CJEM最新文献

{"title":"Team decision-making in high-stakes time-pressured environments: what helps and what hinders?","authors":"Fiona Raymond, Mitchell C Profeit, Andrew K Hall, Valentina Ly, Warren J Cheung","doi":"10.1007/s43678-026-01285-1","DOIUrl":"https://doi.org/10.1007/s43678-026-01285-1","url":null,"abstract":"<p><strong>Purpose: </strong>Team decision-making is central to effective practice in high-acuity healthcare environments, yet most decision-making research in medicine remains focused on individuals rather than teams. This narrative review synthesizes evidence across various fields, including aviation, military, crisis response, and team sport, to identify key factors that influence team decision-making in time-bound, high-stakes settings, and to examine how these insights may inform practice in acute care and resuscitation medicine.</p><p><strong>Methods: </strong>A systematic search of MEDLINE and Scopus databases following previously identified best practices for narrative review identified 595 unique records; after review by the first and second authors, 25 studies met inclusion criteria and focused explicitly on team-level decisions made under conditions of time pressure and high stakes. Included studies spanned healthcare, emergency response, crisis management, aviation, sport, business, and military contexts. These studies were then analyzed by the first author and themes were identified.</p><p><strong>Results: </strong>Content analysis revealed five factors shaping team decision-making: role clarity, hierarchy, information sharing, team cognition, and team training. Across domains, clear and mutually understood roles have been shown to facilitate coordination, whereas role ambiguity resulted in conflict, redundancy, or unsafe task prioritization. Flexible, psychologically safe hierarchies, rather than rigid structures, enabled inclusive communication and reduced deference-based errors. Effective information sharing required both sufficiency and restraint, emphasizing relevance, timeliness, and shared situational awareness. Team cognition, including the development of shared mental models, was foundational for synchronizing actions under dynamic conditions. Finally, team training approaches that emphasize adaptability, cross-role understanding, pre-briefing, and debriefing cultivated resilience and improved decision accuracy under pressure.</p><p><strong>Conclusion: </strong>These findings suggest opportunities to strengthen decision-making in acute care by prioritizing early role clarification, flattening communication pathways, and designing training that targets soft resilience, shared cognition, and adaptive communication.</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":"149120106","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":"Simple telemonitoring to bridge the vulnerability gap after emergency department discharge.","authors":"Ali Afdjei, Bruno Mégarbane","doi":"10.1007/s43678-026-01291-3","DOIUrl":"https://doi.org/10.1007/s43678-026-01291-3","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149120057","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":"Physicians at triage: innovation requires administrative clarity.","authors":"Paul Atkinson, Kavish Chandra","doi":"10.1007/s43678-026-01226-y","DOIUrl":"10.1007/s43678-026-01226-y","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"901-903"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148427404","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":"Benchmarking the trauma airway intubation.","authors":"Andrew P Pirotte, Lyn Pugh, Martin Than","doi":"10.1007/s43678-026-01279-z","DOIUrl":"https://doi.org/10.1007/s43678-026-01279-z","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":"28 10","pages":"893-894"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169418","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":"Infective endocarditis in an HIV-positive patient without IV drug use: a case of multifocal septic complications.","authors":"Toby Mathew, Yael Altschuler, Enrique Martinez-Ortiz, Trevor Dixon, Michael Halperin, Ariella Gartenberg","doi":"10.1007/s43678-026-01211-5","DOIUrl":"10.1007/s43678-026-01211-5","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"990-993"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148297906","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 population-based analysis of prognostic factors associated with survival in adult traumatic cardiac arrest patients.","authors":"Robert S Green, Darby Green, Michael Hannah, Izabella Opra, Jan L Jensen, Nelofar Kureshi, Judah Goldstein","doi":"10.1007/s43678-026-01247-7","DOIUrl":"10.1007/s43678-026-01247-7","url":null,"abstract":"<p><strong>Objectives: </strong>Historically, traumatic cardiac arrest studies have described poor survival rates and argued that resuscitation is futile. However, recent reports have demonstrated that survival rates may be higher than previously appreciated. Our objectives were to determine survival rates in traumatic cardiac arrest patients and assess for factors associated with survival to hospital discharge.</p><p><strong>Methods: </strong>We conducted a registry review study of adult traumatic cardiac arrest patients (≥ 17 years old) in Nova Scotia over a 16-year period (2007-2023). Data were collected from the paramedic electronic Patient Care Record and the Nova Scotia Trauma Registry. The primary outcome was survival to hospital discharge. We compared characteristics between survivors and non-survivors and assessed for predictors of survival. Descriptive statistics, t-tests, chi-square analysis, and multivariable logistic regression models were used.</p><p><strong>Results: </strong>A total of 1042 patients were included in the analysis. Ages ranged from 17 to 96 years (mean 50.03 ± 19.2), and 80.7% were male. Most injuries were blunt trauma (71.7%, 747/1042). The overall survival rate was 1.9% (20/1042). Compared to non-survivors, patients who survived to hospital discharge had lower mean Injury Severity Score (17.8 ± 11.1 vs. 34.4 ± 21.3, p < 0.001). On multivariate analysis, survival to discharge was associated with critical care transport (OR 27.16, 95%CI 7.32-103.86) and direct transport to final facility (OR 4.10, 95%CI 1.37-11.80), while increasing Injury Severity Score (OR 0.93, 95%CI 0.88-0.97) was associated with mortality.</p><p><strong>Conclusions: </strong>Survival to hospital discharge was observed in 1.9% of traumatic cardiac arrest patients. Critical care transport and direct transport to the final facility were associated with patient survival. The identified predictors of survival may help inform prehospital triage and resuscitation strategies for patients experiencing traumatic cardiac arrest.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"939-948"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148595116","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 arterial line placement affect outcomes in patients with shock?","authors":"Madison Van Dusen, Kevin Durr, Christian Vaillancourt","doi":"10.1007/s43678-026-01191-6","DOIUrl":"10.1007/s43678-026-01191-6","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"912-914"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148201194","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":"Inhaled isopropyl alcohol for substance-related nausea in adults at electronic dance music festivals: a randomized controlled trial.","authors":"Anthony Seto, Logan Haynes, Craig Bertagnolli, David Lai","doi":"10.1007/s43678-026-01219-x","DOIUrl":"10.1007/s43678-026-01219-x","url":null,"abstract":"<p><strong>Objectives: </strong>Inhaled isopropyl alcohol has demonstrated benefit in managing nausea in emergency departments. This study investigated inhaled isopropyl alcohol's effect on patients with substance-related nausea at 20 Canadian electronic dance music festivals.</p><p><strong>Methods: </strong>This double-blind randomized control trial enrolled patients aged 18 years or older, who self-reported substance use, and presented with nausea. Exclusion criteria were allergy to isopropyl alcohol, inability to inhale through nares, inability to verbally report nausea level, and prior antiemetic given by medical staff. Randomization was to 70% isopropyl alcohol or placebo saline, inhaled from a soaked pad for ten breaths. Nausea was rated on an 11-point scale (0 = no nausea, 10 = worst nausea imaginable) before and ten minutes post-intervention. Percentage of cases where patients vomited and cases where rescue antiemetics were requested were also computed.</p><p><strong>Results: </strong>Self-reported reduction in nausea ten minutes post-intervention occurred with isopropyl alcohol (n = 34) and placebo (n = 23). Isopropyl alcohol reduced average nausea scores from 6.4 to 4.5 (- 30%, p < 0.001, r = 0.74); placebo reduced nausea from 5.8 to 4.9 (- 16%, p = 0.009, r = 0.66). The magnitude of nausea reduction from isopropyl alcohol was greater than placebo by an additional 14% (p = 0.024, rrβ = 0.35). No side effects were reported. Post-intervention vomiting occurred in 15% versus 13% for isopropyl alcohol versus placebo, respectively (n.s.). Post-intervention request for antiemetics occurred in 35% for isopropyl alcohol versus 70% placebo, respectively (p = 0.01, NNT 3).</p><p><strong>Conclusions: </strong>Inhaling isopropyl alcohol or placebo reduced nausea in patients who consumed recreational substances. Isopropyl alcohol reduced nausea by two-fold that of placebo and reduced requests for antiemetics by half that of placebo. Inhaled isopropyl alcohol offers a simple approach to managing nausea in the electronic dance music festival context. Trial registry NCT04307550 (registered 13 March 2020).</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"920-928"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148581824","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: fomepizole for acetaminophen overdose.","authors":"Laurel Murphy, Marc Brousseau, Caitlin Wolfe","doi":"10.1007/s43678-026-01151-0","DOIUrl":"10.1007/s43678-026-01151-0","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"904-907"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148392743","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":"Global Research Highlights.","authors":"","doi":"10.1007/s43678-026-01244-w","DOIUrl":"10.1007/s43678-026-01244-w","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"994-996"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149120031","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}