Radon in Schools: A Review of Radon Testing Efforts in Canadian Schools

Radon, a known carcinogen, becomes a health risk when it accumulates inside buildings. Exposure is of particular concern for children, as their longer life expectancy increases their lifetime risk of developing cancer. In 2016, 5.5 million students were enrolled in Canadian elementary and secondary schools. With no national policy on radon testing in schools, children may be at risk from radon exposure while attending school and school-based programs. This study explored radon testing efforts in publicly funded Canadian schools and summarizes where testing programs have occurred. Radon testing in schools was identified through a systematic qualitative enquiry, surveying members from different levels of government (health and education) and other stakeholders (school boards, research experts, among others). Overall, this research found that approaches to radon testing varied considerably by province and region. Responsibility for radon testing in schools was often deferred between government, school boards, building managers and construction parties. Transparency around radon testing, including which schools had been tested and whether radon levels had been mitigated, also emerged as an issue. Radon testing of schools across Canada, including mitigation and clear communication strategies, needs to improve to ensure a healthy indoor environment for staff and students

Early Integrated Palliative Care Within a Surgical Oncology Clinic

Importance: Advance directive (AD) designation is an important component of advance care planning (ACP) that helps align care with patient goals. However, it is underutilized in high-risk surgical patients with cancer, and multiple barriers contribute to the low AD designation rates in this population. Objective: To assess the association of early palliative care integration with changes in AD designation among patients with cancer who underwent surgery. Design, setting, and participants: This cohort study was a retrospective analysis of a prospectively maintained registry of adult patients who underwent elective surgery for advanced abdominal and soft tissue malignant tumors at a surgical oncology clinic in a comprehensive cancer center with expertise in regional therapeutics between June 2016 and May 2022, with a median (IQR) postoperative follow-up duration of 27 (15-43) months. Data analysis was conducted from December 2022 to April 2023. Exposure: Integration of ACP recommendations and early palliative care consultations into the surgical workflow in 2020 using electronic health records (EHR), preoperative checklists, and resident education. Main outcomes and measures: The primary outcomes were AD designation and documentation. Multivariable logistic regression was performed to assess factors associated with AD designation and documentation. Results: Among the 326 patients (median [IQR] age 59 [51-67] years; 189 female patients [58.0%]; 243 non-Hispanic White patients [77.9%]) who underwent surgery, 254 patients (77.9%) designated ADs. The designation rate increased from 72.0% (131 of 182 patients) before workflow integration to 85.4% (123 of 144 patients) after workflow integration in 2020 (P = .004). The AD documentation rate did not increase significantly after workflow integration in 2020 (48.9% [89 of 182] ADs documented vs 56.3% [81 of 144] ADs documented; P = .19). AD designation was associated with palliative care consultation (odds ratio [OR], 41.48; 95% CI, 9.59-179.43; P Conclusions and relevance: An integrated ACP initiative was associated with increased AD designation rates among patients with advanced cancer who underwent surgery. These findings demonstrate the feasibility and importance of modifying clinical pathways, integrating EHR-based interventions, and cohabiting palliative care physicians in the surgical workflow for patients with advanced care.</p

Researching what matters to improve chronic pain care in Canada: A priority-setting partnership process to support patient-oriented research

<p><b>Background</b>: Chronic pain affects more than 6 million Canadians. Patients need to be involved in setting research priorities to ensure a focus on areas important to those who will be most impacted by the results.</p> <p><b>Aims</b>: The aim of this study was to leverage patient experiences to identify chronic pain research priorities in Canada.</p> <p><b>Method</b>: The process was informed by the James Lind Alliance. After gathering an exhaustive list of questions using surveys, town hall meetings, interviews, and social media consultations, we used a computerized Delphi with four successive iterations to select the final list of research priorities. The final Delphi round was conducted by a panel of ten patients living with chronic pain and ten clinicians from different disciplines.</p> <p><b>Results</b>: We received more than 5000 suggestions from 1500 people. The Delphi process led to the identification of 14 questions fitting under the following 4 themes: (1) improving knowledge and competencies in chronic pain; (2) improving patient-centered chronic pain care; (3) preventing chronic pain and reducing associated symptoms; and (4) improving access to and coordination of patient-centered chronic pain care. Challenges included the issue of chronic pain being ubiquitous to many diseases, leading to many initial suggestions focusing on these diseases. We also identified the need for further engagement efforts with marginalized groups in order to validate the priorities identified or identify different sets of priorities specific to these groups.</p> <p><b>Conclusion</b>: The priorities identified can guide patient-oriented chronic pain research to ultimately improve the care offered to people living with chronic pain.</p