CJEM最新文献

{"title":"Just say no to metered dose inhalers.","authors":"James C Worrall, Ariel Hendin, Salmaan Kanji","doi":"10.1007/s43678-025-00918-1","DOIUrl":"https://doi.org/10.1007/s43678-025-00918-1","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":"27 5","pages":"317-318"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144044957","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":"CAEP 2024 Academic Symposium: adaptive platform trials in emergency medicine in Canada.","authors":"Nathalie Germain, Martyne Audet, Lorraine Graves, Srinivas Murthy, Shelley L McLeod, Jaspreet Khangura, Shirin Golchi, Andrew D McRae, Corinne M Hohl, Ivy Cheng, Gabrielle Olivier Chevrier, John C Marshall, Patrick M Archambault","doi":"10.1007/s43678-025-00874-w","DOIUrl":"10.1007/s43678-025-00874-w","url":null,"abstract":"<p><strong>Objective: </strong>The Canadian Association of Emergency Physicians 2024 Academic Symposium Panel on adaptive platform trials explored whether adaptive platform trials could be implemented in Canadian emergency departments (EDs). This panel aimed to propose and refine recommendations formulated by the results of a rapid review and responses from a panel of experts about conducting adaptive platform trials in EDs.</p><p><strong>Methods: </strong>From November 2023 to May 2024, a rapid review was conducted on the existing logistical and ethical barriers and facilitators to structuring adaptive platform trials in emergency medicine. The emerging themes and ideas were collected and used to conduct individual semi-structured interviews with key stakeholders, including leaders in emergency medicine research, methodologists and biostatisticians specializing in these designs, patient partners, research personnel, and investigators involved in platform trials across Canada and abroad.</p><p><strong>Results: </strong>From 23 articles and 17 expert interviews, we identified facilitators and barriers to adaptive platform trials in Canadian emergency medicine spread across five domains: evidence strength and quality, relative advantage, adaptability, complexity, and implementation climate and readiness. The most salient needs according to investigators were purposeful and clinically relevant trial design, methodological expertise, and harmonious collaboration with ethics authorities. We provide 14 recommendations across 4 levels: policy, trialist, site, and patient to address barriers to adaptive platform trials in emergency medicine. For each recommendation, we provided corresponding implementation strategies from the Expert Recommendations for Implementing Change (ERIC).</p><p><strong>Conclusions: </strong>Adaptive trial designs are well suited for emergency settings provided the interventions are both easy for clinicians to administer and relevant enough to ameliorate the practice of emergency medicine. These designs are particularly tailored to tackle confirmatory trials, emerging diseases, and trauma care, but barriers like a chaotic ED, complex statistical and methodological requirements, and regulatory considerations persist and require thoughtful implementation strategies.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":"27 5","pages":"329-341"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031946","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":"We are all connected: reimagining care for people experiencing houselessness.","authors":"Jaspreet Khangura, Les Umpherville, Kathryn Dong","doi":"10.1007/s43678-025-00922-5","DOIUrl":"https://doi.org/10.1007/s43678-025-00922-5","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":"27 5","pages":"324-326"},"PeriodicalIF":2.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144048165","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":"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":"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":"Development of a scoring tool for emergency department note quality: a modified Delphi approach.","authors":"Daniel Z Foster, Stuart L Douglas, Akshay Rajaram","doi":"10.1007/s43678-025-00914-5","DOIUrl":"https://doi.org/10.1007/s43678-025-00914-5","url":null,"abstract":"<p><strong>Objective: </strong>Emergency department (ED) documentation is essential for patient care. Accepted standards are required to teach best practices; however, tools to assess ED note quality are deficient, either lacking validation or performing poorly. We sought to develop a tool for assessing ED note quality for lower acuity visits in patients 16 years of age or older.</p><p><strong>Methods: </strong>We employed a modified Delphi approach with two rounds of electronic surveys. We invited 40 Canadian emergency physicians to serve as experts. In round one, we gathered feedback on dimensions (content elements, attributes, and scoring) relevant to ED note quality. Using these data, we derived a draft tool which was shared with the experts in round two, and then modified based on their feedback. Outcome data included survey response rates, and quantitative and qualitative feedback.</p><p><strong>Results: </strong>Response rates were 44% (n = 17) and 47% (n = 8) for the first and second rounds. Key perspectives from round one emphasized differences between broadly applicable (\"universal\") versus context-specific (\"conditional\") elements, the importance of certain attributes, and a binary scoring system. The authors drew on perspectives to develop a tool with eight universal and 16 conditional elements, four attributes, scored using a binary system. Feedback from the second round recommended minor changes, but demonstrated consensus on the tool's stated function.</p><p><strong>Conclusion: </strong>We developed the Tool for ED Note Quality. Limitations include a small sample size and a focus on physician perspectives. Next steps include generation of evidence for validity and refinement of the scoring system. Once validated, the tool may be used in assessing ED note quality for the purposes of medical education, quality improvement, and digital health research.</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":"144031783","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}