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The mental wellness of university students can be critical for their success. In an attempt to minimize stress for students, many universities have implemented a policy for a fall break with limited evidence to support its intended outcomes. This case study offers a critical appraisal of the formation of the fall break policy at one medium sized comprehensive university using qualitative and quantitative forms of evidence triangulated from (1) University Student Union survey, (2) document analysis and; (3) informant interview. The lack of uniformity on how the fall break is labelled, the timing of the break and its evaluation emerged as design flaws in the creation stage that perhaps, could have been mitigated if faculty and student voices were included in policy creation decisions. [ABSTRACT FROM AUTHOR]

Background: Pain and agitation are closely linked to the development of delirium, which affects 60%–87% of critically ill patients. Delirium is associated with increased mortality and morbidity. Clinical guidelines that suggest routine assessment, treatment and prevention of pain, agitation and delirium (PAD) is crucial to improving patient outcomes. However, the adoption of and adherence to PAD guidelines remain suboptimal, especially in community hospitals. The aim of this quality improvement study is to evaluate the impact of a multifaceted and multidisciplinary intervention on PAD management in a Canadian community intensive care unit (ICU). Methods: This is a quality improvement, uncontrolled, before-and-after study of a multifaceted and multidisciplinary intervention targeting nurses (educational modules, visual reminders), family members (interviews, educational pamphlets and an educational video), physicians (multidisciplinary round script) and the multidisciplinary team as a whole (delirium poster). We will collect data every day for 6 weeks before implementing the intervention. Data collection will include clinical information and information on process of care. We will then implement the intervention. Four weeks after, we will collect data daily for 6 weeks to evaluate the effect of the intervention. On the basis of the volume of the ICU, we expect to enroll approximately 280 patients. We have obtained local ethics approval from the Hamilton Integrated Research Ethics Board (HiREB 18-040-C). Interpretation: The results of this quality improvement study will provide information on adherence to PAD guidelines in a Canadian community ICU setting. They will also supply information on the feasibility of implementing multifaceted and multidisciplinary PAD interventions in community ICUs. [ABSTRACT FROM AUTHOR]

The objective of this study was to determine the factors that increase the odds of long-stay delayed discharge in alternate level of care (ALC) patients using data collected from the Ontario Wait Time Information System (WTIS) database. Retrospective cohort study utilizing data from Niagara Health's WTIS database. WTIS includes individuals admitted to any of the Niagara Health sites that have been designated as ALC. Sample consisted of 16,429 ALC patients who received care in Niagara Health hospitals from September 2014 to September 2019 and were recorded in the WTIS database. ALC designation of 30 or more days was used as the threshold for a long-stay delayed discharge. This study used binary logistic regression modeling to analyze sex, age, admission source, and discharge destination as well needs/barriers requirements to assess the likelihood of a long-stay delayed discharge among acute care (AC) and post-acute care (PAC) patients given the presence of each variable. Sample sizes calculations and receiver operating characteristic curves were used to verify the validity of the regression model. Overall, 10.2% of the sample were considered long-stay ALC patients. Both AC and PAC long-stay ALC patients were more likely to be male [OR = 1.23, (1.06–1.43); OR = 1.28, (1.03–1.60)] and have a discharge destination of a long-term care bed [OR = 28.68, (22.83–36.04); OR = 6.22, (4.75–8.15)]. AC patients had bariatric [OR = 7.16, (3.45–14.83)], behavioral [OR = 1.89, (1.22–2.91)], infection (isolation) [OR = 2.31, (1.63–3.28)], and feeding [OR = 6.38, (1.82–22.30)] barriers hindering discharge. PAC patients had no significant barriers hindering patient discharge. Shifting the focus from ALC patient designation to short- vs long-stay ALC patients allowed this study to focus on the subset of patients that are disproportionately affecting delayed discharges. Understanding the importance of specialized patient requirements in addition to clinical factors can help hospitals become more prepared in preventing delayed discharges. [ABSTRACT FROM AUTHOR]

Introduction: Few studies have examined the effect of clinical teaching on patient satisfaction in rural and community-based settings. We sought to examine whether patient satisfaction differed when patients were seen by a physician alone or by a physician and medical student in these settings. Methods: We conducted a cross-sectional study in rural and community-based settings in southern Ontario (3 obstetrician-gynecologist offices and 4 family medicine clinics). Patients seen by a physician with or without a medical student present completed satisfaction and attitudes questionnaires about their experience. Results: Patient satisfaction was high across both groups and did not differ when segregated by patient age, sex or employment status. Satisfaction scores were similar for patients seen by a physician with or without a student present. Satisfaction scores did not differ based on practice location. Patients' reasons for agreeing to be seen by a medical student included helping to teach students about medical concerns and helping to train future doctors. Conclusion: Patients in rural and community-based outpatient settings were satisfied with their care when a medical student was involved. [ABSTRACT FROM AUTHOR]

Background Accelerated courses continue to be part of the changing landscape in medical education despite limited evidence to support their efficacy in relation to knowledge retention. The purpose of this study was to determine if a difference in knowledge retention exists over time between students enrolled in a traditional versus an accelerated clinical epidemiology course. Methods The current study incorporated an epidemiologic prospective cohort design. The course in clinical epidemiology focused on evidence-based decision making for diagnostic and therapeutic research methods and problem-based learning. Knowledge retention was assessed at four-times points (baseline, three, six and 12 months) for students enrolled in either traditional (13 weeks) or accelerated (1 week) courses. Linear mixed-effect regression modeling was incorporated to examine the change in trajectory of knowledge retention over four points in time between students enrolled in traditional and accelerated teaching formats. Results A significant main effect of traditional versus accelerated course format on retention of knowledge over time was not found (β=-0.341, p = 0.410), suggesting that knowledge retention is not compromised regardless of teaching format. Furthermore, the greatest diminished knowledge retention was observed between baseline and 12 months (β = 10.595, p < 0.0001), followed by three months (β = 3.864, p < 0.0001) and six months (β = 1.180, p < 0.0001). Conclusion This study determined that accelerated course format does not compromise short- and long-term clinical epidemiology knowledge retention in students. Key message University administrators and faculty should not be suspicious of knowledge retention issues in accelerated courses and should endorse accelerated learning opportunities. [ABSTRACT FROM AUTHOR]

A qualitative design was used to explore the nature of caregiver involvement in care transitions of patients being transferred from an acute care hospital to a rehabilitation hospital. Participants included older adults (n=13), informal caregivers (n=9) and health care professionals (n=50) from inpatient orthopedic units in two academic health science centers and one orthopedic inpatient rehabilitation unit. Semistructured interviews were conducted, audiotaped and transcribed. Directed content analysis revealed the following four themes: watching, being an active care provider, advocating and navigating the health care system. Participants described being actively involved in the care of their family member, yet they were not actively engaged by health care professionals to be involved in the care of their family member. There is a need to reconcile the tension between the level of involvement of caregivers in the care of family members who are patients and the level of engagement throughout the care transition. By providing relevant information and authentically engaging caregivers as equal partners in the care transition, they are better able to navigate the health care system post-transfer to the rehabilitation setting and discharge to home. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic continues to demonstrate the risks and profound health impacts that result from infectious disease emergencies. Emergency preparedness has been defined as the knowledge, capacity and organizational systems that governments, response and recovery organizations, communities and individuals develop to anticipate, respond to, or recover from emergencies. This scoping review explored recent literature on priority areas and indicators for public health emergency preparedness (PHEP) with a focus on infectious disease emergencies. Methods: Using scoping review methodology, a comprehensive search was conducted for indexed and grey literature with a focus on records published from 2017 to 2020 onward, respectively. Records were included if they: (a) described PHEP, (b) focused on an infectious emergency, and (c) were published in an Organization for Economic Co-operation and Development country. An evidence-based all-hazards Resilience Framework for PHEP consisting of 11 elements was used as a reference point to identify additional areas of preparedness that have emerged in recent publications. The findings were analyzed deductively and summarized thematically. Results: The included publications largely aligned with the 11 elements of the all-hazards Resilience Framework for PHEP. In particular, the elements related to collaborative networks, community engagement, risk analysis and communication were frequently observed across the publications included in this review. Ten emergent themes were identified that expand on the Resilience Framework for PHEP specific to infectious diseases. Planning to mitigate inequities was a key finding of this review, it was the most frequently identified emergent theme. Additional emergent themes were: research and evidence-informed decision making, building vaccination capacity, building laboratory and diagnostic system capacity, building infection prevention and control capacity, financial investment in infrastructure, health system capacity, climate and environmental health, public health legislation and phases of preparedness. Conclusion: The themes from this review contribute to the evolving understanding of critical public health emergency preparedness actions. The themes expand on the 11 elements outlined in the Resilience Framework for PHEP, specifically relevant to pandemics and infectious disease emergencies. Further research will be important to validate these findings, and expand understanding of how refinements to PHEP frameworks and indicators can support public health practice. [ABSTRACT FROM AUTHOR]

Public health responses to the COVID‐19 pandemic, such as business restrictions, social distancing and lockdowns, had social and economic impacts on individuals and communities. Caremongering Facebook groups spread across Canada to support vulnerable individuals by providing a forum for sharing information and offering assistance. We sought to understand the specific impacts of Caremongering groups on individuals 1 year after the pandemic began. We used a convergent parallel mixed‐methods approach that included semi‐structured interviews with group moderators from 16 Caremongering groups and survey data from 165 group members. We used a constant comparative approach for thematic analysis of interview transcripts and open‐ended text responses to the survey. We used source theme tables as joint displays to integrate interview and survey findings. Our results revealed five major themes: providing food, sharing information, supporting health and wellness, acquiring goods and services (non‐food), and connecting communities. Respondents of our survey tended to be 35–65 years of age range, but reported helping adults of all ages. Our findings illustrate the potential of using a social media platform to connect with others and provide and access support. The Caremongering initiative demonstrates a community‐driven, social media solution to issues such as isolation, loneliness and community health promotion. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic generated a growing interest in and need for evidence-based tools to facilitate the implementation of emergency management strategies within public health practice. Quality improvement (QI) is a key framework and philosophy to guide organizational emergency response efforts; however, the nature and extent to which it has been used in public health settings during the COVID-19 pandemic remains unclear.Methods: We conducted a scoping review of literature published January 2020 - February 2021 and focused on the topic of QI at public health agencies during the COVID-19 pandemic. The search was conducted using four bibliographic databases, in addition to a supplementary grey literature search through custom Google search engines and targeted website search methods. Of the 1,878 peer-reviewed articles assessed, 15 records met the inclusion criteria. An additional 11 relevant records were identified during the grey literature search, for a total of 26 records included in the scoping review.Results: Records were organized into five topics: 1) collaborative problem solving and analysis with stakeholders; 2) supporting learning and capacity building in QI; 3) learning from past emergencies; 4) implementing QI methods during COVID-19; and 5) evaluating performance using frameworks/indicators.Conclusions: The literature indicates that QI-oriented activities are occurring at the organizational and program levels to enhance COVID-19 response. To optimize the benefits that QI approaches and methodologies may offer, it is important for public health agencies to focus on both widespread integration of QI as part of an organization's management philosophy and culture, as well as project level activities at all stages of the emergency management cycle. [ABSTRACT FROM AUTHOR]

Objective The goal was to explore the perspectives of health care professionals on factors that influence change to policies, protocols and practices in the Neonatal Intensive Care Unit (NICU) with regard to nosocomial infection and chronic lung disease. Study design An exploratory descriptive design using semi-structured individual and focus group interviews was used. Individual interviews ( n = 76) and focus group sessions ( n = 14 with a total of 78 participants) were conducted for a total of 154 health professional participants. Methods Mayring’s qualitative content analysis approach was used to analyse the data. All interviews were audio-taped, transcribed and analysed using inductive reasoning. The data were then organized into categories that reflected emerging themes. Results Seven categories that influenced practice change were derived from the data including staffing issues, consistency in practice, the approval process, a multidisciplinary approach to care, frequency and consistency of communication, rationale for change and the feedback process. These categories were further delineated into three emerging themes related to human resources, organizational structure and communications. Pettigrew’s conceptual framework provided a lens to view the results in relation to the process of change. Conclusions This study has helped to further our understanding of individual and organizational factors that facilitate and hinder changes in clinical practice in the NICU. These factors will be used as a starting point for organizational change to enhance infant outcomes in the NICU. [ABSTRACT FROM AUTHOR]