Search

The article discusses the need to stop extractive health research on South Asian diaspora communities in Canada. It highlights the unequal power relations and lack of meaningful involvement of South Asian academics and communities in research processes led by predominantly White academics. The article emphasizes the apprehension and mistrust that many South Asian communities have towards research originating outside their communities. It calls for research institutes, funding programs, and academic journals to prioritize accountability, ownership, and best practices in research involving South Asian participants to reduce health inequities in Canada. The article also emphasizes the importance of representative leadership and inclusion of South Asian researchers in research teams to avoid misguided interpretations, stereotypes, and scientific and structural racism. It concludes by calling for major changes to dismantle harmful research practices and engage South Asian communities and academics in a meaningful health research process. [Extracted from the article]

(New recommendation)Evidence: moderate-qualityCCS/CHRS AF19We recommend that most patients should receive a DOAC (apixaban, dabigatran, edoxaban or rivaroxaban) in preference to warfarin when OAC therapy is indicated for patients with NVAF. An ARB can be used if the patient is intolerant of an ACEi.Recommendation: grade AAntihypertensive therapy is recommended for average SBP measurements of 140 mm Hg or DBP measurements of 90 mm Hg in pregnant patients with chronic hypertension, gestational hypertension or preeclampsia. It is recommended over ASA and dual antiplatelet therapy.ASA: evidence: level A Dual antiplatelet therapy: evidence: level BDementiaScreening and diagnostic strategiesDementia20An objective assessment of the patient's cognitive function could be achieved by using rapid psychometric screening tools such as the memory impairment screen and clock drawing test, the Mini-Cog, the AD8, the 4-item version of the MoCA (clock drawing, tap at letter A, orientation and delayed recall) and the GP Assessment of Cognition. [Extracted from the article]

Background: The Health TAPESTRY (Health Teams Advancing Patient Experience: STRengthening QualitY) intervention was designed to improve primary care teamwork and promote optimal aging. We evaluated the effectiveness of Health TAPESTRY in attaining goals of older adults (e.g., physical activity, productivity, social connection, medical status) and other outcomes.Methods: We conducted a pragmatic randomized controlled trial between January and October 2015 in a primary care practice in Hamilton, Ontario. Older adults were randomized (1:1) to Health TAPESTRY (n = 158) or control (n = 154). Trained community volunteers gathered information on people's goals, needs and risks in their homes, using electronic forms. Interprofessional primary care teams reviewed summaries and addressed issues. Participants reported goal attainment (primary outcome), self-efficacy, quality of life, optimal aging, social support, empowerment, physical activity, falls, and access to and comprehensiveness of the health system. We determined use of health care resources through chart audit.Results: There were no differences between groups in goal attainment or many other patient-reported outcome and experience assessments at 6 months. More primary care visits took place in the intervention versus control group over 6 months (mean ± standard deviation [SD] 4.93 ± 3.86 v. 3.50 ± 3.53; difference of 1.52 [95% confidence interval (CI) 0.84 to 2.19]). The odds of having 1 or more hospital admission were lower for the intervention group (odds ratio [OR] 0.44 [95% CI 0.20 to 0.95]).Interpretation: Health TAPESTRY did not improve the primary outcome of goal attainment but showed signals of shifting care from reactive to active preventive care. Further evaluation will help in understanding effective components, costs and consequences of the intervention. Trial registration: ClinicalTrials.gov, no. NCT02283723. [ABSTRACT FROM AUTHOR]

Background: Low-income older adults who live in subsidized housing have higher mortality and morbidity. We aimed to determine if a community paramedicine program - in which paramedics provide health care services outside of the traditional emergency response - reduced the number of ambulance calls to subsidized housing for older adults.Methods: We conducted an open-label pragmatic cluster-randomized controlled trial (RCT) with parallel intervention and control groups in subsidized apartment buildings for older adults. We selected 6 buildings using predefined criteria, which we then randomly assigned to intervention (Community Paramedicine at Clinic [CP@clinic] for 1 yr) or control (usual health care) using computer-generated paired randomization. CP@clinic is a paramedic-led, community-based health promotion program to prevent diabetes, cardiovascular disease and falls for residents 55 years of age and older. The primary outcome was building-level mean monthly ambulance calls. Secondary outcomes were individual-level changes in blood pressure, health behaviours and risk of diabetes assessed using the Canadian Diabetes Risk Questionnaire. We analyzed the data using generalized estimating equations and hierarchical linear modelling.Results: The 3 intervention and 3 control buildings had 455 and 637 residents, respectively. Mean monthly ambulance calls in the intervention buildings (3.11 [standard deviation (SD) 1.30] calls per 100 units/mo) was significantly lower (-0.88, 95% confidence interval [CI] -0.45 to -1.30) than in control buildings (3.99 [SD 1.17] calls per 100 units/mo), when adjusted for baseline calls and building pairs. Survey participation was 28.4% (n = 129) and 20.3% (n = 129) in the intervention and control buildings, respectively. Residents living in the intervention buildings showed significant improvement compared with those living in control buildings in quality-adjusted life years (QALYs) (mean difference 0.09, 95% CI 0.01 to 0.17) and ability to perform usual activities (odds ratio 2.6, 95% CI 1.2 to 5.8). Those who received the intervention had a significant decrease in systolic (mean change 5.0, 95% CI 1.0 to 9.0) and diastolic (mean change 4.8, 95% CI 1.9 to 7.6) blood pressure.Interpretation: A paramedic-led, community-based health promotion program (CP@clinic) significantly lowered the number of ambulance calls, improved QALYs and ability to perform usual activities, and lowered systolic blood pressure among older adults living in subsidized housing. Trial registration: Clinicaltrials.gov, no. NCT02152891. [ABSTRACT FROM AUTHOR]

Thank you to Dr. Minhas for raising the important topic of "self-whitening", whereby racialized individuals seek to remove evidence of nonwhite attributes, activities or connections in an effort to become more acceptable to employers or colleagues.[1] He suggests that his actions were due to his own internalized racism. It has also involved removing traces of South Asian heritage from my curriculum vitae (CV), known as "resumé-whitening" or "white-washing a CV."[2] I have been advised to remove my ability to speak a South Asian language, extracurricular talents in South Asian music and academic credits gained in religious studies that were non-Eurocentric to render myself more attractive to the academic medical job market. 2020;192:E1169-70. 2 Brait E. "Resume whitening" doubles callbacks for minority job candidates, study finds. [Extracted from the article]

Presents a letter to the editor in response to the article "The Impact of New Guidelines for Glucose Tolerance Testing on Clinical Practice and Laboratory Services," by Andrew W. Lyon et al., which appeared in a 2004 issue of the "Canadian Medical Association Journal."

Presents a humorous month-by-month guide that explains what supervising staff need to know about the first year with new medical residents. Problems and issues outlined for the preceptor in the month-by-month guide including cocky residents, depression, separation anxiety, sleep deprivation.