Canadian Journal of Rural Medicine最新文献

{"title":"Recharged.","authors":"Gavin Gerard Parker","doi":"10.4103/cjrm.cjrm_34_25","DOIUrl":"10.4103/cjrm.cjrm_34_25","url":null,"abstract":"","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"30 3","pages":"118"},"PeriodicalIF":0.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144817770","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":"We're recruiting.","authors":"Peter Hutten-Czapski","doi":"10.4103/cjrm.cjrm_32_25","DOIUrl":"10.4103/cjrm.cjrm_32_25","url":null,"abstract":"","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"30 3","pages":"115"},"PeriodicalIF":0.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144817774","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":"Access to endovascular thrombectomy treatment for stroke patients with large vessel occlusion in Northern Ontario.","authors":"Konnor Kennedy, Cory Tremblay, Alice Nielissen, Karanvir Gill, Ruba Kiwan, Aviraj Deshmukh, Stefano Priola, Jaspreet Kaur, Ravinder-Jeet Singh","doi":"10.4103/cjrm.cjrm_40_24","DOIUrl":"10.4103/cjrm.cjrm_40_24","url":null,"abstract":"<p><strong>Introduction: </strong>Globally, stroke is the second-leading cause of death and the third-leading cause of combined death and disability. Stroke caused by large vessel occlusion (LVO) carries high morbidity and mortality. Endovascular thrombectomy (EVT) has improved the outcome of patients with LVO-related stroke. Despite therapeutic advances, timely access to EVT remains a critical challenge in many parts of the world, particularly large geographical areas with low population density and rural/remote regions. Our study aimed to share the real world data on the outcome of patients treated with EVT in a large geographic region with long transfer distances and high representation of rural and remote populations.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of the first 103 patients treated between February 2020 and December 2022 at a newly launched regional EVT programme in Northeastern Ontario, Canada. Data included patient demographic, clinical characteristics, treatment metrics and 90-day functional outcomes assessed by modified Rankin score (mRS).</p><p><strong>Results: </strong>Establishment of a regional EVT programme led to a significant improvement in the access to EVT treatment (<1% prelaunch to ~6% postlaunch). Median transport distances between the site of initial stroke presentation to the EVT centre decreased substantially from 450.80 km pre-launch to 108.04 km post-launch. Over half of the treated patients (53/103, 51.5%) were ambulating independently (mRS 0-3) while mortality was 39.8%. Younger age (odds ratio [OR] 0.896, 95% confidence interval [CI] 0.824-0.975; P = 0.011), lower stroke severity (0.840, interquartile range [IQR] 0.745-0.946, P = 0.004) and shorter time from symptom onset to reperfusion (0.796, IQR 0.677-0.936, P = 0.006) were associated with lower odds of unfavourable outcomes (mRS 4-6).</p><p><strong>Conclusion: </strong>Our study shows improved access to EVT treatment after the establishment of a regional EVT programme. About 51.5% of patients had favourable outcomes with LVO-related stroke following EVT in a large geographic region with long transfer distances and high representation of rural and remote populations. More data are needed from similar regions across the globe to help understand treatment and outcome trends following EVT and strategies to improve EVT access.</p><p><strong>Introduction: </strong>À l'échelle mondiale, l'AVC est la deuxième cause de décès et la troisième cause de décès et d'invalidité combinés. Les AVC causés par une occlusion de gros vaisseaux (OGV) entraînent une morbidité et une mortalité élevées. La thrombectomie endovasculaire (TE) a amélioré les résultats chez les patients victimes d'un AVC lié à une OGV. Malgré les progrès thérapeutiques, l'accès rapide à la TE reste un défi majeur dans de nombreuses régions du monde, en particulier dans les zones géographiques vastes à faible densité de population et dans les régions rurales/isolées. Notre é","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"30 3","pages":"132-140"},"PeriodicalIF":0.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144817766","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":"Réénergisés.","authors":"Gavin Gerard Parker","doi":"10.4103/cjrm.cjrm_34_25","DOIUrl":"https://doi.org/10.4103/cjrm.cjrm_34_25","url":null,"abstract":"","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"30 3","pages":"118"},"PeriodicalIF":0.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144817771","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":"Peer coaching in a rural setting: A feasibility study.","authors":"Sofia Valanci-Aroesty, Mylene Juneau, Tim Lapp, Jessica Nairn, Lisa Allen, Roy Kirkpatrick","doi":"10.4103/cjrm.cjrm_41_24","DOIUrl":"10.4103/cjrm.cjrm_41_24","url":null,"abstract":"<p><strong>Introduction: </strong>Peer coaching has gained traction as a method for enhancing practical and personal skills without the hierarchical dynamic sometimes found in mentorship. It creates a collaborative environment, encourages inclusivity and community building, and supports skill development across various disciplines and levels of experience. The objective of our study was to assess the feasibility, satisfaction, and effects of a reciprocal peer coaching pilot program for practising physicians in Northern Ontario's remote and rural regions.</p><p><strong>Methods: </strong>Participants completed 'Peer coaching in practice' micromodules from The Royal College of Physicians and Surgeons of Canada and attended an in-person demonstration. Each participant committed to 2 sessions as both coach and coachee with a self-selected partner. Feedback was gathered at each study interval.</p><p><strong>Results: </strong>Our qualitative study found that peer coaching positively impacted physicians' daily habits, wellness, and professional growth. The study emphasised the importance of cohesive partnerships in peer coaching and highlighted substantial benefits for both coaches and coachees. The feasibility of peer coaching was a key finding, demonstrating its potential to build supportive communities, particularly for providers in remote areas. While in-person interaction was preferred, the study also acknowledged the potential of virtual coaching, which could benefit providers isolated by geography, demographics, or practice modality.</p><p><strong>Conclusion: </strong>Peer coaching is an alternative, novel form of continuing medical education and knowledge exchange. It is particularly relevant in rural communities offering crucial support to local providers, especially those in rural or isolated areas where access to formal continued medical education is limited. Our results suggest that peer coaching can significantly improve the daily practices and overall well-being of physicians.</p><p><strong>Introduction: </strong>Le coaching entre pairs s'est imposé comme une méthode permettant d'améliorer les compétences pratiques et personnelles sans la dynamique hiérarchique que l'on retrouve parfois dans le mentorat. Il crée un environnement collaboratif, favorise l'inclusion et le développement communautaire, tout en soutenant le développement des compétences dans diverses disciplines et à différents niveaux d'expérience. L'objectif de cette étude était d'évaluer la faisabilité, la satisfaction et les effets d'un programme pilote de coaching réciproque entre pairs destiné aux médecins en exercice dans les régions rurales et isolées du nord de l'Ontario.</p><p><strong>Mthodes: </strong>Les participants ont suivi les micromodules \" Expérience Coaching entre pairs \" du Collège royal des médecins et chirurgiens du Canada et ont assisté à une démonstration en personne. Chaque participant s'est engagé à participer à deux séances en tant que coach et aidé (e)","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"30 3","pages":"125-131"},"PeriodicalIF":0.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144817769","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 rolodex of skills and roles: listening and learning from northern physician recruiters.","authors":"Cheri Heather Bethune, Holly M Fleming, Eloho Ukochovwera Ologan, Ghislaine Attema, Erin Cameron","doi":"10.4103/cjrm.cjrm_58_24","DOIUrl":"10.4103/cjrm.cjrm_58_24","url":null,"abstract":"<p><strong>Introduction: </strong>In Canada, 18% of the population lives in rural areas, yet only 8% of practising physicians work rurally. Rural communities face ongoing challenges in both recruitment and retention of physicians and other healthcare professionals. Improving quality and access to care for rural Canadians rests on the successful recruitment and retention of community-based physicians. The aim of this study was a broad exploration of the roles, experiences, and strategies of physician recruiters. Their stories, when woven together, provide us with valuable insights from the \"front lines.\"</p><p><strong>Methods: </strong>Using a grounded theory approach, we conducted semi-structured interviews with Northern Ontario Physician Recruiters.</p><p><strong>Results: </strong>Twelve physician recruiters were interviewed. Six themes were identified: (1) Community engagement: Big and small 'e' engagement, (2) Recruiter role: Know thyself, know thy community, (3) Strategies: It is all about movement: reaching people, pulling strings and dodging bullets, (4) Outcomes: listening, learning, liaising, (5) LEARN (er) ING opportunities and (6) A PanNorthern approach: Their success is our success. Comments from recruiters provide insight and valuable information on their role in securing adequate health professionals in their area.</p><p><strong>Conclusion: </strong>Physician Recruiters have a very challenging job. They are expected to generate results with scant resources within a complex environment that poorly understands or values their role. Yet, their stories highlighted the relevance and joy in their challenges.</p><p><strong>Introduction: </strong>Au Canada, 18% de la population vit en milieu rural, mais seulement 8% des médecins en exercice travaillent dans ces régions. Les communautés rurales sont confrontées à des défis permanents en matière de recrutement et de maintien en poste des médecins et autres professionnels de la santé. L'amélioration de la qualité et de l'accès aux soins pour les Canadiennes et Canadiens vivant en milieu rural repose sur le recrutement et le maintien en poste de médecins exerçant en milieu communautaire. L'objectif de cette étude était d'explorer de manière approfondie les rôles, les expériences et les stratégies des recruteurs de médecins. Une fois mises en perspective, leurs histoires nous fournissent des informations précieuses provenant directement du terrain.</p><p><strong>Mthodes: </strong>À l'aide d'une approche fondée sur la théorie, nous avons mené des entrevues semi-structurées auprès de recruteurs de médecins du Nord de l'Ontario.</p><p><strong>Rsultats: </strong>Douze recruteurs de médecins ont été interviewés. Six thèmes ont été identifiés: 1) Engagement communautaire: engagement avec un grand \" E \" et un petit \" e \", 2) Rôle du recruteur: se connaître soi-même, connaître sa communauté, 3) Stratégies: tout est question de mouvement: aller vers les gens, tirer les ficelles et esquiver les obstacles, ","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"30 3","pages":"141-147"},"PeriodicalIF":0.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144817765","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":"Sepsis management in a rural hospital in Northwest Ontario.","authors":"Len Kelly, Sharen Madden, Catherine Wong, Sonya Fewer, Tamar Shemesh-Lobl, Shanthive Asokan, Laurel Laakso","doi":"10.4103/cjrm.cjrm_60_24","DOIUrl":"10.4103/cjrm.cjrm_60_24","url":null,"abstract":"<p><strong>Introduction: </strong>A retrospective quantitative study of emergency department (ED) management of patients diagnosed with sepsis in a rural hospital in northwest Ontario was conducted to understand the management of sepsis guidelines and department performance.</p><p><strong>Methods: </strong>Our study includes all adult ED patients (18+) receiving an ED diagnosis of sepsis as identified by hospital medical records coding according to National Ambulatory Care Reporting System diagnostic codes from January 1, 2021 to December 31, 2021. Charts were reviewed for patient demographics, initial presentation, timing of ED management and outcomes. Statistical analysis involved descriptive methods.</p><p><strong>Results: </strong>Twenty-five adults were eligible, 16 female, average age 53.1 years (standard deviation [SD] = 21.9). Mortality rate was 28%. The average age of the 7 non-survivors was 64 (SD = 14.73). Time to nursing assessment averaged 8 min (SD = 7.27); time to MD assessment was 41 min (SD = 30.93). Canadian Triage and Acuity Scale scores were urgent or higher in 20 of 23 cases. Retrospective Systemic inflammatory Response Syndrome scores were elevated in 17/25 cases. Average time to fluids administration was 85 min (SD = 79.41). Sixteen of the 23 patients with recorded times of antibiotic delivery received them in 180 min or less.</p><p><strong>Conclusion: </strong>Patients with sepsis present with a variety of clinical features, and laboratory findings. Awareness of the urgency of sepsis treatment and an organised departmental approach is important in the management of potentially septic patients.</p><p><strong>Introduction: </strong>Une étude quantitative rétrospective sur la prise en charge aux urgences des patients diagnostiqués avec une septicémie dans un hôpital rural du nord-ouest de l'Ontario a été menée afin de comprendre les directives en matière de prise en charge de la septicémie et les performances du service.</p><p><strong>Mthodes: </strong>Notre étude porte sur tous les patients adultes (âgés de 18 ans et plus) admis aux urgences et ayant reçu un diagnostic de septicémie selon le codage des dossiers médicaux de l'hôpital, conformément aux codes diagnostiques du Système national d'information sur les soins ambulatoires (SNISA), entre le 1er janvier 2021 et le 31 décembre 2021. Les dossiers ont été examinés afin de recueillir des données démographiques sur les patients, les premiers symptômes, le moment de la prise en charge aux urgences et les résultats. L'analyse statistique a été réalisée à l'aide de méthodes descriptives.</p><p><strong>Rsultats: </strong>Vingt-cinq adultes étaient admissibles, dont 16 femmes, avec un âge moyen de 53.1 ans (écart-type = 21,9). Le taux de mortalité était de 28%. L'âge moyen des seven patients décédés était de 64 ans (écart-type = 14,73). Le délai moyen avant l'évaluation infirmière était de 8 min (écart-type = 7,27); le délai avant l'évaluation médicale était de 41 min (écart-typ","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"30 3","pages":"119-124"},"PeriodicalIF":0.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144817772","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":"How to rescue a crashing asthmatic patient in a remote emergency department: Ketamine and non-invasive ventilation.","authors":"Lindsay Dolomount, Paul Crocker","doi":"10.4103/cjrm.cjrm_82_24","DOIUrl":"10.4103/cjrm.cjrm_82_24","url":null,"abstract":"","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"30 3","pages":"148-150"},"PeriodicalIF":0.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144817767","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":"Nous recrutons constamment.","authors":"Peter Hutten-Czapski","doi":"10.4103/cjrm.cjrm_42_25","DOIUrl":"https://doi.org/10.4103/cjrm.cjrm_42_25","url":null,"abstract":"","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"30 3","pages":"116"},"PeriodicalIF":0.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144817768","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 Occasional insertion of intrauterine devices: new approaches.","authors":"Peter Hutten-Czapski","doi":"10.4103/cjrm.cjrm_14_25","DOIUrl":"10.4103/cjrm.cjrm_14_25","url":null,"abstract":"","PeriodicalId":44615,"journal":{"name":"Canadian Journal of Rural Medicine","volume":"30 3","pages":"151-156"},"PeriodicalIF":0.8,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144817773","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}