Creating space for Indigenous healing practices in patient care plans

Background: The Truth and Reconciliation Commission of Canada’s Calls to Action ask that those who can effect change within the Canadian healthcare system recognize the value of Indigenous healing practices and support them in the treatment of Indigenous patients. Methods: We distributed a survey to the Canadian Rheumatology Association membership to assess awareness of Indigenous healing practices, and attitudes informing their acceptance in patient care plans. Results: We received responses from 77/514 members (15%), with most (73%) being unclear or unaware of what Indigenous healing practices were. Nearly all (93%) expressed interest in the concept of creating space for Indigenous healing practices in rheumatology care plans. The majority of support was for the use in preventive or symptom management strategies, and less as adjuncts to disease activity control. Themes identified through qualitative analysis of free-text responses included a desire for patient-centered care and support for reconciliation in medicine, but with a colonial construct of medicine, demonstration of an evidence bias, and hierarchy of medicines. Conclusions: Overall, respondents were open to the idea of inclusion of Indigenous healing practices in patient’s car plans, emphasizing importance for patient empowerment and patient-centered care. However, they cited concerns that provide the indication for further learning and reconciliation in medicine

Participant-reported effect of an Indigenous health continuing professional development initiative for specialists

Background: Health outcomes of Indigenous patients are impacted by culturally unsafe specialty care environments. The ‘Educating for Equity (E4E)’ program is a continuing professional development (CPD) intervention which incorporates skill-based teaching to improve Indigenous patient experiences and outcomes in healthcare interactions. Methods: The E4E program was delivered to rheumatologists in two phases, each delivered as experiential learning workshops where participants engaged with and applied course content within an interactive format focusing on real-time feedback. The phase 1 workshop focused on skill development of E4E Framework concepts and principles. Phase 2 concentrated on building capacity for teaching of E4E content. Evaluation of the program’s effectiveness was through longitudinal responses to the Social Cultural Confidence in Care Survey (SCCCS), self-reported strategies employed to address social issues and improve therapeutic relationships, engagement with teaching others, and satisfaction with the program. Results: Two cohorts of participants have participated in the program (n = 24 Phase 1, n = 10 Phase 2). For participants completing both phases of training, statistically significant improvements were observed in exploring social factors with patients, gaining knowledge and skills related to cultural aspects of care, improved communication and relationship building, and reflections on held stereotypes. Strategies to address social issues and build therapeutic relationships remained consistent throughout participation, while the training enhanced exploration and confidence to ask about cultural and traditional practices, and stronger communication strategies for exploring beliefs, expectations, social barriers, and residential school impacts on health. Participants reported feeling prepared to teach Indigenous health concepts to others and subsequently lead teaching with residents, fellows, and allied health professionals. Satisfaction with the delivery and content of the workshops was high, and participants valued interactions with peers in learning. Conclusions: This CPD intervention had a beneficial impact on self-reported confidence and enhanced practice strategies to engage with Indigenous patients

Estudo prospectivo dos efeitos da translocação Robertsoniana 1/29 sobre a fertilidade de machos Marchigiana

The effects of the 1/29 transIocation on fertility of Marchigiana males were investigated on a prospective study. We have compared normal Nelore females artificially inseminated by an heterozygote Marchigiana sire (experimental group) with those resulting from a normal male insemination (control group). We could observe: 1. Higher mean number of A.I. I conception in the experimental group; 2. Significant reduction of pregnant females at first service, in the experimental group; 3. No difference in the period between the A.I.(s) or in obortion rates, in both groups; 4. F1 obtained from experimental group were analysed and the 1/29 distribution does nor differ from 1:1. The reduction of fertility may be due to zygotic loss and/or production of aneuploidy gametes. We have performed a meiotic and spermatic study in two heterozygote 1/29 translocated males resulting from Marchigiana x Nelore crossbreed. We found alterations in the spermatic characteristics of the heterozygote, mainly reduction of sperm concentration/mm3. Meiotic analysis of a translocated male shows no association between any autosome and the sex vesicleO presente estudo refere-se aos efeitos da translocação 1/29 sobre a fertilidade de bovinos machos Marchigiana, de forma prospectiva. Comparamos fêmeas Nelore normais, inseminadas artificialmente com sêmen de touro Marchigiana heterozigoto (grupo experimental) com aqueles resultantes de inseminação com sêmen de touro normal (grupo controle). Os resultados revelaram: 1° n° médio significantemente aumentado de Inseminações Artificiais/concepção, no grupo experimental; 2. Redução significante de fêmeas prenhes ao 1° serviço, no grupo experimental; 3. comparando-se os grupos experimental e controle, não se verificou diferença nas taxas de aborto ou no período entre inseminações; 4. A distribuição de translocados 1/29 não diferiu da proporção 1:1, dentro da F1 obtida do grupo experimental. A redução de fertilidade pode ser devida a perda zigótica e/ou produção de gametas aneuplóides. Desenvolvemos estudos meióticos e espermáticos em 2 touros heterozigotos 1/29, resultantes do cruzamento Nelore x Marchigiana. Pudemos verificar alterações nas características espermáticas do heterozigoto, principalmente redução da concentração de espermatozóides/mm3. A análise meiótica de um macho F1 translocado mostrou não haver associação entre autossomos e a vesícula sexual.

Complicated intra-abdominal infections in a worldwide context: an observational prospective study (CIAOW Study)

Peer reviewe

Participant-reported effect of an Indigenous health continuing professional development initiative for specialists

Background: Health outcomes of Indigenous patients are impacted by culturally unsafe specialty care environments. The ‘Educating for Equity (E4E)’ program is a continuing professional development (CPD) intervention which incorporates skill-based teaching to improve Indigenous patient experiences and outcomes in healthcare interactions. Methods: The E4E program was delivered to rheumatologists in two phases, each delivered as experiential learning workshops where participants engaged with and applied course content within an interactive format focusing on real-time feedback. The phase 1 workshop focused on skill development of E4E Framework concepts and principles. Phase 2 concentrated on building capacity for teaching of E4E content. Evaluation of the program’s effectiveness was through longitudinal responses to the Social Cultural Confidence in Care Survey (SCCCS), self-reported strategies employed to address social issues and improve therapeutic relationships, engagement with teaching others, and satisfaction with the program. Results: Two cohorts of participants have participated in the program (n = 24 Phase 1, n = 10 Phase 2). For participants completing both phases of training, statistically significant improvements were observed in exploring social factors with patients, gaining knowledge and skills related to cultural aspects of care, improved communication and relationship building, and reflections on held stereotypes. Strategies to address social issues and build therapeutic relationships remained consistent throughout participation, while the training enhanced exploration and confidence to ask about cultural and traditional practices, and stronger communication strategies for exploring beliefs, expectations, social barriers, and residential school impacts on health. Participants reported feeling prepared to teach Indigenous health concepts to others and subsequently lead teaching with residents, fellows, and allied health professionals. Satisfaction with the delivery and content of the workshops was high, and participants valued interactions with peers in learning. Conclusions: This CPD intervention had a beneficial impact on self-reported confidence and enhanced practice strategies to engage with Indigenous patients.Medicine, Faculty ofNon UBCMedicine, Department ofReviewedFacult

Additional file 1 of Advancing health equity for Indigenous peoples in Canada: development of a patient complexity assessment framework

Supplementary Material 1

“There are still a lot of things that I need”: a qualitative study exploring opportunities to improve the health services of First Nations People with arthritis seen at an on-reserve outreach rheumatology clinic

Background: Arthritis is a highly prevalent disease and leading cause of disability in the Indigenous population. A novel model of care consisting of a rheumatology outreach clinic in an on-reserve primary healthcare center has provided service to an Indigenous community in Southern Alberta since 2010. Despite quality assessments suggesting this model of care improves accessibility and is effective in meeting treatment targets, substantial improvements in patient-reported outcomes have not been realized. Therefore, the objective of this study was to explore the experiences of Indigenous persons with arthritis and healthcare providers involved in this model of care to inform the development of health service improvements that enhance patient outcomes. Methods: This was a narrative-based qualitative study involving a purposeful sample of 32 individuals involved in the Indigenous rheumatology model of care. In-depth interviews were conducted to elicit experiences with the existing model of care and to encourage reflections on opportunities to improve it. A two-stage analysis was conducted. The first stage aimed to produce a narrative synthesis of concepts through a dialogical method comparing people with arthritis and health providers’ narratives. The second stage involved a collective effort to synthesize concepts and propose specific recommendations to improve the quality of the current model of care. Triangulation, through participant checking and discussion among researchers, was used to increase the validity of the final recommendations. Results: Ten Indigenous people with arthritis lived experience, 14 health providers and 8 administrative staff were interviewed. One main overarching theme was identified, which reflected the need to provide services that improve people’s physical and mental functioning. Further, the following specific recommendations were identified: 1) enhancing patient-provider communication, 2) improving the continuity of the healthcare service, 3) increasing community awareness about the presence and negative impact of arthritis, and 4) increasing peer connections and support among people living with arthritis. Conclusions: Improving the quality of the current Indigenous rheumatology model of care requires implementing strategies that improve functioning, patient-provider communication, continuity of care, community awareness and peer support. A community-based provider who supports people while navigating health services could facilitate the implementation of these strategies.Medicine, Faculty ofNon UBCMedicine, Department ofRheumatology, Division ofReviewedFacult

Additional file 1: of Barriers, supports, and effective interventions for uptake of human papillomavirus- and other vaccines within global and Canadian Indigenous peoples: a systematic review protocol

PRISMA-P Checklist. (DOCX 39 kb