IMPORTANCE Diprosopus is a medical condition that refers to full or partial craniofacial duplication. A particular subset of this condition, duplication of the mouth, is an exceedingly rare condition, with 7 reported cases in the medical literature. The embryogenesis and mechanism of disease are not well understood. The objective of this report was to describe a case of partial facial duplication with a discussion of the previous literature, leading to a proposed theory of embryogenesis for this rare anomaly. OBSERVATIONS We present a rare case of duplication of the mouth associated with an intraoral dysontogenic cyst, which presented with upper airway obstruction. The diagnostic and management strategies are discussed, as well as the histopathological features and theories of embryogenesis. CONCLUSIONS AND RELEVANCE On the basis of our findings, we propose the mechanism of origin for duplication of the mouth to be duplication of the first branchial arch. This case offers a deeper understanding of the mechanism of this disease than previously reported. Additional basic science and clinical research is needed to corroborate this theory.

ABSTRACT Background Latent safety threats (LSTs) have been defined as system based issues that threaten patient safety that can materialize at any time and were previously unrecognized by healthcare providers, unit directors, or hospital administration. While LSTs such as system deficiencies, equipment failures, training, or conditions predisposing medical errors are frequently reported in the literature, a paucity was noted in the management and mitigation of these threats. The purpose of the translational simulation quality improvement project study was to utilize translational simulations to identify, manage, and mitigate future latent safety threats in our EDs. METHODS In 2017, 18 in-situ inter-professional simulation sessions were conducted at 11 EDs. Following each session, a survey assessment tool, created by the research team, was completed by participants to identify latent safety threats. Findings were shared with site clinical nurse educators and managers to help facilitate institutional follow up. For reporting, latent safety threats were categorized thematically and coded as either (i) resolved, (ii) ongoing, or (iii) not managed. Follow-up with sites was completed 1 year following the simulation. RESULTS A total n=158 LSTs were identified. The number and percentage by theme was: staff 48 (30.4%), equipment 41 (25.9%), medications 33 (20.9%), resuscitation resources 24 (15.2%), and information technology (IT) issues 12 (7.6%).Site follow-up identified that 149 LSTs were resolved and ten required ongoing work to manage. No occurrences of a LST ‘not managed’ were identified. CONCLUSIONS Translation simulation effectively identified latent safety threats and assisted interdisciplinary teams in the creation of a structured plan and systematic follow-up to enhance the health system and patient care. Through use of a threat mitigation strategy all identified threats were addressed while some require ongoing management.

Introduction: High fidelity in-situ simulation has been found to detect system deficiencies, equipment failures, and conditions predisposing to medical errors, also known as latent safety threats (LST). What is not well reported is whether these LSTs are effectively managed. As a part of an ongoing quality improvement project, multidisciplinary, in-situ simulations were conducted across emergency departments (ED) in the Edmonton zone with the aim to identify LST and subsequently manage them to improve patient care. Methods: In 2017 simulations were conducted at EDs in the Edmonton Zone (N = 10). Following each simulation, a cross sectional, survey based assessment tool, was completed by participants to identify LST. These LST were shared with the site clinical nurse educator and/or site manager and a management plan made. Two to six months follow-up was made to track progress. For reporting, LST were grouped into themes, progress on LST were coded as either resolved, ongoing, or not managed. Results: A total of 112 LST were identified through 18 separate simulations. The most commonly identified LTS were: resuscitation resource required (n 23), lack of staff training (21), equipment not immediately available (20), IT resource required (8), medication not immediately available (6), staff requiring familiarization (5), medication resource required (5), IT issue (4), large equipment needed (4), small equipment needed (4), lack of staff resource (3), medication needed, (3), equipment malfunction (2), Environment cluttered (2), non-appropriate resource removed (2). Site follow-up identified a total of 52 LST that where resolved, and 60 LST that had ongoing work to manage them. No occurrences of LST not being managed were identified. Conclusion: Simulation was used to effectively identify LST. Creating a structured plan and follow up allowed many LST to be resolved and effectively managed. In 2018 simulation will reassess if LST remain. Keywords: quality improvement and patient safety, simulation, latent threats Introduction: The ECG diagnosis of acute coronary occlusion (ACO) in the setting of ventricular paced rhythm (VPR) is purported to be impossible. However, VPR has a similar ECG morphology to LBBB. The validated Smith-modified Sgarbossa criteria (MSC) have high sensitivity (Sens) and specificity (Spec) for ACO in LBBB. MSC consist of 1 of the following in 1 lead: concordant ST Elevation (STE) 1 mm, concordant ST depression 1 mm in V1-V3, or ST/S ratio < − 0.25 (in leads with 1 mm STE). We hypothesized that the MSC will have higher Sens for diagnosis of ACO in VPR when compared to the original Sgarbossa criteria. We report preliminary findings of the Paced Electrocardiogram Requiring Fast Emergency Coronary Therapy (PERFECT) study Methods: The PERFECT study is a retrospective, multicenter, international investigation of ED patients from 1/2008 -12/ 2016 with VPR on the ECG and symptoms suggestive of acute coronary syndrome (e.g. chest pain or shortness of breath). Data from four sites are presented. Acute myocar...

Introduction: Alberta Health Services (AHS) Emergency Medical Services (EMS) in the City of Edmonton recently introduced an "EMS Continuing Care Urgent Response Team" (ECCURT) to support continuing care residents by providing urgent care on-site, thereby minimizing unnecessary patient transfers to emergency departments. ECCURT is comprised of Advanced Care Paramedics and Nurse Practitioners, and is dispatched via a dedicated consult line and/or 911. Objectives: This study will identify various patient characteristics that are correlated with frequency of transport to hospital. Methods: This six-month retrospective, observational study of patient data includes all new patients assessed between January 1, 2016 and June 30, 2016. Multiple regression analysis was performed to determine whether a statistically significant correlation exists comparing age, Goals of Care Designation (GCD), and Canadian Triage Acuity Scale (CTAS) score, with transport frequency.Results: Four hundred and seventy-one (83%) of 567 new patients assessed by ECCURT during the study period had established GCDs in place. Five hundred and twenty-one (92%) of our patients had a CTAS score assigned.One hundred and thirty-one (23%) of our patients were transported to hospital. All patients with a GCD of C2 were managed by our team on-site. Multiple regression analysis reveals a statistically significant correlation of age, GCD, and CTAS score with frequency of transport to hospital (F statistic = 3.26 E-11). P-values for each variable are: age = 0.92; GCD = 0.05; CTAS = 5.08 E-12. Conclusion:Although patient age is not strongly correlated with transport frequency independently, GCD and CTAS score may be quite useful predictors for Community Care EMS Teams when selecting patients who can be managed on-site without transport to hospital.