Opioid prescribing practices in trauma patients at discharge: An exploratory retrospective chart analysis.

This study examined the opioid prescribing patterns at discharge in the trauma center of a major Canadian hospital and compared them to the guidelines provided by the Illinois surgical quality improvement collaborative (ISQIC), a framework that has been recognized as being associated with reduced risk. This was a retrospective chart review of patient data from the trauma registry between January 1, 2018, and October 31, 2019. A total of 268 discharge charts of naïve opioid patients were included in the analysis. A Morphine Milligram Equivalents per day (MME/day) was computed for each patient who was prescribed opioids and compared with standard practice guidelines. About 75% of patients were prescribed opioids. More males (75%) than females (25%) were prescribed opioids to patients below 65 years old (91%). Best practice guidelines were followed in most cases. Only 16.6% of patients were prescribed over 50 mg MME/day, the majority (80.9%) were prescribed opioids for =<3 days and only 1% for >7 days. Only 7.5% were prescribed extended-release opioids and none were strong like fentanyl. Patients received a multimodal approach with alternatives to opioids in 88.9% of cases and 82.9% had a plan for opioid discontinuation. However, only 23.6% received an acute pain service referral. The majority of the prescriptions provided adhered to the best practice guidelines outlined by the ISQIC framework. These results are encouraging with respect to the feasibility of implementing opioid prescription guidelines effectively. However, routine monitoring is necessary to ensure that adherence is maintained.

Understanding the Experience of Geriatric Care Professionals in Using Telemedicine to Care for Older Patients in Response to the COVID-19 Pandemic: Mixed Methods Study.

BACKGROUND: Geriatric care professionals were forced to rapidly adopt the use of telemedicine technologies to ensure the continuity of care for their older patients in response to the COVID-19 pandemic. However, there is little current literature that describes how telemedicine technologies can best be used to meet the needs of geriatric care professionals in providing care to frail older patients, their caregivers, and their families. OBJECTIVE: This study aims to identify the benefits and challenges geriatric care professionals face when using telemedicine technologies with frail older patients, their caregivers, and their families and how to maximize the benefits of this method of providing care. METHODS: This was a mixed methods study that recruited geriatric care professionals to complete an online survey regarding their personal demographics and experiences with using telemedicine technologies and participate in a semistructured interview. Interview responses were analyzed using the Consolidated Framework for Implementation Research (CFIR). RESULTS: Quantitative and qualitative data were obtained from 30 practicing geriatric care professionals (22, 73%, geriatricians, 5, 17%, geriatric psychiatrists, and 3, 10%, geriatric nurse practitioners) recruited from across the Greater Toronto Area. Analysis of interview data identified 5 CFIR contextual barriers (complexity, design quality and packaging, patient needs and resources, readiness for implementation, and culture) and 13 CFIR contextual facilitators (relative advantage, adaptability, tension for change, available resources, access to knowledge, networks and communications, compatibility, knowledge and beliefs, self-efficacy, champions, external agents, executing, and reflecting and evaluating). The CFIR concept of external policy and incentives was found to be a neutral construct. CONCLUSIONS: This is the first known study to use the CFIR to develop a comprehensive narrative to characterize the experiences of Ontario geriatric care professionals using telemedicine technologies in providing care. Overall, telemedicine can significantly enable most of the geriatric care that is traditionally provided in person but is less useful in providing specific aspects of geriatric care to frail older patients, their caregivers, and their families.

Impact of artificial intelligence on pathologists' decisions: an experiment.

OBJECTIVE: The accuracy of artificial intelligence (AI) in medicine and in pathology in particular has made major progress but little is known on how much these algorithms will influence pathologists' decisions in practice. The objective of this paper is to determine the reliance of pathologists on AI and to investigate whether providing information on AI impacts this reliance. MATERIALS AND METHODS: The experiment using an online survey design. Under 3 conditions, 116 pathologists and pathology students were tasked with assessing the Gleason grade for a series of 12 prostate biopsies: (1) without AI recommendations, (2) with AI recommendations, and (3) with AI recommendations accompanied by information about the algorithm itself, specifically algorithm accuracy rate and algorithm decision-making process. RESULTS: Participant responses were significantly more accurate with the AI decision aids than without (92% vs 87%, odds ratio 13.30, P < .01). Unexpectedly, the provision of information on the algorithm made no significant difference compared to AI without information. The reliance on AI correlated with general beliefs on AI's usefulness but not with particular assessments of the AI tool offered. Decisions were made faster when AI was provided. DISCUSSION: These results suggest that pathologists are willing to rely on AI regardless of accuracy or explanations. Generalization beyond the specific tasks and explanations provided will require further studies. CONCLUSION: This study suggests that the factors that influence the reliance on AI differ in practice from beliefs expressed by clinicians in surveys. Implementation of AI in prospective settings should take individual behaviors into account.

Smartphone Alcohol Use Disorder Recovery Apps: Cross-sectional Survey of Behavioral Intention to Use.

BACKGROUND: Alcohol use disorder (AUD) carries a huge health and economic cost to society. Effective interventions exist but numerous challenges limit their adoption, especially in a pandemic context. AUD recovery apps (AUDRA) have emerged as a potential complement to in-person interventions. They are easy to access and show promising results in terms of efficacy. However, they rely on individual adoption decisions and remain underused. OBJECTIVE: The aim of this survey study is to explore the beliefs that determine the intention to use AUDRA. METHODS: We conducted a cross-sectional survey study of people with AUD. We used the Unified Theory of Acceptance and Use of Technology, which predicts use and behavioral intention to use based on performance expectancy, effort expectancy, social influence, and facilitating conditions. Participants were recruited directly from 2 sources; first, respondents at addiction treatment facilities in Ontario, Canada, were contacted in person, and they filled a paper form; second, members from AUD recovery support groups on social media were contacted and invited to fill an internet-based survey. The survey was conducted between October 2019 and June 2020. RESULTS: The final sample comprised 159 participants (124 involved in the web-based survey and 35 in the paper-based survey) self-identifying somewhat or very much with AUD. Most participants (n=136, 85.5%) were aware of AUDRA and those participants scored higher on performance expectancy, effort expectancy, and social influence. Overall, the model explains 35.4% of the variance in the behavioral intention to use AUDRA and 11.1% of the variance in use. Social influence (P=.31), especially for women (P=.23), and effort expectancy (P=.25) were key antecedents of behavioral intention. Facilitating conditions were not significant overall but were moderated by age (P=.23), suggesting that it matters for older participants. Performance expectancy did not predict behavioral intention, which is unlike many other technologies but confirms other findings associated with mobile health (mHealth). Open-ended questions suggest that privacy concerns may significantly influence the use of AUDRA. CONCLUSIONS: This study suggests that unlike many other technologies, the adoption of AUDRA is not mainly determined by utilitarian factors such as performance expectancy. Rather, effort expectancy and social influence play a key role in determining the intention to use AUDRA.

Evaluation of an Online System for Routine Outcome Monitoring: Cross-sectional Survey Study.

BACKGROUND: The use of routine outcome monitoring (ROM) in the treatment of mental health has emerged as a method of improving psychotherapy treatment outcomes. Despite this, very few clinicians regularly use ROM in clinical practice. Online ROM has been suggested as a solution to increase adoption. OBJECTIVE: The aim of this study is to identify the influence of moving ROM online on client completion rates of self-reported outcome measures and to identify implementation and utilization barriers to online ROM by assessing clinicians' views on their experience using the online system over previous paper-based methods. METHODS: Client completion rates of self-reported outcome measures were compared pre- and postimplementation of an online system of ROM. In addition, a survey questionnaire was administered to 324 mental health service providers regarding their perception of the benefits with an online system of ROM. RESULTS: Client completion rates of self-reported measures increased from 15.62% (427/2734) to 53.98% (1267/2347) after they were moved online. Furthermore, 57% (56/98) of service providers found the new system less time-consuming than the previous paper-based ROM, and 64% (63/98) found that it helped monitor clients. However, the perceived value of the system remains in doubt as only 23% (23/98) found it helped them identify clients at risk for treatment failure, and only 18% (18/98) found it strengthened the therapeutic alliance. CONCLUSIONS: Although the current study suggests mixed results regarding service providers' views on their experience using an online system for ROM, it has identified barriers and challenges that are actionable for improvement.

An evaluation of cleaning practices at a teaching hospital.

BACKGROUND: The COVID-19 outbreak has highlighted the role of hospital-acquired infections in spreading epidemics. Adequately cleaning surfaces in patient rooms is an essential part of this fight to reduce the spread. Traditional audits, however, are insufficient. This study assesses surface cleaning practices using ultravoilet (UV) marker technology and the extent to which this technology can help improve cleaning audits and practices. METHODS: One hundred and forty-four audits (1,235 surfaces) were retrieved. UV-marker cleaning audits conducted at a major teaching hospital in 2018 after implementing a new cleaning protocol. In addition, semi-structured interviews were conducted with cleaning staff and supervisors. RESULTS: On average, 63% of surfaces were appropriately cleaned. Toilet handles (80%) and toilet seats underside (83%) scored highest while main room sink fixtures (54%), light switch (55%), and bedrails (56%) scored lowest. Training, staffing and time constraints may play a role in low cleaning rates. DISCUSSION: The high-touch patient surfaces in the bedroom remain neglected and a potential source of infections. UV marker audits provided an objective measure of cleaning practices that managers and staff were unaware of. CONCLUSIONS: UV-markers audits can play a key role in revealing deficiencies in cleaning practices and help in raising awareness of these deficiencies and improving cleaning practices.

Glucose point-of-care meter operators competency: An assessment checklist.

BACKGROUND AND OBJECTIVES: Glucose point-of-care testing meters are essential technology ubiquitous in hospitals. They are operated by non-specialized staff who are assessed through an auto-recertification process that is dependent on operators successfully producing expected outcomes. Alternatively, we suggest that operator practices be directly observed using a competency assessment checklist. METHOD: We designed a checklist based on literature and manufacturers' instructions and tested it by observing 30 operators at two sites (three hospitals) over two months in 2018. RESULTS: Despite all operators being auto-recertified, the checklist revealed that only 20% met the 80% threshold of compliance to standards. Moreover, the site with a POCT coordinator had a compliance rate of 82% versus 67% for the site that did not. DISCUSSION: The checklist is more reliable than auto-recertification in assessing operators' competence. It also highlights areas for process improvement and provides an opportunity to give personalized feedback to operators.

Designing and evaluating a balanced scorecard for a health information management department in a Canadian urban non-teaching hospital.

This report is a description of a balanced scorecard design and evaluation process conducted for the health information management department at an urban non-teaching hospital in Canada. The creation of the health information management balanced scorecard involved planning, development, implementation, and evaluation of the indicators within the balanced scorecard by the health information management department and required 6 months to complete. Following the evaluation, the majority of members of the health information management department agreed that the balanced scorecard is a useful tool in reporting key performance indicators. These findings support the success of the balanced scorecard development within this setting and will help the department to better align with the hospital's corporate strategy that is linked to the provision of efficient management through the evaluation of key performance indicators. Thus, it appears that the planning and selection process used to determine the key indicators within the study can aid in the development of a balanced scorecard for a health information management department. In addition, it is important to include the health information management department staff in all stages of the balanced scorecard development, implementation, and evaluation phases.

Survey of Institutional Policies for Provision of "CMV-Safe" Blood in Ontario.

OBJECTIVES: Debate continues on whether leukoreduction alone (LR) is sufficiently similar to leukoreduced cellular products drawn from cytomegalovirus (CMV)-seronegative (SN) donors to minimize the risk of transfusion-transmitted CMV (TT-CMV). We sought to determine the policy, inventory, and practice landscape of the province for TT-CMV mitigation. METHODS: A web-based survey was distributed to hospitals in Ontario by Canadian Blood Services to collect data on their policies with respect to TT-CMV prevention. RESULTS: TT-CMV mitigation practices varied by patient population, hospital size, and region. Smaller institutions remain committed to dual prevention, whereas academic hospitals favor a single-measure approach. Although smaller institutions attempt to align their policies with leadership sites, emulation is often inaccurate. The demands for SN products also appear to be significantly lower than the current screening practices of Canadian Blood Services. CONCLUSIONS: Standardization is lacking on practices to prevent TT-CMV. Although there are barriers to harmonizing practices, the apparent shift to policies acknowledging LR as a sufficient protection is likely to continue.

Evaluation of a regional ST-elevation myocardial infarction primary percutaneous coronary intervention program at the Rouge Valley Health System.

BACKGROUND: ST-elevation myocardial infarction (STEMI) remains the second leading cause of death in Canada. Primary percutaneous coronary intervention (PCI) has been recognized as an effective method for treating STEMI. Improved access to primary PCI can be achieved through the implementation of regional PCI centres, which was the impetus for implementing the PCI program in an east Toronto hospital in 2009. As such, the purpose of this study was to measure the efficacy of this program regional expansion. METHODS: A retrospective review of 101 patients diagnosed with STEMI from May to Sept 2010 was conducted. The average door-to-balloon time for these STEMI patients was calculated and the door-to-balloon times using different methods of arrival were analyzed. Method of arrival was by one of three ways: paramedic initiated referral; patient walk-ins to PCI centre emergency department; or transfer after walk-in to community hospital emergency department. RESULTS: The study found that mean door-to balloon time for PCI was 112.5 minutes. When the door-to-balloon times were compared across the three arrival methods, patients who presented by paramedic-initiated referral had significantly shorter door-to-balloon times, (89.5 minutes) relative to those transferred (120.9 minutes) and those who walked into a PCI centre (126.7 minutes) (p = 0.047). CONCLUSIONS: The findings suggest that the partnership between the hospital and its EMS partners should be continued, and paramedic initiated referral should be expanded across Canada and EMS systems where feasible, as this level of coverage does not currently exist nationwide. Investments in regional centres of excellence and the creation of EMS partnerships are needed to enhance access to primary PCI.

Is there a relation between emergency department and inpatient lengths of stay?

INTRODUCTION: Emergency departments (EDs) are key entry points to hospital care, and issues of overcrowding and poor patient flow have become a priority in Canada. Studies have sought to determine factors that influence ED wait times in an effort to improve patient flow. We sought to identify the impact of factors such as patient age, triage level, comorbid factor level and sex to determine their effects on length of stay (LOS) and the role that they play in the ED and in an inpatient setting. METHODS: We analyzed 2 years of data from 2007 to 2009. We conducted a repeated-measures analysis of variance to measure the effects of age, triage level, comorbid level and sex as they relate to ED and inpatient LOS. RESULTS: Our analysis resulted in a final sample of 4743 patient visits. A longer LOS in the ED was correlated with a longer inpatient LOS. Age, comorbidity level and sex were shown to have an influence on LOS. CONCLUSION: Continued efforts to further reduce ED LOS are crucial, because this has the potential to influence outcomes, efficiency of EDs and succession to inpatient status, which may affect costs to the health care system. Patient-specific factors need to be considered when formulating and refining policies and processes to improve patient flow.

Extensive spatial training does not negate age differences in response latency.

Previously, Nippak et al. [Nippak, P.M.D., Chan, A.D.F., Campbell, Z., Muggenburg, B., Head, E., Ikeda-Douglas, C., Murphy, H., Cotman, C.W., Milgram, N.W., 2003. Response latency in the canine: mental ability or mental strategy? Behav. Neurosci. 117 (5), 1066-1075] reported that young dogs respond significantly slower than aged dogs during the acquisition of a three-component delayed non-match to position (3-DNMP) task. Thus, we examined how age influences response latency (RL) when animals are trained extensively on the 3-DNMP task. Animals were separated into two groups based on their task sophistication. The first group comprised young (N=5) and aged (N=10) dogs that received extensive spatial training on a two-component delayed non-match to position task (2-DNMP) before 3-DNMP testing, while the second group of young (N=8) and aged (N=11) animals received extensive training on a variety of other non-spatial cognitive tasks between each 3-DNMP test period. RL age differences were absent following extensive 3-DNMP testing; however, other age-dependent performance differences emerged: all young animals learned the task and displayed RL slowing and superior response accuracy (RA) on the center-incorrect (CI) subtest, while several aged animals failed to learn the task and displayed no RL or RA subtest variations even when they acquired the task. Toates's [Toates, F., 1998. The interaction of cognitive and stimulus-response processes in the control of behaviour, Neurosci. Biobehav. Rev. 22 (1), 59-83] theory of RL and mental strategy was proposed to explain these age differences in response strategies: the fast-responding aged animals utilized stimulus-response strategies, while the slow-responding young animals adopted cognitive strategies, a specific requirement for solving the CI subtest.

An investigation of the relationship between response latency across several cognitive tasks in the beagle dog.

Response latencies (RLs) extracted from simple motor tasks are a commonly used index of human intelligence. To date few human or animal studies have investigated the relationship between an individuals RL scores across a number of diverse cognitive tasks: Does RL remain consistent between individuals across several cognitive domains? Thus, the current study examined how RL measures gathered from beagle dogs (n=13) tested on three different cognitive tasks were related. RL scores were collected following both discrimination and reversal learning and a test of visuospatial memory, the 3 component delayed non-matching to position (3-DNMP) task. RL scores were recorded from the time the choice stimulus was presented until the animal selected a response. Results indicated that strong correlations emerged between 3-DNMP RLs and both the discrimination and reversal RLs, indicating that animals that responded fast on the 3-DNMP task also responded fast on the discrimination and reversal tasks. Interestingly, 3-DNMP RLs were more strongly correlated with reversal learning RLs. Finally, when mean RL performance across the three tasks was examined, strong RL differences emerged indicating that animals displayed significantly slower RLs on the 3-DNMP task than on the discrimination task, while reversal RLs remained indistinguishable from both. In conclusion, RLs show high between task correlations, indicating individual differences, and also vary between tasks, probably because of differences in task difficulty. These results further validate the use of RLs as an index of cognition, and also highlight the importance of further studies using animal models.

Response latency in Canis familiaris: mental ability or mental strategy?

Animal studies of cognitive aging typically use measures of response accuracy (RA) to evaluate cognitive function, which declines with age. Human aging studies, by contrast, frequently measure response latency (RL), with faster responses being indicative of superior performance. To examine the influence of age on RL in an animal model, the authors assessed RA with RL in young and aged beagle dogs (Canis familiaris) tested on a 3-component delayed nonmatching-to-position task, which comprised 3 subtests. Young dogs displayed significantly slower RLs and higher RAs and showed RL slowing with greater complexity, compared with aged dogs. In addition, the slower responding young dogs made fewer errors. Thus, RL appears to reflect the learning strategy applied, rather than the level of mental ability.

Visuospatial impairments in aged canines (Canis familiaris): the role of cognitive-behavioral flexibility.

This study used a novel delayed nonmatching-to-position task to compare visuospatial learning and memory in young and aged beagle dogs (Canis familiaris). The task used 3, rather than 2, spatial locations, which markedly increased difficulty. There were striking age differences in acquisition. Most of the aged canines did not learn the task, and those that did showed impaired learning when compared with the young canines. The aged canines also showed reduced maximal working memory capacity compared with the young canines. Analysis of the response patterns of individual canines indicated that the deficits were related to the use of ineffective strategies and inflexibility in strategy modification.