The QUIPPED Project: Students’ Attitudes Toward Integrating Interprofessional Education into the Curriculum

Background: Healthcare learners are the future healthcare providers. The preparationthey receive in their pre-registration programs will be vital to ensuring that they practice patient-centred care. One approach to this learning model is interprofessional education (IPE).Methods and Findings: Learner attitudes towards interprofessional education and practice were obtained over a thirty-three month period from the Queen’s University Inter-Professional Patient-centred Education Direction (QUIPPED) project. Attitudes were measured by questionnaires based on a 6-point Likert scale. The learners received a number of opportunities to engage in IPE and demonstrated positive attitudes. The degree to which one or more educational initiatives can make a difference in attitude is limited. However, over the course of the project both statistically significant and clinically meaningful differences were found. Different health professional student groups, including medical, medical radiation technology, nursing, occupational therapy, and physical therapy learners varied in their attitudinal responses, demonstrating they have already acquired professional identity.Conclusions: Recommendations include offering varied opportunities to learners, and providing them with the tools to communicate and collaborate together. Limitations include a lack of empirical evidence as to whether IPE translates into interprofessional practice and better patient-centred care

Sustainability of physical exam skills in a resident-led curriculum in a large internal medicine program with competency based medical education

Background: Competency Based Medical Education (CBME) designates physical examination competency as an Entrustable Professional Activity (EPA). Considerable concern persists regarding the increased time burden CBME may place on educators. We developed a novel physical examination curriculum that shifted the burden of physical examination case preparation and performance assessment from faculty to residents. Our first objective was to determine if participation led to sustainable improvements in physical examination skills. The second objective was to determine if resident peer assessment was comparable to faculty assessment.    Methods: We selected physical exam case topics based on the Objectives of Training in the Specialty of Internal Medicine as prescribed by the Royal College of Physicians and Surgeons of Canada. Internal Medicine residents compiled evidence-based physical exam checklists that faculty reviewed before distribution to all learners. Physical exam practice sessions with whole-group demonstration followed by small-group practice sessions were performed weekly. We evaluated this pilot curriculum with a formative OSCE, during which a resident peer and a faculty member simultaneously observed and assessed examinee performance by .Results: Participation in the novel curriculum practice sessions improved OSCE performance (faculty score mean 78.96 vs. 62.50, p<0.05). Peer assessment overestimated faculty scores (76.2 vs. 65.7, p<0.001), but peer and faculty assessments were highly correlated (R2 = 0.73 (95% CI 0.50-0.87).Conclusion: This novel physical examination curriculum leads to sustainable improvement of physical examination skills. Peer assessment correlated well with the gold standard faculty assessment. This resident-led physical examination curriculum enhanced physical examination skills in a CBME environment, with minimal time commitment from faculty members

Less is more: a rationalization of daily labwork

Routine daily phlebotomy can often act as a replacement for direct patient care.  Some tests are necessary to gauge treatment response, however many are unnecessary and increase a patient’s risk of complications and can impede laboratory processing times. This study addresses the effects of providing resident trainees, who often lack an understanding of the financial impact of the tests they order, with summative feedback. This encouraged them to be resource-conscious. Internal Medicine teams were provided with weekly laboratory spending reports and this resulted in a 33% reduction in Per Person Per Day spending. No changes in mortality were noted

Patient Perceptions of Natural Orifice Translumenal Surgery

Natural orifice translumenal endoscopic surgery (NOTES) is on the forefront of surgical technique, but existing research has produced mixed results regarding factors associated with interest in the procedure. Our objective was to ascertain patient opinions at a Canadian centre regarding scarless surgery. A survey comprising demographic data (gender, age, body mass index [BMI]), interest in NOTES, impact of increased risk, as well as importance of further research and shorter recovery time was administered to volunteer patients at outpatient general surgery clinics. Nonparametric tests were utilized to examine difference in response by age, sex, BMI, and preexisting scars. Of the 335 participants (57% female, mean age of 54.5 ± 15.9 years, mean BMI of 28.7 ± 6.9), the majority (83%) showed some interest, but this dropped to 38% when additional risk was factored in. Generally, women, those under 50 years of age and those of healthy weight, were more interested than male, older, and/or heavier patients. Most felt that research into NOTES and reduced length of inpatient stay were important (80% and 95%, respectively). Further investigation into objective NOTES outcomes are needed to provide patients adequate data to make an informed choice regarding surgical route

Additional Support for Simple Imputation of Missing Quality of Life Data in Nursing Research

Background. Missing data are a significant problem in health-related quality of life (HRQOL) research. We evaluated two imputation approaches: missing data estimation (MDE) and assignment of mean score (AMS). Methods. HRQOL data were collected using the Medical Outcomes Trust SF-12. Missing data were estimated using both approaches, summary statistics were produced for both, and results were compared using intraclass correlations (ICC). Results. Missing data were imputed for 21 participants. Mean values were similar, with ICC >.99 within both the Physical Component Summary and the Mental Component Summary when comparing the two methodologies. When imputed data were added into the full study sample, mean scores were identical regardless of methodology. Conclusion. Results support the use of a practical and simple imputation strategy of replacing missing values with the mean of the sample in cross-sectional studies when less than half of the required items of the SF-12 components are missing

Measurement equivalence of the SF-36 in the canadian multicentre osteoporosis study

BACKGROUND: Studies that compare health-related quality of life (HRQOL) and other patient-reported outcomes in different populations rest on the assumption that the measure has equivalent psychometric properties across groups. This study examined the measurement equivalence (ME) of the 36-item Medical Outcomes Study Short Form Survey (SF-36), a widely-used measure of HRQOL, by sex and race in a population-based Canadian sample. FINDINGS: SF-36 data were from the Canadian Multicentre Osteoporosis Study, a prospective cohort study that randomly sampled adult men and women from nine sites across Canada. Confirmatory factor analysis (CFA) techniques were used to test hypotheses about four forms of ME, which are based on equality of the factor loadings, variances, covariances, and intercepts. Analyses were conducted for Caucasian and non-Caucasian females (n = 6,539) and males (n = 2,884). CFA results revealed that a measurement model with physical and mental health factors provided a good fit to the data. All forms of ME were satisfied for the study groups. CONCLUSIONS: The results suggest that sex and race do not influence the conceptualization of a general measure of HRQOL in the Canadian population

Interatrial block in patients with obstructive sleep apnea

Background: Obstructive sleep apnea (OSA) is a common disorder that affects 5% of the adult North American population. It is associated with atrial arrhythmias and stroke. The mechanisms of this association remain unclear. The aim to the study was to identify the factors associated with interatrial block (IAB) among patients with OSA. Methods: Patients referred for polysomnography were studied. Sleep apnea severity (apnea-hypopnea index [AHI]) was measured in each subject. 12-lead ECGs were scanned and amplified (× 10); P-wave duration and dispersion were measured using a semi-automatic caliper. IAB was defined as a P-wave duration &#8805; 120 ms. Results: Data from 180 consecutive patients was examined. Moderate-severe OSA (mean AHI = 56.2 &#177; 27.9) was present in 144 (OSA group). The remaining 36 had mild or no OSA (mean AHI = 5.6 &#177; 3.6) and were used as controls. Age distribution between the groups did not differ and there were more males in the OSA group (69.4% vs 47.2%, p = 0.01). Obesity (78.5% vs 39.4%, p < 0.001) and hypertension (51.4% vs 27.8%, p < 0.01) were more prevalent in the OSA group. IAB was more prevalent in patients with moderate-severe OSA (34.7% OSA vs 0% controls, p 30 were independent predictors of maximum P-wave duration (p = 0.001 and p < 0.001, respectively). P-wave dispersion was significantly higher in the severe OSA group (14.6 &#177; 7.5 for OSA, 8.9 &#177; 3.1 controls, p < 0.001). Conclusions: Older age and moderate-severe OSA are predictors of IAB. P-wave dispersion is increased in patients with moderate-severe OSA. This may partly explain the high prevalence of atrial arrhythmias in patients with OSA. (Cardiol J 2011; 18, 2: 171-175

Determinants of a healthy lifestyle and use of preventive screening in Canada

BACKGROUND: This study explores the associations between individual characteristics such as income and education with health behaviours and utilization of preventive screening. METHODS: Data from the Canadian National Population Health Survey (NPHS) 1998–9 were used. Independent variables were income, education, age, sex, marital status, body mass index, urban/rural residence and access to a regular physician. Dependent variables included smoking, excessive alcohol use, physical activity, blood pressure checks, mammography in past year and Pap smear in past 3 years. Logistic regression models were developed for each dependent variable. RESULTS: 13,756 persons 20 years of age and older completed the health portion of the NPHS. In general, higher levels of income were associated with healthier behaviours, as were higher levels of education, although there were exceptions to both. The results for age and gender also varied depending on the outcome. The presence of a regular medical doctor was associated with increased rates of all preventive screening and reduced rates of smoking. CONCLUSION: These results expand upon previous data suggesting that socioeconomic disparities in healthy behaviours and health promotion continue to exist despite equal access to medical screening within the Canadian healthcare context. Knowledge, resources and the presence of a regular medical doctor are important factors associated with identified differences

Participation of Lower and Upper Middle-Income Countries in Clinical Trials Led by High-Income Countries.

Importance: Many randomized clinical trials (RCTs) led by high-income countries (HICs) now enroll patients from lower middle-income countries (LMICs) and upper middle-income countries (UMICs). Although enrolling diverse populations promotes research collaborations, there are issues regarding which countries participate in RCTs and how this participation may contribute to global research. Objective: To describe which UMICs and LMICs participate in RCTs led by HICs. Design, Setting, and Participants: A cross-sectional study of all oncology RCTs published globally during January 1, 2014, to December 31, 2017, was conducted. The study cohort was restricted to RCTs led by HICs that enrolled participants from LMICs and UMICs. Study analyses were conducted in November 1, 2021, to May 31, 2022. Main Outcomes and Measures: A bibliometric approach (Web of Science 2007-2017) was used to explore whether RCT participation was proportional to other measures of cancer research activity. Participation in RCTs (ie, percentage of RCTs in the cohort in which each LMIC and UMIC participated) was compared with country-level cancer research bibliometric output (ie, percentage of total cancer research bibliometric output from the same group of countries that came from a specific LMIC and UMIC). Results: Among the 636 HIC-led RCTs, 186 trials (29%) enrolled patients in LMICs (n = 84 trials involving 11 LMICs) and/or UMICs (n = 181 trials involving 26 UMICs). The most common participating LMICs were India (42 [50%]), Ukraine (39 [46%]), Philippines (23 [27%]), and Egypt (12 [14%]). The most common participating UMICs were Russia (115 [64%]), Brazil (94 [52%]), Romania (62 [34%]), China (56 [31%]), Mexico (56 [31%]), and South Africa (54 [30%]). Several LMICs are overrepresented in the cohort of RCTs based on proportional cancer research bibliometric output: Ukraine (46% of RCTs but 2% of cancer research bibliometric output), Philippines (27% RCTs, 1% output), and Georgia (8% RCTs, 0.2% output). Overrepresented UMICs include Russia (64% RCTs, 2% output), Romania (34% RCTs, 2% output), Mexico (31% RCTs, 2% output), and South Africa (30% RCTs, 1% output). Conclusions and Relevance: In this cross-sectional study, a substantial proportion of RCTs led by HICs enrolled patients in LMICs and UMICs. The LMICs and UMICs that participated in these trials did not match overall cancer bibliometric output as a surrogate for research ecosystem maturity. Reasons for this apparent discordance and how these data may inform future capacity-strengthening activities require further study

Allocation of authorship and patient enrollment among global clinical trials in oncology

BACKGROUND: Oncology randomized controlled trials (RCTs) are increasingly global in scope. Whether authorship is equitably shared between investigators from high-income countries (HIC) and low-middle/upper-middle incomes countries (LMIC/UMIC) is not well described. The authors conducted this study to understand the allocation of authorship and patient enrollment across all oncology RCTs conducted globally. METHODS: A cross-sectional retrospective cohort study of phase 3 RCTs (published 2014-2017) that were led by investigators in HIC and recruited patients in LMIC/UMIC. FINDINGS: During 2014-2017, 694 oncology RCTs were published; 636 (92%) were led by investigators from HIC. Among these HIC-led trials, 186 (29%) enrolled patients in LMIC/UMIC. One-third (33%, 62 of 186) of RCTs had no authors from LMIC/UMIC. Forty percent (74 of 186) of RCTs reported patient enrollment by country; in 50% (37 of 74) of these trials, LMIC/UMIC contributed <15% of patients. The relationship between enrollment and authorship proportion is very strong and is comparable between LMIC/UMIC and HIC (Spearman's ρ LMIC/UMIC 0.824, p < .001; HIC 0.823, p < .001). Among the 74 trials that report country enrollment, 34% (25 of 74) have no authors from LMIC/UMIC. CONCLUSIONS: Among trials that enroll patients in HIC and LMIC/UMIC, authorship appears to be proportional to patient enrollment. This finding is limited by the fact that more than half of RCTs do not report enrollment by country. Moreover, there are important outliers as a significant proportion of RCTs had no authors from LMIC/UMIC despite enrolling patients in these countries. The findings in this study reflect a complex global RCT ecosystem that still underserves cancer control outside high-income settings