CJEM最新文献

{"title":"Just the facts: diagnosis and management of generalized pustular psoriasis.","authors":"Jensen Yeung, Vimal H Prajapati, Eric Mutter, Melinda Gooderham","doi":"10.1007/s43678-025-00883-9","DOIUrl":"https://doi.org/10.1007/s43678-025-00883-9","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":"143672039","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: diagnosis and management of heat stroke.","authors":"Steven Sanders, Matthew Lipinski, Jonathan Hooper","doi":"10.1007/s43678-025-00867-9","DOIUrl":"https://doi.org/10.1007/s43678-025-00867-9","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143660100","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":"Back so soon?: the role of initial triage category in ED return visits.","authors":"P R Atkinson, D Lewis, J Fraser, M Howlett","doi":"10.1007/s43678-025-00890-w","DOIUrl":"https://doi.org/10.1007/s43678-025-00890-w","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143631125","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":"Seasonality and school day-based trends in mental-health-related pediatric emergency department visits during COVID-19 in British Columbia.","authors":"Mikayla Fan, Tyler Black, Jeffrey N Bone, Quynh Doan","doi":"10.1007/s43678-025-00892-8","DOIUrl":"https://doi.org/10.1007/s43678-025-00892-8","url":null,"abstract":"<p><strong>Objectives: </strong>The association between mental health related pediatric emergency department (ED) visits and school attendance during the COVID-19 pandemic remains unclear. We aimed to determine the change in rate of mental health-related pediatric ED visits related to type of school day (i.e., school closure days, school days, winter/summer break days) during the pandemic. We also aimed to compare the number of presentations per week during pandemic school periods to expected values based on pre-pandemic trends.</p><p><strong>Methods: </strong>We included all pediatric ED visits by children aged 2-17 years between January 1st, 2014, and December 31st, 2022, at a single quaternary pediatric center. We calculated the rate (number of mental health pediatric ED visits by 100,000 children) in British Columbia per day on each type of school day, as well as the rate of visits per week during each school period of the pandemic in comparison to the expected values.</p><p><strong>Results: </strong>There was a 36% decrease in presentation rates on non-school days relative to school days in both pre-pandemic and pandemic periods. During the two periods of school closure due to pandemic protocols, mental health visits were substantially lower compared to school days during the pandemic. There were fewer mental health pediatric ED visits for three of the four pandemic school years when compared to pre-pandemic trends.</p><p><strong>Conclusions: </strong>Mental health-related pediatric ED visits were consistently higher on school days than non-school days, including COVID-19 school closure days. In comparison to expected rates based on pre-pandemic trends, mental health-related pediatric ED visits decreased in three of the four school years during the pandemic. Our findings suggest an increased need for mental health support in the ED on school days. They also suggest that EDs should be prepared for mental health demands alongside surges and pandemics.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143597283","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":"ED inhaler revolution: a simple method to substantially reduce the carbon footprint and cost of inhaler use in the emergency department.","authors":"Laura F Wilson, Lucas B Chartier, Christian James Turner","doi":"10.1007/s43678-025-00884-8","DOIUrl":"https://doi.org/10.1007/s43678-025-00884-8","url":null,"abstract":"<p><strong>Objectives: </strong>As global warming intensifies, the healthcare industry faces a parallel need to treat climate-related illness and scrutinize our greenhouse gas emissions. Metered-dose inhaler medications for reactive airways diseases constitute a substantial portion of healthcare emissions. Metered-dose inhalers are often overprescribed, underlabeled, and lost after a few actuations in the emergency department (ED). Lower greenhouse gas alternatives of similar cost and efficacy are readily available, such as dry-powder inhalers, and numerous guidelines support practice change, yet no published work has shown attempts to change practice patterns in the ED. This quality improvement initiative sought to improve inhaler prescribing, use, and disposal in our ED through a staff education campaign.</p><p><strong>Methods: </strong>In a tertiary care ED, we implemented a two-staged education campaign for ED nurses and doctors. Passive education techniques (posters, emails, presentations) were followed by active education (one-on-one sessions, simulated cases). Objectives included improvement of green-prescribing practices, medication labeling, patient education, proper disposal, and pulmonary function testing prior to prescribing. We encouraged practice change only in mild and moderate cases of reactive airway disease.</p><p><strong>Results: </strong>We showed a 19% reduction over the first 6 months, and a 43% reduction the following 6 months in salbutamol metered-dose inhaler dispensations, relative to the same period the year prior. This may correspond to the carbon equivalent of driving approximately 96,000 km by car, or nearly 2.5 times the Earth's circumference. Process measures revealed increased dispensations of dry-powder inhalers and a quick improvement in prescriber knowledge and comfort with alternatives.</p><p><strong>Conclusion: </strong>Overburdened ED staff remain willing and able to change practice toward environmental sustainability. The rapid success of this project should encourage expansion of sustainability considerations across Canadian EDs, and into clinical and administrative decision-making at all levels of healthcare.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588850","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 the rates of overtriaging with prehospital trauma team activation protocols.","authors":"Kevin Durr, Krishan Yadav, Michael Ho, Jacinthe Lampron, Alexandre Tran, Doran Drew, Andrew Petrosoniak, Christian Vaillancourt, Natalia Kruger, Derek Goltz, Marie-Joe Nemnom, Jeffrey J Perry","doi":"10.1007/s43678-025-00885-7","DOIUrl":"10.1007/s43678-025-00885-7","url":null,"abstract":"<p><strong>Introduction: </strong>Prehospital trauma team activation protocols are increasingly used to expedite clinical care and potentially improve patient outcomes. However, there is little evidence describing the rates of overtriaging following prehospital activation.</p><p><strong>Methods: </strong>In June 2018, prehospital trauma team activation protocols were implemented at the Ottawa Hospital. We conducted a health records review of all adult trauma team activations at this Lead Trauma Hospital from September 2016 to March 2020. Cases were prospectively recorded in the regional trauma registry. Pre-implementation and post-implementation cohorts were divided based on the implementation date of the local activation protocols. Overtriaging rates were compared between both groups. We defined overtriaging as activating the trauma team without any of the following: death, ≥ 48-h admission, intensive care unit admission, operative management, or an injury severity score ≥ 16. We present descriptive statistics with odds ratios and 95% confidence intervals to describe the rates of overtriaging.</p><p><strong>Results: </strong>We analyzed 762 trauma team activations with 384 in the pre-implementation group and 378 in the post-implementation group. The frequency of prehospital trauma team activation was 25.3% (N = 97) in the pre-implementation period, compared to 47.6% (N = 180) in the post-implementation period. There was no statistically significant increase in overtriaging when comparing the pre-implementation (N = 64, 16.7%) and post-implementation (N = 68, 18.0%) groups (OR 1.10; 95% CI 0.75, 1.60). Furthermore, the rate of overtriaging for each individual criterion of the local protocol adhered to guideline recommendations (< 25-35%). Lastly, in the post-implementation period, there was no significant difference in overtriaging with prehospital (N = 30, 16.7%) compared to in-hospital (N = 38, 19.2%) trauma team activation (OR 0.84; 95% CI 0.50, 1.43).</p><p><strong>Conclusion: </strong>Our study demonstrates that the local prehospital trauma team activation protocol did not result in a statistically significant rise in overtriaging. These findings demonstrate that implementing center-specific prehospital trauma team activation protocols did not increase overtriaging rates.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143582416","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":"Video versus direct laryngoscopy for urgent intubation of newborn infants.","authors":"Min Joon Lee, Stephanie Redpath, Jeffrey J Perry","doi":"10.1007/s43678-025-00859-9","DOIUrl":"10.1007/s43678-025-00859-9","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143582417","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":"Reducing emergency department return visits for ultrasound imaging: a quality improvement initiative.","authors":"Taofiq Olusegun Oyedokun, Revathi Nair, James Stempien, Kyle Moulton, Prosanta Mondal, Sachin V Trivedi","doi":"10.1007/s43678-025-00880-y","DOIUrl":"https://doi.org/10.1007/s43678-025-00880-y","url":null,"abstract":"<p><strong>Background: </strong>The shortage of after-hours ultrasound (US) imaging in the ED puts considerable strain on the patient and the already scant resources in the ED. Implementing an alternate clinical pathway that guides ED physicians to utilize the US imaging centers in the community for non-emergent scans may help alleviate some of these stressors. We aimed to reduce the number of patients returning to the ED for US by 50% within 6 months of implementation.</p><p><strong>Methods: </strong>After performing a root cause analysis and creating a process map, a multidisciplinary team designed an alternate clinical pathway utilizing community radiology centers to perform Next Day US. Following the implementation of a new clinical pathway in January 2022, we performed an analysis of electronic health record data to assess the differences in the usage of next day US in the ED pre- (2019-21) and post-implementation (2022) of the new clinical pathway.</p><p><strong>Results: </strong>The study screened for ED next day US usage in 123,386 patients who visited Saskatoon EDs between January and June 2019-2022. Post-implementation of the pathway in January 2022, there was a 48% decrease in the percentage of patients returning to the ED the next day for US. Run charts displayed non-random signal of change evidenced by a shift. There was no difference in the patient's length of stay (LOS) before and after pathway implementation.</p><p><strong>Conclusions: </strong>Successful implementation of a new imaging pathway led to a significant decrease in the number of patients returning to the ED the next day for ultrasound.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143573785","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":"Implementation of a CPR quality data collection program in the emergency department: a quality improvement initiative.","authors":"Garrick Mok, Samuel Vaillancourt, Minnie Fu, Sara Gray, Lucas B Chartier, Natalie Wong, Katherine S Allan, Farah Warsi, Celine Callender, Melissa McGowan, Andrew Petrosoniak","doi":"10.1007/s43678-025-00882-w","DOIUrl":"https://doi.org/10.1007/s43678-025-00882-w","url":null,"abstract":"<p><strong>Objectives: </strong>We used quality improvement (QI) methodology to improve cardiopulmonary resuscitation (CPR) data collection within the emergency department (ED) for non-traumatic cardiac arrests. This novel program aimed to improve CPR data collection from a baseline of 48.7-80% between August 15th, 2023-April 14th, 2024.</p><p><strong>Methods: </strong>The outcome measure was percentage of cases with CPR data available. The secondary measures included CPR rate and depth (composite measure), compression fraction, and CPR pauses < 10 s. Manual review of electronic health records and Zoll Case Review^© was utilized for data extraction. The project team was created utilizing a stakeholder matrix. Diagnostics included an Ishikawa diagram, QI huddles, simulation, and process mapping. Interventions included: introduction of an emergency medical services (EMS)-to-ED adapter, simulation and education, and data debriefing. Elements were introduced and tested with simulation prior to implementation. P-charts and x-charts were used to determine successful completion of aims.</p><p><strong>Results: </strong>CPR data were available in 48.7% (19/39) of cardiac arrest cases during the baseline period (February 15th, 2023-August 14th, 2023). Special cause variation was met during the implementation period with a shift (≥ 8 consecutive points above or below median), improving data collection to 89.1% (49/55). Improvements were identified with a shift for CPR in target for rate and depth (1.8-20.4%) and compression fraction (82.2-86.9%). No special cause variation was identified for CPR pauses < 10 s.</p><p><strong>Conclusion: </strong>Through the use of QI methodology, we successfully improved CPR data collection within our ED from 48.7-89.1% for non-traumatic cardiac arrests. Improvements were seen in CPR in target for rate and depth, and compression fraction. This program provides a foundation for reliable CPR performance measurement and improvement, and serves as an example for other ED's with similar interest in CPR performance improvement.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574892","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":"Author reply to: Pre-induction vasopressor use to reduce post-intubation hypotension.","authors":"Patricia L G Marks, James Gould","doi":"10.1007/s43678-025-00875-9","DOIUrl":"https://doi.org/10.1007/s43678-025-00875-9","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143574926","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}