Making connections: exploring residents' perspectives on a virtual World Café as a novel approach for teaching Indigenous health issues.

World Café is a methodology where small groups of participants rotate around tables for spirited conversations. It creates an environment for sharing and exchange. Learning about Indigenous healthcare is ideally suited to an intimate discussion format. Adapting the World Café to a virtual platform allowed us to connect disparate learners, encourage peer-to-peer learning, and address inequities in curriculum exposure to different patient groups. Owing to the safe environment, there can be surprising findings too. In our case, participants identified unconscious biases and recognized the program as a new learning opportunity. Try it and see!

Le Café du monde est une méthode permettant aux participants, passant de table en table, de prendre part à des discussions animées en petits groupes. Elle crée un environnement propice au partage et à l'échange. Le format de discussion intime est intéressant pour aborder le sujet des soins de santé autochtones. L'adaptation du Café du monde à une plateforme virtuelle nous a permis de mettre en relation un groupe d'apprenants hétéroclite, d'encourager l'apprentissage entre pairs et de remédier aux inégalités entre les cursus de formation quant à l'exposition des apprenants à des groupes de patients diversifiés. L'environnement sûr donne lieu à des résultats qui peuvent surprendre. Dans notre cas, les participants ont identifié des préjugés inconscients et ont reconnu que le programme constitue une nouvelle possibilité d'apprentissage. Essayez-le pour voir!

Pharmacist-led sedative-hypnotic deprescribing in team-based primary care practice.

BACKGROUND: Sedative-hypnotic (SH) medications are often used to treat chronic insomnia, with potentially serious long-term side effects. The objective of this study is to evaluate an interprofessional SH deprescribing program within a community team-based, primary care practice, with or without cognitive behavioural therapy for insomnia (CBT-I). METHODS: Retrospective chart review for patients referred to the team pharmacist for SH deprescribing from February 2016 to June 2019. RESULTS: A total of 121 patients were referred for SH deprescribing, with 111 (92%) patients who attempted deprescribing (average age 69, range 29-97 years) and 22 patients who also received CBT-I. Overall, 36 patients (32%) achieved complete abstinence, and another 36 patients (32%) reduced their dosage by ≥50%. For the 36 patients who achieved complete abstinence, 26 (72%) patients remained abstinent at 6 months (9 patients resumed using SH and 1 patient was lost to follow-up). The proportion of patients achieving complete abstinence or reduced dosage of ≥50% (successful tapering) was higher with CBT-I than without CBT-I but did not reach statistical significance (77% vs 62%, p = 0.22). There were also no statistically significant differences detected in the success between those who took a benzodiazepine and those who took a Z-drug (67% vs 61%, p = 0.55) or for those who took SH daily and those who took them intermittently (67% vs 44%, p = 0.09). CONCLUSION: Almost two-thirds of patients participating in our pharmacist-led program were able to stop or taper their SH medications by ≥50%. The role of CBT-I in SH deprescribing remains to be further elucidated. Can Pharm J (Ott) 2021;154:xx-xx.

Clinical complaints amongst patients in a Guyanese prison.

BACKGROUND: Incarcerated populations are at particular risk for developing specific health conditions.  Prior studies of prisons in developing countries have focused on the threat of communicable diseases, though anecdotal evidence suggests that chronic conditions are of particular concern. This study constitutes the first published investigation of health complaints offered by residents of a prison in the South American nation of Guyana. METHOD: In 2010, a medical team sent by the Toronto non-governmental organization Ve'ahavta visited the Mazaruni prison in the interior of Guyana. Data on patient encounters was collected as part of the triage activity. RESULTS: Care was given to 108 patients, staff and family members. Contrary to literature expectations, 50% of complaints concerned musculoskeletal issues, while only 11% were genitor-reproductive. Upon examination, 30.6% of patients were experiencing musculoskeletal problems, most commonly back pain. CONCLUSION: Future medical interventions to this and comparable low- and middle-income country prisons should more vigorously consider physiotherapeutic interventions, in addition to the expected addressing of infectious diseases.