Mary Heaton Vorse

The life of Mary Heaton Vorse (1874-1966) reads like a chronology of American radicalism in the first half of the twentieth century. The foremost pioneer of labor journalism in the U.S. and a prominent participant in the women’s universal suffrage movement, Vorse spent her life actively struggling for libertarian socialism, feminism, and world peace. Her friends and colleagues were among the most famous writers, artists, and intellectuals of the time. Her sizeable FBI file was maintained until she was eighty-two years old. This compelling biography restores an important heroine to her place in American and feminist history

Association of Learning Styles with Research Self-Efficacy: Study of Short-Term Research Training Program for Medical Students

PURPOSE: With a growing need for developing future physician scientists, identifying characteristics of medical students who are likely to benefit from research training programs is important. This study assessed if specific learning styles of medical students, participating in federally funded short‐term research training programs, were associated with research self‐efficacy, a potential predictor of research career success. METHOD: Seventy‐five first‐year medical students from 28 medical schools, selected to participate in two competitive NIH‐supported summer programs for research training in aging, completed rating scales to evaluate learning styles at baseline, and research self‐efficacy before and after training. We examined associations of individual learning styles (visual‐verbal, sequential‐global, sensing‐intuitive, and active‐reflective) with students’ gender, ranking of medical school, and research self‐efficacy. RESULTS: Research self‐efficacy improved significantly following the training programs. Students with a verbal learning style reported significantly greater research self‐efficacy at baseline, while visual, sequential, and intuitive learners demonstrated significantly greater increases in research self‐efficacy from baseline to posttraining. No significant relationships were found between learning styles and students’ gender or ranking of their medical school. CONCLUSIONS: Assessments of learning styles may provide useful information to guide future training endeavors aimed at developing the next generation of physician‐scientists

An agile method for teaching agile in business schools

The aim of this paper is to describe, evaluate and discuss a new method for teaching agile project management and similar subjects in higher education. Agile is not only a subject domain in this work, the teaching method itself is based on Scrum, a popular agile methodology mostly used in software development projects. The method is supported by wikis, a natural platform for simulation of software development environments. The findings from the evaluation indicate that the method enables the creation of “significant learning”, which prepares students for life-long learning and increases their employability. However, the knowledge gains, resulting from wiki interactions are found to be more quantitative than qualitative. The results also imply that despite the active promotion of agile values of communication and feedback, issues regarding the teamwork are still emerging. The engagement of the teacher in the learning and teaching process was discovered to be a motivational factor for the team cohesion. This paper could be of interest to anyone planning to teach agile in the higher education settings, but also to a wider academic community interested in applying agile methods in their own teaching practicePeer reviewe

Team approach to polypharmacy evaluation and reduction: feasibility randomized trial of a structured clinical pathway to reduce polypharmacy

Abstract Background Polypharmacy is associated with poorer health outcomes in older adults. Other than the associated multimorbidity, factors contributing to this association could include medication adverse effects and interactions, difficulties in managing complicated medication regimes, and reduced medication adherence. It is unknown how reversible these negative associations may be if polypharmacy is reduced. The purpose of this study was to determine the feasibility of implementing an operationalized clinical pathway aimed to reduce polypharmacy in primary care and to pilot measurement tools suitable for assessing change in health outcomes in a larger randomized controlled trial (RCT). Methods We randomized consenting patients ≥ 70 years old on ≥ 5 long-term medications into intervention or control groups. We collected baseline demographic information and research outcome measures at baseline and 6 months. We assessed four categories of feasibility outcomes: process, resource, management, and scientific. The intervention group received TAPER (team approach to polypharmacy evaluation and reduction), a clinical pathway for reducing polypharmacy using “pause and monitor” drug holiday approach. TAPER integrates patients’ goals, priorities, and preferences with an evidence-based “machine screen” to identify potentially problematic medications and support a tapering and monitoring process, all supported by a web-based system, TaperMD. Patients met with a clinical pharmacist and then with their family physician to finalize a plan for optimization of medications using TaperMD. The control group received usual care and were offered TAPER after follow-up at 6 months. Results All 9 criteria for feasibility were met across the 4 feasibility outcome domains. Of 85 patients screened for eligibility, 39 eligible patients were recruited and randomized; two were excluded post hoc for not meeting the age requirement. Withdrawals (2) and losses to follow-up (3) were small and evenly distributed between arms. Areas for intervention and research process improvement were identified. In general, outcome measures performed well and appeared suitable for assessing change in a larger RCT. Conclusions Results from this feasibility study indicate that TAPER as a clinical pathway is feasible to implement in a primary care team setting and in an RCT research framework. Outcome trends suggest effectiveness. A large-scale RCT will be conducted to investigate the effectiveness of TAPER on reducing polypharmacy and improving health outcomes. Trial registration clinicaltrials.gov NCT02562352 , Registered September 29, 2015

Tolerability of bedtime diuretics: a prospective cohort analysis

Objectives We sought to validate, or refute, the common belief that bedtime diuretics are poorly tolerated due to nocturia.Design Prespecified prospective cohort analysis embedded within the randomised BedMed trial, in which hypertensive participants are randomised to morning versus bedtime antihypertensive administration.Setting 352 community family practices across 4 Canadian provinces between March 2017 and September 2020.Participants 552 hypertensive patients (65.6 years old, 57.4% female) already established on a single once-daily morning antihypertensive and randomised to switch that antihypertensive to bedtime. Of these, 203 used diuretics (27.1% thiazide alone, 70.0% thiazide/non-diuretic combinations) and 349 used non-diuretics.Intervention Switching the established antihypertensive from morning to bedtime, and comparing the experience of diuretic and non-diuretic users.Primary and secondary outcome measures Primary outcome: Adherence to bedtime allocation time at 6 months (defined as the willingness to continue with bedtime use, not an assessment of missed doses). Secondary 6-month outcomes: (1) nocturia considered to be a major burden and (2) increase in overnight urinations/week. All outcomes were self-reported and additionally collected at 6 weeks.Results At 6 months: Adherence to bedtime allocation time was lower in diuretic users than non-diuretic users (77.3% vs 89.8%; difference 12.6%; 95% CI 5.8% to 19.8%; p<0.0001; NNH 8.0), and more diuretic users considered nocturia a major burden (15.6% vs 1.3%; difference 14.2%; 95% CI 8.9% to 20.6%; p<0.0001; NNH 7.0). Compared with baseline, diuretic users experienced 1.0 more overnight urinations/week (95% CI 0.0 to 1.75; p=0.01). Results did not differ between sexes.Conclusions Switching diuretics to bedtime did promote nocturia, but only 15.6% found nocturia a major burden. At 6 months, 77.3% of diuretic users were adherent to bedtime dosing. Bedtime diuretic use is viable for many hypertensive patients, should it ever become clinically indicated.Trial registration number NCT02990663

Team approach to polypharmacy evaluation and reduction: study protocol for a randomized controlled trial

Background Polypharmacy in older adults can be associated with negative outcomes including falls, impaired cognition, reduced quality of life, and general and functional decline. It is not clear to what extent these are reversible if the number of medications is reduced. Primary care does not have a systematic approach for reducing inappropriate polypharmacy, and there are few, if any, approaches that account for the patient’s priorities and preferences. The primary objective of this study is to test the effect of TAPER (Team Approach to Polypharmacy Evaluation and Reduction), a structured operationalized clinical pathway focused on reducing inappropriate polypharmacy. TAPER integrates evidence tools for identifying potentially inappropriate medications, tapering, and monitoring guidance and explicit elicitation of patient priorities and preferences. We aim to determine the effect of TAPER on the number of medications (primary outcome) and health-related outcomes associated with polypharmacy in older adults. Methods We designed a multi-center randomized controlled trial, with the lead implementation site in Hamilton, Ontario. Older adults aged 70 years or older who are on five or more medications will be eligible to participate. A total of 360 participants will be recruited. Participants will be assigned to either the control or intervention arm. The intervention involves a comprehensive multidisciplinary medication review by pharmacists and physicians in partnership with patients. This review will be focused on reducing medication burden, with the assumption that this will reduce the risks and harms of polypharmacy. The control group is a wait list, and control patients will be given appointments for the TAPER intervention at a date after the final outcome assessment. All patients will be followed up and outcomes measured in both groups at baseline and 6 months. Discussion Our trial is unique in its design in that it aims to introduce an operationalized structured clinical pathway aimed to reduce polypharmacy in a primary care setting while at the same time recording patient’s goals and priorities for treatment. Trial registration Clinical Trials.gov NCT02942927. First registered on October 24, 2016.Pharmaceutical Sciences, Faculty ofOther UBCNon UBCReviewedFacultyResearche