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Harasym P, Beaupre LA, Juby AG, Kivi P, Majumdar SR, Hanson HM. Cultural Knowledge in Context - People Aged 50 Years and Over Make Sense of a First Fracture and Osteoporosis. J Patient Exp 2023; 10:23743735231151537. [PMID: 36687165 PMCID: PMC9850129 DOI: 10.1177/23743735231151537] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Catch a Break (CaB) is a secondary fracture prevention program that uses medical understandings of osteoporosis to assess first fractures and determine appropriateness for secondary fracture prevention. In this study, we interviewed CaB program participants to identify the understandings that patients themselves used to make sense of first fractures and the osteoporosis suggestion as cause. Semi-structured interviews were conducted with female and male participants of the CaB program in Canada. An interpretive practice approach was used to analyze the data. A random sample of 20 individuals, 12 women, and eight men all aged 50 years and over participated. First fractures were produced as meaningful in the context of osteoporosis only for seniors of very advanced age, and for people of any age with poor nutrition. The trauma events that led to a first fracture were produced as meaningful only if perceived as accidents, and having an active lifestyle was produced as beneficial only for mental health and well-being unrelated to osteoporosis. Cultural knowledge shapes, but does not determine, how individuals make sense of their health and illness experiences. Risk prevention program designers should include patients on the design team and be more aware of the presumptive knowledge used to identify individuals at risk of disease.
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Affiliation(s)
- Patricia Harasym
- Cumming School of Medicine, University of
Calgary, Calgary, Alberta, Canada,Heather M Hanson, Cumming School of
Medicine, University of Calgary, 3D10, 3280 Hospital Drive NW, Calgary, Alberta
T2N 4Z6 Canada.
| | - Lauren A Beaupre
- Department of Physical Therapy, Faculty of Rehabilitation Medicine,
University of
Alberta, Edmonton, Alberta, Canada,Department of Orthopedics, Faculty of Medicine, University of
Alberta, 2J2.00 WC Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada
| | - Angela G Juby
- Department of Medicine, Faculty of Medicine and Dentistry,
University of Alberta, 2J2.00 WC Mackenzie Health Sciences Centre, Edmonton,
Alberta, Canada
| | - Paul Kivi
- Department of Medicine, Faculty of Medicine and Dentistry,
University of Alberta, 2J2.00 WC Mackenzie Health Sciences Centre, Edmonton,
Alberta, Canada
| | - Sumit R Majumdar
- Department of Medicine, Faculty of Medicine and Dentistry,
University of Alberta, 2J2.00 WC Mackenzie Health Sciences Centre, Edmonton,
Alberta, Canada,School of Public Health, University of Alberta, 3-300 Edmonton
Clinic Health Academy, Edmonton, Alberta, Canada
| | - Heather M Hanson
- Cumming School of Medicine, University of
Calgary, Calgary, Alberta, Canada,Provincial Seniors Health and Continuing Care, Alberta Health
Services, Calgary, Alberta, Canada
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Mele BS, Holroyd-Leduc JM, Harasym P, Dumanski SM, Fiest K, Graham ID, Nerenberg K, Norris C, Parsons Leigh J, Pilote L, Pruden H, Raparelli V, Rabi D, Ruzycki SM, Somayaji R, Stelfox HT, Ahmed SB. Healthcare workers' perception of gender and work roles during the COVID-19 pandemic: a mixed-methods study. BMJ Open 2021; 11:e056434. [PMID: 35139035 PMCID: PMC8718936 DOI: 10.1136/bmjopen-2021-056434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES A high functioning healthcare workforce is a key priority during the COVID-19 pandemic. We sought to determine how work and mental health for healthcare workers changed during the COVID-19 pandemic in a universal healthcare system, stratified by gender factors. DESIGN A mixed-methods study was employed. Phase 1 was an anonymous, internet-based survey (7 May-15 July 2020). Phase 2 was semistructured interviews offered to all respondents upon survey completion to describe how experiences may have differed by gender identity, roles and relations. SETTING National universal healthcare system (Canada). PARTICIPANTS 2058 Canadian healthcare worker survey respondents (87% women, 11% men, 1% transgender or Two-Spirit), including 783 health professionals, 673 allied health professionals, 557 health support staff. Of the 63 unique healthcare worker types reported, registered nurses (11.5%), physicians (9.9%) and pharmacists (4.5%) were most common. Forty-six healthcare workers were interviewed. MAIN OUTCOME MEASURES Reported pandemic-induced changes to occupational leadership roles and responsibilities, household and caregiving responsibilities, and anxiety levels by gender identity. RESULTS Men (19.8%) were more likely to hold pandemic leadership roles compared with women (13.4%). Women (57.5%) were more likely to report increased domestic responsibilities than men (45%). Women and those with dependents under the age of 10 years reported the greatest levels of anxiety during the pandemic. Interviews with healthcare workers further revealed a perceived imbalance in leadership opportunities based on gender identity, a lack of workplace supports disproportionately affecting women and an increase in domestic responsibilities influenced by gender roles. CONCLUSIONS The COVID-19 pandemic response has important gendered effects on the healthcare workforce. Healthcare workers are central to effective pandemic control, highlighting an urgent need for a gender-transformative pandemic response strategy.
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Affiliation(s)
- Bria Scriven Mele
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jayna M Holroyd-Leduc
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Patricia Harasym
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sandra M Dumanski
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, Calgary, Alberta, Canada
| | - Kirsten Fiest
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute of Public Health, Calgary, Alberta, Canada
| | - Ian D Graham
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Kara Nerenberg
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, Calgary, Alberta, Canada
| | - Colleen Norris
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | | | - Louise Pilote
- Faculty of Medicine, McGill University, Montreal, Québec, Canada
| | - Harlan Pruden
- Faculty of Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Valeria Raparelli
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- University Center for Studies on Gender Medicine, University of Ferrara, Ferrara, Italy
| | - Doreen Rabi
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, Calgary, Alberta, Canada
- O'Brien Institute of Public Health, Calgary, Alberta, Canada
| | - Shannon M Ruzycki
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute of Public Health, Calgary, Alberta, Canada
| | - Ranjani Somayaji
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute of Public Health, Calgary, Alberta, Canada
| | - Henry Thomas Stelfox
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute of Public Health, Calgary, Alberta, Canada
| | - Sofia B Ahmed
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, Calgary, Alberta, Canada
- O'Brien Institute of Public Health, Calgary, Alberta, Canada
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Hanson HM, Harasym P, Juby AG, Kivi P, Beaupre LA, Majumdar SR. Accounts of health risk assessment survey administration in the Catch a Break Program: the social construction of osteoporosis risk identification and need for intervention. Arch Osteoporos 2021; 16:136. [PMID: 34535837 DOI: 10.1007/s11657-021-00994-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 08/22/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED Catch a Break staff conducting the organizational work of delivering secondary fracture prevention screening conversations drew on cultural and organizational resources to determine eligibility of individuals. They encountered and navigated their way through interactional troubles as they requested participation, assessed trauma risk, and provided lifestyle information. PURPOSE We investigated delivery of a population-based type C fracture liaison service for non-hip fractures. The purpose of this study was to examine accounts of how osteoporosis health risk screening interactions were delivered. METHODS A pre-determined sample of 5 organizational representatives (program staff) were interviewed by telephone. We analyzed the qualitative data through the lens of interpretive inquiry, informed by discourse analysis, to examine staff's "talk" about conducting the program risk screening conversations. RESULTS A dominant finding emerging from CAB staff's accounts of program delivery was the conversational work required to include only those individuals deemed appropriate for the program while managing the survey interaction. Staff talked about specific examples of interactional troubles they experienced as barriers to the smooth and successful risk screening conversation. They drew on cultural and organizational resources as interpretive frameworks to make decisions about individuals and groups at risk and in need of further investigation. They drew on larger ideas about ageism and genderism, judging as inappropriate for participation the oldest old adults, men involved in high risk occupations, and adults aged 50 to 70. Staff also employed interactional resources useful in managing problems in the conversation during the request to participate, trauma risk assessment, and lifestyle/health information provision sequences of the risk screening call. CONCLUSION We uncovered areas in the screening interaction that were talked about by staff as problematic to achieving the program objective of identifying and enrolling individuals in the secondary fracture prevention program. By highlighting areas for improvement in program delivery, this study may help to reduce the interactional troubles staff negotiate as they deliver this type of program.
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Affiliation(s)
- Heather M Hanson
- Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, 3D10T2N 4Z6, Canada. .,Provincial Seniors Health and Continuing Care, Alberta Health Services, 10301 Southport Lane SW, Calgary, AB, T2W 1S7, Canada.
| | - Patricia Harasym
- Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, 3D10T2N 4Z6, Canada
| | - Angela G Juby
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, 2J2.00 WC Mackenzie Health Sciences Centre, 8440 112 St. NW, Edmonton, AB, T6G 2R7, Canada
| | - Paul Kivi
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, 2J2.00 WC Mackenzie Health Sciences Centre, 8440 112 St. NW, Edmonton, AB, T6G 2R7, Canada
| | - Lauren A Beaupre
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 2-50 Corbett Hall, 8205 114 St. NW, Edmonton, AB, T6G 2G4, Canada.,Department of Orthopedics, Faculty of Medicine, University of Alberta, 2J2.00 WC Mackenzie Health Sciences Centre, 8440 112 St. NW, Edmonton, AB, T6G 2R7, Canada
| | - Sumit R Majumdar
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, 2J2.00 WC Mackenzie Health Sciences Centre, 8440 112 St. NW, Edmonton, AB, T6G 2R7, Canada.,School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 - 87 Ave NW, Edmonton, AB, T6G 1C9, Canada
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Harasym P, Brisbin S, Afzaal M, Sinnarajah A, Venturato L, Quail P, Kaasalainen S, Straus SE, Sussman T, Virk N, Holroyd-Leduc J. Barriers and facilitators to optimal supportive end-of-life palliative care in long-term care facilities: a qualitative descriptive study of community-based and specialist palliative care physicians' experiences, perceptions and perspectives. BMJ Open 2020; 10:e037466. [PMID: 32759247 PMCID: PMC7409966 DOI: 10.1136/bmjopen-2020-037466] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 06/24/2020] [Accepted: 07/07/2020] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE The COVID-19 pandemic has highlighted ongoing challenges to optimal supportive end-of-life care for adults living in long-term care (LTC) facilities. A supportive end-of-life care approach emphasises family involvement, optimal symptom control, multidisciplinary team collaboration and death and bereavement support services for residents and families. Community-based and palliative care specialist physicians who visit residents in LTC facilities play an important role in supportive end-of-life care. Yet, perspectives, experiences and perceptions of these physicians remain unknown. The objective of this study was to explore barriers and facilitators to optimal supportive end-of-life palliative care in LTC through the experiences and perceptions of community-based and palliative specialist physicians who visit LTC facilities. DESIGN Qualitative study using semi-structured interviews, basic qualitative description and directed content analysis using the COM-B (capability, opportunity, motivation - behaviour) theoretical framework. SETTING Residential long-term care. PARTICIPANTS 23 physicians who visit LTC facilities from across Alberta, Canada, including both in urban and rural settings of whom 18 were community-based physicians and 5 were specialist palliative care physicians. RESULTS Motivation barriers include families' lack of frailty knowledge, unrealistic expectations and emotional reactions to grief and uncertainty. Capability barriers include lack of symptom assessment tools, as well as palliative care knowledge, training and mentorship. Physical and social design barriers include lack of dedicated spaces for death and bereavement, inadequate staff, and mental health and spiritual services of insufficient scope for the population. CONCLUSION Findings reveal that validating families' concerns, having appropriate symptom assessment tools, providing mentorship in palliative care and adapting the physical and social environment to support dying and grieving with dignity facilitates supportive, end-of-life care within LTC.
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Affiliation(s)
- Patricia Harasym
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sarah Brisbin
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Misha Afzaal
- Faculty of Science (Undergraduate), University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Patrick Quail
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Sharon E Straus
- St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Tamara Sussman
- School of Social Work, McGill University, Montreal, Quebec, Canada
| | - Navjot Virk
- Brenda Strafford Foundation, Calgary, Alberta, Canada
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Kuntii A, Blahuta R, Stetsyk B, Sichkovska I, Harasym P. ; USE OF SPECIAL MEDICAL KNOWLEDGE BY A PRACTITIONER DURING INTERACTION WITH INVESTIGATOR IN THE INVESTIGATION OF ILLEGAL MEDICAL ACTIVITY. Georgian Med News 2020:182-189. [PMID: 32965272] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The article deals with issues related to the use of specialist medical knowledge by a specialist in the investigation of illegal medical activities. The procedural status of a specialist in criminal procedural legislation of Georgia, Ukraine and certain EU countries has been carried out. The analysis of forms and directions of the use of special knowledge in the course of interaction with the investigator, allows to establish a special value for the process of proving the involvement of a specialist in the field of medicine to conduct procedural actions. It was found that by means of special medical knowledge in the course of the investigation there will be more chances to establish the circumstances to be proven, to properly record the evidence and to increase the effectiveness of the procedural action. Based on the consultations with a medical specialist, in the course of organizational and technical cooperation with the investigator, it will help to identify all circumstances that will influence the qualification of the person's actions in conducting illegal medical activity. On the basis of comparison with the Ukrainian legislation, the role in the form of involvement in procedural actions is determined; coverage of procedural and forensic aspects of using specialist medical knowledge by a specialist. Emphasis is placed on procedural interactions between the investigator and the medical specialist by involving his investigative (search) actions, such as: review of scene of action, search, interrogation and investigative experiment. While characterizing the non-procedural form of interaction between the investigator and medical specialist, the role of the latter in providing consultations on the preparation and conduct of individual procedural actions, reference and advisory assistance regarding the availability of special medical knowledge and consequences resulting from treatment, as well as in formulating questions during the appointment of forensic investigations during the investigation of illicit medical activities has been established.
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Affiliation(s)
- A Kuntii
- Lviv State University of Internal Affairs
| | - R Blahuta
- Lviv State University of Internal Affairs
| | - B Stetsyk
- Lviv State University of Internal Affairs
| | | | - P Harasym
- Lviv State University of Internal Affairs
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6
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Abstract
BACKGROUND The increasing consideration of cannabis legalization in Canada and the United States has motivated physicians to assess its prospective impact on the health care system. Health care providers in the burns community are concerned about injuries sustained as a result of the illegal manufacturing of cannabis oil because it involves highly flammable reagents. METHODS We report a retrospective case series of patients with cannabis oil burns (identified by evidence of combustion during cannabis oil manufacturing) treated from April 2012 to March 2014 at the Foothills Medical Centre in Calgary, Alberta, Canada. We compare the characteristics of these patients with those of patients admitted over the same period with any burns. RESULTS We found that 12 (out of 161 patients) admitted over the review period sustained burns from cannabis oil manufacturing. Compared with patients in the total burn group, patients with cannabis oil burns were younger (75% and 48% were younger than 41 years in the group with cannabis oil burns and the total burn group, respectively), were more likely to be male (83% in the group with cannabis oil burns v. 74% in the total burn group) and sustained burns over a larger percentage of their total body surface area (24% v. 9%). Patients with cannabis oil burns also required extensive surgical management (skin grafting in 75% of cases) and spent a substantial amount of time (mean 32 d) in the burn unit. INTERPRETATION Burns from illegal cannabis oil manufacturing are large, require extensive management and involve younger patients than burns in general. Given that the frequency of cannabis oil burns may increase in Canada after legalization, Canadian burn centres are encouraged to monitor and report on cases with this injury mechanism.
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Affiliation(s)
- Sarthak Sinha
- Affiliations: Departments of Clinical Neurosciences, Pediatrics and Surgery (Sinha, Ricord, Harasym, Gabriel, Nickerson), Faculty of Medicine, University of Calgary; Department of Comparative Biology and Experimental Medicine (Sinha, Harasym, Biernaskie), Faculty of Veterinary Medicine, University of Calgary; Calgary Firefighters Burn Treatment Society (Nickerson, Gabriel), Calgary, Alta
| | - Kyle Ricord
- Affiliations: Departments of Clinical Neurosciences, Pediatrics and Surgery (Sinha, Ricord, Harasym, Gabriel, Nickerson), Faculty of Medicine, University of Calgary; Department of Comparative Biology and Experimental Medicine (Sinha, Harasym, Biernaskie), Faculty of Veterinary Medicine, University of Calgary; Calgary Firefighters Burn Treatment Society (Nickerson, Gabriel), Calgary, Alta
| | - Patricia Harasym
- Affiliations: Departments of Clinical Neurosciences, Pediatrics and Surgery (Sinha, Ricord, Harasym, Gabriel, Nickerson), Faculty of Medicine, University of Calgary; Department of Comparative Biology and Experimental Medicine (Sinha, Harasym, Biernaskie), Faculty of Veterinary Medicine, University of Calgary; Calgary Firefighters Burn Treatment Society (Nickerson, Gabriel), Calgary, Alta
| | - Jeff A Biernaskie
- Affiliations: Departments of Clinical Neurosciences, Pediatrics and Surgery (Sinha, Ricord, Harasym, Gabriel, Nickerson), Faculty of Medicine, University of Calgary; Department of Comparative Biology and Experimental Medicine (Sinha, Harasym, Biernaskie), Faculty of Veterinary Medicine, University of Calgary; Calgary Firefighters Burn Treatment Society (Nickerson, Gabriel), Calgary, Alta
| | - Duncan Nickerson
- Affiliations: Departments of Clinical Neurosciences, Pediatrics and Surgery (Sinha, Ricord, Harasym, Gabriel, Nickerson), Faculty of Medicine, University of Calgary; Department of Comparative Biology and Experimental Medicine (Sinha, Harasym, Biernaskie), Faculty of Veterinary Medicine, University of Calgary; Calgary Firefighters Burn Treatment Society (Nickerson, Gabriel), Calgary, Alta
| | - Vincent A Gabriel
- Affiliations: Departments of Clinical Neurosciences, Pediatrics and Surgery (Sinha, Ricord, Harasym, Gabriel, Nickerson), Faculty of Medicine, University of Calgary; Department of Comparative Biology and Experimental Medicine (Sinha, Harasym, Biernaskie), Faculty of Veterinary Medicine, University of Calgary; Calgary Firefighters Burn Treatment Society (Nickerson, Gabriel), Calgary, Alta
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Horch JD, Carr ECJ, Harasym P, Burnett L, Biernaskie J, Gabriel V. Firefighter willingness to participate in a stem cell clinical trial for burns: A mixed methods study. Burns 2016; 42:1740-1750. [PMID: 27387706 DOI: 10.1016/j.burns.2016.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 06/04/2016] [Accepted: 06/06/2016] [Indexed: 01/17/2023]
Abstract
Adult stem cells represent a potentially renewable and autologous source of cells to regenerate skin and improve wound healing. Firefighters are at risk of sustaining a burn and potentially benefiting from a split thickness skin graft (STSG). This mixed methods study examined firefighter willingness to participate in a future stem cell clinical trial, outcome priorities and factors associated with this decision. METHODS A sequential explanatory mixed methods design was used. The quantitative phase (online questionnaire) was followed by the qualitative phase (semi-structured interviews). A sample of 149 firefighters completed the online survey, and a purposeful sample of 15 firefighters was interviewed. RESULTS A majority (74%) reported they would participate in a future stem cell clinical trial if they experienced burn benefiting from STSG. Hypothetical concerns related to receiving a STSG were pain, itch, scarring/redness and skin durability. Participants indicated willingness to undergo stem cell therapy if the risk of no improvement was 43% or less. Risk tolerance was predicted by perceived social support and having children. Interviews revealed four main themes: a desire to help others, improving clinical outcomes, trusting relationships, and a belief in scientific investigation. Many participants admitted lacking sufficient knowledge to make an informed decision regarding stem cell therapies. CONCLUSIONS Firefighters indicated they were largely willing to participate in a stem cell clinical trial but also indicated a lack of knowledge upon which to make a decision. Public education of the role of stem cells in STSG will be increasingly important as clinical trials are developed.
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Affiliation(s)
- Jenny D Horch
- Department of Allied Health, Foothills Medical Centre, Alberta Health Services, Calgary, Alberta, Canada.
| | - Eloise C J Carr
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Patricia Harasym
- Department of Comparative Biology and Experimental Medicine, Faculty of Veterinary Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lindsay Burnett
- Calgary Firefighters Burn Treatment Centre, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Jeff Biernaskie
- Department of Comparative Biology and Experimental Medicine, Faculty of Veterinary Medicine, Department of Surgery, Faculty of Medicine, Alberta Children's Hospital Research Institute, and Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Vincent Gabriel
- Division of Physical Medicine and Rehabilitation, Departments of Clinical Neurosciences, Pediatrics and Surgery, Faculty of Medicine, Alberta Children's Hospital Research Institute, McCaig Institute for Bone and Joint Research, University of Calgary, Calgary, Alberta, Canada
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Aflatoonian A, Baghianimoghadam B, Abdoli A, Partovi P, Hemmati P, Tabibnejad N, Harasym P. Developing an educational scheme for undergraduate medical Curriculum: the unit of "infertility" as a sample. J Med Life 2012; 5:16-20. [PMID: 22574082 PMCID: PMC3307074] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Accepted: 01/26/2012] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVES To present our first experience in scheme development based on CPC philosophy in Iran. HYPOTHESIS One of the most important reasons of an obvious gap between medical education and professional expectations (outcomes) encountered by recent medical graduates is due to applying conventional curricula, which rely on hypothetical-deductive reasoning model. The University of Calgary has implemented a new curriculum which is organized according to 125 ways in which patients may present to a physician. In this study we will present our first experience in scheme development based on CPC philosophy in Iran. METHODS In 2007, research and clinical center for infertility (Yazd University of medical sciences, IRAN), began developing a full module for infertility (lesson plan) with fourteen components based on the new curricular philosophy. We recruited a scheme of infertility according to a specific way. RESULTS Thus, at the first step of the module creation, a scheme was made as the most important mainstay of presentation module, i.e. a structured scheme that includes all causative diseases of infertility. CONCLUSIONS Any effort in the organization of knowledge around schemes including in the domain of infertility would be valuable to meet some of the standards of WFME. Also, development of modules, by the teams composed of experts and students, can improve the quality of medical education.
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Affiliation(s)
- A Aflatoonian
- Research and Clinical Center for Infertility, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - B Baghianimoghadam
- Research and Clinical Center for Infertility, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - A Abdoli
- Research and Clinical Center for Infertility, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - P Partovi
- Research and Clinical Center for Infertility, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - P Hemmati
- Center for Disease Control, Deputy Ministry for Health Affairs, Ministry of Health and Medical Education, Tehran, Iran
| | - N Tabibnejad
- Research and Clinical Center for Infertility, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - P Harasym
- Faculty of Medicine, University of Calgary, Alberta, Canada
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Abstract
OBJECTIVE To evaluate the benefit, for medical students on their surgical rotations, of real-time educational instruction during order entry on a hospital information system. DESIGN Prospective controlled trial. INTERVENTION Access to educational information during computerized order entry. SUBJECTS Medical students in their final year at the University of Calgary. MAIN OUTCOMES Attainment of the surgery rotation educational objectives, as measured by performance on a multiple-choice examination. METHODS Before they began their surgical rotations, students at two hospitals took a multiple-choice examination to measure their knowledge of surgery. One hospital had an information system with computerized order entry; students at this hospital had access, while composing orders, to educational material on the system. The other hospital did not have an information system; students there wrote orders on a paper chart. At the end of the rotation, all students took another multiple-choice examination. RESULTS Of 50 eligible students, 45 agreed to participate in the project, 21 in the treatment group and 24 in the control group. Pre-rotation scores were similar for the two groups (43 percent in the treatment group and 40 percent in the control group; SD, 10 percent). Post-rotation scores were identical for the two groups (65 percent in the treatment group and 65 percent in the control group; SD, 12 percent). A t-test analysis revealed no significant difference in performance on the examinations between the two groups. CONCLUSION This study did not demonstrate a learning advantage for medical students who have access to educational material on a hospital information system.
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Woloschuk W, Harasym P, Mandin H, Jones A. Use of scheme-based problem solving: an evaluation of the implementation and utilization of schemes in a clinical presentation curriculum. Med Educ 2000; 34:437-442. [PMID: 10792683 DOI: 10.1046/j.1365-2923.2000.00572.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
CONTEXT The University of Calgary has implemented a new curriculum which is organized according to 120 ways in which patients may present to a physician. Students are taught scheme-based problem solving rather than the more typical hypothetico-deductive or search and scan approach to problem resolution. OBJECTIVE This study sought to determine the extent to which faculty and students were implementing and utilizing scheme-based problem solving. METHOD All classes taught within the new clinical presentation curriculum were surveyed at the year end. Participants included four classes of first-year students and three classes of second-year students. Using a 5-point scale, students responded to survey items regarding scheme implementation and utilization. RESULTS Data were analysed using MANOVA (multivariate analysis of variance) and revealed significant differences among classes in both first- and second-year students. Increments in scheme implementation and utilization by instructors and students were observed, although instructors' utilization of schemes lagged behind that of students. A levelling effect to the benefits of schemes for problem solving was also evident. First-year students reported schemes to be very useful for learning and organizing new information. CONCLUSION Although it has taken time to implement curriculum change, the student response to schemes has been favourable. Faculty development and further generation of pictorial/spatial representations for all schemes, to ensure that all clinical presentations provide pathways that students can use for both learning and problem solving are recommended. Whether students who utilize schemes are more successful problem solvers is not yet known but will be the subject of study as soon as scheme delivery is predominant.
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Affiliation(s)
- W Woloschuk
- Undergraduate Medical Education, Faculty of Medicine, University of Calgary, Alberta, Canada
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12
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Papa FJ, Harasym P, Schumacker R, Aldrich DG, Stone RC. The impact of an alternative approach to construct definition upon the reliability and utility of diagnostic performance measures. Acad Med 1998; 73:S100-S102. [PMID: 9795666 DOI: 10.1097/00001888-199810000-00059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Affiliation(s)
- F J Papa
- University of North Texas Health Science Center, Fort Worth 76107-2699, USA.
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13
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Taenzer PA, Speca M, Atkinson MJ, Bultz BD, Page S, Harasym P, Davis JL. Computerized quality-of-life screening in an oncology clinic. Cancer Pract 1997; 5:168-75. [PMID: 9171553] [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] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE The purpose of these studies was to assess the feasibility and reliability of computerized quality-of-life screening for patients attending an outpatient breast cancer clinic. The screening program involved a computerized administration of the European Organization for Research and Treatment of cancer QUality of Life Questionnaire (EORTC QLQ-C30). The computer software generated a screening report that clinic staff members used in the clinical encounter to assist in identifying quality-of-life problems. DESCRIPTION OF STUDY Two studies are reported. In study I, 36 patients and either their nurses or physicians evaluated the feasibility of the screening program using questionnaires developed for this study. In study II, a separate sample of 50 patients completed both the computerized and paper-and-pencil versions of the QLQ-C30 to assess reliability and consistency of responding. RESULTS The results of study I indicate that the patients found the computerized administration to be an acceptable means of providing staff members with information on day-to-day functioning. Clinic nurses and physicians indicated that the report was useful in identifying problematic quality-of-life domains. The results of study II indicate that the computerized administration is highly correlated with the paper-and-pencil version and has similar internal consistency. Discrepancies in responses were identified, but were at an acceptable level. CLINICAL IMPLICATIONS The results of these studies indicate that computerized quality-of-life screening is feasible and may provide reliable data for research and quality assurance studies. Staff evaluations suggest that the written report may provide clinic staff members with a tool for identifying quality-of-life concerns in which individual patients are experiencing difficulty. Potential benefit to patients include productive use of waiting room time, greater efficiency in the assessment process, and an improved likelihood that nurses and physicians will recognize and attend to quality-of-life deficits. The valid, reliable, and efficient identification of important patient quality-of-life concerns allows multidisciplinary team members to focus meaningfully their clinical efforts within their respective areas of responsibility.
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Affiliation(s)
- P A Taenzer
- Department of Psychology, Foothills Hospital, Calgary, Alberta, Canada
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14
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Abstract
Analysis of problem-solving strategies reveals that although there is no universal, generic problem-solving process, there is a clinical reasoning process that is specific and highly tailored to the complexity of each clinical problem. Research reveals that successful problem solvers must possess comprehensive knowledge, but that the way they organize and understand their knowledge is even more critical. Moreover, using "schemes" for both learning and problem solving provides the advantage of combining the creation of a knowledge structure and a search-and-retrieval strategy into a single operation. (A "scheme" in this context is a mental categorization of knowledge that includes a particular organized way of understanding and responding to a complex situation.) The implication for medical education is that a comprehensive knowledge domain must be appropriately organized for knowledge mastery, which in turn is essential for clinical problem solving. Problem-solving strategies must be specific for each problem and not based on the assumption of a universal generic process. Consequently, a new taxonomy of medical problems is recommended, along with an altered problem-based learning (PBL) format. The "hypothetico-deductive" strategy traditionally used in PBL should be replaced by scheme-driven search strategies so that students develop a more organized and logical approach to problem solving.
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Affiliation(s)
- H Mandin
- Department of Medicine, University of Calgary Faculty of Medicine, Alberta, Canada.
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15
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Abstract
Currently, medical curricula are structured according to disciplines, body systems, or clinical problems. Beginning in 1988, the faculty of the University of Calgary Faculty of Medicine (U of C) carefully evaluated the advantages and disadvantages of each of these models in seeking to revise their school's curriculum. However, all three models fell short of a curricular structure based on current knowledge and principles of adult learning, clinical problem solving, community demands, and curriculum management. By 1991, the U of C had formulated a strategic plan for a revised curriculum structure based on the way patients present to physicians, and implementation of this plan has begun. In creating the new curriculum, 120 clinical presentations (e.g., "loss of consciousness/syncope") were defined and each was assigned to an individual or small group of faculty for development based on faculty expertise and interest. Terminal objectives (i.e., "what to do") were defined for each presentation to describe the appropriate clinical behaviors of a graduating physician. Experts developed schemes that outlined how they differentiated one cause (i.e., disease category) from another. The underlying enabling objectives (i.e., knowledge, skills, and attitudes) for reaching the terminal objectives for each clinical presentation were assigned as departmental responsibilities. A new administrative structure evolved in which there is a partnership between a centralized multidisciplinary curriculum committee and the departments. This new competency-based, clinical presentation curriculum is expected to significantly enhance students' development of clinical problem-solving skills and affirms the premise that prudent, continuous updating is essential for improving the quality of medical education.
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Affiliation(s)
- H Mandin
- Department of Anesthesia, University of Calgary Faculty of Medicine, Alberta, Canada
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16
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McDougall GM, Vosburgh D, Harasym P. The effect of structure on attendance in a day-hospital program. Int J Partial Hosp 1986; 3:231-6. [PMID: 10284188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
The effects of program structure on patient attendance rates within a day-hospital program were studied. It has been recognized that regular attendance at partial-hospitalization programs is necessary to facilitate improvement in patient skill deficits. In this study, three different program structures were offered in a 40-person day program. Significant differences in attendance rates were achieved.
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17
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Harasym P, Baumber J, Bryant H, Fundytus D, Preshaw R, Watanabe M, Wyse G. An evaluation of the clinical problem-solving process using a simulation technique. Med Educ 1980; 14:381-386. [PMID: 7442576 DOI: 10.1111/j.1365-2923.1980.tb02388.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Currently, research does not agree as to the extent to which medical content and problem-solving processes underlie clinical problem-solving. The results of research in this area fall into two categories: (1) clinical problem-solving is primarily dependent upon medical content specific within the case, and (2) clinical problem-solving is a skill, or series of skills, which can be applied to all clinical problems. In the study reported in this paper, seventy-one second-year medical students who had completed a 2-year, body-systems oriented curriculum were given an examination designed to measure clinical problem-solving. The results indicated that gathering data on patient history and hypotheses generation were specific skills common to clinical problem-solving, while hypotheses refinement, identification of relevant physical examinations, ordering laboratory investigations and making a diagnosis were case-related.
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