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4. A Survey of Female-Specific Cardiovascular Protocols in Emergency Departments in Canada

Author

Nicole L. Tegg, RN, BScN, Opal H. Desmarais, RN, MBA, M. Patrice Lindsay, RN, PhD, FWSO, Susanna McDermott, Sharon L. Mulvagh, MD, FRCPC, M. Madison Desbiens, BHSc, and Colleen M. Norris, PhD, MSc, BScN, RN, FAHA, FCAHS

Subjects
Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Background: Cardiovascular diseases (CVD) remain the leading cause of death for women. However, systematic inequalities exist in how women experience clinical cardiovascular (CV) policies, programs, and initiatives. Methods: In collaboration with the Heart and Stroke Foundation of Canada, a question regarding female-specific CV protocols in an emergency department (ED), or an inpatient or ambulatory care area of a healthcare site was sent via e-mail to 450 healthcare sites in Canada. Contacts at these sites were established through the larger initiative—the Heart Failure Resources and Services Inventory–conducted by the foundation. Results: Responses were received from 282 healthcare sites, with 3 sites confirming the use of a component of a female-specific CV protocol in the ED. Three sites noted using sex-specific troponin levels in the diagnosis of acute coronary syndromes; 2 of the sites are participants in the hs-cTn—Optimizing the Diagnosis of Acute Myocardial Infarction/Injury in Women (CODE MI) trial. One site reported the integration of a female-specific CV protocol component into routine use. Conclusions: We have identified an absence of female-specific CVD protocols in EDs that may be associated with the identified poorer outcomes in women impacted by CVD. Female-specific CV protocols may serve to increase equity and ensure that women with CV concerns have access to the appropriate care in a timely manner, thereby helping to mitigate some of the current adverse effects experienced by women who present to Canadian EDs with CV symptoms. Résumé: Contexte: Les maladies cardiovasculaires (MCV) demeurent la principale cause de décès chez les femmes. Toutefois, il existe des inégalités systématiques à l’égard des femmes dans les politiques, les programmes et les initiatives cliniques cardiovasculaires (CV). Méthodologie: En collaboration avec la Fondation des maladies du cœur et de l’AVC du Canada, une question relative à l’utilisation de protocoles de prise en charge des manifestations cardiovasculaires spécifiques aux femmes dans les services d’urgence ou les services de soins pour patients hospitalisés et ambulatoires a été envoyée par courriel à 450 établissements de santé au Canada. Les contacts ont été établis dans ces centres dans le cadre d’une initiative de plus grande envergure, l’inventaire des ressources et des services en matière d’insuffisance cardiaque, menée par la Fondation. Résultats: Des réponses ont été reçues de 282 établissements de santé; dont trois ont confirmé l’utilisation d’une composante spécifique aux femmes dans leurs protocoles de prise en charge des manifestations CV dans leur service des urgences. Trois centres ont déclaré utiliser un taux de troponine adapté au sexe pour le diagnostic du syndrome coronarien aigu; or, deux de ces centres participent à l’essai CODE MI (hs-cTn—Optimizing the Diagnosis of Acute Myocardial Infarction/Injury in Women), qui porte sur l’optimisation du diagnostic de l’infarctus du myocarde aigu ou des atteintes myocardiques chez les femmes. Un seul centre a signalé l’intégration d’une composante spécifique aux femmes dans son protocole CV en pratique courante. Conclusions: Nous avons constaté que l’absence de protocoles spécifiques aux femmes en matière de prise en charge des manifestations CV dans les services d’urgences pourrait être associée aux moins bons résultats observés chez les femmes atteintes de MCV. Des protocoles spécifiques aux femmes en matière de prise en charge des manifestations CV pourraient contribuer à accroître l’équité et à faire en sorte que les femmes souffrant de problèmes CV aient accès aux soins appropriés en temps opportun. Une telle initiative contribuerait à atténuer certains des effets indésirables dont sont victimes les femmes qui se présentent aux urgences des établissements de soins canadiens avec des symptômes CV.

Published
2023
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10. COVID-19 Pandemic: Global Impact and Potential Implications for Cardiovascular Disease in Canada

Author

Leigh C.P. Botly, PhD, Michelle Martin-Rhee, PhD, Adrienne Kasiban, BMath, Richard H. Swartz, MD, PhD, FRCPC, Sharon L. Mulvagh, MD, FRCPC, FACC, FASE, FAHA, M. Patrice Lindsay, RN, PhD, Cristina Goia, MSc, Eric E. Smith, MD, MPH, FRCPC, Michael D. Hill, MD, MSc, FRCPC, Thalia S. Field, MD, MHSc, FRCPC, Andrew D. Krahn, MD, FRCPC, FHRS, Gavin Y. Oudit, MD, PhD, FRCPC, Shelley Zieroth, MD, FRCPC, and Cindy Y.Y. Yip, MASc, PhD, PMP

Subjects
Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Background: The literature indicates that cardiovascular disease (CVD; including stroke), older age, and availability of health care resources affect COVID-19 case fatality rates (CFRs). The cumulative effect of COVID-19 CFRs in global CVD populations and the extrapolated effect on access to health care services in the CVD population in Canada are not fully known. In this study we explored the relationships of factors that might affect COVID-19 CFRs and estimated the potential indirect effects of COVID-19 on Canadian health care resources. Methods: Country-level epidemiological data were analyzed to study the correlation, main effect, and interaction between COVID-19 CFRs and: (1) the proportion of the population with CVD; (2) the proportion of the population 65 years of age or older; and (3) the availability of essential health services as defined by the World Health Organization Universal Health Coverage index. For indirect implications on health care resources, estimates of the volume of postponed coronary artery bypass grafting, percutaneous coronary intervention, and valve surgeries in Ontario were calculated. Results: Positive correlations were found between COVID-19 CFRs and: (1) the proportion of the population with CVD (ρ = 0.40; P = 0.001); (2) the proportion of the population 65 years of age or older (ρ = 0.43; P = 0.0005); and (3) Universal Health Coverage index (ρ = 0.27; P = 0.03). For every 1% increase in the proportion of the population 65 years of age or older or proportion of the population with CVD, the COVID-19 CFR was 9% and 19% higher, respectively. Approximately 1252 procedures would be postponed monthly in Ontario because of current public health measures. Conclusions: Countries with more prevalent CVD reported higher COVID-19 CFRs. Strain on health care resources is likely in Canada. Résumé: Contexte: La littérature indique que les maladies cardiovasculaires (MCV, incluant les accidents vasculaires cérébraux), l’âge avancé et la facilité d’accès aux ressources de soins de santé ont une incidence sur les taux de létalité (TL) des cas de COVID-19. L’effet cumulatif du TL de la COVID-19 dans l’ensemble de la population atteinte de MCV et l’impact anticipé sur l'accès aux services de santé dans la population atteinte de MCV au Canada ne sont pas entièrement connus. Cette étude a exploré les liens entre les facteurs pouvant influencer le TL des cas de COVID-19 et a estimé le potentiel impact indirect de la COVID-19 sur les ressources de soins de santé au Canada. Méthodes: Les données épidémiologiques à l’échelle du pays ont été analysées pour étudier la corrélation, l’effet principal et l’interaction entre le TL de laCOVID-19 et : 1) la proportion de la population souffrant de MCV, 2) la proportion de la population ≥ 65 ans, et 3) l’accessibilité des services de santé essentiels tels que définis par l’indice de couverture sanitaire universelle (CSU) de l’Organisation Mondiale de la Santé. Pour les implications indirectes concernant les ressources de santé, des estimations du volume d’opération de pontages coronariens, d'interventions coronariennes percutanées et de chirurgies valvulaires reportées en Ontario ont été calculées. Résultats: Des corrélations positives ont été trouvées entre le TL de la COVID-19 et 1) la proportion de la population souffrant de MCV (ρ= 0,40, P = 0,001), 2) la proportion de la population ≥ 65 ans (ρ= 0,43, P = 0,0005), et 3) l’indice CSU (ρ= 0,27, P = 0,03). Pour chaque augmentation de 1 % de la proportion de la population ≥ 65 ans ou de la proportion de la population souffrant de MCV, le TL de la COVID-19 était respectivement supérieur de 9 % et 19 %. Environ 1 252 interventions seraient reportées chaque mois en Ontario en raison des mesures de santé publique actuelles. Conclusions: Les pays où les MCV sont plus répandues ont signalé un TL de la COVID-19 plus élevé. Il est probable que les ressources de soins de santé soient soumises à de fortes contraintes au Canada.

Published
2020
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11. Stroke Prevalence, Mortality and Disability-Adjusted Life Years in Children and Youth Aged 0-19 Years: Data from the Global and Regional Burden of Stroke 2013

Author

Krishnamurthi, Rita V, deVeber, Gabrielle, Feigin, Valery L, Barker-Collo, Suzanne, Fullerton, Heather, Mackay, Mark T, O'Callahan, Finbar, Lindsay, M Patrice, Kolk, Anneli, Lo, Warren, Shah, Priyanka, Linds, Alexandra, Jones, Kelly, Parmar, Priya, Taylor, Steve, Norrving, Bo, Mensah, George A, Moran, Andrew E, Naghavi, Mohsen, Forouzanfar, Mohammed H, Nguyen, Grant, Johnson, Catherine O, Vos, Theo, Murray, Christopher JL, and Roth, Gregory A

Subjects
Prevention, Brain Disorders, Neurosciences, Stroke, Emerging Infectious Diseases, Aetiology, 2.4 Surveillance and distribution, Good Health and Well Being, Adolescent, Adult, Child, Child, Preschool, Cost of Illness, Disabled Persons, Female, Global Health, Health Surveys, Humans, Incidence, Infant, Male, Prevalence, Quality-Adjusted Life Years, Young Adult, Childhood stroke, Stroke epidemiology, Deaths, Disability-adjusted life years, GBD 2013 Stroke Panel Experts Group, Public Health and Health Services, Epidemiology
Abstract

BackgroundThere is increasing recognition of stroke as an important contributor to childhood morbidity and mortality. Current estimates of global childhood stroke burden and its temporal trends are sparse. Accurate and up-to-date estimates of childhood stroke burden are important for planning research and the resulting evidence-based strategies for stroke prevention and management.ObjectivesTo estimate the prevalence, mortality and disability-adjusted life years (DALYs) for ischemic stroke (IS), hemorrhagic stroke (HS) and all stroke types combined globally from 1990 to 2013.MethodologyStroke prevalence, mortality and DALYs were estimated using the Global Burden of Disease 2013 methods. All available data on stroke-related incidence, prevalence, excess mortality and deaths were collected. Statistical models and country-level covariates were employed to produce comprehensive and consistent estimates of prevalence and mortality. Stroke-specific disability weights were used to estimate years lived with disability and DALYs. Means and 95% uncertainty intervals (UIs) were calculated for prevalence, mortality and DALYs. The median of the percent change and 95% UI were determined for the period from 1990 to 2013.ResultsIn 2013, there were 97,792 (95% UI 90,564-106,016) prevalent cases of childhood IS and 67,621 (95% UI 62,899-72,214) prevalent cases of childhood HS, reflecting an increase of approximately 35% in the absolute numbers of prevalent childhood strokes since 1990. There were 33,069 (95% UI 28,627-38,998) deaths and 2,615,118 (95% UI 2,265,801-3,090,822) DALYs due to childhood stroke in 2013 globally, reflecting an approximately 200% decrease in the absolute numbers of death and DALYs in childhood stroke since 1990. Between 1990 and 2013, there were significant increases in the global prevalence rates of childhood IS, as well as significant decreases in the global death rate and DALYs rate of all strokes in those of age 0-19 years. While prevalence rates for childhood IS and HS decreased significantly in developed countries, a decline was seen only in HS, with no change in prevalence rates of IS, in developing countries. The childhood stroke DALY rates in 2013 were 13.3 (95% UI 10.6-17.1) for IS and 92.7 (95% UI 80.5-109.7) for HS per 100,000. While the prevalence of childhood IS compared to childhood HS was similar globally, the death rate and DALY rate of HS was 6- to 7-fold higher than that of IS. In 2013, the prevalence rate of both childhood IS and HS was significantly higher in developed countries than in developing countries. Conversely, both death and DALY rates for all stroke types were significantly lower in developed countries than in developing countries in 2013. Men showed a trend toward higher childhood stroke death rates (1.5 (1.3-1.8) per 100,000) than women (1.1 (0.9-1.5) per 100,000) and higher childhood stroke DALY rates (120.1 (100.8-143.4) per 100,000) than women (90.9 (74.6-122.4) per 100,000) globally in 2013.ConclusionsGlobally, between 1990 and 2013, there was a significant increase in the absolute number of prevalent childhood strokes, while absolute numbers and rates of both deaths and DALYs declined significantly. The gap in childhood stroke burden between developed and developing countries is closing; however, in 2013, childhood stroke burden in terms of absolute numbers of prevalent strokes, deaths and DALYs remained much higher in developing countries. There is an urgent need to address these disparities with both global and country-level initiatives targeting prevention as well as improved access to acute and chronic stroke care.

Published
2015

13. An Exploratory Mixed Methods Study of Experiences of Interprofessional Teams Who Received Coaching to Simultaneously Redesign Primary Care Education and Clinical Practice

Author

Patricia A. Carney, W. Perry Dickinson, Jay Fetter, Eric J. Warm, Brenda Zierler, Jill Patton, Greg Kirschner, Steven D. Crane, Sarah Shrader, and M. Patrice Eiff

Subjects
Computer applications to medicine. Medical informatics, R858-859.7, Public aspects of medicine, RA1-1270
Abstract

Introduction/Objectives: Coaching is emerging as a form of facilitation in health professions education. Most studies focus on one-on-one coaching rather than team coaching. We assessed the experiences of interprofessional teams coached to simultaneously improve primary care residency training and interprofessional practice. Methods: This three-year exploratory mixed methods study included transformational assistance from 9 interprofessional coaches, one assigned to each of 9 interprofessional primary care teams that included family medicine, internal medicine, pediatrics, nursing, pharmacy and behavioral health. Coaches interacted with teams during 2 in-person training sessions, an in-person site visit, and then as requested by their teams. Surveys administered at 1 year and end study assessed the coaching relationship and process. Results: The majority of participants (82% at end of Year 1 and 76.6% at end study) agreed or strongly agreed that their coach developed a positive working relationship with their team. Participants indicated coaches helped them: (1) develop as teams, (2) stay on task, and (3) respond to local context issues, with between 54.3% and 69.2% agreeing or strongly agreeing that their coaches were helpful in these areas. Cronbach’s alpha for the 15 coaching survey items was 0.965. Challenges included aligning the coach’s expertise with the team’s needs. Conclusions: While team coaching was well received by interprofessional teams of primary care professionals undertaking educational and clinical redesign, the 3 primary care disciplines have much to learn from each other regarding how to improve inter- and intra-professional collaborative practice among clinicians and staff as well as with interprofessional learners rotating through their outpatient clinics.

Published
2021
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15. Resident Visit Productivity and Attitudes About Continuity According to 3 Versus 4 Years of Training in Family Medicine: A Length of Training Study

Author

M. Patrice Eiff, Annie Ericson, Dang H. Dinh, Steele Valenzuela, Mark T. Nadeau, W. Perry Dickinson, Colleen M. Conry, James C. Martin, and Patricia A. Carney

Subjects
Family Practice
Abstract

Background and Objectives: Training models in the Length of Training Pilot (LOTP) vary. How innovations in training length affect patient visits and resident perceptions of continuity is unknown. Methods: We analyzed resident in-person patient encounters (2013-2014 through 2018-2019) for each postgraduate year (PGY) and total visits at graduation derived from the Accreditation Council for Graduate Medical Education reports for each LOTP program. We collected data on residents’ perceptions of continuity from annual surveys (2015-2019). We analyzed continuous variables using independent samples t tests with unequal variance and categorical variables using χ2 tests in comparing 3-year (3YR) versus 4-year (4YR) programs. Results: PGY-1 and PGY-2 residents in 4YR programs saw statistically more patients than their counterparts in 3YR programs. In PGY3, 3YR program residents had statistically higher visit volume compared to 4YR program residents. Visits conducted in PGY4 ranged from 832 to 884. The additional year of training resulted in approximately 1,000 more total patient visits. Most residents in 3YR and 4YR programs rated their continuity clinic experience as somewhat or very adequate (range 86.3% to 93.7%), which did not statistically differ according to length of training. Conclusions: Resident visits were significantly different at each PGY level when comparing 3YR and 4YR programs in the LOTP and the additional year of training resulted in about 1,000 more total visits. Resident perspectives on the adequacy of their continuity clinic experience appeared to not be affected by length of training. Future research should explore how the volume of patient visits performed in residency affects scope of practice and clinical preparedness.

Published
2023

16. The Association Between Length of Training and Family Medicine Residents’ Clinical Knowledge: A Report From the Length of Training Pilot Study

Author

Patricia A. Carney, Steele Valenzuela, Annie Ericson, Lars Peterson, Dang H. Dinh, Colleen M. Conry, James C. Martin, Karen B. Mitchell, Stephanie E. Rosener, Miguel Marino, and M. Patrice Eiff

Subjects
Family Practice
Abstract

Background and Objective: The associations between training length and clinical knowledge are unknown. We compared family medicine in-training examination (ITE) scores among residents who trained in 3- versus 4-year programs and to national averages over time. Methods: In this prospective case-control study, we compared the ITE scores of 318 consenting residents in 3-year programs to 243 who completed 4 years of training between 2013 through 2019. We obtained scores from the American Board of Family Medicine. The primary analyses involved comparing scores within each academic year according to length of training. We used multivariable linear mixed effects regression models adjusted for covariates. We performed simulation models to predict ITE scores after 4 years of training among residents who underwent only 3 years of training. Results: At baseline postgraduate year-1 (PGY1), the estimated mean ITE scores were 408.5 for 4-year programs and 386.5 for 3-year programs, a 21.9 point difference (95% CI=10.1–33.8). At PGY2 and PGY3, 4-year programs scored 15.0 points higher and 15.6 points higher, respectively. When extrapolating an estimated mean ITE score for 3-year programs, 4-year programs would still score 29.4 points higher (95% CI=15.0–43.8). Our trend analysis revealed those in 4-year programs had a slightly lesser slope increase compared to 3-year programs in the first 2 years. Their drop-off in ITE scores is less steep in later years, though these differences were not statistically significant. Conclusions: While we found significantly higher absolute ITE scores in 4 versus 3-year programs, these increases in PGY2, PGY3 and PGY4 may be due to initial differences in PGY1 scores. Additional research is needed to support a decision to change the length of family medicine training.

Published
2023

17. Recommandations canadiennes pour les pratiques optimales de soins de l'AVC, septieme edition : l'acide acetylsalicylique pour la prevention d'evenements vasculaires

Author

Wein, Theodore, Lindsay, M. Patrice, Gladstone, David J., Poppe, Alexandre, Bell, Alan, Casaubon, Leanne K., Foley, Norine, Coutts, Shelagh B., Cox, Jafna, Douketis, James, Field, Thalia, Gioia, Laura, Habert, Jeffrey, Lang, Eddy, Mehta, Shamir R., Papoushek, Christine, Semchuk, William, Sharma, Mikul, Udell, Jacob A., Lawrence, Stephanie, Mountain, Anita, Gubitz, Gord, Dowlatshahi, Dar, Simard, Anne, de Jong, Andrea, and Smith, Eric E.

Subjects
Salicylates, Anabolic steroids, Health
Abstract

En 2016, au Canada (a l'exclusion du Quebec), 270204 personnes ont ete admises a l'hopital pour un trouble cardiaque, un accident vasculaire cerebral (AVC) ou un deficit cognitif d'origine vasculaire; [...]

Published
2020
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18. Canadian Stroke Best Practice Recommendations, seventh edition: acetylsalicylic acid for prevention of vascular events

Author

Wein, Theodore, Lindsay, M. Patrice, Gladstone, David J., Poppe, Alexandre, Md, Alan Bell, Casaubon, Leanne K., Foley, Norine, Coutts, Shelagh B., Cox, Jafna, Douketis, James, Field, Thalia, Gioia, Laura, Habert, Jeffrey, Lang, Eddy, Mehta, Shamir R., Papoushek, Christine, Semchuk, William, Sharma, Mikul, Udell, Jacob A., Lawrence, Stephanie, Mountain, Anita, Gubitz, Gord, Dowlatshahi, Dar, Simard, Anne, de Jong, Andrea, and Smith, Eric E.

Subjects
Canadian Stroke Best Practice Recommendations, 7th ed. (Textbook) -- Criticism and interpretation, Aspirin -- Analysis -- Dosage and administration, Cardiovascular diseases -- Prevention, Health
Abstract

In 2016, 270 204 people in Canada (excluding Quebec) were admitted to hospital for heart conditions, stroke and vascular cognitive impairment, including 107391 women and 162813 men, of whom 91524 [...]

Published
2020
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19. People With Lived Experience at the Centre of Canadian Stroke Best Practice Recommendations: A Model for Guideline Developers

Author

M Patrice Lindsay RN, PhD, Natalie Gierman MHSc, Jocelyn E Harris OT, PhD, Gavin Arthur PhD, Moira E Teed MSc, MSW, Anita Mountain MD, FRCPC, Gordon Gubitz MD, FRCPC, Eric E Smith MD, MSc, FRCPC, Dar Dowlatshahi MD, PhD, FRCPC, Andrea de Jong RN, MSN, and Leigh C P Botly PhD

Subjects
Medicine (General), R5-920
Abstract

Actively engaging people with lived experience (PWLE) in stroke-related clinical practice guideline development has not been effectively implemented. This pilot project evaluated the feasibility, perceived value, and effectiveness of the Community Consultation and Review Panel (CCRP), a new model to engage PWLE in the writing and review of Canadian Stroke Best Practice Recommendations. Responses to a standardized evaluation tool indicated that participants perceived the CCRP as valued, impactful, effective, and beneficial to stroke care. This project successfully demonstrated that values, experiences, and recommendations of PWLE can be effectively incorporated into guideline content and is applicable to all guideline development processes.

Published
2020
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20. Canadian Consensus Conference on Diagnosis and Treatment of Dementia (CCCDTD)5: Guidelines for management of vascular cognitive impairment

Author

Eric E. Smith, Philip Barber, Thalia S. Field, Aravind Ganesh, Vladimir Hachinski, David B. Hogan, Krista L. Lanctôt, M. Patrice Lindsay, Mukul Sharma, Richard H. Swartz, Zahinoor Ismail, Serge Gauthier, and Sandra E. Black

Subjects
dementia, guidelines, vascular cognitive impairment, vascular dementia, Neurology. Diseases of the nervous system, RC346-429, Geriatrics, RC952-954.6
Abstract

Abstract Introduction Vascular disease is a common cause of dementia, and often coexists with other brain pathologies such as Alzheimer's disease to cause mixed dementia. Many of the risk factors for vascular disease are treatable. Our objective was to review evidence for diagnosis and treatment of vascular cognitive impairment (VCI) to issue recommendations to clinicians. Methods A subcommittee of the Canadian Consensus Conference on Diagnosis and Treatment of Dementia (CCCDTD) reviewed areas of emerging evidence. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was used to assign the quality of the evidence and strength of the recommendations. Results Using standardized diagnostic criteria, managing hypertension to conventional blood pressure targets, and reducing risk for stroke are strongly recommended. Intensive blood pressure lowering in middle‐aged adults with vascular risk factors, using acetylsalicylic acid in persons with VCI and covert brain infarctions but not if only white matter lesions are present, and using cholinesterase inhibitors are weakly recommended. Conclusions The CCCDTD has provided evidence‐based recommendations for diagnosis and management of VCI for use nationally in Canada, that may also be of use worldwide.

Published
2020
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22. Canadian Stroke Best Practice Recommendations

Author

Nancy M, Salbach, Anita, Mountain, M Patrice, Lindsay, Dylan, Blacquiere, Rebecca, McGuff, Norine, Foley, Hélène, Corriveau, Joyce, Fung, Natalie, Gierman, Elizabeth, Inness, Elizabeth, Linkewich, Colleen, O'Connell, Brodie, Sakakibara, Eric E, Smith, Ada, Tang, Debbie, Timpson, Tina, Vallentin, Katie, White, and Jennifer, Yao

Subjects
Stroke, Canada, Consensus, Rehabilitation, Stroke Rehabilitation, Humans, Physical Therapy, Sports Therapy and Rehabilitation, Telerehabilitation
Abstract

The seventh edition of the Canadian Stroke Best Practice Recommendations for Rehabilitation and Recovery following Stroke includes a new section devoted to the provision of virtual stroke rehabilitation. This consensus statement uses Grading of Recommendations, Assessment, Development and Evaluations methodology and Appraisal of Guidelines for ResearchEvaluation II principles. A literature search was conducted using PubMed, Embase, and Cochrane databases. An expert writing group reviewed all evidence and developed recommendations, as well as consensus-based clinical considerations where evidence was insufficient for a recommendation. All recommendations underwent internal and external review. These recommendations apply to hospital, ambulatory care, and community-based settings where virtual stroke rehabilitation is provided. This guidance is relevant to health professionals, people living with stroke, healthcare administrators, and funders. Recommendations address issues of access, eligibility, consent and privacy, technology and planning, training and competency (for healthcare providers, patients and their families), assessment, service delivery, and evaluation. Virtual stroke rehabilitation has been shown to safely and effectively increase access to rehabilitation therapies and care providers, and uptake of these recommendations should be a priority in rehabilitation settings. They are key drivers of access to high-quality evidence-based stroke care regardless of geographical location and personal circumstances in Canada.

Published
2022

24. The Association Between Length of Training and Family Medicine Residents’ Clinical Knowledge: A Report From the Length of Training Pilot Study

Author

Carney, Patricia A., primary, Valenzuela, Steele, additional, Ericson, Annie, additional, Peterson, Lars, additional, Dinh, Dang H., additional, Conry, Colleen M., additional, Martin, James C., additional, Mitchell, Karen B., additional, Rosener, Stephanie E., additional, Marino, Miguel, additional, and Eiff, M. Patrice, additional

Published
2023
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25. Young Stroke Survivors With No Early Recurrence at High Long‐Term Risk of Adverse Outcomes

Author

Jodi D. Edwards, Moira K. Kapral, M. Patrice Lindsay, Jiming Fang, and Richard H. Swartz

Subjects
case‐control study, secondary prevention, young, stroke in, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract

Background Approximately 8% to 21% of strokes affect adults aged 5× that of young controls (hazard ratio, 5.2; 95% CI, 2.8–9.4), compared with a 30% increase at 5 years for older patients (hazard ratio, 1.3; 95% CI, 1.3–1.4). Conclusions Young stable stroke/transient ischemic attack survivors show a higher long‐term hazard of adverse outcomes compared with matched controls than older patients. Findings support the need for long‐term follow‐up and aggressive risk reduction in young survivors and suggest secondary prevention guidelines for these patients are required.

Published
2019
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26. Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015

Author

Wang, Haidong, Naghavi, Mohsen, Allen, Christine, Barber, Ryan M, Bhutta, Zulfiqar A, Carter, Austin, Casey, Daniel C, Charlson, Fiona J, Chen, Alan Zian, Coates, Matthew M, Coggeshall, Megan, Dandona, Lalit, Dicker, Daniel J, Erskine, Holly E, Ferrari, Alize J, Fitzmaurice, Christina, Foreman, Kyle, Forouzanfar, Mohammad H, Fraser, Maya S, Fullman, Nancy, Gething, Peter W, Goldberg, Ellen M, Graetz, Nicholas, Haagsma, Juanita A, Hay, Simon I, Huynh, Chantal, Johnson, Catherine O, Kassebaum, Nicholas J, Kinfu, Yohannes, Kulikoff, Xie Rachel, Kutz, Michael, Kyu, Hmwe H, Larson, Heidi J, Leung, Janni, Liang, Xiaofeng, Lim, Stephen S, Lind, Margaret, Lozano, Rafael, Marquez, Neal, Mensah, George A, Mikesell, Joe, Mokdad, Ali H, Mooney, Meghan D, Nguyen, Grant, Nsoesie, Elaine, Pigott, David M, Pinho, Christine, Roth, Gregory A, Salomon, Joshua A, Sandar, Logan, Silpakit, Naris, Sligar, Amber, Sorensen, Reed J D, Stanaway, Jeffrey, Steiner, Caitlyn, Teeple, Stephanie, Thomas, Bernadette A, Troeger, Christopher, VanderZanden, Amelia, Vollset, Stein Emil, Wanga, Valentine, Whiteford, Harvey A, Wolock, Timothy, Zoeckler, Leo, Abate, Kalkidan Hassen, Abbafati, Cristiana, Abbas, Kaja M, Abd-Allah, Foad, Abera, Semaw Ferede, Abreu, Daisy M X, Abu-Raddad, Laith J, Abyu, Gebre Yitayih, Achoki, Tom, Adelekan, Ademola Lukman, Ademi, Zanfina, Adou, Arsène Kouablan, Adsuar, José C, Afanvi, Kossivi Agbelenko, Afshin, Ashkan, Agardh, Emilie Elisabet, Agarwal, Arnav, Agrawal, Anurag, Kiadaliri, Aliasghar Ahmad, Ajala, Oluremi N, Akanda, Ali Shafqat, Akinyemi, Rufus Olusola, Akinyemiju, Tomi F, Akseer, Nadia, Lami, Faris Hasan Al, Alabed, Samer, Al-Aly, Ziyad, Alam, Khurshid, Alam, Noore K M, Alasfoor, Deena, Aldhahri, Saleh Fahed, Aldridge, Robert William, Alegretti, Miguel Angel, Aleman, Alicia V, Alemu, Zewdie Aderaw, Alexander, Lily T, Alhabib, Samia, Ali, Raghib, Alkerwi, Ala'a, Alla, François, Allebeck, Peter, Al-Raddadi, Rajaa, Alsharif, Ubai, Altirkawi, Khalid A, Martin, Elena 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2016
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27. Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015

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Wang, Haidong, Bhutta, Zulfiqar A, Coates, Matthew M, Coggeshall, Megan, Dandona, Lalit, Diallo, Khassoum, Franca, Elisabeth Barboza, Fraser, Maya, Fullman, Nancy, Gething, Peter W, Hay, Simon I, Kinfu, Yohannes, Kita, Maaya, Kulikoff, Xie Rachel, Larson, Heidi J, Liang, Juan, Liang, Xiaofeng, Lim, Stephen S, Lind, Margaret, Lopez, Alan D, Lozano, Rafael, Mensah, George A, Mikesell, Joseph B, Mokdad, Ali H, Mooney, Meghan D, Naghavi, Mohsen, Nguyen, Grant, Rakovac, Ivo, Salomon, Joshua A, Silpakit, Naris, Sligar, Amber, Sorensen, Reed J D, Vos, Theo, Zhu, Jun, Abajobir, Amanuel Alemu, Abate, Kalkidan Hassen, Abbas, Kaja M, Abd-Allah, Foad, Abdulle, Abdishakur M, Abera, Semaw Ferede, Aboyans, Victor, Abraham, Biju, Abubakar, Ibrahim, Abu-Raddad, Laith J, Abu-Rmeileh, Niveen M E, Abyu, Gebre Yitayih, Achoki, Tom, Adebiyi, Akindele Olupelumi, Adedeji, Isaac Akinkunmi, Adelekan, Ademola Lukman, Adou, Arsène Kouablan, Agarwal, Arnav, Ajala, Oluremi N, Akinyemiju, Tomi F, Akseer, Nadia, Alam, Khurshid, Alam, Noore K M, Alasfoor, Deena, Aldridge, Robert William, Alegretti, Miguel Angel, Alemu, Zewdie Aderaw, Ali, Raghib, Alkerwi, Ala'a, Alla, François, Al-Raddadi, Rajaa, Alsharif, Ubai, Altirkawi, Khalid A, Martin, Elena Alvarez, Alvis-Guzman, Nelson, Amare, Azmeraw T, Amberbir, Alemayehu, Amegah, Adeladza Kofi, Ameh, Emmanuel A, Ammar, Walid, Amrock, Stephen Marc, Andersen, Hjalte H, Anderson, Gregory M, Antonio, Carl Abelardo T, Ärnlöv, Johan, Artaman, Al, Asayesh, Hamid, Asghar, Rana Jawad, Assadi, Reza, Atique, Suleman, Avokpaho, Euripide Frinel G Arthur, Awasthi, Ashish, Quintanilla, Beatriz Paulina Ayala, Bacha, Umar, Badawi, Alaa, Balakrishnan, Kalpana, Banerjee, Amitava, Banigbe, Bolanle F, Barac, Aleksandra, Barber, Ryan M, Barker-Collo, Suzanne L, Bärnighausen, Till, Barrero, Lope H, Bayou, Tigist Assefa, Bayou, Yibeltal Tebekaw, Bazargan-Hejazi, Shahrzad, Beardsley, Justin, Bedi, Neeraj, Bekele, Tolesa, Bell, Michelle L, Bello, Aminu K, Bennett, Derrick A, Bensenor, Isabela M, Berhane, Adugnaw, Bernabé, Eduardo, Betsu, Balem Demtsu, Beyene, Addisu Shunu, Bhatt, Samir, Biadgilign, Sibhatu, Bikbov, Boris, Birlik, Sait Mentes, Bisanzio, Donal, Bjertness, Espen, Blore, Jed D, Bourne, Rupert R A, Brainin, Michael, Brazinova, Alexandra, Breitborde, Nicholas J K, Brown, Alexandria, Buckle, Geoffrey Colin, Burch, Michael, Butt, Zahid A, Campos-Nonato, Ismael Ricardo, Campuzano, Julio Cesar, Cárdenas, Rosario, Carpenter, David O, Carrero, Juan Jesus, Carter, Austin, Casey, Daniel C, Castañeda-Orjuela, Carlos A, Rivas, Jacqueline Castillo, Castro, Ruben Estanislao, Catalá-López, Ferrán, Cercy, Kelly, Chang, Hsing-Yi, Chang, Jung-Chen, Chibueze, Chioma Ezinne, Chisumpa, Vesper Hichilombwe, Choi, Jee-Young Jasmine, Chowdhury, Rajiv, Christopher, Devasahayam Jesudas, Ciobanu, Liliana G, Colquhoun, Samantha M, Cooper, Cyrus, Cornaby, Leslie, Damtew, Solomon Abrha, Danawi, Hadi, Dandona, Rakhi, das Neves, José, Davis, Adrian C, de Jager, Pieter, De 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Amador, Gopalani, Sameer Vali, Goto, Atsushi, Gouda, Hebe N, Gugnani, Harish Chander, Guo, Yuming, Gupta, Rahul, Gupta, Rajeev, Gupta, Vipin, Gyawali, Bishal, Haagsma, Juanita A, Hafezi-Nejad, Nima, Haile, Demewoz, Hailu, Alemayehu Desalegne, Hailu, Gessessew Bugssa, Hamadeh, Randah Ribhi, Hamidi, Samer, Hancock, Jamie, Handal, Alexis J, Hankey, Graeme J, Harb, Hilda L, Harikrishnan, Sivadasanpillai, Harun, Kimani M, Havmoeller, Rasmus, Hay, Roderick J, Heredia-Pi, Ileana Beatriz, Hoek, Hans W, Horino, Masako, Horita, Nobuyuki, Hosgood, H Dean, Hotez, Peter J, Hoy, Damian G, Hsairi, Mohamed, Hu, Guoqing, Huang, Cheng, Huang, John J, Huang, Hsiang, Huiart, Laetitia, Huynh, Chantal, Iburg, Kim Moesgaard, Idrisov, Bulat T, Innos, Kaire, Jacobsen, Kathryn H, Jahanmehr, Nader, Javanbakht, Mehdi, Jayatilleke, Achala Upendra, Jee, Sun Ha, Jeemon, Panniyammakal, Jha, Vivekanand, Jiang, Guohong, Jiang, Ying, Jibat, Tariku, Jin, Ye, Jonas, Jost B, Kabir, Zubair, Kalkonde, Yogeshwar, Kamal, 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Sturua, Lela, Sunguya, Bruno F, Swaminathan, Soumya, Sykes, Bryan L, Szoeke, Cassandra E I, Tabarés-Seisdedos, Rafael, Tavakkoli, Mohammad, Taye, Bineyam, Tedla, Bemnet Amare, Tefera, Worku Mekonnen, Tekle, Tesfaye, Shifa, Girma Temam, Terkawi, Abdullah Sulieman, Tesfay, Fisaha Haile, Tessema, Gizachew Assefa, Thapa, Kiran, Thomson, Alan J, Thorne-Lyman, Andrew L, Tobe-Gai, Ruoyan, Tonelli, Marcello, Topor-Madry, Roman, Topouzis, Fotis, Tran, Bach Xuan, Troeger, Christopher, Truelsen, Thomas, Dimbuene, Zacharie Tsala, Tura, Abera Kenay, Tyrovolas, Stefanos, Ukwaja, Kingsley N, Uneke, Chigozie Jesse, Uthman, Olalekan A, Vaezghasemi, Masoud, Vasankari, Tommi, Vasconcelos, Ana Maria Nogales, Venketasubramanian, Narayanaswamy, Verma, Raj Kumar, Violante, Francesco S, Vladimirov, Sergey K, Vlassov, Vasiliy Victorovich, Vollset, Stein Emil, Wang, Linhong, Wang, Yanping, Weichenthal, Scott, Weiderpass, Elisabete, Weintraub, Robert G, Weiss, Daniel J, Werdecker, Andrea, Westerman, Ronny, Widdowson, Marc-Alain, Wijeratne, Tissa, Williams, Thomas Neil, Wiysonge, Charles Shey, Wolfe, Charles D A, Wolfe, Ingrid, Won, Sungho, Wubshet, Mamo, Xiao, Qingyang, Xu, Gelin, Yadav, Ajit Kumar, Yakob, Bereket, Yano, Yuichiro, Yaseri, Mehdi, Ye, Pengpeng, Yebyo, Henock Gebremedhin, Yip, Paul, Yonemoto, Naohiro, Yoon, Seok-Jun, Younis, Mustafa Z, Yu, Chuanhua, Zaidi, Zoubida, Zaki, Maysaa El Sayed, Zeeb, Hajo, Zhang, Hao, Zhao, Yong, Zheng, Yingfeng, Zhou, Maigeng, Zodpey, Sanjay, and Murray, Christopher J L

Published
2016
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28. An antidote to what’s ailing healthcare workers: a new (old) way of relational leadership

Author

Brian Park, Anaïs Tuepker, Cirila Estela Vasquez Guzman, Samuel Edwards, Elaine Waller Uchison, Cynthia Taylor, and M. Patrice Eiff

Abstract

Purpose The purpose of the study’s mixed-methods evaluation was to examine the ways in which a relational leadership development intervention enhanced participants’ abilities to apply relationship-oriented skills on their teams. Design/methodology/approach The authors evaluated five program cohorts from 2018–2021, involving 127 interprofessional participants. The study’s convergent mixed-method approach analyzed post-course surveys for descriptive statistics and interpreted six-month post-course interviews using qualitative conventional content analysis. Findings All intervention features were rated as at least moderately impactful by at least 83% of participants. The sense of community, as well as psychological safety and trust created, were rated as impactful features of the course by at least 94% of participants. At six months post-intervention, participants identified benefits of greater self-awareness, deeper understanding of others and increased confidence in supporting others, building relationships and making positive changes on their teams. Originality/value Relational leadership interventions may support participant skills for building connections, supporting others and optimizing teamwork. The high rate of skill application at six months post-course suggests that relational leadership development can be effective and sustainable in healthcare. As the COVID-19 pandemic and systemic crises continue to impact the psychological well-being of healthcare colleagues, relational leadership holds promise to address employee burnout, turnover and isolation on interprofessional care teams.

Published
2023

29. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

Author

Forouzanfar, Mohammad H, Alexander, Lily, Anderson, H Ross, Bachman, Victoria F, Biryukov, Stan, Brauer, Michael, Burnett, Richard, Casey, Daniel, Coates, Matthew M, Cohen, Aaron, Delwiche, Kristen, Estep, Kara, Frostad, Joseph J, KC, Astha, Kyu, Hmwe H, Moradi-Lakeh, Maziar, Ng, Marie, Slepak, Erica Leigh, Thomas, Bernadette A, Wagner, Joseph, Aasvang, Gunn Marit, Abbafati, Cristiana, Ozgoren, Ayse Abbasoglu, Abd-Allah, Foad, Abera, Semaw F, Aboyans, Victor, Abraham, Biju, Abraham, Jerry Puthenpurakal, Abubakar, Ibrahim, Abu-Rmeileh, Niveen M E, Aburto, Tania C, Achoki, Tom, Adelekan, Ademola, Adofo, Koranteng, Adou, Arsène K, Adsuar, José C, Afshin, Ashkan, Agardh, Emilie E, Al Khabouri, Mazin J, Al Lami, Faris H, Alam, Sayed Saidul, Alasfoor, Deena, Albittar, Mohammed I, Alegretti, Miguel A, Aleman, Alicia V, Alemu, Zewdie A, Alfonso-Cristancho, Rafael, Alhabib, Samia, Ali, Raghib, Ali, Mohammed K, Alla, François, Allebeck, Peter, Allen, Peter J, Alsharif, Ubai, Alvarez, Elena, 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M, Rushton, Lesley, Sabin, Nsanzimana, Sacco, Ralph L, Saha, Sukanta, Sahathevan, Ramesh, Sahraian, Mohammad Ali, Salomon, Joshua A, Salvo, Deborah, Sampson, Uchechukwu K, Sanabria, Juan R, Sanchez, Luz Maria, Sánchez-Pimienta, Tania G, Sanchez-Riera, Lidia, Sandar, Logan, Santos, Itamar S, Sapkota, Amir, Satpathy, Maheswar, Saunders, James E, Sawhney, Monika, Saylan, Mete I, Scarborough, Peter, Schmidt, Jürgen C, Schneider, Ione J C, Schöttker, Ben, Schwebel, David C, Scott, James G, Seedat, Soraya, Sepanlou, Sadaf G, Serdar, Berrin, Servan-Mori, Edson E, Shaddick, Gavin, Shahraz, Saeid, Levy, Teresa Shamah, Shangguan, Siyi, She, Jun, Sheikhbahaei, Sara, Shibuya, Kenji, Shin, Hwashin H, Shinohara, Yukito, Shiri, Rahman, Shishani, Kawkab, Shiue, Ivy, Sigfusdottir, Inga D, Silberberg, Donald H, Simard, Edgar P, Sindi, Shireen, Singh, Abhishek, Singh, Gitanjali M, Singh, Jasvinder A, Skirbekk, Vegard, Sliwa, Karen, Soljak, Michael, Soneji, Samir, Søreide, Kjetil, Soshnikov, Sergey, Sposato, Luciano A, Sreeramareddy, Chandrashekhar T, Stapelberg, Nicolas J C, Stathopoulou, Vasiliki, Steckling, Nadine, Stein, Dan J, Stein, Murray B, Stephens, Natalie, Stöckl, Heidi, Straif, Kurt, Stroumpoulis, Konstantinos, Sturua, Lela, Sunguya, Bruno F, Swaminathan, Soumya, Swaroop, Mamta, Sykes, Bryan L, Tabb, Karen M, Takahashi, Ken, Talongwa, Roberto T, Tandon, Nikhil, Tanne, David, Tanner, Marcel, Tavakkoli, Mohammad, Te Ao, Braden J, Teixeira, Carolina M, Téllez Rojo, Martha M, Terkawi, Abdullah S, Texcalac-Sangrador, José Luis, Thackway, Sarah V, Thomson, Blake, Thorne-Lyman, Andrew L, Thrift, Amanda G, Thurston, George D, Tillmann, Taavi, Tobollik, Myriam, Tonelli, Marcello, Topouzis, Fotis, Towbin, Jeffrey A, Toyoshima, Hideaki, Traebert, Jefferson, Tran, Bach X, Trasande, Leonardo, Trillini, Matias, Trujillo, Ulises, Dimbuene, Zacharie Tsala, Tsilimbaris, Miltiadis, Tuzcu, Emin Murat, Uchendu, Uche S, Ukwaja, Kingsley N, Uzun, Selen B, van de Vijver, Steven, Van Dingenen, Rita, van Gool, Coen H, van Os, Jim, Varakin, Yuri Y, Vasankari, Tommi J, Vasconcelos, Ana Maria N, Vavilala, Monica S, Veerman, Lennert J, Velasquez-Melendez, Gustavo, Venketasubramanian, N, Vijayakumar, Lakshmi, Villalpando, Salvador, Violante, Francesco S, Vlassov, Vasiliy Victorovich, Vollset, Stein Emil, Wagner, Gregory R, Waller, Stephen G, Wallin, Mitchell T, Wan, Xia, Wang, Haidong, Wang, JianLi, Wang, Linhong, Wang, Wenzhi, Wang, Yanping, Warouw, Tati S, Watts, Charlotte H, Weichenthal, Scott, Weiderpass, Elisabete, Weintraub, Robert G, Werdecker, Andrea, Wessells, K Ryan, Westerman, Ronny, Whiteford, Harvey A, Wilkinson, James D, Williams, Hywel C, Williams, Thomas N, Woldeyohannes, Solomon M, Wolfe, Charles D A, Wong, John Q, Woolf, Anthony D, Wright, Jonathan L, Wurtz, Brittany, Xu, Gelin, Yan, Lijing L, Yang, Gonghuan, Yano, Yuichiro, Ye, Pengpeng, Yenesew, Muluken, Yentür, Gökalp K, Yip, Paul, Yonemoto, Naohiro, Yoon, Seok-Jun, Younis, Mustafa Z, Younoussi, Zourkaleini, Yu, Chuanhua, Zaki, Maysaa E, Zhao, Yong, Zheng, Yingfeng, Zhou, Maigeng, Zhu, Jun, Zhu, Shankuan, Zou, Xiaonong, Zunt, Joseph R, Lopez, Alan D, Vos, Theo, and Murray, Christopher J

Published
2015
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30. Contributors

Author

Eiff, M. Patrice, primary, Hatch, Robert L., additional, Malaty, John, additional, Petering, Ryan C., additional, Petrizzi, Michael J., additional, Prawer, Adam J., additional, Smith, Michael Seth, additional, and Webb, Charles W., additional

Published
2018
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32. Preface

Author

Eiff, M. Patrice, primary and Hatch, Robert L., additional

Published
2018
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34. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

Author

Vos, Theo, Barber, Ryan M, Bell, Brad, Bertozzi-Villa, Amelia, Biryukov, Stan, Bolliger, Ian, Charlson, Fiona, Davis, Adrian, Degenhardt, Louisa, Dicker, Daniel, Duan, Leilei, Erskine, Holly, Feigin, Valery L, Ferrari, Alize J, Fitzmaurice, Christina, Fleming, Thomas, Graetz, Nicholas, Guinovart, Caterina, Haagsma, Juanita, Hansen, Gillian M, Hanson, Sarah Wulf, Heuton, Kyle R, Higashi, Hideki, Kassebaum, Nicholas, Kyu, Hmwe, Laurie, Evan, Liang, Xiofeng, Lofgren, Katherine, Lozano, Rafael, MacIntyre, Michael F, Moradi-Lakeh, Maziar, Naghavi, Mohsen, Nguyen, Grant, Odell, Shaun, Ortblad, Katrina, Roberts, David Allen, Roth, Gregory A, Sandar, Logan, Serina, Peter T, Stanaway, Jeffrey D, Steiner, Caitlyn, Thomas, Bernadette, Vollset, Stein Emil, Whiteford, Harvey, Wolock, Timothy M, Ye, Pengpeng, Zhou, Maigeng, Ãvila, Marco A, Aasvang, Gunn Marit, Abbafati, Cristiana, Ozgoren, Ayse Abbasoglu, Abd-Allah, Foad, Aziz, Muna I Abdel, Abera, Semaw F, Aboyans, Victor, Abraham, Jerry P, Abraham, Biju, Abubakar, Ibrahim, Abu-Raddad, Laith J, Abu-Rmeileh, Niveen ME, Aburto, Tania C, Achoki, Tom, Ackerman, Ilana N, Adelekan, Ademola, Ademi, Zanfina, Adou, Arsène K, Adsuar, Josef C, Arnlov, Johan, Agardh, Emilie E, Al Khabouri, Mazin J, Alam, Sayed Saidul, Alasfoor, Deena, Albittar, Mohammed I, Alegretti, Miguel A, Aleman, Alicia V, Alemu, Zewdie A, Alfonso-Cristancho, Rafael, Alhabib, Samia, Ali, Raghib, Alla, Francois, Allebeck, Peter, Allen, Peter J, AlMazroa, Mohammad AbdulAziz, Alsharif, Ubai, Alvarez, Elena, Alvis-Guzman, Nelson, Ameli, Omid, Amini, Heresh, Ammar, Walid, Anderson, Benjamin O, Anderson, H. Ross, Antonio, Carl Abelardo T, Anwari, Palwasha, Apfel, Henry, Arsenijevic, Valentain S Arsic, Artaman, Al, Asghar, Rana J, Assadi, Reza, Atkins, Lydia S, Atkinson, Charles, Badawi, Alaa, Bahit, Maria C, Bakfalouni, Talal, Balakrishnan, Kalpana, Balalla, Shivanthi, Banerjee, Amitava, Barker-Collo, Suzanne L, Barquera, Simon, Barregard, Lars, Barrero, Lope H, Basu, Sanjay, Basu, Arindam, Baxter, Amanda, Beardsley, Justin, Bedi, Neeraj, Beghi, Ettore, Bekele, Tolesa, Bell, Michelle L, Benjet, Corina, Bennett, Derrick A, Bensenor, Isabela M, Benzian, Habib, Bernabe, Eduardo, Beyene, Tariku J, Bhala, Neeraj, Bhalla, Ashish, Bhutta, Zulfiqar, Bienhoff, Kelly, Bikbov, Boris, Abdulhak, Aref Bin, Blore, Jed D, Blyth, Fiona M, Bohensky, Megan A, Basara, Berrak Bora, Borges, Guilherme, Bornstein, Natan M, Bose, Dipan, Boufous, Soufiane, Bourne, Rupert R, Boyers, Lindsay N, Brainin, Michael, Brauer, Michael, Brayne, Carol EG, Brazinova, Alexandra, Breitborde, Nicholas JK, Brenner, Hermann, Briggs, Adam DM, Brooks, Peter M, Brown, Jonathan, Brugha, Traolach S, Buchbinder, Rachelle, Buckle, Geoffrey C, Bukhman, Gene, Bulloch, Andrew G, Burch, Michael, Burnett, Richard, Cardenas, Rosario, Cabral, Norberto L, Nonato, Ismael R Campos, Campuzano, Julio C, Carapetis, Jonathan R, Carpenter, David O, Caso, Valeria, Castaneda-Orjuela, Carlos A, Catala-Lopez, Ferran, Chadha, Vineet K, Chang, Jung-Chen, Chen, Honglei, Chen, Wanqing, Chiang, Peggy P, Chimed-Ochir, Odgerel, Chowdhury, Rajiv, Christensen, Hanne, Christophi, Costas A, Chugh, Sumeet S, Cirillo, Massimo, Coggeshall, Megan, Cohen, Aaron, Colistro, Valentina, Colquhoun, Samantha M, Contreras, Alejandra G, Cooper, Leslie T, Cooper, Cyrus, Cooperrider, Kimberly, Coresh, Josef, Cortinovis, Monica, Criqui, Michael H, Crump, John A, Cuevas-Nasu, Lucia, Dandona, Rakhi, Dandona, Lalit, Dansereau, Emily, Dantes, Hector G, Dargan, Paul I, Davey, Gail, Davitoiu, Dragos V, Dayama, Anand, De la Cruz-Gongora, Vanessa, de la Vega, Shelley F, De Leo, Diego, del Pozo-Cruz, Borja, Dellavalle, Robert P, Deribe, Kebede, Derrett, Sarah, Des Jarlais, Don C, Dessalegn, Muluken, deVeber, Gabrielle A, Dharmaratne, Samath D, Diaz-Torne, Cesar, Ding, Eric L, Dokova, Klara, Dorsey, E R, Driscoll, Tim R, Duber, Herbert, Durrani, Adnan M, Edmond, Karen M, Ellenbogen, Richard G, Endres, Matthias, Ermakov, Sergey P, Eshrati, Babak, Esteghamati, Alireza, Estep, Kara, Fahimi, Saman, Farzadfar, Farshad, Fay, Derek FJ, Felson, David T, Fereshtehnejad, Seyed-Mohammad, Fernandes, Jefferson G, Ferri, Cluesa P, Flaxman, Abraham, Foigt, Nataliya, Foreman, Kyle J, Fowkes, F Gerry R, Franklin, Richard C, Furst, Thomas, Futran, Neal D, Gabbe, Belinda J, Gankpe, Fortune G, Garcia-Guerra, Francisco A, Geleijnse, Johanna M, Gessner, Bradford D, Gibney, Katherine B, Gillum, Richard F, Ginawi, Ibrahim A, Giroud, Maurice, Giussani, Giorgia, Goenka, Shifalika, Goginashvili, Ketevan, Gona, Philimon, de Cosio, Teresita Gonzalez, Gosselin, Richard A, Gotay, Carolyn C, Goto, Atsushi, Gouda, Hebe N, Guerrant, Richard l, Gugnani, Harish C, Gunnell, David, Gupta, Rajeev, Gupta, Rahul, Gutierrez, Reyna A, Hafezi-Nejad, Nima, Hagan, Holly, Halasa, Yara, Hamadeh, Randah R, Hamavid, Hannah, Hammami, Mouhanad, Hankey, Graeme J, Hao, Yuantao, Harb, Hilda L, Haro, Josep Maria, Havmoeller, Rasmus, Hay, Roderick J, Hay, Simon, Hedayati, Mohammad T, Pi, Ileana B Heredia, Heydarpour, Pouria, Hijar, Martha, Hoek, Hans W, Hoffman, Howard J, Hornberger, John C, Hosgood, H. Dean, Hossain, Mazeda, Hotez, Peter J, Hoy, Damian G, Hsairi, Mohamed, Hu, Howard, Hu, Guoqing, Huang, John J, Huang, Cheng, Huiart, Laetitia, Husseini, Abdullatif, Iannarone, Marissa, Iburg, Kim M, Innos, Kaire, Inoue, Manami, Jacobsen, Kathryn H, Jassal, Simerjot K, Jeemon, Panniyammakal, Jensen, Paul N, Jha, Vivekanand, Jiang, Guohong, Jiang, Ying, Jonas, Jost B, Joseph, Jonathan, Juel, Knud, Kan, Haidong, Karch, Andre, Karimkhani, Chante, Karthikeyan, Ganesan, Katz, Ronit, Kaul, Anil, Kawakami, Norito, Kazi, Dhruv S, Kemp, Andrew H, Kengne, Andre P, Khader, Yousef S, Khalifa, Shams Eldin AH, Khan, Ejaz A, Khan, Gulfaraz, Khang, Young-Ho, Khonelidze, Irma, Kieling, Christian, Kim, Daniel, Kim, Sungroul, Kimokoti, Ruth W, Kinfu, Yohannes, Kinge, Jonas M, Kissela, Brett M, Kivipelto, Miia, Knibbs, Luke, Knudsen, Ann Kristin, Kokubo, Yoshihiro, Kosen, Soewarta, Kramer, Alexander, Kravchenko, Michael, Krishnamurthi, Rita V, Krishnaswami, Sanjay, Defo, Barthelemy Kuate, Bicer, Burcu Kucuk, Kuipers, Ernst J, Kulkarni, Veena S, Kumar, Kaushalendra, Kumar, G Anil, Kwan, Gene F, Lai, Taavi, Lalloo, Ratilal, Lam, Hilton, Lan, Qing, Lansingh, Van C, Larson, Heidi, Larsson, Anders, Lawrynowicz, Alicia EB, Leasher, Janet L, Lee, Jong-Tae, Leigh, James, Leung, Ricky, Levi, Miriam, Li, Bin, Li, Yichong, Li, Yongmei, liang, Juan, Lim, Stephen, Lin, Hsien-Ho, Lind, Margaret, Lindsay, M Patrice, Lipshultz, Steven E, Liu, Shiwei, Lloyd, Belinda K, Ohno, Summer Lockett, Logroscino, Giancarlo, Looker, Katharine J, Lopez, Alan D, Lopez-Olmedo, Nancy, Lortet-Tieulent, Joannie, Lotufo, Paulo A, Low, Nicola, Lucas, Robyn M, Lunevicius, Raimundas, Lyons, Ronan A, Ma, Jixiang, Ma, Stefan, Mackay, Mark T, Majdan, Marek, Malekzadeh, Reza, Mapoma, Christopher C, Marcenes, Wagner, March, Lyn M, Margono, Chris, Marks, Guy B, Marzan, Melvin B, Masci, Joseph R, Mason-Jones, Amanda J, Matzopoulos, Richard G, Mayosi, Bongani M, Mazorodze, Tasara T, McGill, Neil W, McGrath, John J, McKee, Martin, McLain, Abby, McMahon, Brian J, Meaney, Peter A, Mehndiratta, Man Mohan, Mejia-Rodriguez, Fabiola, Mekonnen, Wubegzier, Melaku, Yohannes A, Meltzer, Michele, Memish, Ziad A, Mensah, George, Meretoja, Atte, Mhimbira, Francis A, Micha, Renata, Miller, Ted R, Mills, Edward J, Mitchell, Philip B, Mock, Charles N, Moffitt, Terrie E, Ibrahim, Norlinah Mohamed, Mohammad, Karzan A, Mokdad, Ali H, Mola, Glen L, Monasta, Lorenzo, Montico, Marcella, Montine, Thomas J, Moore, Ami R, Moran, Andrew E, Morawska, Lidia, Mori, Rintaro, Moschandreas, Joanna, Moturi, Wilkister N, Moyer, Madeline, Mozaffarian, Dariush, Mueller, Ulrich O, Mukaigawara, Mitsuru, Murdoch, Michele E, Murray, Joseph, Murthy, Kinnari S, Naghavi, Paria, Nahas, Ziad, Naheed, Aliya, Naidoo, Kovin S, Naldi, Luigi, Nand, Devina, Nangia, Vinay, Narayan, K.M. Venkat, Nash, Denis, Nejjari, Chakib, Neupane, Sudan P, Newman, Lori M, Newton, Charles R, Ng, Marie, Ngalesoni, Frida N, Nhung, Nguyen T, Nisar, Muhammad I, Nolte, Sandra, Norheim, Ole F, Norman, Rosana E, Norrving, Bo, Nyakarahuka, Luke, Oh, In Hwan, Ohkubo, Takayoshi, Omer, Saad B, Opio, John Nelson, Ortiz, Alberto, Pandian, Jeyaraj D, Panelo, Carlo Irwin A, Papachristou, Christina, Park, Eun-Kee, Parry, Charles D, Caicedo, Angel J Paternina, Patten, Scott B, Paul, Vinod K, Pavlin, Boris I, Pearce, Neil, Pedraza, Lilia S, Pellegrini, Carlos A, Pereira, David M, Perez-Ruiz, Fernando P, Perico, Norberto, Pervaiz, Aslam, Pesudovs, Konrad, Peterson, Carrie B, Petzold, Max, Phillips, Michael R, Phillips, David, Phillips, Bryan, Piel, Frederic B, Plass, Dietrich, Poenaru, Dan, Polanczyk, Guilherme V, Polinder, Suzanne, Pope, C A, Popova, Svetlana, Poulton, Richie G, Pourmalek, Farshad, Prabhakaran, Dorairaj, Prasad, Noela M, Qato, Dima, Quistberg, D A, Rafay, Anwar, Rahimi, Kazem, Rahimi-Movaghar, Vafa, Rahman, Sajjad ur, Raju, Murugesan, Rakovac, Ivo, Rana, Saleem M, Razavi, Homie, Refaat, Amany, Rehm, Jurgen, Remuzzi, Giuseppe, Resnikoff, Serge, Ribeiro, Antonio L, Riccio, Patricia M, Richardson, Lee, Richardus, Jan Hendrik, Riederer, Anne M, Robinson, Margot, Roca, Anna, Rodriguez, Alina, Rojas-Rueda, David, Ronfani, Luca, Rothenbacher, Dietrich, Roy, Nobhojit, Ruhago, George M, Sabin, Nsanzimana, Sacco, Ralph L, Ksoreide, Kjetil, Saha, Sukanta, Sahathevan, Ramesh, Sahraian, Mohammad Ali, Sampson, Uchechukwu, Sanabria, Juan R, Sanchez-Riera, Lidia, Santos, Itamar S, Satpathy, Maheswar, Saunders, James E, Sawhney, Monika, Saylan, Mete I, Scarborough, Peter, Schoettker, Ben, Schneider, Ione JC, Schwebel, David C, Scott, James G, Seedat, Soraya, Sepanlou, Sadaf G, Serdar, Berrin, Servan-Mori, Edson E, Shackelford, Katya, Shaheen, Amira, Shahraz, Saeid, Levy, Teresa Shamah, Shangguan, Siyi, She, Jun, Sheikhbahaei, Sara, Shepard, Donald S, Shi, Peilin, Shibuya, Kenji, Shinohara, Yukito, Shiri, Rahman, Shishani, Kawkab, Shiue, Ivy, Shrime, Mark G, Sigfusdottir, Inga D, Silberberg, Donald H, Simard, Edgar P, Sindi, Shireen, Singh, Jasvinder A, Singh, Lavanya, Skirbekk, Vegard, Sliwa, Karen, Soljak, Michael, Soneji, Samir, Soshnikov, Sergey S, Speyer, Peter, Sposato, Luciano A, Sreeramareddy, Chandrashekhar T, Stoeckl, Heidi, Stathopoulou, Vasiliki Kalliopi, Steckling, Nadine, Stein, Murray B, Stein, Dan J, Steiner, Timothy J, Stewart, Andrea, Stork, Eden, Stovner, Lars J, Stroumpoulis, Konstantinos, Sturua, Lela, Sunguya, Bruno F, Swaroop, Mamta, Sykes, Bryan L, Tabb, Karen M, Takahashi, Ken, Tan, Feng, Tandon, Nikhil, Tanne, David, Tanner, Marcel, Tavakkoli, Mohammad, Taylor, Hugh R, Te Ao, Braden J, Temesgen, Awoke Misganaw, Have, Margreet Ten, Tenkorang, Eric Yeboah, Terkawi, Abdullah Sulieman, Theadom, Alice M, Thomas, Elissa, Thorne-Lyman, Andrew L, Thrift, Amanda G, Tleyjeh, Imad M, Tonelli, Marcello, Topouzis, Fotis, Towbin, Jeffrey A, Toyoshima, Hideaki, Traebert, Jefferson, Tran, Bach X, Trasande, Leonardo, Trillini, Matias, Truelsen, Thomas, Trujillo, Ulises, Tsilimbaris, Miltiadis, Tuzcu, Emin M, Ukwaja, Kingsley N, Undurraga, Eduardo A, Uzun, Selen B, van Brakel, Wim H, van de Vijver, Steven, Dingenen, Rita Van, van Gool, Coen H, Varakin, Yuri Y, Vasankari, Tommi J, Vavilala, Monica S, Veerman, Lennert J, Velasquez-Melendez, Gustavo, Venketasubramanian, Narayanaswamy, Vijayakumar, Lakshmi, Villalpando, Salvador, Violante, Francesco S, Vlassov, Vasiliy V, Waller, Stephen, Wallin, Mitchell T, Wan, Xia, Wang, Linhong, Wang, JianLi, Wang, Yanping, Warouw, Tati S, Weichenthal, Scott, Weiderpass, Elisabete, Weintraub, Robert G, Werdecker, Andrea, Wessells, K. Ryan R, Westerman, Ronny, Wilkinson, James D, Williams, Hywel C, Williams, Thomas N, Woldeyohannes, Solomon M, Wolfe, Charles DA, Wong, John Q, Wong, Haidong, Woolf, Anthony D, Wright, Jonathan L, Wurtz, Brittany, Xu, Gelin, Yang, Gonghuan, Yano, Yuichiro, Yenesew, Muluken A, Yentur, Gokalp K, Yip, Paul, Yonemoto, Naohiro, Yoon, Seok-Jun, Younis, Mustafa, Yu, Chuanhua, Kim, Kim Yun, Zaki, Maysaa El Sayed, Zhang, Yong, Zhao, Zheng, Zhao, Yong, Zhu, Jun, Zonies, David, Zunt, Joseph R, Salomon, Joshua A, and Murray, Christopher JL

Published
2015
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35. Concerning trends in allopathic medical school faculty rank for Indigenous people: 2014–2016

Author

Erik Brodt, Amanda Bruegl, Erin K. Thayer, M. Patrice Eiff, Kelly Gonzales, Carlos Crespo, Dove Spector, Martina Kamaka, Dee-Ann Carpenter, and Patricia A. Carney

Subjects
Medical school faculty, faculty rank, race/ethnicity, Indigenous people, diversity, Special aspects of education, LC8-6691, Medicine (General), R5-920
Abstract

Background: Trends in faculty rank according to racial and ethnic composition have not been reviewed in over a decade. Objective: To study trends in faculty rank according to racial and ethnicity with a specific focus on Indigenous faculty, which has been understudied. Methods: Data from the Association of American Medical Colleges’ Faculty Administrative Management Online User System was used to study trends in race/ethnicity faculty composition and rank between 2014 and 2016, which included information on 481,753 faculty members from 141 US allopathic medical schools. Results: The majority of medical school faculty were White, 62.4% (n = 300,642). Asian composition represented 14.7% (n = 70,647). Hispanic, Latino, or of Spanish Origin; Multiple Race-Hispanic; Multiple Race-Non-Hispanic; and Black/African American faculty represented 2.2%, 2.3%, 3.0%, and 3.0%, respectively. Indigenous faculty members, defined as American Indian/Alaska Native (AIAN), Native Hawaiian or Other Pacific Islander (NHPI), represented the smallest percentage of faculty at 0.11% and 0.18%, respectively. White faculty predominated the full professor rank at 27.5% in 2016 with a slight decrease between 2014 and 2016. Indigenous faculty represented the lowest percent of full professor faculty at 5.2% in 2016 for AIAN faculty and a decline from 4.6% to 1.6% between 2014 and 2016 for NHPI faculty (p

Published
2018
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36. Endovascular thrombectomy and intravenous alteplase in patients with acute ischemic stroke due to large vessel occlusion: A clinical practice guideline

Author

Ye, Zhikang, primary, Busse, Jason W., additional, Hill, Michael D., additional, Lindsay, M. Patrice, additional, Guyatt, Gordon H., additional, Prasad, Kameshwar, additional, Agarwal, Arnav, additional, Beattie, Cheryl, additional, Beattie, Jim, additional, Dodd, Cynthia, additional, Heran, Manraj K.S., additional, Narayan, Sunil, additional, Chartúir, Norita NÍ, additional, O'Donnell, Martin, additional, Resmini, Ilaria, additional, Sacco, Simona, additional, Sylaja, P N, additional, Volders, David, additional, Wang, Xin, additional, Xie, Feng, additional, Zachrison, Kori S., additional, Zhang, Lingli, additional, Zhong, Hongliang, additional, An, Zhuoling, additional, and Smith, Eric E., additional

Published
2022
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37. Canadian Stroke Best Practice Recommendations: Secondary Prevention of Stroke Update 2020

Author

William Semchuk, Gord Gubitz, Jennifer Mandzia, Shelagh B. Coutts, Daniel Ngui, Carmen Tuchak, Tammy Tebbutt, Marilyn Labrie, Karina Villaluna, Eric E. Smith, Stephen van Gaal, Alexandre Y Poppe, Aline Bourgoin, Jacob A. Udell, John Falconer, Jafna L. Cox, Dar Dowlatshahi, Norine Foley, James D. Douketis, Brett R Graham, Lena McDonald, Rebecca McGuff, Amanda Rodgerson, Anita D. Mountain, David J. Gladstone, Theodore Wein, Paul Pageau, and M. Patrice Lindsay

Subjects
Male, Canada, medicine.medical_specialty, Disease, Atrial Fibrillation, Antithrombotic, Secondary Prevention, medicine, Humans, cardiovascular diseases, Intensive care medicine, Stroke, Ischemic Stroke, business.industry, Anticoagulants, Atrial fibrillation, General Medicine, Guideline, medicine.disease, Triage, Neurology, Ischemic Attack, Transient, Patent foramen ovale, Female, Neurology (clinical), business, Risk assessment
Abstract

The 2020 update of the Canadian Stroke Best Practice Recommendations (CSBPR) for the Secondary Prevention of Stroke includes current evidence-based recommendations and expert opinions intended for use by clinicians across a broad range of settings. They provide guidance for the prevention of ischemic stroke recurrence through the identification and management of modifiable vascular risk factors. Recommendations address triage, diagnostic testing, lifestyle behaviors, vaping, hypertension, hyperlipidemia, diabetes, atrial fibrillation, other cardiac conditions, antiplatelet and anticoagulant therapies, and carotid and vertebral artery disease. This update of the previous 2017 guideline contains several new or revised recommendations. Recommendations regarding triage and initial assessment of acute transient ischemic attack (TIA) and minor stroke have been simplified, and selected aspects of the etiological stroke workup are revised. Updated treatment recommendations based on new evidence have been made for dual antiplatelet therapy for TIA and minor stroke; anticoagulant therapy for atrial fibrillation; embolic strokes of undetermined source; low-density lipoprotein lowering; hypertriglyceridemia; diabetes treatment; and patent foramen ovale management. A new section has been added to provide practical guidance regarding temporary interruption of antithrombotic therapy for surgical procedures. Cancer-associated ischemic stroke is addressed. A section on virtual care delivery of secondary stroke prevention services in included to highlight a shifting paradigm of care delivery made more urgent by the global pandemic. In addition, where appropriate, sex differences as they pertain to treatments have been addressed. The CSBPR include supporting materials such as implementation resources to facilitate the adoption of evidence into practice and performance measures to enable monitoring of uptake and effectiveness of recommendations.

Published
2021

38. Endovascular thrombectomy and intravenous alteplase in patients with acute ischemic stroke due to large vessel occlusion: A clinical practice guideline

Author

Zhikang, Ye, Busse, Jason W, Hill, Michael D, Lindsay, M Patrice, Guyatt, Gordon H, Prasad, Kameshwar, Agarwal, Arnav, Beattie, Cheryl, Beattie, Jim, Dodd, Cynthia, Heran, Manraj K S, Narayan, Sunil, Chartúir, Norita Ní, O'Donnell, Martin, Resmini, Ilaria, Sacco, Simona, Sylaja, P N, Volders, David, Wang, Xin, Xie, Feng, Zachrison, Kori S, Zhang, Lingli, Zhong, Hongliang, Zhuoling, An, and Smith, Eric E

Subjects
Health Policy, Endovascular Procedures, endovascular thrombectomy, General Medicine, Brain Ischemia, Stroke, Treatment Outcome, Fibrinolytic Agents, Tissue Plasminogen Activator, Humans, Thrombolytic Therapy, alteplase, clinical practice guideline, stroke, Ischemic Stroke, Thrombectomy
Abstract

Whether or not use of intravenous alteplase in combination with endovascular thrombectomy (EVT) improves outcomes versus EVT alone, for acute stroke patients with large vessel occlusion presenting directly to a comprehensive stroke center, is uncertain.Six randomized trials exploring this issue were published, and we synthesized this evidence to inform a rapid guideline based on the Guidelines International Network principles and guided by the GRADE approach.We enlisted an international panel that included 4 patient partners and 1 caregiver, individuals from 6 countries. The panel considered low certainty evidence that EVT alone, relative to EVT with intravenous alteplase, possibly results in a small decrease in the proportion of patients that achieve functional independence and possibly a small increase in mortality. Both effect estimates were downgraded twice due to very serious imprecision. The panel also considered moderate certainty evidence that EVT alone probably decreases symptomatic intracranial hemorrhage, versus EVT with alteplase, and combination therapy was more costly than EVT alone. As a result of the low certainty for improved recovery without impairment and mortality for combination therapy versus EVT alone, and moderate certainty for increased harm with combination therapy, the panel made a weak recommendation in favor of EVT alone for stroke patients eligible for both treatments, and initially presenting directly to a comprehensive stroke center that provides both treatments.Consistent with this weak recommendation, optimal patient management will likely often include co-treatment with intravenous alteplase, depending on local circumstances and patient presentation.

Published
2022

39. Canadian Stroke Best Practice Recommendations: Secondary Prevention of Stroke Update 2020 - ADDENDUM

Author

David J. Gladstone, M. Patrice Lindsay, James Douketis, Eric E. Smith, Dar Dowlatshahi, Theodore Wein, Aline Bourgoin, Jafna Cox, John B. Falconer, Brett R. Graham, Marilyn Labrie, Lena McDonald, Jennifer Mandzia, Daniel Ngui, Paul Pageau, Amanda Rodgerson, William Semchuk, Tammy Tebbutt, Carmen Tuchak, Stephen van Gaal, Karina Villaluna, Norine Foley, Shelagh Coutts, Anita Mountain, Gord Gubitz, Jacob A Udell, Rebecca McGuff, Manraj K.S. Heran, Pascale Lavoie, and Alexandre Y. Poppe

Subjects
Neurology, Neurology (clinical), General Medicine
Published
2022

40. Financial Considerations Associated With a Fourth Year of Residency Training in Family Medicine: Findings From the Length of Training Pilot Study

Author

James C. Martin, Samuel M. Jones, M. Patrice Eiff, Annie Ericson, Patricia A. Carney, Colleen Conry, Deborah S. Clements, and Perry A. Pugno

Subjects
Finance, medicine.medical_specialty, Descriptive statistics, business.industry, Loan repayment, Internship and Residency, Financial plan, Pilot Projects, Training (civil), Focus group, Test (assessment), Education, Medical, Graduate, Surveys and Questionnaires, Family medicine, medicine, Humans, Student debt, Family Practice, Psychology, business, Residency training
Abstract

Background and Objectives: The feasibility of funding an additional year of residency training is unknown, as are perspectives of residents regarding related financial considerations. We examined these issues in the Family Medicine Length of Training Pilot. Methods: Between 2013 and 2019, we collected data on matched 3-year and 4-year programs using annual surveys, focus groups, and in-person and telephone interviews. We analyzed survey quantitative data using descriptive statistics, independent samples t test, Fisher’s Exact Test and χ2. Qualitative analyses involved identifying emergent themes, defining them and presenting exemplars. Results: Postgraduate year (PGY)-4 residents in 4-year programs were more likely to moonlight to supplement their resident salaries compared to PGY-3 residents in three-year programs (41.6% vs 23.0%; P=.002), though their student debt load was similar. We found no differences in enrollment in loan repayment programs or pretax income. Programs’ descriptions of financing a fourth year as reported by the program director were limited and budget numbers could not be obtained. However, programs that required a fourth year typically reported extensive planning to determine how to fund the additional year. Programs with an optional fourth year were budget neutral because few residents chose to undertake an additional year of training. Resources needed for a required fourth year included resident salaries for the fourth year, one additional faculty, and one staff member to assist with more complex scheduling. Residents’ concerns about financial issues varied widely. Conclusions: Adding a fourth year of training was financially feasible but details are local and programs could not be compared directly. For programs that had a required rather than optional fourth year much more financial planning was needed.

Published
2021

41. Endovascular thrombectomy with or without intravenous alteplase for acute ischemic stroke due to large vessel occlusion: a systematic review and meta-analysis of randomized trials

Author

Wang, Xin, primary, Ye, Zhikang, additional, Busse, Jason W, additional, Hill, Michael D, additional, Smith, Eric E, additional, Guyatt, Gordon H, additional, Prasad, Kameshwar, additional, Lindsay, M Patrice, additional, Yang, Hui, additional, Zhang, Yi, additional, Liu, Ying, additional, Tang, Borui, additional, Wang, Xinrui, additional, Wang, Yushu, additional, Couban, Rachel J, additional, and An, Zhuoling, additional

Published
2022
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42. Canadian stroke best practice recommendations: Management of Spontaneous Intracerebral Hemorrhage, 7th Edition Update 2020

Author

Mark Crowther, Thien J. Huynh, Anne Cayley, M. Patrice Lindsay, Gord Gubitz, Samuel Yip, Laura C. Gioia, Shane W. English, Lana A Castellucci, Dar Dowlatshahi, Kerstin de Wit, Cian O'Kelly, Jeanne Teitelbaum, Sharon Hoosein, Norine Foley, Eric E. Smith, Anita Mountain, Aleksandra Pikula, Michael Kelly, and Ashkan Shoamanesh

Subjects
medicine.medical_specialty, Rehabilitation, Neurology, business.industry, medicine.medical_treatment, Emergency medicine, Ischemic stroke, Medicine, Spontaneous intracerebral hemorrhage, business, medicine.disease, Stroke
Abstract

Spontaneous intracerebral hemorrhage is a particularly devastating type of stroke with greater morbidity and mortality compared with ischemic stroke and can account for half or more of all deaths from stroke. The seventh update of the Canadian Stroke Best Practice Recommendations includes a new stand-alone module on intracerebral hemorrhage, with a focus on elements of care that are unique or affect persons disproportionately relative to ischemic stroke. Prior to this edition, intracerebral hemorrhage was included in the Acute Stroke Management module and was limited to its management during the first 12 h. With the growing evidence on intracerebral hemorrhage, a separate module focused on this topic across the care continuum was added. In addition to topics related to initial clinical management, neuroimaging, blood pressure management, and surgical management, new sections have been introduced addressing topics surrounding inpatient complications such as venous thromboembolism, seizure management, and increased intracranial pressure, rehabilitation as well as issues related to secondary management including lifestyle management, maintaining a normal blood pressure and antithrombotic therapy, are addressed. The Canadian Stroke Best Practice Recommendations ( CSBPR) are intended to provide up-to-date evidence-based guidelines for the prevention and management of stroke and to promote optimal recovery and reintegration for people who have experienced stroke, including patients, families, and informal caregivers.

Published
2020

43. Recommandations canadiennes pour les pratiques optimales de soins de l’AVC, septième édition : l’acide acétylsalicylique pour la prévention d’événements vasculaires

Author

James D. Douketis, Andrea de Jong, Thalia S. Field, Anita Mountain, Jafna L. Cox, Anne Simard, David J. Gladstone, Alexandre Y Poppe, Mikul Sharma, William Semchuk, Jacob A. Udell, Shelagh B. Coutts, M. Patrice Lindsay, Gord Gubitz, Leanne K. Casaubon, Theodore Wein, Alan Bell, Shamir R. Mehta, Laura C. Gioia, Jeffrey Habert, Norine Foley, Christine Papoushek, Stephanie Lawrence, Eric E. Smith, Dar Dowlatshahi, and Eddy Lang

Subjects
Gynecology, 03 medical and health sciences, medicine.medical_specialty, 0302 clinical medicine, Ligne Directrice, business.industry, medicine, 030212 general & internal medicine, General Medicine, 030204 cardiovascular system & hematology, business
Abstract

POINTS CLES En 2016, au Canada (a l’exclusion du Quebec), 270 204 personnes ont ete admises a l’hopital pour un trouble cardiaque, un accident vasculaire cerebral (AVC) ou un deficit cognitif d’origine vasculaire; de ce nombre, 107 391 etaient des femmes, 162 813 etaient des hommes

Published
2020

44. Conditions Influencing Collaboration Among the Primary Care Disciplines as They Prepare the Future Primary Care Physician Workforce

Author

Carol Carraccio, Larry A. Green, Eric J. Warm, Erin K. Thayer, Eric S. Holmboe, Patricia A. Carney, and M. Patrice Eiff

Subjects
Medical education, Complete data, business.industry, education, Stressor, Primary care physician, Identity (social science), Primary care, Interprofessional education, Health care, Workforce, Family Practice, business, Psychology
Abstract

Background and Objectives: Much can be gained by the three primary care disciplines collaborating on efforts to transform residency training toward interprofessional collaborative practice. We describe findings from a study designed to align primary care disciplines toward implementing interprofessional education. Methods: In this mixed methods study, we included faculty, residents and other interprofessional learners in family medicine, internal medicine, and pediatrics from nine institutions across the United States. We administered a web-based survey in April/May of 2018 and used qualitative analyses of field notes to study resident exposure to team-based care during training, estimates of career choice in programs that are innovating, and supportive and challenging conditions that influence collaboration among the three disciplines. Complete data capture was attained for 96.3% of participants. Results: Among family medicine resident graduates, an estimated 87.1% chose to go into primary care compared to 12.4% of internal medicine, and 36.5% of pediatric resident graduates. Qualitative themes found to positively influence cross-disciplinary collaboration included relationship development, communication of shared goals, alignment with health system/other institutional initiatives, and professional identity as primary care physicians. Challenges included expressed concerns by participants that by working together, the disciplines would experience a loss of identity and would be indistinguishable from one another. Another qualitative finding was that overwhelming stressors plague primary care training programs in the current health care climate—a great concern. These include competing demands, disruptive transitions, and lack of resources. Conclusions: Uniting the primary care disciplines toward educational and clinical transformation toward interprofessional collaborative practice is challenging to accomplish.

Published
2020

45. Canadian Stroke Best Practice Guidance During the COVID-19 Pandemic

Author

Michael D. Hill, Anne Simard, Leanne K. Casaubon, Elizabeth Linkewich, Theodore Wein, Dylan Blacquiere, M. Patrice Lindsay, Anita Mountain, Gord Gubitz, Eric E. Smith, and Norine Foley

Subjects
Canada, 2019-20 coronavirus outbreak, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Best practice, Pneumonia, Viral, Clinical Neurology, Knowledge translation, Betacoronavirus, Pandemic, medicine, Coronavirus 2019, Humans, Intensive care medicine, Pandemics, Stroke, biology, SARS-CoV-2, business.industry, Prevention, Rehabilitation, COVID-19, General Medicine, biology.organism_classification, medicine.disease, Neurology, Telestroke, Practice Guidelines as Topic, Commentary, Neurology (clinical), Coronavirus Infections, business, Clinical practice guidelines
Published
2020

46. Canadian Stroke Best Practice Recommendations, seventh edition: acetylsalicylic acid for prevention of vascular events

Author

Jafna L. Cox, Andrea de Jong, Anne Simard, Eddy Lang, Mikul Sharma, Theodore Wein, James D. Douketis, Gord Gubitz, Christine Papoushek, Jacob A. Udell, Eric E. Smith, Alan Bell, Norine Foley, Jeffrey Habert, Stephanie Lawrence, William Semchuk, Anita Mountain, Leanne K. Casaubon, Shelagh B. Coutts, David J. Gladstone, Shamir R. Mehta, Dar Dowlatshahi, Alexandre Y Poppe, Thalia S. Field, M. Patrice Lindsay, and Laura C. Gioia

Subjects
Canada, medicine.medical_specialty, Best practice, MEDLINE, Guideline, 030204 cardiovascular system & hematology, Risk Assessment, 03 medical and health sciences, 0302 clinical medicine, Secondary Prevention, medicine, Humans, Letters, 030212 general & internal medicine, Cognitive impairment, Stroke, Aspirin, business.industry, General Medicine, medicine.disease, Primary Prevention, Cardiovascular Diseases, Emergency medicine, business, Decision Making, Shared
Abstract

KEY POINTS In 2016, 270 204 people in Canada (excluding Quebec) were admitted to hospital for heart conditions, stroke and vascular cognitive impairment, including 107 391 women and 162 813 men, of whom 91 524 died.[1][1] This equates to 1 out of every 3 deaths in Canada and outpaces other diseases

Published
2020

47. Canadian Stroke Best Practice Recommendations: Rehabilitation, Recovery, and Community Participation following Stroke. Part One: Rehabilitation and Recovery Following Stroke; 6th Edition Update 2019

Author

Sue Verrilli, Jill I. Cameron, Sherri L. Carter, Sepideh Pooyania, Andrea de Jong, Erin Symcox, Nancy M. Salbach, Bridget D. Stack, Annie Rochette, Nicole E. Acerra, Jocelyn E. Harris, Suja Varghese, Dar Dowlatshahi, Andrea Noland, Gord Gubitz, Robert Teasell, Mary Lou Halabi, Joyce Fung, Norine Foley, Leanne K. Casaubon, Esther Kim, Diana Bastasi, Anita Mountain, Debbie Timpson, M. Patrice Lindsay, and Jerome Iruthayarajah

Subjects
030506 rehabilitation, medicine.medical_specialty, Rehabilitation, Activities of daily living, business.industry, medicine.medical_treatment, media_common.quotation_subject, Psychological intervention, medicine.disease, Neglect, 03 medical and health sciences, 0302 clinical medicine, Hemiparesis, Physical medicine and rehabilitation, Neurology, Aphasia, Medicine, Pediatric stroke, medicine.symptom, 0305 other medical science, business, Stroke, 030217 neurology & neurosurgery, media_common
Abstract

The sixth update of the Canadian Stroke Best Practice Recommendations: Rehabilitation, Recovery, and Reintegration following Stroke. Part one: Rehabilitation and Recovery Following Stroke is a comprehensive set of evidence-based guidelines addressing issues surrounding impairments, activity limitations, and participation restrictions following stroke. Rehabilitation is a critical component of recovery, essential for helping patients to regain lost skills, relearn tasks, and regain independence. Following a stroke, many people typically require rehabilitation for persisting deficits related to hemiparesis, upper-limb dysfunction, pain, impaired balance, swallowing, and vision, neglect, and limitations with mobility, activities of daily living, and communication. This module addresses interventions related to these issues as well as the structure in which they are provided, since rehabilitation can be provided on an inpatient, outpatient, or community basis. These guidelines also recognize that rehabilitation needs of people with stroke may change over time and therefore intermittent reassessment is important. Recommendations are appropriate for use by all healthcare providers and system planners who organize and provide care to patients following stroke across a broad range of settings. Unlike the previous set of recommendations, in which pediatric stroke was included, this set of recommendations includes primarily adult rehabilitation, recognizing many of these therapies may be applicable in children. Recommendations related to community reintegration, which were previously included within this rehabilitation module, can now be found in the companion module, Rehabilitation, Recovery, and Community Participation following Stroke. Part Two: Transitions and Community Participation Following Stroke.

Published
2020

48. Endovascular thrombectomy with or without intravenous alteplase for acute ischemic stroke due to large vessel occlusion: a systematic review and meta-analysis of randomized trials

Author

Xin Wang, Zhikang Ye, Jason W Busse, Michael D Hill, Eric E Smith, Gordon H Guyatt, Kameshwar Prasad, M Patrice Lindsay, Hui Yang, Yi Zhang, Ying Liu, Borui Tang, Xinrui Wang, Yushu Wang, Rachel J Couban, and Zhuoling An

Subjects
Neurology (clinical), Cardiology and Cardiovascular Medicine
Abstract

BackgroundAmong patients who had an ischaemic stroke presenting directly to a stroke centre where endovascular thrombectomy (EVT) is immediately available, there is uncertainty regarding the role of intravenous thrombolysis agents before or concurrently with EVT. To support a rapid guideline, we conducted a systematic review and meta-analysis to examine the impact of EVT alone versus EVT with intravenous alteplase in patients who had an acute ischaemic stroke due to large vessel occlusion.MethodsIn November 2021, we searched MEDLINE, Embase, PubMed, Cochrane, Web of Science, clincialtrials.gov and the ISRCTN registry for randomised controlled trials (RCTs) comparing EVT alone versus EVT with alteplase for acute ischaemic stroke. We conducted meta-analyses using fixed effects models and assessed the certainty of evidence using the GRADE approach.ResultsIn total 6 RCTs including 2334 participants were eligible. Low certainty evidence suggests that, compared with EVT and alteplase, there is possibly a small decrease in the proportion of patients independent with EVT alone (risk ratio (RR) 0.97, 95% CI 0.89 to 1.05; risk difference (RD) −1.5%; 95% CI −5.4% to 2.5%), and possibly a small increase in mortality with EVT alone (RR 1.07, 95% CI 0.88 to 1.29; RD 1.2%, 95% CI −2.0% to 4.9%) . Moderate certainty evidence suggests that there is probably a small decrease in symptomatic intracranial haemorrhage (sICH) with EVT alone (RR 0.75, 95% CI 0.52 to 1.07; RD −1.0%; 95%CI −1.8% to 0.27%).ConclusionsLow certainty evidence suggests that there is possibly a small decrease in the proportion of patients that achieve functional independence and a small increase in mortality with EVT alone. Moderate certainty evidence suggests that there is probably a small decrease in sICH with EVT alone. The accompanying guideline provides contextualised guidance based on this body of evidence.PROSPERO registration numberCRD42021249873.

Published
2022

49. news & views

Author

MANN, ROBERT and TUCKER, M. PATRICE

Published
2010

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