme tels, le salaire du personnel, l’infrastructure et les allocations aux chercheurs.

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          Most cited references14

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          Is Open Access

          Sensitivity of computed tomography performed within six hours of onset of headache for diagnosis of subarachnoid haemorrhage: prospective cohort study

          Objective To measure the sensitivity of modern third generation computed tomography in emergency patients being evaluated for possible subarachnoid haemorrhage, especially when carried out within six hours of headache onset. Design Prospective cohort study. Setting 11 tertiary care emergency departments across Canada, 2000-9. Participants Neurologically intact adults with a new acute headache peaking in intensity within one hour of onset in whom a computed tomography was ordered by the treating physician to rule out subarachnoid haemorrhage. Main outcome measures Subarachnoid haemorrhage was defined by any of subarachnoid blood on computed tomography, xanthochromia in cerebrospinal fluid, or any red blood cells in final tube of cerebrospinal fluid collected with positive results on cerebral angiography. Results Of the 3132 patients enrolled (mean age 45.1, 2571 (82.1%) with worst headache ever), 240 had subarachnoid haemorrhage (7.7%). The sensitivity of computed tomography overall for subarachnoid haemorrhage was 92.9% (95% confidence interval 89.0% to 95.5%), the specificity was 100% (99.9% to 100%), the negative predictive value was 99.4% (99.1% to 99.6%), and the positive predictive value was 100% (98.3% to 100%). For the 953 patients scanned within six hours of headache onset, all 121 patients with subarachnoid haemorrhage were identified by computed tomography, yielding a sensitivity of 100% (97.0% to 100.0%), specificity of 100% (99.5% to 100%), negative predictive value of 100% (99.5% to 100%), and positive predictive value of 100% (96.9% to 100%). Conclusion Modern third generation computed tomography is extremely sensitive in identifying subarachnoid haemorrhage when it is carried out within six hours of headache onset and interpreted by a qualified radiologist.
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            The role of triage liaison physicians on mitigating overcrowding in emergency departments: a systematic review.

            The objective was to examine the effectiveness of triage liaison physicians (TLPs) on mitigating the effects of emergency department (ED) overcrowding. Electronic databases (Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, Web of Science, HealthSTAR, Dissertation Abstracts, and ABI/INFORM Global), controlled trial registry websites, conference proceedings, study references, contact with experts in the field, and correspondence with authors were used to identify potentially relevant TLP studies. Intervention studies in which a TLP was used to influence ED overcrowding metrics (length of stay [LOS] in minutes, physician initial assessment [PIA], and left without being seen [LWBS]) were included in the review. Two reviewers independently conducted data extraction and assessed the citation relevance, inclusion, and study quality. For continuous outcomes, weighted mean differences (WMD) were calculated and reported with corresponding 95% confidence intervals (CIs). For dichotomous variables, individual and pooled statistics were calculated as relative risk (RR) with 95% CI. From 14,446 potentially relevant studies, 28 were included in the systematic review. Thirteen were journal publications, 12 were abstracts, and three were Web-based articles. Most studies employed before-after designs; 23 of the 28 studies were considered of weak quality. Based on the statistical pooling of data from two randomized controlled trials (RCTs), TLP resulted in shorter ED LOS compared to nurse-led triage (WMD = -36.85 min; 95% CI = -51.11 to -22.58). One of these RCTs showed a significant reduction in the PIA associated to TLP presence (WMD = -30.00 min; 95% CI = -56.91 to -3.09); the other RCT showed no change in LWBS due to a CI that included unity (RR = 0.82; 95% CI = 0.67 to 1.00). While the evidence summarized here suggests that to have a TLP is an effective intervention to mitigate the effects of ED overcrowding, due to the weak research methods identified, more research is required before its widespread implementation. © 2011 by the Society for Academic Emergency Medicine.
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              Urban emergency department overcrowding: defining the problem and eliminating misconceptions.

              To develop an operational definition and a parsimonious list of postulated determinants for urban emergency department (ED) overcrowding. A panel was formed from clinical and administrative experts in pre-hospital, ED and hospital domains. Key studies and reports were reviewed in advance by panel members, an experienced health services researcher facilitated the panel's discussions, and a formal content analysis of audiotaped recordings was conducted. The panel considered community, patient, ED and hospital determinants of overcrowding. Of 46 factors postulated in the literature, 21 were not retained by the experts as potentially important determinants of overcrowding. Factors not retained included access to primary care services and seasonal influenza outbreaks. Key determinants retained included admitted patients awaiting beds and patient characteristics. Ambulance diversion was considered to be an appropriate operational definition and proxy measure of ED overcrowding. These results help to clarify the conceptual framework around ED overcrowding, and may provide a guide for future research. The relative importance of the determinants must be assessed by prospective studies.
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                Author and article information

                Journal
                applab
                CJEM
                CJEM
                Cambridge University Press (CUP)
                1481-8035
                1481-8043
                July 2015
                July 2 2015
                July 2015
                : 17
                : 04
                : 453-461
                Article
                10.1017/cem.2015.58
                9f49bd8b-e61c-400d-8498-0f545ff417d6
                © 2015
                History

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