Context Health advocacy is an essential component of postgraduate medical education, and is part of many physician competency frameworks such as the Canadian Medical Education Directives for Specialists (CanMEDS) roles. There is little consensus about how advocacy should be taught and assessed in the postgraduate context. There are no consolidated guides to assist in the design and implementation of postgraduate health advocacy curricula. Objectives This scoping review aims to identify and analyse existing literature pertaining to health advocacy education and assessment in postgraduate medicine. We specifically sought to summarise themes from the literature that may be useful to medical educators to inform further health advocacy curriculum interventions. Methods MEDLINE, Embase and ERIC were searched using MeSH (medical student headings) and non‐MeSH search terms. Additional articles were found using forward snowballing. The grey literature search included Google and relevant stakeholder websites, regulatory bodies, physician associations, government agencies and academic institutions. We followed a stepwise scoping review methodology, followed by thematic analysis using an inductive approach. Results Of the 123 documents reviewed in full, five major themes emerged: (i) conceptions of health advocacy have evolved towards advocating with rather than for patients, communities and populations; (ii) longitudinal curricula were less common but appeared the most promising, often linked to scholarly or policy objectives; (iii) hands‐on, immersive opportunities build competence and confidence; (iv) community‐identified needs and partnerships are increasingly considered in designing curriculum, and (v) resident‐led and motivated programmes appear to engage residents and allow for achievement of stated outcomes. There remain significant challenges to assessment of health advocacy competencies, and assessment tools for macro‐level health advocacy were notably absent. Conclusions There is considerable heterogeneity in the way health advocacy is taught, assessed and incorporated into postgraduate curricula across programmes and disciplines. We consolidated recommendations from the literature to inform further health advocacy curriculum design, implementation and assessment.

BackgroundIt is well established that drastic declines in physical activity (PA) occur during young adults’ transition into university; however, our understanding of contextual and environmental factors as it relates to young adults’ PA is limited.ObjectiveThe purpose of our study was to examine the feasibility of using wrist-worn accelerometers and the use of ecological momentary assessment (EMA) to assess the context and momentary correlates of PA on multiple occasions each day during first-year university.MethodsFirst-year university students were asked to participate in the study. The participants completed a brief questionnaire and were subsequently asked to wear an ActiGraph GT9X-Link accelerometer and respond to a series of EMA prompts (7/day) via their phones for 5 consecutive days.ResultsA total of 96 first-year university students with smartphones agreed to participate in the study (mean age 18.3 [SD 0.51]; n=45 females). Overall, there was good compliance for wearing the accelerometers, with 91% (78/86) of the participants having ≥2 days of ≥10 hours of wear time (mean=3.53 valid days). Students were generally active, averaging 10,895 steps/day (SD 3413) or 1123.23 activity counts/min (SD 356.10). Compliance to EMA prompts was less desirable, with 64% (55/86) of the participants having usable EMA data (responding to a minimum of ≥3 days of 3 prompts/day or ≥4 days of 2 prompts/day), and only 47% (26/55) of these participants were considered to have excellent EMA compliance (responding to ≥5 days of 4 prompts/day or ≥ 4 days of 5 prompts/day).ConclusionsThis study represents one of the first studies to use an intensive real-time data capture strategy to examine time-varying correlates of PA among first-year university students. These data will aim to describe the physical and social contexts in which PA occurs and examine the relationships between momentary correlates of PA among the first-year university students. Overall, current results suggest that wrist-worn accelerometers and EMA are feasible methods for data collection among the young adult population; however, more work is needed to understand how to improve upon compliance to a real-time data capture method such as EMA.

BackgroundHealth research knowledge translation (KT) is important to improve population health outcomes. Considering social, geographical and cultural contexts, KT in Inuit communities often requires different methods than those commonly used in non-Inuit populations.ObjectivesTo examine the extent, range and nature of literature about health-related KT in Inuit communities.DesignA scoping review was conducted. A search string was used to search 2 English aggregator databases, ProQuest and EBSCOhost, on 12 March 2015. Study selection was conducted by 2 independent reviewers using inclusion and exclusion criteria. To be included, studies had to explicitly state that KT approaches were used to share human health research results in Inuit communities in the Circumpolar North. Articles that evaluated or assessed KT approaches were thematically analysed to identify and characterize elements that contributed to KT success or challenges.ResultsFrom 680 unique records identified in the initial search, 39 met the inclusion criteria and were retained for analysis. Of these 39 articles, 17 evaluated the KT approach used; thematic analysis identified 3 themes within these 17 articles: the value of community stakeholders as active members in the research process; the importance of local context in tailoring KT strategies and messaging; and the challenges with varying and contradictory health messaging in KT. A crosscutting gap in the literature, however, included a lack of critical assessment of community involvement in research. The review also identified a gap in assessments of KT in the literature. Research primarily focused on whether KT methods reflected the local culture and needs of the community. Assessments rarely focused on whether KT had successfully elicited its intended action.ConclusionsThis review synthesized a small but burgeoning area of research. Community engagement was important for successful KT; however, more discussion and discourse on the tensions, challenges and opportunities for improvement are necessary.

Conclusion:Thyroid hormone use can have important implications for organ selection and cardiac function before and after transplantation. Protocols vary widely with respect to why and how to use and wean thyroid hormone. We believe there should be more detailed reporting of thyroid hormone use for future studies to ensure appropriate donor management. ( 585)Purpose: Brain-stem-death (BSD) causes cardiac injury and dysfunction that is sometimes reversible. The optimum time after BSD at which to assess the function of donor hearts is unknown. We hypothesized that a longer interval may be associated with a higher transplantation rate due to improved function. Methods: Data on adult DBD solid organ donors were obtained retrospectively from the UK Transplant Registry for the period 1 January 2008 to 31 December 2012. Donors above the age of 65 with a past history of cardiothoracic disease, consent for heart donation was refused or whose cause of death was myocardial infarction were excluded. The time when fixed dilated pupils were first noted in the donor was considered as the time of BSD. Retrieval was defined as the time when the abdominal organs were perfused. Results: BSD to retrieval duration was available for 1,839 donors. Of these donors, 461 (25%) donated their heart. The median (IQR) BSD to retrieval duration was 35.6 hours (27.6, 48.7). BSD to retrieval durations differed (p< 0.0001) depending on the time of day when BSD was diagnosed (separated in to four quartiles). A multivariate logistic regression was then performed. Donor age, blood group, gender, cause of death, heart rate, body mass index, past history of hypertension, cardiac arrest and use of prednisolone were all found to influence the probability of donation. Adjusting for these factors, there was evidence to suggest that the BSD to retrieval duration had a non-linear effect upon heart donation (p= 0.047).The effect was such that, longer durations were associated with a higher probability of donation. However, the odds ratio for the probability of heart donation began to plateau at a value of 1 after approximately 1.5 days suggesting that durations beyond this have no impact on the chance of donation. Analysis of a subset of donors attended by a cardiothoracic retrieval team showed a similar pattern. Conclusion: This data suggest that time interval from BSD to retrieval influences the heart retrieval rate. A longer time interval may allow the heart to recover from the BSD induced injury. When the sole reason for decline a donor heart is poor function, a period of further observation and optimisation up to 1.5 days should be considered.

No abstract

checklist significantly decreased the omission rate of important airway management tasks, however it increased the time to definitive airway management. Further study is required to determine if these findings are consistent in a clinical setting and how they impact the rate of adverse events. Keywords: checklist, airway, simulation LO35 Improving the precision of emergency physicians diagnosis of stroke and TIA M. A. Cortel, MD, MHA, M. Sharma, MD, MSc, A. LeBlanc, MD, K. Abdulaziz, MSc, J. J. Perry, MD, MSc, University of Ottawa, Department of Emergency Medicine, Ottawa, ON Introduction: Studies suggest that there is a significant discrepancy between emergency physicians diagnosis of TIA and confirmation by neurologists. The objectives of our study were to identify factors associated with neurologists confirmation of TIA in patients referred from the emergency department. Methods: Data were obtained from a prospective cohort study across more than 8 university-affiliated Canadian hospitals from 2006-2017 of adult patients diagnosed with a TIA or non-disabling stroke in the ED. Patients presenting after 1 week of symptom onset, receiving TPA as part of a stroke code, with a GCS < 15 at baseline, and without a neurology assessment within 90 days were excluded. Univariate analyses were performed with t-tests or chi-square tests as indicated. Multivariate analysis with backward elimination was performed to identify unique predictors of TIA confirmation. Results: Of 8,669 patients diagnosed with TIA in the ED, 7,836 (90%) were assessed by neurology. The mean age of patients was 68.2 years and 71.1% presented with their first ever TIA. The rate of confirmation of TIA by neurology was 56%. The most common alternate diagnoses included migraines (26%), peripheral vertigo (10%), syncope (6%), and seizure (4%). The 3 strongest predictors of confirmation of TIA were infarct on imaging (OR 2.31, 2.03-2.63), history of weakness (OR 2.19, 1.95-2.48), and history of language disturbance (OR 2.05, 1.79-2.34). The 3 strongest predictors of an alternate diagnosis were syncope (OR 0.51, 0.39-0.67), history of bilateral weakness (or 0.51, 0.31-0.84), and confusion (OR 0.57,. Conclusion: The rate of TIA confirmation by neurology in our study was 56%. Emergency physicians should have a high index of suspicion of TIA in patients with history of weakness and language disturbance, and should resist referring to a stroke prevention clinic, patients with syncope, bilateral findings, or confusion. Keywords: transient ischemic attack, stroke, diagnosis Introduction: Health advocacy training is an important part of emergency medicine practice and education. There is little agreement, however, about how advocacy should be taught and evaluated in the postgraduate context, and there is no consolidated evidence-base to guide the design and implementation of post-graduate health advocacy curricula. This literature review aims to identify existing models used for teaching and evaluating advocacy training, and to integrate these findings with curr...