CJEM最新文献

{"title":"Lessons learned while implementing a reusable orthopedic assistive devices recycling program in the pediatric emergency department.","authors":"Sarah Campos, Lucy Chen, Anne Murphy, Riley Wieschkowski, Jordan Levinter, Katherine Kung Cheung, David Lubert, Alia Sunderji, Lianne J McLean","doi":"10.1007/s43678-026-01297-x","DOIUrl":"https://doi.org/10.1007/s43678-026-01297-x","url":null,"abstract":"<p><strong>Objectives: </strong>Lower extremity injuries are a common pediatric emergency presentation that require families to purchase crutches. These may not be affordable for many families, and crutches are often stored or discarded after treatment. There is a need for a solution to reduce the financial burden for families and medical waste. Using Quality Improvement methodology, our group implemented a reusable orthopedic assistive devices recycling program (ROAR) where crutches were dispensed for return and re-use in our pediatric emergency department.</p><p><strong>Methods: </strong>Our aim was to dispense 120 pairs, or at least 50% of crutches used in our department at no cost. After collaborative planning, an operational workflow was designed, and the program was launched in April of 2024.</p><p><strong>Results: </strong>To date, 57 pairs of crutches were dispensed to families at no cost. 25 pairs of these crutches were returned at the time of submission. This represents a 44% return rate within the ROAR program. The program was well received by patients and staff, but faced barriers in recuperation of crutches, ultimately limiting its ability to meet our aim and increasing the cost of the program.</p><p><strong>Conclusions: </strong>Valuable progress was made including alleviating some financial strain on families in purchasing medical devices in our emergency department. In future iterations, adoption and staff buy-in should be maximized by emphasizing repeated education for staff, simple documentation and creative replacement of supplies including considering device donations.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149171666","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":"Opportunities for age-friendly emergency care: a mixed-methods study of older adult experiences in a Canadian Emergency Department.","authors":"Jamie Vander Ende, Renae Wenzel, Brittany Ellis","doi":"10.1007/s43678-026-01280-6","DOIUrl":"https://doi.org/10.1007/s43678-026-01280-6","url":null,"abstract":"<p><strong>Objectives: </strong>The aim of this study was to gain insight into the perceptions of care quality and ED experiences of older adults in a Canadian emergency department to develop targeted interventions to improve care experience and outcomes.</p><p><strong>Methods: </strong>This study utilized a mixed-methods approach. Semi-structured phone interviews were conducted within 30 days of the index ED visit for 19 consenting participants. Survey data were analyzed using descriptive statistics, while qualitative data from interviews were coded using Nvivo software until thematic saturation was achieved.</p><p><strong>Results: </strong>Surveys were administered to 120 older adults (65 years and older). The majority of older adults surveyed use the ED 2-5 times per year and primarily resided in an urban setting. Survey results identified that older adults were hungry and thirsty during their stay (56.7%), relied on care partners for help during their ED visit (29.2%), and the majority felt heard at triage (93.3%). Interview results identified four major themes and 12 subthemes, highlighting many challenges and opportunities in the care of older adults in the ED. Major themes were communication, care, facilities, and attitudes. While older adults expressed appreciation and general acceptance of current ED conditions, they highlighted several areas needing improvement, including enhanced communication from physicians, better privacy measures, parking accessibility, and improved accommodations for caregivers.</p><p><strong>Conclusions: </strong>This study highlights the unique challenges older adults face in the ED. While many expressed satisfaction and appreciation for their care, key areas for improvement emerged, especially in communication, privacy, and support services. Targeted interventions, such as geriatric friendly infrastructure and multidisciplinary teams, could improve care quality, patient satisfaction, and outcomes for older adults in the ED.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149171798","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":"Emergency physicians' knowledge and practice in reporting medically unfit drivers in Atlantic Canada.","authors":"A K Sibley, P Atkinson, S Campbell, K Chandra, G Sheppard, J G Emsley","doi":"10.1007/s43678-026-01195-2","DOIUrl":"https://doi.org/10.1007/s43678-026-01195-2","url":null,"abstract":"<p><strong>Objectives: </strong>Emergency physicians frequently encounter patients with medical conditions affecting their fitness to drive. Emergency physicians have legal and ethical duties to report medically unfit drivers. However, many report low confidence in making these decisions. This may lead to underreporting. We aimed to assess knowledge, practice, and barriers regarding reporting of unfit drivers by Atlantic Canadian emergency physicians.</p><p><strong>Methods: </strong>We conducted a cross-sectional survey of emergency physicians from four Atlantic Provinces. The survey contained 62 questions across four categories: 1) Demographics (seven), 2) General knowledge (five), 3) Scenarios/practice (34), 4) Barriers/needs (16). Where appropriate, participants rated answers on a five-point Likert scale.</p><p><strong>Results: </strong>Seventy-eight emergency physicians (response rate 20.6%) completed the survey: male (59.0%), age 35-44 (37.2%), formally trained in emergency medicine (74.7%). Overall, 88.5% lacked formal training to determine fitness to drive. Familiarity was low regarding provincial regulations (61.5% \"slightly\" or \"somewhat\" familiar) and the Canadian Medical Association Driver's guide (85.9% \"not at all\" to \"somewhat\" familiar) while most (80.8%) use clinical judgment to guide decisions. Half indicated they report (56.4%) and document (50.0%) unfit drivers only \"sometimes\" or less frequently. When presented with clinical scenarios where reporting is indicated (first seizure, recurrent seizure), most (100% and 96.2%) would advise the patients not to drive, but a third (33.4% and 37.2%) would either not report or leave it to another physician to do so. Lack of guideline knowledge was the most significant barrier to reporting, while pocket cards, an electronic app and electronic method to report were identified as enablers. Most emergency physicians (85.9%) would like formal education on this topic.</p><p><strong>Conclusions: </strong>Atlantic Canadian emergency physicians expressed low familiarity with guidelines for determining medical fitness to drive and disclosed potential underreporting. Efforts should focus on targeted education and streamlined tools to improve reporting and enhance road safety.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167781","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":"Just the Facts: Management of patients presenting to the emergency department following therapeutic abortion.","authors":"Matthew Lipinski, Samara Adler, Katie Matthews","doi":"10.1007/s43678-026-01289-x","DOIUrl":"https://doi.org/10.1007/s43678-026-01289-x","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169473","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":"Assessing health advocacy competencies through a novel simulation OSCE-based educational framework.","authors":"Eshal Ali, Melanie Walker, Erin Brennan, Kyla Caners, Isabelle N Colmers-Gray","doi":"10.1007/s43678-026-01287-z","DOIUrl":"https://doi.org/10.1007/s43678-026-01287-z","url":null,"abstract":"<p><p>Health advocacy remains one of the least explicitly assessed CanMEDS roles in Emergency Medicine. Objective structured clinical examination (OSCE) simulation is used to assess performance in real time but has not previously incorporated social determinants of health. We developed and piloted a simulation-based OSCE, embedding advocacy within acute clinical care and introduced novel assessment tools, completed by both examiners and standardized patients. Here we report the feasibility and acceptability of this OSCE and assessment tools. Twenty-two residents completed the advocacy and standard cases; 18 (82%) completed exit surveys. Most participants did not know advocacy would be assessed. Participants described the case as realistic and acceptable with minor suggestions for refinement. Assessors found the assessments intuitive to use and feasible to implement. This pilot suggests structured assessment of patient-level advocacy from both physician and patient perspectives can be feasibly integrated into simulation assessment without disrupting usual performance evaluation.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139858","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":"Submandibular-window point-of-care ultrasound as a bedside clue to deep extension of a peritonsillar abscess.","authors":"Wei-Chun Wang, Chia-Ching Chen","doi":"10.1007/s43678-026-01296-y","DOIUrl":"https://doi.org/10.1007/s43678-026-01296-y","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139864","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":"Performance of updated American College of Surgeons field triage guidelines in identifying need for trauma center care.","authors":"Ian V Beamish, David J Friedman, Rosane Nisenbaum, Ian R Drennan, Daniel Gold-Bersani, Pierre-Marc Dion, Melissa McGowan, Brodie Nolan","doi":"10.1007/s43678-026-01299-9","DOIUrl":"https://doi.org/10.1007/s43678-026-01299-9","url":null,"abstract":"<p><strong>Objective: </strong>The Guidelines for the Field Triage of injured patients were updated in 2021 to improve the reliability of prehospital trauma triage. The objective of this study was to describe the association of the 2021 Field Triage Guidelines criteria with need for advanced trauma center care from a cohort of patients transported to a level 1 trauma center.</p><p><strong>Methods: </strong>This was a health records review of Field Triage Guidelines criteria met for trauma team activations at a level 1 trauma center from January 2020 to December 2021. Hospital-based and injury severity score (ISS)-based trauma center need were defined and sensitivity and specificity of the Field Triage Guidelines calculated for both. Area under the receiver operator curves were used to assess accuracy. Multivariable logistic regression was used to evaluate the association of each criterion with trauma center need.</p><p><strong>Results: </strong>A total of 1427 patients were included and 90.3% met at least one Field Triage Guidelines criteria. Overall, patients meeting hospital-based trauma center need was 33.8% compared to 28.4% which met ISS-based trauma center need. Field Triage Guidelines criteria demonstrated a sensitivity of 97.3% and specificity of 13.3% with respect to hospital-based trauma center need with an area under the ROC of 0.80. Mental status and vital signs showed the highest association with trauma center need.</p><p><strong>Conclusion: </strong>The updated 2021 Field Triage Guidelines demonstrate good accuracy when assessed retrospectively on a cohort of patients transferred to a level 1 trauma center. The very high sensitivity of the new guidelines may help to reduce undertriage rates to the international goal of <5%. New criteria in this iteration of the Field Triage Guidelines could lead to improved rates of undertriage specifically in severely injured geriatric patients.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149139853","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":"Does a personalized hemodynamic resuscitation strategy targeting capillary refill time improve outcomes in patients with early septic shock?","authors":"Naman Arora, Samuel Wilson, Ariel Hendin","doi":"10.1007/s43678-026-01255-7","DOIUrl":"https://doi.org/10.1007/s43678-026-01255-7","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149120039","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":"Clinical applications of gastric point-of-care ultrasound in adult emergency and critical care: a scoping review.","authors":"Saad Razzaq, Zlatitsa Todorova, Rami Hamoudeh, Malick Turenne, Emily R Martin, Aurgho Datta, Astha Chandra, Joel Turner","doi":"10.1007/s43678-026-01265-5","DOIUrl":"https://doi.org/10.1007/s43678-026-01265-5","url":null,"abstract":"<p><strong>Background and objectives: </strong>Point-of-care ultrasound (PoCUS) is a cornerstone of bedside assessment in emergency and critical care, providing rapid, radiation-free visualization of anatomy and pathology. Gastric PoCUS offers a non-invasive method to assess gastric content, volume, and motility, informing management of aspiration risk, airway interventions, and enteral feeding. Despite supporting evidence, its use remains limited and poorly standardized. The objective of this scoping review is to map the clinical applications of gastric PoCUS in adult emergency department (ED) and intensive care unit (ICU) patients.</p><p><strong>Methods: </strong>A scoping review was conducted according to PRISMA-ScR guidelines. Medline, Embase, Scopus, Cochrane, CINAHL, were searched from 1950 to May 2025 for studies evaluating gastric ultrasound in adult ED or ICU populations. Two reviewers independently screened, extracted, and charted data.</p><p><strong>Results: </strong>Thirty-five studies met inclusion criteria. Clinical applications of gastric PoCUS among ED and ICU were clustered under three domains: aspiration risk assessment and airway management (n = 5); enteral nutrition and gastric residual volume monitoring (n = 12); and diagnostic evaluation or therapeutic monitoring (n = 18). Across studies, gastric PoCUS reliably differentiated gastric content types, estimated gastric volume, and informed airway and feeding decisions. In diagnostic contexts, gastric PoCUS enabled rapid bedside identification of gastric outlet obstruction, volvulus, intramural hematoma, and perforated viscus. No studies reported complications or harm caused by performing gastric PoCUS.</p><p><strong>Conclusions: </strong>Gastric PoCUS is a versatile bedside tool bridging diagnostic and therapeutic domains in emergency and critical care. It enhances patient safety, optimizes nutritional management, and reduces radiographic dependence. Standardization of scanning protocols, structured training, and multicenter outcome-based validation studies are needed to support routine integration in acute care.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119766","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":"Healthcare providers' experiences with police in Atlantic Canadian emergency departments: a qualitative study.","authors":"Hannah Boone, Gillian Sheppard, Shabbir Ahmed Sany, Stephen Czarnuch, Ryan Slaney, Maisam Najafizada","doi":"10.1007/s43678-026-01281-5","DOIUrl":"https://doi.org/10.1007/s43678-026-01281-5","url":null,"abstract":"<p><strong>Objectives: </strong>Police involvement is common in emergency departments (EDs), yet evidence from Canada on its impact on care is limited. This study described how ED healthcare providers experience and manage police presence, focusing on perceived impacts on patient care, safety, confidentiality, and training needs.</p><p><strong>Methods: </strong>Emergency physicians, nurses, and paramedics were recruited through the Atlantic Emergency Research Organization network using purposive and snowball sampling. Focus groups were conducted via Webex using a semi-structured topic guide. Sessions were recorded, transcribed verbatim, and de-identified. Data were analyzed using an interpretivist grounded theory-informed thematic approach with iterative open, axial, and selective coding. Four investigators reviewed the coding decisions and theme development.</p><p><strong>Results: </strong>Twenty participants attended focus groups. Participants described police involvement in ED and prehospital encounters, including mental health crises, trauma, intoxication, and criminal legal presentations. Police were often required for managing rising violence and providing practical assistance, yet their presence and actions sometimes escalated agitation, delayed care, or created pressure for rapid \"medical clearance.\" Confidentiality and ethical boundaries were major concerns. Officers positioned for safety could compromise privacy and clinicians reported uncertainty about what information could be shared outside mandated reporting. Most participants reported limited formal training and called for clearer policies, decision tools, and joint training with police and EMS.</p><p><strong>Interpretation: </strong>Police presence in EDs was experienced as simultaneously protective and problematic. Clearer institutional frameworks, operational guidance on information sharing, and joint training with law enforcement are required to support safe, ethical, and trauma-informed emergency care when police are involved.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149120055","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}