CJEM最新文献

{"title":"Simulation education in the age of competency-based medical education: a study of the use of simulation-based education in Canadian emergency medicine programs.","authors":"Patrick Fisk, Andrew K Hall, Michael O'Brien, Warren J Cheung","doi":"10.1007/s43678-025-00935-0","DOIUrl":"10.1007/s43678-025-00935-0","url":null,"abstract":"<p><strong>Objective: </strong>In 2018, Royal College emergency medicine residency programs shifted to a competency-based medical education framework. This study sought to explore the impact of this transition on simulation-based education activities, including the use of simulation for assessment, in emergency medicine programs across Canada.</p><p><strong>Methods: </strong>An interview guide was created by the authors evaluating the current role of simulation in emergency medicine programs based on the Core Components framework of competency-based medical education. Semi-structured interviews of emergency medicine simulation directors across Canada were conducted virtually between May 2022 and December 2022. Descriptive statistics of quantitative data are reported and qualitative responses were analyzed using thematic analysis.</p><p><strong>Results: </strong>Interviews represented 11/14 (78.5%) emergency medicine programs in Canada. Competency-based medical education national standards were commonly used to identify gaps in training experiences, particularly with high acuity low opportunity scenarios that could be addressed using simulation. Furthermore, competency-based medical education provided a framework where simulation curricula were revised and allowed for mapping of simulation scenarios to specific required training experiences and assessment requirements. All programs reported a new role of assessment in simulation largely in the form of entrustable professional activity assessments to satisfy the requirement of competency-based medical education. However, concerns were raised around the increasing role of assessment and its impact on psychological safety of the simulation learning environment.</p><p><strong>Conclusion: </strong>The introduction of competency-based medical education has elevated the role of simulation as a means of assessing learner competencies. This shift has been largely positive, by facilitating resident assessment of required training experiences, but with some possible negative consequences related to the impact of assessments on the psychological safety traditionally afforded by the simulation environment. As such, educators must be intentional in how simulation is used in their program with particular attention given to the validity of assessments and the impact on safety of the learning environment.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"605-613"},"PeriodicalIF":2.0,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112981","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":"Examining the geriatric-friendliness of emergency departments in the Canadian province with the oldest population.","authors":"Queen Jacques, Elise Thorburn, Jennifer Perry, David Bradbury-Squires, Susan Mercer, Michael Parsons, Kayla Furlong","doi":"10.1007/s43678-025-00974-7","DOIUrl":"https://doi.org/10.1007/s43678-025-00974-7","url":null,"abstract":"<p><strong>Objectives: </strong>The number of older adults presenting to emergency departments (EDs) is rising. The care of older adults in the ED is challenged by atypical disease presentations and multimorbidity, among other factors. The geriatric ED guidelines-first developed in the United States in 2014-were developed to help EDs improve the care of older adults. However, little is known about Canadian EDs adherence to or implementation of these guidelines and geriatric-friendly ED principles. Our study aimed to describe the geriatric-friendliness of EDs and identify barriers to implementation in Newfoundland and Labrador, the Canadian province with the oldest population.</p><p><strong>Methods: </strong>A cross-sectional study was performed at EDs across Newfoundland and Labrador. We recruited ED site representatives through social media, email listservs, and word of mouth. ED site representatives were healthcare professionals familiar with the care of older adults in the ED. A 28-item questionnaire and a semi-structured interview via telephone were conducted. Proportions and percentages are reported for categorical data. Interview data were grouped into themes based on common patterns in participant responses.</p><p><strong>Results: </strong>Twenty-three EDs participated in the study. ED site representatives were physicians (n = 13), nurses (n = 5), and advanced care paramedics (n = 2). One site identified a physician with a focused education in geriatric emergency medicine. No sites had a nurse with a focused education in geriatric emergency medicine. Only one site tracked process and outcome measures. Most sites had wheelchair-accessible toilets and food and drink available. Barriers to making EDs more geriatric-friendly were identified and included challenges related to resources, infrastructure, education and training, the provision of adequate care, awareness of geriatric-friendly ED principles, and ability to implement change.</p><p><strong>Conclusion: </strong>This study demonstrates a lack of geriatric-friendly EDs in Newfoundland and Labrador. Barriers to implementation were widespread and similar between participating ED sites.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144736071","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":"No room at the inn: pediatric psychiatric patients wait far longer for inpatient beds than their non-psychiatric counterparts; evidence of structural stigma.","authors":"Cassandra Chisholm, Xiaoming Wang, Kyle Guild, Conné Lategan, Zoe Hsu, Eddy Lang","doi":"10.1007/s43678-025-00984-5","DOIUrl":"https://doi.org/10.1007/s43678-025-00984-5","url":null,"abstract":"<p><strong>Background: </strong>Pediatric emergency department (ED) boarding has considerable implications on patient care, safety, and outcomes. Few Canadian studies explore pediatric patients' boarding. Understanding which pediatric presentations are impacted by boarding is fundamental to informing psychiatric infrastructure, public policy, and system improvements. Our primary objective was to explore pediatric and adolescent ED median boarding time for psychiatric patients versus non-psychiatric patients while considering the impact of COVID-19 on boarding trends.</p><p><strong>Methods: </strong>We performed an observational study for 96 EDs in Alberta, Canada using the National Ambulatory Care Reporting System data from 2018-2023. Admitted patients aged 6-17 were included and classified as psychiatric or non-psychiatric using the International Statistical Classification of Diseases. Boarding was defined as the time from admission decision to patients departing the ED. Descriptive statistics summarized patient and ED visit characteristics and median (IQR) boarding time during three time periods to account for COVID-19. Semi-parametric interrupted time-series analysis compared psychiatric and non-psychiatric patient boarding trends.</p><p><strong>Results: </strong>A total of 38,821 pediatric and adolescent patients were admitted from an ED with psychiatric (25%) or non-psychiatric (75%) diagnoses. Psychiatric patients were predominantly female (70.6%) with an older median age of 15. The median (IQR) boarding time for psychiatric patients was 156% longer (241 min (88-1023)) than non-psychiatric patients (93 min (53-1590)). Comparing the initial and final study periods, psychiatric boarding increased by 52% (94 min), and non-psychiatric patient boarding increased by 7% (7 min).</p><p><strong>Conclusion: </strong>This is the largest and most recent comparison of pediatric and adolescent psychiatric and non-psychiatric boarding in Canada. Pediatric psychiatric patients experience substantially longer ED boarding times than non-psychiatric patients and worsened to a greater extent over the 5-year period. Our findings suggest substantial inequity in pediatric psychiatric patients' access to inpatient acute care beds and disparities in hospital-based psychiatric care.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144736074","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: contrast allergy in the emergency department.","authors":"Derek Lanoue, Adam Byrne, D Blair Macdonald, Ariel Hendin","doi":"10.1007/s43678-025-00995-2","DOIUrl":"https://doi.org/10.1007/s43678-025-00995-2","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144736073","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: management of drug-induced seizures.","authors":"Jessica T Kent, Adrianna Rowe, Emily Austin","doi":"10.1007/s43678-025-00992-5","DOIUrl":"https://doi.org/10.1007/s43678-025-00992-5","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144710309","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":"Letter to the CJEM Editor: response to Dr. Kaplan.","authors":"James C Worrall, A Hendin, S Kanji","doi":"10.1007/s43678-025-00985-4","DOIUrl":"https://doi.org/10.1007/s43678-025-00985-4","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144710310","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: calcium administration in trauma patients receiving massive blood transfusions.","authors":"Theodore Muth, Ian Ball, Raquel Oleksin, Alyssa Ball","doi":"10.1007/s43678-025-00994-3","DOIUrl":"https://doi.org/10.1007/s43678-025-00994-3","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144736072","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":"The relationship between prolonged emergency department (ED) wait times and short-term all-cause mortality: an analysis of multi-institutional administrative data in Alberta.","authors":"Niloofar Taghizadeh, Jeffrey Bakal, Patrick McLane, Marisa Vigna, Carina Vigna, Andrew D McRae, Shawn Dowling, Brian R Holroyd, Eddy Lang","doi":"10.1007/s43678-025-00964-9","DOIUrl":"https://doi.org/10.1007/s43678-025-00964-9","url":null,"abstract":"<p><strong>Objective: </strong>ED wait times have been linked to adverse patient outcomes, including increased mortality. We sought to assess the consequences of ED wait times on patient outcomes.</p><p><strong>Methods: </strong>We conducted a cohort study using administrative data from the 14 Alberta highest-volume adult EDs (2017-2022). The relationships between different components of ED wait times and patient short-term all-cause mortality (primary outcome:7-day mortality, and secondary outcome: 30-day mortality) were assessed using Multi-level logistic regression with adjustment for age, gender, the Canadian Triage and Acuity Scale (CTAS), Deprivation Index, Charlson Comorbidity Index, disposition status, hospital EDs, and visit date.</p><p><strong>Results: </strong>Among 1,358,935 unique adult patient ED visits, 22,692 (1.7%) deaths occurred within 7 days, and 47,441 (3.5%) occurred within 30 days after leaving the EDs. Among the entire cohort, there were no associations between prolonged total length of stay, boarding time or time from arrival to physician initial assessment, and an increased risk of the primary outcome. However, in subgroup analyses, among discharged patients, total length of stay of more than 6 hours was associated with an increased risk of 7-day mortality, and demonstrated a dose-response association with an increased risk of 30-day mortality [odds ratio (OR), 95% confidence interval (CI), (reference<6 hrs.): 1.3 (1.2-1.5) at 6-10 h, 1.8 (1.6-2.0), at 10-19 h, and 2.2 (1.8-2.7) at ≥ 19 h].</p><p><strong>Conclusions: </strong>We did not observe an association between ED wait times and 7-day mortality across the overall patient population. Future work should identify specific patient groups that may be at risk of harm from ED wait times to tailor ED crowding and risk mitigation strategies to reduce adverse outcomes among the most at-risk patients.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144736076","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":"DPIs cannot replace pMDIs in the management of obstructive airways disease.","authors":"Alan Kaplan","doi":"10.1007/s43678-025-00968-5","DOIUrl":"https://doi.org/10.1007/s43678-025-00968-5","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144692767","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":"Acute code stroke activations seen in the emergency department: how often are we missing the mark?","authors":"Emily Li, Mohitt Khinda, Aikta Verma, Garrick Mok, Angela Jerath, Fatima Quraishi, Yasmin Visram, Amy Y X Yu, Manav V Vyas","doi":"10.1007/s43678-025-00972-9","DOIUrl":"https://doi.org/10.1007/s43678-025-00972-9","url":null,"abstract":"<p><strong>Background: </strong>A code stroke activation involves mobilization of finite health care resources. We evaluated the proportion of activations that were non-compliant with code stroke criteria, and the acute treatments and healthcare use after these activations in two urban comprehensive stroke centres.</p><p><strong>Methods: </strong>We conducted a multicentre health records review of adult patients seen in the context of code stroke activations in the emergency departments (ED) at two comprehensive stroke centres in Toronto, Canada, between January 1 and December 31, 2022. Code strokes activated in the field by paramedics, or by physicians or nurses in the ED were included. The primary outcome was the proportion of non-compliant activations, defined as an activation that did not meet institutional criteria. Secondary outcomes were receipt of thrombolysis or thrombectomy in code stroke activations that were non-compliant vs. compliant.</p><p><strong>Results: </strong>A total of 1028 code strokes were included, of which 768 (74.7%) were paramedic-initiated. Overall, 314 (30.5%) were non-compliant: 19.6% paramedic-initiated and 70.7% ED-staff initiated. Incorrect determination of the last seen normal time was the most common cause of non-compliant activations. Although a small number of patients received reperfusion therapy despite non-compliant activation (n = 26, 8.2%), most of these patients were less likely to receive these treatments or be admitted to a stroke unit compared to patients with compliant activations.</p><p><strong>Conclusion: </strong>One in three code stroke activations were non-compliant to activation criteria. Quality improvement strategies such as increasing adherence to code stroke protocols by simplifying the protocol, use of simulation exercises, and involving stroke team for borderline cases could help reduce non-compliant activation and conserve healthcare resources.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144683815","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}