Does the person’s context influence engagement in life activities following primary knee replacement? Results from a Canadian prospective cohort study

Peer reviewe

A scoping review of medical education research in family medicine

Background: Little is known about the state of education research within family medicine. As family medicine education models develop, it is important to develop an understanding of the current state of this research and develop ways to advance the field. Methods: We conducted a scoping review of family medicine education research to describe 1) research topic areas and 2) the methodologies and methods used to study these topics. MEDLINE, Social Sciences Abstracts and ERIC electronic databases were searched. 817 full text articles from 2002 to 2012 were screened; 624 articles were included in the review. Results: The following research topic areas were identified: continuing education, curriculum development, undergraduate education, teaching methods, assessment techniques, selection of entrants, non-clinical skills, professional and faculty development, clinical decision-making and resident well-being. Quantitative studies comprised the large majority of research approaches; overall minimal methodological details were provided. Conclusions: Our review highlights an overall need for increased sophisticated in methodological approaches to education research in family medicine, a problem that could be ameliorated by multiple strategies including better engagement of methodologists throughout the research process. The results provide guidance for future family medicine education research programs

Psychosocial Response to Uncertain Newborn Screening Results for Cystic Fibrosis

Objective To explore the psychosocial implications of diagnostic uncertainty that result from inconclusive results generated by newborn bloodspot screening (NBS) for cystic fibrosis (CF). Study design Using a mixed methods prospective cohort study of children who received NBS for CF, we compared psychosocial outcomes of parents whose children who received persistently inconclusive results with those whose children received true positive or screen-negative results. Results Mothers of infants who received inconclusive results (n = 17), diagnoses of CF (n = 15), and screen-negative results (n = 411) were surveyed; 23 parent interviews were completed. Compared with mothers of infants with true positive/screen-negative results, mothers of infants with inconclusive results reported greater perceived uncertainty (P .05). Qualitatively, parents valued being connected to experts but struggled with the meaning of an uncertain diagnosis, worried about their infant's health-related vulnerability, and had mixed views about surveillance. Conclusion Inconclusive CF NBS results were not associated with anxiety or vulnerability but led to health-related uncertainty and qualitative concerns. Findings should be considered alongside efforts to optimize protocols for CF screening and surveillance. Educational and psychosocial supports are warranted for these families.Peer reviewe

Parent experience with false-positive newborn screening results for cystic fibrosis

BACKGROUND: The risk of psychosocial harm in families of infants with false-positive (FP) newborn bloodspot screening (NBS) results for cystic fibrosis (CF) is a longstanding concern. Whether well designed retrieval and confirmatory testing systems can mitigate risks remains unknown. METHODS: Using a mixed-methods cohort design, we obtained prospective self-report data from mothers of infants with FP CF NBS results 2 to 3 months after confirmatory testing at Ontario\u27s largest follow-up center, and from a randomly selected control sample of mothers of screen negative infants from the same region. Mothers completed a questionnaire assessing experience and psychosocial response. A sample of mothers of FP infants completed qualitative interviews. RESULTS: One hundred thirty-four mothers of FP infants (response rate, 55%) and 411 controls (response rate, 47%) completed questionnaires; 54 mothers of FP infants were interviewed. Selected psychosocial response measures did not detect psychosocial distress in newborns or 1 year later (P \u3e .05). Mothers recalled distress during notification of the positive result and in the follow-up testing period related to fear of chronic illness, but valued the screening system of care in mitigating concerns. CONCLUSIONS: Although immediate distress was reported among mothers of FP infants, selected psychometric tools did not detect these concerns. The NBS center from which mothers were recruited minimizes delay between notification and confirmatory testing and ensures trained professionals are communicating results and facilitating follow-up. These factors may explain the presence of minimal psychosocial burden. The screening system reflected herein may be a model for NBS programs working to minimize FP-related psychosocial harm

A Qualitative Study of Ontario Cancer System Leaders' Views on the "Promises of Accountabiltiy"

How governments compel compliance is a central issue of public policy. The move towards contracting specialized services to agencies is characteristic of a movement that emphasizes a certain set of tools intended to enhance accountability. Critics identify a lack of clarity regarding what accountability is and how it works within and across contexts. Using Dubnick’s “promises of accountability” framework, this study aimed to understand how healthcare leaders’ in Government and a specialized agency make sense of accountability in the context of Ontario’s cancer services system. This study was designed using qualitative description and incorporated key informant interviews, document review of historically relevant texts, and informal observation of advisory council meetings. Findings highlight the need to apply both instrumental and intrinsic tools to foster meaningful inter-personal and inter- organizational relationships. Additionally, while instrumental tools seem to operate sequentially, there is less of a distinction between intrinsic tools.M.Sc

Pregnant during the COVID-19 pandemic: an exploration of patients’ lived experiences

Abstract Background Infectious outbreaks are known to cause fear and panic. Exploration of pregnant individuals’ psychosocial condition using a qualitative lens during an infectious outbreak is limited. In this study we explore pregnant individuals’ lived experiences as well as their psychological and behavioural responses during COVID-19 with the goal of providing useful strategies from the patient’s perspective to enable health care providers to help pregnant patients navigate this and future pandemics. Methods Pregnant individuals between 20-weeks gestation and 3 months postpartum who received maternity care from an urban academic interprofessional teaching unit in Toronto, Canada were invited to participate. Semi-structured 60 min interviews were audio-recorded, transcribed and analyzed using descriptive thematic analysis. Interview questions probed psychological responses to the pandemic, behavioural and lifestyle changes, strategies to mitigate distress while pregnant during COVID-19 and advice for other patients and the healthcare team. Results There were 12 participants, mean age 35 years (range 30–43 years), all 1 to 6 months postpartum. Six main themes emerged: 1) Childbearing-related challenges to everyday life; 2) Increased worry, uncertainty and fear; 3) Pervasive sense of loss; 4) Challenges accessing care; 5) Strategies for coping with pandemic stress; 6) Reflections and advice to other pregnant people and health care professionals. Pregnant individuals described lack of social support due to COVID-19 pandemic restrictions and a profound sense of loss of what they thought their pregnancy and postpartum period should have been. Advice to healthcare providers included providing mental health support, clear and up to date communication as well as more postpartum and breastfeeding support. Conclusions These participants described experiencing psychosocial distress during their pregnancies and postpartum. In a stressful situation such as a global pandemic, health care providers need to play a pivotal role to ensure pregnant individuals feel supported and receive consistent care throughout the pregnancy and postpartum period. The health care provider should ensure that mental health concerns are addressed and provide postpartum and breastfeeding support. Without addressing this need for support, parental mental health, relationships, parent-infant bonding, and infant development may be negatively impacted

A scoping review of medical education research in family medicine

Abstract Background Little is known about the state of education research within family medicine. As family medicine education models develop, it is important to develop an understanding of the current state of this research and develop ways to advance the field. Methods We conducted a scoping review of family medicine education research to describe 1) research topic areas and 2) the methodologies and methods used to study these topics. MEDLINE, Social Sciences Abstracts and ERIC electronic databases were searched. 817 full text articles from 2002 to 2012 were screened; 624 articles were included in the review. Results The following research topic areas were identified: continuing education, curriculum development, undergraduate education, teaching methods, assessment techniques, selection of entrants, non-clinical skills, professional and faculty development, clinical decision-making and resident well-being. Quantitative studies comprised the large majority of research approaches; overall minimal methodological details were provided. Conclusions Our review highlights an overall need for increased sophisticated in methodological approaches to education research in family medicine, a problem that could be ameliorated by multiple strategies including better engagement of methodologists throughout the research process. The results provide guidance for future family medicine education research programs

Approaching a collaborative research agenda for health systems performance in circumpolar regions

Health care in Canada's north and circumpolar regions faces considerable challenges with the remote and widely dispersed population, harsh environmental conditions, and human resource challenges. Despite per capita expenditures that are among the highest in the world, health outcomes continue to lag behind the rest of Canada, and health disparities between the Indigenous and non-Indigenous populations within the north persist. While improving the health of northerners requires addressing underlying social determinants, transforming the health care system holds promise for health improvements in the short- and medium-term . The evidence required to inform a northern-focused and relevant transformation of health care systems remains to be generated and applied. This seminar set out to identify priority areas for a research initiative that will address systems challenges and engage decision-makers in these jurisdictions. The overarching objectives of the seminar were to explore the priority areas for health systems research in circumpolar regions, and to propose how we might best maximize our current resources, and facilitate partnerships for the advancement of a common agenda