CJEM最新文献

{"title":"Exploring the perspectives of non-insured individuals utilizing emergency departments in Toronto: a qualitative study.","authors":"Colin Siu, Sampreeth Rao, Kate Hayman, Jennifer Hulme, Akm Alamgir, Amy Gajaria","doi":"10.1007/s43678-025-00872-y","DOIUrl":"10.1007/s43678-025-00872-y","url":null,"abstract":"<p><strong>Objective: </strong>Non-insured individuals face unique challenges when accessing emergency department (ED) care in Canada. This qualitative study explores the firsthand experiences of non-insured patients within the ED to understand how we can improve the system of care.</p><p><strong>Methods: </strong>This community-based research was conducted in collaboration with a community health center which has multiple service locations in Toronto, Ontario. 24 non-insured participants were recruited using a maximal variation sampling technique for semi-structured individual interviews. Participants must have received care as a patient in an ED in the last 3 years. We analyzed the data using Braun and Clarke's thematic analysis framework.</p><p><strong>Results: </strong>Interview participants felt unwanted and powerless, and faced health system navigation and access challenges. Subthemes include the anxiety of uncertainty regarding how to pay for ED care as well as concerns regarding insurance eligibility, healthcare access points, and language. Non-insured participants experienced stigma and discrimination; delayed care due to a lack of healthcare coverage; and difficulties with the ED registration and triage processes. The study also identified multiple instances where participants had positive experiences with clinicians and devised creative solutions to tackle challenges by engaging informal community networks and self-advocacy.</p><p><strong>Conclusion: </strong>Ways to improve the ED care of non-insured patients include providing ED care for all regardless of their healthcare coverage status, ameliorating clerical training, outlining clearer policies regarding payments, improving health system navigation, and fostering connections to community organizations. Many of the challenges that non-insured patients face may be applicable to other equity-deserving patient groups. By listening to and learning from the experiences of non-insured patients, a more equitable ED system can be built for this marginalized population.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"356-366"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143569148","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":"353-355"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","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":"Just the facts: angioedema in the emergency department.","authors":"Derek Lanoue, Hien Reeves, Moshe Ben-Shoshan, Hans Rosenberg, Ariel Hendin","doi":"10.1007/s43678-024-00834-w","DOIUrl":"10.1007/s43678-024-00834-w","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"345-348"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143018236","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 multicenter prospective cohort study evaluating 30-day outcomes after an emergency department visit for hyperglycemia in Canadian adults with type 1 or 2 diabetes.","authors":"Justin W Yan, Kristine Van Aarsen, Joe Thorne, Igor Karp, Tamara Spaic, Selina L Liu, Nicolas Woods, Ian G Stiell","doi":"10.1007/s43678-025-00913-6","DOIUrl":"https://doi.org/10.1007/s43678-025-00913-6","url":null,"abstract":"<p><strong>Objectives: </strong>Previous retrospective studies have demonstrated that patients with sub-optimally controlled diabetes have higher healthcare resource utilization in emergency department (ED) management of hyperglycemia compared to those with good glycemic control. This study's objective was to prospectively describe 30-day outcomes including return visits and hospitalizations after an initial ED visit for hyperglycemia.</p><p><strong>Methods: </strong>We conducted a multicenter prospective cohort study of adults ≥ 18 years at four Ontario academic EDs diagnosed with hyperglycemia, diabetic ketoacidosis, or hyperosmolar hyperglycemic state. The primary outcome was an unplanned repeat ED visit for hyperglycemia within 30 days of index visit. We conducted telephone follow-up at 14 and 30 days to determine additional outcomes. Data were summarized using descriptive statistics.</p><p><strong>Results: </strong>There were 657 ED visits for hyperglycemia representing 594 unique patients. Mean (SD) age was 52.0 (18.2) years, 53.2% were male. Within 30 days, 96 (14.7%) had a return ED visit for hyperglycemia, 49 (7.5%) were hospitalized, and 4 (0.6%) died. We were able to contact 383 (58.3%) patients by telephone at 14 days and 275 (41.9%) at 30 days. Of these, 68.3% self-identified as Caucasian/White, while 6.3% were Indigenous. 44.9% reported an annual household income below $50,000. 29.1% of working patients took time off following their index visit.</p><p><strong>Conclusion: </strong>This prospective study describes 30-day outcomes and healthcare utilization of ED patients presenting for hyperglycemia. ED clinicians should be aware of the potential for subsequent healthcare utilization and risk for readmission and intervene as appropriate to reduce adverse outcomes in patients with diabetes presenting with hyperglycemia.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060429","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":"Efficacy of nebulized glucocorticoids for acute pharyngitis in an emergency department outpatient population: a multicenter, double-blind, randomized clinical trial.","authors":"Al Yaqdhan Al Atbi, Usama Al Khalasi, Afrah Al Atbi, Sara Al Rawahi, Khamis Al Shaffi, Sufyan Al-Mamari, Mohammed Al Sakiti, Said Al Mujani, Abdullah Al Reesi, Mohammed Al Shamsi","doi":"10.1007/s43678-025-00906-5","DOIUrl":"https://doi.org/10.1007/s43678-025-00906-5","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to assess the efficacy of a single dose of nebulized glucocorticoids (dexamethasone or budesonide) compared to a placebo in relieving sore throat symptoms. The primary outcome was complete symptom resolution at 24 h. Secondary objectives included evaluating pain scores at 48 h, time to pain relief within 7 days, absenteeism, and ED visits or hospital admissions for acute pharyngitis (AP) symptoms or complications within 7 days.</p><p><strong>Methods: </strong>This multicenter, double-blind, randomized controlled trial was conducted across three EDs targeting patients over 5 years old with acute pharyngitis, excluding those with recent steroid or antibiotic use, adenotonsillectomy, or pregnancy. Participants were randomly assigned to one of three groups: nebulized dexamethasone, budesonide, or placebo. Pain severity was assessed using a numeric rating scale from 0 to 10. Analysis involved descriptive statistics and Chi-square tests to compare outcomes across treatment groups.</p><p><strong>Main results: </strong>A total of 163 patients with AP were enrolled. No significant difference in the primary outcome, complete symptom resolution at 24 h, was observed between the glucocorticoids (dexamethasone, budesonide) and placebo groups, with relative risks of 2.2 (95% confidence interval [CI] 0.8-5.1) and 1.1 (95% CI 0.9-1.2), respectively. Among secondary outcomes, time to pain relief was significantly shorter in the glucocorticoid groups (mean onset: 2.6 h for dexamethasone, 3.1 h for budesonide) compared to the placebo group (4.1 h; p = 0.003). There were no significant differences in pain scores at 48 h, ED re-attendance, hospital admissions, or absenteeism. All treatments were well-tolerated, with no significant adverse events reported.</p><p><strong>Conclusion: </strong>Despite a statistically significant earlier onset of pain relief, the study found no significant difference in complete resolution of sore throat at 24 or 48 h between glucocorticoids and placebo groups. Therefore, the routine use of nebulized steroids for managing acute pharyngitis may not be warranted, emphasizing the importance of maintaining standard care practices and considering alternative adjunct therapies.</p><p><strong>Trial registration number: </strong>Clinicaltrial.com NCT04027322. Date: 07/18/2019.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144048184","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 does use of a liberal or restrictive blood transfusion strategy influence neurological outcome in patients with acute brain injury?","authors":"Casey Jones, Laurel Murphy, James Nunn","doi":"10.1007/s43678-025-00909-2","DOIUrl":"https://doi.org/10.1007/s43678-025-00909-2","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061459","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":"Development and implementation of the Compassionate 1 Curriculum: an educational initiative to improve the delivery of care to patients receiving involuntary orders for mental health emergencies.","authors":"Maximilian Strauss, Rachel Sue A Quan, Taya Hyman, Liam Ishaky, Dinah Kalvari, Matthew Hecker-Teper, Tate Newmarch, Mark Unger, Aaron Orkin","doi":"10.1007/s43678-025-00912-7","DOIUrl":"https://doi.org/10.1007/s43678-025-00912-7","url":null,"abstract":"<p><p>Compassion is an indispensable attribute of quality healthcare, but enhancing compassion is seldom the focus of emergency healthcare improvement. The Compassionate 1 Project was launched in the St. Joseph's Emergency Department, Toronto, with a goal of reducing critical agitation events among patients receiving involuntary orders for mental health emergencies. This initiative sought to enhance compassion by improving the quality of communication and material comfort for this patient group. Here, we describe the first component of this project, a novel, whole-of-department educational initiative to teach the delivery of compassionate care to patients with mental health presentations. The second component of this project will evaluate the impact of this initiative in reducing critical agitation events.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056157","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: assessment and management of trauma patients with ankylosing spondylitis.","authors":"Jeffrey J Perry, Hans Rosenberg","doi":"10.1007/s43678-025-00920-7","DOIUrl":"https://doi.org/10.1007/s43678-025-00920-7","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144038103","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":"Social emergency medicine: delivering equity-oriented health care in Canada.","authors":"Dylan Collins, Matthew Douglas-Vail","doi":"10.1007/s43678-025-00899-1","DOIUrl":"https://doi.org/10.1007/s43678-025-00899-1","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053837","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":"Improving patient care experience in the pediatric emergency department: a systematic review.","authors":"Evan Abram, Bhavan Dhaliwal, Banke Oketola, Hoda Badran, Apoorva Gangwani, Peace Eleonu, Carrie Costello, Clara Tam, Terry P Klassen, Elisabete Doyle, Alex Aregbesola","doi":"10.1007/s43678-025-00897-3","DOIUrl":"https://doi.org/10.1007/s43678-025-00897-3","url":null,"abstract":"<p><strong>Objectives: </strong>The primary objective of the project was to summarize existing evidence on patient experiences in pediatric emergency departments (EDs). The secondary objectives were to characterize patient care experience in pediatric EDs, identify barriers to optimal patient care in pediatric EDs, and identify equity, diversity, and inclusion (EDI) principles influencing pediatric emergency care.</p><p><strong>Methods: </strong>We performed a systematic review of cohort, cross-sectional, and controlled clinical studies on children's (≤ 21 years) experience in the pediatric ED. We searched MEDLINE (Ovid), Embase (Ovid), PsycInfo (Ovid), Cochrane Database of Systematic Reviews (Ovid), CENTRAL (Ovid), and CINAHL (EBSCO) from inception until September 7, 2023. Two reviewers independently screened articles for primary outcomes involving any health care outcome or health care utilization, along with secondary outcomes of EDI factors influencing patient care. Data were obtained from included studies using narrative and descriptive analysis. The process was strengthened by input from patients, families, and providers on the Manitoba Emergency Advisory Committee, who proposed additional areas for consideration.</p><p><strong>Results: </strong>Six articles were included, assessing 12 experiences. All studies were from high-volume centers. The primary outcome data indicated an overall satisfaction being rated positively, with satisfaction levels exceeding 70% despite lower ratings in privacy, communication, and waiting areas. Wait times and speed of care were significantly correlated with satisfaction (r = -0.48, P < 0.01 and r = 0.38, P < 0.01, respectively), noting wait times and privacy as barriers to care. The EDI factor impacting patient experience was race, showing decreased scores for privacy and patient voice for those identifying as non-white.</p><p><strong>Conclusions: </strong>Even with a high overall satisfaction in the pediatric EDs, aspects influencing the experience can be improved. Wait times, waiting areas, privacy and EDI factor such as race should be addressed to help overcome barriers and improve the care patients receive.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060856","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}