Improving interprofessional handover on labor and delivery: A needs assessment study.

Handover is the transfer of important clinical information between health providers. The current report describes a needs assessment of interprofessional labor and delivery handover at an urban hospital in Canada. The goal of this study was to explore the perceptions of the current handover meeting and opportunities for improvement. Using a constructivist paradigm, we conducted 28 semi-structured inter- views with handover participants. We used a recruitment grid to ensure we included the voices of participants representing each profession involved in interprofessional handover meetings. An inductive process was used to code the interview transcripts and theme the data. Major themes identified were: (1) Interprofessional handover contributes positively to team situational awareness, interprofessional relationships, and team communication; (2) Handover could be better if it had a more defined process; (3) Interprofessional handover can lead to feelings of intimidation; and (4) Interprofessional handovers on the labor and delivery unit in our setting need increased inclusivity of midwives. From these themes, continued development of interprofessional handover meetings on labor and delivery should be aimed at a formal definition of the scope and process for these meetings reducing feelings of intimidation, increased integration of Midwifery providers, and continued improvement of relationships between different professions and practitioners on labor and delivery.

A systems approach for institutional CBME adoption at Queen's University.

The Royal College of Physicians and Surgeons of Canada (RCPSC) has begun the transition to Competency by Design (CBD), a new curricular model for residency education that 'ensure[s] competence, but teaches for excellence'. By 2022, all Canadian specialty programs are anticipated to have completed the CBD cohort process which includes workshops facilitated by a Royal College Clinician Educator. Queen's University in Ontario, Canada, was granted approval by the RCPSC to embark upon an accelerated path to competency-based medical education (CBME) for all our postgraduate specialties. This accelerated path allowed us to take an institutional approach for CBME implementation and ensure that all specialities were part of a system-wide change. Our unique institution-wide approach to CBD is the first of its kind across Canada. From both a theoretical and practical perspective we undertook CBME using a systems approach that allowed us to build the foundations for CBME, implement the change, and plan for sustainability. This has created opportunities to bridge and connect the various programs involved in the implementation of CBME on Queen's campus. The systems approach was an essential part of our strategy to develop a community dedicated to ensuring a successful CBME implementation.

Exploring How the New Entrustable Professional Activity Assessment Tools Affect the Quality of Feedback Given to Medical Oncology Residents.

The post-graduate medical programs at Queen's University transitioned to a competency-based medical education framework on July 1, 2017. In advance of this transition, the Medical Oncology program participated in a pilot of six Entrustable Professional Activities (EPAs) focused workplace-based assessment (WBA) tools with faculty and residents. The purpose of this sequential explanatory mixed method study was to determine the extent to which these WBAs provided quality feedback for residents. The WBAs were introduced into daily clinical practice and, once completed, were collected by the research team. A resident focus group (n = 4) and faculty interviews (n = 5) were also conducted. Focus group and interview data were analyzed using an emergent thematic analysis. Data from the completed assessment tools were analyzed using both descriptive statistics and a literature-informed framework developed to assess the quality of feedback. Six main findings emerged: Verbal feedback is preferred over written; providing both written and verbal feedback is important; effective feedback was seen as timely, specific, and actionable; the process was conceptualized as coaching rather than high stakes; there were logistical concerns about the WBAs, and additional clarification about the WBA tools is needed. This study provides insight into faculty and resident perceptions of quality feedback and the potential for WBA tools to assist in providing effective feedback to residents as we shift to competency-based medical education in Canada. Our results suggest the need for additional faculty development around the use of the tools, and their intended role, and the elements of quality feedback.

Re-imaging Clinical Education: The Interdependence of the Self-Regulated Clinical Teacher and Nursing Student.

The interdependence of student learning strategies and teacher's pedagogical practices is critical to clinical practice learning. While research demonstrates that formative assessment feedback is important for student learning, clinical teachers do not necessarily have the competencies to provide effective feedback to support students' self-regulated learning (SRL). An examination of clinical education through SRL lenses articulates two roles for clinical teachers in nursing clinical education: self-regulated learner and self-regulated teacher. Teachers as self-regulated learners are practice-content experts and must also learn how to explicitly help students become self-regulated learners. The latter is the self-regulated teacher role, and a self-regulated teacher is an effective clinical teacher. Minimal research addresses the ways in which clinical teachers' effectiveness could be improved if they took on a self-regulated teacher role. A model of SRL and teaching in clinical practice education is presented and its potential to enhance clinical teacher effectiveness and student SRL articulated.

Starting to Think Like an Expert: An Analysis of Resident Cognitive Processes During Simulation-Based Resuscitation Examinations.

STUDY OBJECTIVE: Simulation is commonly used to teach crisis resource management skills and assess them in emergency medicine residents. However, our understanding of the cognitive processes underlying crisis resource management skills is limited because these processes are difficult to assess and describe. The objective of this study is to uncover and characterize the cognitive processes underlying crisis resource management skills and to describe how these processes vary between residents according to performance in a simulation-based examination. METHODS: Twenty-two of 24 eligible emergency medicine trainees from 1 tertiary academic center completed 1 or 2 resuscitation-based examinations in the simulation laboratory. Resident performance was assessed by a blinded expert using an entrustment-based scoring tool. Participants wore eye-tracking glasses that generated first-person video that was used to augment subsequent interviews led by an emergency medicine faculty member. Interviews were audio recorded and then transcribed. An emergent thematic analysis was completed with a codebook that was developed by 4 research assistants, with subsequent analyses conducted by the lead research assistant with input from emergency medicine faculty. Themes from high- and low-performing residents were subsequently qualitatively compared. RESULTS: Higher-performing residents were better able to anticipate, selectively attend to relevant information, and manage cognitive demands, and took a concurrent (as opposed to linear) approach to managing the simulated patient. CONCLUSION: The results provide new insights into residents' cognitive processes while managing simulated patients in an examination environment and how these processes vary with performance. More work is needed to determine how best to apply these findings to improve crisis resource management education.

Getting Inside the Expert's Head: An Analysis of Physician Cognitive Processes During Trauma Resuscitations.

STUDY OBJECTIVE: Crisis resource management skills are integral to leading the resuscitation of a critically ill patient. Despite their importance, crisis resource management skills (and their associated cognitive processes) have traditionally been difficult to study in the real world. The objective of this study was to derive key cognitive processes underpinning expert performance in resuscitation medicine, using a new eye-tracking-based video capture method during clinical cases. METHODS: During an 18-month period, a sample of 10 trauma resuscitations led by 4 expert trauma team leaders was analyzed. The physician team leaders were outfitted with mobile eye-tracking glasses for each case. After each resuscitation, participants were debriefed with a modified cognitive task analysis, based on a cued-recall protocol, augmented by viewing their own first-person perspective eye-tracking video from the clinical encounter. RESULTS: Eye-tracking technology was successfully applied as a tool to aid in the qualitative analysis of expert performance in a clinical setting. All participants stated that using these methods helped uncover previously unconscious aspects of their cognition. Overall, 5 major themes were derived from the interviews: logistic awareness, managing uncertainty, visual fixation behaviors, selective attendance to information, and anticipatory behaviors. CONCLUSION: The novel approach of cognitive task analysis augmented by eye tracking allowed the derivation of 5 unique cognitive processes underpinning expert performance in leading a resuscitation. An understanding of these cognitive processes has the potential to enhance educational methods and to create new assessment modalities of these previously tacit aspects of expertise in this field.

Parents' Understanding of Genetics and Heritability.

Parents have the opportunity to educate their children to facilitate behaviours and lifestyle habits that may prevent or delay genetic disease, or mitigate predispositions within the family. We sought to determine parents' understanding of genetic knowledge and heritability. Using a quantitative survey methodology 108 volunteer participants were surveyed from a convenience sample of all parents/caregivers within the waiting room of a general children's outpatient clinic. Results indicated that average genetic knowledge levels were fairly high, with the majority of participants scoring 70-80 % correct on knowledge-based questions. Further, scores were found to be positively correlated with education, but inversely correlated with self-perceived knowledge. This finding suggests that participants with less experience tended to overestimate their knowledge. We suggest that gaps in knowledge of genetics and heritability could be improved by using educational interventions such as media campaigns, provision of informational brochures, or changes to current high school curriculum which would increase exposure to genetics and heritability for both parents and children.

Patient-Related Risk Factors for the Occurrence of Patient-Reported Medication Errors in One Community Pharmacy: A Local Perspective.

Background: Medication errors have been shown to occur 4 times more often in the community compared to the hospital setting. Therefore, identifying the patient-related factors within the community that contribute to an increased occurrence of medication errors is required. Objective: To assess patients' knowledge and understanding of their medications in order to determine risk for medication errors. Methods: This quantitative descriptive study used a convenience sample of participants filling their prescriptions at one independent pharmacy in Canada. The study used descriptive statistics including frequencies and correlations. Further multiple regressions were conducted to explore the relationship between the patient factors and medication knowledge and use. Results: A total of 33.5% of respondents indicated that they know what medication they are currently taking, and that they know why they taking their current medications. Decreased knowledge of medication taken was significantly associated with likelihood of a medication error by 3.6 times (P = .048). Increased age (P = .01) and the death of a spouse (P = .01) correspond to a decreased knowledge of medications. Those with less education appeared to have decreased understanding as to why they are taking their medications (P = .01). The odds of experiencing a medication error increased with multiple medications. Also, changes in medication dose increased the probability of experiencing a medication error by 2.2 times. This study however had a small sample size. Conclusions: With identification and understanding of patient factors that influence the incidence of medication error, we can increase awareness and determine solutions to decrease risk of medication error in clinical practice.

Crossing boundaries: the design of an interdisciplinary training program to improve care for the frail elderly.

The Technology Evaluation in the Elderly Network (TVN) was funded in July 2012 under the Canadian Networks of Centres of Excellence program. This article highlights the development and preliminary evaluation of the TVN Interdisciplinary Training Program. This program is based on an experiential learning approach that crosses a multitude of disciplines including health sciences, law, social sciences, and ethical aspects of working with the frail elderly. Opportunities within the program include mentorship, interdisciplinary online collaborative projects, external placements, academic products, pre-grant submission, trainee-driven requirements, Network meetings, online modules/webinars, and most importantly active involvement with patients, families, and their support systems. The authors have 120 trainees from approximately 23 different disciplines including law, ethics, public policy, social work, and engineering engaged in the program. Based on our evaluation this program has been perceived as highly valuable by the participants and the community.

Residents' and spouses' experiences of loneliness and depression after separation due to long-term care placement: a qualitative systematic review.

OBJECTIVE: The objective of this review was to describe the experiences of loneliness and/or depression for residents and their spouses who have been separated by long-term care placement. INTRODUCTION: Loneliness and depression have a pernicious influence on the overall health and well-being of older adults. Older adults' mental health is significantly affected by social relationships, including those between spouses. However, there is limited research pertaining to long-term care residents' and community-dwelling spouses' experiences of loneliness and/or depression after separation due to long-term care placement. INCLUSION CRITERIA: This systematic review included studies that recruited community-dwelling spouses and long-term care residents over 50 years of age with living spouses from whom they are separated due to long-term care placement. Studies on the experiences of loneliness and/or depression due to spousal separation with one or both spouses living in long-term care were included in this review. METHODS: Ovid MEDLINE(R) was used for the initial search. A full search strategy was developed for Ovid MEDLINE(R), CINAHL (EBSCOhost), Embase (Ovid), and PsycINFO (Ovid). The review was conducted using the JBI methodology for reviews of qualitative research, with 2 independent reviewers performing study selection, critical appraisal, data extraction, data synthesis, and assessment of confidence in the findings. RESULTS: Eleven papers were included in this systematic review. Four synthesized findings were extracted from 10 categories and 42 findings: i) Loneliness and depression result from a lack of physical and social connection for separated long-term care residents and community-dwelling spouses; ii) Community-dwelling spouses feel unprepared and upset with spousal separation due to a lack of psychological support; iii) Behavioral strategies can prevent community-dwelling spouses and long-term care residents from developing loneliness and/or depression; and iv) Community-dwelling spouses have differing abilities to adapt and cope with feelings of loneliness and/or depression. CONCLUSION: This review provides a comprehensive synthesis of the feelings of loneliness and/or depression in spouses who are separated due to long-term care placement. This review has demonstrated that there is a lack of literature inclusive of the voices and perspectives of all spouses affected by spousal separation in long-term care. The limitations of this review include the small number of included studies and the range of quality in included studies. Recommendations include additional research on the lived experience of spousal separation from the perspectives of long-term care residents and their community-dwelling spouses. Further, additional psychological support is needed for separated spouses, guided by the suggestions and experiences of long-term care residents and their community-dwelling spouses. REVIEW REGISTRATION: PROSPERO CRD42022333014.

Methods for studying medication safety following electronic health record implementation in acute care: a scoping review.

OBJECTIVES: The objective of this scoping review is to map methods used to study medication safety following electronic health record (EHR) implementation. Patterns and methodological gaps can provide insight for future research design. MATERIALS AND METHODS: We used the Joanna Briggs Institute scoping review methodology and a custom data extraction table to summarize the following data: (1) study demographics (year, country, setting); (2) study design, study period, data sources, and measures; (3) analysis strategy; (4) identified limitations or recommendations; (5) quality appraisal; and (6) if a Safety-I or Safety-II perspective was employed. RESULTS: We screened 5879 articles. One hundred and fifteen articles met our inclusion criteria and were assessed for eligibility by full-text review. Twenty-seven articles were eligible for extraction. DISCUSSION AND CONCLUSION: We found little consistency in how medication safety following EHR implementation was studied. Three study designs, 7 study settings, and 10 data sources were used across 27 articles. None of the articles shared the same combination of design, data sources, study periods, and research settings. Outcome measures were neither defined nor measured consistently. It may be difficult for researchers to aggregate and synthesize medication safety findings following EHR implementation research. All studies but one used a Safety-I perspective to study medication safety. We offer a conceptual model to support a more consistent approach to studying medication safety following EHR implementation.

PROTOCOL: Learner-educator co-creation of student assessment in health professional education courses: A scoping review protocol.

This is a protocol for a Campbell Review following JBI scoping review methodology. The objectives are to answer the following questions: What has been reported in the literature about collaborative learner-educator design, implementation, or evaluation of learner assessment in health professional education? (1) Where is learner-educator co-creation of assessment occurring? (i.e., which disciplines, course types, level of learner, year of study). (2) What course assessment decisions are influenced or being made together? (i.e., assessment instructions and/or grades). (3) How much influence do learners have on decision-making? (i.e., where does it fall on Bovill and Bulley's ladder of participation). (4) How do learners and educators go about making decisions together? (i.e., discussion or voting, with a whole class or portion of the class). (5) What are the perceived benefits, disadvantages, barriers, and/or facilitators reported by the authors?

How does the nurse educator measure caring?

The purpose of this article is to advance worldwide scholarship of nursing education by introducing a novel approach to evaluate nursing students' level of human caring. We propose an innovative tool that can be used by nurse educators to measure the construct of caring. Caring encompasses three dimensions: intentionality, relationality, and responsivity. The dimensions are drawn from theoretical, practice, and education literatures. The innovative tool, named the Caring Interaction Inventory, exposes nursing students to audio-video recordings of complex real-life healthcare encounters. Nursing students are required to choose from several options, caring behaviors that would best address holistic patient needs. Caring behaviors chosen for a given healthcare encounter and the rationale provided by the student, enable the nurse educator to evaluate the student's caring in terms of intentionality, relationality, and responsivity. The sum total of the student's performance within each dimension constitutes the student's overall caring grade.

Use of Machine Learning to Assess Cataract Surgery Skill Level With Tool Detection.

Purpose: To develop a method for objective analysis of the reproducible steps in routine cataract surgery. Design: Prospective study; machine learning. Participants: Deidentified faculty and trainee surgical videos. Methods: Consecutive cataract surgeries performed by a faculty or trainee surgeon in an ophthalmology residency program over 6 months were collected and labeled according to degrees of difficulty. An existing image classification network, ResNet 152, was fine-tuned for tool detection in cataract surgery to allow for automatic identification of each unique surgical instrument. Individual microscope video frame windows were subsequently encoded as a vector. The relation between vector encodings and perceived skill using k-fold user-out cross-validation was examined. Algorithms were evaluated using area under the receiver operating characteristic curve (AUC) and the classification accuracy. Main Outcome Measures: Accuracy of tool detection and skill assessment. Results: In total, 391 consecutive cataract procedures with 209 routine cases were used. Our model achieved an AUC ranging from 0.933 to 0.998 for tool detection. For skill classification, AUC was 0.550 (95% confidence interval [CI], 0.547-0.553) with an accuracy of 54.3% (95% CI, 53.9%-54.7%) for a single snippet, AUC was 0.570 (0.565-0.575) with an accuracy of 57.8% (56.8%-58.7%) for a single surgery, and AUC was 0.692 (0.659-0.758) with an accuracy of 63.3% (56.8%-69.8%) for a single user given all their trials. Conclusions: Our research shows that machine learning can accurately and independently identify distinct cataract surgery tools in videos, which is crucial for comparing the use of the tool in a step. However, it is more challenging for machine learning to accurately differentiate overall and specific step skill to assess the level of training or expertise. Financial Disclosures: The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Experience of loneliness and depression due to spousal separation in long-term care residents and their spouses: a qualitative systematic review protocol.

OBJECTIVE: The objective of this review is to describe the experience of loneliness and/or depression due to spousal separation when one or both spouses are admitted into a long-term care facility. INTRODUCTION: Loneliness and depression are important concerns for the health and well-being of older adults separated from their spouses due to long-term care placement. Social relationships, specifically spousal relationships, have a significant impact on the mental health of older adults. However, there is limited research on the experience or effect of spousal separation on long-term care residents' and their spouses' experience of loneliness and/or depression. INCLUSION CRITERIA: This review will include long-term care residents and their spouses who are over the age of 50 and have a spouse they are separated from due to long-term care placement. Studies will be included in this review if they explore the experiences of loneliness and/or depression due to spousal separation with one or both spouses living in a long-term care facility. METHODS: This review will be conducted in line with the JBI methodology for systematic reviews of qualitative evidence. MEDLINE was used for the initial search. A full search strategy was then developed for MEDLINE, CINAHL, Embase, and PsycINFO. The JBI approach to study selection, critical appraisal, data extraction, data synthesis, and assessment of confidence will be used. Two reviewers will pilot test the screening criteria and data extraction protocol. REVIEW REGISTRATION: PROSPERO CRD42022333014.

Multi-source feedback following simulated resuscitation scenarios: a qualitative study.

Background: The direct observation and assessment of learners' resuscitation skills by an attending physician is challenging due to the unpredictable and time-sensitive nature of these events. Multisource feedback (MSF) may address this challenge and improve the quality of assessments provided to learners. We aimed to describe the similarities and differences in the assessment rationale of attending physicians, registered nurses, and resident peers in the context of a simulation-based resuscitation curriculum. Methods: We conducted a qualitative content analysis of narrative MSF of medical residents in their first postgraduate year of training who were participating in a simulation-based resuscitation course at two Canadian institutions. Assessments included an entrustment score and narrative comments from attending physicians, registered nurses, and resident peers in addition to self-assessment. Narrative comments were transcribed and analyzed thematically using a constant comparative method. Results: All 87 residents (100%) participating in the 2017-2018 course provided consent. A total of 223 assessments were included in our analysis. Four themes emerged from the narrative data: 1) Communication, 2) Leadership, 3) Demeanor, and 4) Medical Expert. Relative to other assessor groups, feedback from nurses focused on patient-centred care and communication while attending physicians focused on the medical expert theme. Peer feedback was the most positive. Self-assessments included comments within each of the four themes. Conclusions: In the context of a simulation-based resuscitation curriculum, MSF provided learners with different perspectives in their narrative assessment rationale and may offer a more holistic assessment of resuscitation skills within a competency-based medical education (CBME) program of assessment.

Contexte: Le contexte imprévisible et contraignant au niveau du temps lors de l'observation directe et de la rétroaction associée sur les compétences en réanimation des apprenants constituent un défi pour un médecin superviseur. La rétroaction multisources (RMS) peut être un moyen de relever ce défi et d'améliorer la qualité des rétroactions fournies aux apprenants. Nous visons à décrire les similitudes et les différences quant à la démarche évaluative auprès de médecins traitants, d'infirmières cliniciennes et de pairs résidents dans le cadre d'un cours de réanimation offert par simulation. Méthodes: Nous avons réalisé une analyse de contenu à partir des rétroactions narratives offertes aux résidents en première année de formation postdoctorale dans deux universités canadiennes dans le cadre d'un cours de réanimation offert par simulation. En plus de l'auto-évaluation, la rétroaction comportait un score de confiance et des commentaires narratifs de la part de médecins superviseurs, d'infirmières cliniciennes et des pairs. Les commentaires ont été transcrits et analysés par thèmes en appliquant la méthode générale de comparaison constante. Résultats: Un consentement pour participer à l'étude a été obtenu auprès des 87 résidents (100 %) qui ont suivi le cours en 2017-2018. Nous avons analysé un total de 223 rétroactions. Quatre thèmes ont émergé à partir des données narratives soit : 1) la communication, 2) le leadership, 3) le comportement, et 4) l'expertise médicale. Alors que les infirmières ont ciblé leurs commentaires sur les soins centrés sur le patient et la communication, les médecins superviseurs ont les ont ciblés sur l'expertise médicale. Les commentaires des pairs étaient les plus positifs. Les auto-évaluations comportaient des commentaires sur chacun des quatre thèmes. Conclusions: Dans le contexte d'un cours de réanimation offert par simulation, la RMS a permis aux apprenants d'obtenir des évaluations narratives selon différentes perspectives. Permettant ainsi une approche plus holistique de rétroaction sur les habiletés en réanimation dans le cadre d'un programme d'évaluation axé sur les compétences .

Barriers and facilitators to education experienced by students with disabilities in low- and middle-income African countries: a systematic review of qualitative evidence.

OBJECTIVE: This review sought to collect and synthesize studies that investigated the lived experience of barriers and facilitators to educational access and excellence for students with disabilities in low- and middle-income African countries. INTRODUCTION: Access to education in low- and middle-income African countries for students with disabilities is often inequitable. Although governments have developed policies and programs for student with disabilities, much of the literature guiding policy and program development has focused on the views of academics, parents, teachers, and political figures. INCLUSION CRITERIA: This systematic review considered studies that included participants who were students or trainees at the time of the study, have a disability, and were located in a low- and middle-income African country. The phenomena of interest were barriers and facilitators to educational success for students with disabilities. This review included qualitative, interpretive, and critical studies that drew on the experiences of students with disabilities. METHODS: An initial search was conducted in CINAHL and MEDLINE, followed by development of a full search strategy that was used for AMED, Embase, CINAHL, Global Health, MEDLINE, and Epub Ahead of Print, In-Process and Other Non-Indexed Citations, Daily and Versions, spanning from 1910-2021. Articles were limited to those published in English. The JBI approach was followed for study selection, critical appraisal, data extraction, data synthesis, and assessing confidence in the findings with ConQual. RESULTS: Thirteen qualitative studies were included from seven African countries, and included primary, secondary and postsecondary students. The data were qualitatively synthesized into 64 findings, within six categories, which then formed two synthesized findings. The synthesized findings were: barriers and challenges to engaging in education, and supports for educational success. CONCLUSIONS: This review is a synthesis of the lived experiences of students with disabilities in low- and middle-income African countries to understand, in their own words, the challenges and supports they encounter during their educational journeys. Although many barriers and supports reported by students with disabilities and other stakeholders (eg, parents, teachers, administrators) are similar to those identified in this review, our findings identify that integrated research that includes students with disabilities will provide contextual and individual factors that are crucial for students to achieve equitable access to education. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42019137951.

Lyme Disease Training and Knowledge Translation Resources Available to Canadian Healthcare Professionals: A Gray Literature Review.

INTRODUCTION: Lyme Disease (LD) is the most common tick-borne disease in North America. With the number of cases increasing yearly, Canadian healthcare professionals (HCP) rely on up-to-date and evidence-informed guidelines, instruction, and resources to effectively prevent, diagnose, and treat Lyme disease (LD). This review is the first of its kind to examine gray literature and analyze the diversity of recommendations provided to Canadian HCP about the prevention, diagnosis, and treatment of Lyme disease. METHODS: A gray literature review consisting of 4 search strategies was conducted to retrieve materials targeted to Canadian HCP. Searches within targeted websites, targeted Google searches, and gray literature databases, and consultation with content experts were done to look for continuing medical education (CME) events, clinical flow charts, webinars, videos, and reference documents that discussed the prevention, diagnosis, and treatment of Lyme disease. RESULTS: A total of 115 resources were included in this study. Recommendations surrounding prevention strategies were less varied between materials, whereas diagnosis and treatment recommendations were more varied. Our findings suggest that Canadian HCP are met with varying and sometimes contradictory recommendations for diagnosing and treating LD. CONCLUSIONS: Due to the increasing incidence of LD in Canada, there is a greater need for resource consistency. Providing this consistency may help mitigate LD burden, standardize approaches to prevention, diagnosis and treatment, and improve patient outcomes.

Examining influential drivers of private well users' perceptions in Ontario: A cross-sectional population study.

Private well users are responsible for managing and maintaining the quality of their drinking water source. Previous studies in Canada have reported low testing rates among well users, a cornerstone of well stewardship behaviours that can prevent the consumption of contaminated groundwater. To improve well stewardship, it is important to understand the interactions between, and the impacts of, various factors that may influence behaviours. Accordingly, the objective of the current study was to investigate the impact of socio-demographics, property characteristics, and experiences with well construction and acute gastrointestinal illness (AGI) (i.e., previous experiences) on levels of awareness, attitudes, risk perceptions, and beliefs (i.e., risk domains) among private well users in Ontario. A link to a province-wide online survey was circulated between May and August 2018 and novel "risk domain" scoring protocols were developed to classify and summarize response data. The survey was undertaken by 1228 respondents, of which 1030 completed the survey in full. Results indicate a low level of waterborne pathogen awareness, with 50.8% of respondents unaware of any groundwater associated pathogens. Respondents' geographic location, gender, and well type were significantly associated with well users' attitudes and perceptions of risk regarding their personal well water supply and the quality and quantity of local groundwater sources. Higher levels of awareness and lower risk perception scores (i.e., lower perceptions of risk) were associated with residential presence during well construction (p < 0.001 and p = 0.017, respectively). Previous case(s) of AGI within the respondent's household were significantly associated with negative attitudes towards their well water (p < 0.001) and higher risk perception scores (p = 0.025) with respect to the quantity of local groundwater sources. Results may be used to identify critical experiential control points (e.g., during well construction or after a physician confirmed AGI diagnosis) and develop improved risk management and communication strategies aimed at private well users.

Health Resource and Cost Savings Achieved in a Multidisciplinary Lung Cancer Clinic.

Background: Lung cancer (LC) care is resource and cost intensive. We launched a Multidisciplinary LC Clinic (MDC), where patients with a new LC diagnosis received concurrent oncology consultation, resulting in improved time to LC assessment and treatment. Here, we evaluate the impact of MDC on health resource utilization, patient and caregiver costs, and secondary patient benefits. Methods: We retrospectively analyzed patients in a rapid assessment clinic with a new LC diagnosis pre-MDC (September 2016-February 2017) and post-MDC implementation (February 2017-December 2018). Data are reported as means; unpaired t-tests and ANOVA were used to assess for significance. We also conducted a cost analysis. Resource utilization, out-of-pocket costs, procedure-related costs, and indirect costs were evaluated from the societal perspective and presented in 2019 Canadian dollars (CAD); multi-way worst/best case and threshold sensitivity analyses were conducted. Results: We reviewed 428 patients (78 traditional model, 350 MDC). Patients in the MDC model required significantly fewer oncology visits from LC diagnosis to first LC treatment (1.62 vs. 2.68, p < 0.001), which was significant for patients with stage 1, 3, and 4 disease. Compared with the traditional model, there was no change in mean biopsies/patient (1.32 traditional vs. 1.17 MDC, p = 0.18) or staging investigations/patient (2.24 traditional vs. 2.02 MDC, p = 0.20). Post-MDC, there was an increase in invasive mediastinal staging for patients with stage 2/3 LC (15.0% vs. 60.0%, p < 0.001). Over 22 months, MDC resulted in savings of CAD 48,389 including CAD 24,167 CAD in direct patient out-of-pocket expenses. For the threshold analyses, MDC was estimated to cost CAD 25,708 per quality-adjusted life year (QALY), considered to be below current willingness to pay thresholds (at CAD 80,000 per QALY). MDC also facilitated oncology assessment for 29 non-LC patients. Conclusions: An MDC led to a reduction in patient visits and direct patient and caregiver costs.