CJEM最新文献

{"title":"Just the Facts: role of corticosteroids for patients with septic shock, community-acquired pneumonia, and acute respiratory distress syndrome.","authors":"Steven Skitch, Henry Ajzenberg, Bram Rochwerg","doi":"10.1007/s43678-025-00863-z","DOIUrl":"10.1007/s43678-025-00863-z","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"248-252"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426814","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":"Validity and reliability of an abbreviated Copenhagen Burnout Inventory in Canadian emergency physicians and residents.","authors":"Henry Li, Erica Dance, Zafrina Poonja, Isabelle Colmers-Gray","doi":"10.1007/s43678-024-00849-3","DOIUrl":"10.1007/s43678-024-00849-3","url":null,"abstract":"<p><strong>Objectives: </strong>Emergency physicians have the highest rates of burnout among all medical specialties. There is a need for accurate and reliable burnout assessment tools to monitor changes and assess the effects of interventions. However, existing tools are typically long and/or costly. We sought to validate an abbreviated Copenhagen Burnout Inventory among emergency physicians and trainees in Canada.</p><p><strong>Methods: </strong>We conducted a planned secondary analysis of a national, cross-sectional survey of emergency physicians and trainees in Canada. Exploratory factor analysis was performed followed by confirmatory factor analysis. Kaiser's eigenvalues rule, a scree plot, and Horn's parallel analysis guided the number of factors to extract. Structural validity fit indices and internal consistency were compared to pre-specified cutoffs. Criterion validity was assessed compared to the full Copenhagen Burnout Inventory (burnout defined as mean ≥ 50/100).</p><p><strong>Results: </strong>One hundred eighty-two responses were randomly split into separate cohorts for exploratory factor analysis and confirmatory factor analysis. Data were confirmed to be statistically suitable for factor analysis. Using exploratory factor analysis, a ten-item, two-factor abbreviated Copenhagen Burnout Inventory was reached after removing items based on over correlation (≥ 0.80), cross-loading (≥ 75%), and low factor loading (< 0.60). In confirmatory testing, the abbreviated inventory had a good Comparative Fit Index (0.91) though did not meet cutoffs for the remaining fit indices. Internal consistency was 0.92 (95%CI 0.90-0.95). Using a cutoff of 33/50, sensitivity was 0.99, specificity was 0.82, and area under the ROC curve was 0.86.</p><p><strong>Conclusion: </strong>With further validation, an abbreviated ten-item Copenhagen Burnout Inventory has potential to serve as a short, freely available burnout assessment tool among Canadian emergency physicians and trainees. This abbreviated inventory has evidence to support its internal consistency and criterion validity, albeit with inconsistent structural validity. Future validation with larger samples is required, with special attention paid to content validity, test-retest reliability, and correlation with important outcomes.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"260-267"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143191470","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":"People living with dementia deserve the best care possible in the emergency department.","authors":"Celeste Fung, Debra Eagles, Hans Rosenberg","doi":"10.1007/s43678-025-00895-5","DOIUrl":"10.1007/s43678-025-00895-5","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"239-240"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544931","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: erector spinae plane blocks for rib fractures in the emergency department.","authors":"Michael Y Woo, Pierre-Marc Dion, Reva Ramlogan, Yuqi Gu","doi":"10.1007/s43678-025-00868-8","DOIUrl":"10.1007/s43678-025-00868-8","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"253-256"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143597146","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 scholarship points program to encourage academic productivity in your emergency department.","authors":"Jeffrey J Perry, Christian Vaillancourt, Krishan Yadav, Guy Hebert, Warren J Cheung, Hans Rosenberg, Debra Eagles, Venkatesh Thiruganasambandamoorthy, Cheryl Geymonat, Ian Stiell","doi":"10.1007/s43678-025-00869-7","DOIUrl":"10.1007/s43678-025-00869-7","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"241-245"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143366939","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 caring for patients living with dementia in the emergency department: a qualitative study.","authors":"Dana Jelinski, Krista Reich, Eddy Lang, Jayna Holroyd-Leduc, Zahra Goodarzi","doi":"10.1007/s43678-025-00862-0","DOIUrl":"10.1007/s43678-025-00862-0","url":null,"abstract":"<p><strong>Purpose: </strong>Patients living with dementia are complex and visit the emergency department (ED) more frequently than other populations. There is a knowledge gap regarding challenges in care delivery for these patients from the perspective of interdisciplinary healthcare providers. The aim of this study was to identify the barriers and facilitators to caring for people living with dementia in the ED as perceived by healthcare providers to gain a deeper understanding of current care gaps and inform best care practices.</p><p><strong>Methods: </strong>Semi-structured interviews were conducted with healthcare providers to understand their experiences in caring for people living with dementia in the ED. Healthcare providers currently employed within in a Calgary zone ED and with experience in caring for people living with dementia in the ED were eligible for participation. The Framework Method based on the Theoretical Domains Framework and the Behavior Change Wheel was used in the analysis to inform change interventions by addressing key factors that influence behavior.</p><p><strong>Results: </strong>A total of 11 providers participated. Key facilitators to care included collaborative team approaches; collateral information from care partners, EMS, and care homes; geriatric medicine staff; addressing non-medical needs; and person-centered care. Key barriers to care included the ED environment encompassing challenges with lack of resources, staff, and time constraints; deteriorating cognition and behavioral challenges; and a lack of dementia-specific guidance and training.</p><p><strong>Conclusion: </strong>This study highlights key issues in emergency care delivery at the system, unit, provider, and patient levels for people living with dementia through the analysis of healthcare provider experiences. Environmental context and resources, skills, and social/professional role and identity were key domains correlating to the major barriers and facilitators in these findings. Key opportunities for change are identified through which targeted interventions and policies may address dementia-related care gaps within the ED context.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"285-293"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412013","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":"Position statement on advanced career emergency physicians.","authors":"Rodrick Lim, Riyad B Abu-Laban, Rafiq Andani, Brittany Cameron, Jim Christenson, Si-Cheng Dai, Zumil Damji, Sara Gray, Constance LeBlanc, Jill McEwen, Judy Morris, James Stempien, Louise Rang, Douglas Sinclair","doi":"10.1007/s43678-025-00861-1","DOIUrl":"10.1007/s43678-025-00861-1","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"246-247"},"PeriodicalIF":2.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143412024","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":"Use of activated charcoal in poisoned patients aged over than 5 year old.","authors":"Sophie Gilbert, Maude St-Onge, Xavier Neveu","doi":"10.1007/s43678-025-00881-x","DOIUrl":"https://doi.org/10.1007/s43678-025-00881-x","url":null,"abstract":"<p><strong>Background: </strong>Activated charcoal is the primary agent recommended for gastrointestinal decontamination. Current Canadian practices regarding its administration in poisoned patients are not well known. Our objectives were to measure the frequency of administration of activated charcoal in poisoned patient over the age of five, identify the potential determinants of its use, and describe the characteristics as well as the clinical outcomes in intoxicated patients.</p><p><strong>Methods: </strong>In a multicenter health records review, we reviewed poisonings using data collected from health records between January 2015 and January 2016, at different hospitals in Quebec, Canada. We included all poisoned patients over the age of 5 who presented and were managed in the emergency department within 12 h of ingestion of a potentially toxic dose of a carbo-absorbable substance. The primary endpoint was the progression of toxicity, and the secondary endpoints were mortality and length of stay. We calculated the incidence of administration of activated charcoal and identified the observed side effects.</p><p><strong>Results: </strong>A total of 120 of the 935 poisoned patients received activated charcoal (12.8%). A short post-ingestion time (< 90 min) was the preferred indication for its administration. Charcoal-treated patients had a 9.2% lower risk of increased toxicity in the first 12 h, but twice the likelihood of being admitted to the hospital, and of having a length of stay of 12 h or more. The most common side effect was vomiting (20.8%). Only one of the patients who received it had aspiration pneumonia (0.01%) and two patients subsequently had gastrointestinal obstruction after receiving activated charcoal (0.02%).</p><p><strong>Conclusion: </strong>Among patients who were poisoned with a carbo-absorbable substance, 12.8% were treated with activated charcoal in the emergency department. The majority of patients progressed well clinically. Our results will contribute to developing a protocol for a pan-Canadian prospective multicenter randomized controlled trial to evaluate the efficacy of activated charcoal in this population.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143712501","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 Targeted Engagement and Diversion program reduce emergency department utilization?","authors":"Rebecca Seliga, Krishan Yadav, Caroline Hodgins, Maria Jaramillo, Christina Masters, Jamie Muckle, Marie-Joe Nemnom, Ariel Hendin, Debra Eagles, Rakesh Patel","doi":"10.1007/s43678-025-00888-4","DOIUrl":"https://doi.org/10.1007/s43678-025-00888-4","url":null,"abstract":"<p><strong>Objectives: </strong>The Targeted Engagement and Diversion (TED) program in Ottawa provides health care to unhoused or shelter/community housed adults outside of an emergency department (ED) setting. We sought to determine the proportion of patients diverted away from the ED by the TED program.</p><p><strong>Methods: </strong>We conducted a health records review of adult patients who visited the TED program from January to December 2022 using random sampling to account for seasonal variation. Data were extracted from the Ottawa Inner City Health database and hospital records from two university-affiliated EDs. The primary outcome was successful diversion from the ED, defined as any of the following: TED program patients (i) presenting in the evening or overnight; (ii) brought in by police/paramedic services; (iii) referred from the safe consumption site; (iv) assessed by a nurse or physician; (v) admitted for higher level of observation; or (vi) that received an antidote (e.g., naloxone). Data were described using descriptive statistics.</p><p><strong>Results: </strong>We reviewed 500 total visits of 241 unique patients (76.3% male, median age 38 years). The most common reason for presentation was unspecified intoxication (83.4%, n = 417). A total of 359 visits met criteria for successful diversion from the ED (71.8%, 95% confidence interval (CI) 67.7-75.6). Most patients who met diversion criteria revisited the TED program within 7 days (82.8%, n = 323), whereas 7.9% (n = 31) visited an ED within 7 days. At 2 years, 39% (n = 94) of all patients were stably housed and 10.8% (n = 26) died.</p><p><strong>Conclusion: </strong>The TED program may be successful at attracting patients and diverting their care away from busy local EDs, and few patients treated by the TED program visited the ED within the subsequent 7 days. This model of care may provide a solution to offload from overcrowded EDs and improve access to comprehensive care for patients who are unhoused.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143694230","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 for elder abuse after a low-level fall, we need to do better.","authors":"Eric Mercier, Kerstin de Wit","doi":"10.1007/s43678-025-00910-9","DOIUrl":"https://doi.org/10.1007/s43678-025-00910-9","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143671974","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}