The Moral Call to Learn: A Qualitative Investigation of Encounters with Unfamiliarity in Everyday Life

This qualitative study explored the moral aspects of learners’ “encounters with unfamiliarity” in their everyday experiences. The encounter with unfamiliarity, as a basic phenomenon within the conceptual framework of embodied familiarization, was investigated using a multiple case study approach (Stake, 2006). Findings from this study are presented first as brief case narratives and second as themes based on a cross-case analysis. Themes of the study point to the nature and significance of the encounter as a part of learning, often as an invitation with a kind of moral significance that called participants to learn, or not learn, in particular ways. Moreover, much of the learning described in participants’ accounts was itself a kind of moral action, enacted in response to the significance of the moral call to learn initiated by the encounter

Low-value clinical practices in injury care: a scoping review and expert consultation survey

BACKGROUND: Tests and treatments that are not supported by evidence and could expose patients to unnecessary harm, referred to here as low-value clinical practices, consume up to 30% of healthcare resources. Choosing Wisely and other organisations have published lists of clinical practices to be avoided. However, few apply to injury and most are based uniquely on expert consensus. We aimed to identify low-value clinical practices in acute injury care. METHODS: We conducted a scoping review targeting articles, reviews and guidelines that identified low-value clinical practices specific to injury populations. Thirty-six experts rated clinical practices on a 5-point Likert scale from clearly low-value to clearly beneficial. Clinical practices reported as low-value by at least one level I, II or III study and considered clearly or potentially low-value by at least 75% of experts were retained as candidates for low-value injury care. RESULTS: Of 50,695 citations, 815 studies were included and led to the identification of 150 clinical practices. Of these 63 were considered candidates for low-value injury care; 33 in the emergency room, 9 in trauma surgery, 15 in the intensive care unit and 5 in orthopaedics. We also identified 87 'grey zone' practices, which did not meet our criteria for low-value care. CONCLUSIONS: We identified 63 low-value clinical practices in acute injury care that are supported by empirical evidence and expert opinion. Conditional on future research, they represent potential targets for guidelines, overuse metrics and de-implementation interventions. We also identified 87 'grey zone' practices, which may be interesting targets for value-based decision-making. Our study represents an important step towards the de-implementation of low-value clinical practices in injury care. LEVEL OF EVIDENCE: III

All-terrain vehicle serious injuries and death in children and youth: A national survey of Canadian paediatricians.

Background: All-Terrain Vehicles (ATVs) are a leading cause of serious injury in children and youth. Certain Canadian regions have implemented legislation to promote safety, including age restrictions, mandatory training and helmet use. Jurisdictions with more stringent ATV safety legislation have been shown to have reduced injury rates in the short term. Objectives: To estimate the burden of ATV-related serious injury and death in Canada and to identify Canadian physicians' knowledge of ATV-related legislation, safety and health promotion practices. Methods: A one-time survey was distributed to practicing paediatricians and paediatric subspecialists participating in the Canadian Paediatric Surveillance Program (CPSP) in October 2016. Results: Of 2793 physicians contacted, 904 responded (32.4%). There were 181 reported cases of serious and/or fatal ATV-related injuries, including 6 deaths. Children aged 10 to 14 represented the most number of cases (n=82, 45.3%), followed by 15 to 19 (n=48, 26.5%) and 5 to 9 (n=40, 22.1%). Most cases occurred in July/August (48.3%) and May/June (25.2%), were in males (n=133, 78.2%), and occurred during recreational activity (n=139, 83.2%) or organized racing (n=6, 3.6%). In 99 cases (58.9%), the child was the driver of the ATV. Only two-thirds of respondents (67.5%) knew that ATVs should not carry passengers while under half (42.2%) never discussed ATV safety with their patients. Conclusions: ATV-related injuries and deaths in Canadian children remain a serious public health problem. Education of health care practitioners, including paediatricians, is needed to promote safety. Despite efforts to reduce ATV-related injuries, there remains a significant number of serious injuries and/deaths related to their use.</p

TECHNOLOGY I, II, AND III: CRITERIA FOR UNDERSTANDING AND IMPROVING THE PRACTICE OF INSTRUCTIONAL TECHNOLOGY

of a dissertation submitted b