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Moore JE, Marquez C, Dufresne K, Harris C, Park J, Sayal R, Kastner M, Kelloway L, Munce SEP, Bayley M, Meyer M, Straus SE. Supporting the implementation of stroke quality-based procedures (QBPs): a mixed methods evaluation to identify knowledge translation activities, knowledge translation interventions, and determinants of implementation across Ontario. BMC Health Serv Res 2018; 18:466. [PMID: 29914466 PMCID: PMC6006745 DOI: 10.1186/s12913-018-3220-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 05/22/2018] [Indexed: 11/10/2022] Open
Abstract
Background In 2013, Health Quality Ontario introduced stroke quality-based procedures (QBPs) to promote use of evidence-based practices for patients with stroke in Ontario hospitals. The study purpose was to: (a) describe the knowledge translation (KT) interventions used to support stroke QBP implementation, (b) assess differences in the planned and reported KT interventions by region, and (c) explore determinants perceived to have affected outcomes. Methods A mixed methods approach was used to evaluate: activities, KT interventions, and determinants of stroke QBP implementation. In Phase 1, a document review of regional stroke network work plans was conducted to capture the types of KT activities planned at a regional level; these were mapped to the knowledge to action framework. In Phase 2, we surveyed Ontario hospital staff to identify the KT interventions used to support QBP implementation at an organizational level. Phase 3 involved qualitative interviews with staff to elucidate deeper understanding of survey findings. Results Of the 446 activities identified in the document review, the most common were ‘dissemination’ (24.2%; n = 108), ‘implementation’ (22.6%; n = 101), ‘implementation planning’ (15.0%; n = 67), and ‘knowledge tools’ (10.5%; n = 47). Based on survey data (n = 489), commonly reported KT interventions included: staff educational meetings (43.1%; n = 154), champions (41.5%; n = 148), and staff educational materials (40.6%; n = 145). Survey participants perceived stroke QBP implementation to be successful (median = 5/7; interquartile range = 4–6; range = 1–7; n = 335). Forty-four people (e.g., managers, senior leaders, regional stroke network representatives, and frontline staff) participated in interviews/focus groups. Perceived facilitators to QBP implementation included networks and collaborations with external organizations, leadership engagement, and hospital prioritization of stroke QBP. Perceived barriers included lack of funding, size of the hospital (i.e., too small), lack of resources (i.e., staff and time), and simultaneous implementation of other QBPs. Conclusions Information on the types of activities and KT interventions used to support stroke QBP implementation and the key determinants influencing uptake of stroke QBPs can be used to inform future activities including the development and evaluation of interventions to address barriers and leverage facilitators. Electronic supplementary material The online version of this article (10.1186/s12913-018-3220-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Julia E Moore
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. .,The Center for Implementation, 20 Northampton Dr, Toronto, ON, M9B 4S6, Canada.
| | - Christine Marquez
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Kristen Dufresne
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Charmalee Harris
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Jamie Park
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Radha Sayal
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Monika Kastner
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.,North York General Hospital, 4001 Leslie St, Toronto, ON, M2K 1E1, Canada
| | - Linda Kelloway
- Cardiac Care Network of Ontario, 4100 Yonge Street, Toronto, ON, M2P 2B5, Canada
| | - Sarah E P Munce
- Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
| | - Mark Bayley
- Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, Toronto, ON, M5G 2A2, Canada
| | - Matthew Meyer
- Cardiac Care Network, Department of Epidemiology and Biostatistics, Western University, 1151 Richmond St, Ontario, London, N6A 5C1, Canada
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.,Department of Medicine, Faculty of Medicine, University of Toronto, 1 King's College Circle, Medical Sciences Building, Toronto, ON, M5S 1A8, Canada
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Park JS, Moore JE, Sayal R, Holmes BJ, Scarrow G, Graham ID, Jeffs L, Timmings C, Rashid S, Johnson AM, Straus SE. Evaluation of the "Foundations in Knowledge Translation" training initiative: preparing end users to practice KT. Implement Sci 2018; 13:63. [PMID: 29695267 PMCID: PMC5918493 DOI: 10.1186/s13012-018-0755-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 04/19/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Current knowledge translation (KT) training initiatives are primarily focused on preparing researchers to conduct KT research rather than on teaching KT practice to end users. Furthermore, training initiatives that focus on KT practice have not been rigorously evaluated and have focused on assessing short-term outcomes and participant satisfaction only. Thus, there is a need for longitudinal training evaluations that assess the sustainability of training outcomes and contextual factors that may influence outcomes. METHODS We evaluated the KT training initiative "Foundations in KT" using a mixed-methods longitudinal design. "Foundations in KT" provided training in KT practice and included three tailored in-person workshops, coaching, and an online platform for training materials and knowledge exchange. Two cohorts were included in the study (62 participants, including 46 "Foundations in KT" participants from 16 project teams and 16 decision-maker partners). Participants completed self-report questionnaires, focus groups, and interviews at baseline and at 6, 12, 18, and 24 months after the first workshop. RESULTS Participant-level outcomes include survey results which indicated that participants' self-efficacy in evidence-based practice (F(1,8.9) = 23.7, p = 0.001, n = 45), KT activities (F(1,23.9) = 43.2, p < 0.001, n = 45), and using evidence to inform practice increased over time (F(1,11.0) = 6.0, p = 0.03, n = 45). Interviews and focus groups illustrated that participants' understanding of and confidence in using KT increased from baseline to 24 months after the workshop. Interviews and focus groups suggested that the training initiative helped participants achieve their KT project objectives, plan their projects, and solve problems over time. Contextual factors include teams with high self-reported organizational capacity and commitment to implement at the start of their project had buy-in from upper management that resulted in secured funding and resources for their project. Training initiative outcomes include participants who applied the KT knowledge and skills they learned to other projects by sharing their knowledge informally with coworkers. Sustained spread of KT practice was observed with five teams at 24 months. CONCLUSIONS We completed a longitudinal evaluation of a KT training initiative. Positive participant outcomes were sustained until 24 months after the initial workshop. Given the emphasis on implementing evidence and the need to train implementers, these findings are promising for future KT training.
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Affiliation(s)
- Jamie S. Park
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario Canada
| | - Julia E. Moore
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario Canada
| | - Radha Sayal
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario Canada
| | - Bev J. Holmes
- Michael Smith Foundation for Health Research, Vancouver, British Columbia Canada
| | - Gayle Scarrow
- Michael Smith Foundation for Health Research, Vancouver, British Columbia Canada
| | | | - Lianne Jeffs
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario Canada
- University of Toronto, Toronto, Ontario Canada
| | - Caitlyn Timmings
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario Canada
| | - Shusmita Rashid
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario Canada
| | | | - Sharon E. Straus
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario Canada
- University of Toronto, Toronto, Ontario Canada
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Rashid S, Moore JE, Timmings C, Vogel JP, Ganatra B, Khan DN, Sayal R, Metin Gülmezoglu A, Straus SE. Evaluating implementation of the World Health Organization's Strategic Approach to strengthening sexual and reproductive health policies and programs to address unintended pregnancy and unsafe abortion. Reprod Health 2017; 14:153. [PMID: 29157274 PMCID: PMC5697396 DOI: 10.1186/s12978-017-0405-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 10/27/2017] [Indexed: 11/17/2022] Open
Abstract
Background We conducted a process evaluation to assess how the World Health Organization’s (WHO) Strategic Approach to strengthening sexual and reproductive health policies and programs (“the SA”) was used in 15 countries that requested WHO’s technical support in addressing unintended pregnancy and unsafe abortion. The SA is a three-stage planning, policy, and program implementation process. We used the social ecological model (SEM) to analyze the contextual factors that influenced SA implementation. Methods We used a two-phased sequential approach to data collection and analysis. In Phase A, we conducted a document and literature review and synthesized data thematically. In Phase B, we conducted interviews with stakeholders who used the SA in the countries of interest. We used a qualitative method triangulation technique to analyze and combine data from both phases to understand how the SA was implemented in each country. Results Data from 145 documents and 19 interviews described the SA process and activities in each country. All 15 countries completed Stage 1 activities. The activities of Stage 1 determined activities in subsequent stages and varied across countries. Following Stage 1, some countries focused on reforming policies to improve access to sexual and reproductive health (SRH) services whereas others focused on improving provider-level capacity to enhance SRH service quality and improving community-level SRH education. We identified factors across SEM levels that affected SA implementation, including individual- and community-level perceptions of using the SA and the recommendations that emerged from its use, organizational capacity to conduct SA activities, and how well these activities aligned with the existing political climate. Stakeholders perceived SA implementation to be country-driven and systematic in bringing attention to important SRH issues in their countries. Conclusion We identified key success factors for influencing the individual, organization, and system change required for implementing the SA. These include sustaining stakeholder engagement for all SA stages, monitoring and reporting on activities, and leveraging activities and outputs from each SA stage to obtain technical and financial support for subsequent stages. Results may be used to optimize ongoing implementation efforts to improve access to and the quality of SRH services. Electronic supplementary material The online version of this article (10.1186/s12978-017-0405-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shusmita Rashid
- University of Toronto, 1 King's College Circle, Medical Sciences Building, Toronto, ON, M5S 1A8, Canada.
| | - Julia E Moore
- University of Toronto, 1 King's College Circle, Medical Sciences Building, Toronto, ON, M5S 1A8, Canada
| | - Caitlyn Timmings
- University of Toronto, 1 King's College Circle, Medical Sciences Building, Toronto, ON, M5S 1A8, Canada
| | - Joshua P Vogel
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Headquarters, 20 Avenue Appia, 1211, Geneva, Switzerland
| | - Bela Ganatra
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Headquarters, 20 Avenue Appia, 1211, Geneva, Switzerland
| | - Dina N Khan
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Headquarters, 20 Avenue Appia, 1211, Geneva, Switzerland
| | - Radha Sayal
- University of Toronto, 1 King's College Circle, Medical Sciences Building, Toronto, ON, M5S 1A8, Canada
| | - A Metin Gülmezoglu
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Headquarters, 20 Avenue Appia, 1211, Geneva, Switzerland
| | - Sharon E Straus
- University of Toronto, 1 King's College Circle, Medical Sciences Building, Toronto, ON, M5S 1A8, Canada
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Kastner M, Sayal R, Oliver D, Straus SE, Dolovich L. Sustainability and scalability of a volunteer-based primary care intervention (Health TAPESTRY): a mixed-methods analysis. BMC Health Serv Res 2017; 17:514. [PMID: 28764687 PMCID: PMC5540508 DOI: 10.1186/s12913-017-2468-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 07/24/2017] [Indexed: 11/28/2022] Open
Abstract
Background Chronic diseases are a significant public health concern, particularly in older adults. To address the delivery of health care services to optimally meet the needs of older adults with multiple chronic diseases, Health TAPESTRY (Teams Advancing Patient Experience: Strengthening Quality) uses a novel approach that involves patient home visits by trained volunteers to collect and transmit relevant health information using e-health technology to inform appropriate care from an inter-professional healthcare team. Health TAPESTRY was implemented, pilot tested, and evaluated in a randomized controlled trial (analysis underway). Knowledge translation (KT) interventions such as Health TAPESTRY should involve an investigation of their sustainability and scalability determinants to inform further implementation. However, this is seldom considered in research or considered early enough, so the objectives of this study were to assess the sustainability and scalability potential of Health TAPESTRY from the perspective of the team who developed and pilot-tested it. Methods Our objectives were addressed using a sequential mixed-methods approach involving the administration of a validated, sustainability survey developed by the National Health Service (NHS) to all members of the Health TAPESTRY team who were actively involved in the development, implementation and pilot evaluation of the intervention (Phase 1: n = 38). Mean sustainability scores were calculated to identify the best potential for improvement across sustainability factors. Phase 2 was a qualitative study of interviews with purposively selected Health TAPESTRY team members to gain a more in-depth understanding of the factors that influence the sustainability and scalability Health TAPESTRY. Two independent reviewers coded transcribed interviews and completed a multi-step thematic analysis. Outcomes were participant perceptions of the determinants influencing the sustainability and scalability of Health TAPESTRY. Results Twenty Health TAPESTRY team members (53% response rate) completed the NHS sustainability survey. The overall mean sustainability score was 64.6 (range 22.8–96.8). Important opportunities for improving sustainability were better staff involvement and training, clinical leadership engagement, and infrastructure for sustainability. Interviews with 25 participants (response rate 60%) showed that factors influencing the sustainability and scalability of Health TAPESTRY emerged across two dimensions: I) Health TAPESTRY operations (development and implementation activities undertaken by the central team); and II) the Health TAPESTRY intervention (factors specific to the intervention and its elements). Resource capacity appears to be an important factor to consider for Health TAPESTRY operations as it was identified across both sustainability and scalability factors; and perceived lack of interprofessional team and volunteer resource capacity and the need for stakeholder buy-in are important considerations for the Health TAPESTRY intervention. We used these findings to create actionable recommendations to initiate dialogue among Health TAPESTRY team members to improve the intervention. Conclusions Our study identified sustainability and scalability determinants of the Health TAPESTRY intervention that can be used to optimize its potential for impact. Next steps will involve using findings to inform a guide to facilitate sustainability and scalability of Health TAPESTRY in other jurisdictions considering its adoption. Our findings build on the limited current knowledge of sustainability, and advances KT science related to the sustainability and scalability of KT interventions. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2468-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Monika Kastner
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada.
| | - Radha Sayal
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada
| | - Doug Oliver
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Lisa Dolovich
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
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Riemer M, Voorhees C, Dittmer L, Alisat S, Alam N, Sayal R, Bidisha SH, De Souza A, Lynes J, Metternich A, Mugagga F, Schweizer-Ries P. The Youth Leading Environmental Change Project: A Mixed-Method Longitudinal Study across Six Countries. Ecopsychology 2016. [DOI: 10.1089/eco.2016.0025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Manuel Riemer
- Department of Psychology, Wilfrid Laurier University, Waterloo, Canada
| | | | - Livia Dittmer
- Department of Psychology, Wilfrid Laurier University, Waterloo, Canada
| | - Susan Alisat
- Department of Psychology, Wilfrid Laurier University, Waterloo, Canada
| | | | - Radha Sayal
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | | | - Arun De Souza
- Department of Sociology, St. Xavier's College, Mumbai, India
| | - Jennifer Lynes
- School of Environment, Enterprise and Development, University of Waterloo, Waterloo, Canada
| | | | - Frank Mugagga
- Department of Geography, GeoInformatics and Climatic Sciences, Makerere University, Kampala, Uganda
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Sayal R, Bidisha SH, Lynes J, Riemer M, Jasani J, Monteiro E, Hey B, De Souza A, Wicks S, Eady A. Fostering Systems Thinking for Youth Leading Environmental Change: A Multinational Exploration. Ecopsychology 2016. [DOI: 10.1089/eco.2016.0023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Radha Sayal
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | | | - Jennifer Lynes
- School of Environment, Enterprise and Development, University of Waterloo, Waterloo, Canada
| | - Manuel Riemer
- Department of Psychology, Wilfrid Laurier University, Waterloo, Canada
| | - Janjri Jasani
- Centre for Environmental Research and Education, Mumbai, India
| | - Edel Monteiro
- Centre for Environmental Research and Education, Mumbai, India
| | - Brandon Hey
- Department of Psychology, Wilfrid Laurier University, Waterloo, Canada
| | - Arun De Souza
- Department of Sociology, St. Xavier's College, Mumbai, India
| | - Sara Wicks
- Department of Psychology, Wilfrid Laurier University, Waterloo, Canada
| | - Allison Eady
- Department of Psychology, Wilfrid Laurier University, Waterloo, Canada
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Mascarenhas A, Khan S, Sayal R, Knowles S, Gomes T, Moore JE. Factors that may be influencing the rise in prescription testosterone replacement therapy in adult men: a qualitative study. Aging Male 2016; 19:90-5. [PMID: 26927629 DOI: 10.3109/13685538.2016.1150994] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To explore and describe the factors that may be influencing the rise of prescribing and use of testosterone replacement therapy (TRT) in adult men. DESIGN A rapid qualitative research design using semi-structured interviews with providers and patients. SETTING Ontario, Canada. PARTICIPANTS Nine men who have used TRT (referred to as "patients"), and six primary care clinicians and seven specialists (collectively referred to as "providers") who prescribed or administered TRT. METHOD Patients' and providers' perspectives were investigated through semi-structured interviews. A purposive sampling approach was used to recruit all participants. We conducted qualitative analysis using the framework approach for applied health research. MAIN FINDINGS Participants perceived the following factors to have influenced TRT prescriptions and use in adult men: provider factors (diagnostic ambiguity of age-related hypogonadism and beliefs about appropriateness of TRT) and patient factors (access to information on TRT and drug seeking behavior). They perceived that these factors have perpetuated a rise in prescription in the absence of clear clinical guidelines and unclear research evidence on the safety and efficacy of TRT. CONCLUSION The findings of this study highlight that much work still needs to be done to improve diagnostic accuracy and encourage appropriate TRT prescription in adult men. In addition, both patients and providers need more information about the risks and long-term effects of TRT in men.
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Affiliation(s)
- Alekhya Mascarenhas
- a St. Michael's Hospital, Li Ka Shing Knowledge Institute , Toronto , Ontario , Canada
| | - Sobia Khan
- a St. Michael's Hospital, Li Ka Shing Knowledge Institute , Toronto , Ontario , Canada
| | - Radha Sayal
- a St. Michael's Hospital, Li Ka Shing Knowledge Institute , Toronto , Ontario , Canada
| | - Sandra Knowles
- a St. Michael's Hospital, Li Ka Shing Knowledge Institute , Toronto , Ontario , Canada
| | - Tara Gomes
- a St. Michael's Hospital, Li Ka Shing Knowledge Institute , Toronto , Ontario , Canada
- b The Institute for Clinical Evaluative Sciences , Toronto , Ontario , Canada , and
- c Leslie Dan Faculty of Pharmacy, University of Toronto , Toronto , Ontario , Canada
| | - Julia E Moore
- a St. Michael's Hospital, Li Ka Shing Knowledge Institute , Toronto , Ontario , Canada
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