Margaret Shaw and Kelly Hannah-Moffat consider the discriminatory implications of risk-based classification systems and of actuarial risk assessment tools in the Canadian correctional system.
IMPORTANCE Older patients who undergo surgery may benefit from geriatrician comanagement. It is unclear whether other internal medicine (IM) physician involvement improves outcomes for adults who undergo surgery. OBJECTIVE To evaluate the association of IM physician involvement with clinical and health system outcomes compared with usual surgical care among adults who undergo surgery. DATA SOURCES MEDLINE, Embase, CINAHL, and CENTRAL databases were searched for studies published in English from database inception to April 2, 2019. STUDY SELECTION Prospective randomized or nonrandomized clinical studies comparing IM physician consultation or comanagement with usual surgical care were selected by consensus of 2 reviewers. DATA EXTRACTION AND SYNTHESIS Data were extracted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline by 2 authors independently. Intervention characteristics were described using existing indicators. Risk of bias was assessed using Risk of Bias 2.0 and Risk of Bias in Nonrandomized Studies of Interventions tools. Studies were pooled when appropriate in meta-analysis using random-effects models. Prespecified subgroups included IM physician-only vs multidisciplinary team interventions and patients undergoing elective vs emergency procedures.
MAIN OUTCOMES AND MEASURESThe prespecified primary outcome was length of stay; other outcomes included 30-day readmissions, inpatient mortality, medical complications, functional outcomes, and costs.
RESULTSOf 6027 records screened, 14 studies (with 1 randomized clinical trial) involving 35 800 patients (13 142 [36.7%] in intervention groups) were eligible for inclusion. Interventions varied substantially among studies and settings; most interventions described comanagement by a hospitalist or internist; 7 (50%) included a multidisciplinary team, and 9 (64%) studied predominantly patients who had elective procedures. Risk of bias in 10 studies (71%) was serious.
This article discusses the absence of gender in crime prevention in Canada and internationally. It outlines the development of parallel streams of work on violence against women and women's safety and argues that there is a need to integrate them into a concerted gendered approach, particularly at the level of municipalities. It draws on developing work on women's safety, gender, and the role of women in decision making in local government. The first part of the article is based on a review of international policy and practice on women's safety; it discusses recent trends and developments, as well as some of the problems and questions raised. These relate to the apparently separate worlds of expertise and activity that have grown up around violence against women and women's safety, the emergence of the concept of gender, and the isolation of these areas of work from mainstream crime prevention. The second part of the article evaluates Canadian performance in engendering crime prevention and makes some recommendations for embedding and sustaining engendered practice, particularly at the local level.
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