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Objective The objective of this scoping review is to examine pedagogies used to teach interprofessional health learners how to break bad news collaboratively. Introduction Breaking bad news is a skill health care professionals must be equipped to deliver well, yet literature shows that this skill receives little attention in program curricula. Consequently, health care professionals feel inadequately prepared to deliver bad news, leading to greater burnout, distress, and fatigue. Inclusion criteria Studies that describe pedagogies used to teach breaking bad news will be considered for inclusion. Studies must include two or more undergraduate and/or postgraduate learners working towards a professional health or social care qualification or degree at a university or college. Studies including lay, complementary and alternative, or non-health or social care professional learners will be excluded. Methods The JBI three-step process will be followed for developing the search. Databases to be searched include MEDLINE, CINAHL, Embase, Education Resource Centre, and Social Work Abstracts. Title and abstract screening through to data extraction will be completed by two independent reviewers and any disagreements will be resolved through discussion, or with a third reviewer. Results will be presented in tabular or diagrammatic form, together with a narrative summary.

Context. Public engagement efforts in health policy have posed many value-laden questions, yet those that appreciate the complexity and diversity of the concept of health equity are rare. We introduce the Fairness Dialogues, a new method for deliberating health equity among the general public. We provide its theoretical underpinning and present its empirical illustration and qualitative assessment. Methods. Primarily informed by the scholarship of deliberation, we designed the Fairness Dialogues, featured by reason-giving and inclusive group deliberation using a hypothetical scenario (the town of Troutville) that presents carefully designed, simple, open-ended cases focusing on a chosen equity and fairness issue. To assess whether the Fairness Dialogues encourages reflective views, we conducted a qualitative investigation by focusing on fairness and unfairness of inequalities in life expectancy. Findings. Our results revealed the complex intuitions that people have and their curiosity, patience, and willingness to scrutinize them in-depth through a small group dialogue. Intuitions shared by our study participants are similar to those presented in the scholarly philosophical literature. Conclusions. The Fairness Dialogues is a promising method to incorporate the public’s views into policy-making involving value judgment and to develop the capacity of the public to discuss value-laden questions in a reflective and inclusive manner., Contexte. Les efforts d’engagement du public en politique de santé ont posé de nombreuses questions chargées de valeur, mais celles qui tiennent compte de la complexité et de la diversité du concept d’équité en matière de santé sont rares. Nous présentons les Fairness Dialogues, une nouvelle méthode pour débattre de l’équité en matière de santé auprès du grand public. Nous en fournissons les fondements théoriques et en présentons l’illustration empirique et l’évaluation qualitative. Méthodes. Principalement inspirés par l’érudition de la délibération, nous avons conçu les Fairness Dialogues, caractérisés par une délibération de groupe objective et inclusive utilisant un scénario hypothétique (la ville de Troutville) qui présente des cas soigneusement conçus, simples, ouverts et axés sur une question d’équité et de justice. Pour évaluer si les Fairness Dialogues encouragent la réflexion, nous avons mené une enquête qualitative en nous concentrant sur l’équité et l’iniquité des inégalités en matière d’espérance de vie. Résultats. Nos résultats ont révélé les intuitions complexes des gens et leur curiosité, leur patience et leur volonté de les examiner en profondeur dans le cadre d’un dialogue en petit groupe. Les intuitions partagées par les participants à notre étude sont similaires à celles présentées dans la littérature philosophique académique. Conclusions. Les Fairness Dialogues sont une méthode prometteuse pour intégrer les points de vue du public dans l’élaboration de politiques impliquant un jugement de valeur et pour développer la capacité du public à discuter de questions chargées de valeurs de manière réfléchie et inclusive.

Children and youth whose lives intersect with child welfare systems are amongst the most vulnerable paediatric populations. Despite the increased rates of chronic conditions, these children and youth often experience unmet health care needs.To examine patterns of health care utilization from birth for children and youth in the care of a child welfare authority.This retrospective matched cohort design study examined children/youth aged 0-18 who had visited a paediatric tertiary care facility from 2016 April 1 to 2017 March 31 and had "social worker" documented as their guardian. A control cohort was matched based on age and sex. Primary outcomes of interest included primary health care, emergency, outpatient, and inpatient visits. Visits for immunizations, physiological development, well-baby checks, mental health, and oral health were also examined.A total of 200 cases and 200 controls were included in our cohort. No statistically significant differences were found between primary care visits, well-baby checks, inpatient admissions, outpatient mental health visits, or immunizations for children in care in comparison to their controls. There was a significant difference in oral health visits, lack of physiological development, and emergency department visits for children in care when compared to their controls.Our study revealed disparities in health care utilization amongst children in the care of child welfare in comparison to those who are not, highlighting the need for improved practice, policy, and research initiatives. A collaborative data collection/sharing system is needed to identify and track the health care of this vulnerable population.Children and youth whose lives intersect with child welfare systems are amongst the most vulnerable pediatric populations. Despite the increased rates of chronic health conditions, these children and youth often experience unmet health care needs. Using a retrospective matched cohort design, we sought to examine patterns of health care utilization from birth to age 18 for children and youth in the care of a child welfare authority in comparison to children/youth who were not in the care of child welfare. No statistically significant differences were found between primary care visits, well-baby checks, inpatient admissions, outpatient mental health visits, or immunizations for children in care when compared to their counterparts not in care. There was a significantly higher number of oral health visits, physiological development concerns, and emergency department visits for children in care when compared to their controls. Our study revealed differences in health care use amongst children in the care of a child welfare in comparison to those who are not, highlighting the need for improved practice, policy and research initiatives. A collaborative data collection and sharing system is needed to help accurately identify and track the health care use of this vulnerable population.

Chronic pain is debilitating and depressing. ‘Chronic primary pain has no clear underlying condition or the pain (or its impact) appears to be out of proportion to any observable injury or disease. ’1 In July 2014, Sir Simon Wessely stated in an article in The Times entitled, Pain may be in the mind , that: ‘Many of them [chronic pain patients] have mental health disorders — anxiety, depression, etc’, and that, ‘patients felt dismissed and denigrated when they were referred to mental health services … ’. 2 As patient safety campaigners, we are hearing from many people who are developing ‘unexplained’ chronic pain conditions after taking antidepressants (ADs), as prescribed, and sometimes over many years — and this has often led to polypharmacy with other drugs added ‘for symptoms’ along the way, most likely including ADs, benzodiazepines, Z-drugs, opioids, …

This article presents the results and theorization of a 4-year Grounded Theory project that sought to understand the processes and dynamics involved in the professional adaptation of internationally educated social workers now practicing in Canada. In-depth interviews with 66 participants, who undertook social work education outside of Canada and have subsequently settled to practice in the country, were conducted. Results highlight that the social work educational background of the professionals not only offers key conceptual, theoretical, and analytical foundations needed to adapt knowledge and skills to practice abroad, but also provides tools to navigate and negotiate professional adaptation processes as a whole. We conclude that ultimately, social workers may adapt well to their new work contexts because of the transferability of social work skills, knowledge, and values to new practice settings, thus facilitating interventions with services users and also their own process of professional adaptation.

This paper presents the results of a prospective study on the clinical effect of grafting the buccal gap with platform switching, following flapless tooth extraction and immediate implant placement and provisional restoration, on (1) alterations in buccolingual ridge dimension and (2) midfacial peri-implant soft tissue thickness. Fifty-six patients were placed in one of four treatment groups: (1) a non-platform-switching implant (Non-PS, n = 14); (2) a non-platform-switching implant and bone graft (BG/Non-PS, n = 14); (3) a platform-switching implant (PS, n = 15); and (4) a platform-switching implant and bone graft (BG/PS, n = 13). Buccolingual ridge dimensional change and peri-implant soft tissue thickness at 2 mm below the free gingival margin were measured. Both PS and BG/PS groups showed an increase in buccolingual dimension compared to the contralateral natural tooth site as well as peri-implant soft tissue thickness of > 2.5 mm, clinically. Platform switching was associated with significantly greater midfacial soft tissue thickness than bone grafting (mean ± standard deviation: 2.17 ± 0.04 for Non-PS and 3.55 ± 0.14 for PS). Using platform-switched implants, in conjunction with immediate implant placement and immediate provisional restoration, was associated with a significantly greater stability of ridge dimension and peri-implant soft tissue thickness than using non-platform-switched implants when measured 12 months after placement of the final restoration. Platform switching may help achieve preservation of ridge dimension and enhance the stability of peri-implant soft tissue following immediate implant placement and provisional restoration without bone grafting. Further research is required to assess the long-term outcome.

This February 2020 edition of the BJGP contains topics that are more closely interrelated than first appears, and the relationship is crucial for GPs to recognise. As you say, language matters and ‘The chances of a successful outcome are less good when … the consultation includes topics such as common mental health disorders and the highly contested territories of persistent but “medically” unexplained symptoms and maladaptive responses to commonplace adversities’ :1 …

I was on the TV and radio news recently. I have no media training nor a PA to help me. I don’t enjoy it; I always mumble and speak too quickly. My kids don’t help by saying, ‘Who’s that hideous middle-aged man on the telly?’ But I don’t care, because the topic is so important. A petition was recently sent to the Scottish Parliament to highlight the harm caused by prescription drugs1 — a topic I have been droning on about for decades. With a tripling of the use of antidepressants and painkillers in a decade, which are causing widespread dependence and addiction, …

Background: Stopping antidepressants commonly causes withdrawal symptoms, which can be severe and long-lasting. National Institute for Health and Care Excellence (NICE) guidance has been recently updated to reflect this; however, for many years withdrawal (discontinuation) symptoms were characterised as ‘usually mild and self-limiting over a week’. Consequently, withdrawal symptoms might have been misdiagnosed as relapse of an underlying condition, or new onset of another medical illness, but this has never been studied. Method: This paper outlines the themes emerging from 158 respondents to an open invitation to describe the experience of prescribed psychotropic medication withdrawal for petitions sent to British parliaments. The accounts include polypharmacy (mostly antidepressants and benzodiazepines) but we focus on antidepressants because of the relative lack of awareness about their withdrawal effects compared with benzodiazepines. Mixed method analysis was used, including a ‘lean thinking’ approach to evaluate common failure points. Results: The themes identified include: a lack of information given to patients about the risk of antidepressant withdrawal; doctors failing to recognise the symptoms of withdrawal; doctors being poorly informed about the best method of tapering prescribed medications; patients being diagnosed with relapse of the underlying condition or medical illnesses other than withdrawal; patients seeking advice outside of mainstream healthcare, including from online forums; and significant effects on functioning for those experiencing withdrawal. Discussion: Several points for improvement emerge: the need for updating of guidelines to help prescribers recognise antidepressant withdrawal symptoms and to improve informed consent processes; greater availability of non-pharmacological options for managing distress; greater availability of best practice for tapering medications such as antidepressants; and the vital importance of patient feedback. Although the patients captured in this analysis might represent medication withdrawal experiences that are more severe than average, they highlight the current inadequacy of health care systems to recognise and manage prescribed drug withdrawal, and patient feedback in general.

Introduction: When the soft tissue around an implant is inadequate or poorly contoured, soft tissue augmentation techniques such as connective tissue grafts are used to enhance the gingiva and gingival contour around an implant-supported restoration. There have been some case reports of cystic lesions occurring after a connective tissue graft, but this appears to be the first case report of a cyst in alveolar mucosa adjacent to an implant.Case Presentation: Following the placement of implants in the #6 and #7 positions, a cosmetic soft tissue deficiency was visible and inadequate papilla height was evident interproximally. The #7 implant was subsequently submerged, and multiple connective tissue grafts were placed to reconstruct the soft tissue on the buccal aspect of #5 to #7. Four years later the patient returned for evaluation of a 6 × 3 mm raised, fluid-filled vesicle on the alveolar mucosa, buccal to the submerged #7 implant. A submarginal incision with a semilunar design was placed from #6 to #8. A ...

This case report examined the effectiveness of a home program using neuromuscular electrical stimulation (NMES) during voluntary task-oriented exercise to achieve functional and impairment improvements for an individual with primarily proximal arm paresis after a stroke. The subject initially achieved a Fugl-Meyer Assessment (FMA) score of 58/66, but she reported minimal functional use of her involved, dominant arm. The 6-wk intervention consisted of NMES-assisted task practice involving repetitive reaching for and manipulation of small objects for three daily 1 5-min sessions. The subject applied NMES to the deltoid and triceps brachii muscles to augment shoulder flexion and abduction and elbow extension during task practice. Outcome measures included the FMA, the Action Research Arm Test (ARAT), and the Motor Activity Log Quality of Movement subscale (MAL-QOM). The FMA remained unchanged, but the ARAT and MAL-QOM showed improvements, from the beginning to the conclusion of the intervention, that were maintained at 6-wk follow-up.

This article describes the application of Compendium, a knowledge cartography software tool, for the recording of group process. As a hypertext tool, it enables analysts to visualize connections between people, ideas and information, establishing an evidence base within and across contexts (such as group sessions). After customizing its visual language, templates and keyword system, it has been piloted as a research tool for the measurement of group process. This would appear to hold the promise of providing a 'digital substrate' for recording, discussing and analysing long term group dynamics in new ways. While the project is in its early stages, early indications are that it is a useful tool, which can highlight group process and record change over time. In the longer term, it seems plausible that group processes such as multiple mirroring and identification, and such complex structures as the matrix, could be made visible and researchable through this methodology. © The Group-Analytic Society 2011.

The chapter begins with an overview of the current momentum toward interprofessional education and practice, citing specific trends in Canada as reflections of a global emerging consciousness. Initiatives undertaken at Dalhousie University are discussed in setting the context for this pilot study. Next, the pedagogy of critical diversity education is introduced and explained, with particular relevance for interprofessional education and practice. Comparison of face-to-face and online delivery of an interprofessional module based upon critical diversity education principles is then detailed, including research design and findings. The chapter concludes with a discussion of implications from this study.

Equipment designed for growing plants under conditions of controlled temperature was installed at the Missouri Experiment Station, Columbia, Missouri, in the fall of 1936. Some features of this apparatus are modifications of temperature control equipment devised and used by other workers. Other features, particularly the use made of standard air-conditioning equipment, are believed to represent new developments in apparatus for the growing of plants at controlled temperatures. The description which follows is presented with the idea that other investigators might make use of certain features in the designing of other equipment for the growth of plants in controlled environments.

The Fine Arts Center at the University of Massachusetts, Amherst was formally opened in 1975. It is a nationally acclaimed building and probably one of the most significant works of architecture in the Northeast (Figures 17 and 18). A book dealing with the work of its architects, Kevin Roche and John Dinkeloo, features the Fine Arts Center on its cover, exemplifying the architects’ pride in the structure. Almost every major architectural magazine has featured the building at one time or another.

Canada is a culturally diverse receiving country for transnational migration, and social workers are among the professional migrants who arrive in Canada each year. This article draws on findings from a four-year, grounded theory study on the professional adaptation processes and experiences of migrant social workers (n = 66) in the Canadian context. Study findings highlight a range of internal (personal) attributes and external (contextual) elements that interact to serve as either protective or vulnerabilizing factors during the pre-employment phase of professional adaptation. The focus of this article is to describe the interactions of protective and vulnerabilizing factors associated with the experience of obtaining recognition of foreign credentials and securing employment as a social worker in Canada. The findings demonstrate that migrant social workers in Canada face significant barriers in these two pre-employment phases of professional adaptation. A range of research and policy implications is identified. In particular, we highlight the disconnect that exists between Canada’s migration-friendly policies, and the lack of organizational and governmental supports and services to facilitate successful labour market integration of migrant social workers., Le Canada est une société culturellement diversifiée reconnue comme pays d’accueil pour la migration transnationale. Les travailleurs sociaux font partie des migrants professionnels qui arrivent au Canada tous les ans. Le présent article se fonde sur les données d’une étude théorique à base empirique de quatre ans sur les procédés d’adaptation professionnelle et sur l’expérience des travailleurs sociaux migrants (n = 66) dans le contexte canadien. L’étude expose une série d’attributs personnels (facteurs internes) et d’éléments contextuels (facteurs externes) qui interviennent pour protéger ou vulnérabiliser le migrant lors de la phase d’adaptation professionnelle préalable à l’emploi. L’article vise à décrire les interactions entre les facteurs de protection et de vulnérabilisation qui sont associés aux efforts déployés par le migrant pour faire reconnaître ses titres de compétences étrangers et trouver un emploi comme travailleur social au Canada. Les résultats montrent que les travailleurs sociaux qui immigrent au Canada doivent surmonter d’importants obstacles lors de ces deux étapes de l’adaptation professionnelle préalable à l’emploi. L’article dégage un ensemble de répercussions au niveau de la recherche et des politiques. Il met notamment en lumière le décalage entre les politiques canadiennes favorables à la migration et le manque de soutien et de services de la part d’organismes et du gouvernement pour faciliter l’insertion des travailleurs sociaux migrants dans le marché du travail.