Canadian Journal of Rural Medicine最新文献

{"title":"Enhancing trauma care in remote regions: A trauma training course for physicians in Northern Canada.","authors":"Alexander Laskaris, Kesaan Kandasamy, Jerneja Stare, Fiona Howse, John Whitaker, Natasha G Caminsky, Steven Di Marco, Nathalie Boulanger, Arnaud Messier-Maynard, Ababacar Thorpe, Jeremy Grushka, Dan Deckelbaum, Kosar Khwaja, Evan G Wong","doi":"10.4103/cjrm.cjrm_56_25","DOIUrl":"https://doi.org/10.4103/cjrm.cjrm_56_25","url":null,"abstract":"<p><strong>Introduction: </strong>This study reports the implementation of the Nunavik Trauma Course (NTC), a simulation-based curriculum developed in collaboration with rural physicians in Nunavik.</p><p><strong>Methods: </strong>A needs-assessment pilot questionnaire was distributed to rural physicians in Nunavik through snowball sampling. In response to the questionnaire, an 8-h trauma course was developed, incorporating hands-on and scenario-based training sessions. The curriculum prioritised the unique challenges and training requirements identified by the participants of the pilot survey. A simulation centre hosted the course to replicate realistic, high-stakes scenarios, providing participants an opportunity to enhance their procedural skills and decision-making abilities in a supportive atmosphere. In-training surveys assessed participants' knowledge, confidence and skills pre/post-course.</p><p><strong>Results: </strong>Of the 13 participants, 11 completed the pre-course survey (85% response rate). Most were employed full-time ( n = 8; 73%) and had >5 years of experience ( n = 6; 55%). Among them, 36% managed critically injured people once per week ( n = 4), whereas 64% were involved once every 1-3 months ( n = 7). Following the course, physicians endorsed significantly greater comfort with bougie-assisted endotracheal intubation ( P = 0.014), cricothyroidotomy ( P = 0.003), pleural pigtail insertion ( P = 0.003), pelvic binder application ( P = 0.003), tourniquet placement ( P < 0.001) and increased intracranial pressure management ( P = 0.007).</p><p><strong>Conclusion: </strong>The NTC represents a targeted educational initiative addressing the needs of physicians in remote resource-limited settings. By prioritising contextual relevance and procedural proficiency, the NTC is a model for adaptable, physician-informed rural trauma training.</p><p><p>Améliorer les soins en traumatologie dans les régions éloignées: Une formation en traumatologie destinée aux médecins du Nord canadien.</p><p><strong>Introduction: </strong>Cette étude présente la mise en œuvre du Nunavik Trauma Course (NTC), un programme de formation par simulation élaboré en collaboration avec des médecins ruraux du Nunavik.</p><p><strong>Mthodes: </strong>Un questionnaire pilote d'évaluation des besoins a été distribué à des médecins ruraux du Nunavik au moyen d'un échantillonnage boule de neige. À la suite des réponses obtenues, une formation de huit heures en traumatologie a été conçue, combinant des ateliers pratiques et des mises en situation. Le contenu de la formation a été établi en fonction des défis particuliers et des besoins de formation soulevés par les participants au sondage pilote. La formation s'est déroulée dans un centre de simulation afin de recréer des scénarios réalistes à haut niveau d'enjeu, permettant aux participants de renforcer leurs habiletés techniques et leur prise de décision dans un environnement encadrant. Des questionnaires administrés pe","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"31 3","pages":"93-102"},"PeriodicalIF":0.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148799207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Un regard vers l'avenir.","authors":"Sarah M Giles","doi":"10.4103/cjrm.cjrm_48_26","DOIUrl":"https://doi.org/10.4103/cjrm.cjrm_48_26","url":null,"abstract":"","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"31 3","pages":"92"},"PeriodicalIF":0.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148799171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"La recherche clinique en milieu rural.","authors":"Peter Hutten-Czapski","doi":"10.4103/cjrm.cjrm_47_26","DOIUrl":"https://doi.org/10.4103/cjrm.cjrm_47_26","url":null,"abstract":"","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"31 3","pages":"90"},"PeriodicalIF":0.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148799174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rural clinical research.","authors":"Peter Hutten-Czapski","doi":"10.4103/cjrm.cjrm_42_26","DOIUrl":"https://doi.org/10.4103/cjrm.cjrm_42_26","url":null,"abstract":"","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"31 3","pages":"89"},"PeriodicalIF":0.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148799217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Locally delivered: Identifying factors sustaining rural Northern Ontario's remaining obstetric programmes - A qualitative study.","authors":"Sarah C S Ribey, Iain R Lamb, Eliseo Orrantia","doi":"10.4103/cjrm.cjrm_79_25","DOIUrl":"https://doi.org/10.4103/cjrm.cjrm_79_25","url":null,"abstract":"<p><strong>Introduction: </strong>Over the past 2 decades, rural Northern Ontario has experienced widespread closure of obstetric care services, leaving only 9 sites operational. As a result, many pregnant persons in the region now face substantial travel times to access care, increasing the risk of adverse maternal and fetal outcomes. Understanding how the remaining obstetric programmes continue to operate within the same healthcare environment that has contributed to closures elsewhere in rural Northern Ontario offers insight into factors enabling programme sustainability.</p><p><strong>Methods: </strong>A qualitative study design was used. Semi-structured interviews were conducted with physicians, nurses and administrators from the 9 rural Northern Ontario hospitals that continue to provide obstetrics. Interview guides were informed by previous research on rural obstetric closures and designed to explore the factors participants considered important to programme sustainability. Interviews were analysed using Braun and Clarke's thematic analysis framework to identify the supports, approaches and practices perceived to enable programme continuity.</p><p><strong>Results: </strong>Twenty-three participants were interviewed. Analysis revealed 4 overarching themes participants perceived as important for supporting the continuity of rural obstetrics: (1) passion and commitment, (2) workforce capacity and sustainability, (3) collaborative systems and support and (4) adaptive and safe practices.</p><p><strong>Conclusions: </strong>Sustainability factors identified in rural Northern Ontario's remaining obstetric programmes appear to address challenges linked to programme closures elsewhere, including workforce shortages, declining provider competence and limited structural support. Integrating these sustainability factors into programme design may strengthen current services, reduce risks of closure and guide re-establishment of obstetric care in communities where it has been lost.</p><p><strong>Introduction: </strong>Au cours des deux dernières décennies, le Nord rural de l'Ontario a connu de nombreuses fermetures de services obstétricaux, au point où seulement neuf sites demeurent en activité. Par conséquent, plusieurs personnes enceintes de la région doivent maintenant parcourir de longues distances pour accéder aux soins, ce qui augmente le risque d'issues défavorables pour la mère et le fœtus. Comprendre comment les programmes obstétricaux encore en place réussissent à fonctionner dans le même environnement de soins qui a mené à des fermetures ailleurs dans le Nord rural de l'Ontario permet de mieux cerner les facteurs qui favorisent leur pérennité.</p><p><strong>Mthodes: </strong>Une étude qualitative a été réalisée. Des entrevues semi-dirigées ont été menées auprès de médecins, d'infirmières et d'administrateurs provenant des neuf hôpitaux ruraux du Nord de l'Ontario qui offrent encore des soins obstétricaux. Les guides d'entrevue s'appuyaient su","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"31 3","pages":"113-121"},"PeriodicalIF":0.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148799223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The qualitative impact of the rural exercise for cancer patients and survivor programme (RECaPS).","authors":"Deanna Lavigne, Lisa Allen, Ava Bijl, Hilda A L Chan, Helen Dempster, Lindsay Macmillan, Conner Martin, Jessica Nairn, Magdalena Partyka-Sitnik, Fiona Shearing, Richard Trenholm","doi":"10.4103/cjrm.cjrm_72_25","DOIUrl":"https://doi.org/10.4103/cjrm.cjrm_72_25","url":null,"abstract":"<p><strong>Introduction: </strong>Structured exercise is increasingly reported to be a viable form of adjunct psychological care for cancer patients and survivors, but its availability in rural centres is scarce. Rural cancer survivors face significant psychosocial strain due to limited resources, programming and mental health support. Meta-reviews highlight the physiological and psychosocial benefits of exercise but often overlook hard-to-reach populations. This emphasizes the need for a more integrative, scalable approach to rural health and survivor diversity, a gap this study aims to address. Exercise should be promoted as an accessible form of care for this population. Our study assesses the qualitative outcomes of a rural community-based exercise programme for cancer patients.</p><p><strong>Methods: </strong>This descriptive, mixed-methods study evaluates the implementation and impact of a Rural Exercise for Cancer Survivors and Patient. RECaPS is a 12-week, personalised exercise programme aimed at promoting accessibility to specialised-exercise support services to rural, community-based cancer patients and survivors. The programme incorporated both qualitative insights and fitness assessments to assess physical outcomes and participant experiences.</p><p><strong>Results: </strong>Structured, personalised exercise programming fostered a cohesive environment where participants felt safe and supported in a flexible model that allowed them to improve their physical health despite individual barriers. Where participants may have felt powerless about their cancer diagnosis, RECaPS programming and support enabled them to regain control over their physical recovery.</p><p><strong>Conclusion: </strong>The importance of individualised programming and competent, compassionate care cannot be overstated in the literature of exercise oncology. Structured, yet flexible programming is highly valued by participants across the cancer care continuum. RECaPS programming was effective for all participants to begin rebuilding their physical capacity in a safe, supportive environment.</p><p><p>L'impact qualitatif du programme Rural Exercise for Cancer Patients and Survivors (RECaPS).</p><p><strong>Introduction: </strong>L'exercice structuré est de plus en plus reconnu comme une forme viable de soutien psychologique complémentaire pour les personnes atteintes d'un cancer et les survivants du cancer. Toutefois, ce type de programme demeure peu accessible dans les milieux ruraux. Les survivants du cancer vivant en région rurale font face à une pression psychosociale importante, notamment en raison du manque de ressources, de programmes et de soutien en santé mentale. Les méta-revues soulignent les bienfaits physiologiques et psychosociaux de l'exercice, mais tiennent souvent peu compte des populations plus difficiles à rejoindre. Cela met en évidence la nécessité d'une approche plus intégrée, adaptable et sensible à la diversité des survivants en santé rurale - un ","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"31 3","pages":"103-112"},"PeriodicalIF":0.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148799141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A doctor's last call: Reflections on primary care, failures, hopes and what must change in Nova Scotia.","authors":"Robert Martel","doi":"10.4103/cjrm.cjrm_14_26","DOIUrl":"https://doi.org/10.4103/cjrm.cjrm_14_26","url":null,"abstract":"","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"31 3","pages":"135-137"},"PeriodicalIF":0.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148799184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lepidopterism misdiagnosed as herpes zoster.","authors":"Mohammed Abrahim","doi":"10.4103/cjrm.cjrm_74_25","DOIUrl":"https://doi.org/10.4103/cjrm.cjrm_74_25","url":null,"abstract":"","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"31 3","pages":"132-134"},"PeriodicalIF":0.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148799231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers and facilitators to rural clinical trials: A rapid review.","authors":"Quinn Stewart, Deveshi Deveshi, Denise Jaworsky","doi":"10.4103/cjrm.cjrm_73_25","DOIUrl":"https://doi.org/10.4103/cjrm.cjrm_73_25","url":null,"abstract":"<p><strong>Introduction: </strong>Canada's rural population faces higher rates of chronic disease, worse health outcomes and limited access to health services compared with urban residents. Clinical trials (CTs) can improve equity by expanding access to novel treatments and building healthcare infrastructure. However, rural participation in CTs remains limited. This review aimed to identify barriers and facilitators to the delivery of CTs in rural settings in high-income countries, with a focus on informing the Canadian rural research landscape.</p><p><strong>Methods: </strong>A rapid review was conducted following Cochrane rapid review methods guidelines, incorporating input from key health system partners. Searches were performed in MEDLINE, CINAHL and Cochrane CENTRAL for studies published within the past five years. Inclusion criteria were peer-reviewed, empirical studies from high-income countries describing barriers to and/or facilitators of rural CT delivery. Screening and data extraction were completed using Covidence, with narrative synthesis of results.</p><p><strong>Results: </strong>Twenty-five studies were included. Barriers included geographic isolation, lack of research infrastructure, provider inexperience, regulatory complexity and patient-level challenges such as misconceptions and comorbidities that limit eligibility. Facilitators included community engagement, technology to support decentralisation, professional networks, provider education and financial support. Multiple definitions of rurality were identified, underscoring the lack of standardisation.</p><p><strong>Conclusion: </strong>Rural residents face unique barriers that restrict their participation in CTs, despite evidence of willingness and interest. Expanding rural CT programmes through professional networks, community engagement, technology integration and decentralisation of trial activities could reduce these barriers and help address persistent health inequities.</p><p><p>Obstacles et facteurs facilitants à la réalisation d'essais cliniques en milieu rural: une revue rapide.</p><p><strong>Introduction: </strong>Au Canada, les populations rurales présentent des taux plus élevés de maladies chroniques, de moins bons résultats de santé et un accès plus limité aux services de santé que les populations urbaines. Les essais cliniques peuvent contribuer à une plus grande équité en élargissant l'accès à de nouveaux traitements et en renforçant les infrastructures de soins. Toutefois, la participation des populations rurales aux essais cliniques demeure limitée. Cette revue visait à cerner les obstacles et les facteurs facilitants liés à la réalisation d'essais cliniques en milieu rural dans les pays à revenu élevé, afin d'éclairer plus particulièrement le contexte de la recherche rurale au Canada.</p><p><strong>Mthodes: </strong>Une revue rapide a été menée selon les lignes directrices de Cochrane pour les revues rapides, avec la contribution de partenaires clés du syst","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"31 3","pages":"122-131"},"PeriodicalIF":0.8,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148799135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum: Can implementation of in situ simulation support rural emergency provider self confidence and improve patient safety? A mixed methods study.","authors":"","doi":"10.4103/cjrm.cjrm_89_25","DOIUrl":"10.4103/cjrm.cjrm_89_25","url":null,"abstract":"","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"31 1","pages":"34"},"PeriodicalIF":0.8,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146132845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}