Implementation of targeted screening for poverty in a large primary care team in Toronto, Canada: a feasibility study.

BACKGROUND: Poverty has a significant influence on health. Efforts to optimize income and reduce poverty could make a difference to the lives of patients and their families. Routine screening for poverty in primary care is an important first step but rarely occurs in Canada. We aimed to implement a targeted screening and referral process in a large, distributed primary care team in Toronto, Ontario, Canada. The main outcome was the proportion of targeted patients screened. METHODS: This implementation evaluation was conducted with a large community-based primary care team in north Toronto. The primary care team serves relatively wealthy neighborhoods with pockets of poverty. Physicians were invited to participate. We implemented targeted screening by combining census information on neighborhood-level deprivation with postal codes in patient records. For physicians agreeing to participate, we added prompts to screen for poverty to the charts of adult patients living in the most deprived areas. Standardized electronic medical record templates recommended a referral to a team case worker for income optimization, for those patients screening positive. We recorded the number and percentages of participants at each stage, from screening to receiving advice on income optimization. RESULTS: 128 targeted patients with at least one visit (25%) were screened. The primary care team included 86 physicians distributed across 19 clinical locations. Thirty-four physicians (39%) participated. Their practices provided care for 27,290 patients aged 18 or older; 852 patients (3%) were found to be living in the most deprived neighborhoods. 509 (60%) had at least one office visit over the 6 months of follow up. 25 patients (20%) screened positive for poverty, and 13 (52%) were referred. Eight patients (62% of those referred) were ultimately seen by a caseworker for income optimization. CONCLUSIONS: We implemented a targeted poverty screening program combined with resources to optimize income for patients in a large, distributed community-based primary care team. Screening was feasible; however, only a small number of patients were linked to the intervention Further efforts to scale and spread screening and mitigation of poverty are warranted; these should include broadening the targeted population beyond those living in the most deprived areas.

CGG allele size somatic mosaicism and methylation in FMR1 premutation alleles.

BACKGROUND: Greater than 200 CGG repeats in the 5'UTR of the FMR1 gene lead to epigenetic silencing and lack of the FMR1 protein, causing fragile X Syndrome. Individual carriers of a premutation (PM) allele with 55-200 CGG repeats are typically unmethylated and can present with clinical features defined as FMR1-associated conditions. METHODS: Blood samples from 17 male PM carriers were assessed clinically and molecularly by Southern blot, western blot, PCR and QRT-PCR. Blood and brain tissue from an additional 18 PM males were also similarly examined. Continuous outcomes were modelled using linear regression and binary outcomes were modelled using logistic regression. RESULTS: Methylated alleles were detected in different fractions of blood cells in all PM cases (n=17). CGG repeat numbers correlated with percent of methylation and mRNA levels and, especially in the upper PM range, with greater number of clinical involvements. Inter-tissue/intra-tissue somatic instability and differences in percent methylation were observed between blood and fibroblasts (n=4) and also observed between blood and different brain regions in three of the 18 PM cases examined. CGG repeat lengths in lymphocytes remained unchanged over a period of time ranging from 2 to 6 years, three cases for whom multiple samples were available. CONCLUSIONS: In addition to CGG size instability, individuals with a PM expanded allele can exhibit methylation and display more clinical features likely due to RNA toxicity and/or FMR1 silencing. The observed association between CGG repeat length and percent of methylation with the severity of the clinical phenotypes underscores the potential value of methylation in affected PM to further understand penetrance, inform diagnosis and expand treatment options.

Telephone and Teleradiology-Guided Thrombolysis Can Achieve Similar Outcome as Thrombolysis by Neurologist On-site.

BACKGROUND: Because of the limitation of on-site neurology workforce, telestroke was implemented to overcome this barrier. We explored the efficacy and safety of intravenous (IV) stroke thrombolysis service by telestroke when neurologist was not available on-site. METHODS: From January 2009 to December 2012, we compared patients treated with IV stroke thrombolysis by telestroke in the form of telephone consultation with teleradiology, to patients treated after in-person assessment by the same team of neurologists in a regional hospital. Door-to-needle time, symptomatic intracranial hemorrhage, and functional outcome at 3 months were prospectively collected and compared between the groups. RESULTS: In all, 152 patients were treated with IV thrombolysis; 102 patients were treated with neurologist on-site; whereas 50 patients were treated by internists with telestroke. Fifty-two percent of the telemedical group achieved excellent outcome compared to 43% of the neurologist on-site group (P = .30). Symptomatic intracranial hemorrhage rate (4.0% versus 4.9%, P = 1.0) and mortality (8.3% versus 11.9%, P = .49) were comparable. Using the multiple logistic regression analysis, age, baseline stroke severity, and extent of early ischemic change on brain computed tomography scan, are independent predictors for excellent outcome, whereas the presence of neurologist on-site is not correlated with the outcome. CONCLUSIONS: Patients treated without neurologist on-site achieved similar outcome. Telephone consultation and teleradiology-guided IV stroke thrombolysis, with the support of on-site internist appeared safe and efficacious.

Leveraging data to transform nursing care: insights from nurse leaders.

A study was undertaken to gain insight into how nurse leaders are influencing the use of performance data to improve nursing care in hospitals. Two themes emerged: getting relevant, reliable, and timely data into the hands of nurses, and the leaders' ability to "connect the dots" in working with different stakeholders. Study findings may inform nurse leaders in their efforts to leverage data to transform nursing care.

A systematic review of the literature: Gender-based violence in the construction and natural resources industry.

Gender-based violence (GBV) poses a significant concern in the construction and natural resources industries, where women, due to lower social status and integration, are at heightened risk. This systematic review aimed to identify the prevalence and experience of GBV in the construction and natural resources industries. A systematic search across databases including PubMed, OVID, Scopus, Web of Science, and CINAHL was conducted. The Risk of Bias Instrument for Cross-sectional Surveys of Attitudes and Practices by McMaster University and the Critical Appraisal of Qualitative Studies by the Center for Evidence Based Medicine at the University of Oxford were used to assess the studies included in the review. Six articles were included after full-text analysis. GBV was reported in the construction, mining, urban forestry, and arboriculture sectors. Workplace GBV was measured differently across the studies, and all studies examined more than one form of GBV. The main forms of GBV discussed in these studies were discrimination, sexual harassment, and sexism. The studies provided some insight for demographic factors that may or may not be associated with GBV, such as age, region of work, and number of years working in the industry. The review also suggests that workplace GBV has a negative impact on mental health and well-being outcomes, such as higher levels of stress and lower job satisfaction. The current research has not established the effectiveness of interventions, tools, or policies in these workplaces. Thus, additional research should include intervention studies that aim to minimize or prevent GBV in male-dominated workplaces. The current study can bring awareness and acknowledgement towards GBV in the workplace and highlight the importance of addressing it as this review outlines the negative consequences of GBV on mental health and well-being in these male-dominated industries.

Defining what evidence is, linking it to patient outcomes, and making it relevant to practice: insight from clinical nurses.

BACKGROUND/RATIONALE: Factors that impede or enable successful evidence based practice for nurses in their daily work is well documented. Less known is how nurses define evidence in their daily clinical practice and how this knowledge can inform strategies to enhance evidence based patient care and outcomes. AIMS/METHODS: A qualitative study was undertaken to explore nurses' perceptions of what constitutes evidence as part of EBP and how applicable evidence is to their daily practice. A qualitative design using semi-structured interviews was employed for this study. Data were analyzed using directed content analysis. RESULTS: The following four key themes emerged: viewing evidence as research based and a proven practice; linking evidence to patient outcomes; basing evidence on experience; and making evidence relevant to practice. IMPLICATIONS: Study findings point to having accessible, practical tools to make evidence credible and relevant for nurses tailored to their clinical contexts.

The value of bedside shift reporting enhancing nurse surveillance, accountability, and patient safety.

A study was undertaken to explore nurses' experiences and perceptions associated with implementation of bedside nurse-to-nurse shift handoff reporting. Interviews were conducted with nurses and analyzed using directed content analysis. Two themes emerged that illustrated the value of bedside shift reporting. These themes included clarifying information and intercepting errors and visualizing patients and prioritizing care. Nurse leaders can leverage study findings in their efforts to embed nurse-to-nurse bedside shift reporting in their respective organizations.

Implementing an organization-wide quality improvement initiative: insights from project leads, managers, and frontline nurses.

With the movement to advance quality care and improve health care outcomes, organizations have increasingly implemented quality improvement (QI) initiatives to meet these requirements. Key to implementation success is the multilevel involvement of frontline clinicians and leadership. To explore the perceptions and experiences of frontline nurses, project leads, and managers associated with an organization-wide initiative aimed at engaging nurses in quality improvement work. To address the aims of this study, a qualitative research approach was used. Two focus groups were conducted with a total of 13 nurse participants, and individual interviews were done with 10 managers and 6 project leads. Emergent themes from the interview data included the following: improving care in a networked approach; driving QI and having a sense of pride; and overcoming challenges. Specifically, our findings elucidate the value of communities of practice and ongoing mentorship for nurses as key strategies to acquire and apply QI knowledge to a QI project on their respective units. Key challenges emerged including workload and time constraints, as well as resistance to change from staff. Our study findings suggest that leaders need to provide learning opportunities and protected time for frontline nurses to participate in QI projects.

The era of technology in healthcare: an evaluation of telerehabilitation on patient outcomes-a systematic review and meta-analysis protocol.

BACKGROUND: The World Health Organization announced the outbreak of the Coronavirus disease as a global pandemic on March 11, 2020. Since then, rapid implementation of telehealth approaches into the healthcare system have been evident. The pandemic has drastically impacted the lives of many around the globe and has detrimentally affected our healthcare systems, specifically with the delivery of healthcare. This has had many implications on rehabilitation services such as, occupational therapy, physiotherapy, and speech therapy. The delivery of mental health services remotely may be referred to as teletherapy, telemental health, telepsychiatry, and telepsychology. Telerehabilitation has become a necessity over the course of the pandemic due to safety concerns with COVID-19 transmission. The primary aim of this systematic review protocol is to evaluate the literature on the effect of telerehabilitation on patient outcomes and propose directives for future research based on the evidence reviewed. METHODS: A systematic review and meta-analysis will be conducted to examine the literature on the effect of telerehabilitation on patient outcomes following the Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PRISMA, 2015). The systematic review will use the following databases to examine the literature on telerehabilitation and patient outcomes: APA PsychINFO, Embase (Ovid), MEDLINE (Ovid), CINAHL, and Scopus. DISCUSSION: The utilization of telerehabilitation and similar telehealth treatments has increased throughout the COVID-19 pandemic. However, much is still unclear regarding the effectiveness of these methods in the delivery and service of healthcare, and their effect on health outcomes. This review will identify and address the knowledge gaps in the literature, which will provide further directions for future research. TRIAL REGISTRATION: This systematic review has been registered with PROSPERO under registration number CRD42022297849.

Engaging Employers in Apprentice Training: Focus Group Insights from Small-to-Medium-Sized Employers in Ontario, Canada.

Several factors have been identified to influence the registration and retention of apprentices in the construction trades. Employer engagement is a key factor to promote growth in apprenticeships in the construction trades as participation rates continue to be low among small-to-medium-sized employers. In this study, we evaluated the effectiveness of the Ontario Electrical League's (OEL) employer mentorship program through the perspectives of small-to-medium-sized employers using a qualitative approach. Two focus groups were conducted virtually with 11 employers. Focus group audio transcripts were recorded and transcribed for thematic analysis. Themes were generated using a data-driven approach to examine the relationships between mentorship program outcomes and perspectives on industry-related recruitment and retention barriers. Three themes were identified: (a) long-term apprentice recruitment and retention challenges; (b) equity and mental health in the workplace; and (c) industry challenges and mentorship program outcomes. Generally, this sample of employers appreciated the value of the OEL mentorship program through praise of the continued educational support, employer management expertise, hiring resources, and apprentice onboarding tools despite industry barriers in trade stigma, equity and mental health in the workplace, and recruitment and retention challenges. Industry partners should work with these small-to-medium-sized employers to develop workplace initiatives and engage external partners to provide ongoing apprenticeship mentorship support to address the recruitment and retention barriers identified in this study.

Evaluating the Effectiveness of Return-to-Work Interventions for Individuals with Work-Related Mental Health Conditions: A Systematic Review and Meta-Analysis.

The workplace is a vital setting to support positive mental health. Mental health conditions in the workforce contribute to decreased work engagement and participation. There is existing literature on return-to-work (RTW) interventions for individuals with work-related mental health conditions, however, there lacks consensus on their effectiveness. Therefore, the primary aim of this systematic review was to synthesize the literature and evaluate the effectiveness of return-to-work interventions on return-to-work rates, quality of life, and psychological wellbeing for individuals with work-related mental health conditions. Selected articles were organized and identified using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and the Population/Intervention/Comparison/Outcome (PICO) framework. Quality assessment of the included studies was completed using the Critical Appraisal Skills Programme randomized controlled trials checklist and the Joanna Briggs Institute quasi-experimental studies checklist. A random effects meta-analysis model was performed using DerSimonian-Laird weighting to calculate standard mean difference and risk ratios to assess the impact of RTW interventions on return-to-work rates, absenteeism, stress symptoms, depression symptoms, and quality of life. A total of 28 out of 26,153 articles met the inclusion criteria. Diagnoses for participants in the studies ranged from work-related stress to work-related PTSD following exposure to a psychologically traumatizing event in the workplace. No significant differences were found for the meta-analyses examining return-to-work rates, absenteeism, depression, stress, and quality of life. The most effective interventions were found to be a multi-domain intervention (67% of participants RTW full time) and a health-focused intervention (85% RTW rate). Future research may consider establishing effective interventions to develop programs or policies supporting the RTW of employees and promote mental well-being among employees experiencing work-related mental health conditions.

Factors Associated with Job Satisfaction in Medical Laboratory Professionals during the COVID-19 Pandemic: An Exploratory Study in Ontario, Canada.

Job satisfaction has been widely studied across several healthcare disciplines and is correlated with important outcomes such as job performance and employee mental health. However, there is limited research on job satisfaction among medical laboratory professionals (MLPs), a key healthcare group that aids in diagnosis, treatment, and patient care. The objective of this study is to examine the demographic and psychosocial factors associated with job satisfaction for MLPs in Ontario, Canada during the COVID-19 pandemic. A survey was administered to medical laboratory technologists (MLTs) and medical laboratory technicians/assistants (MLT/As) in Ontario, Canada. The survey included demographic questions and items from the Copenhagen Psychosocial Questionnaire, third edition. Binary logistic regressions were used to examine the association between job satisfaction and demographic variables and psychosocial work factors. There were 688 MLPs included in the analytic sample (72.12% response rate). Having a higher sense of community at work was correlated with higher job satisfaction in both MLT (OR = 2.22, 95% CI: 1.07-4.77) and MLT/A (OR = 3.85, 95% CI: 1.12-14.06). In addition, having higher stress was correlated with lower job satisfaction in both MLT (OR = 0.32, 95% CI: 0.18-0.57) and MLT/A (OR = 0.26, 95% CI: 0.10-0.66). This study provides preliminary evidence on factors associated with job satisfaction in MLT and MLT/A. The findings can be used to support organizational practices and policies to improve psychosocial work factors.

Mental Health Outcomes among Electricians and Plumbers in Ontario, Canada: Analysis of Burnout and Work-Related Factors.

(i) Background: Working in the electrical and plumbing sectors is physically demanding, and the incidence of physical injury and work disability is high. This study aimed to assess the mental health and well-being of skilled trades workers working in the electrical and plumbing sectors; (ii) Methods: Forty participants completed an online survey assessing burnout, work-related factors, and mental health issues. Data were analyzed to determine the association between demographics, the availability, and importance of work-related factors, and burnout using a two-sample Mann-Whitney U test; (iii) Results: Our findings showed that among the work-related factors, workplace safety, family commitments, income and benefits, and full-time employment opportunities might be crucial factors to keep study participants working at their current position. Financial support for external training, which was found to be the most important factor in preventing colleague-related burnout, was available to the satisfaction of approximately 50% of the participants; (iv) Conclusion: Work-related factors such as workplace safety and the availability and support for external training may be protective against all types of burnout among this population. Future studies may consider a larger sample size with a more diverse group of participants and perform an intersectional analysis to incorporate minority identities in the analyses.

Transoral Minimally Invasive Tracheoplasty Technique for Cervical Tracheomalacia.

We report a case of cervical tracheomalacia successfully treated by tracheoplasty. The resection of redundant posterior tracheal tissue was performed with a novel minimally invasive transoral approach.

Anti-N-methyl-D-aspartate receptor encephalitis in a young woman with an ovarian tumour.

Anti-N-methyl-D-aspartate receptor encephalitis is characterised by psychiatric and neurological abnormalities and occurs in frequent association with ovarian teratoma. We report the first confirmed case of teratoma-associated anti-N-methyl-D-aspartate receptor encephalitis in Hong Kong in a young woman presenting with confusion and prominent dyskinesia, followed by a review of the current literature.

An examination of the difference in performance of self-care behaviours between white and non-white patients following CABG surgery: a secondary analysis.

BACKGROUND: The demographic profile of the patient receiving coronary artery bypass graft (CABG) surgery in Canada has changed significantly over the past 20 years from mainly white (i.e., English, Irish, Scottish) to non-white (i.e., Indian or Chinese). To support individuals who have recently undergone a CABG procedure, patient education is provided to guide performance of self-care behaviours in the home environment. The relevance of this education, when applied to the current CABG surgery population, is questionable, as it was designed and tested using a white, homogenous sample. Thus, the number and type of self-care behaviours performed by persons of Indian and Chinese origin has not been investigated. These individuals may have varying self-care needs that are not reflected in the current self-care patient education materials. PURPOSE: The intent of this study was to examine the difference in the type and number of self-care behaviours performed between white and non-white patients following CABG surgery. METHODS: This study is a sub-study of a descriptive, exploratory design that included a convenience sample. Ninety-nine patients were recruited, representing three cultural groups (White, Indian, and Chinese). Descriptive data were used to describe the sample and identify specific self-care behaviours performed in the home environment. FINDINGS: Results indicate statistically significant differences between white and non-white individuals related to use of incentive spirometer (p = 0.04), deep breathing and coughing exercises (p = 0.04), and activity modification (p < 0.05) at 1 week following hospital discharge. IMPLICATIONS: Future research and theoretical exploration are required to assist in the understanding of the underlying mechanisms that contribute to the differences that are noted between white and non-white groups.

Circulatory collapse in a patient with gastrinoma after metoclopramide administration.

A patient who was given metoclopramide for vomiting and diarrhoea developed circulatory collapse with his blood pressure dropping to 50/20 mm Hg. A gastrinoma was diagnosed histologically. The extent of the tumour was defined by octreotide scanning and magnetic resonance imaging. Metoclopramide was again given for colicky abdominal pain and the patient developed circulatory collapse a second time. A laparotomy involving extensive resection of the tumour was performed. The MEN1 mutation was not detected in blood or tumour tissue. Follow-up octreotide scanning did not show any residual tumour. Possible causes for the circulatory collapse are discussed. Our case is probably the first patient with gastrinoma to develop circulatory collapse after being given metoclopramide.

Intensive care unit management of transcatheter aortic valve recipients.

Severe aortic stenosis is an increasingly prevalent disease that continues to be associated with significant mortality. Transcatheter aortic valve replacements have been used as an alternative to surgical aortic valve replacement in high-risk patients with multiple comorbidities. In this review, we discuss postoperative considerations pertinent to the successful management of these complicated patients in the intensive care unit.

Is four a deadly number for the Chinese?

BACKGROUND: The numbers 4, 14 and 24 are associated with death for Cantonese-speaking Chinese people, as the words for these numbers sound like the words for "death", "must die" and "easy to die", respectively. A previous study in the United States investigating psychological stress engendered by fear of the number 4 found more cardiac deaths in Chinese and Japanese people, compared with white Americans, on the 4th day of the month. OBJECTIVE: To determine whether more cardiac deaths occur in Hong Kong Chinese people on the days of the month with "deathly connotations" (4, 14 and 24). DESIGN: Analysis of mortality data (1995-2000) of the Chinese population of Hong Kong from the Census and Statistics Department of the Hong Kong Government for these three days of the month, compared with the remaining days, according to both the Gregorian and Lunar calendars. RESULTS: There were 17 346 cardiac deaths registered under ICD-9 codes 410-414 in 1995-2000. The mean (+ 1 SD) of the cumulative number of cardiac deaths on each day of the month was 587 (+ 30) for the Gregorian calendar or 573 (+ 24) for the Lunar calendar. The mean number of deaths on the 4th, 14th and 24th day of the month was not significantly different from the mean number of deaths on the remaining days of the month. CONCLUSION: Our study of Hong Kong Chinese people does not support the concept that more cardiac deaths occur in Cantonese people on the 4th, 14th and 24th day of the month.