Patient and stakeholder involvement in resilient healthcare : an interactive research study protocol

Introduction Resilience in healthcare (RiH) is understood as the capacity of the healthcare system to adapt to challenges and changes at different system levels, to maintain high-quality care. Adaptive capacity is founded in the knowledge, skills and experiences of the people in the system, including patients, family or next of kin, healthcare providers, managers and regulators. In order to learn from and support useful adaptations, research is needed to better understand adaptive capacity and the nature and context of adaptations. This includes research on the actors involved in creating resilient healthcare, and how and in what circumstances different groups of patients and other key healthcare stakeholders enact adaptations that contribute to resilience across all levels of the healthcare system.Methods and analysis This 5-year study applies an interactive design in a two-phased approach to explore and conceptualise patient and stakeholder involvement in resilient healthcare. Study phase 1 is exploratory and will use such data collection methods as literature review, document analysis, interviews and focus groups. Study phase 2 will use a participatory design approach to develop, test and evaluate a conceptual model for patient and stakeholder involvement in RiH. The study will involve patients and other key stakeholders as active participants throughout the research process.Ethics and dissemination The RiH research programme of which this study is a part is approved by the Norwegian Centre for Research Data (No. 864334). Findings will be disseminated through scientific articles, presentations at national and international conferences, through social media and popular press, and by direct engagement with the public, including patient and stakeholder representatives

Breaking the Cycle of Incarceration: Strategies for Successful Reentry Final Report for Labyrinth Outreach Services for Women

Working with a local reentry organization, Labyrinth Outreach Services to Women, the purpose of this study was to gather information about opportunities and barriers related to two aspects of their program: employment services and establishment of a microbusiness. Information was obtained through a 22-item questionnaire given to a sample of local businesses, key informant interviews, and secondary data analysis. Thirty-nine businesses in the Bloomington-Normal area responded to the questionnaire via on-line and paper survey methods, nine face-to-face interviews were conducted, along with three case studies of similar reentry microbusiness programs and a review of current literature. Stigmas of formerly incarcerated women, such as being unmotivated, irresponsible, disobedient, and violent were found to be major barriers to hiring. Significant facilitators identified for increased consideration for employment were: having support of a job coach, professionalism, expressing passion for the job, and seeking jobs with low customer contact. Successful microbusinesses within similar reentry organizations involved realistic expectations, client control over business operations, local community involvement, practice of a holistic approach, insurance of high product quality, and a focus on multiple products. Major barriers identified were obtaining start-up capital and revenue not meeting expenses. The most appropriate structure was found to be a social enterprise, which focuses more on non-monetary benefits for the employees rather than a profit focus of a traditional microbusiness. Recommendations based on the findings were made to the client

Validation of the StimQ2: A parent-report measure of cognitive stimulation in the home.

Considerable evidence demonstrates the importance of the cognitive home environment in supporting children's language, cognition, and school readiness more broadly. This is particularly important for children from low-income backgrounds, as cognitive stimulation is a key area of resilience that mediates the impact of poverty on child development. Researchers and clinicians have therefore highlighted the need to quantify cognitive stimulation; however existing methodological approaches frequently utilize home visits and/or labor-intensive observations and coding. Here, we examined the reliability and validity of the StimQ2, a parent-report measure of the cognitive home environment that can be delivered efficiently and at low cost. StimQ2 improves upon earlier versions of the instrument by removing outdated items, assessing additional domains of cognitive stimulation and providing new scoring systems. Findings suggest that the StimQ2 is a reliable and valid measure of the cognitive home environment for children from infancy through the preschool period

Bringing Value-Based Perspectives to Care: Including Patient and Family Members in Decision-Making Processes

Background: Recent evidence shows that patient engagement is an important strategy in achieving a high performing healthcare system. While there is considerable evidence of implementation initiatives in direct care context, there is limited investigation of implementation initiatives in decision-making context as it relates to program planning, service delivery and developing policies. Research has also shown a gap in consistent application of system-level strategies that can effectively translate organizational policies around patient and family engagement into practice. Methods: The broad objective of this initiative was to develop a system-level implementation strategy to include patient and family advisors (PFAs) at decision-making points in primary healthcare (PHC) based on wellestablished evidence and literature. In this opportunity sponsored by the Canadian Foundation for Healthcare Improvement (CFHI) a co-design methodology, also well-established was applied in identifying and developing a suitable implementation strategy to engage PFAs as members of quality teams in PHC. Diabetes management centres (DMCs) was selected as the pilot site to develop the strategy. Key steps in the process included review of evidence, review of the current state in PHC through engagement of key stakeholders and a co-design approach. Results: The project team included a diverse representation of members from the PHC system including patient advisors, DMC team members, system leads, providers, Public Engagement team members and CFHI improvement coaches. Key outcomes of this 18-month long initiative included development of a working definition of patient and family engagement, development of a Patient and Family Engagement Resource Guide and evaluation of the resource guide. Conclusion: This novel initiative provided us an opportunity to develop a supportive system-wide implementation plan and a strategy to include PFAs in decision-making processes in PHC. The well-established co-design methodology further allowed us to include value-based (customer driven quality and experience of care) perspectives of several important stakeholders including patient advisors. The next step will be to implement the strategy within DMCs, spread the strategy PHC, both locally and provincially with a focus on sustainabilit

Patient partner perspectives on compensation: Insights from the Canadian Patient Partner Survey

Abstract Introduction There is a growing role for patients, family members and caregivers as consultants, collaborators and partners in health system settings in Canada. However, compensation for this role is not systematized. When offered, it varies in both type (e.g., one‐time honorarium, salary) and amount. Further, broad‐based views of patient partners on compensation are still unknown. We aimed to describe the types and frequency of compensation patient partners have been offered and their attitudes towards compensation. Methods This study uses data from the Canadian Patient Partner Study (CPPS) survey. The survey gathered the experiences and perspectives of those who self‐identified as patient partners working across the Canadian health system. Three questions were about compensation, asking what types of compensation participants had been offered, if they had ever refused compensation, and whether they felt adequately compensated. The latter two questions included open‐text comments in addition to menu‐based and scaled response options. Basic frequencies were performed for all questions and open‐text comments were analyzed through inductive qualitative content analysis. Results A total of 603 individuals participated in the CPPS survey. Most respondents were never or rarely offered salary (81%), honorarium (64%), gift cards (80%) or material gifts (93%) while half were offered conference registration and expenses at least sometimes. A total of 129 (26%) of 499 respondents reported refusing compensation. Of 511 respondents, half felt adequately compensated always or often, and half only sometimes, rarely or never. Open‐text comments revealed positive, ambivalent and negative attitudes towards compensation. Attitudes were framed by perceptions about their role, sentiments of giving back to the health system, feelings of acknowledgement, practical considerations, values of fairness and equity and accountability relationships. Conclusions Our findings confirm that compensation is not standardized in Canada. Half of survey respondents routinely feel inadequately compensated. Patient partners have diverse views of what constitutes adequate compensation inclusive of personal considerations such as a preference for volunteering, and broader concerns such as promoting equity in patient partnership. Organizations should attempt to ensure that compensation practices are clear, transparent and attentive to patient partners' unique contexts. Patient Contribution Two patient partners are members of the CPPS research team and have been fully engaged in all study phases from project conception to knowledge translation. They are co‐authors of this manuscript. The survey was co‐designed and pilot tested with patient partners and survey participants were patient partners

Gross and microscopic visceral anatomy of the male Cape fur seal, Arctocephalus pusillus pusillus (Pinnipedia: Otariidae), with reference to organ size and growth

The gross and microscopic anatomy of the Cape fur seal heart, lung, liver, spleen, stomach, intestine and kidneys (n = 31 seals) is described. Absolute and relative size of organs from 30 male seals are presented, with histological examination conducted on 7 animals. The relationship between log body weight, log organ weight and age was investigated using linear regression. Twenty five animals were of known age, while 6 were aged from counts of incremental lines observed in the dentine of tooth sections. For the range of ages represented in this study, body weight changes were accurately described by the exponential growth equation, weight = w(o)r(t), with body weight increasing by 23% per annum until at least 9–10 y of age. Organ weight increased at a rate of between 25% and 33% per annum until at least 9–10 y of age, with the exception of the intestines, where exponential increase appeared to have ceased by about 7 y. The relationship between body weight and organ weight was investigated using logarithmic transformations of the allometric equation, y = ax(b), where the exponent b is 1 if organ weight is proportional to body weight. Most organs increased in proportion to the body. However, the heart, liver and spleen had exponents b > 1, suggesting that these organs increased at a faster rate than the body. The basic anatomical features of the viscera were similar to those of other pinnipeds, with some exceptions, including the arrangement of the multilobed lung and liver. Apart from the large liver and kidneys, relative size of the organs did not differ greatly from similar sized terrestrial carnivores. The histological features of the organs were generally consistent with those previously described for this species and other otariids. The heart, as in other pinnipeds, was unlike that of cetacea in not having unusually thick endocardium or prominent Purkinje cells. Notable histological features of the lungs included prominent fibrous septa, prominent smooth muscle bundles, cartilage extending to the level of the alveolar sacs and ample lymphoid tissue. The spleen had a thick capsule, well developed trabeculae and plentiful plasma cells. Abundant parietal cells were present in the fundic glands and lymphoid follicles were present in the gastric lamina propria, particularly in the pyloric region. Small intestinal villi were very long but this could have resulted from underlying chronic inflammation. Lymphoid follicles were prominent in the colon. The kidney reniculi each had a complete cortex, medulla and calyx, but a sportaperi medullaris musculosa was not identified

Numerical investigations of 3D aspects of fire/atmosphere interactions

Idealized FIRETEC grassfire simulations were used to study some of the roles that three-dimensional aspects of coupled atmosphere/fire interactions play on fire behavior. Domains of various widths that were periodic in the cross-stream direction, simulating an infinite-length fireline, were used to isolate local fireline-scale threedimensional effects. Two-dimensional vertical plane (zero width) simulations were performed for comparison. Idealized finite-length fire simulations were used to study the larger fire-scale three-dimensional effects. In the infinitely long simulations the fireline remains fairly straight on a macroscale while significant heterogeneities develop along the fireline at fireline-scales. These simulations suggest that the nature of atmosphere–fire coupling and these heterogeneities are influenced by wind speed. At low wind speed, the spread rate is not significantly affected by the width of the domain (for domains greater than 10 m wide). For higher wind speeds, the flank of the simulated firelines is fingered and the front of the fireline exhibits lobes. The average spread rates vary by approximately 20% for the different domain widths. In the finite-length fireline simulations, the fireline shape was fairly parabolic and the headfire rate of spread (ROS) increased with wind speed and length of ignition line. The curvature of the fire was also influenced by the length of the ignition line. The indrafts of the headfire and flanking fire lines compete for upstream wind. For wider fires, the separation between the flanking fire lines is larger and more of the upstream wind is able to reach the headfire. These finite-length simulations also suggest that there might be an overall negative pressure gradient from upwind of the fireline to downwind of the fireline near the ground. This pressure gradient is believed to be tied to the penetration of wind through the fireline and the convective heating of unburned fuel. Streamwise-vorticity pairs contribute to the heterogeneous appearance of the fire front by feeding upward momentum in the location where towers are seen on the fireline and thrusting hot gases through the fireline and down to the unburned fuel in the troughs between the firelines. These streamwise vorticies have also been recognized in the periodic infinite length and finite-length simulated firelines as well as laboratory tests. In the two-dimensional simulations with wind speeds above 3 m/s, one major effect of the two-dimensional restrictions is to preclude the nominally streamwise-vorticity structures from forming upstream of the fireline. This thus diminishes the ability of the wind to mix through the heated plume and entrain hot gases down into the fuels ahead of the fire. These simulations suggest that caution should be used when attempting to use one or two-dimensional models to simulate wildland fires. These simulations also suggest the significant value of experiments in which details of both flow and fire dynamics can be studied at scales ranging from fireline scale to overall fire geometry scales in order to better understand fire behavior. The hypothesis generated here can help provide insight in support of experimental design and analysis

A Patient-Oriented Approach to the Development of a Primary Care Physical Activity Screen for Embedding into Electronic Medical Records

Physical activity questionnaires exist, but effective implementation in primary care remains an issue. We sought to develop a physical activity screen (PAS) for electronic medical record (EMR) integration by: 1) identifying healthcare professionals’ (HCPs), patients’ and stakeholders’ barriers to and preferences for physical activity counseling in primary care; and 2) using the information to co-create the PAS. We conducted semi-structured interviews with primary care HCPs, patients and stakeholders, and used content and thematic analyses to inform iterative co-design of the PAS. Interviews with 38 participants (mean age 41 years) resulted in two themes: 1) HCPs are willing to conduct physical activity screening, but acknowledge they don’t do it well; and 2) HCPs have limited opportunity and capacity to discuss physical activity, and need a streamlined process for EMR that goes beyond quantifying physical activity. HCPs, patients and stakeholders co-designed a physical activity screen for integration into the EMR that can be tested for feasibility and effects on HCP behaviour and patients’ physical activity levels. Novelty: • EMR-integration of physical activity screening needs to go beyond just asking about physical activity minutes. • Primary care professionals have variable knowledge and time, and need physical activity counselling prompts and resources. • We co-developed a physical activity EMR tool with patients and primary care providers.The accepted manuscript in pdf format is listed with the files at the bottom of this page. The presentation of the authors' names and (or) special characters in the title of the manuscript may differ slightly between what is listed on this page and what is listed in the pdf file of the accepted manuscript; that in the pdf file of the accepted manuscript is what was submitted by the author