BackgroundPhysicians today are increasingly faced with healthcare challenges that require an understanding of global health trends and practices, yet little is known about what constitutes appropriate global health training.MethodsA literature review was undertaken to identify competencies and educational approaches for teaching global health in medical schools.ResultsUsing a pre-defined search strategy, 32 articles were identified; 11 articles describing 15 global health competencies for undergraduate medical training were found. The most frequently mentioned competencies included an understanding of: the global burden of disease, travel medicine, healthcare disparities between countries, immigrant health, primary care within diverse cultural settings and skills to better interface with different populations, cultures and healthcare systems. However, no consensus on global health competencies for medical students was apparent. Didactics and experiential learning were the most common educational methods used, mentioned in 12 and 13 articles respectively. Of the 11 articles discussing competencies, 8 linked competencies directly to educational approaches.ConclusionsThis review highlights the imperative to document global health educational competencies and approaches used in medical schools and the need to facilitate greater consensus amongst medical educators on appropriate global health training for future physicians.
Our findings indicate that an imbalance in consumption of fatty acids, vegetables, and fruits is associated with increased risks for CD among Canadian children.
Objectives Canadian contraceptive providers report many barriers to access to contraception, and perceive youth as particularly vulnerable to these barriers. This study explores Quebec youth’s experience of obtaining contraception. Methods A convenience sample of Quebec youth (aged 14 to 21 years) participated in an online anonymous survey of their experiences obtaining contraception. Data were collected between June 1, 2016 and December 31, 2016. Results One hundred and five youth were eligible to participate. Of these, 95 had used at least one form of contraception. Twelve (13%) reported not being able to obtain their preferred method of contraception, with cost being the most common barrier (N=10). Eleven participants (12%) stopped using their preferred contraceptive method: cost was a factor in four cases, and difficulty with access to the clinic/prescription in seven. Youth who required confidential access experienced more difficulty obtaining contraception (P<0.01). Conclusion Despite benefitting from universal pharmacare and a network of youth sexual and reproductive health clinics, Quebec youth still experience barriers to obtaining and continuing their preferred contraceptive. Youth who desire confidential care are more likely to experience difficulty obtaining contraception.
IntroductionAsthma exacerbations are a leading cause of paediatric hospitalisations. Corticosteroids are key in the treatment of asthma exacerbations. Most current corticosteroids treatment regimens for children admitted with asthma exacerbation consist of a 5-day course of prednisone or prednisolone. However, these medications are associated with poor taste and significant vomiting, resulting in poor compliance with the treatment course. While some centres already use a short course of dexamethasone for treating children hospitalised with asthma, there is no evidence to support this practice in the inpatient population.Methods and analysisThis single-site, pragmatic, feasibility randomised controlled trial will determine the feasibility of a non-inferiority trial, comparing two treatment regimens for children admitted to the hospital and receiving asthma treatment. Children 18 months to 17 years presenting to a Canadian tertiary care centre will be randomised to receive either a short course of dexamethasone or a longer course of prednisone/prednisolone once admitted to the inpatient units. The primary clinical outcome for this feasibility study will be readmission to hospital or repeat emergency department visits, or unplanned visits to primary healthcare providers for asthma symptoms within 4 weeks of hospital discharge. Feasibility outcomes will include recruitment and allocation success, compliance with study procedures, retention rate, and safety and tolerability of study medications. We plan on recruiting 51 children, and between-group comparisons of the clinical outcome will be conducted to gain insights on probable effect sizes.Ethics and disseminationResearch Ethics Board approval has been obtained for this study. The results of this study will inform a multisite trial comparing prednisone/prednisolone to dexamethasone in inpatient asthma treatment, which will have the potential to improve the delivery of asthma care, by improving compliance with a mainstay of treatment. Results will be disseminated through peer-reviewed publications, organisations and meetings.Trial registration number NCT03133897; Pre-results.
Primary Subject area Hospital Paediatrics Background Paging is an important method of communication in hospitals but can also interrupt clinical care unnecessarily. These interruptions decrease workflow efficiency and negatively affect patient care. Objectives The goal of this project was to decrease clinical care interruptions from non-urgent pages to pediatric residents by implementing a priority indication system that was: (1) consistently used (90% pages with a priority level indicated); (2) clearly defined (80% concordance in the priority levels between senders and recipients); and (3) satisfying to end users (80% rating the paging system as satisfied). Design/Methods The Plan-Do-Study-Act method of quality improvement was used. The study was conducted at an academic children’s hospital, where numeric paging occurs through a switchboard operator. Three priority levels (1 being most urgent) with a respective expected callback time (5-15, 15-30, 60+ minutes) were determined through a pilot study and stakeholder consensus. A priority level was selected by the page sender and displayed beside a callback number. Process measures were indication of priority levels and concordance of priority levels between senders and recipients. Outcome measures were reduced interruptions to clinical care from non-urgent pages and user satisfaction. Balancing measures included patient safety incidents. Run charts, surveys, and page logs were used to track the impact of interventions. Results In the first two months, 1325 out of 2208 (60%) pages had a priority level indicated. In the subsequent two months after providing feedback to users, the proportion increased to 1822 out of 2410 (76%). Subsequent bimonthly indication rates have ranged between 74% and 83%. Among pages with a priority level indicated over 16 months (n=13,934), 26% were assigned priority 1, 62% priority 2, and 11% priority 3. There was a 74% concordance in priority levels between senders and recipients. 26% of pages were received while a resident was directly interacting with a patient. Fewer residents felt that their workflow was being frequently interrupted by non-urgent pages (from 65% to 39%). End user satisfaction improved. There were no patient safety incidents. Conclusion Using existing infrastructure, we implemented a paging priority indication system that decreased interruptions to clinical care. Residents reported improved workflow efficiency, and end users expressed improved satisfaction with paging communication. The gap in the perception of urgency between senders and recipients will need to be further evaluated. While a priority level indication is particularly pertinent to hospitals using numeric pagers, a standardized indication of priority levels can also be beneficial in hospitals using an alternative communication system.
Background: Hand hygiene (HH) is the most effective means of preventing healthcare-associated infections (HAI). HH improvement strategies primarily focus on healthcare staff, often overlooking the significant contribution of caregivers to HAI risk. We sought to understand caregivers’ HH knowledge and practices to identify improvement opportunities. Methods: A self-administered survey was developed and distributed to families from June to August 2019; open-ended questions and Likert scales assessed caregivers’ perceptions and practices regarding HH at home and in hospital. HH compliance audits of caregivers entering and exiting inpatient rooms were performed in the same time period. Results: Among 81 caregivers surveyed, median patient age was 4.0 (IQR, 0.9–13.0) years. This was the first admission for 42 patients (53.8%). During this admission, 22 (27.2%) patients had been admitted for ≤1 day and 45 (55.6%) for >3 days. Caregivers reported good knowledge of HH practice, with strongly positive responses to knowledge of HH moments (94%) and proper technique (96%). Caregivers recognized that HH is required of hospital visitors (96%) to protect others (99%) and prevent illness in hospital (93%). Responses were less consistent for performing HH before entering a hospital room (83%), after exiting the room (70%), or after coughing or sneezing (65%). The attitudes of caregivers of children above 2 years were equivocal regarding expectations of their child to wash hands upon entering (40%), or exiting (41%) the hospital room. Multivariable modeling identified higher self-reported HH compliance in caregivers during first admission to hospital, compared to subsequent admissions (OR, 3.15; 95% CI, 1.11–9.65). Reported barriers to HH included hand irritation (27.2%) and perceived HH frequency (18.5%). At the time of survey completion, 62 caregivers (77%) reported not having received HH information during their child’s admission from a healthcare provider or volunteer. Information was most commonly gained from posters (75%) and information in the room (31%). Most caregivers (58.0%) reported that they would prefer to receive HH information in the first 24 hours of admission. Among 200 audits, overall caregiver compliance with HH was 9%; HH before entering the room was 7.2% compared to 11.2% after exiting (P = .33). Conclusions: Reported caregiver knowledge of HH was not reflected in audited practice. Fewer than 1 in 4 had received HH information from healthcare staff. HH education in the hospital environment within the first day of admission provides an opportunity for caregivers to improve compliance as partners in HAI prevention and safer pediatric care.Funding: NoneDisclosures: None
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