CJEM最新文献

Introduction: Transgender and gender diverse people report high rates of healthcare avoidance, yet they also access emergency departments at higher rates than the general population. Our research explores the paramedic perspective of providing care to transgender and gender diverse populations. The objectives were to assess paramedic comfort, confidence, and knowledge in providing healthcare to transgender and gender diverse communities.

Methods: A descriptive, cross-sectional electronic survey was administered to paramedics licensed with the College of Paramedics of Nova Scotia (n = 1281) between April 9 and May 7, 2018. A 4-point Likert scale and open-ended questions about paramedic comfort, confidence, and knowledge were included. Descriptive statistics were used to describe respondent characteristics. Open-ended questions pertaining to paramedic knowledge needs were evaluated using constant comparative analyses employing open coding to identify themes.

Results: The response rate for the survey was 30%, with 387 licensed paramedics participating. Most respondents (66.2%) reported providing care to a patient who identified as transgender and gender diverse. A few respondents (4.9%) felt very confident in their knowledge regarding transgender and gender diverse identities and only 26.6% felt very comfortable in providing optimal care. Of those surveyed, 74.7% had no formal education on transgender and gender diverse health. Close to half (41.9%) reported observing transphobia in the workplace. Most respondents (70%) were interested in obtaining formal education and believed that it should be included in formative education curricula. Paramedics identified four distinct barriers to delivering equitable healthcare to transgender and gender diverse populations: (1) systemic, (2) personal, (3) socio-cultural, and (4) educational barriers.

Conclusion: Paramedics provide emergency healthcare to transgender and gender diverse patients. Comfort and confidence in providing this care were relatively low and identifiable barriers inhibit paramedic capacity to provide equitable healthcare. There was strong interest for education on transgender and gender diverse health and emergency presentations.

Purpose: The cultural mosaic within Canadian emergency department patient populations remains underrepresented in the medical workforce, yet minimal data exist on emergency medicine trainee demographics. This raises questions about recruitment practices and how equity, diversity, inclusion, Indigeneity, and accessibility are being advanced. This study evaluates the current state of diversity and inclusion among Royal College emergency medicine residents to identify key areas of underrepresentation.

Methods: A national cross-sectional survey was conducted across all programs. An online Qualtrics® questionnaire, adapted from the Canadian Resident Matching Service self-identification tool, was distributed to residents (PGY 1-5) by program directors and administrators. The survey captured gender identity, sexual orientation, racialized background, teenage household income, and disability. It was translated into French by a French-speaking author. Ethics approval was granted by the University of British Columbia research ethics board. Descriptive statistics were applied and responses were compared with 2021 Canadian Census data.

Results: We received 227/418 responses (54.3%) from residents across all programs. Emergency medicine residents were significantly less likely to report teenage household income under $100,000 (36.1% vs. 59.6% in the Canadian population). Disability was reported by 10.1% of residents, compared to 27.0% nationally. Indigenous representation was slightly lower overall (4.0% vs. 5.0%), with the largest regional gap in the Prairies (2.5% vs. 10.6%). Visible minority representation was comparable nationally (27.4% vs. 26.5%) but varied geographically, with lower proportions in the Prairies and Ontario. Representation was higher among junior trainees, suggesting recent progress in admissions inclusivity.

Conclusion: This is the first national description of the demographic and socioeconomic profile of Canadian emergency medicine residents. While some national-level metrics were encouraging, significant underrepresentation was observed in income, disability, and Indigenous identity, with notable regional disparities. Establishing this baseline enables ongoing monitoring and informs equity-focused reforms in admissions and residency training. Query ID="Q3" Text="As per the instruction, other language abstracts like ……….. are required, but are not provided. Could you please provide the other language abstracts?"

Introduction: Emergency medicine can involve irregular working hours and shiftwork with unpredictable down time, making adequate nutrition and hydration difficult to obtain. The objectives of this study were to examine: (a) the extent to which Canadian Emergency Medicine physicians eat and/or drink during shifts; (b) factors influencing these habits; and (c) the impact on them when they do not eat/drink. A secondary objective was to examine the impact of the number of practice years on the frequency of eating on-shift.

Methods: A mixed-methods study of 16 closed- and 2 open-ended survey questions was created using REDCap. Canadian staff physicians and residents who identified as "Emergency Medicine Physicians" were targeted via email and social media. Analyses involved descriptive statistics, multivariable logistic regression, and inductive and summative content analyses.

Results: Among 527 respondents, nearly 35% reported "never" or "hardly ever" eating during shifts and 36.6% reported "never" or "hardly ever" drinking water during shifts. Major barriers included lack of time (91.4%) and easily available food for purchase (35.9%). Open-ended responses reflected health reasons, mental clarity, and hospital culture as influencing factors. Years of practice were a significant predictor of eating "frequently" or "almost always" on shift [1.03 (95% CI 1.01-1.06)].

Conclusion: Over one-third of Canadian Emergency Medicine physicians in this study rarely or never eat or drink on shift. These nutrition and hydration habits of Emergency Medicine physicians require further study given their importance for physicians' physical and mental health, as well as patient care. The results of this study can influence conversations surrounding Emergency Medicine physicians' eating habits and ED culture, which could lead to improvements in overall wellness.

Background: Patients presenting to the emergency department (ED) with hip fractures are typically treated with opioids, which are associated with adverse events such as delirium and respiratory depression. The fascia iliaca compartment block (hereafter fascia iliaca block) is a regional analgesia technique which avoids these negative outcomes. We sought to increase the rate of use of this technique to 50% of all patients with hip fractures who presented to our EDs within an 18-month period.

Methods: We held three Plan-Do-Study-Act cycles designed in accordance with surveys sent to our physician group. The first cycle consisted of the dissemination of educational materials and standardization of equipment carts. Next, we held educational sessions for staff and trainee physicians. The third cycle consisted of additional education, Audit and Feedback methodology and incentives. Our outcome measure was the rate of fascia iliaca blocks performed. We tracked the number of unique physicians performing the fascia iliaca block as well as physician-reported comfort with the procedure for our process measures. Our balancing measure was the rate of adverse events.

Results: We went from a baseline rate of 2.0% to 22.6% of patients receiving fascia iliaca blocks. The number of physicians doing this increased from 6 pre-project to 35. Only one adverse event occurred (arterial puncture), which did not cause any significant patient harm. Our statistical process control chart revealed special cause variation in the form of a shift.

Conclusion: Although we did not meet our goal, we were able to significantly improve the rate of fascia iliaca blocks performed at our center. This was largely achieved through educational interventions. Our approach can be adapted by other centers looking to pursue a similar project.

Purpose: Higher mortality has been reported in older patients with moderate traumatic brain Injuries (TBI) compared to younger patients. To identify the risk factors associated with in-hospital mortality, complications and extended length of stay in moderate TBI patients.

Methods: DESIGN: a multicentre observational cohort study using the Quebec Trauma Registry.

Population: Hospitalized patients aged ≥ 16 with a moderate TBI (a head injury with an Abbreviated Injury Scale (AIS) ≥ 3, and a GCS score of 9-12).

Outcomes: In-hospital mortality, complications and prolonged length of stay.

Analyses: Multivariable logistic regression.

Results: We included 1005 patients, 38.1% of whom were aged ≥ 65. The in-hospital mortality rate was 20.1%. Male sex (OR = 1.6 [95% CI:1.02-2.6], age (≥ 85 years old VS < 65 years) (OR = 18.7 [95% CI: 9.2-38.1]), ≥ 2 comorbidities (OR = 2.3 [95% CI: 1.3-4.0]), Injury Severity Score (OR = 1.04 [95% CI: 1.01-1.1]), presence of intraparenchymal hematoma (OR = 3.5 [95% CI: 2.2-5.5]) or other CT scan findings (cerebral edema, pneumocephalus, subpial hemorrhage, and pituitary injury) (OR = 1.9 [95% CI: 1.2-3.1]) were associated with increased odds of mortality. Male sex (OR = 1.8 [95% CI: 1.2-2.6]), age (65-74: OR = 1.7 [95% CI: 1.1-2.8] & 75-84: OR = 1.6 [95% CI: 1.03-2.6]), ≥ 2 comorbidities (OR = 2.9 [95% CI: 1.8-4.7]), thoraco-abdominal concomitant injury (OR = 2.0 [95% CI: 1.01-3.8]), and subarachnoid hemorrhage (OR = 7.6 [95% CI:1.5-38.5]) were associated with increased odds of complications. The number of comorbidities (≥ 2 OR = 1.7 [95% CI: 1.1-2.7]), spine injury (OR = 2.4 [95% CI: 1.4-4.1]), and delirium (OR = 3.1 [95% CI:1.8-5.2]) were associated with an increased odd of extended length of stay.

Conclusions: This study identified risk factors of in-hospital mortality, complications and extended length of stay, most of which are quickly available in the Emergency Department (ED). These factors could help clinicians identify moderate TBI patients at high risk of in-hospital mortality and guide shared decision-making regarding goals of care.