This document summarizes six research studies that will impact family medicine practice. The studies include: 1) decreased STI screening rates in young women after changes to cervical cancer guidelines, 2) reduced cervical dysplasia in adolescent girls receiving the HPV vaccine, 3) potential cost savings of a universal public drug plan in Canada, 4) using an online smoking cessation program to increase medication use, 5) unintended effects of wait time policies on medical education, and 6) increasing potentially inappropriate bupropion prescriptions suggesting misuse. The document provides an overview of each study's question, methods, findings, and implications for academic and clinical practice.
New York State Drug Court Program: The
participant will be able to: Demonstrate the efficacy of
patient navigation in order to improve maternal/child
health outcomes and parenting skills for the court
involved population.
Slide Presentation from the July 9, 2013 webinar to present results of a survey of patients and clinicians assessing views on comparative effective research (CER) and engagement in research.
New York State Drug Court Program: The
participant will be able to: Demonstrate the efficacy of
patient navigation in order to improve maternal/child
health outcomes and parenting skills for the court
involved population.
Slide Presentation from the July 9, 2013 webinar to present results of a survey of patients and clinicians assessing views on comparative effective research (CER) and engagement in research.
Evaluation of the TB-HIV Integration Strategy on Treatment OutcomesMEASURE Evaluation
Shared at a data dissemination and data use workshop on the results of the impact evaluation of the Strengthening Tuberculosis Control in Ukraine project. Access another presentation at https://www.slideshare.net/measureevaluation/evaluation-of-the-impact-of-a-social-support-strategy-on-treatment-outcomes/.
In first of two-part series, Pamela Greenhouse explores the differences and similarities of the Patient and Family Centered Care Methodology and Practice (PFCC M/P) and leean process improvement approachs, such as Lean, Six Sigma and Toyota. She believes that the PFCC M/P can be the unifying theme for health care, incorporating both process improvement and performance improvement.
Clinical practice guidelines and quality metrics often emphasize effectiveness over patient-centered care. In this article, the authors offer three approaches to personalizing quality measurement to ensure patient preferences and values guide all clinical decisions.
Sally Redman | Early findings from SPIRITSax Institute
Professor Sally Redman AM, CEO of the Sax Institute, recently addressed a CIPHER forum to share how the SPIRIT trial is testing a program designed to increase the use of research in policy and programs.
CIPHER, the Centre for Informing Policy in Health with Evidence from Research, is an Australian collaborative research centre managed by the Sax Institute, that is investigating the tools, skills and systems that might contribute to an increased use of research evidence in policy.
For more information visit www.saxinstitute.org.au.
Learn about the new MedRec rebranding strategy and what it means for patients/consumers, and healthcare professionals
2.What’s new with ‘5 Questions to Ask About Your Medications’
3.Hear how organizations are using ‘5 Questions to Ask About Your Medications’ to engage patients and consumers
Evaluation of the Impact of a Social Support Strategy on Treatment OutcomesMEASURE Evaluation
Shared at a data dissemination and data use workshop on the results of the impact evaluation of the Strengthening Tuberculosis Control in Ukraine project. Access another presentation at https://www.slideshare.net/measureevaluation/evaluation-of-the-tbhiv-integration-strategy-on-treatment-outcomes.
This webinar will shift the focus from WHAT you are doing with your improvement efforts, instead shedding light on the importance of HOW you are doing it!
Paul Bristow, BKPA, and Karen Thomas, UKRR gave a presentation at BRS2017: Embedding patient reported experience into future QI - 1st National PREM Pilot Survey 2016
Family experiences with pediatric rare disease care: findings from the Canadian Inherited Metabolic Diseases Research Network Beth Potter, University of Ottawa
Rare Disease Day Conference 2020 March 9-10
Electronic cigarettes for smoking cessation: What's the evidence?Health Evidence™
Health Evidence hosted a 90 minute webinar examining the effectiveness of electronic cigarettes for smoking cessation.
Muhannad Malas and Robert Schwartz led the session and presented findings from their recent review:
Malas M, van der Tempel J, Schwartz R, Minichiello A, Lightfoot C, Noormohamed A, et al. (2016). Electronic cigarettes for smoking cessation: A systematic review. Nicotine & Tobacco Research, 18(10), 1926-1936.
http://healthevidence.org/view-article.aspx?a=electronic-cigarettes-smoking-cessation-systematic-review-29830
Cigarette smoking is among the top causes of preventable death and disease. Electronic cigarettes have been increasing in popularity among smokers who report using them for quitting or reducing smoking. This review examines the effectiveness of electronic cigarettes as cessation aids. Sixty two articles, including RCTs, experimental, longitudinal and cross sectional studies are included in this review. Findings suggest there is inconclusive evidence due to low quality of research. This webinar provides a comprehensive overview of current literature examining the effectiveness of electronic cigarettes for smoking cessation.
Evaluation of the TB-HIV Integration Strategy on Treatment OutcomesMEASURE Evaluation
Shared at a data dissemination and data use workshop on the results of the impact evaluation of the Strengthening Tuberculosis Control in Ukraine project. Access another presentation at https://www.slideshare.net/measureevaluation/evaluation-of-the-impact-of-a-social-support-strategy-on-treatment-outcomes/.
In first of two-part series, Pamela Greenhouse explores the differences and similarities of the Patient and Family Centered Care Methodology and Practice (PFCC M/P) and leean process improvement approachs, such as Lean, Six Sigma and Toyota. She believes that the PFCC M/P can be the unifying theme for health care, incorporating both process improvement and performance improvement.
Clinical practice guidelines and quality metrics often emphasize effectiveness over patient-centered care. In this article, the authors offer three approaches to personalizing quality measurement to ensure patient preferences and values guide all clinical decisions.
Sally Redman | Early findings from SPIRITSax Institute
Professor Sally Redman AM, CEO of the Sax Institute, recently addressed a CIPHER forum to share how the SPIRIT trial is testing a program designed to increase the use of research in policy and programs.
CIPHER, the Centre for Informing Policy in Health with Evidence from Research, is an Australian collaborative research centre managed by the Sax Institute, that is investigating the tools, skills and systems that might contribute to an increased use of research evidence in policy.
For more information visit www.saxinstitute.org.au.
Learn about the new MedRec rebranding strategy and what it means for patients/consumers, and healthcare professionals
2.What’s new with ‘5 Questions to Ask About Your Medications’
3.Hear how organizations are using ‘5 Questions to Ask About Your Medications’ to engage patients and consumers
Evaluation of the Impact of a Social Support Strategy on Treatment OutcomesMEASURE Evaluation
Shared at a data dissemination and data use workshop on the results of the impact evaluation of the Strengthening Tuberculosis Control in Ukraine project. Access another presentation at https://www.slideshare.net/measureevaluation/evaluation-of-the-tbhiv-integration-strategy-on-treatment-outcomes.
This webinar will shift the focus from WHAT you are doing with your improvement efforts, instead shedding light on the importance of HOW you are doing it!
Paul Bristow, BKPA, and Karen Thomas, UKRR gave a presentation at BRS2017: Embedding patient reported experience into future QI - 1st National PREM Pilot Survey 2016
Family experiences with pediatric rare disease care: findings from the Canadian Inherited Metabolic Diseases Research Network Beth Potter, University of Ottawa
Rare Disease Day Conference 2020 March 9-10
Electronic cigarettes for smoking cessation: What's the evidence?Health Evidence™
Health Evidence hosted a 90 minute webinar examining the effectiveness of electronic cigarettes for smoking cessation.
Muhannad Malas and Robert Schwartz led the session and presented findings from their recent review:
Malas M, van der Tempel J, Schwartz R, Minichiello A, Lightfoot C, Noormohamed A, et al. (2016). Electronic cigarettes for smoking cessation: A systematic review. Nicotine & Tobacco Research, 18(10), 1926-1936.
http://healthevidence.org/view-article.aspx?a=electronic-cigarettes-smoking-cessation-systematic-review-29830
Cigarette smoking is among the top causes of preventable death and disease. Electronic cigarettes have been increasing in popularity among smokers who report using them for quitting or reducing smoking. This review examines the effectiveness of electronic cigarettes as cessation aids. Sixty two articles, including RCTs, experimental, longitudinal and cross sectional studies are included in this review. Findings suggest there is inconclusive evidence due to low quality of research. This webinar provides a comprehensive overview of current literature examining the effectiveness of electronic cigarettes for smoking cessation.
The scientific study of methods to promote the systematic uptake of research findings and other evidence-based practices into routine practice and hence improve the quality and effectiveness of health services
Dissemination and Implementation Research - Getting FundedHopkinsCFAR
Alice Ammerman, DrPh
Director, Center for Health Promotion and Disease Prevention
Professor, Department of Nutrition
Gillings School of Global Public Health
University of North Carolina
SHARE Webinar: Why Should I Join a Clinical Trial with Dr. Hershmanbkling
Dr. Dawn L. Hershman of the Herbert Irving Comprehensive Cancer Center at Columbia University presented the basics of clinical trials and emphasized how important it is for more patients to participate in them. She also discussed trials currently available for early stage and metastatic breast cancers. The webinar was presented on June 25, 2014. To hear the webinar, visit www.sharecancersupport.org/hershman
Deborah K. Armstrong, M.D., explains the newly-released patient guide for ovarian cancer patients, which was sponsored by the National Ovarian Cancer Coalition (NOCC).
How evidence affects clinical practice in egyptWafaa Benjamin
Evidence based medicine is the gold standard for clinical care.
It implies the integration of best research evidence with clinical expertise and patient values.
There is still a wide gap between availability of evidence and its incorporation into routine practice in our country.
Barriers to implementation could be personal, social, institutional, financial and legal barriers.
True practice of evidence based care can only occur where evidence based decisions coincide with patients’ beliefs and clinicians’ preferences.
Continuing medical education programs should be set with integrating evidence based medicine teaching and learning within clinical training.
The importance of presence of local national guidelines which need to take into account variation in expertise, resources and patient preferences across our geographical and cultural contexts .
Customisation of a guideline to meet the local needs of a target patient population is critical to successful implementation.
Purpose of the Call:
Women's College Hospital is an academic ambulatory hospital. The speaker will share their hospital’s journey as they sought to implement best practices for medication reconciliation from other settings customized for the ambulatory environment.
Read more and watch the webinar recording: http://bit.ly/1sxHIUP
The Commonwealth Fund 2015 International Health Care Policy Survey of Primary...Odyssey Recruitment
This study looks at primary care services in industrialised countries comparing access to the various systems. Switzerland and Germany have the best results with swift access to Family Physicians.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
1. DFCM Pearls: What Is New?
The top six research studies that will impact
clinical practice for academic family physicians
Dr. David M. Kaplan MD MSc CCFP
Associate Professor, North York General, Department of Family & Community
Medicine
Primary Care Lead, Central Local Health Integration Network
Dr. Tara Kiran MD MSc CCFP
Assistant Professor, St. Michael’s Hospital, Department of Family & Community
Medicine. Associate Scientist, Centre for Research on Inner City Health, St. Michael’s
Hospital
Adjunct scientist, Institute for Clinical Evaluative Studies
6. DFCM 2015 – Pearl 1
Missed connections: Unintended
consequences of updated cervical
cancer screening guidelines on
screening rates for sexually transmitted
infections
Bogler, T., Farber, A., Stall, N., Wijayasinghe, S., Slater, M.,
Guiang, C. & Glazier, R.H
Canadian Family Physician
7. The Bottom Line
• The introduction of new cervical screening
guidelines in 2012 was associated with a
50% decrease in screening for chlamydia
and gonorrhea in women age 19 to 25
8. The Research Question
• To compare rates of Pap testing and
screening for STIs among women age 19
to 25 before and after introduction of new
cervical cancer screening guidelines
• Why this is important?
–Rates of chlamydia and gonorrhea are
rising in Canada
–Family MDs relied on Pap testing to
provide an opportunity for a health
review
12. What This Means for Academic and
Clinical Practice
• Beware of unintended consequences of
guideline changes
• Practices (and communities) should
implement processes to ensure high-risk
women are screened for STIs even if they
are not coming in for routine Pap testing
13. DFCM 2015 – Pearl 2
The Early Benefits of Human
Papillomavirus Vaccination on Cervical
Dysplasia and Anogenital Warts
Smith, L.M., Strumpf, E.C., Kaufman, J.S., Lofters, A.,
Schwandt, M. & Levesque, L.E
Pediatrics
14. The Bottom Line
• qHPV vaccination is associated with
reduced cervical dysplasia among
adolescent girls
15. The Research Question
• To assess the impact of the qHPV vaccine
and Ontario’s grade 8 qHPV vaccination
program on cervical dysplasia and anogenital
warts
• Why this is important?
– qHPV vaccination remains controversial for
some parents
16.
17. What the Researchers Did
Population-based cohort of grade 8 girls
Exposures:
i) Eligible for vaccine program
ii) Received 3 doses of the
vaccine
Outcomes:
i) Cervical dysplasia*
ii) Anogenital warts*
*New cases in gr 10-12Regression
discontinuit
y design
qHPV program
introduced
19. What the Researchers Found
• 1 case of cervical dysplasia was prevented
for every 431 (95% CI 248 to 1639) girls
eligible for publicly funded vaccination and
for every 175 (95% CI 101 to 667) girls who
received the vaccine
• A non-significant reduction in anogenital
warts attributable to program eligibility and
vaccination
20. What This Means for Academic and
Clinical Practice
• qHPV vaccine is effective in reducing
cervical dysplasia and possibly anogenital
warts in a real-world setting
• Benefits of qHPV vaccine in girls can be
seen as early as age 14 to 17
• Vaccination should not be delayed
21. DFCM 2015 – Pearl 3
Estimated cost of universal public
coverage of prescription drugs in
Canada
Morgan, S.G., Law, M., Daw, J.R., Abraham, L. & Martin, D
Canadian Medical Association Journal
22. The Bottom Line
• Universal public drug coverage
could reduce total spending on
prescription drugs in Canada by
$7.3 billion per year or 32%
23. The Research Question
• To model the impact of universal public
coverage of prescription drugs in Canada on
public sector, private sector and total societal
costs
• Why this is important?
– 1 in 10 Canadians cannot afford to take their
medications as prescribed
24. What the Researchers Did
• Canadian Rx Atlas used to model change in
total cost of prescriptions (Product x volume x
$)
• 3 key factors impacting change in cost:
– use of prescription drugs
– Cost-effective product selection
– Consolidated purchasing power
• Other assumptions:
– Included small patient copayments
– Excluded drugs for ED and fertility
28. What This Means for Academic and
Clinical Practice
• Adds to the evidence supporting universal
public coverage of drugs
✓ access
✓ equity
? effective
✓ efficient (financially viable)
29. What This Means for Academic and
Clinical Practice
• Adds to the evidence supporting universal
public coverage of drugs
✓ access
✓ equity
? effective
✓ efficient (financially viable)
30. DFCM 2015 – Pearl 4
Empowering smokers with a web-
assisted tobacco intervention to use
prescription smoking cessation
medications: a feasibility trial
Selby, P., Hussain, S., Voci, S. & Zawertailo, L.
31. The Bottom Line
• It is feasible to use the Internet and
free medication to enable smokers to
engage physicians to treat smoking
addiction. Implementation of this
intervention can be scaled up by
leveraging existing healthcare
systems to treat smokers on a
population level.
32. The Research Question
• Is it feasible to use a web-assisted tobacco
intervention offering free prescription smoking
cessation medication by mail to reduce smoking
addition?
• Why this is important?
• In 2013, smoking prevalence in Ontario was 12.6%, below
the national average of 14.6%.
• FP should strongly advise patients to quit smoking, and use
motivational interviewing techniques for patients who are not
yet willing to stop smoking
• Cochrane review found no demonstrated effect of MD CME
training on provision of smoking cessation medications
34. What the Researchers Did
• Ontarians >18 who were smoking
• >= 10 cigarettes/d
• intending to quit within 30 days
Excluded those with contraindications to bupropion
(Zyban) or varenicline (Champix)
35. What the Researchers Did
• participants received an electronic personalized
printable prescription form for a 12w course of
varenicline or bupropion to bring to MD within
3w for authorization
• MD faxed prescriptions to an online pharmacy
that couriered medication to the patient
• Weekly motivational emails were sent during
treatment
• Completed follow-up questionnaires online at 7,
11, 15 and 41 weeks after enrollment
38. What the Researchers Found
• Novel method maintained advantages of
Internet-based treatment delivery (increased
efficiency and lower cost)
• Overcame a limitation by integrating in-person
clinical contact with a physician and brief
telephone counselling with a pharmacist
• abstinence rate among respondents at 41-week
follow-up was 16.2 % for the group that did not
receive medication, 30.3 % for the varenicline
group and 24.3 % for the bupropion group.
39. What This Means for Academic and
Clinical Practice
• Sending Electronic Communication to our
patients via newsletters with online
programs such as STOPSTUDY could be
a useful way of engaging patients in
healthy behaviours outside of regular clinic
visits
40.
41. DFCM 2015 – Pearl 5
Failure to Cope: The Hidden
Curriculum of Emergency Department
Wait Times and the Implications for
Clinical Training
Webster, F., Rice, K., Dainty, K.N., Zwarenstein, M.,
Durant, S. & Kuper, A.
42. The Bottom Line
• Ontario wait times policy had unplanned
effects on the education of the trainees
involved in the consultation process at the
study site.
• There was a shift in priorities from
teaching and learning good clinical care
and assessment to meeting organizational
performance measures.
43. The Research Question
• Did the Ontario Wait Times Policy have an
effect on the intraprofessional education of
trainees?
• Why this is important?
– Our academic programs ‘live’ in a context that
we, as teachers, sometimes do not control.
Could there be unintended consequences of
policy decisions on the academic mission?
44. What the Researchers Did
• ethnographic study
• from 2010-2011, observed consults between
GIM and ED at an urban teaching hospital in
Toronto
• additional ad hoc interviews were conducted
with residents, nurses, and faculty from both
departments
• formal one-on-one interviews with 12 physicians
• data were coded and analyzed using concepts
of institutional ethnography
45. What the Researchers Found
• perception that efficiency was more important
than education
• efficiency was the new definition of "good" patient
care
• informal label "failure to cope” describes high-
needs patients suggested that in many instances,
patients were experienced as a barrier to optimal
efficiency
• tension during consults as well as reduced
opportunities for education
46. What This Means for Academic and
Clinical Practice
• Policies introduced to reduce system
inefficiencies can have unintended
implications for medical education, and
thus for the care that medical trainees will
ultimately provide to the public
47. DFCM 2015 – Pearl 6
Rates of Anomalous Bupropion
Prescriptions in Ontario, Canada
Steele, L.S., Macdonald, E.M., Gomes, T., Hollands, S.,
Paterson, J.M., Mamdani, M.M., Juurlink, D.N.
48. The Bottom Line
• Although no marked differences were
seen for early refills of bupropion relative
to its comparators, potentially duplicitous
prescriptions have increased dramatically
in Ontario, suggesting growing misuse of
the drug.
49. The Research Question
• To explore trends in bupropion prescribing
suggestive of misuse or diversion in
Ontario, Canada.
• Why this is important?
– Bupropion is commonly prescribed in FM
– Reports of bupropion misuse have increased
since it was first reported in 2002
50. What the Researchers Did
• Administrative Database
• serial cross-sectional study
• Ontarians < 65 years who received an Rx
from the public drug program between
2000-2013
51. What the Researchers Did
• number of potentially inappropriate
prescriptions in each quarter
• defined as early refills dispensed within 50% of the
duration of the preceding prescription
• potentially duplicitous prescriptions
• defined as similarly early refills originating from a
different prescriber and different pharmacy
• analyses replicated for citalopram and
sertraline
52. What the Researchers Found
Early refills for bupropion, sertraline, and citalopram, by quarter
53. What the Researchers Found
Potentially duplicitous prescriptions for bupropion, sertraline, and citalopram, by
quarter
54. What This Means for Academic and
Clinical Practice
• Administrative Rx datasets can be mined
to confirm anecdotal observations
• Potentially duplicitous prescriptions for a
commonly used anti-depressant and
smoking cessation aid have increased
dramatically in Ontario, suggesting
growing misuse of the drug.
This slide must be visually presented to the audience AND verbalized by the speaker.
This slide must be visually presented to the audience AND verbalized by the speaker.
This slide must be visually presented to the audience AND verbalized by the speaker.
DK to describe the change to the 2015 process
RAP – Tali and Alison now staff
New guidelines from CCO introduced May 2012 – delay screening until age 21 and every three years if results are normal – were there unintended consquences
This may mean coming in more for an annual visit but it may also involve providing women with the means to self-test, e.g with self-administered vaginal swabs
Public coverage of medically necessary rx drugs on universal terms with limited copayments and a national formulary
1 in 10 – stat from CCHS survey data – pts reported making their meds last longer, not filling the rx or not renewing the rx. (as high as 3.5/10 for patients who are low income with no insurance)
Cdn experiences with changes in rx drug coverage
Product selection under existing provincial drug plans
Comparotor countries
Pharmacy dispensing fees and retail markups allowed
Small increase in expenditure by government and substantial cost savings to individuals and private sector
Role for physician advocacy
BMC Family Pract 2014;15:16. Epub ahead of print.(Principal Author)
Barriers to the use of these medications exist at the patient, system and practitioner level. Patient-level barriers include poor awareness, perceived lack of effectiveness, low desirability including concern regarding adverse effects, and poor accessibility of treatment [11, 12]. Accessibility issues include anticipated difficulties obtaining a prescription from a physician and perceived high cost of medication [11].
. Study information, including an electronic copy of a recruitment poster that could be printed and posted, was provided to healthcare professionals from public health units, community health centres, family health teams and community pharmacies across Ontario. Physicians were also informed about the study via the Ontario College of Family Physicians newsletter.
Adult smokers from Ontario, Canada, interested in quitting could enroll at the study website (www.stopstudy.ca; see Additional file 1). Study information, including an electronic copy of a recruitment poster that could be printed and posted, was provided to healthcare professionals from public health units, community health centres, family health teams and community pharmacies across Ontario. Physicians were also informed about the study via the Ontario College of Family Physicians newsletter.
The cost per patient that received medication was C$409.69. The cost per quitter ranged from approximately C$1003 to C$1835
.
Hospitals are monitored and ranked, and data
are publicly provided in “stocktake” reports that are intended to inform a “performance management approach.
ED vs GIM
The hidden curriculum, rst described in the medical education literature by Hafferty,15 refers to “cultural mores that are transmitted, but not openly acknowledged, through formal and informal educational endeavours.”
systematic study of people and cultures. It is designed to explore cultural phenomena where the researcher observes society from the point of view of the subject of the study.
the resulting field study or a case report reflects the knowledge and the system of meanings in the lives of a cultural group
IE explores the social relations that structure people's everyday lives, specifically by looking at the ways that people interact with one another in the context of social institutions (school, marriage, work, for example) and understanding how those interactions are institutionalized. IE is best understood as an ethnography of interactions which have been institutionalized, rather than an ethnography of specific companies, organizations or employment sectors, which would be considered industrial sociology or the sociology of work.
Policy makers should consider the potential for policies that affect medical practice to also influence medical education through the hidden curriculum, and the impact that the hidden curriculum can ultimately have on patient care.
Access, QI, other 'pressures' in FM
People who misuse bupropion sometimes characterize its effects as a cocaine-like high. Bupropion can be misused by ingestion, nasal insufflation, or intravenous injection, although the latter often produces extensive local tissue necrosis.4–9 Reports of seizures following bupropion misuse have also been documented.10,11 In May 2013, the Chief Coroner for Ontario issued a public health alert following 6 deaths involving bupropion insufflation or injection
.
During the final year of the study, they found 1,502 potentially dupliciitous prescriptions for bupropion .With an average of 32 tablets per prescription, this amount corresponds
to approximately 48,000 tablets potentially subject to misuse in our study sample