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Broken families. Gender, family, and mutual assistance in New France: widows, widowers, and orphans in eighteenth-century Quebec / Josette Brun ; A "painful dependence": female begging letters and the familial economy of obligation / Nancy Christie ; Itineraries of marriage and widowhood in nineteenth-century Montreal / Bettina Bradbury ; Marginal by definition? stepchildren in Quebec, 1866-1920/ Peter Gossage -- Bachelors and spinsters. The invention of the margin as an invention of the family: the case of rural Quebec in the eighteenth and nineteenth centuries / Ollivier Hubert ; The peddler's tale: radical religion and family marginality in the journal of Ralph Merry, 1804-1863 / J.I. Little ; "Old maidism itself": spinsterhood in eighteenth- and nineteenth-century literary and life-writing texts from maritime Canada / Gwendolyn Davies ; Matthews and Marillas: bachelors and spinsters in Prince Edward Island in 1881 / Michele Stairs -- Institutions and marginality. The lunatic fringe: families, madness, and institutional confinement in Victorian Ontario / James Moran, David Wright, and Mat Savelli ; Orphans in Quebec: on the margins of which family? Denyse Baillargeon ; Nova Scotia and its unmarried mothers, 1945-1975 / Suzanne Morton ; Grizzled old men and lonely widows: constructing the single elderly as a social problem in Canada's welfare state, 1945-1967 / James Struthers ; The family as pathology: psychology, social science and history construct the nuclear family, 1945-1980 / Michael Gauvrea

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

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population.The aim of this study was to inform vaccination prioritization by modelling the impact of vaccination on elective inpatient surgery. The study found that patients aged at least 70 years needing elective surgery should be prioritized alongside other high-risk groups during early vaccination programmes. Once vaccines are rolled out to younger populations, prioritizing surgical patients is advantageous