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Background: Enhanced Recovery After Surgery (ERAS) is a global surgical quality-improvement initiative. Little is known about the economic effects of implementing multiple ERAS guidelines in both the short and long term. Methods: We performed a return on investment (ROI) analysis of the implementation of multiple ERAS guidelines (for colorectal, pancreas, cystectomy, liver and gynecologic oncology procedures) across multiple sites (9 hospitals) in Alberta using 30-, 180- and 365-day time horizons. The effects of ERAS on health services utilization (length of stay of the primary admission, number of readmissions, length of stay of the readmissions, number of emergency department visits, number of outpatient clinic visits, number of specialist visits and number of general practitioner visits) were assessed by mixed-effect multilevel multivariate negative binomial regressions. Net benefits and ROI were estimated by a decision analytic modelling analysis. All costs were reported in 2019 Canadian dollars. Results: The net health system savings per patient ranged from $26.35 to $3606.44 and ROI ranged from 1.05 to 7.31, meaning that every dollar invested in ERAS bro-brought $1.05 to $7.31 in return. Probabilities for ERAS to be cost-saving were from 86.5% to 99.9%. The effects of ERAS were found to be larger in the longer time horizons, indicating that if only the 30-day time horizon had been used, the benefits of ERAS would have been underestimated. Conclusion: These results demonstrated that ERAS multiguideline implementation was cost-saving in Alberta. To produce a better ROI, it is important to consider a broad range of health service utilizations, long-term impact, economies of scale, productive efficiency and allocative efficiency for sustainability, scale and spread of ERAS implementations. Contexte : L'initiative de recuperation amelioree apres la chirurgie (RAAC) est un projet international d'amelioration de la qualite en chirurgie. On en sait peu sur les retombees economiques, tant a court qu'a long terme, de la mise en [alpha]euvre de multiples lignes directrices de RAAC. Methodes : Nous avons realise une analyse du rendement sur l'investissement (RSI) visant la mise en oeuvre de multiples lignes directrices de RAAC (pour les operations colorectales, pancreatiques, hepatiques ou d'oncologie gynecologique et la cystectomie) dans 9 hopitaux albertains sur un horizon temporel de 30, 180 et 365 jours. L'incidence de la RAAC sur l'utilisation des services de sante (duree du sejour a l'hospitalisation initiale, nombre de readmissions, duree du sejour a la rehospitalisation et nombre de visites a l'urgence, en consultation externe, chez un specialiste et chez un omnipraticien) a ete evaluee a l'aide d'un modele multiniveau de regressions binomiales negatives a effets mixtes multivaries. Les benefices nets et le RSI ont ete estimes a l'aide d'un processus de modelisation analytique decisionnelle. Tous les couts ont ete rapportes en dollars canadiens de 2019. Resultats : Les economies nettes du systeme de sante allaient de 26,35 $ a 3606,44 $ par patient, et le RSI variait de 1,05 a 7,31; chaque dollar investi dans l'initiative de RAAC a donc genere un retour sur l'investissement de 1,05 $ a 7,31 $. Les probabilites d'economie grace au RAAC allaient de 86,5 % a 99,9 %. Les retombees generees augmentaient avec un horizon temporel a plus long terme, ce qui suggere que l'utilisation unique d'un horizon temporel de 30 jours aurait mene a une sous-estimation des benefices. Conclusion : Les resultats montrent que la mise en oeuvre de multiples lignes directrices de RAAC a permis des economies en Alberta. En vue d'obtenir un RSI optimal, il est important de tenir compte d'une grande variete d'utilisations des services de sante, des retombees a long terme, des economies d'echelle, de l'efficacite productive et de l'efficience des allocations pour la perennite, la mise a l'echelle et la diffusion des projets de mise en oeuvre de RAAC., Enhanced Recovery After Surgery (ERAS) is a multi-modal, multidisciplinary approach to providing best practice perioperative care before, during and after surgery. (1) Drawing from best practices and evidence from around [...]

Background: The sustainability of prelicensure nursing clinical learning models within ambulatory care is dependent on strong partnership and the availability of ambulatory nurse preceptors. Evaluation of preceptor and student satisfaction with ambulatory clinical experiences is necessary to identify program strengths and opportunities. Method: Nursing students' and nurse preceptors' perceptions of an ambulatory dedicated education unit (DEU) in primary care and general internal medicine practices were measured from 2021 to 2023. Results: Students' survey responses indicated a high level of agreement for 20 (90.9%) of 22 items in 2021, 35 (100%) of 35 items in 2022, and 32 (91.4%) of 35 items in 2023. Preceptor responses demonstrated favorable agreement with all of the work-life satisfaction across the 3 years of the survey, with the exception of one question on the 2021 survey. Conclusion: Nursing students and staff nurse preceptors found the ambulatory DEU teaching and learning experience to be positive and satisfying. [J Nurs Educ. 2024;63(3):171–177.] [ABSTRACT FROM AUTHOR]

The soybean industry in Canada aimed to extensively expand soybean production to benefit from new early-maturing varieties and the warming climate. However, setbacks in the soybean industry since 2017 demonstrated the impacts of climate risk and global market uncertainty. Therefore, a better understanding of future climate conditions that will impact soybean growth in Canada is needed for decision-making in the sector, such as prioritizing regions for expansion and developing climate change adaptation strategies through either agronomic management practices or breeding new cultivars. Based on climate projections from a set of global climate models, we analyzed climate conditions for growing soybeans, including growing season start, crop heat units, precipitation, precipitation deficits and climate extremes, in the near-term (2030s), the mid-term (2050s) and the distant future (2070s). We found that a future warmer climate with an increase of 1.6, 2.8 and 4.1 °C in the growing season (May–September) mean temperature averaged over Canada's land area in the near-term, mid-term and distant future under SSP3-7.0 would favour the expansion of soybean production further north and west. However, an increase of approximately 200 mm in precipitation deficits on the semiarid Canadian Prairies in the mid-term would constrain soybean production unless irrigation could be introduced. Heat- and drought-tolerant cultivars should be developed to adapt soybean production to a changing climate, in addition to the adoption of late-maturing cultivars that would benefit from the lengthened growing season and increased crop heat units. [ABSTRACT FROM AUTHOR]

In contemporary Western societies, disciplinary and normalising technologies function to create a sense of moral obligation within each individual to monitor and regulate the body in terms of health, including diet and exercise. The settler/Aboriginal experience in Australia provides an example of the ways in which biopolitics has operated at a population level for all Australians and in specific ways for Indigenous bodies. This study sought to explore the perceptions of a group of urban Indigenous young people regarding their views of their bodies in the context of health and physical activity. Using the lens of biopolitics, complemented by post-colonial theory, this paper will draw attention to the ways in which historical and current discourses around Indigenous health might illustrate biopolitical technologies of power whilst also highlighting the ways in which Indigenous young people have navigated both disciplinary and normalising regimes. Fourteen participants (six male and eight female) were interviewed seven times over two and a half years using mapping, photos and drawing as stimuli. Data were analysed both thematically and through a process of discourse analysis with a view to explore the ways in which participants negotiated discursive constructions of the body, particularly notions of self-governance. It appeared that the young people engaged with, were ambivalent to, contested and resisted discourses around "proper" bodily appearance, the obligation to "work" on their bodies, their perceptions of an ideal body, their negotiation of an authentic "black" body and the ways in which they used their bodies to perform or achieve. The voices of the young people illustrate these themes. This research contributes significantly to the modest body of physical education and health literature from the perspectives of Indigenous young people. It raises questions about the impact of normalising discourses on Indigenous young people and in particular the ways in which those who resist them might be positioned. (Contains 1 note.)

This paper aims to present what is currently known about Indigenous Australians and their engagement in physical activity and to then challenge some of the "taken-for-granted" ways of thinking about promoting or researching physical activity with Indigenous Australians. Major health, education and sport databases, as well as government websites were searched using the key terms of physical activity, sport, leisure, recreation, Indigenous and Aboriginal/Aborigine. A social-ecological model of health was adapted and used as an organizing framework to synthesize the literature. It is concluded that socioecological models can be valuable tools for understanding and promoting issues related to physical activity engagement for a range of populations but they may require complementary critical insights, including those from Indigenous perspectives. Productive theoretical spaces where Western and Indigenous knowledges come together can assist health educators to consider the complexity and diversity of Indigenous people's lived experiences when planning and implementing programs. (Contains 2 figures.)

In light of the policy and research interests in optimising the educational experiences and outcomes of Indigenous young people, this paper aims to give voice to young Indigenous students' experiences of school and to convey a sense of the varied and complex nature of their educational and life pathways. Using a qualitative, life history research approach, 14 young people were interviewed seven times over two and a half years as they transitioned from primary school to secondary school in order to explore their perceptions of health, schooling and plans for the future. The findings demonstrate the complex and multifarious lived experiences of these young people and the incongruence with apparent assumptions underpinning education policies focused on improving and measuring educational outcomes. We argue that in order to avoid isolating, threatening or marginalising Indigenous (or any other) students within education systems, traditional educational pathways and trajectories need to be challenged so as to celebrate the cultural wealth of young people; recognise, value and build on their previous educational experiences; and support the transition across different learning and vocational avenues. (Contains 2 tables.)

"Taking exercise", whether it be recreational walking, participating in club sport, or joining in a physical education (PE) lesson, is a culturally loaded behaviour. We all see, do and talk about physical activity differently, yet, there has been relatively little research or theorising around difference in race, ethnicity, cultural diversity and physical activity from an educational perspective. This paper presents snapshots of data from three research projects with Indigenous and Muslim young people to illuminate how they and their families think about PE, physical activity and health. We will draw on "post" discussions around biopolitics, colonisation, governmentality and citizenship to argue that PE needs to better account for "others" and "othering" in its research, planning and practices. (Contains 1 note.)

The need for additional support for Indigenous children at school is well documented. Occupational therapists are well positioned to form part of this support. However, many occupational therapists report that Indigenous families do not access their services and when they do, the occupational therapist feels uncertain about how best to meet their needs. This article documents a pilot project which delivered occupational therapy services within several schools and preschools in Brisbane which had significant numbers of Indigenous students. The project was evaluated using a qualitative methodology and included focus groups and interviews with teachers and parents. The results indicated that in general the service provided valuable support to students, teachers and parents. In particular, providing the service within the school context was seen as critical to its success. Suggestions for improvements in future support services are also provided. (Contains 2 tables.)

Abstract: Teaching youth about sexual health in the classroom can be a daunting task. In-service training is an important vehicle for increasing the knowledge, comfort and skills of teachers new [...]