How Emergency Medicine Residents Have Conversations About Life-Sustaining Treatments in Critical Illness: A Qualitative Study Using Inductive Thematic Analysis.

STUDY OBJECTIVE: The inherent pressures of high-acuity, critical illness in the emergency department create a unique environment whereby acute goals-of-care discussions must be had with patients or substitute decision makers to rapidly decide between divergent treatment paths. Among university-affiliated hospitals, resident physicians are often conducting these highly consequential discussions. This study aimed to use qualitative methods to explore how emergency medicine residents make recommendations regarding life-sustaining treatments during acute goals-of-care discussions in critical illness. METHODS: Using qualitative methods, semistructured interviews were conducted with a purposive sample of emergency medicine residents in Canada from August to December 2021. Inductive thematic analysis of the interview transcripts was conducted using line-by-line coding, and key themes were identified through comparative analysis. Data collection continued until thematic saturation was reached. RESULTS: Seventeen emergency medicine residents from 9 Canadian universities were interviewed. Two factors guided residents' treatment recommendations (a duty to provide a recommendation and the balance between disease prognosis and patient values). Three factors influenced residents' comfort when making recommendations (time constraints, uncertainty, and moral distress). CONCLUSION: While conducting acute goals-of-care discussions with critically ill patients or their substitute decision makers in the emergency department, residents felt a sense of duty to provide a recommendation informed by an intersection between the patient's disease prognosis and the patient's values. Their comfort in making these recommendations was limited by time constraints, uncertainty, and moral distress. These factors are important for informing future educational strategies.

Studying the "sexuality-health-technology nexus": a new materialist visual methodology.

A school of critical sexual health scholars argues that biomedical and digital technologies need to be understood not as mere objects of use, but as having the agentic capacity to effect new senses of the self and transform social/sexual health relations and outcomes. Such a call to grapple with the multidimensionality of technologies, their affects and effects poses a challenge to current methodological frameworks. To address this challenge, we introduce a novel visual methodology called "embodied mapping" that builds on the arts-based method of body mapping. Drawing from new materialism scholarship, embodied mapping extends the scope of inquiry of sexual-health research and conventional qualitative methods. It does so by interrogating the capacities and properties of sexual agents, technologies and readily available discourses on sexual health and HIV prevention as co-constitutive within the sexual-health-technologies nexus itself. Embodied mapping's research process is collaborative and emergent; researchers, together with an artist and research participants co-create a visual collage tracing the thick moments of sexual/health encounters. Embodied mapping's methodological and analytical capacity to approach sexual health phenomena as performative and immanent to the research process could open new sight lines for comprehending and intervening in this globalised era marked by an increasing technologising of sexual health care.

Paradoxes of an assimilation politics: media production of gay male belonging in the Canadian 'vital public' from the tainted blood scandal to the present.

Canadian media discourses on gay men's sexuality and political inclusion serve as a rich site for understanding current tensions in debates on sexual citizenship under biopolitical regimes. This paper addresses how public health reporting in one health news media source, Canada's leading newspaper The Globe and Mail, discursively produced contiguous understandings of the moral, social and biological dimensions of gay male subjectivity and sexuality within the context of HIV risk discourses. Specifically, we critically examine the newspaper's coverage of what constitutes the public good when national blood supplies are at stake. Our analysis reveals a profound dichotomy in which gay men - as sexual subjects and subjects of rights - are recalibrated following the political and economic investments of bourgeoisie communities of interest. However encompassing the securing of legal social rights might be, gay men's sexuality is resistant to a reformatting under a heteronormative regulatory regime, as the social traumas caused by HIV continue to cast a shadow on sexual behaviours that purportedly risk leakage of contamination into the body politic.

Zoomification of medical education: can the rapid online educational responses to COVID-19 prepare us for another educational disruption? A scoping review.

Introduction: In response to the COVID-19 pandemic, educators have increasingly shifted delivery of medical education to online/distance learning. Given the rapid and heterogeneous nature of adaptations; it is unclear what interventions have been developed, which strategies and technologies have been leveraged, or, more importantly, the rationales given for designs. Capturing the content and skills that were shifted to online, the type of platforms used for the adaptations, as well as the pedagogies, theories, or conceptual frameworks used to inform the adapted educational deliveries can bolster continued improvement and sustainability of distance/online education while preparing medical education for future large-scale disruptions. Methods: We conducted a scoping review to map the rapid medical educational interventions that have been adapted or transitioned to online between December 2019 and August 2020. We searched MEDLINE, EMBASE, Education Source, CINAHL, and Web of Science for articles pertaining to COVID-19, online (distance) learning, and education for medical students, residents, and staff. We included primary research articles and reports describing adaptations of previous educational content to online learning. Results: From an initial 980 articles, we identified 208 studies for full-text screening and 100 articles for data extraction. The majority of the reported scholarship came from Western Countries and was published in clinical science journals. Cognitive content was the main type of content adapted (over psychomotor, or affective). More than half of the articles used a video-conferencing software as the platform to pivot their educational intervention into virtual. Unfortunately, most of the reported work did not disclose their rationale for choosing a platform. Of those that did, the majority chose technological solutions based on availability within their institutions. Similarly, most of the articles did not report the use of any pedagogy, theory, or framework to inform the educational adaptations.

Introduction: En réponse à la pandémie de la COVID-19, l'enseignement médical a été progressivement déplacé vers l'espace virtuel. Compte tenu de la rapidité et de l'hétérogénéité des adaptations opérées, nous n'avons qu'une idée peu précise des activités éducatives élaborées, des stratégies et des technologies mobilisées et, plus important encore, des raisons avancées pour les motiver. Une meilleure connaissance du contenu et des compétences dont l'enseignement a été transféré en ligne, du type de plateformes utilisées pour le virage, ainsi que des pédagogies, des théories ou des cadres conceptuels utilisés pour guider les activités éducatives adaptées soutiendrait une amélioration continue et la pérennité de l'enseignement à distance, tout en préparant la formation médicale à de futures perturbations d'envergure. Méthodes: Nous avons effectué une revue exploratoire pour recenser les activités éducatives en médecine qui ont été expéditivement adaptées ou transposées en ligne entre décembre 2019 et août 2020. Nous avons interrogé les bases de données MEDLINE, EMBASE, Education Source, CINAHL et Web of Science à la recherche d'articles portant sur la COVID-19, sur l'apprentissage en ligne (à distance) et sur la formation des étudiants en médecine, des résidents et du personnel enseignant. Nous avons inclus des articles de recherche originale et d'autres décrivant l'adaptation de contenus éducatifs à l'apprentissage en ligne. Résultats: Des 980 articles trouvés, nous avons sélectionné 208 études pour un examen du texte intégral et 100 articles pour une extraction de données. La plupart des travaux provenaient de pays occidentaux et ont été publiés dans des revues médicales. Le type de contenu adapté était principalement cognitif, dans une moindre mesure psychomoteur ou affectif. Plus de la moitié des articles présentaient un logiciel de visioconférence comme plateforme utilisée pour transposer des activités éducatives en mode virtuel. Malheureusement, la plupart des études ne précisaient pas les raisons justifiant le choix de plateforme. Celles qui l'ont fait indiquaient majoritairement que les solutions technologiques avaient été choisies en fonction de leur disponibilité au sein de l'établissement. De la même manière, seulement une poignée d'articles font état de l'utilisation d'une pédagogie, d'une théorie ou d'un cadre pour guider les adaptations pédagogiques.

Diet and anxiety. An exploration into the Orthorexic Society.

The modern food system has radically modified the social-anthropological framework that informs food choices. To explore factors that influence food choices within this modified framework, eight focus groups consisting of women 15-45 years old were conducted in Nova Scotia (Canada). Using a grounded theory approach, two main themes emerged centered around (1) perceptions of a changing culinary order that emphasizes individual dietary responsibility and decision making and (2) the confusion/anxiety experienced as participants try to assimilate the information generated by today's modern food system. Participants inextricably linked food and health to the point where it was the central organizing determinant guiding their food selection. They also felt the need to make informed dietary choices, but perceived their search for a healthy diet to be thwarted by the amount, type, and accuracy of information concerning the elements in today's food products. A constant search for accurate information and the instability of what participants consider expert advice contribute to feelings of anxiety around food choices and a sense of futility in their efforts to navigate through the information available. The focus group discussions reflected the emergence of an Orthorexic Society, whereby individuals are socialized to take charge of their own dietary health. They do so constrained by a food system that is increasingly complex, contradictory, and opaque and where commercial dietary regimes offer quick yet incomplete solutions.

International Legal Approaches to Neurosurgery for Psychiatric Disorders.

Neurosurgery for psychiatric disorders (NPD), also sometimes referred to as psychosurgery, is rapidly evolving, with new techniques and indications being investigated actively. Many within the field have suggested that some form of guidelines or regulations are needed to help ensure that a promising field develops safely. Multiple countries have enacted specific laws regulating NPD. This article reviews NPD-specific laws drawn from North and South America, Asia and Europe, in order to identify the typical form and contents of these laws and to set the groundwork for the design of an optimal regulation for the field. Key challenges for this design that are revealed by the review are how to define the scope of the law (what should be regulated), what types of regulations are required (eligibility criteria, approval procedures, data collection, and oversight mechanisms), and how to approach international harmonization given the potential migration of researchers and patients.