What is a clinical pathway? Refinement of an operational definition to identify clinical pathway studies for a Cochrane systematic review

Clinical pathways (CPWs) are a common component in the quest to improve the quality of health. CPWs are used to reduce variation, improve quality of care, and maximize the outcomes for specific groups of patients. An ongoing challenge is the operationalization of a definition of CPW in healthcare. This may be attributable to both the differences in definition and a lack of conceptualization in the field of clinical pathways. This correspondence article describes a process of refinement of an operational definition for CPW research and proposes an operational definition for the future syntheses of CPWs literature. Following the approach proposed by Kinsman et al. (BMC Medicine 8(1):31, 2010) and Wieland et al. (Alternative Therapies in Health and Medicine 17(2):50, 2011), we used a four-stage process to generate a five criteria checklist for the definition of CPWs. We refined the operational definition, through consensus, merging two of the checklist’s criteria, leading to a more inclusive criterion for accommodating CPW studies conducted in various healthcare settings. The following four criteria for CPW operational definition, derived from the refinement process described above, are (1) the intervention was a structured multidisciplinary plan of care; (2) the intervention was used to translate guidelines or evidence into local structures; (3) the intervention detailed the steps in a course of treatment or care in a plan, pathway, algorithm, guideline, protocol or other ‘inventory of actions’ (i.e. the intervention had time-frames or criteria-based progression); and (4) the intervention aimed to standardize care for a specific population. An intervention meeting all four criteria was considered to be a CPW. The development of operational definitions for complex interventions is a useful approach to appraise and synthesize evidence for policy development and quality improvement

What is a clinical pathway? Refinement of an operational definition to identify clinical pathway studies for a Cochrane systematic review

Clinical pathways (CPWs) are a common component in the quest to improve the quality of health. CPWs are used to reduce variation, improve quality of care, and maximize the outcomes for specific groups of patients. An ongoing challenge is the operationalization of a definition of CPW in healthcare. This may be attributable to both the differences in definition and a lack of conceptualization in the field of clinical pathways. This correspondence article describes a process of refinement of an operational definition for CPW research and proposes an operational definition for the future syntheses of CPWs literature. Following the approach proposed by Kinsman et al. (BMC Medicine 8(1):31, 2010) and Wieland et al. (Alternative Therapies in Health and Medicine 17(2):50, 2011), we used a four-stage process to generate a five criteria checklist for the definition of CPWs. We refined the operational definition, through consensus, merging two of the checklist's criteria, leading to a more inclusive criterion for accommodating CPW studies conducted in various healthcare settings. The following four criteria for CPW operational definition, derived from the refinement process described above, are (1) the intervention was a structured multidisciplinary plan of care; (2) the intervention was used to translate guidelines or evidence into local structures; (3) the intervention detailed the steps in a course of treatment or care in a plan, pathway, algorithm, guideline, protocol or other 'inventory of actions' (i.e. the intervention had time-frames or criteria-based progression); and (4) the intervention aimed to standardize care for a specific population. An intervention meeting all four criteria was considered to be a CPW. The development of operational definitions for complex interventions is a useful approach to appraise and synthesize evidence for policy development and quality improvement

Unknowable bodies, unthinkable sexualities: lesbian and transgender legal invisibility in the Toronto women's bathhouse raid

Although litigation involving sexual orientation and gender identity discrimination claims has generated considerable public attention in recent years, lesbian and transgender bodies and sexualities still remain largely invisible in Anglo-American courts. While such invisibility is generally attributed to social norms that fail to recognize lesbian and transgender experiences, the capacity to 'not see' or 'not know' queer bodies and sexualities also involves wilful acts of ignorance. Drawing from R. v Hornick (2002) a Canadian case involving the police raid of a women's bathhouse, this article explores how lesbian and transgender bodies and sexualities are actively rendered invisible via legal knowledge practices, norms and rationalities. It argues that limited knowledge and limited thinking not only regulate the borders of visibility and belonging, but play an active part in shaping identities, governing conduct and producing subjectivity

Envisioning global LGBT human rights : (neo)colonialism, neoliberalism, resistance and hope

Envisioning Global LGBT Human Rights: (Neo)colonialism, Neoliberalism, Resistance and Hope is an outcome of a five-year international collaboration among partners that share a common legacy of British colonial laws that criminalise same-sex intimacy and gender identity/expression. The project sought to facilitate learning from each other and to create outcomes that would advance knowledge and social justice. The project was unique, combining research and writing with participatory documentary filmmaking. This visionary politics infuses the pages of the anthology. The chapters are bursting with invaluable first hand insights from leading activists at the forefront of some of the most fiercely fought battlegrounds of contemporary sexual politics in India, the Caribbean and Africa. As well, authors from Canada, Botswana and Kenya examine key turning points in the advancement of SOGI issues at the United Nations, and provide critical insights on LGBT asylum in Canada. Authors also speak to a need to reorient and decolonise queer studies, and turn a critical gaze northwards from the Global South. It is a book for activists and academics in a range of disciplines from postcolonial and sexualities studies to filmmaking, as well as for policy-makers and practitioners committed to envisioning, and working for, a better future

The Canadian war on queers : national security as sexual regulation

From the 1950s to the late 1990s, agents of the state spied on, interrogated, and harassed gays and lesbians in Canada, employing social ideologies and other practices to construct their target -- people who deviated from the so-called norm -- as threats to society and enemies of the state. Reconstructed from official security regime documents released through the Access to Information Act and interviews with gays, lesbians, civil servants, and high-ranking officials, The Canadian War on Queers offers a passionate, personalized account of a national security campaign that violated people’s civil rights and freedoms in an attempt to regulate their sexual practices. Gary Kinsman and Patrizia Gentile disclose not only the acts of state repression that accompanied the Canadian war on queers but also forms of resistance that raise questions about just whose security was being protected and about national security as an ideological practice. This path-breaking account of how the state used national security to wage war on its own people offers ways of understanding, and resisting, contemporary ideological conflicts such as the "war on terror." It is required reading for students, scholars, and social activists in lesbian, gay, and queer studies or anyone interested in the issues of national security, state repression, and human rights. (UBC Press