Not in the file: How competency committees work with undocumented contributions.

INTRODUCTION: Competence committees (CCs) centre their work around documentation of trainees' performance; undocumented contributions (i.e. informal, unrecorded material like personal judgements, experiential anecdotes and contextual information) evoke suspicion even though they may play a role in decision making. This qualitative multiple case study incorporates insights from a social practice perspective on writing to examine the use of undocumented contributions by the CCs of two large post-graduate training programmes, one in a more procedural (MP) speciality and the other in a less procedural (LP) one. METHODS: Data were collected via observations of meetings and semi-structured interviews with CC members. In the analysis, conversations were organised into triptychs of lead-up, undocumented contribution(s), and follow-up. We then created thick descriptions around the undocumented contributions, drawing on conversational context and interview data to assign possible motivations and significance. RESULTS: We found no instances in which undocumented contributions superseded the contents of a trainee's file or stood in for missing documentation. The number of undocumented contributions varied between the MP CC (six instances over two meetings) and the LP CC (22 instances over three meetings). MP CC discussions emphasised Entrustable Professional Activity (EPA) observations, whereas LP CC members paid more attention to narrative data. The divergent orientations of the CCs-adding an 'advis[ing]/guid[ing]' role versus focusing simply on evaluation-offers the most compelling explanation. In lead-ups, undocumented contributions were prompted by missing and flawed documentation, conflicting evidence and documentation at odds with members' perceptions. Recognising other 'red flags' in documentation often required professional experience. In follow-ups, purposes served by undocumented contributions varied with context and were difficult to generalise; we, therefore, provide deeper analysis of two vignettes to illustrate. CONCLUSIONS: Our data suggest undocumented contributions often serve best efforts to ground decisions in documentation. We would encourage CC practices and policies be rooted in more nuanced approaches to documentation.

The persistent threat of emerging plant disease pandemics to global food security.

Plant disease outbreaks are increasing and threaten food security for the vulnerable in many areas of the world. Now a global human pandemic is threatening the health of millions on our planet. A stable, nutritious food supply will be needed to lift people out of poverty and improve health outcomes. Plant diseases, both endemic and recently emerging, are spreading and exacerbated by climate change, transmission with global food trade networks, pathogen spillover, and evolution of new pathogen lineages. In order to tackle these grand challenges, a new set of tools that include disease surveillance and improved detection technologies including pathogen sensors and predictive modeling and data analytics are needed to prevent future outbreaks. Herein, we describe an integrated research agenda that could help mitigate future plant disease pandemics.

What do you mean, 'negotiating?': Patient, physician, and healthcare professional experiences of navigating hierarchy in networks of interprofessional care.

Interprofessional collaborative practice is a phenomenon that can be fraught with power dynamics between professions, within professions, and between professionals and patients. In the literature, the dominant notion is that conflicting viewpoints and interests arising from unequal power dynamics can be resolved through negotiation. This study examined COPD patients, health professionals, and physician experiences of negotiation within 10 interprofessional collaborative COPD care teams. Physicians, patients, and healthcare professionals each had strikingly different conceptions and experiences of negotiating their perspective with other team members. Our study suggests that negotiation is an idealized notion rather than a relational process embedded in interprofessional collaborative practice. Importantly, we found that the ability and opportunity to negotiate one's perspective is heavily influenced by one's position in the workplace division of labor and professional hierarchy. We conclude that "negotiation" is only one approach among many in navigating interprofessional relations. Further, the rhetorical and ideological appeal of "negotiation" may overstate its role in interactions in interprofessional care settings, and lead to a misunderstanding of the power dynamics at play. It may be naïve to assume team members can control their situation through the competitive assertion of their individual perspective in a rational debate. Unfortunately, adopting the language of negotiation uncritically may not offer relevant solutions to structural and collective problems within a healthcare workplace.

A qualitative study of medical students' perceptions of resident feedback.

CONTEXT: Residents play a pivotal role in medical students' clinical education. From a feedback lens, the near-peer relationship between student and resident holds the potential to foster an educational alliance that could influence learning. We undertook the current qualitative study to explore medical students' perceptions of feedback experiences with residents, addressing when, how and why (and conversely when not and why not) resident feedback plays a role in their clinical education. METHODS: Our methodology was qualitative interpretive description, informed by phenomenology. We conducted 24 semi-structured interviews with third and fourth year medical students at one institution. The interviews aimed to foster rich discussion about students' feedback experiences with residents during clinical rotations. Data collection and analysis proceeded iteratively. Initial interviews were independently open-coded by three investigators and then collaboratively refined. Codes were applied to subsequent interviews, and new codes were developed. During the final stages of analysis, we organised our themes by drawing on a sociocultural perspective to examine students' perceptions of relationship-building with residents and when and how this influenced feedback and learning. RESULTS: From the students' perspectives, when residents contributed to building interpersonal relationships with students, this in turn influenced students' receptivity to both encouraging and constructive feedback conversations. In the context of resident-student relationships that were perceived as supportive, resident feedback influenced how students approached learning and working in the clinical environment, as well as students' visions of their future selves. In unsupportive relationships, students were less inclined to engage in feedback with residents and students noted resident behaviours that they wanted to avoid in themselves. CONCLUSION: Residents are uniquely positioned to create a strong educational alliance with students in which feedback conversations can flourish. Focusing educational efforts on resident feedback conversations has the potential to significantly impact the feedback culture of our clinical environments.

Diverse adaptation strategies helped local food producers cope with initial challenges of the Covid-19 pandemic: Lessons from Québec, Canada.

The Covid-19 pandemic has demonstrated the vulnerability of food systems to disturbances. Advocates have promoted short food supply chains as more resilient and adaptable thanks to their embeddedness in local economic and ecological networks. As part of a broader case study on challenges facing farmers in local food supply chains in Québec, Canada, we asked farmers about the pandemic's impacts on food production and marketing in the province, including how food producers coped with these challenges. We sent an online questionnaire to 1,046 farmers who distribute food through direct marketing in Québec, identified through consumer-facing online platforms. We conducted follow-up interviews with 15 of the 133 farmers that completed the questionnaire to gain a better understanding of their pandemic-related challenges and opportunities, as well as their adaptation needs and strategies. We identified four main types of challenges among farmers: workforce shortages, balancing food demand and supply, changes in sales outlets and marketing channels, and other operational and development issues. In turn, six key adaptation strategies helped farmers reorganize their marketing and sales, which we categorize as: redistribution, streamlining, replacement, collaboration, farm adjustment, and outlet adjustment. Most surveyed local farmers felt well-prepared to adapt to the four major challenges that the Covid-19 pandemic forged or escalated, and our findings suggest that they demonstrated remarkable resilience to additional challenges posed by the pandemic. Our study therefore contributes important insights about how flexibility and redundancy among local farmers stabilized the local food system during the onset of a global pandemic.

Macro and meso level influences on distributed integrated COPD care delivery: a social network perspective.

BACKGROUND: Care guidelines for people with chronic obstructive pulmonary disease (COPD) recommend an integrated approach for holistic, flexible, and tailored interventions. Continuity of care is also emphasised. However, many patients with COPD experience fragmented care. Discontinuities in healthcare and related social services are likely to result in disjointed rather than integrated care which can negatively affect patient health outcomes. The purpose of this qualitative study was to improve our understanding of, and how, contextual features pertaining to structures and processes of COPD integrated care influence delivery of care within patients' healthcare networks. METHODS: We conducted individual interviews with 28 participants (9 patients, 16 healthcare professionals, and 3 spousal caregivers). Participants were recruited through the lung clinic at a city hospital in western Canada. We employed a social network paradigm to analyse and interpret the data. RESULTS: The analysis revealed an overarching theme of fragmented COPD care with two sub-themes: (1) Funding shortfalls and availability of resources, and (2) Dis(mis)connected communication pathways. The overarching theme depicts variations, delays, and discontinuities in patient care. The sub-themes describe how macro level influences and meso level shortfalls were perceived to influence the availability of respiratory care resources that contributed to fragmented COPD care. CONCLUSIONS: Employing a social network lens drew particular attention to family physicians' pivotal role in delivering community-based COPD care. While an integrated approach to care is recommended by care guidelines, institutional and organizational structures and processes, such as financial and communication structures, may inhibit delivery of integrated care. Thus, macro and meso level structures and processes have the potential to shape patient care by constraining family physicians' purposive and communication actions necessary for facilitating an integrated distributed approach to care. We propose a context of care which fosters a context for family physicians' delivery of patient-centered care. Integrated care delivery may improve patients' wellbeing and alleviate financial constraints on the healthcare system.

Definitive chemoradiotherapy for cervical cancer: A 11-year population-based study.

PURPOSE: To assess the recurrence pattern and survival in women treated with definitive chemoradiotherapy for cervical cancer. METHODS: A retrospective cohort study of women FIGO (2012) stage IB2 to IVA from the Grampian region of Scotland between February 2000 and March 2011. These women were followed up until April 2018. RESULTS: A total of 121 eligible women allocated with mean age at treatment 50.59 years (SD = 13.98, range 22-82). Tumours staged: IB2: n = 24 (19.8%), II: n = 45 (37.2%), III: n = 43 (35.5%) and IVA: n = 7 (5.8%). Two (1.7%) women had no available data. Fifty-five (45.5%) women had recurrence after treatment, and 51 (42.15%) women died from the disease. The sites of recurrence were as follows: central pelvic only (n = 4, 7.27%), pelvic and distant (n = 39, 70.91%) and distant only (n = 12, 21.82%) with median time from end of treatment to first recurrence 44 months (range 2-98), 26 months (range 1-146) and 22 months (range 3-66) respectively. 5-and 8-year overall survival was 76.0% (95% CI: 68.8%-84.0%) and 64.4% (95% CI: 56.4%-73.5%) respectively. CONCLUSIONS: Though overall survival is better than with radiotherapy alone, recurrence occurs up to 10 years after treatment. This raises the issues of how to reduce late recurrence and the appropriateness of current follow-up protocols.

Mitigating the bilateral deficit: reducing neural deficits through residual force enhancement and activation reduction.

PURPOSE: The bilateral deficit (BLD) is characterized by a reduction in maximal voluntary torque during a bilateral contraction relative to the sum of left and right unilateral contractions. The BLD has been attributed to interhemispheric inhibition as a result of unilateral torque differences between limbs. If the BLD is the result of interhemispheric inhibition, lowering activation for a torque matching task, as shown in residual force enhancement (RFE), may help overcome the decrease in neural drive during bilateral contractions. Therefore, the purpose of the present study was to determine whether RFE could reduce the BLD. METHODS: Participants (n = 12) performed both isometric and RFE MVCs of the elbow flexors under three conditions: (1) unilateral-left; (2) unilateral-right; and (3) bilateral. To directly address the purpose of the study, a sub-group of participants that displayed both RFE and a BLD ("Responders", n = 6) were selected from the participant pool. RESULTS: "Responders" displayed RFE (7.1 ± 5.3%) and an isometric BLD (BI: - 9.9 ± 3.2%). In the RFE state, the BLD was no longer significant (- 5.8 ± 7.9%), accompanied by the elimination of differences in biceps brachii EMG between arms (left: - 11.7 ± 10.3%; right: - 11.5 ± 13.2%), as seen during isometric contractions (left: - 12.0 ± 23.2%; right: - 21.1 ± 16.6%). CONCLUSION: Residual force enhancement appears to mitigate the BLD, alleviating the effects of a decrease in neural drive by allowing more force for a given level of muscle activation when compared to a purely isometric contraction.

eHealth Technologies, Multimorbidity, and the Office Visit: Qualitative Interview Study on the Perspectives of Physicians and Nurses.

BACKGROUND: eHealth is a broad term referring to the application of information and communication technologies in the health sector, ranging from health records to telemedicine and multiple forms of health education and digital tools. By providing increased and anytime access to information, opportunities to exchange experiences with others, and self-management support, eHealth has been heralded as transformational. It has created a group of informed, engaged, and empowered patients as partners, equipped to take part in shared decision making and effectively self-manage chronic illness. Less attention has been given to health care professionals' (HCPs) experiences of the role of eHealth in patient encounters. OBJECTIVE: The objective of this study was to examine HCPs' perspectives on how eHealth affects their relationships with patients living with multiple chronic conditions, as well as its ethical and practical ramifications. METHODS: We interviewed HCPs about their experiences with eHealth and its impact on the office visit. Eligible participants needed to report a caseload of ≥25% of patients with multimorbidity to address issues of managing complex chronic conditions and coordination of care. We used a semistructured discussion guide for in-depth interviews, and follow-up interviews served to clarify and expand upon initial discussions. Constant comparisons and a narrative approach guided the analyses, and a relational ethics conceptual lens was applied to the data to identify emergent themes. RESULTS: A total of 12 physicians and nurses (6 male, 6 female; median years of practice=13) participated. eHealth tools most frequently described were Web-based educational resources for patients and Web-based resources for HCPs such as curated scientific summaries on diagnostic criteria, clinical therapies, and dosage calculators. Analysis centered on a grand theme of the two-way conversation between HCPs and patients, which addresses a general recentering of the ethical relationship between HCPs and patients around engagement. Subthemes explain the evolution of the two-way conversation, and having, using, and supporting the two-way conversation with patients, primarily as this relates to achieving adherence and health outcomes. CONCLUSIONS: Emerging ethical concerns were related to the ambiguity of the ideal of empowered patients and the ways in which health professionals described enacting those ideals in practice, showing how the cultural shift toward truly mutually respectful and collaborative practice is in transition. HCPs aim to act in the best interests of their patients; the challenge is to benefit from emergent technologies that may enhance patient-HCP interactions and effective care, while abiding by regulations, dealing with the strictures of the technology itself, and managing changing demands on their time.

Socio-environmental consideration of phosphorus flows in the urban sanitation chain of contrasting cities.

Understanding how cities can transform organic waste into a valuable resource is critical to urban sustainability. The capture and recycling of phosphorus (P), and other essential nutrients, from human excreta is particularly important as an alternative organic fertilizer source for agriculture. However, the complex set of socio-environmental factors influencing urban human excreta management is not yet sufficiently integrated into sustainable P research. Here, we synthesize information about the pathways P can take through urban sanitation systems along with barriers and facilitators to P recycling across cities. We examine five case study cities by using a sanitation chains approach: Accra, Ghana; Buenos Aires, Argentina; Beijing, China; Baltimore, USA; and London, England. Our cross-city comparison shows that London and Baltimore recycle a larger percentage of P from human excreta back to agricultural lands than other cities, and that there is a large diversity in socio-environmental factors that affect the patterns of recycling observed across cities. Our research highlights conditions that may be "necessary but not sufficient" for P recycling, including access to capital resources. Path dependencies of large sanitation infrastructure investments in the Global North contrast with rapidly urbanizing cities in the Global South, which present opportunities for alternative sanitation development pathways. Understanding such city-specific social and environmental barriers to P recycling options could help address multiple interacting societal objectives related to sanitation and provide options for satisfying global agricultural nutrient demand.

Agronomic phosphorus imbalances across the world's croplands.

Increased phosphorus (P) fertilizer use and livestock production has fundamentally altered the global P cycle. We calculated spatially explicit P balances for cropland soils at 0.5° resolution based on the principal agronomic P inputs and outputs associated with production of 123 crops globally for the year 2000. Although agronomic inputs of P fertilizer (14.2 Tg of P·y(-1)) and manure (9.6 Tg of P·y(-1)) collectively exceeded P removal by harvested crops (12.3 Tg of P·y(-1)) at the global scale, P deficits covered almost 30% of the global cropland area. There was massive variation in the magnitudes of these P imbalances across most regions, particularly Europe and South America. High P fertilizer application relative to crop P use resulted in a greater proportion of the intense P surpluses (>13 kg of P·ha(-1)·y(-1)) globally than manure P application. High P fertilizer application was also typically associated with areas of relatively low P-use efficiency. Although manure was an important driver of P surpluses in some locations with high livestock densities, P deficits were common in areas producing forage crops used as livestock feed. Resolving agronomic P imbalances may be possible with more efficient use of P fertilizers and more effective recycling of manure P. Such reforms are needed to increase global agricultural productivity while maintaining or improving freshwater quality.

Identifying leverage points for sustainable nutrient policy integration in Canada.

Addressing the 'wicked problem' of nutrient pollution requires coordinated policies spanning across diverse sectors and environmental systems. Using a case study of Canadian legislation, we apply semantic network analysis to identify thematic links across an inventory of 245 nutrient-related policies. Our analysis identifies twelve topics with unique types of connections across multiple facets of Canadian society. 'Hub' policies include broad environmental protection, land use planning, and climate-related legislation with close ties to multiple other topics. 'Bridge' policies create connections among otherwise disconnected topics in the network, representing opportunities to inform new policy proposals. Some legislation, such as food processing regulations, indirectly relates to nutrient use but could inform policy integration towards more coordinated and holistic nutrient management across the food system. A computational text network approach can be useful for addressing challenges in complex policy analysis, including by identifying unique entry points to guide more cross-cutting nutrient policy development.

A patienthood that transcends the patient: An analysis of patient research partners' narratives of involvement in a Canadian arthritis patient advisory board.

OBJECTIVES: Incorporating the perspectives of patients and public into the conduct of research has the potential to make scientific research more democratic. This paper explores how being a patient partner on an arthritis patient advisory board shapes the patienthood of a person living with arthritis. METHODS: An analysis was undertaken of the narratives of 22 patient research partners interviewed about their experiences on the Arthritis Patient Advisory Board (APAB), based in Vancouver, Canada. RESULTS: Participants' motivations to become involved in APAB stemmed largely from their desire to change their relationship with their condition. APAB was a living collective project in which participants invested their hope, both for their own lives as patients and for others with the disease. CONCLUSIONS: Our findings highlight how the journeys of patient partners connect and integrate seemingly disparate conceptions of what it means to be a patient. One's experience as a clinical 'patient' transforms into the broader notion of civic patienthood.

Genomics of sablefish (Anoplopoma fimbria): expressed genes, mitochondrial phylogeny, linkage map and identification of a putative sex gene.

BACKGROUND: The sablefish (order: Scorpaeniformes) is an economically important species in commercial fisheries of the North Pacific and an emerging species in aquaculture. Aside from a handful of sequences in NCBI and a few published microsatellite markers, little is known about the genetics of this species. The development of genetic tools, including polymorphic markers and a linkage map will allow for the successful development of future broodstock and mapping of phenotypes of interest. The significant sexual dimorphism between females and males makes a genetic test for early identification of sex desirable. RESULTS: A full mitochondrial genome is presented and the resulting phylogenetic analysis verifies the placement of the sablefish within the Scorpaeniformes. Nearly 35,000 assembled transcript sequences are used to identify genes and obtain polymorphic SNP and microsatellite markers. 360 transcribed polymorphic loci from two sablefish families produce a map of 24 linkage groups. The sex phenotype maps to sablefish LG14 of the male map. We show significant conserved synteny and conservation of gene-order between the threespine stickleback Gasterosteus aculeatus and sablefish. An additional 1843 polymorphic SNP markers are identified through next-generation sequencing techniques. Sex-specific markers and sequence insertions are identified immediately upstream of the gene gonadal-soma derived factor (gsdf), the master sex determinant locus in the medaka species Oryzias luzonensis. CONCLUSIONS: The first genomic resources for sablefish provide a foundation for further studies. Over 35,000 transcripts are presented, and the genetic map represents, as far as we can determine, the first linkage map for a member of the Scorpaeniformes. The observed level of conserved synteny and comparative mapping will allow the use of the stickleback genome in future genetic studies on sablefish and other related fish, particularly as a guide to whole-genome assembly. The identification of sex-specific insertions immediately upstream of a known master sex determinant implicates gsdf as an excellent candidate for the master sex determinant for sablefish.

An acute bout of self-myofascial release increases range of motion without a subsequent decrease in muscle activation or force.

Foam rolling is thought to improve muscular function, performance, overuse, and joint range of motion (ROM); however, there is no empirical evidence demonstrating this. Thus, the objective of the study was to determine the effect of self-myofascial release (SMR) via foam roller application on knee extensor force and activation and knee joint ROM. Eleven healthy male (height 178.9 ± 3.5 cm, mass 86.3 ± 7.4 kg, age 22.3 ± 3.8 years) subjects who were physically active participated. Subjects' quadriceps maximum voluntary contraction force, evoked force and activation, and knee joint ROM were measured before, 2 minutes, and 10 minutes after 2 conditions: (a) 2, 1-minute trials of SMR of the quadriceps via a foam roller and (b) no SMR (Control). A 2-way analysis of variance (condition × time) with repeated measures was performed on all dependent variables recorded in the precondition and postcondition tests. There were no significant differences between conditions for any of the neuromuscular dependent variables. However, after foam rolling, subjects' ROM significantly (p < 0.001) increased by 10° and 8° at 2 and 10 minutes, respectively. There was a significant (p < 0.01) negative correlation between subjects' force and ROM before foam rolling, which no longer existed after foam rolling. In conclusion, an acute bout of SMR of the quadriceps was an effective treatment to acutely enhance knee joint ROM without a concomitant deficit in muscle performance.

Exploring Mistreatment of Medical Students by Patients: A Qualitative Study.

PURPOSE: Mistreatment of medical students by patients has not been qualitatively explored in the literature. The authors sought to develop a rich understanding of the impact and consequences of medical students' experiences of mistreatment by patients. METHOD: This exploratory descriptive qualitative study was conducted at a large Canadian medical school from April-November 2020. Fourteen medical students were recruited for semistructured interviews. Students were asked about their experiences of mistreatment by patients and how they responded to these experiences. Transcripts were thematically analyzed using an inductive approach, and the authors interwove critical theory into their conceptual interpretation of the data. RESULTS: Fourteen medical students (median age = 25.5; 10, 71.4% self-reported male; 12, 85.7% self-identified visible minority) participated in this study. Twelve (85.7%) participants had personally experienced patient mistreatment and 2 (14.3%) had witnessed mistreatment of another learner. Medical students described being mistreated by patients based on their gender and race/ethnicity. Although all participants were aware of the institution's official mechanism for reporting mistreatment, none filed an official report. Some participants described turning to their formal (faculty members and residents) and informal (family and friends) social supports to cope with mistreatment by patients. Participants described resenting and avoiding patients who mistreated them and struggling to maintain empathy for, openness to, and overall ethical engagement with discriminatory patients. Students often described a need to be stoic toward their experiences of mistreatment by patients, often seeing it as their "professional duty" to overcome and thus suppress the negative emotions associated with mistreatment. CONCLUSIONS: Medical schools must proactively develop multifaceted mechanisms to support medical students who experience mistreatment by patients. Future research can further uncover this neglected dimension of the hidden curriculum to better develop responses to incidents of mistreatment that commit to antiracism, antisexism, patient care, and learner care.

Untangling the role of social relationships for overcoming challenges in local food systems: a case study of farmers in Québec, Canada.

Advocates for re-localizing food systems often encourage consumers to support local farmers and strengthen local food economies. Yet, local food systems hinge not only on consumers' willingness to buy local food but also on whether farmers have the social support networks to address diverse challenges during food production and distribution. This study characterizes the challenges and support systems of farmers selling to local markets in Québec, Canada, across multiple growing seasons using a mixed-methods research design. We sent an online questionnaire to 1046 farmers and conducted follow-up interviews with 15 of the 133 respondents. Our findings show that farmers relied on an average of four support actor groups, particularly employees, customers, and other farmers. Actors played distinct roles in terms of the importance, frequency, and formality of interactions, providing immediate and long-term support through formal and informal relationships across multiple spatial scales (farm, local community, and regional/international). Our thematic analysis showed that support actors helped farmers in four key domains: (1) Knowledge sharing and emotional support; (2) Labour and workforce; (3) Material and financial aid; and (4) Consumer education and business promotion. Farmer associations provided resources to tackle various challenges, acting as bridges across multiple support actor groups. Yet, our results suggest that political desires to encourage local food systems are in some cases poorly matched with resources to address specific types of challenges farmers face. Specifically, overlooking the role of diverse social support actors in helping farmers build food production and distribution capacity could undermine efforts to foster localization. Supplementary Information: The online version contains supplementary material available at 10.1007/s10460-022-10343-0.

A new dietary guideline balancing sustainability and nutrition for China's rural and urban residents.

Diets have important but often complex implications for both environmental quality and nutrition. We establish a production-oriented life cycle model to quantify and compare the farm-to-gate environmental impacts and food nutritional qualities underlying rural and urban diets in China from 1980 to 2019, a period of rapid urbanization and socioeconomic changes. The environmental impacts of rural diets were generally higher than those of urban diets, but this gap reduced after 2000. Environmental and nutritional values varied considerably across the 31 Chinese provinces due to their different food intakes and dietary structures. Dietary changes coinciding with urbanization increased greenhouse gas emissions, eutrophication potential, and nutritional quality, but decreased energy consumption and acidification potential. Based on our results, we propose a new dietary guideline to mitigate environmental impacts and improve nutritional quality.

Perspectives of Persons With Arthritis on the Use of Wearable Technology to Self Monitor Physical Activity: A Qualitative Evidence Synthesis.

OBJECTIVE: We aimed to broaden understanding of the perspectives of persons with arthritis on their use of wearables to self-monitor physical activity, through a synthesis of evidence from qualitative studies. METHODS: We conducted a systematic search of 5 databases (including Medline, CINAHL, and Embase) from inception to 2018. Eligible studies qualitatively examined the use of wearables from the perspectives of persons with arthritis. All relevant data were extracted and coded inductively in a thematic synthesis. RESULTS: Of 4,358 records retrieved, 7 articles were included. Participants used a wearable during research participation in 3 studies and as part of usual self-management in 2 studies. In remaining studies, participants were shown a prototype they did not use. Themes identified were: 1) the potential to change dynamics in patient-health professional communication: articles reported a common opinion that sharing wearable data could possibly enable patients to improve communication with health professionals; 2) wearable-enabled self-awareness, whether a benefit or downside: there was agreement that wearables could increase self-awareness of physical activity levels, but perspectives were mixed on whether this increased self-awareness motivated more physical activity; 3) designing a wearable for everyday life: participants generally felt that the technology was not obtrusive in their everyday lives, but certain prototypes may possibly embarrass or stigmatize persons with arthritis. CONCLUSION: Themes hint toward an ethical dimension, as participants perceive that their use of wearables may positively or negatively influence their capacity to shape their everyday self-management. We suggest ethical questions pertinent to the use of wearables in arthritis self-management for further exploration.