CJEM最新文献

{"title":"A battle for attention: how do emergency physicians respond to interruptions? A scoping review.","authors":"Gabrielle Trépanier, Philippe Dubuc-Gaudreau, Antoine Brouillard, Rose Nadeau, Nicolas Elazhary","doi":"10.1007/s43678-025-00950-1","DOIUrl":"https://doi.org/10.1007/s43678-025-00950-1","url":null,"abstract":"<p><strong>Objectives: </strong>Managing constant interruptions is an intrinsic aspect of emergency medicine practice; however, effective physician responses to mitigate their impact remain unclear. Although interruptions are exceedingly common and closely linked to adverse patient outcomes, the approaches for managing such disruptions have yet to be established. In this study, we aimed to identify how emergency physicians and residents respond to interruptions and the factors influencing their responses.</p><p><strong>Methods: </strong>We conducted a scoping review to identify how emergency physicians and residents manage interruptions in the emergency department, searching the following databases using controlled vocabulary: Medline, APA PsycInfo, SCOPUS, and PubMed. Data extraction was conducted using the Covidence platform through a standardized and structured process.</p><p><strong>Results: </strong>The scoping review identified 18 relevant articles, the majority of which (12/18) employed observational methods, involving a total of 417 emergency physicians. These observations, amounting to 778.6 h, were conducted across 25 emergency departments in 4 countries. Physicians responded to interruptions through task switching, multitasking, deferral, acknowledgment, and rejection. Their responses were influenced by the nature of the interrupted activity, cognitive load management, use of telecommunications, physicians' perceptions, and the work environment.</p><p><strong>Conclusion: </strong>Emergency departments are inherently fast-paced and prone to interruptions; therefore, it is important to better understand how emergency physicians and residents navigate these disruptions. This study explores how physicians respond to interruptions and provides insights to support clinicians in identifying and developing effective management strategies.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144644379","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: rivastigmine for the management of anticholinergic toxicity.","authors":"Jesse Godwin, Stephanie Cheung, Gregory Mah, Anthony Lau","doi":"10.1007/s43678-025-00952-z","DOIUrl":"https://doi.org/10.1007/s43678-025-00952-z","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144638906","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 well does GPT-4 perform on an emergency medicine board exam? A comparative assessment.","authors":"Naser Almehairi, Gregory Clark, Seth Davis","doi":"10.1007/s43678-025-00951-0","DOIUrl":"https://doi.org/10.1007/s43678-025-00951-0","url":null,"abstract":"<p><strong>Background: </strong>Recent advancements in artificial intelligence have shown promise in enhancing diagnostic precision within healthcare sectors. In emergency departments, artificial intelligence has demonstrated potential for improving triage, guiding the choice of radiologic imaging and crafting individualized medical notes and discharge summaries, including tailored care plans. Advances in generative artificial intelligence have led to the development of sophisticated models such as OpenAI's GPT-4. This study assessed the ability of generative artificial intelligence in diagnosis and management in emergency medicine. Specifically, we compared GPT-4 with the performance of emergency medicine trainees in Canada, as gauged by the Canadian In-Training Examination.</p><p><strong>Methods: </strong>We compared the performance of emergency medicine residents to GPT-4 on the Canadian in-training exams for the years 2021 and 2022. Each question was entered into a fresh GPT-4 chat and the first response was recorded without any prompting. GPT-4's responses were then assessed using the same marking grid that is employed for evaluating medical trainees. We then compared GPT-4'sscores to the average scores of each post-graduate year (PGY) level of residents across all FRCPC training programs. Ethical approval was obtained, then Canadian In-Training Examination committee provided exam questions and anonymized national results.</p><p><strong>Results: </strong>The participants in this study included 389 residents in 2021 and 333 residents in the 2022 exams. In 2021, mean trainee scores increased progressively across the levels, with PGY1 trainees scoring 48.0% (SD 15.6), PGY2 at 56.2% (SD 14.7), PGY3 at 59.8% (SD 16.7), PGY4 at 67.2% (12.3), and PGY5 at 70.1% (SD 12.5), whereas GPT-4 scored 88.7%. In 2022, a similar pattern, with PGY1 scoring 46.3% (SD 14.7), PGY2 at 51.8% (SD 14.7), PGY3 at 58.2% (SD 14.3), PGY4 at 66.2% (SD 15.3), and PGY5 at 64.3% (SD 8.5), while GPT-4 scored 82.0%.</p><p><strong>Conclusions: </strong>GPT-4 has shown impressive capabilities, surpassing the performance of medical trainees at different postgraduate levels in the clinical written exam. These findings highlight the potential of artificial intelligence to serve as a valuable support tool in medical practice. However, it should be used with caution and must not substitute for established, evidence-based medical resources.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144562301","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: resuscitative point-of-care ultrasound in pediatrics.","authors":"Lianne McLean, Jade Seguin, Paul Olszynski, Daniel J Kim","doi":"10.1007/s43678-025-00954-x","DOIUrl":"https://doi.org/10.1007/s43678-025-00954-x","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144556181","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":"If we can intubate, we can communicate: why goals of care conversations belong in the ED.","authors":"Julie A Brown, Ariel Hendin, Erik P Hess","doi":"10.1007/s43678-025-00956-9","DOIUrl":"https://doi.org/10.1007/s43678-025-00956-9","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":"27 7","pages":"503-504"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676853","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":"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":"543-550"},"PeriodicalIF":2.0,"publicationDate":"2025-07-01","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: 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":"10.1007/s43678-025-00883-9","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"514-517"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12279558/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143672039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Healthcare leadership in the specialty of prehospital and transport medicine: inspiring excellence and innovation.","authors":"Michael A Austin","doi":"10.1007/s43678-025-00886-6","DOIUrl":"10.1007/s43678-025-00886-6","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"509-511"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143426813","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":"Easy with the IO: Intravenous versus intraosseous access in out-of-hospital cardiac arrest.","authors":"Sarah Gagnon, Amaury Gossiome, Francis Desmeules, Axel Benhamed, Pierre-Gilles Blanchard","doi":"10.1007/s43678-025-00921-6","DOIUrl":"10.1007/s43678-025-00921-6","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"521-523"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112907","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":"Treating intractable pain with the erector spinae plane block: preventing recurrent emergency department visits and psychological distress in seniors with acute zoster pain-a case report.","authors":"Mauricio Forero, Laura Olejnik","doi":"10.1007/s43678-025-00924-3","DOIUrl":"10.1007/s43678-025-00924-3","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"568-570"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112983","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}