Public Health Commons^™

Addressing The Persistence Of Tuberculosis Among The Canadian Inuit Population: The Need For A Social Determinants Of Health Framework, Kassandra C. Kulmann Ma Candidate, Chantelle Am Richmond Professor

Chantelle Richmond

Canadian Aboriginal people have poorer levels of health than the general population. A serious issue is the high rate of tuberculosis (TB) among the Inuit population; rates are much higher than those of the general Canadian population. Several social determinants of health (SDOH), including household crowding and poverty, are strongly correlated with TB prevalence. In this paper, we describe the medical and social determinants of TB, and critically examine the TB literature specific to the Inuit population. The majority of studies recommend biomedical interventions for the treatment of TB. Few researchers have employed the social determinants of health theory to …

University Students' Satisfaction With, Interest In Improving, And Receptivity To Attending Programs Aimed At Health And Well-Being, Patricia Tucker, Jennifer Irwin

Trish Tucker

The purpose of this pilot study is to investigate students' (a) satisfaction with nine health constructs, (b) interest in improving these health areas, and (c) receptivity to participating in programming targeting these areas. The study sample is composed of 1,778 undergraduate students from a Canadian university. Students complete a five-page paper-and-pencil questionnaire assessing the above objectives along a 5-point Likert-type scale. Students are most satisfied with their social health and report their lowest satisfaction with physical activity (M = 3.16, SD = 1.09). Overall, students are most interested in enhancing their physical activity (M = 4.10, SD = 0.79), followed …

Sociodemographic Profile Of Older Adults With Hiv/Aids: Gender And Sexual Orientation Differences, David J. Brennan, Charles A. Emlet, Sarah Brennenstuhl, Sergio Rueda

Charles Emlet

Social Determinants Of Health In Canada: Are Healthy Living Initiatives There Yet? A Policy Analysis, Dana Gore, Anita Kothari

Anita Kothari

Introduction: Preventative strategies that focus on addressing the social determinants of health to improve healthy eating and physical activity have become an important strategy in British Columbia and Ontario for combating chronic diseases. What has not yet been examined is the extent to which healthy living initiatives implemented under these new policy frameworks successfully engage with and change the social determinants of health. Methods: Initiatives active between January 1, 2006 and September 1, 2011 were found using provincial policy documents, web searches, health organization and government websites, and databases of initiatives that attempted to influence to nutrition and physical activity …

Working Off The Record: Physicians' And Nurses' Transformations Of Electronic Patient Record-Based Patient Information, Lara Varpio, Catherine Schryer, Pascale Lehoux, Lorelei Lingard

Lorelei Lingard

BACKGROUND: Electronic patient records (EPRs) are increasingly being used in health care, but little is known about how EPR-based patient information is used in daily care activities, nor about its potential influence on novice training.

METHOD: Seventy-two physicians and nurses participated in an eight-month study on a single pediatric ward. Eighty hours of nonparticipant observations and 20 interviews were conducted. Data were analyzed using constructivist grounded theory and visual rhetoric.

RESULTS: Three main features of participant interactions with EPR-based information were identified: (1) EPR-based information was routinely transformed into paper documents; (2) these transformations were organized by profession-specific guiding principles; …

The Anatomy Of The Professional Lapse: Bridging The Gap Between Traditional Frameworks And Students' Perceptions, Shiphra Ginsburg, Glenn Regehr, David Stern, Lorelei Lingard

Lorelei Lingard

PURPOSE: To support students' developing professionalism, it is necessary to understand the professional challenges and dilemmas they perceive in the clinical setting. This study systematically documented and catalogued students' reports of professional lapses. METHOD: Six focus groups were conducted with senior medical students (n = 29) at three universities. Using a grounded-theory approach, three researchers analyzed the students' reports of specific lapses in professionalism for recurrent themes. The resulting coding structure was applied using NVivo qualitative data analysis software. RESULTS: A total of 120 pages of text yielded 48 specific incidents of professional lapses, which were analyzed by three researchers …

Tensions Influencing Operating Room Team Function: Does Institutional Context Make A Difference?, Lorelei Lingard, Stacey Garwood, Dan Poenaru

Lorelei Lingard

BACKGROUND: A recent study of operating room (OR) team communication in a large, urban hospital described recurrent tension catalysts and a preliminary theory of team members' interpretive processes. To determine to what extent these findings were transferable to other institutional contexts, we conducted a validation study in 2 small, academic hospitals in a mid-size city. METHODS: Eight focus groups and 8 interviews were conducted with 6 general surgeons, 22 OR nurses, 5 anaesthesiologists and 10 trainees. Observations of 10 surgeons and their team members were conducted over 4 months. Data were analysed by applying thematic codes derived from previous research …

Clinical Oversight: Conceptualizing The Relationship Between Supervision And Safety, Tara Kennedy, Lorelei Lingard, G. Baker, Lisa Kitchen, Glenn Regehr

Lorelei Lingard

BACKGROUND: Concern about the link between clinical supervision and safe, quality health care has led to widespread increases in the supervision of medical trainees. The effects of increased supervision on patient care and trainee education are not known, primarily because the current multifacted and poorly operationalized concept of clinical supervision limits the potential for evaluation.

OBJECTIVE: To develop a conceptual model of clinical supervision to inform and guide policy and research.

DESIGN, SETTING, AND PARTICIPANTS: Observational fieldwork and interviews were conducted in the Emergency Department and General Internal Medicine in-patient teaching wards of two academic health sciences centers associated with …

A Qualitative Study Of Interphysician Telephone Consultations: Extending The Opinion Leader Theory, Anupma Wadhwa, Elizabeth Ford-Jones, Lorelei Lingard

Lorelei Lingard

INTRODUCTION: It has been suggested that the use of opinion leaders in the dissemination of information may be an effective method of changing clinical practice. Recent reviews on this topic, however, have found mixed results and have concluded that further research is needed to explore the circumstances that effectively utilize opinion leaders. We studied the interphysician telephone consultation, a situation in medical practice in which we see opinion leaders at work, to generate a grounded theory of opinion leader activity. METHODS: Data were collected and triangulated among 3 sources: documentation of 129 telephone consultations received, 51 hours of field observations …

Perceptions Of Operating Room Tension Across Professions: Building Generalizable Evidence And Educational Resources, Lorelei Lingard, Glenn Regehr, Sherry Espin, Isabella Devito, Sarah Whyte, Douglas Buller, Bohdan Sadovy, David Rogers, Richard Reznick

Lorelei Lingard

BACKGROUND: Effective team communication is critical in health care, yet no curriculum exists to teach it. Naturalistic research has revealed systematic patterns of tension and profession-specific interpretation of operating room team communication. Replication of these naturalistic findings in a controlled, video-based format could provide a basis for formal curricula. METHOD: Seventy-two surgeons, nurses, and anesthesiologists independently rated three video-based scenarios for the three professions' level of tension, responsibility for creating tension and responsibility for resolution. Data were analyzed using three-way, mixed-design analyses of variance. RESULTS: The three professions rated tension levels of the various scenarios similarly (F=1.19, ns), but rated …

A Certain Art Of Uncertainty: Case Presentation And The Development Of Professional Identity, Lorelei Lingard, K. Garwood, C. Schryer, M. Spafford

Lorelei Lingard

Healthcare professionals use the genre of case presentation to communicate among themselves the salient patient information during treatment and management. In case presentation, many uncertainties surface, regarding, e.g., the reliability of patient reports, the sensitivity of laboratory tests, and the boundaries of scientific knowledge. The management and portrayal of uncertainty is a critical aspect of professional discourse. This paper documents the rhetorical features of certainty and uncertainty in novice case presentations, considering their pragmatic and problematic implications for students' professional socialization. This study was conducted during the third-year inpatient clerkship at a tertiary care, pediatric hospital in hospital in Canada. …

Technical Skills In Paediatrics: A Qualitative Study Of Acquisition, Attitudes And Assumptions In The Neonatal Intensive Care Unit, Susan Bannister, Robert Hilliard, Glenn Regehr, Lorelei Lingard

Lorelei Lingard

PURPOSE: While the effective acquisition of technical skills is essential for excellent paediatric care, little is known about how technical skills are learned in the paediatric setting. This study sought to describe and theorise the variables influencing technical skills acquisition in a tertiary care neonatal intensive care unit (NICU) inpatient setting. METHODOLOGY: Using non-participant field methodology, paediatric residents and their teachers (nurses, respiratory therapists, neonatal staff and fellows) were observed at various times in the NICU for 8 weeks. Thirteen semistructured interviews with these teachers and learners and 1 focus group of additional learners were conducted and used to triangulate …

Before The White Coat: Perceptions Of Professional Lapses In The Pre-Clerkship, Shiphra Ginsburg, Natasha Kachan, Lorelei Lingard

Lorelei Lingard

BACKGROUND: It has been shown that the professional development of clinical clerks is influenced by their experiences of unprofessional behaviour, but the perceptions of pre-clerkship students have received relatively little attention. Our purpose was to develop a greater contextual understanding of the situations in which pre-clerkship students encounter professional challenges, and to investigate what pre-clerkship students consider to be professional lapses in these situations.

METHODS: We conducted 4 focus groups (n = 22 students); transcripts were analysed by 3 researchers using grounded theory.

RESULTS: Pre-clerkship students reported lapses in the areas of communicative violation, role resistance, objectification, accountability and harm, …

A Medical Student's Perspective Of Participation In An Interprofessional Education Placement: An Autoethnography, Jennifer Gallé, Lorelei Lingard

Lorelei Lingard

Interprofessional education (IPE) has emerged as a critical pedagogy for promoting interprofessional collaboration (IPC) within healthcare. However, the literature includes few reports of students' perspectives on IPE experiences. Understanding students' experiences is critical, as they are the crux of IPE's culture change agenda. This paper presents an autoethnographic account of my experiences as a medical student participating in an IPE placement within a Canadian academic hospital. During the five-week placement, I collected data using participant observation and reflective journaling on all placement experiences. I expanded my notes using the emotional recall technique and conducted thematic analysis. Using a series of …

To Report Or Not To Report: A Descriptive Study Exploring Icu Nurses' Perceptions Of Error And Error Reporting, Sherry Espin, Abigail Wickson-Griffiths, Michelle Wilson, Lorelei Lingard

Lorelei Lingard

OBJECTIVE: To explore the emergent factors influencing nurses' error reporting preferences, scenarios were developed to probe reporting situations in the intensive care unit.

SETTING: Three Canadian intensive care unit settings including: one urban academic tertiary hospital, one community hospital and one academic paediatric hospital. RESEARCH METHODOLOGY/DESIGN: Using qualitative descriptive methodology, semi-structured interviews were guided by a script which included a series of both closed and open-ended questions. One near miss and four error scenarios were used as prompts during the interview. Four of the five scenarios were identical across all the three sites; however, one scenario differed in the community …

Factors Behind Hiv Testing Practices Among Canadian Aboriginal Peoples Living Off-Reserve, Treena Orchard, C. Mcinnes, K. Fernandes, M. Clement, M. Gilbert, V. Lima, J. Montaner, R. Hogg

Dr. Treena Orchard

The objective of this study was to examine factors associated with HIV testing among Aboriginal peoples in Canada who live off-reserve. Data were drawn for individuals aged 15–44 from the Aboriginal Peoples Survey (2001), which represents a weighed sample of 520,493 Aboriginal men and women living off-reserve. Bivariable analysis and logistic regression were used to identify factors associated with individuals who had received an HIV test within the past year. In adjusted multivariable analysis, female gender, younger age, unemployment, contact with a family doctor or traditional healer within the past year, and “good” or “fair/poor” self-rated health increased the odds …

Uptake Of A Team Briefing In The Operating Theatre: A Burkean Dramatistic Analysis, Sarah Whyte, Carrie Cartmill, Fauzia Gardezi, Richard Reznick, Beverley Orser, Diane Doran, Lorelei Lingard

Lorelei Lingard

Communication among healthcare professionals is a focus for research and policy interventions designed to improve patient safety, but the challenges of changing interprofessional communication patterns are rarely described. We present an analysis of 756 preoperative briefings conducted by general surgery teams (anesthesiologists, nurses, and surgeons) at four urban Canadian hospitals in the context of two research studies conducted between August 2004 and December 2007. We ask the questions: how and why did briefings succeed, how and why did they fail, and what did they mean for different participants? Ethnographic fieldnotes documenting the coordination and performance of team briefings were analyzed …

Priority Setting: What Constitutes Success? A Conceptual Framework For Successful Priority Setting, Shannon Sibbald, Peter Singer, Ross Upshur, Douglas Martin

Shannon L. Sibbald

BACKGROUND: The sustainability of healthcare systems worldwide is threatened by a growing demand for services and expensive innovative technologies. Decision makers struggle in this environment to set priorities appropriately, particularly because they lack consensus about which values should guide their decisions. One way to approach this problem is to determine what all relevant stakeholders understand successful priority setting to mean. The goal of this research was to develop a conceptual framework for successful priority setting. METHODS: Three separate empirical studies were completed using qualitative data collection methods (one-on-one interviews with healthcare decision makers from across Canada; focus groups with representation …

Stroke In The Very Elderly: Hospital Care, Case Fatality And Disposition., Gustavo Saposnik

Gustavo Saposnik

No abstract provided.

The Rhetoric Of Patient Voice: Reported Talk With Patients In Referral And Consultation Letters, Marlee Spafford, Catherine Schryer, Lorelei Lingard

Lorelei Lingard

Referral and consultation letters are written to enable the exchange of patient information and facilitate the trajectory of patients through the healthcare system. Yet, these letters, written about yet apart from patients, also sustain and constrain professional relationships and influence attitudes towards patients. We analysed 35 optometry referral letters and 35 corresponding ophthalmology consultation letters for reported 'patient voice' coded as 'experience' or 'agenda' and we interviewed 15 letter writers (eight optometry students, six optometrists, and one community ophthalmologist). There were 80 instances of reported 'patient voice' in 35 letters. The majority (68%) of the instances occurred in referral letters, …

Health Care In Canada: Provinces Versus The Federal Government, Vivian C. Mcalister

Vivian C. McAlister

Radiation Treatment For Cervical Esophagus: Patterns Of Practice Study In Canada, 1996, Patricia Tai, Jake Van Dyk, Edward Yu, Jerry Battista, Matthew Schmid, Larry Stitt, Jon Tonita, Terry Coad

Edward Yu

PURPOSE: To assess the patterns of practice among Canadian radiation oncologists who treat esophageal cancers, using a trans-Canada survey, completed at the end of 1996. METHODS AND MATERIALS: One of 3 case presentations of different stages of cervical esophageal cancer was randomly assigned and sent to participating radiation oncologists by mail. Respondents were asked to fill in questionnaires regarding treatment techniques and to outline target volumes for the boost phase of radiotherapy. Radiation oncologists from 26 of 27 (96%) of all Canadian centers participated. RESULTS: High-energy X-rays (>/= 10 MV) were employed by 68% of the respondents in part …

Variability Of Target Volume Delineation In Cervical Esophageal Cancer, Patricia Tai, Jake Van Dyk, Edward Yu, Jerry Battista, Larry Stitt, Terry Coad

Edward Yu

PURPOSE: Three-dimensional (3D) conformal radiation therapy (CRT) assumes and requires the precise delineation of the target volume. To assess the consistency of target volume delineation by radiation oncologists, who treat esophageal cancers, we have performed a transCanada survey. MATERIALS AND METHODS: One of three case presentations, including CT scan images, of different stages of cervical esophageal cancer was randomly chosen and sent by mail. Respondents were asked to fill in questionnaires regarding treatment techniques and to outline boost target volumes for the primary tumor on CT scans, using ICRU-50 definitions. RESULTS: Of 58 radiation oncologists who agreed to participate, 48 …