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BackgroundElderly patients discharged from hospital experience fragmented care, repeated and lengthy emergency department (ED) visits, relapse into their earlier condition, and rapid cognitive and functional decline. The Acute Care for Elders (ACE) program at Mount Sinai Hospital in Toronto, Canada uses innovative strategies, such as transition coaches, to improve the care transition experiences of frail elderly patients. The ACE program reduced the lengths of hospital stay and readmission for elderly patients, increased patient satisfaction, and saved the health care system over Can $4.2 million (US $2.6 million) in 2014. In 2016, a context-adapted ACE program was implemented at one hospital in the Centre intégré de santé et de services sociaux de Chaudière-Appalaches (CISSS-CA) with a focus on improving transitions between hospitals and the community. The quality improvement project used an intervention strategy based on iterative user-centered design prototyping and a “Wiki-suite” (free web-based database containing evidence-based knowledge tools) to engage multiple stakeholders. ObjectiveThe objectives of this study are to (1) implement a context-adapted CISSS-CA ACE program in four hospitals in the CISSS-CA and measure its impact on patient-, caregiver-, clinical-, and hospital-level outcomes; (2) identify underlying mechanisms by which our context-adapted CISSS-CA ACE program improves care transitions for the elderly; and (3) identify underlying mechanisms by which the Wiki-suite contributes to context-adaptation and local uptake of knowledge tools. MethodsObjective 1 will involve staggered implementation of the context-adapted CISSS-CA ACE program across the four CISSS-CA sites and interrupted time series to measure the impact on hospital-, patient-, and caregiver-level outcomes. Objectives 2 and 3 will involve a parallel mixed-methods process evaluation study to understand the mechanisms by which our context-adapted CISSS-CA ACE program improves care transitions for the elderly and by which our Wiki-suite contributes to adaptation, implementation, and scaling up of geriatric knowledge tools. ResultsData collection started in January 2019. As of January 2020, we enrolled 1635 patients and 529 caregivers from the four participating hospitals. Data collection is projected to be completed in January 2022. Data analysis has not yet begun. Results are expected to be published in 2022. Expected results will be presented to different key internal stakeholders to better support the effort and resources deployed in the transition of seniors. Through key interventions focused on seniors, we are expecting to increase patient satisfaction and quality of care and reduce readmission and ED revisit. ConclusionsThis study will provide evidence on effective knowledge translation strategies to adapt best practices to the local context in the transition of care for elderly people. The knowledge generated through this project will support future scale-up of the ACE program and our wiki methodology in other settings in Canada. Trial RegistrationClinicalTrials.gov NCT04093245; https://clinicaltrials.gov/ct2/show/NCT04093245. International Registered Report Identifier (IRRID)DERR1-10.2196/17363

Artificial intelligence (AI) is seen as a strategic lever to improve access, quality, and efficiency of care and services and to build learning and value-based health systems. Many studies have examined the technical performance of AI within an experimental context. These studies provide limited insights into the issues that its use in a real-world context of care and services raises. To help decision makers address these issues in a systemic and holistic manner, this viewpoint paper relies on the health technology assessment core model to contrast the expectations of the health sector toward the use of AI with the risks that should be mitigated for its responsible deployment. The analysis adopts the perspective of payers (ie, health system organizations and agencies) because of their central role in regulating, financing, and reimbursing novel technologies. This paper suggests that AI-based systems should be seen as a health system transformation lever, rather than a discrete set of technological devices. Their use could bring significant changes and impacts at several levels: technological, clinical, human and cognitive (patient and clinician), professional and organizational, economic, legal, and ethical. The assessment of AI’s value proposition should thus go beyond technical performance and cost logic by performing a holistic analysis of its value in a real-world context of care and services. To guide AI development, generate knowledge, and draw lessons that can be translated into action, the right political, regulatory, organizational, clinical, and technological conditions for innovation should be created as a first step.

BackgroundLittle is known about factors influencing professionals’ use of wikis. ObjectiveWe developed and validated two questionnaires to assess health care professionals’ intention to use wiki-based reminders for the management of trauma patients. MethodsWe developed questionnaires for emergency physicians (EPs) and allied health professions (AHPs) based on the Theory of Planned Behavior and adapted them to the salient beliefs of each, identified in an earlier study. Items measured demographics and direct and indirect theoretical constructs. We piloted the questionnaires with 2 focus groups (5 EPs and 5 AHPs) to identify problems of wording and length. Based on feedback, we adjusted the wording and combined certain items. A new convenience sample of 25 EPs and 26 AHPs then performed a test-retest of the questionnaires at a 2-week interval. We assessed internal consistency using Cronbach alpha coefficients and temporal stability of items with an agreement intraclass correlation coefficient (ICC). ResultsFive EPs and 5 AHPs (3 nurses, 1 respiratory therapist, and 1 pharmacist) formed 2 focus groups; 25 EPs and 26 AHPs (12 nurses, 7 respiratory therapists, and 7 pharmacists) completed the test and retest. The EP questionnaire test-retest scores for consistency (Cronbach alpha) and stability (ICC) were intention (test: Cronbach alpha=.94; retest: Cronbach alpha=.98; ICC=.89), attitude (.74, .72, .70), subjective norm (.79, .78, .75), perceived behavioral control (.67, .65, .66), attitudinal beliefs (.94, .86, .60), normative beliefs (.83, .87, .79), and control beliefs barriers (.58, .67, .78) and facilitators (.97, .85, .30). The AHP questionnaire scores for consistency and stability were: intention (test Cronbach alpha=.69, retest Cronbach alpha=.81, ICC=.48), attitude (.85, .87, .83), subjective norm (.47, .82, .62), perceived behavioral control (.55, .62, .60), attitudinal beliefs (.92, .91, .82), normative beliefs (.85, .90, .74), and control beliefs barriers (.58, .55, .66) and facilitators (.72, .94, –.05). To improve the psychometric properties of both questionnaires, we reformulated poorly consistent or unstable items. ConclusionsOur new theory-based questionnaires to measure health care professionals’ intention to use wiki-based reminders have adequate validity and reliability for use in large surveys. In the long run, they can be used to develop a theory-based implementation intervention for a wiki promoting best practices in trauma care.

Background: Injury severity scales have traditionally been used to assess the perform ance of prehospital trauma triage protocols, but they correlate weakly with the urgent needs of specialized trauma care interventions. This study aimed to develop a list of in-hospital urgent and specialized trauma care interventions that require direct transport to the highest-level trauma centre within the catchment area. Methods: Based on a list of potential participants we obtained using data on training, experience, geographic location, affliations and role within key trauma organizations, we recruited multidisciplinary trauma experts (including prehospital, emergency, surgery and intensive care clinicians, epidemiologists and clinician/decision-makers) from across Canada to complete a 3-round modified Delphi survey. We conducted a literature review of the criteria used to define urgent and specialized trauma care, and included all diagnostic and therapeutic interventions presented in previously published studies in the list of interventions to present to the panellists. The final list was determined by our advisory committee, 5 clinicians with experience in trauma care. Participants were asked to rate their level of agreement for potentially including the 38 items as urgent and specialized trauma care interventions on a 9-point Likert scale. Interventions were retained if more than 67% of participants moderately or strongly agreed (7-9 on the Likert scale). Interventions that did not reach consensus were presented again in the subsequent round. Results: Twenty-three panellists were recruited. The response rate was 91%, 96% and 83% for the 3 rounds. After the Delphi process, 30 of the 38 interventions, including endotracheal intubation, blood product administration and angioembolization, and abdominal, thoracic, neurosurgical, spinal and/or orthopedic operations (excluding hip or limb surgery, and toe or finger amputation), were selected. Hospital admission to the intensive care unit and/or for observation of brain, spinal, thoracic or abdominal injuries were also retained. Conclusion: We developed a Canadian consensus-based list of urgent and specialized in-hospital trauma care interventions requiring direct transportation to a major trauma centre. This list should help standardize assessments of current protocols and derive new triage tools. Contexte : Les echelles de gravite des blessures sont habituellement utilisees pour evaluer les performances des protocoles de triage prehospitalier des traumatismes, mais elles sont inadaptees aux besoins urgents des interventions specialisees en traumatologie. La presente etude visait a concevoir une liste des interventions hospitalieres urgentes et specialisees en traumatologie necessitant un transport direct vers le centre de traumatologie du niveau le plus eleve de la circonscription hospitaliere. Methodes : Nous avons constitue une liste de participants potentiels d'apres des donnees sur la formation, l'experience, l'emplacement geographique, les affliations et le poste au sein d'etablissements majeurs en traumatologie pour recruter differents experts en traumatologie (dont des professionnels des soins prehospitaliers, des soins d'urgence, des soins intensifs et de la chirurgie, des epidemiologistes ainsi que des cliniciens decideurs) de tout le Canada a qui nous avons demande de remplir un questionnaire Delphi modife en 3 etapes. Nous avons effectue une revue de la litterature des criteres utilises pour definir les soins urgents et specialises en traumatologie et avons inclus l'ensemble des interventions diagnostiques et therapeutiques decrites dans les etudes precedentes a la liste des interventions presentees aux panelistes. Notre comite consultatif, 5 professionnels de la sante connaissant bien la traumatologie, s'est entendu sur la liste definitive. Les participants ont note la classification potentielle de 38 elements comme des interventions urgentes et specialisees en traumatologie sur une echelle de Likert en 9 points. Les interventions moderement ou fortement approuvees par plus de 67 % des participants (7-9 sur l'echelle de Likert) ont ete retenues, tandis que celles qui n'ont pas abouti a un consensus ont ete presentees a nouveau a l'etape suivante. Resultats : Vingt-trois panelistes ont ete recrutes et ont ete 91 %, 96 % et 83 % a repondre a chaque etape du sondage. A l'issue du processus Delphi, 30 des 38 interventions, dont l'intubation tracheale, l'administration de produits sanguins et l'angioembolisation, ainsi que les chirurgies abdominales, thoraciques, neurochirurgicales, orthopediques et du rachis (a l'exclusion de la chirurgie de la hanche ou des membres et l'amputation des orteils ou des doigts) ont ete selectionnees. L'hospitali sa tion en soins intensifs ou pour observation d'un traumatisme cranien, medullaire, tho ra cique ou abdominal a aussi ete retenue. Conclusion : Nous avons elabore une liste canadienne par consensus des interventions hospitalieres urgentes et specialisees en traumatologie necessitant un transport direct vers un grand centre de traumatologie afin de normaliser les evaluations des protocoles actuels pour en tirer de nouveaux outils de triage., Trauma is the leading cause of mortality, morbidity and health-related productivity loss among young adults and carries an estimated annual cost of $27 billion in Canada. (1) For critically injured [...]

Background: The conventional methods and strategies used for knowledge translation (KT) in academic research often fall short in effectively reaching stakeholders, such as citizens, practitioners, and decision makers, especially concerning complex healthcare issues. In response, a growing number of scholars have been embracing arts-based knowledge translation (ABKT) to target a more diverse audience with varying backgrounds and expectations. Despite the increased interest, utilization, and literature on arts-based knowledge translation over the past three decades, no studies have directly compared traditional knowledge translation with arts-based knowledge translation methods. Thus, our study aimed to evaluate and compare the impact of an arts-based knowledge translation intervention–a circus show–with two traditional knowledge translation interventions (webinar and research report) in terms of awareness, accessibility, engagement, advocacy/policy influence, and enjoyment. Methods: To conduct this exploratory convergent mixed method study, we randomly assigned 162 participants to one of the three interventions. All three knowledge translation methods were used to translate the same research project: "Rural Emergency 360: Mobilization of decision-makers, healthcare professionals, patients, and citizens to improve healthcare and services in Quebec's rural emergency departments (UR360)." Results: The findings revealed that the circus show outperformed the webinar and research report in terms of accessibility and enjoyment, while being equally effective in raising awareness, increasing engagement, and influencing advocacy/policy. Each intervention strategy demonstrates its unique array of strengths and weaknesses, with the circus show catering to a diverse audience, while the webinar and research report target more informed participants. These outcomes underscore the innovative and inclusive attributes of Arts-Based Knowledge translation, showcasing its capacity to facilitate researchers' engagement with a wider array of stakeholders across diverse contexts. Conclusion: As a relevant first step and a complementary asset, arts-based knowledge translation holds immense potential in increasing awareness and mobilization around crucial health issues. [ABSTRACT FROM AUTHOR]

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Introduction: The goal of this study was to meet a small, remote emergency department's need to reflect on the minimum threshold of services to offer. The study's main objectives were to I 1) provide a statistical profile of the emergency services in Fermont, Quebec, 2) assess the staff's and users' perception of the threshold of services offered and 3) propose solutions for improving care and services. Methods: This case study was conducted with a participatory approach and a mixed methodology. I We compared the results from a questionnaire on the emergency services that was validated during a previous study with the results concerning the other rural emergency services in Quebec as well as with national and provincial recommendations. The questionnaire concerned users' sociodemographic characteristics, the hospital's and the emergency services' descriptors, the services available locally, and the physician and nurse staff. Interviews were also carried out with 33 people (health care professionals, policy-makers and citizens). Results: Fermont's emergency department is smaller than the average rural emergency department in Quebec. They have resources that are in some respects comparable to those of other emergency departments and in line with the recommendations; in other respects, their resources are rather limited. Respondents emphasized how important it is to take into account the environment's specific features when establishing the minimum threshold of services. The proposed solutions would promote collaboration, break down silos within professional practice and focus on training. Conclusion: Fermont's case aside, this exploratory case study highlights how important it is to adopt a pluralistic, participatory and local approach in order to support reflection on the threshold of services in remote emergency departments and to improve their overall performance. Introduction : Cette etude visait a repondre au besoin d'une petite urgence eloignee d'assoir sa reflexion autour d'un seuil minimum de services a offrir. Les principaux objectifs de l'etude I etaient de : 1) dresser le portrait statistique de l'urgence de Fermont, Quebec, 2) evaluer la perception du personnel et des usagers en lien avec le seuil de services offert et 3) enoncer des solutions permettant d'ameliorer les soins et les services. Methodes : Cette etude de cas a ete realisee avec une approche participative et une methodologie mixte. Nous avons comparee les donnees d'un questionnaire sur l'urgence qui a ete valide lors d'une etude precedente aux donnees des autres urgences rurales quebecoises et a des recommandations nationales et provinciales. Le questionnaire portait sur les caracteristiques sociodemographiques des usagers, les descripteurs du centre hospitalier et de l'urgence, les services disponibles localement et les effectifs medicaux et infirmiers. Des entrevues ont aussi ete realisees aupres de 33 personnes (professionnels de la sante, decideurs et citoyens). Resultats : L'urgence de Fermont est plus petite que la moyenne des urgences rurales quebecoises et dotee de ressources a certains egards comparables aux autres urgences et aux recommandations et a d'autres egards limites. Les repondants ont souligne l'importance de tenir compte des particularites du milieu dans l'etablissement d'un seuil minimum de services. Les solutions proposees concernent l'importance de favoriser la collaboration, de decloisonner la pratique professionnelle et de miser sur la formation. Conclusion : Au-dela du cas de Fermont, cette etude de cas exploratoire a permis de souligner l'importance d'adopter une approche pluraliste, participative et locale pour soutenir la reflexion autour du seuil minimum de services a offrir dans les urgences eloignees et pour ameliorer la performance generale des urgences rurales., INTRODUCTION La medecine d'urgence en milieu rural et eloigne est assuree majoritairement par des medecins de famille, qui sont confrontes a plusieurs defis particuliers (1). Ils doivent notamment composer avec [...]

Efforts at cost containment through regionalization have led to reduced services in several rural emergency departments (EDs) in Canada. As a result, questions have been raised about patient safety and equitable access to care, compelling physicians to advocate for their patients. Few published reports on physicians' advocacy experiences pertaining to rural EDs exist. We describe our experience of patient advocacy after major service cuts at Kootenay Lake Hospital in Nelson, BC. Despite mixed results, we suggest increased physician involvement in patient advocacy. Les efforts de compression des couts par la regionalisation ont abouti a une reduction des services dans plusieurs services d'urgence en milieu rural au Canada. En resultat, on s'est interroge sur la securite des patients et sur l'acces equitable aux soins, ce qui a pousse les medecins a se porter a la defense de leurs patients. Il existe peu de rapports publies sur les experiences des medecins en representation des patients dans le contexte des services d'urgence ruraux. Nous decrivons notre experience en representation des patients apres d'importantes reductions de services a l'Hopital Kootenay Lake de Nelson (C.-B.). En depit de resultats mitiges, nous suggerons que les medecins interviennent davantage en representation des patients., At 4 am, an elderly patient presented with abdominal pain. I (R.F.) performed bedside ultrasonography in search of an explanation for her pain. She had a large (6. 5 cm) [...]

We consider external reflection rainbow caustics due to the reflection of light from a pendant droplet where the light rays are at an arbitrary angle with respect to the horizontal. We compare this theory to observation of glare spots from pendant drops on grass; we also consider the potential application of this theory to the determination of liquid surface tension. OCIS codes: 010.7340, 290.0290.

In the mid-morning on a sunny day one can sometimes see glare spots associated with uncolored 'rainbow' (i.e., fold) caustics due to the sunlight reflected from the surface of dew or guttation drops. We show that these dewdrop reflection rainbows are due to places on the droplet (i.e., from an 'inflection circle') where its Gaussian curvature becomes zero. We work out the theory of such caustics with horizontally incident light and present a comparison of the theory to measurements made in the laboratory. OCIS codes: 010.7340, 290.0290.