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Introduction: There is a critical need for low-carbon, environmentally-sustainable health systems in the climate crisis. Healthcare trainees can play a vital role in this process, and we have aimed to explore how they can be motivated and supported by faculties of medicine and health systems to pursue this ambition by conducting an exploratory, qualitative descriptive study of Canadian healthcare trainees engaged in healthcare sustainability initiatives. Materials and methods: Transcripts from individual in-depth interviews were analyzed to identify themes related to the actions that healthcare trainees can take to promote sustainable healthcare, as well as the motivators, barriers and facilitators of healthcare trainee engagement in sustainable healthcare. Results: Participants (N = 17) engaged in a spectrum of healthcare sustainability initiatives, including education, quality improvement and advocacy. They were motivated to advance healthcare sustainability through positive role models, the health impacts of climate change, observation of unsustainable healthcare practices, and a sense of social responsibility. Participants articulated that supportive networks, access to resources and funding, and having a growth mindset were facilitators to their engagement. In contrast, the lack of institutional prioritization of healthcare sustainability, limitations of the trainee role, challenges finding allies, and the perceived futility of their individual actions were characterized as barriers. Discussion: Healthcare trainees could support healthcare decarbonization efforts if they are adequately supported by their learning environments. The study's findings can guide educational innovations and health systems transformations to motivate and empower healthcare trainees to reduce the climate impact of healthcare throughout their careers.

Abstract Background The COVID-19 pandemic has led to increased utilization of telemedicine services. Methods A retrospective analysis of all referral-based ambulatory telemedicine services in Ontario from November 2019 to June 2021 was collected from the Ontario Health Insurance Plan (OHIP) billing database. Only fee-for-service billings were included in the present analysis. Coincident COVID-19 cases were obtained from Public Health Ontario. Comparisons were made based on age bracket, sex, telemedicine and in-person care. Results Billings for telemedicine services in Ontario increased from $1.7 million CAD in November 2019 to $64 million CAD in April 2020 and the proportions reached a mean peak of 72% in April 2020 and declined to 46% in June 2021. A positive correlation was found between the use of telemedicine and COVID-19 cases (p = 0.05). The age group with the highest proportion of telemedicine use was the 10–20-year-olds, followed by the 20–50-year-olds (61 ± 9.0%, 55 ± 7.3%, p = 0.01). Both age groups remained above 50% telemedicine services at the end of the study period. There seemed to be higher utilization by females (females 54.2 ± 8.0%, males 47.9 ± 7.7%, ANCOVA p = 0.05) for all specialties, however, after adjusting for male to female ratio m:f of 0.952:1.0 according to the 2016 census, this was no longer significant. Conclusions The use of telemedicine services remained at a high level across groups, particularly the 10–50-year-olds. There were clear age preferences for using telemedicine. Studying these differences may provide insights into how the delivery of non-hospital-based medicine has changed during the COVID-19 pandemic.

Summary: Increasing numbers of health-care professionals are aware of the need to deliver low-carbon sustainable health systems. We aimed to explore how physicians can be motivated and supported to pursue this ambition by conducting an exploratory qualitative descriptive study that involved individual in-depth interviews with climate-engaged Canadian physicians participating in health-care sustainability advocacy and action. Interview transcripts were analysed to identify themes related to the actions that physicians can take to promote sustainable health care, and the motivators and enablers of physician engagement in sustainable health care. Participants (n=19) engaged in a spectrum of health-care sustainability initiatives ranging from reducing health-care waste to lobbying and political action. They were motivated to advance health-care sustainability by their concern about the health implications of climate change, frustration with health-care waste, and recognition of their locus of influence as physicians. Participants articulated that policy and system, organisational and team, and knowledge generation and translation supports are required to strengthen their capacity to advance health-care sustainability. These findings can provide inspiration for engagement opportunities in health-care sustainability, guide service delivery and educational innovations to promote health-care professionals’ interest in becoming sustainability champions, and extend the capacity of health-care professionals to reduce the climate impact of health care.

Purpose: Radiation dermatitis (RD) is a side effect that frequently arises during radiotherapy (RT) in breast cancer patients. The present study investigates possible predictive factors of RD, as well as the use of skin treatments to manage symptoms. Methods: Demographic and treatment characteristics were collected retrospectively, while skin symptoms and treatments were collected prospectively for patients who received adjuvant RT between December 2013 and November 2015. Patients were seen weekly by clinicians throughout treatment, during which a clinician-reported survey was completed on RD symptoms and skin treatments. Possible predictive factors were correlated with skin outcomes through a univariate ordinal logistic regression analysis. Results: A total of 1093 patients were included in this analysis. Predictive factors for erythema included dose fractionation (p