Medicine and Health Sciences Commons^™

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 …

Effect Of Interval To Definitive Breast Surgery On Clinical Presentation And Survival In Early-Stage Invasive Breast Cancer, Olga Vujovic, Edward Yu, Anil Cherian, Francisco Perera, A. Dar, Larry Stitt, A. Hammond

Edward Yu

Purpose: To examine the effect of clinical presentation and interval to breast surgery on local recurrence and survival in early-stage breast cancer. Methods and materials: The data from 397 patients with Stage T1-T2N0 breast carcinoma treated with conservative surgery and breast radiotherapy between 1985 and 1992 were reviewed at the London Regional Cancer Program. The clinical presentation consisted of a mammogram finding or a palpable lump. The intervals from clinical presentation to definitive breast surgery used for analysis were 0-4, >4-12, and >12 weeks. The Kaplan-Meier estimates of the time to local recurrence, disease-free survival, and cause-specific survival were determined …

Current Practice In Physical Child Abuse Forensic Reports: A Preliminary Exploration, Marcellina Mian, Catherine Schryer, Marlee Spafford, Jan Joosten, Lorelei Lingard

Lorelei Lingard

No abstract provided.

What Factors Predict Outcome At Relapse After Previous Esophagectomy And Adjuvant Therapy In High-Risk Esophageal Cancer?, Edward Yu, Patricia Tai, Richard Malthaner, Larry Stitt, George Rodrigues, Rashid Dar, Brian Yaremko, Jawaid Younus, Michael Sanatani, Mark Vincent, Brian Dingle, Dalilah Fortin, Richard Inculet

Edward Yu

Management of patients who have disease relapse after completion of surgery and adjuvant chemo-radiation (CRT) is controversial. Some oncologists would advocate intensive therapeutic intervention due to promising experience on treatment for recurrence disease while others would recommend palliative support due to the concerns for poor patient outcome post disease recurrence. In Addition, it is not clear if patient outcome is improved post adjuvant CRT when patients at risk have resection margin involvement and if time interval to recurrence can affect patient survival post relapse. The present study was conducted to determine what factors will affect patient outcome at relapse after …

Understanding Screen-Related Sedentary Behavior And Its Contributing Factors Among School-Aged Children: A Social-Ecologic Exploration, Meizi He, Stewart Harris, Leonard Piché, Charlene Beynon

Leonard Piché

Purpose: To explore the factors that contribute to children's screen-related sedentary (S-RS) behaviors. Settings: Elementary schools. Subjects: A random sample of children in grades five and six and their parents. Measures: The outcome measure was children's S-RS activity level measured by a self-administered questionnaire. A full spectrum of potential contributing factors for children's S-RS behaviors was obtained through surveys. Multilevel linear regression methods were used to determine the associations between these factors and children's screen time (hours per day) and results were expressed as regression coefficients (g). Results: Of 955 child-parent pairs in 14 participating schools, 508 pairs (53%) completed …

The Sum Of The Parts Detracts From The Intended Whole: Competencies And In-Training Assessments, Elaine Zibrowski, S. Singh, Mark Goldszmidt, Christopher Watling, Cynthia Kenyon, Valerie Schulz, Heather Maddocks, Lorelei Lingard

Lorelei Lingard

OBJECTIVES: Despite the fact that Canadian residency programmes are required to assess trainees' performance within the context of the CanMEDS Roles Framework, there has been no inquiry into the potential relationship between residents' perceptions of the framework and their in-training assessments (ITA). Using data collected during the study of ITA, we explored residents' perceptions of these competencies.

METHODS: From May 2006-07, a purposive sample of 20 resident doctors from internal medicine, paediatrics, and surgery were interviewed about their ITA experiences. Data collection and analysis proceeded in an iterative fashion consistent with grounded theory. In April 2008, a summary of recurrent …

Social Determinants Of Health And Disease Working Together, Amresh Srivastava

Amresh Srivastava

No abstract provided.

Reviewing Ethiopia’S Health System Development, Richard Wamai

Richard G. Wamai

A country in the horn of Africa region and one of the oldest states, Ethiopia has poor health outcomes even by sub-Saharan Africa’s standards characterized by many decades without a national health policy, weak healthcare system infrastructure and low government spending. Crucially, Ethiopia has taken critical steps in policy and programs to improving the country’s health status. Nevertheless, a World Bank study simulating different scenarios to meet the United Nations Millennium Development Goals (MDGs) on health in the country shows that unprecedented levels of aid flow would be needed. This paper overviews key health measures of Ethiopia and discusses some …

Silence, Power And Communication In The Operating Room, Fauzia Gardezi, Lorelei Lingard, Sherry Espin, Sarah Whyte, Beverley Orser, G. Baker

Lorelei Lingard

Aim.  This paper is a report of a study conducted to explore whether a 1- to 3-minute preoperative interprofessional team briefing with a structured checklist was an effective way to support communication in the operating room.

Background.  Previous research suggests that nurses often feel constrained in their ability to communicate with physicians. Previous research on silence and power suggests that silence is not only a reflection of powerlessness or passivity, and that silence and speech are not opposites, but closely interrelated.

Methods.  We conducted a retrospective study of silences observed in communication between nurses and surgeons in a multi-site observational …

'It's A Cultural Expectation...' The Pressure On Medical Trainees To Work Independently In Clinical Practice, Tara Kennedy, Glenn Regehr, G. Baker, Lorelei Lingard

Lorelei Lingard

CONTEXT: Medical trainees demonstrate a reluctance to ask for help unless they believe it is absolutely necessary, a situation which could impact on the safety of patients. This study aimed to develop a theoretical exploration of the pressure on medical trainees to be independent and to generate theory-based approaches to the implications for patient safety of this pressure towards independent working.

METHODS: In Phase 1, 88 teaching team members from internal and emergency medicine were observed during clinical activities (216 hours), and 65 participants completed brief interviews. In Phase 2, 36 in-depth interviews were conducted using video vignettes. Data collection …

Routine And Adaptive Expert Strategies For Resolving Ict Mediated Communication Problems In The Team Setting, Lara Varpio, Catherine F Schryer, Lorelei Lingard

Lorelei Lingard

CONTEXT: The use of information and communication technologies (ICTs) for supporting interprofessional communication is becoming increasingly common in health care. However, little research has explored how ICTs affect interprofessional communication, or how novices are trained to be effective interprofessional ICT users. This study explores the interprofessional communication strategies of nurses and doctors (trainees and experts) when their communications were mediated by a specific ICT: an electronic patient record (EPR).

METHODS: A total of 72 doctors and nurses participated in this 8-month study on a paediatric in-patient ward. Eighty hours of non-participant observations and 20 semi-structured interviews were conducted. All data …

What's So Great About Rehabilitation Teams? An Ethnographic Study Of Interprofessional Collaboration In A Rehabilitation Unit, Lynne Sinclair, Lorelei Lingard, Ravindra Mohabeer

Lorelei Lingard

OBJECTIVE: To explore team structures, team relationships, and organizational culture constituting interprofessional collaboration (IPC) in a particular rehabilitation setting; to develop a description of IPC practice that may be translated, adapted, and operationalized in other clinical environments.

DESIGN: An ethnographic study involving: Field observations: 40 hours, over 4 weeks, daily activities, 7 interprofessional meetings, 3 care planning meetings, 1 business meeting, and 3 family meetings; Individual observations: a physiotherapist, an occupational therapist, and a social worker individually observed for 45 minutes to an hour; and Interviews: 19 participants, 11 professions, 27 informal, 5 formal interviews. Data analysis consisted of an …

Communication Channels In General Internal Medicine: A Description Of Baseline Patterns For Improved Interprofessional Collaboration, Lesley Gotlib Conn, Lorelei Lingard, Scott Reeves, Karen-Lee Miller, Ann Russell, Merrick Zwarenstein

Lorelei Lingard

General internal medicine (GIM) is a communicatively complex specialty because of its diverse patient population and the number and diversity of health care providers working on a medicine ward. Effective interprofessional communication in such information-intensive environments is critical to achieving optimal patient care. Few empirical studies have explored the ways in which health professionals exchange patient information and the implications of their chosen communication forms. In this article, we report on an ethnographic study of health professionals' communication in two GIM wards through the lens of communication genre theory. We categorize and explore communication in GIM into two genre sets-synchronous …

The Trial Of The Expert Witness: Negotiating Credibility In Child Abuse Correspondence, Catherine Schryer, Elena Afros, Marcellina Mian, Marlee Spafford, Lorelei Lingard

Lorelei Lingard

This article reports on forensic letters written by physicians specializing in identifying children who have experienced maltreatment. These writers face an extraordinary exigence in that they must provide an opinion as to whether a child has experienced abuse without specifically diagnosing abuse and thus crossing into a legal domain. Their credibility was also at issue because, in this jurisdiction, child abuse identification was not recognized as a medical subspecialty and because the status of expert witnesses is currently being challenged. Through an analysis of 72 forensic letters combined with interview data from six letter writers and five letter readers, we …

Timing Of Surgical Antibiotic Prophylaxis Administration: Complexities Of Analysis, Carrie Cartmill, Lorelei Lingard, Glenn Regehr, Sherry Espin, John Bohnen, Ross Baker, Lorne Rotstein

Lorelei Lingard

BACKGROUND: The timing of prophylactic antibiotic administration is a patient safety outcome that is recurrently tracked and reported. The interpretation of these data has important implications for patient safety practices. However, diverse data collection methods and approaches to analysis impede knowledge building in this field. This paper makes explicit several challenges to quantifying the timing of prophylactic antibiotics that we encountered during a recent study and offers a suggested protocol for resolving these challenges. CHALLENGES: Two clear challenges manifested during the data extraction process: the actual classification of antibiotic timing, and the additional complication of multiple antibiotic regimens with different …

Whether To Get An H1n1 Vaccination Or Not?, Chiehwen Ed Hsu

Chiehwen Ed Hsu

In this interview Dr. Hsu provided public health informatics expertise to answer why or why not to receive H1N1 vaccination.

When Every Drops Counts: The Public Health Impact Of Drought, R. Konkel, Mark Miller, Robert Blake, Valeria Carlson

Steve Konkel

What are the public health effects of drought? What is the role of public health and environmental health in planning for drought? What are the political implications of drought and need for public health to be involved in drought planning? How can we reshape environmental health involvement in drought planning?

The Honeypot Study Protocol: A Randomised Controlled Trial Of Exit Site Application Of Medihoney Antibacterial Wound Gel For The Prevention Of Catheter-Associated Infections In Peritoneal Dialysis Patients, David Johnson, Carolyn Clark, Nicole Isbel, Carmel Hawley, Elaine Beller, Alan Cass, Janak De Zoysa, Steven Mctaggart, Geoffrey Playford, Brenda Rosser, Charles Thompson, Paul Snelling

Elaine Beller

Objectives: The primary objective of this study is to determine whether daily exit-site application of standardized antibacterial honey (Medihoney Antibacterial Wound Gel; Comvita, Te Puke, New Zealand) results in a reduced risk of catheter-associated infections in peritoneal dialysis (PD) patients compared with standard topical mupirocin prophylaxis of nasal staphylococcal carriers.

Design: Multicenter, prospective, open label, randomized controlled trial.

Setting: PD units throughout Australia and New Zealand.

Participants: The study will include both incident and prevalent PD patients (adults and children) for whom informed consent can be provided. Patients will be excluded if they have had (1) a history of psychological …

Using An Innovative Electronic Interface To Develop A Public Health Guidance Document, R. Konkel

Steve Konkel

This is part of a presentation given at the NEHA (National Environmental Health Association) 2009 conference in the Atlanta Enterprise Center June 21-24 in Atlanta Georgia.

Swine Flu Myths - Experts Debunk Four Common Myths About Swine Flu, Chiehwen Ed Hsu

Chiehwen Ed Hsu

To date, no evidence has been found to link eating or handling pork to contracting swine flu. As the cases of the new swine flu virus continue to rise, so too do the misconceptions about the illness. "By eating pork or handling pork products you won't [contract] H1N1," said Ed Hsu, an associate professor of health informatics at the University of Texas Health Science Center and a contributor to ABC News's OnCall+ Swine Flu site. "There is no scientific evidence or literature or any studies that suggest that one contracts H1N1 virus through eating pork or handling pork products." Additionally, …

Should I Wear A Mask To Protect Myself From The Flu?, Chiehwen Ed Hsu

Chiehwen Ed Hsu

It depends. If you already have H1N1 virus infection, you are recommended to wear a mask just to prevent yourself from spreading the virus to others.

Can One Get H1n1 Flu (Swine Flu) From Eating Pork?, Chiehwen Ed Hsu

Chiehwen Ed Hsu

there is no literature (study) suggesting that human being would get swine flu by eating pork or handling raw pork. Usually, if you prepare or cook your pork/meat product above temperature 70C (160F) the temperature could kill most of the germs and viruses, including h1n1 virus

Swine Flu Vs. Bird Flu: Which Is The Greater Pandemic Threat? New Research Hints At Why Swine Flu Overshadows Bird Flu In Pandemic Potential, Chiehwen Ed Hsu

Chiehwen Ed Hsu

Ed Hsu, associate professor of public health informatics at the University of Texas School of Health Information Sciences and School of Public Health, agreed. "This study renders potential explanations for why Avian Flu virus does not effectively transmit from human to human -- an important indicator for raising pandemic level." Take, for example, the virulence of bird flu. Despite the relative paucity of human cases of bird flu among humans, Hsu said, 258 people have died since 2003 as a result of the bird flu virus -- a case fatality rate of more than 60 percent. "Once [bird flu] viruses …

2 Billion Infected? Who Stokes Swine Flu Fear, Chiehwen Ed Hsu

Chiehwen Ed Hsu

One could reasonably question the reliability of WHO's statement of mass infection," he said. "By making such statement without strong backing WHO may risk putting its accountability on the line. "I think that WHO could serve the world health better by providing a more evidence-based, sensible 'benchmark' of H1N1 infection," said Ed Hsu, associate professor of public health informatics at the University of Texas School of Health Information Sciences and School of Public Health. He argued that the 2 billion figure, based on past pandemics, does not take into account recent public health improvements. Moreover, his own research has suggested …

Swine Flu Likely To Return To U.S. Next Winter - Experts Can't Predict Whether It Will Be More Virulent Or Not, Chiehwen Ed Hsu

Chiehwen Ed Hsu

explained C. Ed Hsu, an associate professor of public health informatics at the University of Texas School of Health Information Sciences at Houston and associate director of health informatics at the Center for Biosecurity and Public Health Preparedness at the University of Texas School of Public Health. "How and when the flu spreads is dependent on other factors as well: the fitness and efficiency of the virus itself along with its innate ability to replicate; the susceptibility of the host; and the environment, which includes not only the weather, but also human behavior (for example, groups of people confined together …

Flu Experts Debate Potential Number Of H1n1 Infections Worldwide, Chiehwen Ed Hsu

Chiehwen Ed Hsu

According to ABC News. "I think that WHO could serve the world health better by providing a more evidence-based, sensible 'benchmark' of H1N1 infection," said Ed Hsu, associate professor of public health informatics at the University of Texas School of Health Information Sciences and School of Public Health. Hsu said that while the WHO's estimates are grounded in historic data, they fail to consider improvement in public health, and his research shows signs that the numbers of swine flu infections in the U.S. are stabilizing. "One could reasonably question the reliability of WHO's statement of mass infection," Hsu said. "By …

Protecting The Young From Pandemic Flu., Chiehwen Ed Hsu

Chiehwen Ed Hsu

whether these past findings will be borne out with this new virus have yet to be seen, warns Ed Hsu, associate professor at the University of Texas School of Health Information Sciences and School of Public Health. "We may need another week until the H1N1 outbreak runs the full course of its incubation and infectivity period," he said. "By this weekend we should have enough data to make some meaningful inferences from worldwide distribution of the disease, including susceptibility or vulnerability by age over time."

Cautious Optimism On Swine Flu?, Chiehwen Ed Hsu

Chiehwen Ed Hsu

"I'm cautiously optimistic that we will begin seeing a decline in swine flu cases by mid-May or in a couple of weeks," said C. Ed Hsu, director of Preventive Health Informatics and SpaTial Analysis at the University of Texas Health Science Center

Swine Flu -- Answers To Your Questions., Chiehwen Ed Hsu

Chiehwen Ed Hsu

Ed Hsu from the University of Texas predicts a rise in cases over the next week followed by a sharp decline thereafter: “Based on the analysis of the SARS data … and our analysis of worldwide H5N1 data, if the trends hold true for H1N1 [swine flu], we will see substantial increase …next week through early May. However, again if the trends hold true, we can also reasonably expect the cases will go down dramatically beginning the week after (i.e., week of 5/3). Note that the rise in cases in next week is normal and expected …Next week will be …

Public Health Informatics Perspective On Swine Flu, Chiehwen Ed Hsu

Chiehwen Ed Hsu

Despite the action being taken by national and international health organizations, some infectious disease experts, including Ed Hsu, say it is far too early to fear the worst -- a global flu pandemic.