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2. Safe and Appropriate Use of Methadone in Hospice and Palliative Care: Expert Consensus White Paper.
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McPherson, Mary Lynn, Walker, Kathryn A., Davis, Mellar P., Bruera, Eduardo, Reddy, Akhila, Paice, Judith, Malotte, Kasey, Lockman, Dawn Kashelle, Wellman, Charles, Salpeter, Shelley, Bemben, Nina M., Ray, James B., Lapointe, Bernard J., and Chou, Roger
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HOSPICE care , *PALLIATIVE treatment , *METHADONE hydrochloride , *DRUG addiction , *ANALGESIA , *METHADONE treatment programs , *THERAPEUTIC use of narcotics , *ANALGESICS , *COMPARATIVE studies , *RESEARCH methodology , *MEDICAL cooperation , *NARCOTICS , *PAIN , *RESEARCH , *EVALUATION research - Abstract
Methadone has several unique characteristics that make it an attractive option for pain relief in serious illness, but the safety of methadone has been called into question after reports of a disproportionate increase in opioid-induced deaths in recent years. The American Pain Society, College on Problems of Drug Dependence, and the Heart Rhythm Society collaborated to issue guidelines on best practices to maximize methadone safety and efficacy, but guidelines for the end-of-life scenario have not yet been developed. A panel of 15 interprofessional hospice and palliative care experts from the U.S. and Canada convened in February 2015 to evaluate the American Pain Society methadone recommendations for applicability in the hospice and palliative care setting. The goal was to develop guidelines for safe and effective management of methadone therapy in hospice and palliative care. This article represents the consensus opinion of the hospice and palliative care experts for methadone use at end of life, including guidance on appropriate candidates for methadone, detail in dosing, titration, and monitoring of patients' response to methadone therapy. [ABSTRACT FROM AUTHOR]
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- 2019
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3. Mapping communication spaces: The development and use of a tool for analyzing the impact of EHRs on interprofessional collaborative practice.
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Rashotte, Judy, Varpio, Lara, Day, Kathy, Kuziemsky, Craig, Parush, Avi, Elliott-Miller, Pat, King, James W., and Roffey, Tyson
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ELECTRONIC health records , *MEDICAL care , *INFORMATION prescriptions , *COLLECTIVE action , *LONGITUDINAL method , *CHILDREN'S hospitals , *COMMUNICATION , *COMPARATIVE studies , *COOPERATIVENESS , *HEALTH care teams , *INTERPROFESSIONAL relations , *RESEARCH methodology , *MEDICAL cooperation , *MEDICAL protocols , *RESEARCH , *EVALUATION research , *ACQUISITION of data , *IMPACT of Event Scale - Abstract
Introduction: Members of the healthcare team must access and share patient information to coordinate interprofessional collaborative practice (ICP). Although some evidence suggests that electronic health records (EHRs) contribute to in-team communication breakdowns, EHRs are still widely hailed as tools that support ICP. If EHRs are expected to promote ICP, researchers must be able to longitudinally study the impact of EHRs on ICP across communication types, users, and physical locations.Objective: This paper presents a data collection and analysis tool, named the Map of the Clinical Interprofessional Communication Spaces (MCICS), which supports examining how EHRs impact ICP over time, and across communication types, users, and physical locations.Methods: The tool's development evolved during a large prospective longitudinal study conducted at a Canadian pediatric academic tertiary-care hospital. This two-phased study [i.e., pre-implementation (phase 1) and post implementation (phase 2)] of an EHR employed a constructivist grounded theory approach and triangulated data collection strategies (i.e., non-participant observations, interviews, think-alouds, and document analysis). The MCICS was created through a five-step process: (i) preliminary structural development based on the use of the paper-based chart (phase 1); (ii) confirmatory review and modification process (phase 1); (iii) ongoing data collection and analysis facilitated by the map (phase 1); (iv) data collection and modification of map based on impact of EHR (phase 2); and (v) confirmatory review and modification process (phase 2).Results: Creating and using the MCICS enabled our research team to locate, observe, and analyze the impact of the EHR on ICP, (a) across oral, electronic, and paper communications, (b) through a patient's passage across different units in the hospital, (c) across the duration of the patient's stay in hospital, and (d) across multiple healthcare providers. By using the MCICS, we captured a comprehensive, detailed picture of the clinical milieu in which the EHR was implemented, and of the intended and unintended consequences of the EHR's deployment. The map supported our observations and analysis of ICP communication spaces, and of the role of the patient chart in these spaces.Conclusions: If EHRs are expected to help resolve ICP challenges, it is important that researchers be able to longitudinally assess the impact of EHRs on ICP across multiple modes of communication, users, and physical locations. Mapping the clinical communication spaces can help EHR designers, clinicians, educators and researchers understand these spaces, appreciate their complexity, and navigate their way towards effective use of EHRs as means for supporting ICP. We propose that the MCICS can be used "as is" in other academic tertiary-care pediatric hospitals, and can be tailored for use in other healthcare institutions. [ABSTRACT FROM AUTHOR]- Published
- 2016
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4. A comparative analysis of regulations for the geologic storage of carbon dioxide.
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Condor, Jose, Unatrakarn, Datchawan, Asghari, Koorosh, and Wilson, Malcolm
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GEOLOGICAL carbon sequestration ,COMPARATIVE studies ,INTERNATIONAL relations - Abstract
Abstract: This paper presents a summary of the main international and national regulations for geologic storage of carbon dioxide. The international group includes the EU Directives, London Convention, and OSPAR. For the national regulations, three countries were covered in this study: United States, Canada, and Australia. In addition to these regulations, a group of guidelines and best practice manuals were also included in this study. As discussion, although this paper recognizes that current legislations have contributed for the regulation of this technology, it is still necessary the development of new rules in other regions. Industry will not invest in large CCS plants without such regulations because of high CCS costs and large financial risks related to CCS. [Copyright &y& Elsevier]
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- 2011
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5. Assessment of SUNY Version 3 Global Horizontal and Direct Normal Solar Irradiance in Canada.
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Djebbar, Reda, Morris, Robert, Thevenard, Didier, Perez, Richard, and Schlemmer, James
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SOLAR radiation ,SOLAR energy ,SPATIOTEMPORAL processes ,HEATING ,COOLING ,COMPARATIVE studies ,DATA analysis - Abstract
Abstract: In this paper, hourly, daily and annual solar resource data derived form the latest SUNY solar model (version 3) using visible and infrared satellite data is analysed and compared with ground measured solar data from eighteen northern- latitude locations distributed all across Canada. The statistics of spatial and temporal differences between the two datasets obtained from the two versions of SUNY model, i.e., V1 and V3, are analysed for both global horizontal irradiance (GHI) and direct normal irradiance (DNI). SUNY V3 GHI and DNI data set is also compared to a dataset produced by the MAC3 cloud layer model for ten northern-latitude locations across Canada. The MAC3 model, using ground-based data, is the basis of the weather design input data files referred to in the current Canadian Model National Energy Code. It is also the model used for generating the CWEEDS (Canadian Weather Energy and Engineering Data Sets) long term hourly dataset, which is in turn used to derive the CWEC files (Canadian Weather year for Energy Calculations) also called typical meteorological years. CWEC files are used for design and analysis in various applications, including buildings heating and cooling as well as solar systems. Overall, results show that SUNY V3 has improved slightly compared to SUNY V1 in terms of estimating global and beam irradiance. Comparison of the SUNY V3 beta model with the MAC3 model seems to indicate that SUNY V3 model is resulting in better DNI estimates than those derived by the MAC3 model. Both SUNY V3 and MAC 3 models give similar estimates for GHI. [Copyright &y& Elsevier]
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- 2012
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6. Arctic indigenous peoples experience the nutrition transition with changing dietary patterns and obesity.
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Kuhnlein, H.V., Receveur, O., Soueida, R., and Egeland, G.M.
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OBESITY , *BODY weight , *NUTRITION , *HEALTH , *INSULIN , *AGING , *COMPARATIVE studies , *DIET , *FOOD habits , *INDIGENOUS peoples , *RESEARCH methodology , *MEDICAL cooperation , *RESEARCH , *SURVEYS , *EVALUATION research , *DISEASE prevalence , *NUTRITIONAL status - Abstract
Indigenous Peoples globally are part of the nutrition transition. They may be among the most extreme for the extent of dietary change experienced in the last few decades. In this paper, we report survey data from 44 representative communities from 3 large cultural areas of the Canadian Arctic: the Yukon First Nations, Dene/Métis, and Inuit communities. Dietary change was represented in 2 ways: 1) considering the current proportion of traditional food (TF) in contrast to the precontact period (100% TF); and 2) the amount of TF consumed by older vs. younger generations. Total diet, TF, and BMI data from adults were investigated. On days when TF was consumed, there was significantly less (P < 0.01) fat, carbohydrate, and sugar in the diet, and more protein, vitamin A, vitamin D, vitamin E, riboflavin, vitamin B-6, iron, zinc, copper, magnesium, manganese, phosphorus, potassium, and selenium. Vitamin C and folate, provided mainly by fortified food, and fiber were higher (P < 0.01) on days without TF for Inuit. Only 10-36% of energy was derived from TF; adults > 40 y old consistently consumed more (P < 0.05) TF than those younger. Overall obesity (BMI > or = 30 kg/m(2)) of Arctic adults exceeded all-Canadian rates. Measures to improve nutrient-dense market food (MF) availability and use are called for, as are ways to maintain or increase TF use. [ABSTRACT FROM AUTHOR]
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- 2004
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7. Exploring how virtual primary care visits affect patient burden of treatment.
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Kelley, L.T., Phung, M., Stamenova, V., Fujioka, J., Agarwal, P., Onabajo, N., Wong, I., Nguyen, M., Bhatia, R.S., and Bhattacharyya, O.
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RESEARCH , *CHRONIC diseases , *RESEARCH methodology , *EVALUATION research , *MEDICAL cooperation , *PRIMARY health care , *PATIENTS' attitudes , *COMPARATIVE studies - Abstract
Background: There is growing emphasis on the role of digital solutions in supporting chronic disease management. This has the potential to increase the burden patients experience in managing their health by offloading care from the health system to patients. This paper explores the effects of virtual visits on patient burden using an explicit framework measuring both the work patients do to care for their health and the challenges they experience that exacerbate burden.Methods: This mixed methods study evaluates a large pilot implementation of virtual visits (video, audio, and asynchronous messaging with providers) in primary care in Ontario, Canada. Participants were recruited using convenience sampling from patients using a virtual visit platform to complete a semi-structured interview or a survey including a free-text response. We conducted 17 interviews and reviewed 427 free text responses related to explore patients' perceived value and burden of these visits. We used qualitative analyses to map patients' feedback on their experience to the framework on patient burden.Main Findings: Virtual visits appear to reduce the work patients must do to manage their care by 1) improving access, convenience, and time needed for medical appointments, and 2) making it easier to access information and support for chronic disease management. Virtual visits also alleviate patients' perceived burden by improving continuity of care, experience of care, and providing some cost savings.Conclusions: Virtual visits reduced overall patient burden of treatment by decreasing the required patient effort of managing medical appointments and monitoring their health, and by minimizing challenges experienced when accessing care. For regions that want to improve patient experience of care, virtual visits are likely to be of benefit. There is need for further research on the generalizability of the findings herein, particularly for high-needs populations under-represented such as those of low socioeconomic status and those in rural and remote locations. [ABSTRACT FROM AUTHOR]- Published
- 2020
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