Academic Health Science Centre Research Articles

Diagnostic accuracy of X-ray versus CT in COVID-19: a propensity-matched database study

ObjectivesTo identify the diagnostic accuracy of common imaging modalities, chest X-ray (CXR) and CT, for diagnosis of COVID-19 in the general emergency population in the UK and to find the...

Leadership Development in Academic Health Science Centers: Towards a Paradigm Shift.

ProblemIn an era of increasing complexity, leadership development is an urgent need for academic health science centers (AHSCs). The Association of American Medical Colleges (AAMC) and others have described the need for a focus on organizational leadership development and more rigorous evaluation of outcomes. Although the business literature notes the importance of evaluating institutional leadership culture, there is sparse conversation in the medical literature about this vital aspect of leadership development. Defining the leadership attributes that best align with and move an AHSC forward must serve as the foundational framework for strategic leadership development.ApproachIn 2015, the Medical University of South Carolina (MUSC) began a systematic process to approach strategic leadership development for the organization. An interprofessional group completed an inventory of our leadership development programs and identified key drivers of a new institutional strategic plan. A strategic leadership advisory committee designed a series of leadership retreats to evaluate both individual and collective leadership development needs.OutcomesThree key drivers were identified as critical attributes for the success of our institutional strategy. Four specific areas of focus for the growth of the institution’s ideal leadership culture were identified, with specific action items or behaviors developed for our leaders to model. As a result of this foundational work, we have now launched the MUSC Leadership Institute.Next StepsKnowledge of our current leadership culture, key drivers of strategy and our desired collective leadership attributes are the basis for building our institutional leadership development strategy. This will be a longitudinal process that will start with senior leadership engagement, organizational restructuring, new programming and involve significant experimentation. Disciplined, thoughtful evaluation will be required to find the right model. In addition to individual transformation with leadership development, MUSC will measure specifically identified strategic outcomes and performance metrics for the institution.

Flipping the paradigm: a qualitative exploration of research translation centres in the United Kingdom and Australia

BackgroundOver the past decade, Research Translation Centres (RTCs) have been established in many countries. These centres (sometimes referred to as Academic Health Science Centres) are designed to bring universities and healthcare providers together in order to accelerate the generation and translation of new evidence that is responsive to health service and community priorities. This has the potential to effectively ‘flip’ the traditional research and education paradigms because it requires active participation and continuous engagement with stakeholders (especially service users, the community and frontline clinicians). Although investment and expectations of RTCs are high, the literature confirms a need to better understand the processes that RTCs use to mobilise knowledge, build workforce capacity, and co-produce research with patients and the public to ensure population impact and drive healthcare improvement.MethodsSemi-structured interviews were conducted with selected leaders and members from select RTCs in England and Australia. Convenience sampling was utilised to identify RTCs, based on their geography, accessibility and availability. Purposive sampling and a snowballing approach were employed to recruit individual participants for interviews, which were conducted face to face or via videoconferencing. Interviews were recorded, transcribed verbatim and analysed using a reflexive and inductive approach. This involved two researchers comparing codes and interrogating themes that were analysed inductively against the study aims and through meetings with the research team.ResultsA total of 41 participants, 22 from England and 19 from Australia were interviewed. Five major themes emerged, including (1) dissonant metrics, (2) different models of leadership, (3) public and patient involvement and research co-production, (4) workforce development and (5) barriers to collaboration.ConclusionsParticipants identified the need for performance measures that capture community impact. Better aligned success metrics, enhanced leadership, strategies to partner with patients and the public, enhanced workforce development and strategies to enhance collaboration were all identified as crucial for RTCs to succeed.

Student Success Centers in Nursing Education: A Case Study Example.

A student success center was established at an academic health science center in an effort to address student performance in a diverse undergraduate nursing program. A process for determining student needs and narrowly tailored support interventions was determined through a modified Delphi focus group of students enrolled in a Hispanic Serving Institution's undergraduate nursing program. Findings of this study are presented along with the 5-year outcomes associated with the center's efforts. Implementation of these narrowly tailored interventions has led to a considerable improvement in student engagement, as well as higher first-time pass rates on the NCLEX-RN® examination by graduates. To address the critical shortage of diverse nurses in the United States, schools of nursing must provide all necessary support mechanisms to ensure underrepresented and first-generation college students have every opportunity to graduate and enter the nursing workforce. [J Nurs Educ. 2020;59(7):396-399.].

Exploring pairing of new graduate nurses with mentors: An interpretive descriptive study

To explore mentorship pairing practices for new graduate nurses in a tertiary care hospital. Many organisations have implemented mentorship transition programmes to decrease new nursing graduate turnover in the first two years of practice. Little is known about mentorship pairing processes. An interpretive descriptive qualitative study was conducted in a multicampus academic health science centre in Ontario, Canada. The COREQ reporting guideline was used. Thirty-one semistructured interviews were conducted from July 2018-July 2019 in a multicampus academic health science centre with new nursing graduates, experienced nurses and nurse leaders who participated in the New Graduate Guarantee programme or were involved in the mentor-mentee pairing process in 2016 or 2017. Data collected were analysed using thematic analysis within the groups and triangulated across groups. Neither the new graduates nor the mentors were aware of the pairing processes. Nursing leaders relied on their knowledge of the participants to pair new graduates and mentors with many stating participants' personalities were considered. New graduates and mentors described making an initial connection and socialisation as important themes related to facilitating the pairing process. Organisational influences on pairing included taking breaks together, the location of the final student placement, and the management of workload and scheduling. Increased awareness and transparency regarding nursing mentorship pairing processes is required. Pairing processes suggested by participants warrant further investigation to determine efficacy. Findings reinforce the need to discuss and research nursing specific mentorship pairing processes.

Malnutrition in an Academic Health Sciences Centre: Applying results from nutritionDay 2011 to the proposed Global Leadership Initiative on Malnutrition approach to diagnosing malnutrition

BackgroundMalnutrition remains a significant ongoing issue in hospitalized patients, with cancer patients having one of the highest rates of malnutrition. Early identification with appropriate intervention is vitally important. nutritionDay is an international nutrition research study that was launched in 2006 to improve malnutrition awareness, education and research. The Canadian Nutrition Screening Tool [CNST] is validated to screen and identify patients at risk of malnutrition. In 2016, the Global Leadership Initiative on Malnutrition [GLIM] was convened to address the urgent need for simple and relevant clinical care guidelines for screening and diagnosing malnutrition.AimThe primary aim was to determine malnutrition prevalence at the three sites of an Academic Health Sciences Centre [AHSC] by applying data gathered from nutritionDay 2011 to the GLIM two-step approach to diagnosing malnutrition. The secondary aim was to compare malnutrition prevalence between the three sites, with a specific interest in the results from AHSC-a, the cancer center, since cancer patients are known to have one of the highest rates of malnutrition The tertiary aim was to explore possible reasons for poor intake in AHSC overall.MethodsA one-day cross-sectional audit involving 264 patients at three AHSC sites was conducted in 2011 as part of the international nutritionDay research study. The unintentional weight loss and food consumption data were applied to CNST. Malnutrition diagnosis was determined using data for body mass index [BMI] and the fraction of study meal consumed. The nutritionDay adaptation of GLIM criteria to fit the nutritionDay survey was used.Statistical analysisCategorical data are presented as actual numbers or percentages, with the groups compared by the Chi square test. Continuous variables expressed as mean ± SEM were used. One-way analysis of variance and Student t-tests were used to compare variables of interest. Significance p < 0.05, SPSS v.26 was used for analysis.Results44% (264/600) of patients at the AHSC participated in the nutritionDay 2011 study. 59% of patients at AHSC-a screened positive for risk of malnutrition compared to the other two sites (AHSC-b and AHSC-c),p = 0.002 and 0.014 respectively. Overall, 23% of patients would have been diagnosed as malnourished with AHSC-b at 56% compared to 17% AHSC-c [p = 0.041).ConclusionUsing the GLIM two-step approach, we report 38% of patients were at risk for malnutrition using the CNST and 1 in 4 of those identified at risk would be diagnosed as malnourished. As well, more patients at the cancer site were found to be at risk for malnutrition. Malnutrition remains a significant ongoing issue in hospitalized patients, with cancer patients having one of the highest rates of malnutrition. Early identification with appropriate intervention is vitally important. nutritionDay is an international nutrition research study that was launched in 2006 to improve malnutrition awareness, education and research. The Canadian Nutrition Screening Tool [CNST] is validated to screen and identify patients at risk of malnutrition. In 2016, the Global Leadership Initiative on Malnutrition [GLIM] was convened to address the urgent need for simple and relevant clinical care guidelines for screening and diagnosing malnutrition. The primary aim was to determine malnutrition prevalence at the three sites of an Academic Health Sciences Centre [AHSC] by applying data gathered from nutritionDay 2011 to the GLIM two-step approach to diagnosing malnutrition. The secondary aim was to compare malnutrition prevalence between the three sites, with a specific interest in the results from AHSC-a, the cancer center, since cancer patients are known to have one of the highest rates of malnutrition The tertiary aim was to explore possible reasons for poor intake in AHSC overall. A one-day cross-sectional audit involving 264 patients at three AHSC sites was conducted in 2011 as part of the international nutritionDay research study. The unintentional weight loss and food consumption data were applied to CNST. Malnutrition diagnosis was determined using data for body mass index [BMI] and the fraction of study meal consumed. The nutritionDay adaptation of GLIM criteria to fit the nutritionDay survey was used. Categorical data are presented as actual numbers or percentages, with the groups compared by the Chi square test. Continuous variables expressed as mean ± SEM were used. One-way analysis of variance and Student t-tests were used to compare variables of interest. Significance p < 0.05, SPSS v.26 was used for analysis. 44% (264/600) of patients at the AHSC participated in the nutritionDay 2011 study. 59% of patients at AHSC-a screened positive for risk of malnutrition compared to the other two sites (AHSC-b and AHSC-c),p = 0.002 and 0.014 respectively. Overall, 23% of patients would have been diagnosed as malnourished with AHSC-b at 56% compared to 17% AHSC-c [p = 0.041). Using the GLIM two-step approach, we report 38% of patients were at risk for malnutrition using the CNST and 1 in 4 of those identified at risk would be diagnosed as malnourished. As well, more patients at the cancer site were found to be at risk for malnutrition.

Reperfusion of ST-Segment-Elevation Myocardial Infarction in the COVID-19 Era: Business as Usual?

Reperfusion of ST-Segment-Elevation Myocardial Infarction in the COVID-19 Era: Business as Usual?

Analysis of Chat Conversations between Two Semesters after the Implementation of New Electronic Services at an Academic Health Sciences Center

Library chat queries changed between the Spring 2018 and Spring 2019 semesters. During the Fall 2018 semester, the Library implemented two major services. Researchers saw trends associated with these services reflected in chats. Analysis examined how the frequency of controlled terms applied to chat transcripts changed before and after the services’ implementation. During the Spring 2018 semester, 411 substantive chat conversations occurred. During the Spring 2019 semester, 237 substantive chat conversations occurred. The terms associated with the new services showed a dramatic decline in frequency. An association is strongly suggested between changes in chat frequency and new services.

A226 CHILD AND PARENT PERCEPTIONS OF FAECAL MICROBIOTA TRANSPLANT (FMT): QUALITATIVE PERSPECTIVES FROM PARTICIPANTS IN A TRIAL OF FMT FOR PEDIATRIC ULCERATIVE COLITIS

Abstract Background Fecal microbiota transplant (FMT) is being increasingly studied across a range of therapeutic indications, including ulcerative colitis (UC). Pediatric patients may have unique responses to microbiome-based therapeutics, given their younger age, fewer comorbidities, and greater susceptibility to medication-related side effects. Aims We recently conducted the first pilot RCT of FMT in Canada for the treatment of pediatric ulcerative colitis (PediFETCh Trial) and conducted qualitative interviews post-study of participants and their parents. This study aims to describe the experience and perceptions of children who received FMT, and their parents. Methods Patients enrolled in the PediFETCh Trial (ClinicalTrials.gov: NCT02487238) and their parents were invited to participate in face-to-face, semi-structured interviews. Interviews were audiotaped, transcribed, and analyzed using open coding (NVivo 12 Pro). Results 8 patients and 8 parents were interviewed. Our data has been summarized into 4 domains and 11 composite themes (Table 1). Most patients and parents saw FMT as a natural treatment. Pre-treatment, patients were concerned with receiving “someone else’s poo” and physical discomfort, while parents were concerned with transmission of enteric infections or psychiatric diseases. Both felt their decision to pursue FMT was influenced by frustration with previous lack of response to medications and a fear of medication side effects. Post-treatment, most patients and families expressed no concerns over potential future side effects as a result of the FMT, and all patients reported feeling “completely normal”. Patients were split between preferring FMT or medication, with convenience of medication being an important factor, while others favored FMT for its perceived naturality and symptomatic improvements. For most families, natural therapies and diet played an important role in influencing their decision to pursue FMT; however, several parents reported that alternative healthcare practitioners did not support their desire to pursue FMT. Conclusions The study offers valuable insights into pediatric patients’ and parents’ experiences receiving FMT across several themes. Our results suggest a high rate of acceptance and interest in FMT research by pediatric patients and their parents. These findings suggest strategies to improve future delivery of FMT in clinical trials, and should support inclusion of children in FMT-based studies. Funding Agencies Hamilton Health Sciences New Investigator Fund (2015, Spring); Innovation Fund of the Alternative Funding Plan for the Academic Health Sciences Centres of Ontario (HAH-17-002)

Prioritizing Access to Surgical Care During the Coronavirus Pandemic.

Department of Surgery, Manchester Academic Health Sciences Centre, Salford Royal NHS Foundation Trust, Manchester, United Kingdom Funding/Support: None reported. Financial Disclosures: None reported. Correspondence: Gordon L. Carlson, C.B.E., M.D., F.R.C.S., F.R.C.S.Ed., Department of Colorectal Surgery, National Intestinal Failure Centre, Salford Royal NHS Foundation Trust, Manchester, M6 8HD, UK. E-mail: [email protected]

Treatment of Executive Function Deficits in autism spectrum disorder with repetitive transcranial magnetic stimulation: A double-blind, sham-controlled, pilot trial

BackgroundIn youth and young adults with autism spectrum disorder (ASD), executive function (EF) deficits may be a promising treatment target with potential impact on everyday functioning. ObjectiveTo conduct a pilot randomized, double-blind, parallel, controlled trial evaluating repetitive transcranial magnetic stimulation (rTMS) for EF deficits in ASD. MethodIn Toronto, Ontario (November 2014 to June 2017), a 20-session, 4-week course of 20 Hz rTMS targeting dorsolateral prefrontal cortex (DLPFC) (90%RMT) was compared to sham stimulation in 16–35 year-olds with ASD (28 male/12 female), without intellectual disability, who had impaired everyday EF performance (n = 20 active/n = 20 sham). Outcome measures evaluated protocol feasibility and clinical effects of active vs. sham rTMS on EF performance. The moderating effect of baseline functioning was explored. ResultsOf eligible participants, 95% were enrolled and 95% of randomized participants completed the protocol. Adverse events across treatment arms were mild-to-moderate. There was no significant difference between active vs. sham rTMS on EF performance. Baseline adaptive functioning moderated the effect of rTMS, such that participants with lower baseline functioning experienced significant EF improvement in the active vs. sham group. ConclusionsOur pilot RCT demonstrated the feasibility and acceptability of using high frequency rTMS targeting DLPFC in youth and young adults with autism. No evidence for efficacy of active versus sham rTMS on EF performance was found. However, we found promising preliminary evidence of EF performance improvement following active versus sham rTMS in participants with ASD with more severe adaptive functioning deficits. Future work could focus on examining efficacy of rTMS in this higher-need population. Clinical trial registrationRepetitive Transcranial Magnetic Stimulation (rTMS) for Executive Function Deficits in Autism Spectrum Disorder and Effects on Brain Structure: A Pilot Study; https://clinicaltrials.gov/ct2/show/NCT02311751?term = ameis&rank = 1; NCT02311751. The trial was funded by: an American Academy of Child and Adolescent Psychiatry (AACAP) Pilot Research Award, the Innovation Fund from the Alternate Funding Plan of the Academic Health Sciences Centres of Ontario, and an Ontario Mental Health Foundation (OMHF) Project A Grant and New Investigator Fellowship.

Study of preparatory activities on using BIM-technologies in the medical enterprise design

Introduction. When designing buildings and installations, Building Information Modeling (BIM) is spread more and more widely. The adoption of national and international standards and classifications is of great importance for the implementation of information technology. Application of the BIM-technologies for constructing public buildings, in the first turn, medical ones, seems to be very promising. The paper discusses the problems of developing indigenous parametric blocks (families) and preparatory activities in using the BIM-technology.&#x0D; Materials and methods. One of the information technology tasks is to develop equipment specifications and transfer them through the technological chain of the construction facility life cycle. The creation and application of classifiers are necessary to prepare for using the BIM-technologies.&#x0D; Results. A project of an academic health science centre with an extensive equipment range is analysed. The project of a modern medical building contains a description of several hundreds of specific medical equipment types. The specifications should contain information, including denominations and quantities of the equipment units, data on overall dimensions and weights of the units, connection interfaces to the power supply, water supply, water drainage. When creating parametric blocks, the international classifiers Uniclass-2015 and OmniClass are often used. However, they do not cover the necessary equipment range and contradict the domestic practice of purchasing equipment and services for state demand.&#x0D; Conclusions. The cost of preparing for the design process as creating parametric blocks can make a total of tens or hundreds of man-days that should be taken into account when planning design activities. In terms of procurement for state and municipal demand, it is necessary to make design specifications following the available range of medical equipment.

Computed tomography scanning in the prone position for a critically hypoxic patient with COVID-19.

Anaesthesia ReportsVolume 8, Issue 1 p. 71-72 Multimedia Computed tomography scanning in the prone position for a critically hypoxic patient with COVID-19 B. A. McGrath, B. A. McGrath Consultant Anaesthetist, Honorary Senior Lecturer orcid.org/0000-0003-3048-3480 Manchester University Hospital NHS Foundation Trust, Manchester, UK Manchester Academic Critical Care, Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, the University of Manchester, Manchester Academic Health Science Centre, Manchester, UKSearch for more papers by this authorR. Lowe, R. Lowe Specialty Trainee in Anaesthesia Health Education England North West, Manchester, UKSearch for more papers by this authorW. Brady, W. Brady Consultant Anaesthetist @willbrady72 Manchester University Hospital NHS Foundation Trust, Manchester, UKSearch for more papers by this authorA. Sharman, A. Sharman Consultant Radiologist Manchester University Hospital NHS Foundation Trust, Manchester, UKSearch for more papers by this authorT. Felton, T. Felton Senior Lecturer, Honorary Consultant Physician orcid.org/0000-0001-6868-6633 Manchester Academic Critical Care, Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, the University of Manchester, Manchester Academic Health Science Centre, Manchester, UK Manchester University Hospital NHS Foundation Trust, Manchester, UKSearch for more papers by this authorC. L. Shelton, Corresponding Author C. L. Shelton Consultant Anaesthetist, Senior Clinical Lecturer [email protected] orcid.org/0000-0002-8438-398X Manchester University Hospital NHS Foundation Trust, Manchester, UK Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, UK Correspondence to: C. L. Shelton Email: [email protected]Search for more papers by this author B. A. McGrath, B. A. McGrath Consultant Anaesthetist, Honorary Senior Lecturer orcid.org/0000-0003-3048-3480 Manchester University Hospital NHS Foundation Trust, Manchester, UK Manchester Academic Critical Care, Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, the University of Manchester, Manchester Academic Health Science Centre, Manchester, UKSearch for more papers by this authorR. Lowe, R. Lowe Specialty Trainee in Anaesthesia Health Education England North West, Manchester, UKSearch for more papers by this authorW. Brady, W. Brady Consultant Anaesthetist @willbrady72 Manchester University Hospital NHS Foundation Trust, Manchester, UKSearch for more papers by this authorA. Sharman, A. Sharman Consultant Radiologist Manchester University Hospital NHS Foundation Trust, Manchester, UKSearch for more papers by this authorT. Felton, T. Felton Senior Lecturer, Honorary Consultant Physician orcid.org/0000-0001-6868-6633 Manchester Academic Critical Care, Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, the University of Manchester, Manchester Academic Health Science Centre, Manchester, UK Manchester University Hospital NHS Foundation Trust, Manchester, UKSearch for more papers by this authorC. L. Shelton, Corresponding Author C. L. Shelton Consultant Anaesthetist, Senior Clinical Lecturer [email protected] orcid.org/0000-0002-8438-398X Manchester University Hospital NHS Foundation Trust, Manchester, UK Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, UK Correspondence to: C. L. Shelton Email: [email protected]Search for more papers by this author First published: 30 June 2020 https://doi.org/10.1002/anr3.12050Citations: 2Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume8, Issue1January-June 2020Pages 71-72 RelatedInformation

Pharmacist linkage in care transitions: From academic medical center to community

ObjectivesTo improve the care of patients discharged from the University of Mississippi Medical Center (UMMC) after treatment for acute myocardial infarction, heart failure, pneumonia, and chronic obstructive pulmonary disease; reduce preventable hospital readmissions; and inform future care transition collaborations between hospital teams and community pharmacies. SettingStudy was conducted at UMMC, UMMC outpatient pharmacies, and targeted community pharmacies. Practice descriptionUMMC is the state’s only academic health science center, providing all levels of care. Participants were at UMMC’s 722-bed hospital in Jackson, MS. Participating pharmacies included 2 UMMC outpatient pharmacies and community pharmacy research partner sites within 60 miles of UMMC. Practice innovationA pharmacist transitions coordinator (PTC) worked with inpatient and community-based pharmacists to provide predischarge medication reconciliation and 30 days of medications on discharge. The PTC with access to inpatient and outpatient records facilitated communication among settings/providers. Community pharmacists provided telephonic and face-to-face medication therapy management (MTM). EvaluationThe project was structured as a prospective, randomized controlled trial of pharmacist-led care coordination during transition from inpatient to community setting, with follow-up MTM by community pharmacists. In this intention-to-treat analysis, readmission rates were assessed with propensity adjustment. Drug therapy problems (DTPs) identified/resolved were assessed and reported through descriptive statistics. ResultsNinety-six patients were enrolled. Positive outcomes in overall reduced readmission rates were observed in the intervention group at 30, 60, 90, and 180 days, although statistical significance was not achieved because of limited enrollment. Approximately 60% participated in MTM postdischarge, with 453 interventions and 169 DTPs identified and addressed (98% > 1 DTP; 20% > 5 DTPs). Implementation experience includes PTC successes, new partnerships, and connectivity among all providers, as well as enrollment challenges, follow-up, and service delivery timeframe. ConclusionWith access to patient records, pharmacists have the potential to positively affect patient outcomes through medication management during care transitions.

Exploring patient preferences for involvement in medication management in hospitals.

The aim of this study was to identify patient preferences for involvement in medication management during hospitalization. A qualitative descriptive study. This is a study of 20 inpatients in two medical and two surgical wards at an academic health science centre in Melbourne, Australia. Semi-structured interviews were recorded and analysed using content analysis. Three themes were identified: (a) 'understanding the medication' established large variation in participants' understanding of their pre-admission medication and current medication; (b) 'ownership of medication administration' showed that few patients had considered an alternative to their current regimen; only some were interested in taking more control; and (c) 'supporting discharge from hospital' showed that most patients desired written medication instructions to be explained by a health professional. Family involvement was important for many. There was significant diversity of opinion from participants about their involvement in medication management in hospital. Patient preferences for inclusion need to be identified on admission where appropriate. Education about roles and responsibilities of medication management is required for health professionals, patients and families to increase inclusion and engagement across the health continuum and support transition to discharge. Little is known about patient preferences for participation in medication administration and hospital discharge planning. Individual patient understanding of and interest in participation in medication administration varies. In accordance with individual patient preferences, patients need to be included more effectively and consistently in their own medication management when in hospital.

Overcoming Challenges to Support Clinician-Scientist Roles in Canadian Academic Health Sciences Centres.

Clinician-scientists (CSs) make significant contributions to the healthcare system, yet their roles are not fully understood, supported or recognized by healthcare leaders or policy makers. CSs are healthcare professionals with advanced research training who continue to pursue clinical work and are considered an essential component of the research infrastructure in academic health sciences centres. The current literature supports the role of CSs but is also clear that there are multiple challenges in attracting and retaining clinicians to the role. To gain a comprehensive understanding of the current status of the CS role, two literature reviews were conducted. The findings reported here include an overview of: the education and training preparation for CS roles; the importance of the CS role; barriers and challenges to developing and implementing the CS role; and strategies for supporting and sustaining CS roles in practice. The paper further describes one Canadian academic health sciences centre's approach to supporting and increasing the number of CSs from nursing and allied health professions to support academic practice. Non-physician CSs may conduct research using multiple research designs across the research continuum from randomized controlled trials to grounded theory or qualitative descriptive approaches. Their research generally focuses on practice-based issues such as best practices for managing pain or frailty or evaluating the effectiveness of new approaches to care. Researchers and healthcare leaders in other organizations may find this work helpful for establishing their own structures to enhance research capacity and practice-based research, especially for non-physician CSs.

Beyond silos: An interprofessional, campus-wide ethics education program.

Ethics education is essential to the education of all healthcare professionals. The purpose of this study was to evaluate an interprofessional approach to ethics education to all students across an academic health science center. The objectives were to (1) compare student perception of ethics education before and after the implementation of the campus-wide ethics program and (2) determine changes in student ethical decision-making skills following implementation of a campus-wide ethics program. This study was a quasi-experimental design with seniors graduating prior to the intervention serving as the control group. The setting was a comprehensive health science center in the southwestern United States. All students enrolled in the university participated in the intervention; however, 976 graduating students were used for evaluation of the intervention. Study materials for each survey were submitted to the university's IRB, and the project was approved as exempt by the Committee for the Protection of Human Subjects. Student participation in the surveys was voluntary. No names or other identifying information were collected, and responses to the survey questions were kept confidential. Students' perception of the adequacy of time spent on the ethics content in course instruction and practical training decreased from the baseline to the fifth-year survey. Students' overall comfort level with their abilities to deal with ethical issues increased from the baseline to the fifth year. Student ethical decision-making skills were higher at the third-year evaluation for all indicators. For the fifth-year survey, responses were also higher scoring on all four indicators. After participation in an interprofessional campus-wide effort on health professions ethics, students demonstrated higher ethical decision-making scores according to the Health Professional Ethics Rubric. However, their scores still did not reach the proficiency level identified in the rubric. Examination of the effectiveness of each part of the intervention is needed.

The Current State of Physician Assistant Pain Curriculum: A National Survey.

Insufficient pain management and inappropriate use of pain medication are problems across the health care spectrum. Recent clinical practice guidelines and standardized core curricula have been developed to combat the deficiencies in pain education to ensure that health care professionals are proficient in assessing and managing pain; however, the extent to which physician assistant (PA) programs have implemented these in their training programs is unclear. The purpose of this study was to determine the magnitude of pain education in current PA programs in the United States, including how pain medicine instruction is incorporated into the curriculum, time spent teaching about pain management, the methods used, and barriers to providing pain medicine education. Data from the 2016 Physician Assistant Education Association's Support to Advance Research grant, which allowed the inclusion of questions in the annual program survey, were analyzed. The response rate was 100%. Descriptive statistics were used to describe results. Nonparametric statistics used the Mann-Whitney U test and Kruskal-Wallis analysis to assess mean ranks and calculate effect sizes. Of the 209 programs surveyed, 14% reported that pain management is not included in the curriculum, and 3% reported that it is a stand-alone module. The reason most often cited to explain lack of curriculum was insufficient time (39%), and 32% reported that it is not mandated by the program accreditors. Further analysis included assessment of differences in pain medicine curriculum by program housing, academic health science center status, and geography. Eighty-six percent of programs include pain education in their curriculum, suggesting that PA programs recognize the importance of pain education. The methods of instruction and topics included across programs are inconsistent. As the first comprehensive benchmark of pain medicine education for PAs, this study shows that although most programs address pain curriculum, opportunities exist to improve pain training in PA programs in the United States.

A WISH TO DIE AND THE OLDER ADULT: THE IMPACT OF BESPOKING ON VIRTUAL CONTINUING EDUCATION

Introduction Older adults with depression or chronic illness may express a wish to die. Front-line healthcare professionals may be clinically tasked with the challenging scenario of distinguishing whether a patient is depressed, suicidal and/or requesting a medically assisted death (MAID), a procedure recently legalized in Canada. Baycrest, a large academic geriatric health centre in Toronto, offers virtual interactive learning through modules and webinars, which have been shared nationally with healthcare professionals interested in geriatric mental health. Our mandate is to create continuing education that engages learners and optimizes learning outcomes. In our most recent module, “A Wish to Die: MAID, Depression and the Older Adult”, we introduced the process of customization or bespoking and examined the impact on learning of this novel educational methodology. Methods 1) Bespoking A free learning event, “Depression, MAID and the Older Adult” was advertised through national memberships and databases of Canadian healthcare professionals working in the area of seniors' mental health. Through SurveyMonkey, participants were asked to choose the nature of the case (acute care vs. community vs. long-term care) and other components that could be individualized and customized. A small group of registrants was not bespoked and comprised the comparison group. 2) Virtual Blended Learning An interactive online module was made available for 2 weeks and was followed 1 week later by a live, facilitated webinar to consolidate learning. 3) Evaluation Knowledge and comfort in working with older adults who express a wish to die were assessed pre-module and post-webinar. Impact and change in practice (e.g., use of a new tool) were assessed at 6 weeks post-webinar. The data were summarized using descriptive statistics, including Fisher's exact tests to compare groups, and longitudinal logistic regression with random intercepts. All analyses were done using SAS version 9.4. Results The proportion of participants with an approach to working with older adults who express a wish to die significantly increased from 22% (pre, N=27) to 63% (post, N=27, p=0.003) and non-significantly increased from post to 86% at follow up (N=22, p=0.08) for the Bespoke group (Figure 1). The non-Bespoke group significantly increased from 28% (pre, N=36) to 72% (post, N=36, p=0.0003) but then non-significantly decreased from post to 58% at follow up (N=19, p=0.32). There was no significant group difference in the change in proportions from pre to post (p=0.85) but the change in proportions from post to follow up was significantly greater for the Bespoke group compared to the non-Bespoke group (p=0.05). At follow up, the Bespoke group had a larger proportion with an approach to working with an older adult who expresses a wish to die, but it was not significant (86% versus 58%, p=0.08). At 6 weeks post-webinar, ∼89% (N=45, all participants) reported participation in the learning activity had a positive impact on their practice. ∼72% indicated that participation had helped with client/patient care (N=43). 93% (N=27, Bespoke group) wanted more bespoke education opportunities. Conclusions A large majority of study participants responded that the learning activity had a positive impact on their practice and helped with patient care. Interest in further bespoke learning opportunities was high. Learning outcomes were similar between groups with a positive trend for bespoked participants to identify having an approach to an expressed wish to die after the intervention. Bespoking is easy to implement, appears to contribute to engagement and through virtual technology, can target the needs of multiple learners simultaneously. Incorporating customization into the development of an online learning module was an effective means for transmitting knowledge about a clinical approach to an older adult who expresses a wish to die. The utility and feasibility of using bespoke methodology in continuing education merits study in other subject areas, both within geriatric psychiatry and more broadly, with larger sample sizes. This research was funded by This project was funded by the Ontario Ministry of Health and Long-term Care Academic Health Sciences Centres Alternate Funding Plan Innovation Fund.

Understanding the Impact of Chronic Pain in the Emergency Department: Prevalence and Characteristics of Patients Visiting the Emergency Department for Chronic Pain at an Urban Academic Health Sciences Centre

ABSTRACT Background Canadians make approximately 16 million visits to the emergency department (ED) each year. ED visits for non-urgent reasons contribute to suboptimal patient care and ineffective resource use. Aims To estimate the proportion of ED visits related to chronic pain at our institution. Methods. We conducted a retrospective review of 1000 randomly selected ED visits at TOH during the 2012–2013 fiscal year (April 1, 2012 to March 31, 2013). Visits for chronic pain were identified using pre-defined criteria. Demographic and medical data were extracted from medical charts. Results 104 visits during this time period were related to chronic pain (10.4%; 95% CI: 8.2–12.6). All visits were from unique patients (i.e., no patients contributed more than 1 visit). Patients were predominantly women (71%), with a mean age of 45.9 years. Seventy-eight percent of patients had a primary care provider. The most common location of pain included the abdomen (24%), the head or face (21%), and the low back (21%). Only 5% of patients had consultation with a pain medicine specialist while 78% were awaiting a consultation. More than 2/3 of patients (71%) reported using opioids for their pain. Conclusion Presenting to the ED for chronic pain was found to occur among a sample of ED visits reviewed. This can result in ineffective care for patients with chronic pain. Cost-effective solutions to improve clinical outcomes and reduce ED use for chronic pain may yield significant improvements in health outcomes of patients and benefits for the health care system.