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Haim GB, Braun A, Eden H, Burshtein L, Barash Y, Irony A, Klang E. AI in the ED: Assessing the efficacy of GPT models vs. physicians in medical score calculation. Am J Emerg Med 2024; 79:161-166. [PMID: 38447503 DOI: 10.1016/j.ajem.2024.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 01/23/2024] [Accepted: 02/09/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND AND AIMS Artificial Intelligence (AI) models like GPT-3.5 and GPT-4 have shown promise across various domains but remain underexplored in healthcare. Emergency Departments (ED) rely on established scoring systems, such as NIHSS and HEART score, to guide clinical decision-making. This study aims to evaluate the proficiency of GPT-3.5 and GPT-4 against experienced ED physicians in calculating five commonly used medical scores. METHODS This retrospective study analyzed data from 150 patients who visited the ED over one week. Both AI models and two human physicians were tasked with calculating scores for NIH Stroke Scale, Canadian Syncope Risk Score, Alvarado Score for Acute Appendicitis, Canadian CT Head Rule, and HEART Score. Cohen's Kappa statistic and AUC values were used to assess inter-rater agreement and predictive performance, respectively. RESULTS The highest level of agreement was observed between the human physicians (Kappa = 0.681), while GPT-4 also showed moderate to substantial agreement with them (Kappa values of 0.473 and 0.576). GPT-3.5 had the lowest agreement with human scorers. These results highlight the superior predictive performance of human expertise over the currently available automated systems for this specific medical outcome. Human physicians achieved a higher ROC-AUC on 3 of the 5 scores, but none of the differences were statistically significant. CONCLUSIONS While AI models demonstrated some level of concordance with human expertise, they fell short in emulating the complex clinical judgments that physicians make. The study suggests that current AI models may serve as supplementary tools but are not ready to replace human expertise in high-stakes settings like the ED. Further research is needed to explore the capabilities and limitations of AI in emergency medicine.
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Affiliation(s)
- Gal Ben Haim
- Department of Emergency Medicine, Sheba Medical Center, Ramat-Gan, Israel; Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel.
| | - Adi Braun
- Department of Emergency Medicine, Sheba Medical Center, Ramat-Gan, Israel; Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Haggai Eden
- Department of Emergency Medicine, Sheba Medical Center, Ramat-Gan, Israel; Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Livnat Burshtein
- Department of Emergency Medicine, Sheba Medical Center, Ramat-Gan, Israel
| | - Yiftach Barash
- Division of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel; DeepVision Lab, Sheba Medical Center, Tel Hashomer, Israel; Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Avinoah Irony
- Department of Emergency Medicine, Sheba Medical Center, Ramat-Gan, Israel; Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Eyal Klang
- Division of Diagnostic Imaging, Sheba Medical Center, Tel Hashomer, Israel; DeepVision Lab, Sheba Medical Center, Tel Hashomer, Israel; Tel Aviv University, Sackler Faculty of Medicine, Tel Aviv, Israel
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Chi ZH, Liu L, Zheng J, Tian L, Chevrier J, Bornman R, Obida M, Goodyer CG, Hales BF, Bayen S. Biomonitoring of bisphenol A (BPA) and bisphenol analogues in human milk from South Africa and Canada using a modified QuEChERS extraction method. Environ Pollut 2024; 348:123730. [PMID: 38458524 DOI: 10.1016/j.envpol.2024.123730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/28/2024] [Accepted: 03/05/2024] [Indexed: 03/10/2024]
Abstract
A sensitive modified QuEChERS extraction method was developed to assess the levels of free and conjugated bisphenols (BPs) in human milk collected between 2018 and 2019 from two regions of South Africa (the Limpopo Province Vhembe district, n = 194; Pretoria, n = 193) and Canada (Montreal, n = 207). Total BPA (free and conjugated) and BPS were the predominant bisphenols detected in samples from Vhembe and Pretoria, whereas total BPS was the predominant bisphenol detected in Montreal samples. The levels of total BPA in samples from Vhembe and Pretoria ranged between < MDL-18.61 and
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Affiliation(s)
- Zhi Hao Chi
- Department of Food Science and Agricultural Chemistry, McGill University, Montreal, QC, Canada
| | - Lan Liu
- Department of Food Science and Agricultural Chemistry, McGill University, Montreal, QC, Canada
| | - Jingyun Zheng
- Department of Food Science and Agricultural Chemistry, McGill University, Montreal, QC, Canada
| | - Lei Tian
- Department of Food Science and Agricultural Chemistry, McGill University, Montreal, QC, Canada
| | - Jonathan Chevrier
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | | | | | | | - Barbara F Hales
- Department of Pharmacology and Therapeutics, McGill University, Montreal, QC, Canada
| | - Stéphane Bayen
- Department of Food Science and Agricultural Chemistry, McGill University, Montreal, QC, Canada.
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Gonzalo-Ciria L, Gascón-Catalán A, Laborda-Soriano AA, Cambra-Aliaga A, Ruiz-Garrós MC, Perez-de-Heredia-Torres M. Difficulties Fulfilling Self-Care Needs Among Family Caregivers: An Observational Study. Am J Occup Ther 2024; 78:7803205020. [PMID: 38640086 DOI: 10.5014/ajot.2024.050528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024] Open
Abstract
IMPORTANCE Assuming the care of a family member with a disability or chronic illness constitutes a health risk factor for caregivers, who frequently overlook their own self-care. OBJECTIVE To analyze the self-care activities (SCAs) among caregivers of a family member with a disability or chronic illness and assess the impact on their satisfaction and quality of life (QoL). DESIGN Descriptive, cross-sectional, analytic study. SETTING Community. PARTICIPANTS Five hundred caregivers of family members with a disability or chronic illness in the city of Zaragoza, Spain. OUTCOMES AND MEASURES The family caregivers' occupational performance and satisfaction were assessed with the Canadian Occupational Performance Measure, and their QoL was assessed with the World Health Organization-Quality of Life. RESULTS In total, 32.8% of family caregivers had difficulty in all activities related to self-care, 46.6% had difficulty sleeping and resting, 31.6% had difficulty receiving health-related treatments, and 31.2% had difficulty with physical exercise. Women and younger family caregivers showed greater impairment in self-care. Occupational performance, satisfaction, and QoL worsened as the number of affected activities increased. CONCLUSIONS AND RELEVANCE Caring for a family member with a disability or chronic illness has a negative impact on the SCAs of caregivers, especially among female caregivers and those of younger age. Caregiving is also associated with lower occupational performance, satisfaction, and QoL. Plain-Language Summary: Caring for a family member with a disability or chronic illness can become a health risk for caregivers, who frequently ignore their own self-care. The study results found that women and younger family caregivers showed a greater decline in self-care. This study provides information to help occupational therapists to work with family caregivers to prevent a decline in their self-care and improve their quality of life.
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Affiliation(s)
- Laura Gonzalo-Ciria
- Laura Gonzalo-Ciria, PhD, OT, is Professor and Occupational Therapist, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain;
| | - Ana Gascón-Catalán
- Ana Gascón-Catalán, PhD, MD, is Professor, Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain
| | - Ana A Laborda-Soriano
- Ana A. Laborda-Soriano, PhD, OT, is Professor and Occupational Therapist, Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain
| | - Alba Cambra-Aliaga
- Alba Cambra-Aliaga, PhD, OT, is Professor and Occupational Therapist, Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain
| | - María C Ruiz-Garrós
- María C. Ruiz-Garrós, PhD, OT, is Professor and Occupational Therapist, Department of Physiatry and Nursing, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain
| | - Marta Perez-de-Heredia-Torres
- Marta Perez-de-Heredia-Torres, PhD, OT, is Professor and Occupational Therapist, Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Faculty of Health Sciences, Rey Juan Carlos University, Madrid, Spain
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Pezaro DS, Zarbiv G, Jones J, Feika ML, Fitzgerald L, Lukhele S, Mcmillan-Bohler J, Baloyi OB, Maravic da Silva K, Grant C, Bayliss-Pratt L, Hardtman P. Characteristics of strong midwifery leaders and enablers of strong midwifery leadership: An international appreciative inquiry. Midwifery 2024; 132:103982. [PMID: 38579551 DOI: 10.1016/j.midw.2024.103982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 02/22/2024] [Accepted: 03/25/2024] [Indexed: 04/07/2024]
Abstract
OBJECTIVES This research aimed to identify the characteristics of strong midwifery leaders and explore how strong midwifery leadership may be enabled from the perspective of midwives and nurse-midwives globally. DESIGN In this appreciative inquiry, we collected qualitative and demographic data using a cross-sectional online survey between February and July 2022. SETTING Responses were received from many countries (n = 76), predominantly the United Kingdom (UK), Australia, the United States of America (USA), Canada, Uganda, Saudi Arabia, Tanzania, Rwanda, India, and Kenya. PARTICIPANTS An international population (n = 429) of English-speaking, and ethnically diverse midwives (n = 211) and nurse-midwives (n = 218). MEASUREMENTS Reflexive thematic analysis was used to make sense of the qualitative data collected. Identified characteristics of strong midwifery leadership were subsequently deductively mapped to established leadership styles and leadership theories. Demographic data were analysed using descriptive statistics. FINDINGS Participants identified strong midwifery leaders as being mediators, dedicated to the profession, evidence-based practitioners, effective decision makers, role models, advocates, visionaries, resilient, empathetic, and compassionate. These characteristics mapped to compassionate, transformational, servant, authentic, and situational leadership styles. To enable strong midwifery leadership, participants identified a need for investment in midwives' clear professional identity, increased societal value placed upon the midwifery profession, ongoing research, professional development in leadership, interprofessional collaborations, succession planning and increased self-efficacy. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE This study contributes to understandings of trait, behavioural, situational, transformational and servant leadership theory in the context of midwifery. Investing in the development of strong midwifery leadership is essential as it has the potential to elevate the profession and improve perinatal outcomes worldwide. Findings may inform the development of both existing and new leadership models, frameworks, and validated measurement tools.
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Affiliation(s)
- Dr Sally Pezaro
- Research Centre for Healthcare and Communities, Coventry University, UK; Adjunct Associate Professor, University of Notre Dame, Australia.
| | - Gila Zarbiv
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Jude Jones
- TALENT Groups Project Manager, University of Salford, Salford, United Kingdom
| | | | - Laura Fitzgerald
- Jhpiego, an affiliate of Johns Hopkins University, Baltimore, Maryland, United States of America
| | | | - Jacquelyn Mcmillan-Bohler
- Duke University, School of Nursing, 307 Trent Drive, Durham, NC 27710, 2043 Pearson Hall, North Carolina, United States of America
| | - Olivia B Baloyi
- University of KwaZulu-Natal, School of Nursing and Public Health, Durban, South Africa
| | | | - Christine Grant
- The Centre for Healthcare Research, Coventry University, United Kingdom
| | - Lisa Bayliss-Pratt
- Director - Chief Academic Officer Fatima College of Health Sciences. United Arab Emirates
| | - Pandora Hardtman
- Chief Nursing and Midwifery Officer, Jhpiego, United States of America
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Karabin M, Kyröläinen AJ, Kuperman V. Increase in Linguistic Complexity in Older Adults During COVID-19. Exp Aging Res 2024; 50:312-330. [PMID: 36892044 DOI: 10.1080/0361073x.2022.2163831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 12/23/2022] [Indexed: 03/10/2023]
Abstract
The reported psychological impact of the COVID-19 pandemic and related public health measures included a decline in cognitive functioning in older adults. Cognitive functioning is known to correlate with the lexical and syntactic complexity of an individual's linguistic productions. We examined written narratives from the CoSoWELL corpus (v 1.0), collected from over 1,000 U.S. and Canadian older adults (55+ y.o.) before and during the first year of the pandemic. We expected a decrease in the linguistic complexity of the narratives, given the oft-reported reduction in cognitive functioning associated with COVID-19. Contrary to this expectation, all measures of linguistic complexity showed a steady increase from the pre-pandemic level throughout the first year of the global lockdown. We discuss possible reasons for this boost in light of existing theories of cognition and offer a speculative link between the finding and reports of increased creativity during the pandemic.
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Affiliation(s)
- Megan Karabin
- Department of Linguistics & Languages, McMaster University, Hamilton, Canada
| | | | - Victor Kuperman
- Department of Linguistics & Languages, McMaster University, Hamilton, Canada
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Shephard R, Uy J, Otterman V, Betker C, Sandhu HS, Tjaden L, Apatu E, Di Ruggiero E, Musto R, Pawa J, Steinberg M, Payne E, Fang L. The Core Competencies for Public Health in Canada: Opportunities and Recommendations for Modernization. J Public Health Manag Pract 2024; 30:432-441. [PMID: 38603751 DOI: 10.1097/phh.0000000000001884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
CONTEXT The 2008 Public Health Agency of Canada's (PHAC's) "Core Competencies for Public Health in Canada" (the "Canadian core competencies") outline the skills, attitudes, and knowledge essential for the practice of public health. The core competencies represent an important part of public health practice, workforce development, and education in Canada and internationally. However, the core competencies are considered outdated and are facing calls for review, expansion, and revision. OBJECTIVE To examine the literature on public health competencies to identify opportunities and recommendations for consideration when reviewing and updating the Canadian core competencies. METHODS This narrative literature review included 4 components: 3 literature searches conducted between 2021 and 2022 using similar search strategies, as well as an analysis of competency frameworks from comparable jurisdictions. The 3 searches were conducted in collaboration with the Health Library to identify core competency-relevant scholarly and gray literature published in English since 2007. Reference lists of sources identified were also reviewed. During the data extraction process, one researcher screened each source, extracted competency-relevant information, and categorized these data into key findings. RESULTS After identifying 2392 scholarly and gray literature sources, 166 competency-relevant sources were included in the review. Findings from these sources were synthesized into 3 main areas: (1) competency framework methodology and structure; (2) competencies to add; and (3) competencies to modify. DISCUSSION These findings demonstrate that updates to Canada's core competencies are needed and overdue. Recommendations to support this process include establishing a formal governance structure for the competencies' regular review, revision, and implementation, as well as ensuring that priority topics applicable across all competency categories are integrated as overarching themes. Limitations of the evidence include the potential lack of applicability and generalizability to the Canadian context, as well as biases associated with the narrative literature review methodology.
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Affiliation(s)
- Rosemarie Shephard
- Author Affiliations: Public Health Agency of Canada, Ottawa, Ontario, Canada (Mss Shephard, Uy, Otterman, Payne, and Fang); National Collaborating Centre for Determinants of Health, St. Francis Xavier University, Antigonish, Nova Scotia, Canada (Dr Betker, Mr Sandhu, and Ms Tjaden); Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada (Mr Sandhu and Drs Di Ruggiero and Pawa); Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada (Dr Apatu); Canadian Public Health Association, Ottawa, Ontario, Canada (Dr Musto); Division of Clinical Sciences, NOSM University, Sudbury, Ontario, Canada (Dr Pawa); and Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada (Dr Steinberg)
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57
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Owais S, Ospina MB, Ford C, Hill T, Savoy CD, Van Lieshout R. Screen Time and Socioemotional and Behavioural Difficulties Among Indigenous Children in Canada: Temps d'écran et difficultés socio-émotionnelles et comportementales chez les enfants autochtones du Canada. Can J Psychiatry 2024; 69:337-346. [PMID: 38151919 PMCID: PMC11032090 DOI: 10.1177/07067437231223333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
OBJECTIVES To describe screen time levels and determine their association with socioemotional and behavioural difficulties among preschool-aged First Nations, Métis, and Inuit children. METHOD Data were taken from the Aboriginal Children's Survey, a nationally representative survey of 2-5-year-old Indigenous children in Canada. Socioemotional and behavioural difficulties were defined using parent/guardian reports on the Strengths and Difficulties Questionnaire. Multiple linear regression analyses were conducted separately for First Nations, Métis, and Inuit participants, and statistically adjusted for child age, child sex, and parent/guardian education. Statistical significance was set at P < 0.002 to adjust for multiple comparisons. RESULTS Of these 2-5-year-old children (mean [M] = 3.57 years) 3,085 were First Nations (53.5%), 2,430 Métis (39.2%), and 990 Inuit (7.3%). Screen time exposure was high among First Nations (M = 2 h and 58 min/day, standard deviation [SD] = 1.89), Métis (M = 2 h and 50 min [SD = 1.83]), and Inuit children (M = 3 h and 25 min [SD = 2.20]), with 79.7% exceeding recommended guidelines (>1 h/day). After adjusting for confounders, screen time was associated with more socioemotional and behavioural difficulties among First Nations (total difficulties β = 0.15 [95% CI, 0.12 to 0.19]) and Métis (β = 0.16 [95% CI, 0.12 to 0.20]) but not Inuit children (β = 0.12 [95% CI, 0.01 to 0.23]). CONCLUSIONS Screen time exposure is high among Indigenous children in Canada, and is associated with more socioemotional and behavioural difficulties among First Nations and Métis children. Contributing factors could include enduring colonialism that resulted in family dissolution, lack of positive parental role models, and disproportionate socioeconomic disadvantage. Predictors of poor well-being should continue to be identified to develop targets for intervention to optimize the health and development of Indigenous children.
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Affiliation(s)
| | - Maria B. Ospina
- Department of Public Health Sciences, Queen's University, Kingston, Canada
| | - Camron Ford
- Bachelor of Medical Sciences Program, Western University, London, Canada
| | - Troy Hill
- McMaster Alumni Association, McMaster University, Hamilton, Canada
| | - Calan D. Savoy
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Ryan Van Lieshout
- McMaster University, Hamilton, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
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Nafees Z, Ferreira J, Guadagno E, Wray J, Anderzén-Carlsson A, Poenaru D. Adaptation, Translation, and Validation of a Patient-Reported Experience Measure for Children and Young People for the Canadian Context. J Pediatr Surg 2024; 59:810-817. [PMID: 38369398 DOI: 10.1016/j.jpedsurg.2024.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 01/22/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Patient-reported experience measures (PREMs) evaluate children's and young people's (CYP) perceptions of care. An important PREM developed with and for children was created in London, UK. Given the absence of similar North American instruments, we aimed to adapt, translate, and linguistically validate this instrument for use in a Canadian pediatric outpatient setting. METHODS A qualitative design was used, involving CYP and their parents/caregivers. Phase 1 entailed the English survey adaptation using think-aloud testing, revision, and cognitive testing. Phase 2 involved translation into French, revision and back-translation, and cognitive testing. Phase 3 encompassed a cross-validation of the English and French versions of the adapted instrument. RESULTS Fifty-five children in 3 age groups (8-11y, 12-13y, 14-16y) participated in creating the Canadian PREM. In Phases 1 and 2, 41 children participated in reviewing and updating specific questions in the instrument, resulting in adjustments and revisions based on their feedback. In Phase 3, 14 bilingual children linguistically validated the PREM instrument. CONCLUSIONS This study reports the development of the first Canadian PREM specifically tailored to children. By incorporating the perspectives and preferences of CYP in clinical practice, this approach has the potential to amplify the delivery of patient-centered care for this vulnerable population and ensure that the needs and voices of CYP are acknowledged. LEVEL OF EVIDENCE V, Therapeutic.
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Affiliation(s)
- Zanib Nafees
- Department of Surgical and Interventional Sciences, McGill University Faculty of Medicine and Health Sciences, Montreal, Quebec, Canada.
| | - Julia Ferreira
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Elena Guadagno
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Jo Wray
- Great Ormond Street Hospital for Children (GOSH), London, United Kingdom
| | - Agneta Anderzén-Carlsson
- University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Dan Poenaru
- Department of Surgical and Interventional Sciences, McGill University Faculty of Medicine and Health Sciences, Montreal, Quebec, Canada; Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
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Balijepalli C, Gullapalli L, Joshy J, Rawson NSB. The impact of willingness-to-pay threshold on price reduction recommendations for oncology drugs: a review of assessments conducted by the Canadian Agency for Drugs and Technologies in Health. J Comp Eff Res 2024; 13:e230178. [PMID: 38567953 PMCID: PMC11037021 DOI: 10.57264/cer-2023-0178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/15/2024] [Indexed: 04/23/2024] Open
Abstract
Since late 2020, the Canadian Agency of Drugs and Technologies in Health (CADTH) has been using a threshold of $50,000 (CAD) per quality-adjusted life-year (QALY) for both oncology and non-oncology drugs. When used for oncology products, this threshold is hypothesized to have a higher impact on the time to access these drugs in Canada. We studied the impact of price reductions on time to engagement and negotiation with the pan-Canadian Pharmaceutical Alliance for oncology drugs reviewed by CADTH between January 2020 and December 2022. Overall, 103 assessments reported data on price reductions recommended by CADTH to meet the cost-effectiveness threshold for reimbursement. Of these assessments, 57% (59/103) recommendations included a price reduction of greater than 70% off the list price. Eight percent (8/103) were not cost-effective even at a 100% price reduction. Of the 47 assessments that had a clear benefit, in 21 (45%) CADTH recommended a price reduction of at least 70%. The median time to price negotiation (not including time to engagement) for assessments that received at least 70% vs >70% price reduction was 2.6 vs 4.8 months. This study showed that there is a divergence between drug sponsor's incremental cost-effectiveness ratio (ICER) and CADTH revised ICER leading to a price reduction to meet the $50,000/QALY threshold. For the submissions with clear clinical benefit the median length of engagement (2.5 vs 3.3 months) and median length of negotiation (3.1 vs 3.6 months) were slightly shorter compared with the submissions where uncertainties were noted in the clinical benefit according to CADTH. This study shows that using a $50,000 per QALY threshold for oncology products potentially impacts timely access to life saving medications.
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Affiliation(s)
| | | | - Juhi Joshy
- Pharmalytics Group, Vancouver, BC V6B 2Z4, Canada
| | - Nigel SB Rawson
- Canadian Health Policy Institute, Toronto, ON, Canada
- Macdonald-Laurier Institute, Ottawa, ON, Canada
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60
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Kameda-Smith MM, Ragulojan M, Elliott C, Bliss L, Moore H, Sader N, Alsuwaihel M, Tso MK, Dakson A, Ajani O, Yarascavitch B, Fleming A, Mehta V, Aminnejad M, Farrokhyar F, Singh SK. National multicentered retrospective review of clinical and intraoperative factors associated with the development of cerebellar mutism after pediatric posterior fossa tumor resection. Childs Nerv Syst 2024; 40:1339-1347. [PMID: 38279985 DOI: 10.1007/s00381-024-06292-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/14/2024] [Indexed: 01/29/2024]
Abstract
BACKGROUND Cerebellar mutism (CM) is characterized by a significant loss of speech in children following posterior fossa (PF) surgery. The biological origin of CM remains unclear and is the subject of ongoing debate. Significant recovery from CM is less likely than previously described despite rigorous multidisciplinary neuro-rehabilitational efforts. METHODS A national multi-centered retrospective review of all children undergoing PF resection in four midsized Canadian academic pediatric institutions was undertaken. Patient, tumor and surgical factors associated with the post-operative development of CM were reviewed. Retrospective identification of PF surgery patients including those developing and those that did not (internal control). RESULTS The study identified 258 patients across the 4 centers between 2010 and 2020 (mean age 6.73 years; 42.2% female). Overall, CM was experienced in 19.5% of patients (N = 50). Amongst children who developed CM histopathology included medulloblastoma (35.7%), pilocytic astrocytoma (32.6%) and ependymoma (17.1%). Intraoperative impression of adherence to the floor of the 4th ventricle was positive in 36.8%. Intraoperative abrupt changes in blood pressure and/or heart rate were identified in 19.4% and 17.8% of cases. The clinical resolution of CM was rated to be complete, significant resolution, slight improvement, no improvement and deterioration in 56.0%, 8.0%, 20.0%, 14.0% and 2.0%, respectively. In the cohort of children who experienced post-operative CM as compared to their no-CM counterpart, proportionally more tumors were felt to be adherent to the floor of the 4th ventricle (56.0% vs 49.5%), intraoperative extent of resection was a GTR (74% vs 68.8%) and changes in heart rate were noted (≥ 20% from baseline) (26.0% vs 15.9%). However, a multiple regression analysis identified only abrupt changes in HR (OR 5.97, CI (1.53, 23.1), p = 0.01) to be significantly associated with the development of post-operative CM. CONCLUSION As a devastating surgical complication after posterior fossa tumor surgery with variable clinical course, identifying and understanding the operative cues and revising intraoperative plans that optimizes the child's neurooncological and clinical outcome are essential.
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Affiliation(s)
- Michelle M Kameda-Smith
- Division of Neurosurgery, McMaster University, Hamilton, ON, Canada.
- Great Ormond Street Hospital for Children, London, England.
- Canadian Neurosurgery Research Collaborative (CNRC), Hamilton, Canada.
- McMaster Pediatric Brain Tumor Study Group (PBTSG), Hamilton, ON, Canada.
| | - Malavan Ragulojan
- McMaster Pediatric Brain Tumor Study Group (PBTSG), Hamilton, ON, Canada
| | - Cameron Elliott
- Canadian Neurosurgery Research Collaborative (CNRC), Hamilton, Canada
- Division of Neurosurgery, University of Alberta, Edmonton, AB, Canada
| | - Lori Bliss
- Division of Neurosurgery, University of Alberta, Edmonton, AB, Canada
| | - Hanna Moore
- Division of Neurosurgery, University of Alberta, Edmonton, AB, Canada
| | - Nicholas Sader
- Division of Neurosurgery, University of Calgary, Calgary, AB, Canada
| | | | - Michael K Tso
- Canadian Neurosurgery Research Collaborative (CNRC), Hamilton, Canada
- Division of Neurosurgery, University of Calgary, Calgary, AB, Canada
| | - Ayoub Dakson
- Canadian Neurosurgery Research Collaborative (CNRC), Hamilton, Canada
- Division of Neurosurgery, Dalhousie University, Halifax, NS, Canada
| | - Olufemi Ajani
- Great Ormond Street Hospital for Children, London, England
- McMaster Pediatric Brain Tumor Study Group (PBTSG), Hamilton, ON, Canada
| | - Blake Yarascavitch
- Division of Neurosurgery, McMaster University, Hamilton, ON, Canada
- McMaster Pediatric Brain Tumor Study Group (PBTSG), Hamilton, ON, Canada
| | - Adam Fleming
- McMaster Pediatric Brain Tumor Study Group (PBTSG), Hamilton, ON, Canada
| | - Vivek Mehta
- Division of Neurosurgery, University of Alberta, Edmonton, AB, Canada
| | - Minoo Aminnejad
- McMaster Pediatric Brain Tumor Study Group (PBTSG), Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Forough Farrokhyar
- Division of Neurosurgery, McMaster University, Hamilton, ON, Canada
- McMaster Pediatric Brain Tumor Study Group (PBTSG), Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Sheila K Singh
- Division of Neurosurgery, McMaster University, Hamilton, ON, Canada
- McMaster Pediatric Brain Tumor Study Group (PBTSG), Hamilton, ON, Canada
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Beland Lindahl K, Wilson GN, Allard C, Poelzer G. To Approve or not to Approve? A Comparative Analysis of State-Company-Indigenous Community Interactions in Mining in Canada and Sweden. Environ Manage 2024; 73:946-961. [PMID: 38446188 PMCID: PMC11023974 DOI: 10.1007/s00267-024-01949-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 02/01/2024] [Indexed: 03/07/2024]
Abstract
This Special Section explores the interplay between Indigenous peoples, industry, and the state in five proposed and active mining projects in Canada and Sweden. The overall aim is to identify factors shaping the quality of Indigenous community-industry-state interactions in mining and mine development. An ambition underlying the research is to develop knowledge to help manage mining related land-use conflicts in Sweden by drawing on Canadian comparisons and experience. This paper synthesizes the comparative research that has been conducted across jurisdictions in three Canadian provinces and Sweden. It focuses on the interplay between the properties of the governance system, the quality of interaction and governance outcomes. We combine institutional and interactive governance theory and use the concept of governability to assess how and why specific outcomes, such as mutually beneficial interaction, collaboration, or opposition, occurred. The analysis suggests there are measures that can be taken by the Swedish Government to improve the governability of mining related issues, by developing alternative, and more effective, avenues to recognize, and protect, Sámi rights and culture, to broaden the scope and increase the legitimacy and transparency of the EIAs, to raise the quality of interaction and consultation, and to develop tools to actively stimulate and support collaboration and partnerships on equal terms. Generally, we argue that Indigenous community responses to mining must be understood within a larger framework of Indigenous self-determination, in particular the communities' own assessments of their opportunities to achieve their long-term objectives using alternative governing modes and types of interactions.
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Affiliation(s)
- Karin Beland Lindahl
- Political Science, Division of Social Sciences, Luleå University of Technology, Luleå, Sweden.
- Ájtte - the Swedish Mountain and Sámi Museum, Jokkmokk, Sweden.
| | - Gary N Wilson
- Department of Political Science, University of Northern British Columbia, Prince George, BC, Canada
| | - Christina Allard
- Law, Division of Social Sciences, Luleå University of Technology, Luleå, Sweden
| | - Greg Poelzer
- School of Environment and Sustainability, University of Saskatchewan, Saskatoon, SK, Canada
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Patel V, Carey N, Briatico D, VanHouwelingen L. Management of Pediatric Patients With Spontaneous Pneumomediastinum: A Retrospective Chart Review. J Pediatr Surg 2024; 59:930-934. [PMID: 38519387 DOI: 10.1016/j.jpedsurg.2024.01.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 01/22/2024] [Indexed: 03/24/2024]
Abstract
PURPOSE Given the paucity of data on pediatric spontaneous pneumomediastinum (SPM), management is largely informed by extrapolation from adult studies or personal clinical experience, resulting in significant heterogeneity. The purpose of this study was to describe how pediatric patients with SPM are clinically managed at our institution and propose a treatment algorithm. METHODS Retrospective chart review of pediatric patients with SPM from April 2002 to December 2021 at a single Canadian tertiary care center. Data on medical history, presentation characteristics, clinical management, and complications were gathered. Descriptive and inferential statistics were used to analyze data. RESULTS We identified 63 patients for inclusion, median age was 15 years. Twenty-nine patients were transferred from another facility. Most common presenting symptoms were chest pain (72.3%), shortness of breath (44.6%), and subcutaneous emphysema (21.5%). Initial workup included chest x-ray (93.6%), CT scan (20.6%), and upper GI series (7.9%). There was no difference in the number of initial tests between admitted and discharged patients (p = 0.10). Of admitted patients (n = 35), 31.4% had primary SPM (no underlying comorbidity/inciting event) and 68.8% were secondary SPM (underlying comorbidity/inciting event). No patients with primary SPM developed complications or recurrences. In contrast, 16.7% of those with secondary SPM developed complications and 54.2% had at least one additional intervention after admission. DISCUSSION There is significant variability in diagnostic investigation and treatment of pediatric SPM at our center. Amongst primary SPM, additional tests did not change complication rate or recurrence, including those transferred from another facility. An expeditious treatment algorithm is warranted. TYPE OF STUDY Retrospective Cohort Study. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Vivek Patel
- McMaster Pediatric Surgery Research Collaborative, McMaster University, Hamilton, Ontario, Canada; Division of Pediatric Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
| | - Nathalie Carey
- McMaster Pediatric Surgery Research Collaborative, McMaster University, Hamilton, Ontario, Canada; Division of Pediatric Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Daniel Briatico
- McMaster Pediatric Surgery Research Collaborative, McMaster University, Hamilton, Ontario, Canada; Division of Pediatric Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Lisa VanHouwelingen
- McMaster Pediatric Surgery Research Collaborative, McMaster University, Hamilton, Ontario, Canada; Division of Pediatric Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada; McMaster Children's Hospital, Hamilton, Ontario, Canada
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63
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Botelho F, Gerk A, Harley JM, Poenaru D. Improving Pediatric Trauma Education by Teaching Non-technical Skills: A Randomized Controlled Trial. J Pediatr Surg 2024; 59:874-888. [PMID: 38369400 DOI: 10.1016/j.jpedsurg.2024.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 01/16/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Pediatric trauma is a significant cause of child mortality, and the absence of non-technical skills (NTS) among health providers is linked with errors in patients' care. In this study, we evaluate the effectiveness of a structured debriefing protocol in enhancing NTS during pediatric trauma simulation. METHODS A total of 45 medical students were successfully recruited from two medical schools, one in Brazil and one in Canada. Medical students were assigned to a control (N = 20) or intervention group (N = 25) in a randomized control trial. Following simulated scenarios, participants in the intervention group underwent NTS debriefing, while the control received standard debriefing based on the Advanced Trauma Life Support (ATLS) protocol. Students' confidence, NTS level, and performance were measured through self-assessment surveys, the Non-Technical Skills for Surgeons (NOTSS) score, and adherence to the trauma protocol, respectively. Baseline characteristics and outcomes were compared using t-tests, Mann-Whitney, Wilcoxon signed-rank Kruskal-Wallis, ANOVA, and a repeated-measures ANCOVA. A significance level was set at p < 0.05. RESULTS The workshop increased students' confidence in leading trauma resuscitation regardless of their assignment to condition. While controlling for covariates, students in the intervention group significantly improved their overall NOTSS compared to those in the control and in all categories: situational awareness, decision-making, communication and teamwork, and leadership. The intervention teams also demonstrated a significant increase in completing trauma protocol steps. CONCLUSION Implementing structured debriefing focusing on NTS enhanced these skills and improved adherence to protocol among medical students managing pediatric trauma-simulated scenarios. These findings support integrating NTS training in pediatric trauma education. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Fabio Botelho
- Department of Surgery, McGill University, Montreal General Hospital, Montreal, Canada; Harvey E. Beardmore Division of Pediatric Surgery, Montreal Children's Hospital, Montreal, Canada.
| | - Ayla Gerk
- Department of Surgery, McGill University, Montreal General Hospital, Montreal, Canada
| | - Jason M Harley
- Department of Surgery, McGill University, Montreal General Hospital, Montreal, Canada; Steinberg Centre for Simulation and Interactive Learning, McGill University, Montreal, Canada; Institute of Health Sciences Education, McGill University, Montreal, Canada; Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Dan Poenaru
- Department of Surgery, McGill University, Montreal General Hospital, Montreal, Canada; Harvey E. Beardmore Division of Pediatric Surgery, Montreal Children's Hospital, Montreal, Canada; Institute of Health Sciences Education, McGill University, Montreal, Canada; Research Institute of the McGill University Health Centre, Montreal, Canada
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Brown CJM, Noble BF, Munkittrick KR. Examination of recent hydroelectric dam projects in Canada for alignment of baseline studies, predictive modeling, and postdevelopment monitoring phases of aquatic environmental impact assessments. Integr Environ Assess Manag 2024; 20:616-644. [PMID: 37526129 DOI: 10.1002/ieam.4823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/14/2023] [Accepted: 07/31/2023] [Indexed: 08/02/2023]
Abstract
Environmental impact assessment (EIA) has been widely criticized by the aquatic science community for poorly aligned approaches when selecting endpoints and collecting data during the baseline, predictive modeling, and postdevelopment monitoring phases. If these critical phases of the EIA process are not aligned properly, it can be difficult to evaluate the presence of postdevelopment effects. Examples of the misalignment of these phases include baseline studies failing to measure indicators that are monitored postdevelopment; predictive assessments that do not quantitatively predict conditions or potential impacts postdevelopment; and the failure to identify relevant indicators that may detect effects postdevelopment. For aquatic assessments, understanding how to protect critical ecosystem attributes to satisfy regulatory concerns could help to better align aquatic science monitoring activities across EIA phases. In this article we investigate recent Canadian hydroelectric dam EIAs to evaluate how well recent assessment approaches are meeting these necessary conditions of good aquatic EIA practice through the lens of ecosystem services from a fish's perspective. We found that larger facilities generally had baseline studies and modeling that better supported postdevelopment monitoring, but improvements in structure, linkages, and expectations would better align EIA phases in a manner that would improve assessments and environmental protection. Integr Environ Assess Manag 2024;20:616-644. © 2023 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals LLC on behalf of Society of Environmental Toxicology & Chemistry (SETAC).
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Affiliation(s)
- Carolyn J M Brown
- Department of Biology, Wilfrid Laurier University, Waterloo, Ontario, Canada
- Canadian Rivers Institute, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Bram F Noble
- Department of Geography and Planning, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Kelly R Munkittrick
- Canadian Rivers Institute, University of New Brunswick, Fredericton, New Brunswick, Canada
- Department of Biological Sciences, University of Calgary, Calgary, Alberta, Canada
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Ivanitskaya LV, Bogner MP. Culture Change in Older Adult Care Settings: A Bibliometric Review. Gerontologist 2024; 64:gnad128. [PMID: 37740248 DOI: 10.1093/geront/gnad128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Indexed: 09/24/2023] Open
Abstract
BACKGROUND AND OBJECTIVES We systematically analyzed research on the culture change movement, in the context of global efforts to transform the provision of older adult care in institutional settings. RESEARCH DESIGN AND METHODS Using Web of Science and Scopus publications relevant to person-centered care, culture change, or older adult care settings, we built bibliometric networks for keywords and terms extracted from titles and abstracts. Overlays depicted corresponding authors' countries, publication recency, funding, scientific impact, and concept use. RESULTS The keyword network for 337 publications revealed variability in culture change settings and study indexing. Term network overlays showed geographical and chronological research variation. Corresponding authors from 14 countries contributed publications, mostly from the United States (69% of publications), Canada (9%), and Australia (5%). Social environment and person-centeredness studies, particularly in dementia care settings, were more recent than studies on physical environment, quality, organizational culture, turnover, and staffing. Scholars listed funding sources for 38% of publications; funding and scientific impact did not always overlap. Well-cited studies on standards of care and policy were funded at a lower rate than topics of lower impact. Over 60% of titles, abstracts, or keywords referred to quality and person-centeredness. DISCUSSION AND IMPLICATIONS Originating in the 1990s in the United States, culture change quickly became an international phenomenon, drawing researchers' attention. Change research has deep roots in quality improvement and person-centered philosophy. We offered practical strategies for querying this hard to access literature. With some database-related limitations, empirical data on scientific impact can be used to allocate research funding.
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Affiliation(s)
- Lana V Ivanitskaya
- School of Health Sciences, Central Michigan University, Mount Pleasant, Michigan, USA
| | - Matthew P Bogner
- Department of Public Health Sciences, Wichita State University, Wichita, Kansas, USA
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Sinyor M, Ekstein D, Prabaharan N, Fiksenbaum L, Vandermeer C, Schaffer A, Pirkis J, Heisel MJ, Goldstein BI, Redelmeier DA, Taylor P, Niederkrotenthaler T. Changes in Media Reporting Quality and Suicides Following National Media Engagement on Responsible Reporting of Suicide in Canada: Changements de la Qualité des reportages dans les médias sur les suicides suite à l'engagement des médias nationaux à la déclaration responsable du suicide au Canada. Can J Psychiatry 2024; 69:358-368. [PMID: 38174363 PMCID: PMC11032096 DOI: 10.1177/07067437231223334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
OBJECTIVE Responsible media reporting is an accepted strategy for preventing suicide. In 2015, suicide prevention experts launched a media engagement initiative aimed at improving suicide-related reporting in Canada; its impact on media reporting quality and suicide deaths is unknown. METHOD This pre-post observational study examined changes in reporting characteristics in a random sample of suicide-related articles from major publications in the Greater Toronto Area (GTA) media market. Articles (n = 900) included 450 from the 6-year periods prior to and after the initiative began. We also examined changes in suicide counts in the GTA between these epochs. We used chi-square tests to analyse changes in reporting characteristics and time-series analyses to identify changes in suicide counts. Secondary outcomes focused on guidelines developed by media professionals in Canada and how they may have influenced media reporting quality as well as on the overarching narrative of media articles during the most recent years of available data. RESULTS Across-the-board improvement was observed in suicide-related reporting with substantial reductions in many elements of putatively harmful content and substantial increases in all aspects of putatively protective content. However, overarching article narratives remained potentially harmful with 55.2% of articles telling the story of someone's death and 20.8% presenting an other negative message. Only 3.6% of articles told a story of survival. After controlling for potential confounders, a nonsignificant numeric decrease in suicide counts was identified after initiative implementation (ω = -5.41, SE = 3.43, t = 1.58, p = 0.12). CONCLUSIONS We found evidence that a strategy to engage media in Canada changed the content of reporting, but there was only a nonsignificant trend towards fewer suicides. A more fundamental change in media narratives to focus on survival rather than death appears warranted.
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Affiliation(s)
- Mark Sinyor
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Daniella Ekstein
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Nivetha Prabaharan
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | | | - Caroline Vandermeer
- Viterbi School of Engineering, University of Southern California, Los Angeles, USA
| | - Ayal Schaffer
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Marnin J. Heisel
- Department of Psychiatry, The University of Western Ontario, London, Canada
| | - Benjamin I. Goldstein
- Department of Psychiatry, University of Toronto, Toronto, Canada
- Centre for Youth Bipolar Disorder, Center for Addiction and Mental Health, Toronto, Canada
| | - Donald A. Redelmeier
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Paul Taylor
- Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Thomas Niederkrotenthaler
- Unit Suicide Research and Mental Health Promotion, Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Vienna, Austria
- Wiener Werkstaette for Suicide Research, Vienna, Austria
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Petrie S, Cheng I, McMahon M, Lavis JN. Future leaders in a learning health system: Exploring the Health System Impact Fellowship. Healthc Manage Forum 2024; 37:151-155. [PMID: 38016119 PMCID: PMC11044521 DOI: 10.1177/08404704231216951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
The Canadian health system is reeling following the COVID-19 pandemic. Strains have become growing cracks, with long emergency department wait times, shortage of human health resources, and growing dissatisfaction from both clinicians and patients. To address long-needed health system reform in Canada, a modernization of training is required for the next generation health leaders. The Canadian Institutes of Health Research Health System Impact Fellowship (HSIF) is an example of a well-funded and connected training program which prioritizes embedded research and embedding technically trained scholars with health system partners. The program has been successful in the scope and impact of its training outcomes as well as providing health system partners with a pool of connected and capable scholars. Looking forward, integrating aspects of evidence synthesis from both domestic and international sources and adapting a general contractor approach to implementation within the HSIF could help catalyze learning health system reform in Canada.
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Affiliation(s)
- Samuel Petrie
- University Health Network, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Ivy Cheng
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Meghan McMahon
- University of Toronto, Toronto, Ontario, Canada
- CIHR Institute of Health Services and Policy Research, Ottawa, Ontario, Canada
| | - John N. Lavis
- McMaster University, Hamilton, Ontario, Canada
- McMaster Health Forum, Hamilton, Ontario, Canada
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68
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Defriend C, Cook CM. Reawakening of Indigenous matriarchal systems: A feminist approach to organizational leadership. Healthc Manage Forum 2024; 37:160-163. [PMID: 37950639 PMCID: PMC11044517 DOI: 10.1177/08404704231210255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2023]
Abstract
Leadership models that uphold feminist qualities of mutuality, collaboration, and distribution of power can foster organizational and community success. Utilizing a systems perspective grounded in land-based analogies can assist with understanding the diversity and strength that come from entire ecosystems around wicked social issues. While Indigenous leadership models have supported such perspectives since time immemorial, current and ongoing acts of colonialism driven by patriarchal systems and violent gender-based policies and procedures have eroded matriarchal leadership models that sustained what is now known as Canada for generations. Reflections of two evolving Indigenous women in leadership note the opportunities to reawaken matriarchal values in organizational and community leadership as a powerful act of reconciliation.
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Affiliation(s)
| | - Celeta M. Cook
- University of Victoria, Victoria, British Columbia, Canada
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Vakil E, Dumoulin E, Stollery D, Gillson AM, MacEachern P, Dhaliwal I, Mitchell M, Li P, Schieman C, Romatowski N, Chee AC, Tyan CC, Fortin M, Hergott CA, Tremblay A. Molecular analysis of endobronchial ultrasound needle aspirates in patients with non-small cell lung cancer: Results from the SCOPE database. Cytopathology 2024; 35:378-382. [PMID: 38349229 DOI: 10.1111/cyt.13367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/12/2024] [Accepted: 02/02/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVE Molecular subtyping of non-small cell lung cancer (NSCLC) is critical in the diagnostic evaluation of patients with advanced disease. This study aimed to examine whether samples from endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) of intrathoracic lymph nodes and/or lung lesions are adequate for molecular analysis across various institutions. METHODS We retrospectively reviewed all cases of linear EBUS-TBNA with a final bronchoscopic diagnosis of NSCLC entered in the Stather Canadian Outcomes registry for chest ProcEdures database. The primary outcome was specimen inadequacy rate for each molecular target, as defined by the local laboratory or pathologist. RESULTS A total of 866 EBUS-TBNA procedures for NSCLC were identified. Specimen inadequacy rates were 3.8% for EGFR, 2.5% for ALK-1 and 3.5% for PD-L1. Largest target size was not different between adequate and inadequate specimens, and rapid onsite evaluation did not increase specimen adequacy rates. One centre using next-generation sequencing for EGFR had lower adequacy rates than 2 others using matrix-assisted laser desorption/ionization time-of-flight mass spectrophotometry. CONCLUSION EBUS-TBNA specimens have a very low-specimen inadequacy rate for molecular subtyping of non-small cell lung cancer.
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Affiliation(s)
- Erik Vakil
- Division of Respirology, University of Calgary, Calgary, Alberta, Canada
| | - Elaine Dumoulin
- Division of Respirology, University of Calgary, Calgary, Alberta, Canada
| | - Daniel Stollery
- Division of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Ashley-Mae Gillson
- Division of Pulmonary Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Paul MacEachern
- Division of Respirology, University of Calgary, Calgary, Alberta, Canada
| | | | - Michael Mitchell
- Division of Respirology, Western University, London, Ontario, Canada
| | - Pen Li
- Division of Pulmonary Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Colin Schieman
- Section of Thoracic Surgery, University of Calgary, Calgary, Alberta, Canada
| | | | - Alex C Chee
- Division of Respirology, Alberta Health Services, Calgary, Alberta, Canada
| | - Chung Chun Tyan
- Division of Respirology, Critical Care and Sleep Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Marc Fortin
- Department of Medicine, Université Laval, Quebec City, Quebec, Canada
| | | | - Alain Tremblay
- Division of Respirology, University of Calgary, Calgary, Alberta, Canada
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Tetzlaff EJ, Cassan C, Goulet N, Gorman M, Hogya B, Kenny GP. "Breaking down in tears, soaked in sweat, and sick from the heat": Media-based composite narratives of first responders working during the 2021 Heat Dome. Am J Ind Med 2024; 67:442-452. [PMID: 38460501 DOI: 10.1002/ajim.23576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 01/15/2024] [Accepted: 02/19/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND During the summer of 2021, a deadly, unprecedented multiday Heat Dome engulfed western Canada. As a result of this extreme heat event (EHE), emergency dispatchers received an unparalleled increase in incoming 911 calls for ambulance, police, and fire (as first responders) services to attend to hundreds of heat-vulnerable community members succumbing to the heat. With 103 all-time heat records broken during this EHE and indoor temperatures of nearly 40°C, the first responders attending these calls faced extensive job demands and highly challenging operating conditions. Initial investigations have explored the health system-level impacts; however, little has been done to explore the impact on the first responders themselves. Therefore, this study aimed to improve our understanding of EHEs' impacts on the operational capabilities and health of first responders, specifically police, fire, ambulance, and dispatch services. METHODS A systematized review and content analysis of media articles published on the 2021 Heat Dome in Canada was conducted (n = 2909), and four media-based composite narratives were developed highlighting police, fire, ambulance, and dispatch services. The Job Demands-Resources (JD-R) model was applied as a theoretical framework for occupational burnout. RESULTS The media-based composite narratives highlighted that first responders faced record-breaking call volumes, increased mental-health-related claims, and exhaustive heat-related physiological stress. Using the JD-R model as a theoretical framework for occupational burnout, we identified three measures of stressful job demand: work overload (e.g., the surge in call volume, firefighters responding to medical emergencies), emotional demands (e.g., severe medical emergencies, sudden deaths, unresponsive patients, distraught family members), and physical demands (e.g., resuscitation in personal protective equipment, heat-related illness). CONCLUSION The experiences described underscore the importance of supporting first responders during work in extreme heat conditions. These findings have important implications for addressing rising rates of burnout during and following public health crises, such as EHEs, a problem that is increasingly being recognized as a threat to the Canadian public healthcare system.
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Affiliation(s)
- Emily J Tetzlaff
- Human and Environmental Physiology Research Unit, School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Heat Division, Climate Change and Innovation Bureau, Healthy Environments and Consumer Safety Branch, Safe Environments Directorate, Health Canada, Ottawa, Ontario, Canada
| | - Casey Cassan
- Human and Environmental Physiology Research Unit, School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Nicholas Goulet
- Human and Environmental Physiology Research Unit, School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Heat Division, Climate Change and Innovation Bureau, Healthy Environments and Consumer Safety Branch, Safe Environments Directorate, Health Canada, Ottawa, Ontario, Canada
| | - Melissa Gorman
- Heat Division, Climate Change and Innovation Bureau, Healthy Environments and Consumer Safety Branch, Safe Environments Directorate, Health Canada, Ottawa, Ontario, Canada
| | - Brooks Hogya
- BC Emergency Health Services, Provincial Health Services Authority, Vancouver, British Columbia, Canada
| | - Glen P Kenny
- Human and Environmental Physiology Research Unit, School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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Duffy RT, Larsen K, Bélanger M, Brussoni M, Faulkner G, Gunnell K, Tremblay MS, Larouche R. Children's Independent Mobility, School Travel, and the Surrounding Neighborhood. Am J Prev Med 2024; 66:819-831. [PMID: 38081375 DOI: 10.1016/j.amepre.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 12/05/2023] [Accepted: 12/05/2023] [Indexed: 01/15/2024]
Abstract
INTRODUCTION Children's active travel to and from school (AST) and children's independent mobility (CIM) are consistently positively associated with physical activity (PA); however, few researchers have investigated associations between objective measures of the environment and indicators of AST and CIM in national samples. METHODS A national sample of 2,067 Canadian parents of 7- to 12-year-old children was recruited in December 2020. Regression analyses were used in 2023 to assess the association between geographic information system measures of park density, blue space, population density, greenspace, intersection density, and CIM and AST to and from school. RESULTS Children in areas with high versus low park density (>0.025 vs. ≤0.025) had higher odds of travel to school via active modes (OR: 1.47 [1.14, 1.91], p=0.003). Children in neighborhoods in the highest quartile for neighborhood greenspace (Normalized Difference Vegetation Index) were more likely to travel to home actively than those in areas of lower greenspace (OR: 1.70 [1.18, 2.45], p=0.004). On average, children living in areas in the highest versus the lowest quartile for intersection density were more likely to engage in AST to (OR: 2.43 [1.58, 3.75], p<0.001) and from (OR: 2.77 [1.80, 4.29], p<0.001) school. CONCLUSIONS The observed associations underscore a need for city planners and policymakers to ensure sufficient access to parks and neighborhood greenspace, especially if findings are confirmed in longitudinal studies. More research is needed to investigate the role of intersection density in supporting AST and CIM.
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Affiliation(s)
- Robert T Duffy
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; Department of Geography and Environmental Studies, Toronto Metropolitan University, Toronto, ON, Canada
| | - Kristian Larsen
- Department of Geography and Environmental Studies, Toronto Metropolitan University, Toronto, ON, Canada; Health Canada, Office of Environmental Health, Healthy Environments and Consumer Safety Branch, Environmental and Radiation Health Science Directorate, Ottawa, ON, Canada; Department of Geography and Planning, University of Toronto, Toronto, ON, Canada; Department of Public Health Sciences, Queen's University, Kingston, ON, Canada; CAREX Canada, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
| | - Mathieu Bélanger
- Faculté de Médecine et des Sciences de La Santé, Université de Sherbrooke, Sherbrooke, Canada
| | - Mariana Brussoni
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada; Human Early Learning Partnership, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Guy Faulkner
- School of Kinesiology, University of British Columbia, Vancouver, BC, Canada
| | - Katie Gunnell
- Department of Psychology, Carleton University, Ottawa, ON, Canada
| | - Mark S Tremblay
- Healthy Active Living and Obesity Research Group, CHEO Research Institute, Ottawa, ON, Canada; Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada; Department of Health Sciences, Carleton University, Ottawa, ON, Canada
| | - Richard Larouche
- Faculty of Health Sciences, University of Lethbridge, Lethbridge AB, Canada
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72
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Beres AL. The 54th Annual Meeting of the Canadian Association of Pediatric Surgeons. J Pediatr Surg 2024; 59:751. [PMID: 38383178 DOI: 10.1016/j.jpedsurg.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 01/23/2024] [Indexed: 02/23/2024]
Affiliation(s)
- Alana L Beres
- St. Christopher's Hospital for Children, Drexel University School of Medicine, 150 East Erie Avenue, Philadelphia, PA 19134, USA.
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73
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Duignan L, Dutton DJ. The association between allostatic load and guaranteed annual income using the Canadian Longitudinal Study on Aging: A cross-sectional analysis of the benefits of guaranteed public pensions. Health Policy 2024; 143:105054. [PMID: 38522246 DOI: 10.1016/j.healthpol.2024.105054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 03/18/2024] [Accepted: 03/19/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Old Age Security (OAS) represents an public policy through which income-related inequalities in health may be improved. The goal of this cross-sectional study was to investigate the health benefits of receiving OAS in financially insecure older Canadians. METHODS Using data from the Canadian Longitudinal Study on Aging (CLSA) (n=15,691), ordered logistic regression was used to measure associations between financial insecurity and allostatic load. RESULTS Receiving OAS as highest personal income source appeared to remove the health penalty of being financially insecure. While financial insecurity was associated with worse allostatic load in both males and females not receiving OAS, those receiving OAS as highest personal income source had better allostatic load compared to other financially insecure older adults (ORM: 0.398, 95 % CI: 0.227, 0.696; ORF: 0.677, 95 % CI: 0.483, 0.949). DISCUSSION While longitudinal data would be needed to draw causal inferences, these results suggest OAS may play a role improving health outcomes and narrowing income-related health inequalities. Such findings may have important implications on older adults, other vulnerable populations, and future directions of Canadian health and public policy.
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Affiliation(s)
- Luke Duignan
- Faculty of Medicine, Dalhousie University, 5790 University Ave, Halifax, NS B3H 1V7, Canada.
| | - Daniel J Dutton
- Department of Community Health and Epidemiology, Dalhousie University, Canada
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74
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Xie F, Xie S, Pullenayegum E, Ohinmaa A. Understanding Canadian stakeholders' views on measuring and valuing health for children and adolescents: a qualitative study. Qual Life Res 2024; 33:1415-1422. [PMID: 38438665 DOI: 10.1007/s11136-024-03618-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2024] [Indexed: 03/06/2024]
Abstract
OBJECTIVE Valuing child health is critical to assessing the value of healthcare interventions for children. However, there remain important methodological and normative issues. This qualitative study aimed to understand the views of Canadian stakeholders on these issues. METHODS Stakeholders from health technology assessment (HTA) agencies, pharmaceutical industry representatives, healthcare providers, and academic researchers/scholars were invited to attend an online interview. Semi-structured interviews were designed to focus on: (1) comparing the 3-level and 5-level versions of the EQ-5D-Y; (2) source of preferences for valuation (adults vs. children); (3) perspective of valuation tasks; and (4) methods for valuation (discrete choice experiment [DCE] and its variants versus time trade-off [TTO]). Participants were probed to consider HTA guidelines, cognitive capacity, and potential ethical concerns. All interviews were recorded and transcribed verbatim. Framework analysis with the incidence density method was used to analyze the data. RESULTS Fifteen interviews were conducted between May and September 2022. 66.7% (N = 10) of participants had experience with economic evaluations, and 86.7% (N = 13) were parents. Eleven participants preferred the EQ-5D-Y-5L. 12 participants suggested that adolescents should be directly involved in child health valuation from their own perspective. The participants were split on the ethical concerns. Eight participants did not think that there was ethical concern. 11 participants preferred DCE to TTO. Among the DCE variants, 6 participants preferred the DCE with duration to the DCE with death. CONCLUSIONS Most Canadian stakeholders supported eliciting the preferences of adolescents directly from their own perspective for child health valuation. DCE was preferred if adolescents are directly involved.
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Affiliation(s)
- Feng Xie
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Canada.
| | - Shitong Xie
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
| | - Eleanor Pullenayegum
- The Hospital for Sick Children, Toronto, Canada
- Dalla Lana School of Public Health, The University of Toronto, Toronto, Canada
| | - Arto Ohinmaa
- School of Public Health, University of Alberta, Edmonton, Canada
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75
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Geraci G, Smith R, Hansford A, Johnsson E, Critchley H, Khaled LA, King L, Cheng M, Colin T, Kang TS. Industry Perceptions and Experiences with the Access Consortium New Active Substance Work-Sharing Initiative (NASWSI): Survey Results and Recommendations. Ther Innov Regul Sci 2024; 58:557-566. [PMID: 38459358 PMCID: PMC11043105 DOI: 10.1007/s43441-024-00624-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 01/19/2024] [Indexed: 03/10/2024]
Abstract
The Access Consortium New Active Substance Work-Sharing Initiative, or "Access" for simplicity, allows regulatory authorities (RAs) of the Access Consortium countries to jointly review applications for the registration of new active substances or for new indications. Using a survey developed by the pharmaceutical industry trade associations of the five Access Consortium countries-Australia, Canada, Singapore, Switzerland, and the United Kingdom (UK)-this study gathered insights into the perceptions and experiences of the Access pathway held by affiliates of pharmaceutical companies. Understanding industry perceptions of Access is important for the success of the initiative, as participation is voluntary. Findings indicate that affiliates who participated in Access had mostly positive experiences with this pathway; most affiliates were satisfied with their interactions with the Access RAs and appeared willing to continue to participate in the initiative. Affiliates' reasons for not having yet participated in Access included a lack of opportunity to do so and perceived barriers, such as the Access pathway being too complicated to manage. Recommendations to improve Access cover six key areas: ensure predictability, increase guidance and transparency, streamline processes, maintain flexibility, increase harmonization, and advance RA-industry cooperation. This study should facilitate informed discussions among relevant stakeholders on how to improve Access to maximize efficiencies, accelerate approvals, and improve patient access to innovative medicines.
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Affiliation(s)
- Gaia Geraci
- Clarivate, 70 St. Mary Avenue, London, EC3A 8BE, UK.
| | - Robert Smith
- Association of the British Pharmaceutical Industry (ABPI), Hay's Galleria, 2nd Floor Goldings House, 2 Hay's Lane, London, SE1 2HB, UK
| | - Alison Hansford
- Accumulus Synergy, 1534 Plaza Lane, Suite #210, Burlingame, CA, 94010, USA
| | - Eric Johnsson
- Medicines Australia, 17 Denison Street, Deakin, ACT, 2600, Australia
| | - Helen Critchley
- Medicines Australia, 17 Denison Street, Deakin, ACT, 2600, Australia
| | - Lama Abi Khaled
- Innovative Medicines Canada, 1220-55 Metcalfe St., Ottawa, ON, K1P6L5, Canada
| | - Laura King
- Innovative Medicines Canada, 1220-55 Metcalfe St., Ottawa, ON, K1P6L5, Canada
| | - Michelle Cheng
- Singapore Association of Pharmaceutical Industries (SAPI), 151 Chin Swee Rd., #02-13A/14, Manhattan House, 169876, Singapore
| | - Tanja Colin
- Interpharma, Petersgraben 35, 4051, Basel, Switzerland
| | - Tse Siang Kang
- Singapore Association of Pharmaceutical Industries (SAPI), 151 Chin Swee Rd., #02-13A/14, Manhattan House, 169876, Singapore
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Marjan P, Martyniuk CJ, Arlos MJ, Servos MR, Ruecker NJ, Munkittrick KR. Identifying transcriptomic indicators of tertiary treated municipal effluent in longnose dace (Rhinichthys cataractae) caged under semi-controlled conditions in experimental raceways. Sci Total Environ 2024; 923:171257. [PMID: 38417510 DOI: 10.1016/j.scitotenv.2024.171257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 02/14/2024] [Accepted: 02/23/2024] [Indexed: 03/01/2024]
Abstract
To evaluate effects of tertiary treated wastewater treatment plant effluent (MWWE) on transcriptomic responses in longnose dace (Rhinichthys cataractae; LND) we conducted a semi-controlled study in experimental raceways (Advancing Canadian Water Assets facility) imbedded in the Pine Creek treatment plant (Calgary, AB). LND collected from a reference site in the Bow River (REF) were caged in raceways containing either 5 % Pine Creek effluent (PC) or Bow River water (BR; control) over 28 d. Liver transcriptomes were analyzed in males and females sampled on days 7, 14 and 28 from BR and PC, and compared to REF fish on day 0. Concurrent with the caging, selected environmental substances of concern were analyzed in the BR and PC. Significantly different unigenes (SDUs) in females (vs males) within both BR and PC raceways increased over time and compared to REF fish. Moreover, SDUs in females and males within the same treatment (i.e., BR, PC) showed a temporal increase as well as compared to REF fish. Time was the dominant factor affecting SDUs, whereas sex and treatment had less of an impact on the transcriptome profiling. Gene Set Enrichment Analysis of BR vs PC over time revealed effects on genes involved in growth, metabolism of carbohydrates and lipids, and immune system on day 7; however, by day 28, 80-100 % of the transcripts localized to enriched biomarkers were associated with tissue immune responses in both sexes. Exposure to 5 % effluent had significant effects on female liver somatic index but no effects were observed on other phenotypic health indices in either sex. BR was used as the source of reference water, but analyses showed trace amounts of ESOCs. Analyses did not point towards definitive response patterns that could be used in field-based ecotoxicogenomic studies on the impacts of well-treated MWWE but suggested compromised adaptive immune responses.
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Affiliation(s)
- Patricija Marjan
- University of Calgary, Department of Biological Sciences, 2500 University Dr NW, Calgary, AB T2N 1N4, Canada.
| | - Christopher J Martyniuk
- University of Florida, Department of Physiological Sciences, College of Veterinary Medicine, 2187 Mowry Rd., Gainesville, FL 32611, USA
| | - Maricor J Arlos
- University of Alberta, Civil and Environmental Engineering, 9211-116 Street NW, Edmonton, AB T6G 1H9, Canada
| | - Mark R Servos
- University of Waterloo, Department of Biology, 200 University Ave. W, Waterloo, ON N2L 3G1, Canada
| | - Norma J Ruecker
- The City of Calgary, Water Services, UEP-Water Resources, 2100, Station M, #35B, Calgary, AB T2P 2M5, Canada
| | - Kelly R Munkittrick
- University of Calgary, Department of Biological Sciences, 2500 University Dr NW, Calgary, AB T2N 1N4, Canada
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77
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McGibbon E. Applying critical leadership to advance 2SLGBTQIA+ health equity: A complex adaptive systems approach. Healthc Manage Forum 2024; 37:133-140. [PMID: 37982709 DOI: 10.1177/08404704231210868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
Health inequities are increasing in Canada and across the globe. They pose a substantial threat to the health and well-being of millions of people. Organizational leadership, if it is to effectively contribute to tackling these inequities, must become more systematically infused with competencies that address power and the structural determinants of health. Health equity contexts for 2SLGBTQIA+ (Two Spirit, Lesbian, Gay, Bisexual, Trans, Queer, Intersex, Asexual, and Plus) remain a neglected area of focus in organizational leadership. The goals of this article are to provide: (1) a concise description of critical perspectives and critical leadership studies, (2) describe the urgency of theoretical and applied leadership approaches that more fulsomely integrate critical perspectives, and (3) illustrate an integration of a complex adaptive systems approach to support critical perspectives in advancing health equity for 2SLGBTQIA+ people.
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78
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Emil S, Langer JC, Blair G, Aspirot A, Brisseau G, Hancock BJ. The Canadian Pediatric Surgery Workforce: A 10-year Prospective Assessment. J Pediatr Surg 2024; 59:757-762. [PMID: 38395684 DOI: 10.1016/j.jpedsurg.2024.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 01/18/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND The Canadian Association of Paediatric Surgeons launched a 10-year prospective assessment of the Canadian pediatric surgery workforce and training environment, beginning in 2013. The results of the first 5 years (2013-2017) were previously published. Here, we present the results of the last 5 years (2018-2022), and the cumulative results of the past decade. METHODS With IRB approval, a web-based survey was sent to all pediatric surgery division chiefs in Canada each year (2013-2022). The survey gathered workforce data on pediatric surgery practices, as well as data regarding fellowship graduates from Canadian training programs. RESULTS Complete responses were received from all 18 divisions (100% response rate). Over the decade studied, the number of pediatric surgeons and full-time equivalent positions increased from 73 to 81, and 65 to 82, respectively. Thirty positions were vacated (15 retirement, 6 new Canadian practice, 8 leaving Canada, 1 other), and 38 were filled (20 new Canadian fellowship graduates, 8 Canadian surgeons moving from other sites in Canada, 10 surgeons coming from outside Canada). Seventy-five fellows completed training eligible for North American certification, including 34 Canadians, 31 Americans, and 10 non-North American foreign nationals (9 of whom left North America after training). The proportion of Canadian graduates who desired, but could not find, a Canadian position improved from 44% in the first 5 years to 20% in the second 5 years. CONCLUSIONS The Canadian pediatric surgery workforce has experienced a modest increase over a decade. A mismatch still exists between Canadian pediatric surgery graduates and attending staff positions, but the situation has improved during the last 5 years. TYPE OF STUDY Survey. LEVEL OF EVIDENCE: 5
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Affiliation(s)
- Sherif Emil
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
| | - Jacob C Langer
- Division of Pediatric General and Thoracic Surgery, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Geoffrey Blair
- Division of Pediatric Surgery, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Ann Aspirot
- Division of Pediatric Surgery, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Guy Brisseau
- Division of Pediatric Surgery, Sidra Medicine, Doha, Qatar
| | - B J Hancock
- Division of Pediatric Surgery, Children's Hospital of Winnipeg, Winnipeg, Manitoba, Canada
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Heise H, Hrvatin F, Cran A, Matthews J. Canadian farmers' perceptions of social sustainability in agriculture. PLoS One 2024; 19:e0299100. [PMID: 38669228 DOI: 10.1371/journal.pone.0299100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 02/05/2024] [Indexed: 04/28/2024] Open
Abstract
Sustainable food production is an important part of dietetic education and training; however, the focus in the dietetic sphere is often on the environmental aspect. Understanding the multi-dimensional nature of sustainability can enhance dietetic students' sustainability competences-such as empathy and change of perspective, systems thinking, and critical thinking and analysis-to help them in their future careers and strengthen their position in society as trusted and knowledgeable food and nutrition professionals. Enhancing public understanding of sustainable food production is imperative as populations become more urban, are less connected to agriculture, and have expectations for sustainably grown/raised food, often without knowing current food production practices or the multiple aspects of sustainability that must be in place for farmers to meet those demands. The goal of this research was to understand Canadian farmers' perceptions of environmental, economic, and social aspects of sustainable food production. Employing a descriptive qualitative approach and constant comparative analysis, four food and nutrition researchers analyzed interviews from 52 farmers from across Canada. Participants had to be English-speaking, produce food through farming on land, and own or rent the land on which they farm. Telephone/video interviews revealed five overarching social themes: (1) the importance of community and social capital, (2) public perception and social license to operate, (3) lack of infrastructure, and (4) deep connections to personal lives. The final theme, mental health issues (5), reflected the consequences of the multiple sources of stress that can undermine the social sustainability of farmers, farm communities, and food production. These findings may help various audiences appreciate the multiple dimensions of sustainable food production; reflect on their values, perceptions, and actions with regard to agriculture; and enhance their compassion and empathy for all farmers.
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Affiliation(s)
- Heather Heise
- School of Food and Nutritional Sciences, Brescia University College at Western University, London, Ontario, Canada
| | - Felicia Hrvatin
- School of Food and Nutritional Sciences, Brescia University College at Western University, London, Ontario, Canada
| | - Abbey Cran
- School of Food and Nutritional Sciences, Brescia University College at Western University, London, Ontario, Canada
| | - June Matthews
- School of Food and Nutritional Sciences, Brescia University College at Western University, London, Ontario, Canada
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80
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Hisano M, Ghazoul J, Chen X, Chen HYH. Functional diversity enhances dryland forest productivity under long-term climate change. Sci Adv 2024; 10:eadn4152. [PMID: 38657059 PMCID: PMC11042740 DOI: 10.1126/sciadv.adn4152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 03/20/2024] [Indexed: 04/26/2024]
Abstract
Short-term experimental studies provided evidence that plant diversity increases ecosystem resilience and resistance to drought events, suggesting diversity to serve as a nature-based solution to address climate change. However, it remains unclear whether the effects of diversity are momentary or still hold over the long term in natural forests to ensure that the sustainability of carbon sinks. By analyzing 57 years of inventory data from dryland forests in Canada, we show that productivity of dryland forests decreased at an average rate of 1.3% per decade, in concert with the temporally increasing temperature and decreasing water availability. Increasing functional trait diversity from its minimum (monocultures) to maximum value increased productivity by 13%. Our results demonstrate the potential role of tree functional trait diversity in alleviating climate change impacts on dryland forests. While recognizing that nature-based climate mitigation (e.g., planting trees) can only be partial solutions, their long-term (decadal) efficacy can be improved by enhancing functional trait diversity across the forest community.
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Affiliation(s)
- Masumi Hisano
- Graduate School of Informatics, Kyoto University, Yoshida-honmachi, Sakyo, Kyoto, 606-8501, Japan
- Ecosystem Management, Institute of Terrestrial Ecosystems, Department of Environmental System Science, ETH Zürich, Universitätstrasse 16, 8092 Zürich, Switzerland
- Department of Ecosystem Studies, Graduate School of Agricultural and Life Sciences, The University of Tokyo, 1-1-1 Yayoi, Bunkyo, Tokyo 113-8657, Japan
- Faculty of Natural Resources Management, Lakehead University, 955 Oliver Road, Thunder Bay, ON P7B 5E1, Canada
| | - Jaboury Ghazoul
- Ecosystem Management, Institute of Terrestrial Ecosystems, Department of Environmental System Science, ETH Zürich, Universitätstrasse 16, 8092 Zürich, Switzerland
| | - Xinli Chen
- State Key Laboratory of Subtropical Silviculture, Zhejiang A&F University, Hangzhou 311300, China
| | - Han Y. H. Chen
- Faculty of Natural Resources Management, Lakehead University, 955 Oliver Road, Thunder Bay, ON P7B 5E1, Canada
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Pedersen S, Corcoran L. Transgender and gender diverse curriculum in medical imaging programs: a case study. BMC Med Educ 2024; 24:454. [PMID: 38664692 DOI: 10.1186/s12909-024-05426-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 04/15/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Transgender and gender diverse (TGD) individuals face barriers, including harassment and discrimination, when accessing healthcare services. Medical imaging procedures require personal information to be shared, such as date of last menstrual cycle and/or pregnancy status; some imaging exams are also invasive or intimate in nature. Terminology is based on binary sex creating an inherently cis-heteronormative environment. TGD patients fear being outed and often feel a need to function as educators and advocates for their care. Incorporation of inclusive healthcare curriculum related to TGD populations is an effective means of educating new health providers and promotes safer and more inclusive spaces in healthcare settings. Educators face barriers which hinder the creation and implementation of TGD content. The purpose of this study was to examine the impacts educators are faced with when creating and delivering TGD content in their medical imaging curriculum. METHODS A case study of medical imaging programs at a Canadian post-secondary institute was undertaken. Data was collected via semi-structured interviews with faculty. Relevant institutional documents such as strategic plans, policies/procedures, websites, and competency profiles were accessed. Framework analysis was used to analyze the data. RESULTS The study found seven themes that influence the development of TGD curriculum as follows: familiarity and comfort with the curriculum and content change process; collaboration with other healthcare programs; teaching expertise; management of course workload and related. duties; connections to the TGD community; knowledge of required TGD content and existing gaps in curriculum; and access to supports. CONCLUSIONS Understanding educators' perspectives can lead to an increased sense of empowerment for them to create and incorporate TGD curriculum in the future. Many post- secondary institutions are incorporating an inclusive lens to educational plans; this research can be used in future curriculum design projects. The goal is improved medical imaging experiences for the TGD population.
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Jeong B, Allen J, Chapple K. A new commercial boundary dataset for metropolitan areas in the USA and Canada, built from open data. Sci Data 2024; 11:422. [PMID: 38658658 PMCID: PMC11043369 DOI: 10.1038/s41597-024-03275-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 04/17/2024] [Indexed: 04/26/2024] Open
Abstract
The purpose of this study is to define the geographic boundaries of commercial areas by creating a consistent definition, combining various commercial area types, including downtowns, retail centres, financial districts, and other employment subcentres. Our research involved the collection of office, retail and job density data from 69 metropolitan regions across USA and Canada. Using this data, we conducted an unsupervised image segmentation model and clustering methods to identify distinctive commercial geographic boundaries. As a result, we identified 23,751 commercial areas, providing a detailed perspective on the commercial landscape of metropolitan areas in the USA and Canada. In addition, the generated boundaries were successfully validated through comparison with previously established commerce-related boundaries. The output of this study has implications for urban and regional planning and economic development, delivering valuable insights into the overall commercial geography in the region. The commercial boundary and used codes are freely available on the School of Cities Github, and users can reuse, reproduce and modify the boundaries.
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Affiliation(s)
- Byeonghwa Jeong
- Postdoctoral Fellow, School of Cities, University of Toronto, Toronto, Canada.
| | - Jeff Allen
- Lead, Data Visualization, School of Cities, University of Toronto, Toronto, Canada
| | - Karen Chapple
- Director, School of Cities and Professor, Geography & Planning, University of Toronto, Toronto, Canada
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Sutton AO, Strickland D, Lachapelle J, Young RG, Hanner R, Brunton DF, Skevington JH, Freeman NE, Norris DR. Fecal DNA metabarcoding helps characterize the Canada jay's diet and confirms its reliance on stored food for winter survival and breeding. PLoS One 2024; 19:e0300583. [PMID: 38656932 PMCID: PMC11042713 DOI: 10.1371/journal.pone.0300583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 03/01/2024] [Indexed: 04/26/2024] Open
Abstract
Accurately determining the diet of wild animals can be challenging if food items are small, visible only briefly, or rendered visually unidentifiable in the digestive system. In some food caching species, an additional challenge is determining whether consumed diet items have been previously stored or are fresh. The Canada jay (Perisoreus canadensis) is a generalist resident of North American boreal and subalpine forests with anatomical and behavioural adaptations allowing it to make thousands of arboreal food caches in summer and fall that are presumably responsible for its high winter survival and late winter/early spring breeding. We used DNA fecal metabarcoding to obtain novel information on nestling diets and compiled a dataset of 662 published and unpublished direct observations or stomach contents identifications of natural foods consumed by Canada jays throughout the year. We then used detailed natural history information to make informed decisions on whether each item identified to species in the diets of winter adults and nestlings was best characterized as 'likely cached', 'likely fresh' (i.e., was available as a non-cached item when it appeared in a jay's feces or stomach), or 'either possible'. Of the 87 food items consumed by adults in the winter, 39% were classified as 'likely cached' and 6% were deemed to be 'likely fresh'. For nestlings, 29% of 125 food items identified to species were 'likely cached' and 38% were 'likely fresh'. Our results support both the indispensability of cached food for Canada jay winter survival and previous suggestions that cached food is important for late winter/early spring breeding. Our work highlights the value of combining metabarcoding, stomach contents analysis, and direct observations to determine the cached vs. non-cached origins of consumed food items and the identity of food caches, some of which could be especially vulnerable to degradation through climate change.
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Affiliation(s)
- Alex O. Sutton
- Department of Integrative Biology, University of Guelph, Guelph, Ontario, Canada
- School of Natural Sciences, Bangor University, Bangor, Wales, United Kingdom
| | | | - Jacob Lachapelle
- Department of Integrative Biology, University of Guelph, Guelph, Ontario, Canada
| | - Robert G. Young
- Department of Integrative Biology, University of Guelph, Guelph, Ontario, Canada
| | - Robert Hanner
- Department of Integrative Biology, University of Guelph, Guelph, Ontario, Canada
| | - Daniel F. Brunton
- Beaty Centre for Species Discovery and Botany Section, Canadian Museum of Nature, Ottawa, Ontario, Canada
| | | | - Nikole E. Freeman
- Department of Integrative Biology, University of Guelph, Guelph, Ontario, Canada
- School of Natural Sciences, Bangor University, Bangor, Wales, United Kingdom
- Division of Biology, Kansas State University, Manhattan, Kansas, United States of America
| | - D. Ryan Norris
- Department of Integrative Biology, University of Guelph, Guelph, Ontario, Canada
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Aggarwal M, Hutchison BG, Kokorelias KM, Ramsden VR, Ivers NM, Pinto A, Uphsur REG, Wong ST, Pimlott N, Slade S. The Conceptualization and Measurement of Research Impact in Primary Health Care: Protocol for a Rapid Scoping Review. JMIR Res Protoc 2024; 13:e55860. [PMID: 38652900 DOI: 10.2196/55860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/27/2024] [Accepted: 03/04/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND The generation of research evidence and knowledge in primary health care (PHC) is crucial for informing the development and implementation of interventions and innovations and driving health policy, health service improvements, and potential societal changes. PHC research has broad effects on patients, practices, services, population health, community, and policy formulation. The in-depth exploration of the definition and measures of research impact within PHC is essential for broadening our understanding of research impact in the discipline and how it compares to other health services research. OBJECTIVE The objectives of the study are (1) to understand the conceptualizations and measures of research impact within the realm of PHC and (2) to identify methodological frameworks for evaluation and research impact and the benefits and challenges of using these approaches. The forthcoming review seeks to guide future research endeavors and enhance methodologies used in assessing research impact within PHC. METHODS The protocol outlines the rapid review and environmental scan approach that will be used to explore research impact in PHC and will be guided by established frameworks such as the Canadian Academy of Health Sciences Impact Framework and the Canadian Health Services and Policy Research Alliance. The rapid review follows scoping review guidelines (PRISMA-ScR; Preferred Reporting Items for Systematic Review and Meta-Analysis Extension for Scoping Reviews). The environmental scan will be done by consulting with professional organizations, academic institutions, information science, and PHC experts. The search strategy will involve multiple databases, citation and forward citation searching, and manual searches of gray literature databases, think tank websites, and relevant catalogs. We will include gray and scientific literature focusing explicitly on research impact in PHC from high-income countries using the World Bank classification. Publications published in English from 1978 will be considered. The collected papers will undergo a 2-stage independent review process based on predetermined inclusion criteria. The research team will extract data from selected studies based on the research questions and the CRISP (Consensus Reporting Items for Studies in Primary Care) protocol statement. The team will discuss the extracted data, enabling the identification and categorization of key themes regarding research impact conceptualization and measurement in PHC. The narrative synthesis will evolve iteratively based on the identified literature. RESULTS The results of this study are expected at the end of 2024. CONCLUSIONS The forthcoming review will explore the conceptualization and measurement of research impact in PHC. The synthesis will offer crucial insights that will guide subsequent research, emphasizing the need for a standardized approach that incorporates diverse perspectives to comprehensively gauge the true impact of PHC research. Furthermore, trends and gaps in current methodologies will set the stage for future studies aimed at enhancing our understanding and measurement of research impact in PHC. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/55860.
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Affiliation(s)
- Monica Aggarwal
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Brian G Hutchison
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Kristina M Kokorelias
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
- Section of Geriatrics, Sinai Health, Toronto, ON, Canada
| | - Vivian R Ramsden
- Department of Academic Family Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Noah M Ivers
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Women's College Hospital, Toronto, ON, Canada
| | - Andrew Pinto
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, ON, Canada
| | - Ross E G Uphsur
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Sabrina T Wong
- School of Nursing and Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC, Canada
| | - Nick Pimlott
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Steve Slade
- Research Department, College of Family Physicians of Canada, Mississuaga, ON, Canada
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Loewen EJT, Balkwill MA, Mattioli J, Cockx P, Caicedo MV, Muehlenbachs K, Tappert R, Borkent A, Libke C, Engel MS, Somers C, McKellar RC. New Canadian amber deposit fills gap in fossil record near end-Cretaceous mass extinction. Curr Biol 2024; 34:1762-1771.e3. [PMID: 38521062 DOI: 10.1016/j.cub.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/23/2023] [Accepted: 03/01/2024] [Indexed: 03/25/2024]
Abstract
Amber preserves an exceptional record of tiny, soft-bodied organisms and chemical environmental signatures, elucidating the evolution of arthropod lineages and the diversity, ecology, and biogeochemistry of ancient ecosystems. However, globally, fossiliferous amber deposits are rare in the latest Cretaceous and surrounding the Cretaceous-Paleogene (K-Pg) mass extinction.1,2,3,4,5 This faunal gap limits our understanding of arthropod diversity and survival across the extinction boundary.2,6 Contrasting hypotheses propose that arthropods were either relatively unaffected by the K-Pg extinction or experienced a steady decline in diversity before the extinction event followed by rapid diversification in the Cenozoic.2,6 These hypotheses are primarily based on arthropod feeding traces on fossil leaves and time-calibrated molecular phylogenies, not direct observation of the fossil record.2,7 Here, we report a diverse amber assemblage from the Late Cretaceous (67.04 ± 0.16 Ma) of the Big Muddy Badlands, Canada. The new deposit fills a critical 16-million-year gap in the arthropod fossil record spanning the K-Pg mass extinction. Seven arthropod orders and at least 11 insect families have been recovered, making the Big Muddy amber deposit the most diverse arthropod assemblage near the K-Pg extinction. Amber chemistry and stable isotopes suggest the amber was produced by coniferous (Cupressaceae) trees in a subtropical swamp near remnants of the Western Interior Seaway. The unexpected abundance of ants from extant families and the virtual absence of arthropods from common, exclusively Cretaceous families suggests that Big Muddy amber may represent a yet unsampled Late Cretaceous environment and provides evidence of a faunal transition before the end of the Cretaceous.
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Affiliation(s)
- Elyssa J T Loewen
- Biology Department, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada; Royal Saskatchewan Museum, 2340 Albert Street, Regina, SK S4P 2V7, Canada.
| | - Micheala A Balkwill
- Geology Department, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada
| | - Júlia Mattioli
- Geotop & Département des sciences de la Terre et de l'atmosphère, Université du Québec à Montréal, C.P. 8888, Succursale Centre-Ville, Montréal, QC H3C 3P8, Canada
| | - Pierre Cockx
- Biology Department, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada; Royal Saskatchewan Museum, 2340 Albert Street, Regina, SK S4P 2V7, Canada
| | - Maria Velez Caicedo
- Geology Department, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada
| | - Karlis Muehlenbachs
- Department of Earth and Atmospheric Sciences, University of Alberta, 116 St and 85 Ave, Edmonton, AB T6G 2E3, Canada
| | - Ralf Tappert
- Geology Department, Lakehead University, 955 Oliver Rd, Thunder Bay, ON P7B 5E1, Canada
| | - Art Borkent
- Division of Invertebrate Zoology, American Museum of Natural History, 200 Central Park West, New York, NY 10024-5192, USA
| | - Caelan Libke
- Biology Department, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada; Royal Saskatchewan Museum, 2340 Albert Street, Regina, SK S4P 2V7, Canada
| | - Michael S Engel
- Division of Invertebrate Zoology, American Museum of Natural History, 200 Central Park West, New York, NY 10024-5192, USA; Facultad de Ciencias Biológicas, Universidad Nacional Mayor de San Marcos, Av. Óscar R. Benavides 5737, Callao 07006, Lima, Peru; Departamento de Entomología, Museo de Historia Natural, Av. Gral. Antonio Álvarez de Arenales 1256, Jesús María 15072, Lima, Peru
| | - Christopher Somers
- Biology Department, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada
| | - Ryan C McKellar
- Biology Department, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada; Royal Saskatchewan Museum, 2340 Albert Street, Regina, SK S4P 2V7, Canada; Department of Ecology & Evolutionary Biology, University of Kansas, 1450 Jayhawk Blvd, Lawrence, KS 66045, USA
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Brousseau-Foley M, Blanchette V, Houle J, Trudeau F. Developing an interprofessional decision support tool for diabetic foot ulcers management in primary care within the family medicine group model: a Delphi study in Canada. BMC Prim Care 2024; 25:123. [PMID: 38643081 PMCID: PMC11031884 DOI: 10.1186/s12875-024-02387-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 04/12/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Primary care professionals encounter difficulties coordinating the continuum of care between primary care providers and second-line specialists and adhere to practice guidelines pertaining to diabetic foot ulcers management. Family medicine groups are providing primary care services aimed to improve access, interdisciplinary care, coordination and quality of health services, and reduce emergency department visits. Most professionals working in family medicine groups are primary care physicians and registered nurses. The aim of this study was to develop and validate an interprofessional decision support tool to guide the management of diabetic foot ulcers for primary care professionals working within the family medicine group model. METHODS A one-page decision tool developed by the research team was validated by an expert panel using a three-round Delphi protocol held between December 2019 and August 2021. The tool includes 43 individual actions and a care pathway from initial presentation to secondary prevention. Data collection was realized with both paper and electronic questionnaires, and answers were compiled in an electronic spreadsheet. Data was analyzed with use of descriptive statistics, and consensus for each item was defined as ≥ 80% agreement. RESULTS Experts from 12 pre-identified professions of the diabetic foot ulcer interdisciplinary care team were included, 39 participants out of the 59 invited to first round (66.1%), 34 out of 39 for second (87.2%) and 22 out of 34 for third (64.7%) rounds. All items included in the final version of the decision support tool reached consensus and were deemed clear, relevant and feasible. One or more professionals were identified to be responsible for every action to be taken. CONCLUSIONS This study provided a comprehensive decision support tool to guide primary care professionals in the management of diabetic foot ulcers. Implementation and evaluation in the clinical setting will need to be undertaken in the future.
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Affiliation(s)
- Magali Brousseau-Foley
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Boul. Des Forges, Trois-Rivières, Québec, 3351G8Z 4M3, Canada.
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Mauricie et du Centre-du-Québec (CIUSSS-MCQ) affiliated to Université de Montréal, Department of Family and Emergency Medicine, Faculty of Medicine, 731 Rue Ste-Julie, Trois-Rivières, Québec, G9A 1Y1, Canada.
| | - Virginie Blanchette
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Boul. Des Forges, Trois-Rivières, Québec, 3351G8Z 4M3, Canada
- VITAM - Research Centre on Sustainable Health, 2480 Chemin de la Canardière, Québec, QC, G1J 2G1, Canada
| | - Julie Houle
- Department of Nursing, Université du Québec à Trois-Rivières, 3351, Boul. Des Forges, Trois-Rivières, Québec, G8Z 4M3, Canada
| | - François Trudeau
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Boul. Des Forges, Trois-Rivières, Québec, 3351G8Z 4M3, Canada
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Cresswell K, Sullivan C, Theal J, Mozaffar H, Williams R. Concerted adoption as an emerging strategy for digital transformation of healthcare-lessons from Australia, Canada, and England. J Am Med Inform Assoc 2024; 31:1211-1215. [PMID: 38400737 PMCID: PMC11031228 DOI: 10.1093/jamia/ocae034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 02/07/2024] [Accepted: 02/09/2024] [Indexed: 02/26/2024] Open
Abstract
OBJECTIVES With an increasing focus on the digitalization of health and care settings, there is significant scope to learn from international approaches to promote concerted adoption of electronic health records. MATERIALS AND METHODS We review three large-scale initiatives from Australia, Canada, and England, and extract common lessons for future health and social care transformation strategy. RESULTS We discuss how, despite differences in contexts, concerted adoption enables sharing of experience and learning to streamline the digital transformation of health and care. DISCUSSION AND CONCLUSION Concerted adoption can be accelerated through building communities of expertise and partnerships promoting knowledge transfer and circulation of expertise; commonalities in geographical and cultural contexts; and commonalities in technological systems.
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Affiliation(s)
- Kathrin Cresswell
- Usher Institute, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh EH8 9AG United Kingdom
| | - Clair Sullivan
- Queensland Digital Health Centre, Faculty of Medicine, University of Queensland, Brisbane St Lucia, QLD 4072, Australia
| | - Jeremy Theal
- Department of Medicine, University of Alberta, Edmonton AB T6G 2R3, Canada
| | - Hajar Mozaffar
- Business School, University of Edinburgh, Edinburgh EH8 9AG, United Kingdom
| | - Robin Williams
- Institute for the Study of Science, Technology and Innovation, University of Edinburgh, Edinburgh EH1 1LZ, United Kingdom
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Wong A, Brunetta J, De Wet J, Logue K, Loemba H, Saifi T, Mumm D, Marongiu A, Harrison R, Thorpe D, Trottier B. Twelve-month effectiveness and safety of bictegravir/emtricitabine/tenofovir alafenamide in people with HIV from the Canadian cohort of the observational BICSTaR study. Medicine (Baltimore) 2024; 103:e37785. [PMID: 38640301 PMCID: PMC11029942 DOI: 10.1097/md.0000000000037785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/29/2024] [Accepted: 03/13/2024] [Indexed: 04/21/2024] Open
Abstract
The BICSTaR (BICtegravir Single Tablet Regimen) study is investigating the effectiveness and safety of bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) in people with human immunodeficiency virus (HIV) treated in routine clinical practice. BICSTaR is an ongoing, prospective, observational cohort study across 14 countries. Treatment-naïve (TN) and treatment-experienced (TE) people with HIV (≥18 years of age) are being followed for 24 months. We present an analysis of the primary endpoint (HIV-1 RNA < 50 copies/mL; missing-equals-excluded [M = E]) at month 12 in the BICSTaR Canada cohort, including secondary (CD4 count, CD4/CD8 ratio, safety/tolerability) and exploratory (persistence, treatment satisfaction) endpoints. In total, 201 participants were enrolled in the BICSTaR Canada cohort. The analysis population included 170 participants (TN, n = 10; TE, n = 160), with data collected between November 2018 and September 2020. Of the participants, 88% were male, 72% were White, and 90% had ≥ 1 comorbid condition(s). Median (quartile [Q]1-Q3) age was 50 (39-58) years and baseline CD4 count was 391.5 (109.0-581.0) cells/µL in TN participants and 586.0 (400.0-747.0) cells/µL in TE participants. After 12 months of B/F/TAF treatment, HIV-1 RNA was < 50 copies/mL in 100% (9/9) of TN-active participants and 97% (140/145) of TE-active participants (M = E analysis). Median (Q1-Q3) CD4 cell count increased by +195 (125-307) cells/µL in TN participants and by + 30 (-50 to 123) cells/µL in TE participants. Persistence on B/F/TAF was high through month 12 with 10% (1/10) of TN and 7 % (11/160) of TE participants discontinuing B/F/TAF within 12 months of initiation of treatment. No resistance to B/F/TAF emerged. Study drug-related adverse events occurred in 7% (12/169) of participants, leading to B/F/TAF discontinuation in 4 of 169 participants. Improvements in treatment satisfaction were observed in TE participants. B/F/TAF demonstrated high levels of effectiveness, persistence, and treatment satisfaction, and was well tolerated through month 12 in people with HIV treated in routine clinical practice in Canada.
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Affiliation(s)
| | | | | | - Ken Logue
- St Clair Medical Associates, Toronto, ON, Canada
| | | | - Taban Saifi
- Gilead Sciences Canada, Inc., Mississauga, ON, Canada
| | - Dylana Mumm
- Gilead Sciences Canada, Inc., Mississauga, ON, Canada
| | | | | | | | - Benoit Trottier
- Clinique de Médecine Urbaine du Quartier Latin, Montreal, QC, Canada
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Puligandla P, Skarsgard E, Baird R, Guadagno E, Dimmer A, Ganescu O, Abbasi N, Altit G, Brindle M, Fernandes S, Dakshinamurti S, Flageole H, Hebert A, Keijzer R, Offringa M, Patel D, Ryan G, Traynor M, Zani A, Chiu P. Diagnosis and management of congenital diaphragmatic hernia: a 2023 update from the Canadian Congenital Diaphragmatic Hernia Collaborative. Arch Dis Child Fetal Neonatal Ed 2024; 109:239-252. [PMID: 37879884 DOI: 10.1136/archdischild-2023-325865] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 10/02/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVE The Canadian Congenital Diaphragmatic Hernia (CDH) Collaborative sought to make its existing clinical practice guideline, published in 2018, into a 'living document'. DESIGN AND MAIN OUTCOME MEASURES Critical appraisal of CDH literature adhering to Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Evidence accumulated between 1 January 2017 and 30 August 2022 was analysed to inform changes to existing or the development of new CDH care recommendations. Strength of consensus was also determined using a modified Delphi process among national experts in the field. RESULTS Of the 3868 articles retrieved in our search that covered the 15 areas of CDH care, 459 underwent full-text review. Ultimately, 103 articles were used to inform 20 changes to existing recommendations, which included aspects related to prenatal diagnosis, echocardiographic evaluation, pulmonary hypertension management, surgical readiness criteria, the type of surgical repair and long-term health surveillance. Fifteen new CDH care recommendations were also created using this evidence, with most related to the management of pain and the provision of analgesia and neuromuscular blockade for patients with CDH. CONCLUSIONS The 2023 Canadian CDH Collaborative's clinical practice guideline update provides a management framework for infants and children with CDH based on the best available evidence and expert consensus.
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Affiliation(s)
- Pramod Puligandla
- Department of Pediatric Surgery, Harvey E. Beardmore Division of Pediatric Surgery, Montreal Children's Hospital of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Erik Skarsgard
- Department of Surgery, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Robert Baird
- Department of Surgery, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Elena Guadagno
- Department of Pediatric Surgery, Harvey E. Beardmore Division of Pediatric Surgery, Montreal Children's hospital of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Alexandra Dimmer
- Department of Pediatric Surgery, Harvey E. Beardmore Division of Pediatric Surgery, Montreal Children's Hospital of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Olivia Ganescu
- Department of Pediatric Surgery, Harvey E. Beardmore Division of Pediatric Surgery, Montreal Children's Hospital of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Nimrah Abbasi
- Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Gabriel Altit
- Neonatology, Montreal Children's Hospital of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Mary Brindle
- Department of Surgery, Section of Pediatric Surgery, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Sairvan Fernandes
- Department of Surgery, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shyamala Dakshinamurti
- Department of Pediatrics and Child Health, Section of Neonatology, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Helene Flageole
- Department of Pediatric Surgery, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Audrey Hebert
- Department of Pediatrics, Division of Neonatology, Laval University, Quebec City, Quebec, Canada
| | - Richard Keijzer
- Department of Pediatric Surgery and Manitoba Institute of Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Martin Offringa
- Child Health Evaluative Sciences, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Dylan Patel
- Department of Pediatric Surgery, Harvey E. Beardmore Division of Pediatric Surgery, Montreal Children's Hospital of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Greg Ryan
- Department of Obstetrics & Gynaecology, Mount Sinai Hospital, Ontario Fetal Centre, Toronto, Ontario, Canada
| | - Michael Traynor
- Department of Anesthesia, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Augusto Zani
- Department of Surgery, Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Priscilla Chiu
- Department of Surgery, Division of Pediatric General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Théberge J, Smithman MA, Turgeon-Pelchat C, Tounkara FK, Richard V, Aubertin P, Léonard P, Alami H, Singhroy D, Fleet R. Through the big top: An exploratory study of circus-based artistic knowledge translation in rural healthcare services, Québec, Canada. PLoS One 2024; 19:e0302022. [PMID: 38635538 PMCID: PMC11025836 DOI: 10.1371/journal.pone.0302022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 03/26/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND The conventional methods and strategies used for knowledge translation (KT) in academic research often fall short in effectively reaching stakeholders, such as citizens, practitioners, and decision makers, especially concerning complex healthcare issues. In response, a growing number of scholars have been embracing arts-based knowledge translation (ABKT) to target a more diverse audience with varying backgrounds and expectations. Despite the increased interest, utilization, and literature on arts-based knowledge translation over the past three decades, no studies have directly compared traditional knowledge translation with arts-based knowledge translation methods. Thus, our study aimed to evaluate and compare the impact of an arts-based knowledge translation intervention-a circus show-with two traditional knowledge translation interventions (webinar and research report) in terms of awareness, accessibility, engagement, advocacy/policy influence, and enjoyment. METHODS To conduct this exploratory convergent mixed method study, we randomly assigned 162 participants to one of the three interventions. All three knowledge translation methods were used to translate the same research project: "Rural Emergency 360: Mobilization of decision-makers, healthcare professionals, patients, and citizens to improve healthcare and services in Quebec's rural emergency departments (UR360)." RESULTS The findings revealed that the circus show outperformed the webinar and research report in terms of accessibility and enjoyment, while being equally effective in raising awareness, increasing engagement, and influencing advocacy/policy. Each intervention strategy demonstrates its unique array of strengths and weaknesses, with the circus show catering to a diverse audience, while the webinar and research report target more informed participants. These outcomes underscore the innovative and inclusive attributes of Arts-Based Knowledge translation, showcasing its capacity to facilitate researchers' engagement with a wider array of stakeholders across diverse contexts. CONCLUSION As a relevant first step and a complementary asset, arts-based knowledge translation holds immense potential in increasing awareness and mobilization around crucial health issues.
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Affiliation(s)
- Julie Théberge
- Laval University, Québec, Canada
- Research Chair in Emergency Medicine Université-CISSS-CA, Lévis, Canada
- VITAM Centre de recherche en santé durable, Québec, Canada
- Centre de recherche, d’innovation et de transfert en arts du cirque, Montréal, Canada
| | | | | | | | - Véronique Richard
- Centre de recherche, d’innovation et de transfert en arts du cirque, Montréal, Canada
- University of Queensland, Brisbane, Australia
| | - Patrice Aubertin
- Centre de recherche, d’innovation et de transfert en arts du cirque, Montréal, Canada
| | | | | | | | - Richard Fleet
- Laval University, Québec, Canada
- Research Chair in Emergency Medicine Université-CISSS-CA, Lévis, Canada
- VITAM Centre de recherche en santé durable, Québec, Canada
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Knoppers T, Haley CE, Bouhouita-Guermech S, Hagan J, Bradbury-Jost J, Alarie S, Cosquer M, Zawati MH. From code to care: Clinician and researcher perspectives on an optimal therapeutic web portal for acute myeloid leukemia. PLoS One 2024; 19:e0302156. [PMID: 38635542 PMCID: PMC11025855 DOI: 10.1371/journal.pone.0302156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 03/28/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Acute myeloid leukemia (AML), a rapidly progressing cancer of the blood and bone marrow, is the most common and fatal type of adult leukemia. Therapeutic web portals have great potential to facilitate AML research advances and improve health outcomes by increasing the availability of data, the speed and reach of new knowledge, and the communication between researchers and clinicians in the field. However, there is a need for stakeholder research regarding their optimal features, utility, and implementation. METHODS To better understand stakeholder perspectives regarding an ideal pan-Canadian web portal for AML research, semi-structured qualitative interviews were conducted with 17 clinicians, researchers, and clinician-researchers. Interview guides were inspired by De Laat's "fictive scripting", a method where experts are presented with scenarios about a future technology and asked questions about its implementation. Content analysis relied on an iterative process using themes extracted from both existing scientific literature and the data. RESULTS Participants described potential benefits of an AML therapeutic portal including facilitating data-sharing, communication, and collaboration, and enhancing clinical trial matchmaking for patients, potentially based on their specific genomic profiles. There was enthusiasm about researcher, clinician, and clinician-researcher access, but some disagreement about the nature of potential patient access to the portal. Interviewees also discussed two key elements they believed to be vital to the uptake and thus success of a therapeutic AML web portal: credibility and user friendliness. Finally, sustainability, security and privacy concerns were also documented. CONCLUSIONS This research adds to existing calls for digital platforms for researchers and clinicians to supplement extant modes of communication to streamline research and its dissemination, advance precision medicine, and ultimately improve patient prognosis and care. Findings are applicable to therapeutic web portals more generally, particularly in genomic and translational medicine, and will be of interest to portal end-users, developers, researchers, and policymakers.
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Affiliation(s)
- Terese Knoppers
- Centre of Genomics and Policy, McGill University, Montreal, Quebec, Canada
| | - Cassandra E. Haley
- Centre of Genomics and Policy, McGill University, Montreal, Quebec, Canada
| | | | - Julie Hagan
- Centre of Genomics and Policy, McGill University, Montreal, Quebec, Canada
| | | | - Samuel Alarie
- Centre of Genomics and Policy, McGill University, Montreal, Quebec, Canada
| | - Marie Cosquer
- Centre of Genomics and Policy, McGill University, Montreal, Quebec, Canada
| | - Ma’n H. Zawati
- Centre of Genomics and Policy, McGill University, Montreal, Quebec, Canada
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92
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Conombo B, Guertin JR, Hoch JS, Grimshaw J, Bérubé M, Malo C, Berthelot S, Lauzier F, Stelfox HT, Turgeon AF, Archambault P, Belcaid A, Moore L. Implementation of an audit and feedback module targeting low-value clinical practices in a provincial trauma quality assurance program: a cost-effectiveness study. BMC Health Serv Res 2024; 24:479. [PMID: 38632593 PMCID: PMC11025277 DOI: 10.1186/s12913-024-10969-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 04/09/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Audit and Feedback (A&F) interventions based on quality indicators have been shown to lead to significant improvements in compliance with evidence-based care including de-adoption of low-value practices (LVPs). Our primary aim was to evaluate the cost-effectiveness of adding a hypothetical A&F module targeting LVPs for trauma admissions to an existing quality assurance intervention targeting high-value care and risk-adjusted outcomes. A secondary aim was to assess how certain A&F characteristics might influence its cost-effectiveness. METHODS We conducted a cost-effectiveness analysis using a probabilistic static decision analytic model in the Québec trauma care continuum. We considered the Québec Ministry of Health perspective. Our economic evaluation compared a hypothetical scenario in which the A&F module targeting LVPs is implemented in a Canadian provincial trauma quality assurance program to a status quo scenario in which the A&F module is not implemented. In scenarios analyses we assessed the impact of A&F characteristics on its cost-effectiveness. Results are presented in terms of incremental costs per LVP avoided. RESULTS Results suggest that the implementation of A&F module (Cost = $1,480,850; Number of LVPs = 6,005) is associated with higher costs and higher effectiveness compared to status quo (Cost = $1,124,661; Number of LVPs = 8,228). The A&F module would cost $160 per LVP avoided compared to status quo. The A&F module becomes more cost-effective with the addition of facilitation visits; more frequent evaluation; and when only high-volume trauma centers are considered. CONCLUSION A&F module targeting LVPs is associated with higher costs and higher effectiveness than status quo and has the potential to be cost-effective if the decision-makers' willingness-to-pay is at least $160 per LVP avoided. This likely represents an underestimate of true ICER due to underestimated costs or missed opportunity costs. Results suggest that virtual facilitation visits, frequent evaluation, and implementing the module in high-volume centers can improve cost-effectiveness.
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Affiliation(s)
- Blanchard Conombo
- Department of Social and Preventative Medicine, Université Laval, Québec City, Québec, Canada
- Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Quebec University Hospital, Centre de Recherche du CHU de Québec-Université Laval, 18E Rue, Local H-012a, Québec City, Québec, 1401G1J 1Z4, Canada
| | - Jason R Guertin
- Department of Social and Preventative Medicine, Université Laval, Québec City, Québec, Canada
| | - Jeffrey S Hoch
- Division of Health Policy and Management, Department of Public Health Sciences, University of California at Davis, Davis, CA, USA
| | - Jeremy Grimshaw
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Mélanie Bérubé
- Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Quebec University Hospital, Centre de Recherche du CHU de Québec-Université Laval, 18E Rue, Local H-012a, Québec City, Québec, 1401G1J 1Z4, Canada
- Faculty of Nursing, Université Laval, Québec City, Québec, Canada
| | - Christian Malo
- Faculty of Nursing, Université Laval, Québec City, Québec, Canada
| | - Simon Berthelot
- Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Quebec University Hospital, Centre de Recherche du CHU de Québec-Université Laval, 18E Rue, Local H-012a, Québec City, Québec, 1401G1J 1Z4, Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec City, Québec, Canada
- Centre de Recherche Intégrée Pour Un Système Apprenant en Santé Et Services Sociaux, Centre Intégré de Santé Et de Services Sociaux de Chaudière-Appalaches, Lévis, Québec, Canada
| | - François Lauzier
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec City, Québec, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, Medicine and Community Health Sciences, O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Alexis F Turgeon
- Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Quebec University Hospital, Centre de Recherche du CHU de Québec-Université Laval, 18E Rue, Local H-012a, Québec City, Québec, 1401G1J 1Z4, Canada
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Université Laval, Québec City, Québec, Canada
| | - Patrick Archambault
- Department of Family Medicine and Emergency Medicine, Université Laval, Québec City, Québec, Canada
- VITAM-Centre de Recherche en Santé Durable, Québec City, Québec, Canada
| | - Amina Belcaid
- Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Quebec University Hospital, Centre de Recherche du CHU de Québec-Université Laval, 18E Rue, Local H-012a, Québec City, Québec, 1401G1J 1Z4, Canada
| | - Lynne Moore
- Department of Social and Preventative Medicine, Université Laval, Québec City, Québec, Canada.
- Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Quebec University Hospital, Centre de Recherche du CHU de Québec-Université Laval, 18E Rue, Local H-012a, Québec City, Québec, 1401G1J 1Z4, Canada.
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Shah Z, Khan DM, Khan I, Ahmad B, Jeridi M, Al-Marzouki S. A novel flexible exponent power-X family of distributions with applications to COVID-19 mortality rate in Mexico and Canada. Sci Rep 2024; 14:8992. [PMID: 38637663 PMCID: PMC11026430 DOI: 10.1038/s41598-024-59720-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 04/15/2024] [Indexed: 04/20/2024] Open
Abstract
This paper aims to introduce a novel family of probability distributions by the well-known method of the T-X family of distributions. The proposed family is called a "Novel Generalized Exponent Power X Family" of distributions. A three-parameters special sub-model of the proposed method is derived and named a "Novel Generalized Exponent Power Weibull" distribution (NGEP-Wei for short). For the proposed family, some statistical properties are derived including the hazard rate function, moments, moment generating function, order statistics, residual life, and reverse residual life. The well-known method of estimation, the maximum likelihood estimation method is used for estimating the model parameters. Besides, a comprehensive Monte Carlo simulation study is conducted to assess the efficacy of this estimation method. Finally, the model selection criterion such as Akaike information criterion (AINC), the correct information criterion (CINC), the Bayesian information criterion (BINC), the Hannan-Quinn information criterion (HQINC), the Cramer-von-Misses (CRMI), and the ANDA (Anderson-Darling) are used for comparison purpose. The comparison of the NGEP-Wei with other rival distributions is made by Two COVID-19 data sets. In terms of performance, we show that the proposed method outperforms the other competing methods included in this study.
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Affiliation(s)
- Zubir Shah
- Abdul Wali Khan University Mardan, Mardan, Pakistan
| | | | - Imad Khan
- Abdul Wali Khan University Mardan, Mardan, Pakistan
| | - Bakhtiyar Ahmad
- Higher Education Department Afghanistan, Kart-e-Char, Afghanistan.
| | - Mouna Jeridi
- Biology Department, College of Science, King Khalid University, 61413, Abha, Saudi Arabia
| | - Sanaa Al-Marzouki
- Statistics Department, Faculty of Science, King Abdul Aziz University Jeddah, Jeddah, Kingdom of Saudi Arabia
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de Souza M, Melika R, Thebaud B, Barrowman NJ, Tsampalieros A, Lemyre B. Effects of prophylactic hydrocortisone in a tertiary Canadian NICU. Arch Dis Child Fetal Neonatal Ed 2024; 109:342. [PMID: 37827815 DOI: 10.1136/archdischild-2023-325913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/14/2023]
Affiliation(s)
- Marisa de Souza
- Pediatrics, Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Raymond Melika
- Pharmacy, Ottawa Hospital General Campus, Ottawa, Ontario, Canada
| | - Bernard Thebaud
- Neonatology, Ottawa Hospital, Ottawa, Ontario, Canada
- Neonatology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Clinical Research Unit, CHEO Research Institute, Ottawa, Ontario, Canada
- Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Nicholas James Barrowman
- Clinical Research Unit, CHEO Research Institute, Ottawa, Ontario, Canada
- Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Anne Tsampalieros
- Clinical Research Unit, CHEO Research Institute, Ottawa, Ontario, Canada
| | - Brigitte Lemyre
- Neonatology, Ottawa Hospital, Ottawa, Ontario, Canada
- Neonatology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Clinical Research Unit, CHEO Research Institute, Ottawa, Ontario, Canada
- Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
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Murphy K, Gondro JV, Moharrami M. Factors associated with the use of oral health care services among Canadian children and youth. Health Rep 2024; 35:15-26. [PMID: 38630920 DOI: 10.25318/82-003-x202400400002-eng] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Background This study investigates the association between dental insurance, income, and dental care access for Canadian children and youth aged 1 to 17 years. It contributes to a baseline understanding of oral health care use before the implementation of the Canadian Dental Care Plan (CDCP). Data and methods This study used data from the 2019 Canadian Health Survey on Children and Youth (n=47,347). Descriptive statistics and logistic regression models were employed to assess the association of dental insurance, adjusted family net income, and other sociodemographic factors on oral health care visits and cost-related avoidance of oral health care. Results A large percentage of children under the age of 5 had never visited a dentist (79.8% of 1-year-olds to 16.4% of 4-year-olds). Overall, 89.6% of Canadian children and youth aged 5 to 17 had visited a dental professional within the past 12 months: 93.1% of those who were insured and 78.5% of those who were uninsured. Insured children and youth had a 4.5% cost-related avoidance of dental care, contrasting with 23.3% for uninsured children and youth. After adjustment for sociodemographic variables, children and youth with dental insurance were nearly three times more likely (odds ratio [OR]: 2.94; 95% confidence interval [CI]: 2.60 to 3.33) to have visited a dental professional in the past 12 months than uninsured children and youth. Having dental insurance (OR: 0.19; 95% CI: 0.16 to 0.21) was protective against barriers to seeing a dental professional because of cost. There was a strong income gradient for both dental service outcomes. Interpretation The study emphasizes the significant association of dental insurance and access to oral health care for children and youth. It highlights a significant gap between insured and uninsured children and youth and points out the influence of sociodemographic and income factors on this disparity.
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Affiliation(s)
| | | | - Mohammad Moharrami
- Centre for Direct Health Measures, Statistics Canada
- Faculty of Dentistry, University of Toronto
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Lee JT, Crettenden I, Tran M, Miller D, Cormack M, Cahill M, Li J, Sugiura T, Xiang F. Methods for health workforce projection model: systematic review and recommended good practice reporting guideline. Hum Resour Health 2024; 22:25. [PMID: 38632567 PMCID: PMC11025158 DOI: 10.1186/s12960-024-00895-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/22/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND Health workforce projection models are integral components of a robust healthcare system. This research aims to review recent advancements in methodology and approaches for health workforce projection models and proposes a set of good practice reporting guidelines. METHODS We conducted a systematic review by searching medical and social science databases, including PubMed, EMBASE, Scopus, and EconLit, covering the period from 2010 to 2023. The inclusion criteria encompassed studies projecting the demand for and supply of the health workforce. PROSPERO registration: CRD 42023407858. RESULTS Our review identified 40 relevant studies, including 39 single countries analysis (in Australia, Canada, Germany, Ghana, Guinea, Ireland, Jamaica, Japan, Kazakhstan, Korea, Lesotho, Malawi, New Zealand, Portugal, Saudi Arabia, Serbia, Singapore, Spain, Thailand, UK, United States), and one multiple country analysis (in 32 OECD countries). Recent studies have increasingly embraced a complex systems approach in health workforce modelling, incorporating demand, supply, and demand-supply gap analyses. The review identified at least eight distinct types of health workforce projection models commonly used in recent literature: population-to-provider ratio models (n = 7), utilization models (n = 10), needs-based models (n = 25), skill-mixed models (n = 5), stock-and-flow models (n = 40), agent-based simulation models (n = 3), system dynamic models (n = 7), and budgetary models (n = 5). Each model has unique assumptions, strengths, and limitations, with practitioners often combining these models. Furthermore, we found seven statistical approaches used in health workforce projection models: arithmetic calculation, optimization, time-series analysis, econometrics regression modelling, microsimulation, cohort-based simulation, and feedback causal loop analysis. Workforce projection often relies on imperfect data with limited granularity at the local level. Existing studies lack standardization in reporting their methods. In response, we propose a good practice reporting guideline for health workforce projection models designed to accommodate various model types, emerging methodologies, and increased utilization of advanced statistical techniques to address uncertainties and data requirements. CONCLUSIONS This study underscores the significance of dynamic, multi-professional, team-based, refined demand, supply, and budget impact analyses supported by robust health workforce data intelligence. The suggested best-practice reporting guidelines aim to assist researchers who publish health workforce studies in peer-reviewed journals. Nevertheless, it is expected that these reporting standards will prove valuable for analysts when designing their own analysis, encouraging a more comprehensive and transparent approach to health workforce projection modelling.
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Affiliation(s)
- John Tayu Lee
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan.
- National Centre for Health Workforce Studies, College of Health and Medicine, Australian National University, Canberra, Australia.
| | - Ian Crettenden
- National Centre for Health Workforce Studies, College of Health and Medicine, Australian National University, Canberra, Australia
| | - My Tran
- National Centre for Health Workforce Studies, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Daniel Miller
- Health Data Analytics Team, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Mark Cormack
- National Centre for Health Workforce Studies, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Megan Cahill
- National Centre for Health Workforce Studies, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Jinhu Li
- National Centre for Health Workforce Studies, College of Health and Medicine, Australian National University, Canberra, Australia
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
| | - Tomoko Sugiura
- Health Data Analytics Team, College of Health and Medicine, Australian National University, Canberra, Australia
| | - Fan Xiang
- National Centre for Health Workforce Studies, College of Health and Medicine, Australian National University, Canberra, Australia
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97
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Moharrami M, Sano Y, Murphy K, Hu X, Clarke J, McLeish S, Fortin Y. Assessing the role of dental insurance in oral health care disparities in Canadian adults. Health Rep 2024; 35:3-14. [PMID: 38630919 DOI: 10.25318/82-003-x202400400001-eng] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Background This study examines the association of dental insurance with oral health care access and utilization in Canada while accounting for income and sociodemographic factors. It contributes to a baseline of oral health care disparities before the implementation of the Canadian Dental Care Plan (CDCP). Data and methods This retrospective study of Canadians aged 18 to 64 years is based on data from the 2022 Canadian Community Health Survey. Multivariable logistic regression was employed to evaluate the association of dental insurance with the recency and frequency of dental visits, as well as avoidance of dental care because of cost. Results Overall, 65.7% of Canadians reported visiting a dental professional in the previous year: 74.6% of those with private insurance, 62.8% with public insurance, and 49.8% uninsured. Cost-related avoidance of dental care was 16.0%, 20.9%, and 47.4% for the privately insured, publicly insured, and uninsured, respectively. After adjustment, adults with private (odds ratio [OR]=2.54; 95% confidence interval [CI]: 2.32 to 2.78) and public (OR=2.17; 95% CI: 1.75 to 2.68) insurance were more likely to have visited a dental professional in the last year compared with those without insurance. Similarly, both private (OR=0.22; 95% CI: 0.20 to 0.25) and public (OR=0.22; 95% CI: 0.17 to 0.29) insurance holders showed a significantly lower likelihood of avoiding dental visits because of cost when compared with uninsured individuals. Interpretation This study showed the significant association of dental insurance with access to oral health care in Canada, contributing to setting a critical benchmark for assessments of the CDCP's effectiveness in addressing oral health disparities.
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Affiliation(s)
- Mohammad Moharrami
- Centre for Direct Health Measures, Statistics Canada
- Faculty of Dentistry, University of Toronto
| | - Yujiro Sano
- Centre for Direct Health Measures, Statistics Canada
| | | | - Xuefeng Hu
- Centre for Direct Health Measures, Statistics Canada
| | - Janine Clarke
- Centre for Direct Health Measures, Statistics Canada
| | - Scott McLeish
- Centre for Direct Health Measures, Statistics Canada
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Winters M, Fuller D, Cloutier MS, Harris MA, Howard A, Kestens Y, Kirk S, Macpherson A, Moore S, Rothman L, Shareck M, Tomasone JR, Laberee K, Stephens ZP, Sones M, Ayton D, Batomen B, Bell S, Collins P, Diab E, Giles AR, Hagel BE, Harris MS, Harris P, Lachapelle U, Manaugh K, Mitra R, Muhajarine N, Myrdahl TM, Pettit CJ, Pike I, Skouteris H, Wachsmuth D, Whitehurst D, Beck B. Building CapaCITY/É for sustainable transportation: protocol for an implementation science research program in healthy cities. BMJ Open 2024; 14:e085850. [PMID: 38631827 PMCID: PMC11029507 DOI: 10.1136/bmjopen-2024-085850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 03/27/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION Improving sustainable transportation options will help cities tackle growing challenges related to population health, congestion, climate change and inequity. Interventions supporting active transportation face many practical and political hurdles. Implementation science aims to understand how interventions or policies arise, how they can be translated to new contexts or scales and who benefits. Sustainable transportation interventions are complex, and existing implementation science frameworks may not be suitable. To apply and adapt implementation science for healthy cities, we have launched our mixed-methods research programme, CapaCITY/É. We aim to understand how, why and for whom sustainable transportation interventions are successful and when they are not. METHODS AND ANALYSIS Across nine Canadian municipalities and the State of Victoria (Australia), our research will focus on two types of sustainable transportation interventions: all ages and abilities bicycle networks and motor vehicle speed management interventions. We will (1) document the implementation process and outcomes of both types of sustainable transportation interventions; (2) examine equity, health and mobility impacts of these interventions; (3) advance implementation science by developing a novel sustainable transportation implementation science framework and (4) develop tools for scaling up and scaling out sustainable transportation interventions. Training activities will develop interdisciplinary scholars and practitioners able to work at the nexus of academia and sustainable cities. ETHICS AND DISSEMINATION This study received approval from the Simon Fraser University Office of Ethics Research (H22-03469). A Knowledge Mobilization Hub will coordinate dissemination of findings via a website; presentations to academic, community organisations and practitioner audiences; and through peer-reviewed articles.
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Affiliation(s)
- Meghan Winters
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Daniel Fuller
- Department of Community Health and Epidemiology, University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
| | - Marie-Soleil Cloutier
- Centre Urbanisation Culture Société, Institut national de la recherche scientifique, Montreal, Québec, Canada
| | - M Anne Harris
- School of Occupational and Public Health, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Andrew Howard
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Yan Kestens
- École de santé publique, Université de Montréal, Montreal, Québec, Canada
| | - Sara Kirk
- Healthy Populations Institute and Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Alison Macpherson
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Sarah Moore
- School of Health and Human Performance, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Linda Rothman
- School of Occupational and Public Health, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Martine Shareck
- Faculté de médecine et des sciences de la santé, Département des sciences de la santé communautaire, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Jennifer R Tomasone
- School of Kinesiology and Health Studies, Queen's University, Kingston, Ontario, Canada
| | - Karen Laberee
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | | | - Meridith Sones
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Darshini Ayton
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Brice Batomen
- University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Scott Bell
- Department of Geography and Planning, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Patricia Collins
- Department of Geography and Planning, Queen's University, Kingston, Ontario, Canada
| | - Ehab Diab
- Department of Geography and Planning, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Audrey R Giles
- School of Human Kinetics, University of Ottawa, Ottawa, Ontario, Canada
| | - Brent E Hagel
- Departments of Pediatrics and Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Mike S Harris
- City Futures Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Patrick Harris
- Centre for Health Equity Training, Research and Evaluation, University of New South Wales, Sydney, New South Wales, Australia
| | - Ugo Lachapelle
- Département d'études urbaines et touristiques, Université du Québec à Montréal, Montreal, Québec, Canada
| | - Kevin Manaugh
- Department of Geography and Bieler School of Environment, McGill University, Montreal, Québec, Canada
| | - Raktim Mitra
- School of Urban and Regional Planning, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Nazeem Muhajarine
- Department of Community Health and Epidemiology, University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
| | - Tiffany Muller Myrdahl
- Department of Gender, Sexuality, and Women's Studies and Urban Studies Program, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Christopher J Pettit
- City Futures Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Ian Pike
- Department of Pediatrics, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Monash University, Melbourne, Victoria, Australia
| | - David Wachsmuth
- School of Urban Planning, McGill University, Montreal, Québec, Canada
| | - David Whitehurst
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Ben Beck
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Nguyen BX, Luczak-Roesch M, Dinneen JD. Do research collaborations age like wine? Absolute and relative measures of CANZUK research partnerships' strength since the 1950s. PLoS One 2024; 19:e0299319. [PMID: 38626062 PMCID: PMC11020478 DOI: 10.1371/journal.pone.0299319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 02/07/2024] [Indexed: 04/18/2024] Open
Abstract
Although previous studies of today's globalised and competitive research landscape have mentioned the research collaborations of CANZUK countries (i.e., Australia, Canada, New Zealand, and the United Kingdom), none have yet studied them in detail. Further, such studies have used different measures of international research collaboration (IRC), resulting in disparate findings. This paper, therefore, analyses the strengths of CANZUK research collaborations, how those collaborations have changed over time, and assesses the effect of three ways of measures on the results (absolute strength, bilateral similarity, and multilateral similarity). We provide a detailed characterisation of the CANZUK research network and its relationships with partner countries, which reveals that the most collaborative CANZUK countries are the UK and Australia, among other findings. We also confirm that many findings differ depending on which measures are used. We offer an explanation of this difference with reference to the nature of the measures (i.e., what they really measure) and make suggestions for suitable measures in future studies depending on their purpose. Finally, we discuss how this study's findings can be used by research policy makers (in CANZUK and elsewhere) in deciding on research strategy and by researchers in appropriately measuring IRC.
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Affiliation(s)
- Ba Xuan Nguyen
- School of Information Management, Victoria University of Wellington, Wellington, New Zealand
- Faculty of Business Administration, Posts and Telecommunications Institute of Technology, Ho Chi Minh City, Vietnam
| | - Markus Luczak-Roesch
- School of Information Management, Victoria University of Wellington, Wellington, New Zealand
- Te Pūnaha Matatini, Aotearoa New Zealand’s Centre of Research Excellence for Complex Systems, Auckland, New Zealand
| | - Jesse David Dinneen
- School of Library and Information Science, Humboldt-Universität zu Berlin, Berlin, Germany
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Wahl KJ, Brooks M, Trenaman L, Desjardins-Lorimer K, Bell CM, Chokmorova N, Segall R, Syring J, Williams A, Li LC, Norman WV, Munro S. User-Centered Development of a Patient Decision Aid for Choice of Early Abortion Method: Multi-Cycle Mixed Methods Study. J Med Internet Res 2024; 26:e48793. [PMID: 38625731 DOI: 10.2196/48793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 02/23/2024] [Accepted: 02/25/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND People seeking abortion in early pregnancy have the choice between medication and procedural options for care. The choice is preference-sensitive-there is no clinically superior option and the choice depends on what matters most to the individual patient. Patient decision aids (PtDAs) are shared decision-making tools that support people in making informed, values-aligned health care choices. OBJECTIVE We aimed to develop and evaluate the usability of a web-based PtDA for the Canadian context, where abortion care is publicly funded and available without legal restriction. METHODS We used a systematic, user-centered design approach guided by principles of integrated knowledge translation. We first developed a prototype using available evidence for abortion seekers' decisional needs and the risks, benefits, and consequences of each option. We then refined the prototype through think-aloud interviews with participants at risk of unintended pregnancy ("patient" participants). Interviews were audio-recorded and documented through field notes. Finally, we conducted a web-based survey of patients and health care professionals involved with abortion care, which included the System Usability Scale. We used content analysis to identify usability issues described in the field notes and open-ended survey questions, and descriptive statistics to summarize participant characteristics and close-ended survey responses. RESULTS A total of 61 individuals participated in this study. Further, 11 patients participated in think-aloud interviews. Overall, the response to the PtDA was positive; however, the content analysis identified issues related to the design, language, and information about the process and experience of obtaining abortion care. In response, we adapted the PtDA into an interactive website and revised it to include consistent and plain language, additional information (eg, pain experience narratives), and links to additional resources on how to find an abortion health care professional. In total, 25 patients and 25 health care professionals completed the survey. The mean System Usability Scale score met the threshold for good usability among both patient and health care professional participants. Most participants felt that the PtDA was user-friendly (patients: n=25, 100%; health care professionals: n=22, 88%), was not missing information (patients: n=21, 84%; health care professionals: n=18, 72%), and that it was appropriate for patients to complete the PtDA before a consultation (patients: n=23, 92%; health care professionals: n=23, 92%). Open-ended responses focused on improving usability by reducing the length of the PtDA and making the website more mobile-friendly. CONCLUSIONS We systematically designed the PtDA to address an unmet need to support informed, values-aligned decision-making about the method of abortion. The design process responded to a need identified by potential users and addressed unique sensitivities related to reproductive health decision-making.
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Affiliation(s)
- Kate J Wahl
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
| | - Melissa Brooks
- Department of Obstetrics and Gynecology, Dalhousie University, Halifax, NS, Canada
| | - Logan Trenaman
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, United States
| | | | - Carolyn M Bell
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Nazgul Chokmorova
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Romy Segall
- Department of Obstetrics and Gynecology, Dalhousie University, Halifax, NS, Canada
| | - Janelle Syring
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
| | - Aleyah Williams
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
| | - Linda C Li
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Wendy V Norman
- Department of Family Practice, University of British Columbia, Vancouver, BC, Canada
- Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sarah Munro
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, BC, Canada
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, United States
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