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Objectives This scoping review aims to systematically map the empirical evidence on publicly funded medication reviews provided by community pharmacists in Canada and identify gaps that could inform future research directions. Methods We used a scoping review framework and PRISMA guidelines for Scoping Reviews to conduct the study. Three electronic databases were searched for papers published between January 2000 until August 2020. Data was charted on study characteristics, and a thematic synthesis was performed. Key findings Of 41 original studies included, most were conducted in Ontario (n = 21). Majority of the studies employed quantitative designs (70%). Five major themes identified were program uptake, patient health outcomes, stakeholder beliefs and attitudes, processes and collaboration and pharmacy workplace culture, which varied considerably. At the individual, organizational and policy levels, many factors were interrelated and influenced the implementation of reimbursed medication reviews by community pharmacists. Gaps in eligibility policy highlighted some patients who may have complex needs are excluded. Variation in clinical outcomes may relate to different types of medication review and pharmacist practice across Canada. Few researchers evaluated eligibility criteria, the impact of policy changes, strategies to engage patients and healthcare professionals, patient–pharmacist communication or compared practice models of medication reviews. About 12% of the research applied a theoretical framework. Summary Publicly funded medication reviews in Canadian community pharmacies reduce medication-related problems and potentially improve patient health outcomes. Future research and policies could consider addressing barriers and exploring models for sustainable delivery of high-quality medication reviews internationally. [ABSTRACT FROM AUTHOR]

As the integration of health and social care services progresses in the mental health sector, there is concern that mental health social workers are disadvantaged, relative to health professionals, because they cannot identify the knowledge base for their practice. This paper argues that this concern is partly the product of assuming that the knowledge base has to be premised upon randomized controlled trials. Instead, it proposes a non-hierarchical framework based on that developed in health research in Canada by Upshur and colleagues that generates a typology of knowledge which is congruent with the main forms of inquiry that are relevant to mental health social work practice. The framework recognizes the contribution of randomized controlled trials to the knowledge base but also validates knowledge drawn from qualitative, epidemiological, practitioner and user knowledge. It is argued that the framework profiles a wider knowledge base than that promoted by conventional evidence-based practice, and also could be a basis for future development of the research agenda in mental health social work. [ABSTRACT FROM AUTHOR]

Antimicrobial resistance is a continuing challenge to the appropriate, timely, cost-effective and ecologically appropriate delivery of antimicrobials. Surveillance studies conducted globally and nationally can assist in determining trends over specific geographical areas and allow comparisons between countries and within very specific infectious processes. CANWARD is an ongoing, national, Health Canada-endorsed, multiyear study focused on both inpatient and outpatient pathogens isolated in Canadian hospitals and determining their degree of antimicrobial resistance, with a particular emphasis on specific wards (medical, surgical, intensive care units, emergency room and clinics) as well as specific infection sites (urine, blood, respiratory and wound). This Supplement documents the initial 5 years of the CANWARD study (2007–11 inclusive). The seven manuscripts in this Supplement provide a comprehensive examination of pathogens covering multiple infectious processes. The data highlight the continued emergence of resistance and should provide to healthcare professionals nationally and globally the current status of antimicrobial resistance in Canada. [ABSTRACT FROM PUBLISHER]

Objectives. This article will address the process involved in the development and implementation of a clinician-driven portable electronic chart on an Acute Pain Management Service (APMS). We describe the latest version of the program and provide 1 year of clinical data. Setting. Tertiary care center in Kingston, Ontario, Canada. Patients. All patients admitted to the APMS between August 1, 2005, and July 31, 2006. Results. A total of 8,726 APMS visits were made to 2,528 patients. Mean length of stay on the Service was 2.3 days. Sixty-one percent of patients reported an active pain score >3/10. Pain scores were highest with hip or knee surgery. Thirty-five percent of patients reported nausea. Conclusions. Executive sponsorship, alignment with institutional priorities, and user input are essential to the development, implementation, adoption, and sustainability of an electronic patient record. Ready access to data at the bedside can improve quality of care, while ongoing, comprehensive data can contribute to Phase IV drug trials. Incorporating both clinical and research outcomes in the database improves data quality and usability, but must be balanced with the impact of clinical time constraints on documentation. Wireless technology and Tablet computers provide portability and adequate screen size for documentation and reviewing of patient data on an acute pain service. It is necessary to provide solutions to process issues, such as printing electronic records during the transition from paper to electronic records. [ABSTRACT FROM AUTHOR]

Background: On 1 November 2018, Choosing Wisely Canada launched their Using Antibiotics Wisely primary care campaign, which aimed to reduce unnecessary antibiotic prescriptions for respiratory tract infections (RTIs) through educational tools for patients and providers.Objectives: We explored the impact of this campaign on antibiotic utilization in Canada.Methods: We conducted a population-based study in Canada between January 2015 and December 2019. We used interventional autoregressive integrated moving average models to study the impact of the Using Antibiotics Wisely campaign on the prescribing rate (prescriptions per 1000 population) of RTI-indicated antibiotics. We analysed prescription rates overall and stratified by age group, drug class and province, in each month over the study period.Results: There was a 1.5% reduction in the annual prescribing rate of RTI-indicated antibiotics over the study period, which was generally consistent across age groups and provinces. Following the 2018 Using Antibiotics Wisely clinician toolkit release, we observed no significant change in RTI-indicated antibiotic prescribing rates nationally (P = 0.13). This was consistent by age group (children, P = 0.91; adults, P = 0.58; and older adults, P = 0.67) and drug class (narrow-spectrum penicillins, P = 0.88; macrolides, P = 0.85; broad-spectrum penicillins, P = 0.60; cephalosporins, P = 0.45; tetracyclines, P = 0.55; and fluoroquinolones, P = 0.98). In our secondary analysis of prescription rates in provinces that self-identified as prioritizing Using Antibiotics Wisely, we observed no significant change following the launch of the campaign.Conclusions: The introduction of the Using Antibiotics Wisely campaign in Canada has not caused a significant change in short-term antibiotic prescribing patterns. Community antibiotic stewardship campaigns that include components beyond education may be more impactful. [ABSTRACT FROM AUTHOR]

Background: Family physicians and other members of the primary health care (PHC) team may be ideally positioned to provide transition care to adolescents and young adults (AYAs; aged 12-25 years) exiting pediatric specialty services. Potential solutions to well-known challenges associated with integrating PHC and specialty care need to be explored.Objective: To identify strategies to transition care by PHC professionals for AYAs with chronic conditions transitioning from pediatric to adult-oriented care.Methods: Participants were recruited from six Primary Care Networks in Calgary, Alberta. A total of 18 semi-structured individual interviews were completed, and transcribed verbatim. Data were analyzed using a qualitative description approach, involving thematic analysis.Results: Participants offered a range of strategies for supporting AYAs with chronic conditions. Our analysis resulted in three overarching themes: (i) educating AYAs, families, and providers about the critical role of primary care; (ii) adapting existing primary care supports for AYAs and (iii) designing new tools or primary care practices for transition care.Conclusions: Ongoing and continuous primary care is important for AYAs involved with specialty pediatric services. Participants highlighted a need to educate AYAs, families and providers about the critical role of PHC. Solutions to improve collaboration between PHC and pediatric specialist providers would benefit from additional perspectives from providers, AYAs and families. These findings will inform the development of a primary care-based intervention to improve transitional care. [ABSTRACT FROM AUTHOR]

The remit of this paper is to identify what might be the future direction of one of the Ottawa Charter's five main action areas; developing personal skills (DPS). It is contested that this was never going to be an easy task. This opinion article argues that, while a watchful eye should be kept on evolving and innovative DPS strategy and programmes that Ottawa principles generally espouse, that type of activity is not representative of the current location and practice of many health practitioners—particularly clinically located health professionals. Targeting such professionals who, otherwise, might remain unaware of or unengaged with health promotion practice is the main reform required for future DPS activity. It is predicted that, where universal progress can be made, the potential for DPS development would be significant. [ABSTRACT FROM PUBLISHER]

Maintaining body temperature is a unique challenge with burn care. We sought to describe core temperature goals in the operating room (OR) and the methods used to achieve and maintain these goals, along with current methods of warming in the intensive care unit (ICU), the perception of effect of increased ambient temperature on work performance, and concerns with contamination of sterile fields due to increased ambient temperature. A 24 question survey was disseminated to burn centers in the United States and Canada. The questions included demographics, target core and ambient temperatures, warming methods, and beliefs on ambient temperature's effects. Of 121 burn centers, 52 questionnaires were completed (43% response rate). The majority of centers targeted a core temperature between 36 and 38°C in the OR and an ambient temperature between 75 and 95°F in the ICU. The most common methods for maintaining core temperature included warmed ambient temperature, forced air devices, and intravenous fluids. Although the majority of centers reported the belief that increased ambient temperature benefits patients, many also reported that there is a negative impact on staff performance and risk of staff perspiration contaminating sterile fields. Burn centers reported a range of target core temperatures and methods to reach target temperatures. More than a third of respondents perceived a negative impact work performance while more than half acknowledged the potential for contamination of sterile fields. A prospective observational study is needed to determine actual temperature regulation practice patterns and its impact on outcomes. [ABSTRACT FROM AUTHOR]

Objectives: Occupational exposure to antineoplastic agents occurs in various environments and is associated with increased cancer risk and adverse reproductive outcomes. National-level information describing the location and extent of occupational exposure to antineoplastic agents is unavailable in Canada and most other countries. CAREX Canada aimed to estimate the prevalence and relative levels of occupational exposures to antineoplastic agents across work setting, occupation, and sex. Methods: 'Exposure' was defined as any potential for worker contact with antineoplastic agents. Baseline numbers of licensed workers were obtained from their respective professional bodies. For unlicensed workers, Census data or data extrapolated from human resources reports (e.g., staffing ratios) were used. Prevalence was estimated by combining population estimates with exposure proportions from peer-reviewed and grey literature. Exposure levels (classified as low, moderate, and high) by occupation and work setting were estimated qualitatively by combining estimates of contact frequency and exposure control practices. Results: Approximately 75 000 Canadians (0.42% of the total workforce) are estimated as occupationally exposed to antineoplastic agents; over 75% are female. The largest occupational group exposed to antineoplastic agents is community pharmacy workers, with 30 200 exposed. By work setting, 39 000 workers (52% of all exposed) are located in non-hospital settings; the remaining 48% are exposed in hospitals. The majority (75%) of workers are in the moderate exposure category. Conclusions: These estimates of the prevalence and location of occupational exposures to antineo-plastic agents could be used to identify high-risk groups, estimate disease burden, and target new research and prevention activities. The limited secondary data available for developing these estimates highlights the need for increased quantitative measurement and documentation of antineoplastic agent contamination and exposure, particularly in work environments where use is emerging. [ABSTRACT FROM AUTHOR]

Introduction: Pregnant women in socioeconomically disadvantaged circumstances, such as Indigenous women, have a high prevalence of smoking. Tobacco smoking is the most significant reversible risk factor for the health of Indigenous pregnant women and their babies.Methods: As researchers working in this specialized area, we conducted a narrative review of the literature on smoking among Indigenous pregnant women in the United States, Canada, New Zealand, and Australia. We summarize prevalence and factors influencing tobacco use, interventions, and evidence gaps for tobacco control and smoking cessation. Recommendations are made for future interventions, policy changes, and much-needed research.Results: Common themes emerging across the four countries reveal opportunities for cross-cultural collaborative studies and trials. These include the social-normative use of tobacco as barriers to quitting in pregnancy and the need for evaluations of interventions at the family and community level. Socioeconomic disparities underscore the importance of enhancing the implementation and reach of strategies to prevent and reduce prenatal tobacco smoking among Indigenous women. Elders and community health care providers as role models for nontobacco use could be explored. Qualitative work is needed to understand the barriers and opportunities, such as cultural strengths supporting quitting tobacco to develop more effective approaches.Conclusions: Although a high-priority group, there remains a dearth of research on Indigenous women's smoking in pregnancy. Studies have assessed knowledge and attitudes to smoking in pregnancy, and small feasibility studies and a few empirical trials have been conducted. Recommendations for promising culturally appropriate cessation interventions have been made. Larger trials are warranted.Implications: Strategies to support quitting among pregnant Indigenous women need to be multifactorial and take account of the social determinants of smoking including historical antecedents, community norms, cultural strengths, and recognition of individual and community needs. Cross-country research collaborations have the potential to leverage funding, share expertise, and strengthen approaches to tackle an important and poorly attended health disparity that has a profound impact on the entire life course for Indigenous peoples. [ABSTRACT FROM AUTHOR]

This article re-analyses 105 interviews from four qualitative research studies of different kinds of care workers in Canada and Australia, in light of deepening workplace rationalisation and austerity. The sample included: two studies of voluntary sector social service and social workers--one study of nineteen and one of twenty social workers, twenty-two telenurses and forty-four nursing home care workers. Themes that emerged from the data included: restructured and rationalised workplaces, managerialism, reshaped practice, unintended neglect and control of service users, coercion of workers and resistance strategies. Significant similarities were apparent across these similar and yet different care workers, suggesting a strong convergence of working conditions and the policies shaping them. The article used Labour Process Theory and returned to state theory debates in order to re-assess how rationalised care workplaces shape relations between care workers and the individuals they care for. The article contributes to state theory by suggesting a control-coercion care continuum and to Labour Process Theory by suggesting three kinds of workplace control/coercion: control through compliance, cutbacks coercion and contextual coercion. The findings draw attention to deep tensions within increasingly managerialised, austere state-run and state-funded care services in which control and coercion intermingle with resistance and care. [ABSTRACT FROM AUTHOR]

Background Health workers have been at the forefront of treating and caring for patients with COVID-19. They were often under immense pressure to care for severely ill patients with a new disease, under strict hygiene conditions and with lockdown measures creating practical barriers to working. This study aims to explore the range of mental health, financial and other practical support measures that 36 countries in Europe and Canada have put in place to support health workers and enable them to do their job. Methods We use data extracted from the COVID-19 Health Systems Response Monitor (HSRM). We only consider initiatives implemented outside of clinical settings where COVID-19 patients are treated, and therefore exclude workplace provisions such as availability of personal protective equipment, working time limits or mandatory rest periods. Results We show that countries have implemented a range of measures, ranging from mental health and well-being support initiatives, to providing bonuses and temporary salary increases. Practical measures such as childcare provision and free transport and accommodation have also been implemented to ensure health workers can get to their workplace and have their children looked after. Other initiatives such as offering continuing professional development credits for knowledge learnt during the crisis were also offered in some countries, albeit less frequently. Conclusions While a large number of initiatives have been introduced, often as ad-hoc measures, their effectiveness in helping staff is unknown in most countries. The effectiveness of these initiatives should be evaluated to inform future crisis responses and strategies for health workforce development. [ABSTRACT FROM AUTHOR]