CJEM Articles: Jacques S. Lee
Displaying 1-5 of 5 results
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May
2007
9
3
Carolyn E. Snider, Jacques S. Lee
Objective: Concern about youth violence in Canada is growing. Because victims of violence are more likely to become future violent perpetrators, preventative interventions are often based out of inpatient units; however, the question of how often youth who have been injured due to violence are discharged from emergency departments (EDs), or whether there are opportunities for emergency healthcare workers to deliver violence prevention programs, is not known. The primary objectives of this study were to describe the frequency and patterns of violent injuries among youth, to determine how many injured youth are discharged directly from EDs and to estimate the proportion of injured youth who may benefit from ED-based intervention programs.
Methods: We conducted an observational study using a population-based database that records information on all ED visits in Ontario. We analyzed age, sex, cause of injury and disposition for all patients aged 12-19 years who presented to Toronto EDs with violent injuries during a 2-year period (April 2002 to March 2004).
Results: A total of 4100 patients aged 12-19 years visited Toronto EDs with violent injuries during the study period. Assault due to bodily force (in contrast to sharp objects, guns or other) was the most common injury mechanism, accounting for 48.7% of cases (95% confidence interval [CI] 47.1%-50.2%). The majority of patients (89.3%; 95% CI 88.3%-90.2%) were discharged directly from EDs, including 44% of gun-related injuries.
Conclusion: In Toronto, a large proportion (89.3%) of youth injured in violent incidents are discharged directly from EDs. There are opportunities to develop ED-based youth violence prevention initiatives.
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July
2005
7
4
Andrew Worster, Bjug Borgundvaag, Brian H. Rowe, Christopher M.B. Fernandes, Duncan S. Mackey, Ian G. Stiell, Jacques S. Lee, Karen Woolfrey, Marco L.A. Sivilotti, Riyad B. Abu-Laban, Sam G. Campbell
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September
2002
4
5
Jacques S. Lee
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January
2002
4
1
Jacques S. Lee, Jeffrey S. Eisen, Marco L.A. Sivilotti, Robert G. Peterson
Background: Most emergency departments (EDs) have deficiencies in the type and quantity of antidotes readily available to treat severely poisoned patients. Undue emphasis on the purchase price of several expensive antidotes such as anti-digoxin Fab fragments and fomepizole may contribute to this problem by creating the perception that comprehensive antidote stocking is too costly for smaller centres. For rarely used medications, however, purchase price alone is an insufficient estimate of cost.
Objective: To model the initial and annual maintenance cost needed for small to medium Canadian EDs to maintain an appropriate stock of essential antidotes.
Methods: A budget impact analysis was performed from the perspective of the ED pharmacy, using the following input variables: essential antidotes and recommended dose/formulation, estimated frequency of administration, price, shelf-life, and supplier replacement policy for expired drug.
Results: Frequency of use, shelf-life, and especially replacement policy for unused expired antidote are major determinants of cost. Remote hospitals that need to stock sufficient antidote to manage a patient for the initial 4 hours after presentation would incur only modestly increased costs compared to hospitals within one hour of a referral centre.
Conclusions: While other factors (antidote efficacy, safety and available alternate therapy) need to be considered, the cost of maintaining antidote availability is not determined primarily by purchase price. A change in supplier policy to free replacement on expiry for fomepizole and cyanide antidotes would have a considerable effect on making these antidotes less costly for smaller Canadian EDs.
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July
2001
2
3
Jacques S. Lee
