Retrospective Use of the Pictorial Fit-Frail Scale for Determination of Frailty Level in Hospitalized Older Adults with a Hip Fracture.

The Pictorial Fit-Frail Scale (PFFS) is a frailty tool consisting of visual images to comprehensively assess frailty across 14 domains that can be completed by health professionals, patients, or caregivers. The objective of this study was to explore the feasibility of using the PFFS retrospectively to determine a patient's frailty level using data from the hospital electronic health records (EHRs) of older adults admitted with an isolated hip fracture. A random sample of 200 hip fracture patients admitted to a Level 1 Trauma Center hospital in New Brunswick was selected for review using the PFFS. The majority (94.5%) of hospital EHRs contained the clinical information needed to populate most of the 14 PFFS domains, allowing for determination of a frailty score. The mean raw PFFS frailty score was 9.7 (SD 6.6), consistent with moderate frailty. For all patients, a Frailty Index (FI) score was calculated, with the mean being 0.27 (SD 0.18), again consistent with moderate frailty. Comparing the PFFS score to the FI score, the percentage categorized as not frail or very mildly frail fell from 33.3% to 20.1%, and those considered severely frail rose from 30.7% to 34.9%. The PFFS can be successfully used retrospectively with hospital EHRs to determine the frailty level of older patients. When converted to the FI score, there was an increase in the frequency and severity of frailty. This tool may provide a useful way to stratify older adults by frailty that can be helpful in evaluating health outcomes based on frailty levels.

Assessing a research training programme for rural physicians.

INTRODUCTION: To assess the effect of a training programme called 6for6 (the programme) on research competency and productivity amongst rural physicians. The programme develops the research skills of six rural physicians over six weekends. Physicians learn about various research methods and writing techniques through blended learning components. METHODS: We conducted a quasi-experimental study, comparing research competency and productivity between intervention and non-equivalent control groups and over time through a repeated measures design. Generalized linear mixed model (GLMM), ANOVA, and Cochran Q tests were conducted. The intervention was provided to five groups of 6 rural physicians each between 2014 and 2019. Main outcome measures: self-assessed research competency (knowledge, attitudes and skills) and productivity (publications, grants and presentations of research-related work at conferences) were our primary and secondary outcomes, respectively. We measured the outcomes before, during and after the programme. Controls: Rural physicians who expressed interest in the programme and later enrolled. RESULTS: This study shows that, amongst its thirty participants, overall research competency was significantly different between intervention and control groups (65.7% ± 37.6% and 58.6% ± 14.4%, P < 0.05 for GLMM). The percentage of participants who were productive before, during and after the programme was 26.7%, 16.7% and 50.0%, respectively. Overall, productivity rates were significantly different between intervention and control groups (rate difference was 72.2/100 person-years, P < 0.05 for GLMM). CONCLUSION: This study suggests that the programme improves research competency and productivity for rural physicians. Rural physicians who wish to improve their research competency would benefit from participating in similar programmes.

Résumé Introduction: Évaluer l'effet d'un programme de formation intitulé 6for6 (le programme) sur les compétences en recherche et la productivité parmi les médecins des régions rurales. Le programme permet à six médecins en région rurale d'acquérir des compétences en recherche durant six fins de semaine. Les médecins apprennent diverses méthodologies de recherche et techniques de rédaction par l'entremise d'un programme d'apprentissage mixte. Méthodologie: Nous avons réalisé une étude quasi-expérimentale, qui comparait les compétences en recherche et la productivité entre des groupes non-équivalents intervention et témoin, et dans le temps, par une méthodologie à mesures répétitives. Un modèle linéaire à effets mixtes généralisé (GLMM), un modèle d'analyse de variance, et des tests Q de Cochran ont été réalisés. L'intervention a été appliquée à 5 groupes de 6 médecins en région rurale, entre 2014 et 2019 dans tous les cas. Paramètre d'évaluation: compétences en recherche évaluées par l'apprenant (connaissances, attitudes et compétences) et productivité (publications, subventions et présentation des travaux de recherche aux congrès) étaient respectivement nos paramètres d'évaluation principal et secondaire. Nous avons mesuré les paramètres avant, durant et après le programme. Les médecins en région rurale ayant manifesté de l'intérêt à l'égard du programme ont été inscrits. Résultats: L'étude montre que parmi les 30 participants, les compétences générales en recherche étaient significativement différentes entre les groupes intervention et témoin (65,7 ± 37,6% et 58,6 ± 14,4%, P < 0,05 pour le GLMM). Le pourcentage de participants qui étaient productifs avant, durant et après le programme était respectivement de 26,7, 16,7 et 50,0%. Dans l'ensemble, la productivité était significativement différente entre les groupes intervention et témoin (différence des taux: 72,2 par 100 années-personnes, P < 0,05 pour le GLMM). Conclusion: Cette étude laisse penser que le programme améliore les compétences en recherche et la productivité chez les médecins en région rurale. Les médecins en région rurale qui souhaitent améliorer leurs compétences en recherche bénéficieront de programmes semblables. Mots-clés: Compétences en recherche, programme de formation en recherche, santé en région rurale, communautés rurales.

Evaluation plan of the 6for6 research skills program for rural and remote physicians.

Overwhelming issues and barriers often prevent rural and remote physicians (RRPs) from pursuing the many socially accountable research questions they encounter on a daily basis. Although research training programs can empower RRPs to rise to these challenges, there is a lack of evidence on how they should be developed and refined. At Memorial University, a faculty development program (FDP) called 6for6 has been helping RRPs surmount their research quagmires and engage in scholarship since 2014. After an initial three-year (2014-17) pilot, we prepared a detailed plan to evaluate the 6for6 research FDP for RRPs and inform future years of delivery. Using a modified Delphi method and participatory action model a group of program team members, stakeholders and evaluation experts developed an evaluation plan including a logic model and an evaluation matrix addressing five key themes. To our knowledge, this is the first evaluation plan for a research-focused FDP targeting RRPs. While this plan was developed specifically for the 6for6 FDP, our approach to its development may be useful to any institution interested in evaluating an FDP with limited resources.

Effects of Meteorological Factors on Hospitalizations in Adult Patients with Asthma: A Systematic Review.

Background: Environmental factors such as weather variables contribute to asthma exacerbation. The impact of meteorological factors on asthma-related hospital admissions (HAs) or emergency department visits (EDVs) has been assessed in the literature. We conducted a systematic review to establish a conclusion of whether these findings from the literature are consistent and generalizable or if they vary significantly by certain subgroups. Objective: This study aims to review the effect of meteorological variables on asthma HAs and EDVs in adults, to identify knowledge gaps and to highlight future research priorities. Method: A systematic search was conducted in electronic databases such as PubMed, Embase, and CINAHL. All studies published in English were screened and included if they met the eligibility criteria. Two independent reviewers assessed the quality of the studies and extracted the data. The available evidence was summarized and presented using a harvest plot. Results: Our initial search returned a total of 3887 articles. After screening titles, abstracts, and full texts, 16 studies were included. Thirty-one percent of the included studies (5/16) found that temperature was the only factor associated with asthma hospitalization or EDVs. Six studies (37%) found that both temperature and relative humidity were associated with HAs. Four studies (25%) identified thunderstorms as a possible factor associated with asthma hospitalization in adults. Conclusion: Our review suggests that HAs and EDVs due to asthma are associated with many meteorological factors. Among the articles included in this review, changing temperature is the most commonly studied variable. We did not find studies that measured barometric pressure, weather phenomena, or the effect of tornados. To develop effective strategies to protect subjects at risk, further studies are required.