CJEM最新文献

{"title":"Discussions about goals of care in the emergency department: a qualitative study of emergency physicians' opinions using the normalization process theory.","authors":"Fannie Péloquin, Émile Marmen, Véronique Gélinas, Ariane Plaisance, Maude Linteau, Audrey Nolet, Nathalie Germain, Patrick M Archambault","doi":"10.1007/s43678-025-00911-8","DOIUrl":"10.1007/s43678-025-00911-8","url":null,"abstract":"<p><strong>Purpose: </strong>We explored emergency department (ED) physicians' opinions about leading goals of care discussions in their daily practice. We contextualized our findings within the current landscape of ED goals of care.</p><p><strong>Methods: </strong>This qualitative study was based on the Normalization Process Theory. We conducted semi-structured interviews with a convenience sample of ten emergency physicians from one academic ED (Lévis, Canada) and aimed to reach data saturation. Using a mixed deductive and inductive thematic analysis, we codified the interviews under the four Normalization Process Theory constructs: coherence, cognitive participation, collective action, and reflexive monitoring.</p><p><strong>Results: </strong>We interviewed 10 emergency physicians. Fourteen themes were identified as factors influencing the feasibility of implementing goals of care discussions in the ED: (1) interpersonal communication, (2) efficiency of care, (3) anxiety generated by the discussion, (4) meeting between clinicians, patients and family, (5) importance of goals of care during handover, (6) deterioration catalyzing the goals of care discussions, (7) lack of training, (8) availability of protocols, (9) heterogeneous prioritization of goals of care discussions, (10) take action before the ED, (11) need for education, (12) legislation, (13) adapt the ED environment, and (14) requirement to lead goals of care discussions.</p><p><strong>Conclusion: </strong>Goals of care discussions are possible and essential with selected ED patients. Physicians identified outstanding needs to normalize goals of care discussions in their practice: education for both themselves and patients on the concept of goals of care discussions, legislative action for the systematization of goals of care discussions for patients, and proactive documentation of patients' preferences pre-ED. Patient, clinician and system-level policy-making efforts remain necessary to address these needs and ensure the normalization of goals of care discussions in emergency physicians' daily practice as suggested by clinical guidelines.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"559-567"},"PeriodicalIF":2.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144251283","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":"Evidence points to limited utility of inhaled corticosteroids for uncomplicated pharyngitis in the emergency department….for now.","authors":"Jeffrey J Perry, David Schramm","doi":"10.1007/s43678-025-00959-6","DOIUrl":"https://doi.org/10.1007/s43678-025-00959-6","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":"27 7","pages":"507-508"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676852","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: considerations and management of fever in the returning traveler.","authors":"John C Lam, Samuel Bourassa-Blanchette, Stuart J Netherton","doi":"10.1007/s43678-024-00833-x","DOIUrl":"10.1007/s43678-024-00833-x","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"518-520"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142923952","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":"Global research highlights.","authors":"","doi":"10.1007/s43678-025-00976-5","DOIUrl":"10.1007/s43678-025-00976-5","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"571-573"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144562300","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":"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":"524-533"},"PeriodicalIF":2.0,"publicationDate":"2025-07-01","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}

{"title":"To or not to \"pit stop\" at the non-trauma center? The dilemma of field trauma care.","authors":"Marcel Émond, Justine Lessard, Axel Benhamed","doi":"10.1007/s43678-025-00957-8","DOIUrl":"https://doi.org/10.1007/s43678-025-00957-8","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":"27 7","pages":"505-506"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144676854","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":"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":"551-558"},"PeriodicalIF":2.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12279581/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144060429","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":"Analysis of secondary trauma transfers within a Canadian regional trauma network: room for improvement?","authors":"Ryan McAleer, Rachel Stephenson, Melissa McGowan, Brodie Nolan, Johannes von Vopelius-Feldt","doi":"10.1007/s43678-025-00900-x","DOIUrl":"10.1007/s43678-025-00900-x","url":null,"abstract":"<p><strong>Purpose: </strong>This study examines secondary trauma transfers of critically injured patients to an adult regional trauma centre in a mixed urban-suburban setting, to examine if these could be avoided through the provision of prehospital critical care at the scene of injury.</p><p><strong>Methods: </strong>This is a cohort study of trauma activations at an adult regional trauma centre in Toronto, Canada, over a 5-year period. We included all secondary trauma transfers of patients who were either admitted to the ICU, had surgery within 4 h of arrival or died within 48 h of admission. Baseline demographics, injury data, geospatial data and interventions provided were extracted from the hospital's trauma registry.</p><p><strong>Results: </strong>659 cases met the inclusion criteria during the five-year study period. 364 (55%) patients underwent secondary transfer from non-trauma centres located in relatively close proximity of 80 km or less. Within this group, patients had a median injury severity score of 22 (IQR 16-29) and the mortality was 17%. 188 (52%) received at least one critical care intervention at the sending facility prior to secondary transfer to the trauma centre. The most frequently performed interventions were emergency anesthesia and intubation (37%), blood transfusion (27%), and finger and/or tube thoracostomy (13%).</p><p><strong>Conclusion: </strong>A significant proportion of critically injured patients in our mixed urban-suburban trauma network are transferred from non-trauma hospitals in relatively close proximity to the trauma centre. Non-trauma hospitals frequently provide time-critical and life-saving interventions prior to secondary transfer. A prehospital critical care scene response for major trauma should be explored as an option to deliver critical care interventions at the scene, followed by direct transport to a trauma centre.</p>","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"534-542"},"PeriodicalIF":2.0,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144061498","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":"Tribute to Dr. Eric Revue.","authors":"Pierre-Gilles Blanchard","doi":"10.1007/s43678-025-00971-w","DOIUrl":"10.1007/s43678-025-00971-w","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":"512-513"},"PeriodicalIF":2.4,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144661265","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: emergency department approach to vaso-occlusive episodes in sickle cell disease.","authors":"Roy Khalife, Brit Long, Hans Rosenberg","doi":"10.1007/s43678-025-00953-y","DOIUrl":"https://doi.org/10.1007/s43678-025-00953-y","url":null,"abstract":"","PeriodicalId":93937,"journal":{"name":"CJEM","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144478242","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}