Designing systems for the care we need: A transformation journey in Southwestern Ontario.

Primary care is considered the foundation of any health system. In Ontario, Canada Bills 41 and 74 introduced in 2016 and 2019, respectively, aimed to move towards a primary care-focused and sustainable integrated care approach designed around the needs of local populations. These bills collectively set the stage for integrated care and population health management in Ontario, with Ontario Health Teams (OHTs) introduced as a model of integrated care delivery systems. OHTs aim to streamline patient connectivity through the healthcare system and improve outcomes aligned with the Quadruple Aim. When Ontario released a call for health system partners to apply to become an OHT, providers, administrators, and patient/caregiver partners from the Middlesex-London area were quick to respond. We highlight the critical elements and journey of the Middlesex-London Ontario Health Team since its start.

How has body image been evaluated among people with lower limb loss? A scoping review.

PURPOSE: Lower limb loss can result in an altered body image, leading to changes in self-esteem, mental health and quality of life. This scoping review explored how body image has been evaluated among people with lower limb loss. MATERIALS AND METHODS: Five databases (Embase, Medline, PsychINFO, CINHAL, and Nursing and Allied Health Database) were searched from inception until March 19, 2023. Inclusion criteria: 1) people with lower limb loss; 2) evaluated a body image outcome or theme; and 3) a qualitative, quantitative or mixed methods design. RESULTS: Twenty-four quantitative (n = 19 cross-sectional, n = 3 intervention cohort and n = 2 prospective cohort), 2 qualitative and 1 mixed methods design studies were included. The definition of body image varied across studies, with 59% of studies not reporting a conceptual or theoretical definition. People with lower limb loss perceived a more negative body image compared to control groups. In prospective cohort studies, changes in body image over time were inconclusive. CONCLUSION: People with lower limb loss report a negative body image when compared to other populations. Definitions and understanding of body image changed overtime and varied among studies which may impact introducing interventions to promote positive body image during rehabilitation and beyond in this population.

People with lower limb loss experience altered body image following limb amputation, at the initiation, during and after prosthetic rehabilitation, and re-integrating into the community.Clinicians are encouraged to use this study's proposed lower limb loss-specific definition of body image.The proposed definition incorporates common terminology used in past research in the field and amputee-specific situations when referring to altered body image among this patient population.To better support the psychological adjustment of people with lower limb loss in rehabilitation programs and beyond, clinicians and researchers should evaluate body image at multiple time points (e.g., admission and discharge to rehabilitation, follow-up) using an outcome measure that asks about both with and without a prosthesis on the residual limb.