CJEM
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We evaluated impact on length of stay and possible complications of replacing the Clinical Institute Withdrawal Assessment-Alcohol Revised (CIWA-Ar) scale with a slightly modified Richmond Agitation and Sedation Scale (mRASS-AW) to support managing patients admitted with alcohol withdrawal symptoms in a community hospital. Since mRASS-AW is viewed as easier and quicker to use than CIWA-Ar, provided use of mRASS-AW does not worsen outcomes, it could be a safe alternative in a busy ED environment and offer an opportunity to release nursing time to care. ⋯ This was the first study to compare patient outcomes associated with using mRASS-AW for alcohol withdrawal symptoms outside the ICU. Replacing CIWA-Ar with mRASS-AW did not worsen length of stay or complications. These findings provide some evidence that mRASS-AW could be considered an alternative to CIWA-Ar and potentially may provide an opportunity to release nursing time to care.
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Medical training embraces simulation-based education. One important topic that has recently been added to the simulation curriculum at the University of Toronto is unconscious bias. This educational innovation project evaluates a simulation that could be used as a novel instructional design strategy to teach unconscious bias. ⋯ Tangible educational takeaways on team dynamic variation between different gendered team leaders were discussed following the simulation, highlighting its benefit to resident education on bias awareness and response. Limitations include inevitable unconscious bias in facilitators and unequal gender representation in the learner participants, which may impact simulation effectiveness. The findings support translating this simulation to other forms of bias education in future simulation development.