Academic Health Science Centre Research Articles

When Health Systems Consider Research to Be Beyond the Scope of Healthcare Delivery, Research Translation Is Crippled Comment on "Academic Health Science Centres as Vehicles for Knowledge Mobilisation in Australia? A Qualitative Study".

Edelman and colleagues’ analysis of the views of Board members of Australian Research Translation Centres (RTCs) is well timed. There has been little study of Australian RTCs to date. We focus on their recommendations regarding knowledge mobilisation (KM) to open broader debate on the wisdom of regarding UK practices as a blueprint. We go further and ask whether successful RTCs might, as a result of responding to local context, create idiosyncratic structures and solutions, making generalisable learning less likely? There has been much invested in Australian RTCs and implications of government’s formative evaluation of their work is discussed. Five recommendations are made that could help RTCs: allowing system end-users a greater say in funding decisions, taking a broader, more democratic approach to kinds of knowledge that are valued; investing in methodologies derived from the innovation space; and, a creative attention to governance to support these ideas.

Milrinone as Compared with Dobutamine in the Treatment of Cardiogenic Shock

BackgroundCardiogenic shock is associated with substantial morbidity and mortality. Although inotropic support is a mainstay of medical therapy for cardiogenic shock, little evidence exists to guide the selection of inotropic agents in clinical practice.MethodsWe randomly assigned patients with cardiogenic shock to receive milrinone or dobutamine in a double-blind fashion. The primary outcome was a composite of in-hospital death from any cause, resuscitated cardiac arrest, receipt of a cardiac transplant or mechanical circulatory support, nonfatal myocardial infarction, transient ischemic attack or stroke diagnosed by a neurologist, or initiation of renal replacement therapy. Secondary outcomes included the individual components of the primary composite outcome.ResultsA total of 192 participants (96 in each group) were enrolled. The treatment groups did not differ significantly with respect to the primary outcome; a primary outcome event occurred in 47 participants (49%) in the milrinone group and in 52 participants (54%) in the dobutamine group (relative risk, 0.90; 95% confidence interval [CI], 0.69 to 1.19; P=0.47). There were also no significant differences between the groups with respect to secondary outcomes, including in-hospital death (37% and 43% of the participants, respectively; relative risk, 0.85; 95% CI, 0.60 to 1.21), resuscitated cardiac arrest (7% and 9%; hazard ratio, 0.78; 95% CI, 0.29 to 2.07), receipt of mechanical circulatory support (12% and 15%; hazard ratio, 0.78; 95% CI, 0.36 to 1.71), or initiation of renal replacement therapy (22% and 17%; hazard ratio, 1.39; 95% CI, 0.73 to 2.67).ConclusionsIn patients with cardiogenic shock, no significant difference between milrinone and dobutamine was found with respect to the primary composite outcome or important secondary outcomes. (Funded by the Innovation Fund of the Alternative Funding Plan for the Academic Health Sciences Centres of Ontario; ClinicalTrials.gov number, NCT03207165.)

2021 Canadian Spine Society Abstracts.

# Abstract 45. Determining clinically important improvement following surgery for degenerative conditions of the spine: analysis of the Canadian Spine Outcomes and Research Network (CSORN) Registry {#article-title-2} There is significant variability in clinically important improvement (CII)

An Academic Health Sciences Centre's Strategy to Enhance Nurse Resilience and Psychological Safety.

The rapid cadence of change and the fear of acquiring and spreading COVID-19 - coupled with moral distress exacerbated by fulfilling one's duty to care under extremely challenging conditions - continue to impact nurses' coping ability, resilience and psychological safety globally (McDougall et al. 2020). This paper provides an overview of how an academic health sciences centre (AHSC) has responded to the evolving waves of the COVID-19 pandemic. Specifically, we share our context and the strategies we used to build and enhance nurse resilience and psychological safety at the organizational, clinical team and individual levels. This is followed by a description of our nurses' achievements amid the pandemic.

Intervention to reduce unnecessary urinary catheter use in a large academic health science centre: A one-group, pretest, posttest study with a theory-based process evaluation.

AimTo evaluate an intervention to reduce unnecessary urinary catheter use and prevent catheter‐associated urinary‐tract infections (CAUTI) in hospitalized patients across an academic health science centre.MethodsWe conducted a one‐group, pretest, posttest study with a theory‐based process evaluation. Phase 1 consisted of a pre/postintervention to test the impact of a CAUTI protocol. Audits on four units were conducted, and data were analysed descriptively. Phase 2 consisted of a theory‐based process evaluation to understand the barriers/enablers to the implementation. Semistructured interviews were conducted and then analysed using a systematic approach.ResultsIn Phase 1, all inpatients with urinary catheters admitted to the units (N = 4) during the study period (N = 99, pre) and (N = 99, post) were included. CAUTI prevalence rate was 18.2% pre versus 14.1% post (p = .563). In Phase 2, participants (N = 18) who worked on the units were interviewed, and a total of 13 barriers and 19 enablers were found.

Organizational supports for knowledge translation in paediatric health centres and research institutes: insights from a Canadian environmental scan

BackgroundOrganizational supports are thought to help address wide-ranging barriers to evidence-informed health care (EIHC) and knowledge translation (KT). However, little is known about the nature of the resources and services that exist within paediatric health care and research settings across Canada to facilitate evidence use in health care delivery. This survey examined existing supports for EIHC/KT within these organizations to inform the design of similar EIHC/KT support programmes.MethodsA national environmental scan was conducted using a bilingual online survey distributed to leaders at Canadian paediatric academic health science centres and their affiliated research institutes. Participants were invited through email, social media and webinar invitations and snowball sampling. Supports of interest included personnel, resources, services, organizational structures or processes, and partnerships or collaborations; barriers and successes were also probed. Data were compiled by site, reported using descriptive statistics, or grouped thematically. Supports were described using the AIMD (Aims, Ingredients, Mechanism, Delivery) framework.ResultsThirty-one respondents from 17 sites across seven provinces represented a 49% site response rate. Eleven (65%) sites reported an on-site library with variable staffing and services. Ten (59%) sites reported a dedicated KT support unit or staff person. Supports ranged from education, resource development and consultation to protocol development, funded initiatives and collaborations. Organizations leveraged internal and external supports, with the majority also employing supports for clinical research integration. Supports perceived as most effective included personnel, targeted initiatives, leadership, interdepartmental expertise, external drivers and logistical support. Barriers included operational constraints, individual-level factors and lack of infrastructure.ConclusionsThis first survey of organizational supports for EIHC/KT identified the range of supports in place in paediatric research and health care organizations across Canada. The diversity of supports reported across sites may reflect differences in resource capacity and objectives. Similarities in EIHC/KT and research integration supports suggest common infrastructure may be feasible. Moreover, stakeholder engagement in research was common, but not pervasive. Tailored support programmes can target multi-faceted barriers. Findings can inform the development, refinement and evaluation of EIHC/KT support programmes and guide the study of the effectiveness and sustainability of these strategies.

Assessing civility at an academic health science center: Implications for employee satisfaction and well-being.

Incivilities are pervasive among workers in healthcare institutions. Previously identified effects include deterioration of employee physical and mental health, absenteeism, burnout, and turnover, as well as reduced patient safety and quality of care. This study documented factors related to organizational civility at an academic health sciences center (AHSC) as the basis for future intervention work. We used a cross-sectional research design to conduct an online survey at four of five campuses of an AHSC. Using the Organizational Civility Scale (OCS), we assessed differences across gender, race (White and non-White) and job type (faculty or staff) in the eleven subscales (frequency of incivility, perceptions of organizational climate, existence of civility resources, importance of civility resources, feelings about current employment, employee satisfaction, sources of stress, coping strategies, overall levels of stress/coping ability, and overall civility rating). Significant gender differences were found in six of the eleven subscales: perception of organizational climate (p < .001), existence of civility resources (p = .001), importance of civility resources (p < .001), frequency of incivilities (p < .001), employee satisfaction (p = .002), and overall civility rating (p = .007). Significant differences between respondents by self-identified race were found only in one subscale: existence of civility resources (p = .048). Significant differences were found between faculty and staff in four subscales: perception of organizational climate (p = .001), importance of civility resources (p = .02), employee satisfaction (p = .01), and overall levels of stress (p = .03). Results suggest that gender and employment type differences exist in the perception of organizational climate at the academic health center, while significant racial differences only occurred in reference to reported existence of civility resources. Attention to these differences should be incorporated into the development of programs to address the problem.

Implementation evaluation of staff support and wellbeing programmes at an academic health science centre during COVID-19: study protocol

BackgroundEvidence from previous pandemics as well as early evidence from COVID-19 suggests risk of adverse mental health and wellbeing outcomes for healthcare workers. In response to these concerns, healthcare systems and organisations rapidly established staff support and wellbeing programmes. While there is emerging literature related to the effectiveness of such interventions, what is less well understood and evaluated is the evidence base regarding how such programmes are implemented; what supports and hinders their implementation; and how or if they are maintained following the initial acute phase of the pandemic. This study addresses this gap by studying the implementation process of COVID-19-related staff wellbeing programmes in the three UK NHS Trusts that make up one of Europe’s largest academic health sciences centres, King’s Health Partners.MethodsWe will conduct a prospective, cross-sectional descriptive study using qualitative research methods and non-probability purposive sampling to identify a study participant group representative of the population and implementation activity of interest. We will conduct semi-structured interviews of between 30 min and 1 h. We will identify theory-driven elements in the dataset using the Consolidated Framework for Implementation Research (barriers and drivers), Exploration, Preparation, Implementation, Sustainment Framework (timeline/chronology/evolution of the implementation and different issues at different times) and Expert Recommendations for Implementing Change (implementation strategies). We will then identify indicators of these constructs within the dataset and report them, as well as their inter-relationships.DiscussionThrough this study, we hope to better understand what factors hindered and enabled the implementation of three inter-linked staff support and wellbeing programmes and how/to what extent have these programmes been sustained. We will also explore whether implementation science frameworks are applicable and beneficial in conceptualising and understanding crisis driven and rapidly implemented interventions and in what ways, if any, they need to be adjusted when used in unprecedented circumstances such as the COVID-19 pandemic.

Burnout and distress among nurses in a cardiovascular centre of a quaternary hospital network: a cross-sectional survey.

Background:Burnout and distress have a negative impact on nurses and the treatment they provide. Our aim was to measure the prevalence of burnout and distress among nurses in a cardiovascular centre at 2 quaternary referral hospitals in Canada, and compare these outcomes to those for nurses at academic health science centres (AHSCs) in the United States.Methods:We conducted a survey of nurses practising in a cardiovascular centre at 2 quaternary referral hospitals in Toronto, Ontario, between Nov. 27, 2018, and Jan. 31, 2019. The survey tool included the Well-Being Index (WBI), which measures fatigue, depression, burnout, anxiety or stress, mental and physical quality of life, work–life integration, meaning in work and distress; a score of 2 or higher on the WBI indicated high distress. We also evaluated nurses’ perception of the adequacy of staffing levels and of fair treatment in the workplace, and satisfaction with the electronic health record. We carried out standard univariate statistical comparisons using the χ2, Fisher exact or Kruskal–Wallis test as appropriate to perform univariate comparisons in the sample of respondents. We assessed the relation between a WBI score of 2 or higher and demographic characteristics. We compared univariate associations among WBI data for nurses at AHSCs in the US who completed the WBI to responses from our participants.Results:The response rate to the survey was 49.1% (242/493). Of the 242 respondents, 188 (77.7%) reported burnout in the previous month; 189 (78.1%) had a WBI score of 2 or higher, and 132 (54.5%) had a score of 4 or higher (indicative of severe distress). Ordinal multivariable analysis showed that lower WBI scores were associated with satisfaction with staffing levels (odds ratio [OR] 0.33, 95% confidence interval [CI] 0.16–0.69) and the perception of fair treatment in the workplace (OR 0.41, 95% CI 0.23–0.74). Higher proportions of our respondents than nurses at AHSCs in the US reported burnout (77.7% v. 60.5%, p < 0.001) and had a WBI score of 2 or higher (78.1% v. 57.0%) or 4 or higher (54.5% v. 32.0%) (both p < 0.001).Interpretation:Although levels of burnout and distress were high among nurses, their perceptions of adequate staffing and fair treatment were associated with lower distress. Addressing inadequate staffing and unfair treatment may decrease burnout and other dimensions of distress among nurses, and improve their work experience and patient outcomes.

Burnout and distress among physicians in a cardiovascular centre of a quaternary hospital network: a cross-sectional survey.

Background:Burnout and distress have a negative impact on physicians and the treatment they provide. Our aim was to measure the prevalence of burnout and distress among physicians in a cardiovascular centre of a quaternary hospital network in Canada, and compare these outcomes to those for physicians at academic health science centres (AHSCs) in the United States.Methods:We conducted a survey of physicians practising in a cardiovascular centre at 2 quaternary referral hospitals in Toronto, Ontario, between Nov. 27, 2018, and Jan. 31, 2019. The survey tool included the Well-Being Index (WBI), which measures fatigue, depression, burnout, anxiety or stress, mental and physical quality of life, work–life integration, meaning in work and distress; a score of 3 or higher indicated high distress. We also evaluated physicians’ perception of the adequacy of staffing levels and of fair treatment in the workplace, and satisfaction with the electronic health record. We carried out standard univariate statistical comparisons using the χ2, Fisher exact or Kruskal–Wallis test as appropriate to perform univariate comparisons in the sample of respondents. We assessed the relation between a WBI score of 3 or higher and demographic characteristics. We compared univariate associations among WBI data for physicians at AHSCs in the US who completed the WBI to responses from our participants.Results:The response rate to the survey was 84.1% (127/151). Of the 127 respondents, 83 (65.4%) reported burnout in the previous month, and 68 (53.5%) reported emotional problems. Sixty-nine respondents (54.3%) had a WBI score of 3 or higher. Respondents were more likely to have a WBI score of 3 or higher versus a score less than 3 if they perceived insufficient staffing levels (52/69 [75%] v. 26/58 [45%], p = 0.02) or unfair treatment (23/69 [33%] v. 8/58 [14%], p = 0.03), or were anesthesiologists (26/35 [74%] v. 43/92 [47%] for other specialists, p = 0.005). Compared to 21 594 physicians in practice at AHSCs in the US, our respondents had a higher mean WBI score (2.4 v. 1.8, p = 0.004) and reported a higher prevalence of burnout (65.4% v. 56.6%, p = 0.048).Interpretation:Physicians in this study had high levels of burnout and distress, driven by the perception of inadequate staffing levels and being treated unfairly in the workplace. Addressing these institutional factors may improve physicians’ work experience and patient outcomes.

Academic Health Science Centres as Vehicles for Knowledge Mobilisation in Australia? A Qualitative Study.

Background: Despite increasing investments in academic health science centres (AHSCs) in Australia and an expectation that they will serve as vehicles for knowledge translation and exchange, there is limited empirical evidence on whether and how they deliver impact. The aim of this study was to examine and compare the early development of four Australian AHSCs to explore how they are enacting their impact-focused role. Methods: A descriptive qualitative methodology was employed across four AHSCs located in diverse health system settings in urban and regional locations across Australia. Data were collected via semi-structured interviews with 15 academic, industry and executive board members of participating AHSCs. The analysis combined inductive and deductive elements, with inductive categories mapped to deductive themes corresponding to the study aims. Results: AHSCs in Australia are in an emergent state of development and are following different pathways. Whilst varied approaches to support research translation are apparent, there is a dominant focus on structure and governance, as opposed to action-oriented roles and processes to deliver strategic goals. Balancing collaboration and competition between partners presents a challenge, as does identifying appropriate ways to evaluate impact. Conclusion: The early stage of development of AHSCs in Australia presents an important opportunity for formative learning and evaluation to optimise their enactment of knowledge mobilisation processes for impact.

Leaders\u2019 perspectives on learning health systems: a qualitative study

BackgroundIntegrated utilisation of digital health data has the power to transform healthcare to deliver more efficient and effective services, and the learning health system (LHS) is emerging as a model to achieve this. The LHS uses routine data from service delivery and patient care to generate knowledge to continuously improve healthcare. The aim of this project was to explore key features of a successful and sustainable LHS to inform implementation in an Academic Health Science Centre context.MethodsWe purposively identified and conducted semi-structured qualitative interviews with leaders, experienced in supporting or developing data driven innovations in healthcare. A thematic analysis using NVivo was undertaken.ResultsAnalysis of 26 interviews revealed five themes thought to be integral in an effective, sustainable LHS: (1) Systematic approaches and iterative, continuous learning with implementation into healthcare contributing to new best-practice care; (2) Broad stakeholder, clinician and academic engagement, with collective vision, leadership, governance and a culture of trust, transparency and co-design; (3) Skilled workforce, capability and capacity building; (4) Resources with sustained investment over time and; (5) Data access, systems and processes being integral to a sustainable LHS.ConclusionsThis qualitative study provides insights into the elements of a sustainable LHS across a range of leaders in data-driven healthcare improvement. Fundamentally, an LHS requires continuous learning with implementation of new evidence back into frontline care to improve outcomes. Structure, governance, trust, culture, vision and leadership were all seen as important along with a skilled workforce and sustained investment. Processes and systems to optimise access to quality data were also seen as vital in an effective, sustainable LHS. These findings will inform a co-designed framework for implementing a sustainable LHS within the Australian healthcare and Academic Health Science Centre context. It is anticipated that application of these findings will assist to embed and accelerate the use of routine health data to continuously generate new knowledge and ongoing improvement in healthcare delivery and health outcomes.

Association Between ABO and Rh Blood Groups and SARS-CoV-2 Infection or Severe COVID-19 Illness : A Population-Based Cohort Study.

The ABO and rhesus (Rh) blood groups may influence risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. To determine whether ABO and Rh blood groups are associated with risk for SARS-CoV-2 infection and severe coronavirus disease 2019 (COVID-19) illness. Population-based cohort study. Ontario, Canada. All adults and children who had ABO blood group assessed between January 2007 and December 2019 and who subsequently had SARS-CoV-2 testing between 15 January and 30 June 2020. The main study outcome was SARS-CoV-2 infection, determined by viral RNA polymerase chain reaction testing. A second outcome was severe COVID-19 illness or death. Adjusted relative risks (aRRs) and absolute risk differences (ARDs) were adjusted for demographic characteristics and comorbidities. A total of 225 556 persons were included, with a mean age of 54 years. The aRR of SARS-CoV-2 infection for O blood group versus A, AB, and B blood groups together was 0.88 (95% CI, 0.84 to 0.92; ARD, -3.9 per 1000 [CI, -5.4 to -2.5]). Rhesus-negative (Rh-) blood type was protective against SARS-CoV-2 infection (aRR, 0.79 [CI, 0.73 to 0.85]; ARD, -6.8 per 1000 [CI, -8.9 to -4.7]), especially for those who were O-negative (O-) (aRR, 0.74 [CI, 0.66 to 0.83]; ARD, -8.2 per 1000 [CI, -10.8 to -5.3]). There was also a lower risk for severe COVID-19 illness or death associated with type O blood group versus all others (aRR, 0.87 [CI, 0.78 to 0.97]; ARD, -0.8 per 1000 [CI, -1.4 to -0.2]) and with Rh- versus Rh-positive (aRR, 0.82 [CI, 0.68 to 0.96]; ARD, -1.1 per 1000 [CI, -2.0 to -0.2]). Persons who rapidly died of severe COVID-19 illness may not have had SARS-CoV-2 testing. The O and Rh- blood groups may be associated with a slightly lower risk for SARS-CoV-2 infection and severe COVID-19 illness. Ontario Academic Health Sciences Centre AFP Innovation Fund and the Ontario Ministry of Health and Long-Term Care.

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?