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Introduction: Patients who stay in the emergency department (ED) for prolonged periods of time require verification of home medications, a process known as medication reconciliation. The complex nature of medication reconciliation can lead to adverse events and staff dissatisfaction. A multidisciplinary team was formed to improve accuracy, timing, and staff satisfaction with the medication reconciliation process.Methods: Between November 2021–January 2022, stakeholders were surveyed to identify gaps in the medication reconciliation process. This project implemented education on role-specific tasks, as well as a “Let’s chat!” huddle, bringing together the entire care team to perform medication reconciliation. We used real-time evaluations by frontline staff to evaluate effectiveness during plan- do-study-act cycles and obtain feedback. Following the implementation period, stakeholders completed the post-intervention survey between June-July 2022, using a 4-point Likert scale (0 = very dissatisfied to 3 = very satisfied). We calculated the change in staff satisfaction from pre-intervention to post-intervention. Differences in proportions and 95% confidence intervals are reported. This study adhered to the Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0) and followed the Lean Six Sigma rapid cycle process improvement (define-measure-analyze-improve-control).Results: A total of 111 front-line ED staff (physicians, nurse practitioners, physician assistants, pharmacists, nurses) completed the pre-intervention survey (of 350 ED staff, corresponding to a 31.7%response rate), and 89 stakeholders completed the post-intervention survey (a 25.4% response rate). Subjective feedback from staff identifying causes of low satisfaction with the initial process included the following: complexity of process; unclear delineation of staff roles; time burden to completion; high patient volume; and lack of standardized communication of task completion. Overall satisfaction improved after the intervention. The greatest improvement was seen in the correct medication (difference 20.7%, confidence interval [CI] 6.3–33.9%, P < 0.01), correct dose (25.6%, CI 11.4–38.6%, P < 0.001) and time last taken (24.5%, CI 11.4–37.0%, P < 0.001).Conclusion: There is a steep learning curve to educate multidisciplinary staff on a new process and implement the associated changes. With goals to impact the safety of our patients and reduce negative outcomes, engagement and awareness of the team involved in the medication reconciliation process is critical to improve staff satisfaction.

The authors argue that attempts to establish more placements to meet the growing demands of undergraduate medical students in North America for international experiences may be outweighing critical reflection on the ethical issues, curricular content, and pedagogical strategies necessary to support equitable engagements with countries of the Global South. On the basis of a critical analysis of literature on international medical electives and experiences (IMEs), the article explores trends in IMEs and exposes several prominent issues, including paradoxes in underlying motivations, missing or ad hoc curricula and pedagogical approaches in IMEs, and ethical challenges that frequently arise. By engaging perspectives from critical educational theory, the authors suggest that IMEs as currently conceived are potentially ripe sites for the reproduction of colonialist ideas of North-South relationships. The authors conclude that IMEs will do little to address historically and politically rooted global health inequities unless critical consciousness is raised through improved global health curricula and appropriate pedagogical strategies. (Contains 4 notes.)

Social transformation models of internationalization suggest the need for radical reform to curricula to foster engaged global citizenship, yet little is written depicting how individual courses and their instructors might support such reform. This article stems from and explores philosophical, pedagogical, institutional, and curricular issues related to that challenge. The article reports on a 6-year outcome evaluation of the impact and transformative potential of two interdisciplinary global health courses taught using transformative pedagogies. Results of the evaluation show promise that this model of internationalized curricula can foster personal transformation and global citizenship while creating bridges of understanding between local and global health issues. The course pedagogy may hold keys to increasing potential for social transformation through the process of internationalizing curriculum. (Contains 2 notes.)

In May 2017, the Saskatchewan Transportation Company (STC), a 70-year-old bus company in Saskatchewan, Canada, was shut down through an austerity budget that saw several cuts. The government justified its decision on budgetary grounds although opponents cited possible negative impacts of the decision. A Foucauldian Discourse Analysis (FDA) was employed to examine discourses used by different actors to explain the closure and the implications of these discourses for health and health equity. Data from 47 days of parliamentary debates, 751 newspaper articles, and 2 focus group discussions were imported into NVivo software for analysis. Discourses and counter-discourses surrounding the closure were explored and interpreted in the broader context of austerity and the politics of health. The evidence suggests that the closure of STC was facilitated by several contextual factors anchored around discourses of economic rationalization, minimization, government discretion, and the representation of the bus as a relic of a socialist past. Opponents of the closure defended the bus on the grounds of its utility and the possibility of marginalization/victimization of former bus users. A democratic and an evidence deficit as well as secondary discourses of human rights and environmental/climate impacts were used to argue against the STC closure. The research reveals the critical role of power in the creation of health inequities through austerity measures, particularly through discourses that negate the existence and associated rights of vulnerable users of public services such as public transportation. [ABSTRACT FROM AUTHOR]

Garnets are present in two horizons of the schist of Stevens Spring from the Basin Creek area of the Grouse Creek Mountains in northwest Utah. The two horizons possess different bulk compositions, which resulted in garnet growth by different reactions along the same pressure-temperature (P-T) path. Garnet in the upper horizon grew from the breakdown of chlorite at upper greenschistfacies conditions and garnet in the lower horizon grew from the breakdown of staurolite at upper amphibolite-facies conditions. From the upper horizon, five garnets from three samples were analyzed. All display growth zoning, ragged morphologies associated with secondary rim consumption, and yield garnet-biotite geothermometry temperatures of ~460-490 [degrees] C. From the lower horizon, one garnet from each of two samples was analyzed. These also display growth zoning, but differ from garnet in the upper horizon in that they are dominantly idioblastic and yield garnet-biotite geothermometry temperatures of ~635 [degrees] C. Garnet-biotite geothermometry calculated for every point along detailed compositional traverses across the garnets revealed localized reequilibration along rims, cracks and inclusions in both generations of garnet. Garnets from the upper horizon display prograde reequilibration and the garnets from the lower horizon display retrograde reequilibration. Numerical simulations of garnet growth using the Gibbs method with Duhem's theorem were carried out to determine P-T paths. The P-T path defined by the modeling of five garnets from the upper horizon is an isothermal pressure increase of ~1.7 kbar. The P-T path defined by the modeling of two garnets from the lower horizon has a steep P-T trajectory (dP/dT = 32 bars/[degrees] C) and a total pressure change of ~0.9 kbar. Both paths are indicative of thrust burial; however, the two paths cannot be reconciled as products of a single thrust episode. These data are interpreted to indicate two different episodes of thrust burial during the Sevier Orogeny, separated by ~150 [degrees] C of heating and partial exhumation.

Background Global obesity estimates show a steadily increasing pattern across socioeconomic and geographical divides, especially among women. Our analysis tracked and described obesity trends across multiple equity dimensions among women of reproductive age (15–49 y) in 11 sub-Saharan African (SSA) countries during 1994–2015. Methods This study consisted of a cross-sectional series analysis using nationally representative demographic and health surveys (DHS) data. The countries included were Cameroon, Comoros, Congo, Cote d'Ivoire, Ghana, Kenya, Lesotho, Nigeria, Senegal, Zambia and Zimbabwe. The data reported are from a reanalysis conducted using the WHO Health Equity Assessment Toolkit that assesses inter- and intra-country health inequalities across socioeconomic and geographical dimensions. We generated equiplots to display intra- and inter-country equity gaps. Results There was an increasing trend in obesity among women of reproductive age across all 11 SSA countries. Obesity increased unequally across wealth categories, place of residence and educational measures of inequality. The wealthiest, most educated and urban dwellers in most countries had a higher prevalence of obesity. However, in Comoros, obesity did not increase consistently with increasing wealth or education compared with other countries. The most educated and wealthiest women in Comoros had lower obesity rates compared with their less wealthy and less well-educated counterparts. Conclusion A window of opportunity is presented to governments to act structurally and at policy level to reduce obesity generally and prevent a greater burden on disadvantaged subpopulation groups in sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

Rationale, aims, and objectives: Waist circumference (WC) and waist‐to‐height ratio (WHtR) are superior surrogate markers of central obesity than body mass index. However, WC is not measured routinely in paediatric clinics. The objective of this study was to implement measurement of WC during routine assessment of children in an ambulatory outpatient clinic setting and subsequent dissemination of cardiometabolic risk counselling in children with central obesity (defined as WHtR ≥0.5). Method: Prospective cohort of patients aged 6 to 20 years. Study period was divided into three phases: baseline (3 months), process improvement (2 months), and implementation (6 months). Define‐Measure‐Analyse‐Improve‐Control (DMAIC) strategy was applied. Measurement of WC was implemented as a component of the physical examination in patients. Outcome measures were (1) improvement in frequency of WC measurement and (2) utilization of WHtR in cardiometabolic risk counselling. Results: Waist circumference was not measured in any patient during baseline phase (n = 551). During process improvement phase, of the total 347 patients, WC was measured in 35% vs target of 30%. In the implementation phase, WC was measured in 37% patients (365 out of 964). Of these 365 patients, 175 (48%) had elevated WHtR, and 73% of them (n = 128) were counselled about their increased cardiometabolic risk. Conclusions: Application of an evidence‐based DMAIC protocol led to significant improvement in assessment for central obesity in an ambulatory clinic practice and appropriate counselling regarding cardiometabolic risk reduction in children and adolescents with central obesity over an 8‐month period. Meticulous planning and execution, frequent reinforcement, and integrating feedback from the involved multi‐disciplinary team were important factors in successful implementation of this quality improvement project. [ABSTRACT FROM AUTHOR]