Bringing experiences of healthcare in custody into quality improvement.

Patient experience is an essential component of safe and high-quality healthcare, yet rarely examined in the context of carceral settings. This article describes a project undertaken by the Ontario Ministry of the Solicitor General to collect evidence and perspectives on how to bring patient experiences of healthcare services delivered in provincial correctional facilities into ongoing quality improvement work. We first conducted a scoping review and jurisdictional scan to learn from existing processes and experiences. We then engaged frontline healthcare providers delivering services in custody and people with recent experience of incarceration regarding priority measures and processes for data collection and mechanisms for implementing evidence-based change. This article describes methods used to engage stakeholders, including a survey and focus groups, as well as key lessons learned. This work is relevant to readers experiencing barriers to patient engagement, interested in collaborative research processes, and developing services for people who have experienced incarceration.

The relationship between mood disorder diagnosis and experiencing an unmet health-care need in Canada: findings from the 2014 Canadian Community Health Survey.

BACKGROUND: Despite Canada's universal health-care system, millions of Canadians experience unmet health-care needs (UHCN). People with mood disorders may be at higher risk of UHCN due to barriers such as stigma and gaps in health-care services. AIM: We aimed to examine the relationship between having a diagnosed mood disorder and experiencing UHCN using a recent, nationally representative survey. METHODS: Using the 2014 Canadian Community Health Survey, we used multivariate logistic regression to estimate the association between mood disorder and UHCN in the past 12 months, adjusting for sociodemographic variables and health status. RESULTS: Among 52,825 respondents, 11.8% reported UHCN. Respondents with a diagnosed mood disorder were more likely to report UHCN [adjusted odds ratio (OR) 1.61, 95% confidence interval (CI) 1.38, 1.89]. Among respondents with a regular doctor, people with mood disorders were still more likely to report UHCN (OR 1.63, 95% CI 1.38, 1.93). Sensitivity analyses using propensity score and missing data imputation approaches resulted in similar estimates. CONCLUSIONS: Adults diagnosed with a mood disorder are more likely to report UHCN in the past year, even those with a regular doctor. Our findings suggest that barriers beyond physician attachment may impact access to care for people with mood disorders.

Diagnosis and treatment of the invasive extension of bacteria (cellulitis) from chronic wounds utilising point-of-care fluorescence imaging.

Early diagnosis of wound-related cellulitis is challenging as many classical signs and symptoms of infection (erythema, pain, tenderness, or fever) may be absent. In addition, other conditions (ie, chronic stasis dermatitis) may present with similar clinical findings. Point-of-care fluorescence imaging detects elevated bacterial burden in and around wounds with high sensitivity. This prospective observational study examined the impact of incorporating fluorescence imaging into standard care for diagnosis and management of wound-related cellulitis. Two hundred thirty-six patients visiting an outpatient wound care centre between January 2020 and April 2021 were included in this study. Patients underwent routine fluorescence scans for bacteria (range: 1-48 scans/patient). Wound-related cellulitis was diagnosed in 6.4% (15/236) of patients. In these patients, fluorescence scans showed an irregular pattern of red (bacterial) fluorescence extending beyond the wound bed and periwound that could not be removed through cleansing or debridement, indicating the invasive extension of bacteria (wound-related cellulitis). Point-of-care identification facilitated rapid initiation of treatments (source control and antibiotics, when warranted) that resolved the fluorescence. No patients had worsening of cellulitis requiring intravenous antibiotics and/or hospitalisation. These findings demonstrate the utility of point-of-care fluorescence imaging for efficient detection and proactive, targeted management of wound-related cellulitis.

Global Prison Health Care Governance and Health Equity: A Critical Lack of Evidence.

The large and growing population of people who experience incarceration makes prison health an essential component of public health and a critical setting for reducing health inequities. People who experience incarceration have a high burden of physical and mental health care needs and have poor health outcomes. Addressing these health disparities requires effective governance and accountability for prison health care services, including delivery of quality care in custody and effective integration with community health services.Despite the importance of prison health care governance, little is known about how prison health services are structured and funded or the methods and processes by which they are held accountable. A number of national and subnational jurisdictions have moved prison health care services under their ministry of health, in alignment with recommendations by the World Health Organization and the United Nations Office on Drugs and Crime. However, there is a critical lack of evidence on current governance models and an urgent need for evaluation and research, particularly in low- and middle-income countries.Here we discuss why understanding and implementing effective prison health governance models is a critical component of addressing health inequities at the global level.

Twelve tips for developing and implementing curriculum in dedicated 'collaborative classrooms'.

Many health professional schools may be investing time and resources on dedicated educational spaces intended to promote collaborative learning. Alone, innovative physical space or technologies are not sufficient to ensure success in this. Lesson plans informed by collaborative praxis, individual motivation, faculty development, learner feedback, and team interactions also play a necessary and substantial role. We have used faculty observations, quantitative and qualitative student evaluation data, and the existing educational literature to provide twelve tips on leveraging curricular content, activity setup, physical space, learner behavior, and faculty facilitation to make the most of collaborative learning spaces.

Participant-Driven Health Education Workshops With Men Transitioning From Prison to Community.

As part of a participatory health research project seeking to support men in achieving their health goals during the transition from prison to community, a workshop program was developed and piloted in a Community Residential Facility in British Columbia, Canada. The pilot program was evaluated through feedback surveys at each of the 16 workshops and a focus group interview at the end of the program. Workshops were highly valued by participants and seen as a means for (1) building skills relevant to their health and wellness, (2) working toward changing attitudes and behaviors adopted in prison, and (3) helping others and accepting help from others. Similar programs may be an effective support for men working to achieve their health goals during other transitions (e.g., bereavement, cancer patients, returning soldiers, and veterans).

Static cerebrovascular pressure autoregulation remains intact during deep hypothermia.

BACKGROUND: Clinical studies measuring cerebral blood flow in infants during deep hypothermia have demonstrated diminished cerebrovascular pressure autoregulation. The coexistence of hypotension in these cohorts confounds the conclusion that deep hypothermia impairs cerebrovascular pressure autoregulation. AIM: We sought to compare the lower limit of autoregulation and the static rate of autoregulation between normothermic and hypothermic piglets. METHODS: Twenty anesthetized neonatal piglets (5-7 days old; 10 normothermic and 10 hypothermic to 20°C) had continuous measurements of cortical red cell flux using laser Doppler flowmetry, while hemorrhagic hypotension was induced without cardiopulmonary bypass. Lower limit of autoregulation was determined for each subject using piecewise regression and SRoR was determined above and below each lower limit of autoregulation as (%change cerebrovascular resistance/%change cerebral perfusion pressure). RESULTS: The estimated difference in lower limit of autoregulation was 1.4 mm Hg (lower in the hypothermic piglets; 95% C.I. -10 to 14 mm Hg; P=0.6). The median lower limit of autoregulation in the normothermic group was 39 mm Hg [IQR 38-51] vs 35 mm Hg [31-50] in the hypothermic group. Intact steady-state pressure autoregulation was defined as static rate of autoregulation >0.5 and was demonstrated in all normothermic subjects (static rate of autoregulation=0.72 [0.65-0.87]) and in 9/10 of the hypothermic subjects (static rate of autoregulation=0.65 [0.52-0.87]). This difference in static rate of autoregulation of 0.06 (95% C.I. -0.3 to 0.1) was not significant (P=0.4). CONCLUSION: Intact steady-state cerebrovascular pressure autoregulation is demonstrated in a swine model of profound hypothermia. Lower limit of autoregulation and static rate of autoregulation were similar in hypothermic and normothermic subjects.

Development and implementation of the Saskatchewan Leadership Program: Leading for healthcare transformation.

The Saskatchewan Leadership Program (SLP) was developed based on the LEADS framework and aligned with Lean management to build leadership renewal and sustainability conducive to transformational change in the Saskatchewan health system. This article describes the development, implementation, and evaluation of the SLP, including experiences and lessons learned.

Discriminatory Performance of the Calcaneal Quantitative Ultrasound and Osteoporosis Self-Assessment Tool to Select Older Women for Dual-Energy X-ray Absorptiometry.

The objective of this cross-sectional study was to evaluate the accuracy of the calcaneal quantitative ultrasound (QUS) and the Osteoporosis Self-Assessment Tool (OST) in identifying older women with osteoporosis as defined by dual-energy X-ray absorptiometry (DXA), and to establish optimal cutoffs to determine risk. We assessed bone mineral density of the femoral neck and lumbar spine using DXA and subsequent calcaneal QUS and OST measurements in 174 women aged 50-80 years. Pearson product correlation coefficients between QUS, OST, and DXA parameters were calculated. Receiver operating characteristic curves were constructed and areas under the curves (AUCs) and optimal thresholds for QUS and OST were defined based on sensitivity, specificity, and likelihood ratio analysis. The ability of calcaneal QUS to identify women with a T-score ≤-2.5 at the femoral neck (AUC = 0.892) consistently outperformed a T-score ≤-2.5 at the lumbar spine (AUC = 0.696) and OST at both the femoral neck and lumbar spine (AUC = 0.706-0.807). Stiffness index cutoff values that fall between 65 and 78 were found to warrant DXA screening, with a cutoff <65 indicating high likelihood of osteoporosis. Further prospective research is needed to examine the gender-related differences of QUS and OST diagnostic performance and their usefulness in clinical practice.