Une animation multilingue sur la santé sexuelle et reproductive : un nouvel outil éducatif pour les nouveaux arrivants

Implication Statement Newcomer populations face many barriers accessing healthcare, including language barriers. Language-concordant care has been shown to enhance equity and optimize health outcomes for underserved populations. This paper describes a sexual and reproductive health (SRH) animation for newcomer populations. The animation was created collaboratively by the Department of Obstetrics and Gynaecology Global Health Unit, the Halifax Newcomer Health Clinic, and student volunteers. Integrating this animation into other healthcare settings may help improve inclusion, trust, and patient-centred care for newcomer patients. Institutions may also consider creating further SRH animations based on the needs of the patients they serve.Énoncé des implications de la recherche Les nouveaux arrivants sont confrontés à de nombreux obstacles dans l'accès aux soins de santé, notamment des barrières linguistiques. Il a été démontré qu’une concordance linguistique au cours des soins améliorent l'équité et les résultats en matière de santé pour les populations mal desservies. Cet article décrit une animation sur la santé sexuelle et reproductive pour les nouveau arrivants. Cette animation a été conçue en collaboration par l'unité de santé mondiale du département d'obstétrique et de gynécologie, la clinique de santé pour les nouveaux arrivants de Halifax et des étudiants bénévoles. L'intégration de cette animation dans d'autres contextes de soins peut contribuer à améliorer l'inclusion, la confiance et les soins centrés sur le patient pour les nouveaux arrivants. Les établissements peuvent également envisager de concevoir d'autres animations sur la santé sexuelle et reproductive en fonction des besoins de la population qu’ils desservent

A multilingual sexual and reproductive health animation: a novel educational tool for newcomer patients

Implication Statement Newcomer populations face many barriers accessing healthcare, including language barriers. Language-concordant care has been shown to enhance equity and optimize health outcomes for underserved populations. This paper describes a sexual and reproductive health (SRH) animation for newcomer populations. The animation was created collaboratively by the Department of Obstetrics and Gynaecology Global Health Unit, the Halifax Newcomer Health Clinic, and student volunteers. Integrating this animation into other healthcare settings may help improve inclusion, trust, and patient-centred care for newcomer patients. Institutions may also consider creating further SRH animations based on the needs of the patients they serve

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

“I’d like more options!” : Interviews to explore young people and family decision-making needs for pain management in juvenile idiopathic arthritis

Background: Juvenile idiopathic arthritis (JIA) is a common pediatric rheumatic condition and is associated with symptoms such as joint pain that can negatively impact health-related quality of life. To effectively manage pain in JIA, young people, their families, and health care providers (HCPs) should be supported to discuss pain management options and make a shared decision. However, pain is often under-recognized, and pain management discussions are not optimal. No studies have explored decision-making needs for pain management in JIA using a shared decision making (SDM) model. We sought to explore families’ decision-making needs with respect to pain management among young people with JIA, parents/caregivers, and HCPs. Methods We conducted semi-structured virtual or face-to-face individual interviews with young people with JIA 8–18 years of age, parents/caregivers and HCPs using a qualitative descriptive study design. We recruited participants online across Canada and the United States, from a hospital and from a quality improvement network. We used interview guides based on the Ottawa Decision Support Framework to assess decision-making needs. We audiotaped, transcribed verbatim and analyzed interviews using thematic analysis. Results A total of 12 young people (n = 6 children and n = 6 adolescents), 13 parents/caregivers and 11 HCPs participated in interviews. Pediatric HCPs were comprised of rheumatologists (n = 4), physical therapists (n = 3), rheumatology nurses (n = 2) and occupational therapists (n = 2). The following themes were identified: (1) need to assess pain in an accurate manner; (2) need to address pain in pediatric rheumatology consultations; (3) need for information on pain management options, especially nonpharmacological approaches; (4) importance of effectiveness, safety and ease of use of treatments; (5) need to discuss young people/families’ values and preferences for pain management options; and the (6) need for decision support. Themes were similar for young people, parents/caregivers and HCPs, although their respective importance varied. Conclusions Findings suggest a need for evidence-based information and communication about pain management options, which would be addressed by decision support interventions and HCP training in pain and SDM. Work is underway to develop such interventions and implement them into practice to improve pain management in JIA and in turn lead to better health outcomes.Medicine, Faculty ofNon UBCPhysical Therapy, Department ofReviewedFacultyResearcherGraduateOthe

Evaluating the value of intrapartum fetal scalp blood sampling to predict adverse neonatal outcomes: A UK multicentre observational study.

ObjectiveTo evaluate the value of fetal scalp blood sampling (FBS) as an adjunct test to cardiotocography, to predict adverse neonatal outcomes.Study designA multicentre service evaluation observational study in forty-four maternity units in the UK. We collected data retrospectively on pregnant women with singleton pregnancy who received FBS in labour using a standardised data collection tool. The primary outcome was prediction of neonatal acidaemia diagnosed as umbilical cord arterial pH < 7.05, the secondary outcomes were the prediction of Apgar scores<7 at 1st and 5th minutes and admission to the neonatal intensive care unit (NICU). We evaluated the correlation between the last FBS blood gas before birth and the umbilical cord blood and adjusted for time intervals. We constructed 2 × 2 tables to calculate the sensitivity, specificity, positive (PPV) and negative predictive value (NPV) and generated receiver operating curves to report on the Area Under the Curve (AUC).ResultsIn total, 1422 samples were included in the analysis; pH values showed no correlation (r = 0.001, p = 0.9) in samples obtained within an hour (n = 314), or within half an hour from birth (n = 115) (r=-0.003, p = 0.9). A suboptimal FBS pH value (<7.25) had a poor sensitivity (22%) and PPV (4.9%) to predict neonatal acidaemia with high specificity (87.3%) and NPV (97.4%). Similar performance was noted to predict Apgar scores <7 at 1st (sensitivity 14.5%, specificity 87.5%, PPV 23.4%, NPV 79.6%) and 5th minute (sensitivity 20.3%, specificity 87.4%, PPV 7.6%, NPV 95.6%), and admission to NICU (sensitivity 20.3%, specificity 87.5%, PPV 13.3%, NPV 92.1%). The AUC for FBS pH to predict neonatal acidaemia was 0.59 (95%CI 0.59–0.68, p = 0.3) with similar performance to predict Apgar scores<7 at 1st minute (AUC 0.55, 95%CI 0.51–0.59, p = 0.004), 5th minute (AUC 0.55, 95%CI 0.48–0.62, p = 0.13), and admission to NICU (AUC 0.58, 95%CI 0.52–0.64, p = 0.002).Forty-one neonates had acidaemia (2.8%, 41/1422) at birth. There was no significant correlation in pH values between the FBS and the umbilical cord blood in this subgroup adjusted for sampling time intervals (r = 0.03, p = 0.83).ConclusionsAs an adjunct tool to cardiotocography, FBS offered limited value to predict neonatal acidaemia, low Apgar Scores and admission to NICU