Heather Murray - Academia.edu (original) (raw)
Papers by Heather Murray
Academic Emergency Medicine, 2007
CJEM, 2019
Introduction: Individualizing risk for stroke following a transient ischemic attack (TIA) is a to... more Introduction: Individualizing risk for stroke following a transient ischemic attack (TIA) is a topic of intense research, as existing scores are context-dependent or have not been well validated. The Canadian TIA Score stratifies risk of subsequent stroke into low, moderate and high risk. Our objective was to prospectively validate the Canadian TIA Score in a new cohort of emergency department (ED) patients. Methods: We conducted a prospective cohort study in 14 Canadian EDs over 4 years. We enrolled consecutive adult patients with an ED visit for TIA or nondisabling stroke. Treating physicians recorded standardized clinical variables onto data collection forms. Given the ability of prompt emergency carotid endarterectomy (CEA) to prevent stroke (NNT = 3) in high risk patients, our primary outcome was the composite of subsequent stroke or CEA ≤7 days. We conducted telephone follow-up using the validated Questionnaire for Verifying Stroke Free Status at 7 and 90 days. Outcomes were a...
BMJ, 2021
Objective To validate the previously derived Canadian TIA Score to stratify subsequent stroke ris... more Objective To validate the previously derived Canadian TIA Score to stratify subsequent stroke risk in a new cohort of emergency department patients with transient ischaemic attack. Design Prospective cohort study. Setting 13 Canadian emergency departments over five years. Participants 7607 consecutively enrolled adult patients attending the emergency department with transient ischaemic attack or minor stroke. Main outcome measures The primary outcome was subsequent stroke or carotid endarterectomy/carotid artery stenting within seven days. The secondary outcome was subsequent stroke within seven days (with or without carotid endarterectomy/carotid artery stenting). Telephone follow-up used the validated Questionnaire for Verifying Stroke Free Status at seven and 90 days. All outcomes were adjudicated by panels of three stroke experts, blinded to the index emergency department visit. Results Of the 7607 patients, 108 (1.4%) had a subsequent stroke within seven days, 83 (1.1%) had car...
CJEM, 2020
Introduction: Recent evidence shows an increase in alcohol-related emergency department (ED) visi... more Introduction: Recent evidence shows an increase in alcohol-related emergency department (ED) visits among youth. Highly publicized collegiate rituals such as Homecoming may create a climate for problematic alcohol use. This study describes the frequency of youth alcohol-related ED visits per year and during pre-specified ritualized drinking dates in one academic centre. Methods: This was a chart review of patients aged 12-24 with alcohol-related ED presentations between Sept 2013-Aug 2017. The National Ambulatory Care Reporting System (NACRS) database was searched for visits with ICD-10 codes related to alcohol. The Canadian Hospital Injury Reporting and Prevention Program (CHIRPP) database was also searched using the keyword alcohol. Duplicate visits were removed. Visits were excluded if patients had a history of psychosis, were held in the ED for involuntary psychiatric assessment, were homeless, were inmates from a correctional institute, if alcohol use was not mentioned and for ...
Annals of emergency medicine, 2014
From January 20 to 24, 2014, Annals continued a successful collaboration with an academic Web sit... more From January 20 to 24, 2014, Annals continued a successful collaboration with an academic Web site, Academic Life in Emergency Medicine (ALiEM), to host another Global Emergency Medicine Journal Club session featuring the 2013 Journal of the American Medical Association article "Clinical Decision Rules to Rule Out Subarachnoid Hemorrhage for Acute Headache" by Perry et al. This online journal club used the power of rapid Twitter conversations, a live videocast with the authors, and more detailed discussions hosted on the ALiEM Web site's comment section. There were more than 1,431 individuals from 501 cities in 59 countries who viewed the blog post. During this 5-day event, 28 comments (average word count 153 words) and 206 tweets were made. This summary article details the community discussion, shared insights, and analytic data generated during this novel, multiplatform approach.
Academic medicine : journal of the Association of American Medical Colleges, Feb 17, 2016
Publishing in academic journals is challenging for learners. Those who pass the initial stages of... more Publishing in academic journals is challenging for learners. Those who pass the initial stages of internal review by an editor often find the anonymous peer review process harsh. Academic blogs offer alternate avenues for publishing medical education material. Many blogs, however, lack a peer review process, which some consumers argue compromises the quality of materials published. CanadiEM (formerly BoringEM) is an academic educational emergency medicine blog dedicated to publishing high-quality materials produced by learners (i.e., residents and medical students). The editorial team has designed and implemented a collaborative "coached peer review" process that comprises an open exchange among the learner-author, editors, and reviewers. The goal of this process is to facilitate the publication of high-quality academic materials by learner-authors while providing focused feedback to help them develop academic writing skills. The authors of this Innovation Report surveyed ...
Academic Emergency Medicine, 2008
Objectives: To ascertain whether the sedative agent administered during neuromuscular-blocking ag... more Objectives: To ascertain whether the sedative agent administered during neuromuscular-blocking agent-facilitated intubation (rapid sequence intubation [RSI]) influences the number of attempts and overall success at RSI. Methods: Records were drawn from an ongoing, prospective multicenter registry of emergency department intubations. Conditional logistic regression stratified by institution was used to identify factors associated with multiple intubation attempts and unsuccessful RSI. Results: Of 3,407 intubations over 33 months in 22 institutions, 2,380 involved RSI. After correcting for the specialty and experience of the intubator and for the presence of airway aberrancy, the sedative agent was significantly associated with the number of attempts at intubation (p ¼ 0.002). Specifically, the use of etomidate (adjusted odds ratio [OR] 0.35 [95% CI ¼ 0.17 to 0.72]), ketamine (OR 0.27 [95% CI ¼ 0.11 to 0.65]), a benzodiazepine (OR 0.47 [95% CI ¼ 0.23 to 0.95]), or no sedative agent (OR 0.51 [95% CI ¼ 0.23 to 1.13]) prior to neuromuscular blockade was associated with a lower likelihood of successful intubation on the first attempt, as compared with thiopental, methohexital, or propofol. The adjusted odds ratios for the likelihood of overall success had similar point estimates, but did not reach statistical significance due to lack of power (p ¼ 0.2, with 36 unsuccessful intubations). Among patients receiving etomidate, intubation was more likely to be successful on the first attempt with increasing doses of either etomidate or succinylcholine. Conclusions: Thiopental, methohexital, and propofol appear to facilitate RSI in emergency department patients, independent of patient characteristics or intubator training. A deeper plane of anesthesia may improve intubating conditions in emergency patients undergoing RSI by complementing incomplete muscle paralysis.
CJEM, 2018
CLINICIAN’S CAPSULE What is known about the topic? Infographics are graphical illustrations of co... more CLINICIAN’S CAPSULE What is known about the topic? Infographics are graphical illustrations of complex ideas that are broadly shared on social media platforms. What did this study ask? What is the effect of a social media strategy using infographics on the readership and dissemination of research articles? What did this study find? Infographic articles were associated with increased Altmetric scores and abstract views, but not full-text views. Why does this study matter to clinicians? The promotion of articles with infographics may increase awareness and dissemination of research findings among clinicians.
CJEM
Soft tissue abscess used to be an easy emergency department (ED) presentation: perform an incisio... more Soft tissue abscess used to be an easy emergency department (ED) presentation: perform an incision and drainage (I + D) and discharge your patient. Times have changed. Methicillin-resistant Staphylococcus aureus (MRSA) is now a major cause of soft tissue abscess in ED patients. MRSA is, by definition, resistant to cloxacillin and cephalosporins. Almost all Canadian strains are susceptible to vancomycin and linezolid. MRSA strains are variably susceptible to trimethoprim-sulfamethoxazole (TMP-SMX), tetra/doxycycline, and clindamycin, with pooled Canadian clindamycin resistance just over 40%.
CJEM
The acquisition of competence in diagnostic reasoning is essential for medical trainees. Exposure... more The acquisition of competence in diagnostic reasoning is essential for medical trainees. Exposure to a variety of patient presentations helps develop the skills of diagnostic reasoning, but reliance on ad hoc clinical encounters is inefficient and does not guarantee timely exposure for all trainees. We present a novel teaching series led by emergency physicians that builds upon the existing medical education literature to teach diagnostic reasoning to preclinical (2nd year) medical students. The series used emergency department simulations involving patient actors and simulated vital signs to provide students with exposure to three acute care presentations: chest pain, abdominal pain, and headache. Emergency physicians coached and provided immediate feedback to the students as they actively worked through diagnostic reasoning. The participating medical students reported benefit from these sessions immediately following the sessions and in an 18-month follow-up survey where the stude...
Academic Emergency Medicine, 2007
CJEM, 2019
Introduction: Individualizing risk for stroke following a transient ischemic attack (TIA) is a to... more Introduction: Individualizing risk for stroke following a transient ischemic attack (TIA) is a topic of intense research, as existing scores are context-dependent or have not been well validated. The Canadian TIA Score stratifies risk of subsequent stroke into low, moderate and high risk. Our objective was to prospectively validate the Canadian TIA Score in a new cohort of emergency department (ED) patients. Methods: We conducted a prospective cohort study in 14 Canadian EDs over 4 years. We enrolled consecutive adult patients with an ED visit for TIA or nondisabling stroke. Treating physicians recorded standardized clinical variables onto data collection forms. Given the ability of prompt emergency carotid endarterectomy (CEA) to prevent stroke (NNT = 3) in high risk patients, our primary outcome was the composite of subsequent stroke or CEA ≤7 days. We conducted telephone follow-up using the validated Questionnaire for Verifying Stroke Free Status at 7 and 90 days. Outcomes were a...
BMJ, 2021
Objective To validate the previously derived Canadian TIA Score to stratify subsequent stroke ris... more Objective To validate the previously derived Canadian TIA Score to stratify subsequent stroke risk in a new cohort of emergency department patients with transient ischaemic attack. Design Prospective cohort study. Setting 13 Canadian emergency departments over five years. Participants 7607 consecutively enrolled adult patients attending the emergency department with transient ischaemic attack or minor stroke. Main outcome measures The primary outcome was subsequent stroke or carotid endarterectomy/carotid artery stenting within seven days. The secondary outcome was subsequent stroke within seven days (with or without carotid endarterectomy/carotid artery stenting). Telephone follow-up used the validated Questionnaire for Verifying Stroke Free Status at seven and 90 days. All outcomes were adjudicated by panels of three stroke experts, blinded to the index emergency department visit. Results Of the 7607 patients, 108 (1.4%) had a subsequent stroke within seven days, 83 (1.1%) had car...
CJEM, 2020
Introduction: Recent evidence shows an increase in alcohol-related emergency department (ED) visi... more Introduction: Recent evidence shows an increase in alcohol-related emergency department (ED) visits among youth. Highly publicized collegiate rituals such as Homecoming may create a climate for problematic alcohol use. This study describes the frequency of youth alcohol-related ED visits per year and during pre-specified ritualized drinking dates in one academic centre. Methods: This was a chart review of patients aged 12-24 with alcohol-related ED presentations between Sept 2013-Aug 2017. The National Ambulatory Care Reporting System (NACRS) database was searched for visits with ICD-10 codes related to alcohol. The Canadian Hospital Injury Reporting and Prevention Program (CHIRPP) database was also searched using the keyword alcohol. Duplicate visits were removed. Visits were excluded if patients had a history of psychosis, were held in the ED for involuntary psychiatric assessment, were homeless, were inmates from a correctional institute, if alcohol use was not mentioned and for ...
Annals of emergency medicine, 2014
From January 20 to 24, 2014, Annals continued a successful collaboration with an academic Web sit... more From January 20 to 24, 2014, Annals continued a successful collaboration with an academic Web site, Academic Life in Emergency Medicine (ALiEM), to host another Global Emergency Medicine Journal Club session featuring the 2013 Journal of the American Medical Association article "Clinical Decision Rules to Rule Out Subarachnoid Hemorrhage for Acute Headache" by Perry et al. This online journal club used the power of rapid Twitter conversations, a live videocast with the authors, and more detailed discussions hosted on the ALiEM Web site's comment section. There were more than 1,431 individuals from 501 cities in 59 countries who viewed the blog post. During this 5-day event, 28 comments (average word count 153 words) and 206 tweets were made. This summary article details the community discussion, shared insights, and analytic data generated during this novel, multiplatform approach.
Academic medicine : journal of the Association of American Medical Colleges, Feb 17, 2016
Publishing in academic journals is challenging for learners. Those who pass the initial stages of... more Publishing in academic journals is challenging for learners. Those who pass the initial stages of internal review by an editor often find the anonymous peer review process harsh. Academic blogs offer alternate avenues for publishing medical education material. Many blogs, however, lack a peer review process, which some consumers argue compromises the quality of materials published. CanadiEM (formerly BoringEM) is an academic educational emergency medicine blog dedicated to publishing high-quality materials produced by learners (i.e., residents and medical students). The editorial team has designed and implemented a collaborative "coached peer review" process that comprises an open exchange among the learner-author, editors, and reviewers. The goal of this process is to facilitate the publication of high-quality academic materials by learner-authors while providing focused feedback to help them develop academic writing skills. The authors of this Innovation Report surveyed ...
Academic Emergency Medicine, 2008
Objectives: To ascertain whether the sedative agent administered during neuromuscular-blocking ag... more Objectives: To ascertain whether the sedative agent administered during neuromuscular-blocking agent-facilitated intubation (rapid sequence intubation [RSI]) influences the number of attempts and overall success at RSI. Methods: Records were drawn from an ongoing, prospective multicenter registry of emergency department intubations. Conditional logistic regression stratified by institution was used to identify factors associated with multiple intubation attempts and unsuccessful RSI. Results: Of 3,407 intubations over 33 months in 22 institutions, 2,380 involved RSI. After correcting for the specialty and experience of the intubator and for the presence of airway aberrancy, the sedative agent was significantly associated with the number of attempts at intubation (p ¼ 0.002). Specifically, the use of etomidate (adjusted odds ratio [OR] 0.35 [95% CI ¼ 0.17 to 0.72]), ketamine (OR 0.27 [95% CI ¼ 0.11 to 0.65]), a benzodiazepine (OR 0.47 [95% CI ¼ 0.23 to 0.95]), or no sedative agent (OR 0.51 [95% CI ¼ 0.23 to 1.13]) prior to neuromuscular blockade was associated with a lower likelihood of successful intubation on the first attempt, as compared with thiopental, methohexital, or propofol. The adjusted odds ratios for the likelihood of overall success had similar point estimates, but did not reach statistical significance due to lack of power (p ¼ 0.2, with 36 unsuccessful intubations). Among patients receiving etomidate, intubation was more likely to be successful on the first attempt with increasing doses of either etomidate or succinylcholine. Conclusions: Thiopental, methohexital, and propofol appear to facilitate RSI in emergency department patients, independent of patient characteristics or intubator training. A deeper plane of anesthesia may improve intubating conditions in emergency patients undergoing RSI by complementing incomplete muscle paralysis.
CJEM, 2018
CLINICIAN’S CAPSULE What is known about the topic? Infographics are graphical illustrations of co... more CLINICIAN’S CAPSULE What is known about the topic? Infographics are graphical illustrations of complex ideas that are broadly shared on social media platforms. What did this study ask? What is the effect of a social media strategy using infographics on the readership and dissemination of research articles? What did this study find? Infographic articles were associated with increased Altmetric scores and abstract views, but not full-text views. Why does this study matter to clinicians? The promotion of articles with infographics may increase awareness and dissemination of research findings among clinicians.
CJEM
Soft tissue abscess used to be an easy emergency department (ED) presentation: perform an incisio... more Soft tissue abscess used to be an easy emergency department (ED) presentation: perform an incision and drainage (I + D) and discharge your patient. Times have changed. Methicillin-resistant Staphylococcus aureus (MRSA) is now a major cause of soft tissue abscess in ED patients. MRSA is, by definition, resistant to cloxacillin and cephalosporins. Almost all Canadian strains are susceptible to vancomycin and linezolid. MRSA strains are variably susceptible to trimethoprim-sulfamethoxazole (TMP-SMX), tetra/doxycycline, and clindamycin, with pooled Canadian clindamycin resistance just over 40%.
CJEM
The acquisition of competence in diagnostic reasoning is essential for medical trainees. Exposure... more The acquisition of competence in diagnostic reasoning is essential for medical trainees. Exposure to a variety of patient presentations helps develop the skills of diagnostic reasoning, but reliance on ad hoc clinical encounters is inefficient and does not guarantee timely exposure for all trainees. We present a novel teaching series led by emergency physicians that builds upon the existing medical education literature to teach diagnostic reasoning to preclinical (2nd year) medical students. The series used emergency department simulations involving patient actors and simulated vital signs to provide students with exposure to three acute care presentations: chest pain, abdominal pain, and headache. Emergency physicians coached and provided immediate feedback to the students as they actively worked through diagnostic reasoning. The participating medical students reported benefit from these sessions immediately following the sessions and in an 18-month follow-up survey where the stude...