Exploring the Impact of ECHO Ontario Integrated Mental and Physical Health on Participants' Approach and Attitude Toward the Care of Patients With Complex Needs.

OBJECTIVE: To examine how project Extension for Community Healthcare Outcomes-Integrated Mental and Physical Health (ECHO-IMPH) influences the attitudes and approaches of primary care providers and other participants towards patients. METHODS: An exploratory qualitative approach was undertaken using semistructured interviews conducted between August 2020 and March 2021. One hundred and sixty-four individuals from two cycles of ECHO-IMPH were invited to participate, and 22 (n = 22) agreed to participate. Data were analyzed using the Braun and Clarke method for thematic analysis. RESULTS: Three major themes were identified: 1) enhanced knowledge and skills; 2) changes in attitude and approach; 3) space for reflection and exploration. When participants were asked about areas for improvement, suggestions were focused on the structure of the sessions. Participants identified that ECHO-IMPH helped them to view patients more holistically, which led to greater patient-centered care in their practice. Additionally, skills gained in ECHO-IMPH gave participants the concrete tools needed to have more empathetic interactions with patients with complex needs. CONCLUSIONS: ECHO-IMPH created a safe space for participants to reflect on their practice with patients with complex needs. Participants applied newly acquired knowledge and skills to provide more empathetic and patient-centered care for patients with complex needs. Based on the shift in perspectives described by participants, transformative learning theory was proposed as a model for how ECHO-IMPH created change in participants' practice.

Building Complex Care Capacity in Primary Care: An Educational Evaluation of Project ECHO Ontario Integrated Mental and Physical Health.

BACKGROUND: Project Extension for Community Healthcare Outcomes (ECHO) is a virtual training and capacity building model that uses videoconferencing to link expert interdisciplinary teams with primary care clinicians in local communities. In this study, we evaluated ECHO Ontario Integrated Mental and Physical Health (ECHO-IMPH). This is the first consultation-liaison psychiatrist-led Project ECHO explicitly designed to support health care providers (HCPs) within primary care in delivering better care for patients with co-occurring mental and physical health needs. We assessed the impact of ECHO-IMPH on HCP engagement, learning, and practice change. METHODS: Using Moore's Evaluation Framework, we used attendance logs and weekly surveys to investigate HCP engagement and satisfaction with ECHO-IMPH, as well as questionnaires to assess impact on their learning, self-efficacy, and practice change with respect to patient care. A pre-post design was used to assess change in the latter. RESULTS: A total of 322 HCPs participated in ECHO-IMPH across five cycles. High mean ratings were observed for satisfaction across all five cycles (4.35 ± 0.59). Precycle and postcycle questionnaires were available for 145 participants, allowing for paired comparison. Mean self-efficacy scores were significantly higher after the cycle than that before (64.26 ± 15.63 to 78.15 ± 11.44; t(144) = 11.61, P < 0.001, d = 1.03). Over 80% of participants reported changes in their professional practice post ECHO-IMPH. CONCLUSIONS: This is the first study to describe the impact of a Project ECHO led by consultation-liaison psychiatrists focused on integrated mental and physical health care and to demonstrate that this can be effective in changing HCP professional practice and self-efficacy, with high engagement and satisfaction.

Zika Virus-Associated Aseptic Meningitis and Guillain-Barre Syndrome in a Traveler Returning from Latin America: a Case Report and Mini-Review.

ZIKV-associated Guillain-Barré syndrome presents with an accelerated clinical course compared to classic post-infectious Guillain-Barré syndrome. Clinicians should anticipate and screen patients with ZIKV infection for neurologic complications bearing in mind that these may manifest during the acute viremic phase or during early convalescence.

Ethnobotany of Mexican and northern Central American cycads (Zamiaceae).

BACKGROUND: This study documents cycad-human relationships in Mexico, Belize, Guatemala, El Salvador, and Honduras over the last 6000 years. The impetus was acute need for a better understanding of previously undocumented uses of cycads in this region, and the need to improve cycad conservation strategies using ethnobotanical data. We hypothesized that cycads are significant dietary items with no long-term neurological effects, are important to religious practice, and contribute to cultural identity and sense of place, but that traditional knowledge and uses are rapidly eroding. Guiding questions focused on nomenclature, food and toxicity, relationships to palms and maize, land management issues, roles in religious ceremony, and medicinal uses, among others, and contributions of these to preservation of cycads. METHODS: From 2000 to 2017, the authors conducted 411 semi-structured ethnographic interviews, engaged in participant-observation in Mexican and Honduran communities, and carried out archival research and literature surveys. RESULTS: We documented 235 terms and associated uses that 28 ethnic groups have for 57 species in 19 languages across 21 Mexican states and 4 Central American nations. Carbohydrate-rich cycads have been both famine foods and staples for at least six millennia across the region and are still consumed in Mexico and Honduras. Certain parts are eaten without removing toxins, while seed and stem starches are detoxified via several complex processes. Leaves are incorporated into syncretic Roman Catholic-Mesoamerican religious ceremonies such as pilgrimages, Easter Week, and Day of the Dead. Cycads are often perceived as ancestors and protectors of maize, revealing a close relationship between both groups. Certain beliefs and practices give cycads prominent roles in conceptions of sense of place and cultural heritage. CONCLUSIONS: Cycads are still used as foods in many places. Though they do not appear to cause long-term neurological damage, their health effects are not fully understood. They are often important to religion and contribute to cultural identity and sense of place. However, because most traditional knowledge and uses are rapidly eroding, new community-based biocultural conservation efforts are needed. These should incorporate tradition where possible and seek inspiration from existing successful cases in Honduras and Mexico.

A novel interprofessional shadowing initiative for senior medical students.

BACKGROUND: Interprofessional collaboration is vital to patient care. However, many medical students interact poorly with nurses during clinical clerkships, and less is known about their relationships with other healthcare professionals (HCPs). Two nurse shadowing interprofessional education (IPE) initiatives for first-year medical students have been studied. Similar programs for senior medical students have not been reported and none have included non-nurse HCPs. METHODS: Two-hundred seven third-year medical students were assigned to shadow a HCP from one of 20 professions for a two-hour period, one week prior to clerkship. The authors analyzed Likert-like rating scales and qualitative feedback from post-experience surveys. RESULTS: A large majority (92.3%) of the 207 respondents found the experience to be a valuable component of their medical education. Three quarters (74.9%) of students felt better equipped to communicate with HCPs. Qualitative feedback revealed students felt the program was practical, improved their understanding of HCPs and wanted additional similar opportunities to learn about HCPs. CONCLUSIONS: Analysis of this innovative IPE intervention suggests it may benefit senior medical students and other HCPs. Other medical schools may wish to pilot similar IPE activities in order to prepare a collaborative, practice-ready health workforce.