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Background: Research has shown that by peri-adolescence (~8 to 14 years), participation in physical activity (PA) declines drastically in girls and this decline is largely maintained throughout adulthood. One of the core domains of physical literacy (PL) -- fundamental movement skills - has been shown to be associated with PA in childhood through to early adulthood: children with proficient movement skills are more likely to participate in PA than are those with poor movement skills. Recent work has demonstrated that there is also a gender gap in PL during the periadolescent/ adolescent period. Methods: A 3-phase, sequential, explanatory mixed-design study to examine (1) the association between PL and PA; (2) why girls have lower PL than boys during the peri-adolescent period; and (3) if we can effect positive change in PL in girls using a gender-enhanced program. Phase 1: PL will be assessed in children aged 8-14 years attending a stratified, random sample of Ontario afterschool programs using the Physical Literacy Assessment for Youth (PLAY) Fun tool developed for children and youth. Phase 2: children will be divided into tertiles based on their PL scores. A random subsample of children stratified by gender and PL score will be selected to participate in a semi-structured interview to understand the contextual factors related to the gender gap in PL and to wear a pedometer to assess their level of PA. Phase 3: Information from the interviews will be used to modify the afterschool programs in order to target the positive development of PL in girls. The 12-week modified program will be tested using a randomized, pre-post test control design of 10 randomly selected afterschool programs. PL and PA will be assessed using PLAYFun and pedometers, respectively. Results: Data collection for Phase 1 is currently underway: testing at 9 of 15 sites has been completed; all site visits are scheduled to be completed by April 2016. Phase 2 interviews and pedometer wear will occur in May-June 2016. Discussion: This study will be among the first to examine potential gender differences in physical literacy from the perspective of child and youth themselves. [ABSTRACT FROM AUTHOR]

Objectives: Community Paramedicine (CP) is increasingly being used to provide chronic disease management for vulnerable populations in the community. CP@clinic took place in social housing buildings to support cardiovascular health and diabetes management for older adults. The purpose of this study was to examine participant perceptions of their experience with CP@clinic as well as potential ongoing programme benefits., Design: This descriptive qualitative study used focus groups to understand resident experiences of the CP@clinic programme. Groups were facilitated by experienced moderators using a semistructured guide. An inductive coding approach was used with at least two researchers taking part in each step of the analysis process., Setting: Community-based social housing buildings in Ontario, Canada., Participants: Forty-one participants from four CP@clinic sites took part in a focus group. Convenience sampling was used with anyone having taken part in a CP@clinic session being eligible to attend the focus group., Results: Analysis yielded six themes across two broad areas: timely access to health information and services, support to achieve personal health goals, better understanding of healthcare system (Personal Benefits); and sense of community, comfortable and familiar place to talk about health, facilitated communication between healthcare professionals (Programme Structure). Participants experienced discernible health changes that motivated their participation. CP@clinic was viewed as a programme that created connections within the building and outside of it. Participants were enthusiastic for the continuation of the programme and appreciated the consistent support to meet their health goals., Conclusions: CP@clinic was successful in creating a supportive and friendly environment to facilitate health behavioural changes. Ongoing implementation of CP@clinic would allow residents to continue to build their chronic disease management knowledge and skills., Trial Registration Number: Trial registration number: NCT02152891, Clinicaltrials.gov., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: the Confusion Assessment Method (CAM) is commonly used to detect delirium. Although accurate when administered by trained researchers, its sensitivity is low when performed by nurses in clinical practice. We aimed to understand the perspectives of nurses who used the CAM on orthopaedic wards., Design: qualitative focus group study., Setting: two academic hospitals in Hamilton, Ontario, Canada., Participants: forty-three nurses who worked on orthopaedic inpatient units and used the CAM daily participated in one of eight focus group sessions., Measurements: structured focus groups explored nurses' perception of delirium and the use of the CAM. Each transcript was coded and sampling continued until theme saturation., Results: the participants (84% female, mean age 40 years, mean years in practice 12.8) had mixed feelings about the CAM. Some nurses praised its simplicity, while others preferred a narrative description of the delirium episode. Only 35% recalled receiving training to administer the CAM. Across the groups, disorientation was inappropriately used to evaluate level of consciousness and inattention. Objective testing was reportedly rarely used for assessing inattention. Most nurses retrospectively completed the CAM at the end of their shift by extrapolating from earlier observations rather than formally administering the tool. Reported challenges included differentiating delirium from dementia, assessing non-verbal patients and those with language barriers, time constraints, discrepancy with physicians' assessments and pressure to diagnose delirium., Conclusion: despite its widespread use, the CAM was poorly understood by orthopaedic nurses at two academic institutions. The CAM may be difficult to implement in practice.

Purpose: Primary care is the cornerstone of the health care system and increasingly countries are developing indicators for assessing quality in primary care practices. The 'Quality Tool', developed in Ontario, Canada, provides a framework for assessing practices and consists of indicators and criteria. The purpose of this study was to validate the indicators and simplify the Quality Tool., Methods: This study involved a systematic comparison of indicators in the Quality Tool with those in other local and international tools to determine common indicators to include as valid in the Quality Tool. A Delphi process was used to help reach consensus for inclusion of any indicators that were not included in the comparison exercise., Setting: Primary care in Ontario, Canada., Subjects: Key informants were those with known expertise and experience in quality assessment in primary care., Main Outcome: Validated set of indicators for inclusion in an updated Quality Tool., Results: Twenty-three stakeholders participated in the Delphi panel. Forty-four indicators were included as valid after the systematic comparison of similar indicators in other assessment tools. Of the 63 indicators brought to the Delphi panel, 37 were included as valid, 15 were excluded and 11 became criteria for other included indicators., Conclusions: The study resulted in a set of 81 validated primary care indicators. The validation of the indicators provided a strong foundation for the next version of the Quality Tool and may be used for quality assessment in primary care., (© The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

The Institute of Medicine (IOM) framework has been used frequently to assess and monitor quality in secondary and tertiary care, but not in primary care. This article describes and proposes a conceptual framework for categorizing primary care indicators that align with the IOM's six aims for quality in healthcare performance (Safe, Effective, Patient-Centred, Timely, Efficient and Equitable.) Using an iterative process, the authors developed and compared a primary care framework for categorizing indicators in the Quality in Family Practice Book of Tools (QBT) with the IOM aims and other local healthcare systems frameworks (Integrated and Continuous, Appropriate Practice Resources). They also compared, cross-matched and analyzed their QBT categories and indicators with other international primary care assessment tools. And they compared the QBT titles and descriptions of groups of indicators with those published in the international tools.

Problem Addressed: Family physicians provide most of the care for the frail elderly population, but many challenges and barriers can lead to difficulties with fragmented, ineffective, and inefficient services., Objective of Program: To improve the quality, efficiency, and coordination of care for the frail elderly living in the community and to enhance geriatric and interprofessional skills for providers and learners., Program Description: The Seniors Collaborative Care Program used an interprofessional, shared-care, geriatric model. The feasibility of the program was evaluated through a pilot study conducted between November 2008 and June 2009 at Stonechurch Family Health Centre, part of the McMaster Family Health Team. The core team comprised a nurse practitioner, an FP, and a registered practical nurse. Additional team members included a pharmacist, a dietitian, a social worker, and a visiting geriatrician. Twenty-five seniors were evaluated through the pilot program. Patients were assessed within 5 weeks of initial contact. Patients and practitioners valued timely, accessible, preventive, and multidisciplinary aspects of care. The nurse practitioner's role was prominent in the program, while the geriatrician's clinical role was focused efficiently., Conclusion: The family health team is ideally positioned to deliver shared care for the frail elderly. Our model allowed for a short referral time and easy access, which might allow seniors to remain in their environment of choice.

Background: A common and often integral method of delivering patient information is the use of patient guides. However, the acceptability, utility and impact of evidence-based therapeutic guides on physicians, pharmacists and patients have not been well evaluated., Methods: This study was a prospective evaluation of 53 general practitioners' offices and 30 community pharmacies from three locations in Canada. Evidence-based guides were provided to 1176 patients who presented to either a general practitioner or a community pharmacist and were interested in receiving information about sore throat, heartburn, or osteoporosis (http://www.ti.ubc.ca/canadadrugguide). The acceptability, utility and impact of the guides were assessed via structured patient telephone interviews, structured health professional interviews, and patient chart audits., Results: Eighty to 90% of patients reported that the guides were 'very easy' to understand. Fifty six per cent/47%/38% (sore throat/heartburn/osteoporosis) of patients rated the guides as 'very' or 'extremely' useful. Seventy-two per cent/67%/58% of respondents reported that the information helped them make decisions about their treatment. Ninety eight per cent of physicians and 92% of pharmacists reported that the guides helped their patients understand the issues involved in their treatment. None of the analyses showed any significant differences in prescribing of medications between the intervention and control groups., Interpretations: Patients found these evidence-based guides to be useful, easy to understand, and that they helped them in their understanding of treatment options and the decision-making process. Physicians and pharmacists reported that the guides helped their patients understand the issues involved in their treatment. Further research is required to determine the degree to which providing evidence-based guides to patients can impact on prescribing and patient outcomes.

Objectives: To assess patients' preferred method of consent for the use of information from electronic medical records for research., Design: Interviews and a structured survey of patients in practices with electronic medical records., Setting: Family practices in southern Ontario, Canada., Participants: 123 patients: 17 were interviewed and 106 completed a survey., Main Outcome Measures: Patients' opinions and concerns on use of information from their medical records for research and their preferences for method of consent., Results: Most interviewees were willing to allow the use of their information for research purposes, although the majority preferred that consent was sought first. The seeking of consent was considered an important element of respect for the individual. Most interviewees made little distinction between identifiable and anonymised data. Research sponsored by private insurance firms generated the greatest concern, and research sponsored by foundation the least. Sponsorship by drug companies evoked negative responses during interview and positive responses in the survey., Conclusions: Patients are willing to allow information from their medical records to be used for research, but most prefer to be asked for consent either verbally or in writing.