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Li M, Mathura P, Hagtvedt R, Dytoc M. Sun Safety in Elementary School: Trialing Strategies for Keeping Children Protected. J Cutan Med Surg 2023; 27:657-658. [PMID: 37947200 DOI: 10.1177/12034754231211329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Affiliation(s)
- Miriam Li
- University of Alberta, Edmonton, Canada
| | - Pamela Mathura
- Department of Medicine, Quality Council, University of Alberta, Edmonton, Canada
| | - Reidar Hagtvedt
- University of Alberta Alberta School of Business, Edmonton, Canada
| | - Marlene Dytoc
- Division of Dermatology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
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Mathura P, Marini S, Hagtvedt R, Spalding K, Duhn L, Kassam N, Medves J. Factors of a physician quality improvement leadership coalition that influence physician behaviour: a mixed methods study. BMJ Open Qual 2023; 12:e002016. [PMID: 37290908 PMCID: PMC10255283 DOI: 10.1136/bmjoq-2022-002016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 05/25/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND A coalition (Strategic Clinical Improvement Committee), with a mandate to promote physician quality improvement (QI) involvement, identified hospital laboratory test overuse as a priority. The coalition developed and supported the spread of a multicomponent initiative about reducing repetitive laboratory testing and blood urea nitrogen (BUN) ordering across one Canadian province. This study's purpose was to identify coalition factors enabling medicine and emergency department (ED) physicians to lead, participate and influence appropriate BUN test ordering. METHODS Using sequential explanatory mixed methods, intervention components were grouped as person focused or system focused. Quantitative phase/analyses included: monthly total and average of the BUN test for six hospitals (medicine programme and two EDs) were compared pre initiative and post initiative; a cost avoidance calculation and an interrupted time series analysis were performed (participants were divided into two groups: high (>50%) and low (<50%) BUN test reduction based on these findings). Qualitative phase/analyses included: structured virtual interviews with 12 physicians/participants; a content analysis aligned to the Theoretical Domains Framework and the Behaviour Change Wheel. Quotes from participants representing high and low groups were integrated into a joint display. RESULTS Monthly BUN test ordering was significantly reduced in 5 of 6 participating hospital medicine programmes and in both EDs (33% to 76%), resulting in monthly cost avoidance (CAN$900-CAN$7285). Physicians had similar perceptions of the coalition's characteristics enabling their QI involvement and the factors influencing BUN test reduction. CONCLUSIONS To enable physician confidence to lead and participate, the coalition used the following: a simply designed QI initiative, partnership with a coalition physician leader and/or member; credibility and mentorship; support personnel; QI education and hands-on training; minimal physician effort; and no clinical workflow disruption. Implementing person-focused and system-focused intervention components, and communication from a trusted local physician-who shared data, physician QI initiative role/contribution and responsibility, best practices, and past project successes-were factors influencing appropriate BUN test ordering.
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Affiliation(s)
- Pamela Mathura
- Department of Medicine, University of Alberta Hospital, Edmonton, Alberta, Canada
- Alberta Health Services, Edmonton Zone Medicine, Edmonton, Alberta, Canada
| | - Sandra Marini
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Reidar Hagtvedt
- Alberta School of Business, University of Alberta, Edmonton, Alberta, Canada
| | - Karen Spalding
- School of Nursing, Queen's University, Kingston, Ontario, Canada
| | - Lenora Duhn
- School of Nursing, Queen's University, Kingston, Ontario, Canada
| | - Narmin Kassam
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer Medves
- School of Nursing, Queen's University, Kingston, Ontario, Canada
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Els C, Jackson TD, Hagtvedt R, Kunyk D, Sonnenberg B, Lappi VG, Straube S. High-dose opioids for chronic non-cancer pain: an overview of Cochrane Reviews. Cochrane Database Syst Rev 2023; 3:CD012299. [PMID: 36961252 PMCID: PMC10037930 DOI: 10.1002/14651858.cd012299.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 03/25/2023]
Abstract
BACKGROUND This overview was originally published in 2017, and is being updated in 2022. Chronic pain is typically described as pain on most days for at least three months. Chronic non-cancer pain (CNCP) is any chronic pain that is not due to a malignancy. Chronic non-cancer pain in adults is a common and complex clinical issue, for which opioids are prescribed by some physicians for pain management. There are concerns that the use of high doses of opioids for CNCP lacks evidence of effectiveness, and may increase the risk of adverse events. OBJECTIVES To describe the evidence from Cochrane Reviews and overviews regarding the efficacy and safety of high-dose opioids (defined as 200 mg morphine equivalent or more per day) for CNCP. METHODS We identified Cochrane Reviews and overviews by searching the Cochrane Database of Systematic Reviews in The Cochrane Library. The date of the last search was 21 July 2022. Two overview authors independently assessed the search results. We planned to analyse data on any opioid agent used at a high dose for two weeks or more for the treatment of CNCP in adults. MAIN RESULTS We did not identify any reviews or overviews that met the inclusion criteria. The excluded reviews largely reflected low doses or titrated doses, where all doses were analysed as a single group; we were unable to extract any data for high-dose use only. AUTHORS' CONCLUSIONS There is a critical lack of high-quality evidence, in the form of Cochrane Reviews, about how well high-dose opioids work for the management of CNCP in adults, and regarding the presence and severity of adverse events. No evidence-based argument can be made on the use of high-dose opioids, i.e. 200 mg morphine equivalent or more daily, in clinical practice. Considering that high-dose opioids have been, and are still being used in clinical practice to treat CNCP, knowing about the efficacy and safety of these higher doses is imperative.
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Affiliation(s)
- Charl Els
- Department of Psychiatry, University of Alberta, Edmonton, Canada
- College of Physicians and Surgeons of Alberta, Edmonton, Canada
| | - Tanya D Jackson
- Department of Medicine, Division of Preventive Medicine, University of Alberta, Edmonton, Canada
| | - Reidar Hagtvedt
- Accounting and Business Analytics, Alberta School of Business, University of Alberta, Edmonton, Canada
| | - Diane Kunyk
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - Barend Sonnenberg
- Medical Services, Workers' Compensation Board - Alberta, Edmonton, Canada
| | - Vernon G Lappi
- Department of Medicine, Division of Preventive Medicine, University of Alberta, Edmonton, Canada
| | - Sebastian Straube
- Department of Medicine, Division of Preventive Medicine, University of Alberta, Edmonton, Canada
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Turk T, Liu C, Fujiwara E, Straube S, Hagtvedt R, Dennett L, Abba-Aji A, Dytoc M. Pharmacological Interventions for Primary Psychodermatologic Disorders: An Evidence Mapping and Appraisal of Randomized Controlled Trials. J Cutan Med Surg 2023; 27:140-149. [PMID: 36802832 PMCID: PMC10068402 DOI: 10.1177/12034754231155888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
BACKGROUND The lack of clinical guidelines for the treatment of primary psychodermatologic disorders (PPDs) hinders the delivery of optimal care to patients. The review aimed to identify, appraise, and summarize the currently available evidence about the safety and effectiveness of pharmacological management of PPDs through randomized controlled trials (RCTs). METHODS The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRIMSA) statement and the Global Evidence Mapping Initiative guidance were followed. Medline, Embase, PsycInfo, Cochrane and Scopus were searched, and two reviewers independently completed article review, data extraction, and quality assessment. RESULTS Among 2618 unique studies, full texts of 83 were reviewed and 21 RCTs were included. Five PDDs were identified: trichotillomania (n = 12), pathologic skin picking (n = 5), nail biting (n = 2), delusional parasitosis (n = 1), and dermatitis from compulsive hand washing (n = 1). Seven different classes of medications were investigated: SSRIs (i.e., fluoxetine, sertraline, and citalopram), tricyclic antidepressants (i.e., clomipramine and desipramine), antipsychotics (i.e., olanzapine and pimozide), anticonvulsant (i.e., lamotrigine), N-acetylcysteine, inositol, and milk thistle. RCT-derived evidence supports the use of antidepressants in trichotillomania (sertraline and clomipramine), pathologic skin picking (fluoxetine), pathologic nail biting and dermatitis from compulsive hand washing (clomipramine or desipramine); antipsychotics in trichotillomania (olanzapine) and delusional parasitosis (pimozide); N-acetyl cysteine in trichotillomania and skin picking. CONCLUSION Few pharmacotherapies for primary psychodermatologic disorders are assessed through controlled trials in the literature. This review serves as a roadmap for researchers and clinicians to reach informed decisions with current evidence, and to build on it to establish guidelines in the future.
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Affiliation(s)
- Tarek Turk
- 3158 Department of Psychiatry, University of Alberta, Edmonton, Canada.,Department of Dermatology and Venereology, Syrian Arab Red Crescent Hospital, Ministry of Health, Damascus, Syria
| | - Chaocheng Liu
- 8166 Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada
| | - Esther Fujiwara
- 3158 Department of Psychiatry, University of Alberta, Edmonton, Canada
| | - Sebastian Straube
- 12357 Division of Preventive Medicine, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Reidar Hagtvedt
- 12357 ABA, Alberta School of Business, University of Alberta, Edmonton, Canada
| | - Liz Dennett
- 67111 Scott Health Sciences Library, University of Alberta, Edmonton, Canada
| | - Adam Abba-Aji
- 3158 Department of Psychiatry, University of Alberta, Edmonton, Canada
| | - Marlene Dytoc
- 3158 Division of Dermatology, Department of Medicine, University of Alberta, Edmonton, Canada
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Thirsk LM, Hagtvedt R, Bryan V, Corcoran L, Dewart G, Stahlke S. Effect of online versus in-person clinical experiences on nursing student's competency development: A cross-sectional, quasi-experimental design. Nurse Educ Today 2022; 117:105461. [PMID: 35853291 DOI: 10.1016/j.nedt.2022.105461] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/02/2022] [Accepted: 06/30/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Clinical experience is an important component of nursing education, yet placements in agencies are hard to secure, and evaluation of outcomes challenging. The shift to virtual, online clinical courses during the pandemic created the conditions of a natural experiment. OBJECTIVES To compare differences in outcomes between an in-person and online design for a family and community health clinical course. DESIGN Quasi-experimental, 2-group, cross-sectional study. METHODS Competency evaluations were reviewed from a baccalaureate nursing program in Canada from 19 students who completed an in-person clinical, and 32 students who completed an online clinical. Quantitative analysis compared competencies achieved, interest in community health nursing, and linguistic analysis of unstructured narratives using natural language processing. RESULTS There are differences in competency evaluations for in-person versus online community clinical courses, and potential implications for future interest in community health. Natural language processing detected differences in content and psychological processes between the two groups. CONCLUSIONS Nursing programs could apply this methodology to track impact of changes to clinical course design on achievement of competencies. There are important differences in outcomes between online and in-person clinical courses.
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Affiliation(s)
- Lorraine M Thirsk
- Faculty of Health Disciplines, Athabasca University, 1 University Drive, Athabasca, Alberta T9S 3A3, Canada.
| | - Reidar Hagtvedt
- Alberta School of Business, University of Alberta, 11211 Saskatchewan Dr NW, Edmonton, Alberta T6G 2R6, Canada
| | - Venise Bryan
- Faculty of Health Disciplines, Athabasca University, 1 University Drive, Athabasca, Alberta T9S 3A3, Canada
| | - Lynn Corcoran
- Faculty of Health Disciplines, Athabasca University, 1 University Drive, Athabasca, Alberta T9S 3A3, Canada
| | - Georgia Dewart
- Faculty of Health Disciplines, Athabasca University, 1 University Drive, Athabasca, Alberta T9S 3A3, Canada
| | - Sarah Stahlke
- Faculty of Arts, University of Alberta, 6-5 Humanities Centre, Edmonton, Alberta T6G 2E5, Canada
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Thirsk LM, Panchuk JT, Stahlke S, Hagtvedt R. Cognitive and implicit biases in nurses' judgment and decision-making: A scoping review. Int J Nurs Stud 2022; 133:104284. [PMID: 35696809 DOI: 10.1016/j.ijnurstu.2022.104284] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Cognitive and implicit biases of healthcare providers can lead to adverse events in healthcare and have been identified as a patient safety concern. Most research on the impact of these systematic errors in judgment has been focused on diagnostic decision-making, primarily by physicians. As the largest component of the workforce, nurses make numerous decisions that affect patient outcomes; however, literature on nurses' clinical judgment often overlooks the potential impact of bias on these decisions. The aim of this study was to map the evidence and key concepts related to bias in nurses' judgment and decision-making, including interventions to correct or overcome these biases. METHODS We conducted a scoping review using Joanna Briggs methodology. In November 2020 we searched CINAHL, PsychInfo, and PubMed databases to identify relevant literature. Inclusion criteria were primary research about nurses' bias; evidence of a nursing decision or action; and English language. No date or geographic limitations were set. RESULTS We found 77 items that met the inclusion criteria. Over half of these items were published in the last 12 years. Most research focused on implicit biases related to racial/ethnic identity, obesity, and gender; other articles examined confirmation, attribution, anchoring, and hindsight biases. Some articles examined heuristics and were included if they described the process of, and the problems with, nurse decision-making. Only 5 studies tested interventions to overcome or correct biases. 61 of the studies relied on vignettes, surveys, or recall methods, rather than examining real-world nursing practice. This could be a serious oversight because contextual factors such as cognitive load, which have a significant impact on judgment and decision-making, are not necessarily captured with vignette or survey studies. Furthermore, survey and vignette studies make it difficult to quantify the impact of these biases in the healthcare system. CONCLUSIONS Given the serious effects that bias has on nurses' clinical judgment, and thereby patient outcomes, a concerted, systematic effort to identify and test debiasing strategies in real-world nursing settings is needed. TWEETABLE ABSTRACT Bias affects nurses' clinical judgment - we need to know how to fix it.
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Affiliation(s)
- Lorraine M Thirsk
- Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada.
| | - Julia T Panchuk
- Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada
| | - Sarah Stahlke
- Department of Sociology, Faculty of Arts, University of Alberta, Edmonton, Alberta, Canada
| | - Reidar Hagtvedt
- Alberta School of Business, University of Alberta, Edmonton, Alberta, Canada
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Turk T, Liu C, Straube S, Dytoc M, Hagtvedt R, Dennett L, Abba-Aji A, Fujiwara E. The Global Prevalence of Primary Psychodermatologic Disorders: A Systematic Review. J Eur Acad Dermatol Venereol 2022; 36:2267-2278. [PMID: 35924420 DOI: 10.1111/jdv.18478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 06/15/2022] [Indexed: 11/30/2022]
Abstract
The management of primary psychodermatologic disorders (PPDs) (i.e., psychiatric disorders with dermatologic presentation) is challenging. The scarceness of reported prevalence hinders the development of coordinated interventions to improve healthcare delivery. This review aimed to explore the global prevalence of PPDs. The review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analyses statement. Of the 4632 identified publications, 60 were included. Five PPDs were investigated from the included studies: delusional parasitosis (n=9), skin picking disorder (n=26), trichotillomania (n=22), tanning dependence (n=5), and repetitive nail biting (n=6). Delusional parasitosis was rare in the general population (prevalence ranging from 0.0002% to 0.03%), with higher rates in the psychiatric settings (outpatient=0.5%; inpatient=0.1%). Other pathologic or subclinical forms of PPDs had a minimum prevalence of 0.3% (median=7.0%; mean=17.0%). The distribution of the prevalence rates was highly skewed, with large differences based on the study setting (e.g., dermatologic settings, psychiatric settings, and general population). The most common condition was pathologic skin picking (prevalence, 1.2%-11.2%) in the general population. Its rates were higher in the psychiatric settings (obsessive-compulsive disorder, 38.5%; Tourette syndrome, 13.0%; body dysmorphic disorder, 26.8%-64.7%). The prevalence of trichotillomania in the general population ranged from 0.6% to 2.9%, while that of pathologic tanning and nail biting could not be ascertained as the studies were mainly in students (range; 12.0%-39.3% and 3.0%-10.1%, respectively). In conclusion, PPDs are common, especially in the dermatologic and psychiatric settings. Further population-based studies are needed to determine more accurate prevalence rates.
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Affiliation(s)
- T Turk
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.,Department of Dermatology and Venereology, Syrian Arab Red Crescent Hospital, Ministry of Health, Damascus, Syria
| | - C Liu
- Department of Dermatology and Skin Science, University of British Colombia, Vancouver, BC, Canada
| | - S Straube
- Division of Preventive Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - M Dytoc
- Division of Dermatology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - R Hagtvedt
- ABA, Alberta School of Business, University of Alberta, Edmonton, AB, Canada
| | - L Dennett
- Scott Health Sciences Library, University of Alberta, Edmonton, AB, Canada
| | - A Abba-Aji
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - E Fujiwara
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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Mathura P, Boettger C, Hagtvedt R, Sweeney C, Williams S, Suranyi Y, Kassam N, Gill M. Reduction of urea test ordering in the emergency department: multicomponent intervention including education, electronic ordering, and data feedback. CAN J EMERG MED 2022; 24:636-640. [PMID: 35857240 PMCID: PMC9297275 DOI: 10.1007/s43678-022-00333-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 01/18/2022] [Accepted: 05/25/2022] [Indexed: 11/13/2022]
Abstract
Introduction In the emergency department (ED), laboratory testing accounts for a significant portion of the medical assessment. Although excess laboratory test ordering has been proven to be prevalent, different types of interventions have been used to encourage a behavioural change in how physicians order tests. In one western Canadian hospital medicine program, a quality improvement project aimed to reduce the total monthly blood urea nitrogen (BUN) test ordered by physicians was found to be successful. The objective of this project was to evaluate a similar multicomponent intervention aimed at ED physician ordering, with the primary goal of reducing the number of monthly BUN tests ordered per ED visit. Methods A pre post intervention design was conducted over 12-months. The first intervention component was an educational presentation conducted by physician leaders. Second, a regularly used order panel within the ED electronic order system was modified, removing the BUN test. The third component involved audit and feedback; the total monthly BUN test ordered for the ED department post intervention start was shared with all ED physicians twice (at 5 and 12 months).An interrupted time series analysis was completed to evaluate the multicomponent intervention effect. Results The total monthly ordered BUN test declined from an average of 1905 pre-intervention to 448 post-intervention, and the total monthly BUN test to total ED visit ratio declined from 0.46 to 0.1. These results were a statistically significant reduction in physician BUN test ordering. Conclusions Targeted education, order panel design and data feedback interventions can impact physician ordering behaviour in the emergent healthcare context, where diagnostic tests are often over used. Supplementary Information The online version contains supplementary material available at 10.1007/s43678-022-00333-w.
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Affiliation(s)
- Pamela Mathura
- Department of Medicine, University of Alberta Hospital, University of Alberta, Edmonton, AB, Canada. .,Alberta Health Services, Edmonton, AB, Canada.
| | - Cole Boettger
- Department of Medicine, University of Alberta Hospital, University of Alberta, Edmonton, AB, Canada
| | - Reidar Hagtvedt
- University of Alberta, Alberta School of Business, Edmonton, AB, Canada
| | - Colleen Sweeney
- Alberta Health Services, Edmonton, AB, Canada.,Covenant Health, Edmonton, AB, Canada.,Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada
| | - Stephen Williams
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Narmin Kassam
- Department of Medicine, University of Alberta Hospital, University of Alberta, Edmonton, AB, Canada.,Alberta Health Services, Edmonton, AB, Canada
| | - Manpreet Gill
- Department of Medicine, University of Alberta Hospital, University of Alberta, Edmonton, AB, Canada.,Alberta Health Services, Edmonton, AB, Canada.,Covenant Health, Edmonton, AB, Canada
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Beckson M, Hagtvedt R, Els C. Cannabis use before safety-sensitive work: What delay is prudent? Neurosci Biobehav Rev 2021; 133:104488. [PMID: 34896430 DOI: 10.1016/j.neubiorev.2021.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/29/2021] [Accepted: 12/06/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Mace Beckson
- Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 11301W. Olympic Boulevard #657, Los Angeles, CA, 90064, United States.
| | - Reidar Hagtvedt
- Department of Accounting and Business Analytics, Alberta School of Business, University of Alberta, 2-43 Business Building, Edmonton, AB T6G 2R6, Canada
| | - Charl Els
- Department of Psychiatry, University of Alberta, Suite 3400 Manulife Place 10180 101 St NW, Edmonton, AB T5J 3S4, Canada
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Mathura P, Boettger C, Hagtvedt R, Suranyi Y, Kassam N. Does admission order form design really matter? A reduction in urea blood test ordering. BMJ Open Qual 2021; 10:bmjoq-2020-001330. [PMID: 34210669 PMCID: PMC8252868 DOI: 10.1136/bmjoq-2020-001330] [Citation(s) in RCA: 2] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 06/22/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction Laboratory blood testing is one of the most high-volume medical procedures and continues to increase steadily with instances of inappropriate testing resulting in significant financial implications. Studies have suggested that the design of a standard hospital admission order form and laboratory request forms influence physician test ordering behaviour, reducing inappropriate ordering and promoting resource stewardship. Aim/method To redesign the standard medicine admission order form-laboratory request section to reduce inappropriate blood urea nitrogen (BUN) testing. Results A redesign of the standard admission order form used by general internal medicine physicians and residents in two large teaching hospitals in one health zone in Alberta, Canada led to a significant step reduction in the ordering of the BUN test on hospital admission. Conclusions Redesigning the standard medicine admission order form-laboratory request section can have a beneficial effect on the reduction in BUN ordering altering physician ordering patterns and behaviour.
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Affiliation(s)
- Pamela Mathura
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Cole Boettger
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Reidar Hagtvedt
- Alberta School of Business, University of Alberta, Edmonton, Alberta, Canada
| | - Yvonne Suranyi
- Emergency Department, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Narmin Kassam
- Medicine, University of Alberta, Edmonton, Alberta, Canada
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Els C, Jackson TD, Milen MT, Kunyk D, Wyatt G, Sowah D, Hagtvedt R, Deibert D, Straube S. Random drug and alcohol testing for preventing injury in workers. Cochrane Database Syst Rev 2020; 12:CD012921. [PMID: 33368213 PMCID: PMC8130990 DOI: 10.1002/14651858.cd012921.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Drug- and alcohol-related impairment in the workplace has been linked to an increased risk of injury for workers. Randomly testing populations of workers for these substances has become a practice in many jurisdictions, with the intention of reducing the risk of workplace incidents and accidents. Despite the proliferation of random drug and alcohol testing (RDAT), there is currently a lack of consensus about whether it is effective at preventing workplace injury, or improving other non-injury accident outcomes in the work place. OBJECTIVES To assess the effectiveness of workplace RDAT to prevent injuries and improve non-injury accident outcomes (unplanned events that result in damage or loss of property) in workers compared with no workplace RDAT. SEARCH METHODS We conducted a systematic literature search to identify eligible published and unpublished studies. The date of the last search was 1 November 2020. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, two other databases, Google Scholar, and three trials registers. We also screened the reference lists of relevant publications known to us. SELECTION CRITERIA Study designs that were eligible for inclusion in our review included randomised controlled trials (RCTs), cluster-randomised trials (CRTs), interrupted time-series (ITS) studies, and controlled before-after (CBA) studies. Studies needed to evaluate the effectiveness of RDAT in preventing workplace injury or improving other non-injury workplace outcomes. We also considered unpublished data from clinical trial registries. We included employees working in all safety-sensitive occupations, except for commercial drivers, who are the subject of another Cochrane Review. DATA COLLECTION AND ANALYSIS Independently, two review authors used a data collection form to extract relevant characteristics from the included study. They then analysed a line graph included in the study of the prevalence rate of alcohol violations per year. Independently, the review authors completed a GRADE assessment, as a means of rating the quality of the evidence. MAIN RESULTS Although our searching originally identified 4198 unique hits, only one study was eligible for inclusion in this review. This was an ITS study that measured the effect of random alcohol testing (RAT) on the test positivity rate of employees of major airlines in the USA from 1995 to 2002. The study included data from 511,745 random alcohol tests, and reported no information about testing for other substances. The rate of positive results was the only outcome of interest reported by the study. The average rate of positive results found by RAT increased from 0.07% to 0.11% when the minimum percentage of workers who underwent RAT annually was reduced from 25% to 10%. Our analyses found this change to be a statistically significant increase (estimated change in level, where the level reflects the average percentage points of positive tests = 0.040, 95% confidence interval 0.005 to 0.075; P = 0.031). Our GRADE assessment, for the observed effect of lower minimum testing percentages associating with a higher rate of positive test results, found the quality of the evidence to be 'very low' across the five GRADE domains. The one included study did not address the following outcomes of interest: fatal injuries; non-fatal injuries; non-injury accidents; absenteeism; and adverse effects associated with RDAT. AUTHORS' CONCLUSIONS In the aviation industry in the USA, the only setting for which the eligible study reported data, there was a statistically significant increase in the rate of positive RAT results following a reduction in the percentage of workers tested, which we deem to be clinically relevant. This result suggests an inverse relationship between the proportion of positive test results and the rate of testing, which is consistent with a deterrent effect for testing. No data were reported on adverse effects related to RDAT. We could not draw definitive conclusions regarding the effectiveness of RDAT for employees in safety-sensitive occupations (not including commercial driving), or with safety-sensitive job functions. We identified only one eligible study that reflected one industry in one country, was of non-randomised design, and tested only for alcohol, not for drugs or other substances. Our GRADE assessment resulted in a 'very low' rating for the quality of the evidence on the only outcome reported. The paucity of eligible research was a major limitation in our review, and additional studies evaluating the effect of RDAT on safety outcomes are needed.
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Affiliation(s)
- Charl Els
- Department of Psychiatry, University of Alberta, Edmonton, Canada
| | - Tanya D Jackson
- Department of Medicine, Division of Preventive Medicine, University of Alberta, Edmonton, Canada
| | - Mathew T Milen
- Department of Medicine, Division of Preventive Medicine, University of Alberta, Edmonton, Canada
| | - Diane Kunyk
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - Graeme Wyatt
- Department of Medicine, Division of Preventive Medicine, University of Alberta, Edmonton, Canada
| | - Daniel Sowah
- Department of Medicine, Division of Preventive Medicine, University of Alberta, Edmonton, Canada
| | - Reidar Hagtvedt
- AOIS, Alberta School of Business, University of Alberta, Edmonton, Canada
| | - Danika Deibert
- Department of Medicine, Division of Preventive Medicine, University of Alberta, Edmonton, Canada
| | - Sebastian Straube
- Department of Medicine, Division of Preventive Medicine, University of Alberta, Edmonton, Canada
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Beckson M, Jones AW, Els C, Hagtvedt R. Cannabis, crashes and blood: challenges for observational research. Addiction 2020; 115:589-590. [PMID: 31746490 DOI: 10.1111/add.14891] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 11/04/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Mace Beckson
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Alan W Jones
- Department of Clinical Pharmacology, University of Linköping, Linköping, Sweden
| | - Charl Els
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Reidar Hagtvedt
- Department of Accounting, Operations, and Information Science, Alberta School of Business, University of Alberta, Edmonton, AB, Canada
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Hayward J, Hagtvedt R, Ma W, Gauri A, Vester M, Holroyd BR. Predictors of Admission in Adult Unscheduled Return Visits to the Emergency Department. West J Emerg Med 2018; 19:912-918. [PMID: 30429921 PMCID: PMC6225947 DOI: 10.5811/westjem.2018.8.38225] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 06/26/2018] [Accepted: 08/11/2018] [Indexed: 11/24/2022] Open
Abstract
Introduction The 72-hour unscheduled return visit (URV) of an emergency department (ED) patient is often used as a key performance indicator in emergency medicine. We sought to determine if URVs with admission to hospital (URVA) represent a distinct subgroup compared to unscheduled return visits with no admission (URVNA). Methods We performed a retrospective cohort study of all 72-hour URVs in adults across 10 EDs in the Edmonton Zone (EZ) over a one-year period (January 1, 2015 - December 31, 2015) using ED information-system data. URVA and URVNA populations were compared, and a multivariable analysis identified predictors of URVA. Results Analysis of 40,870 total URV records, including 3,363 URVAs, revealed predictors of URVA on the index visit including older age (>65 yrs, odds ratio [OR] 3.6), higher disease acuity (Canadian Emergency Department Triage and Acuity Scale [CTAS] 2, OR 2.6), gastrointestinal presenting complaint (OR 2.2), presenting to a referral hospital (OR 1.4), fewer annual ED visits (<4 visits, OR 2.0), and more hours spent in the ED (>12 hours, OR 2.0). A decrease in CTAS score (increase in disease acuity) upon return visit also increased the risk of admission (-1 CTAS level, OR 2.6). ED crowding at the index visit, as indicated by occupancy level, was not a predictor. Conclusion We demonstrate that URVA patients comprise a distinct subgroup of 72-hour URV patients. Risk factors for URVA are present at the index visit suggesting that patients at high risk for URVA may be identifiable prior to admission.
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Affiliation(s)
- Jake Hayward
- University of Alberta, Department of Emergency Medicine, Edmonton, Alberta, Canada
| | - Reidar Hagtvedt
- University of Alberta, Alberta School of Business, Edmonton, Alberta, Canada
| | - Warren Ma
- University of Alberta, Department of Emergency Medicine, Edmonton, Alberta, Canada
| | - Aliyah Gauri
- University of Alberta, Department of Emergency Medicine, Edmonton, Alberta, Canada
| | - Michael Vester
- University of Alberta, Department of Emergency Medicine, Edmonton, Alberta, Canada
| | - Brian R. Holroyd
- University of Alberta, Department of Emergency Medicine, Edmonton, Alberta, Canada
- Alberta Health Services, Emergency Strategic Clinical Network, Edmonton, Alberta, Canada
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Hayward J, Hagtvedt R, Ma W, Gauri A, Vester M, Holroyd B. Predictors of Admission in Adult Unscheduled Return Visits to the Emergency Department. West J Emerg Med 2018. [DOI: 10.5811/westjem.2018.38225] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Jake Hayward
- University of Alberta, Department of Emergency Medicine, Edmonton, Alberta, Canada
| | - Reidar Hagtvedt
- University of Alberta, Alberta School of Business, Edmonton, Alberta, Canada
| | - Warren Ma
- University of Alberta, Department of Emergency Medicine, Edmonton, Alberta, Canada
| | - Aliyah Gauri
- University of Alberta, Department of Emergency Medicine, Edmonton, Alberta, Canada
| | - Michael Vester
- University of Alberta, Department of Emergency Medicine, Edmonton, Alberta, Canada
| | - Brian Holroyd
- University of Alberta, Department of Emergency Medicine, Edmonton, Alberta, Canada; Alberta Health Services, Emergency Strategic Clinical Network, Edmonton, Alberta, Canada
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Abstract
BACKGROUND Chronic pain is typically described as pain on most days for at least three months. Chronic non-cancer pain (CNCP) is any chronic pain that is not due to a malignancy. Chronic non-cancer pain in adults is a common and complex clinical issue where opioids are routinely used for pain management. There are concerns that the use of high doses of opioids for chronic non-cancer pain lacks evidence of effectiveness and may increase the risk of adverse events. OBJECTIVES To describe the evidence from Cochrane Reviews and Overviews regarding the efficacy and safety of high-dose opioids (here defined as 200 mg morphine equivalent or more per day) for chronic non-cancer pain. METHODS We identified Cochrane Reviews and Overviews through a search of the Cochrane Database of Systematic Reviews (The Cochrane Library). The date of the last search was 18 April 2017. Two review authors independently assessed the search results. We planned to analyse data on any opioid agent used at high dose for two weeks or more for the treatment of chronic non-cancer pain in adults. MAIN RESULTS We did not identify any reviews or overviews meeting the inclusion criteria. The excluded reviews largely reflected low doses or titrated doses where all doses were analysed as a single group; no data for high dose only could be extracted. AUTHORS' CONCLUSIONS There is a critical lack of high-quality evidence regarding how well high-dose opioids work for the management of chronic non-cancer pain in adults, and regarding the presence and severity of adverse events. No evidence-based argument can be made on the use of high-dose opioids, i.e. 200 mg morphine equivalent or more daily, in clinical practice. Trials typically used doses below our cut-off; we need to know the efficacy and harm of higher doses, which are often used in clinical practice.
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Affiliation(s)
- Charl Els
- University of AlbertaDepartment of PsychiatryEdmontonAlbertaCanada
| | - Tanya D Jackson
- University of AlbertaDepartment of Medicine, Division of Preventive MedicineEdmontonAlbertaCanada
| | - Reidar Hagtvedt
- University of AlbertaAOIS, Alberta School of BusinessEdmontonAlbertaCanada
| | - Diane Kunyk
- University of AlbertaFaculty of NursingEdmontonAlbertaCanada
| | - Barend Sonnenberg
- Workers' Compensation Board of AlbertaMedical ServicesEdmontonAlbertaCanada
| | - Vernon G Lappi
- University of AlbertaDepartment of Medicine, Division of Preventive MedicineEdmontonAlbertaCanada
| | - Sebastian Straube
- University of AlbertaDepartment of Medicine, Division of Preventive MedicineEdmontonAlbertaCanada
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Els C, Jackson TD, Kunyk D, Lappi VG, Sonnenberg B, Hagtvedt R, Sharma S, Kolahdooz F, Straube S. Adverse events associated with medium- and long-term use of opioids for chronic non-cancer pain: an overview of Cochrane Reviews. Cochrane Database Syst Rev 2017; 10:CD012509. [PMID: 29084357 PMCID: PMC6485910 DOI: 10.1002/14651858.cd012509.pub2] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Chronic pain is common and can be challenging to manage. Despite increased utilisation of opioids, the safety and efficacy of long-term use of these compounds for chronic non-cancer pain (CNCP) remains controversial. This overview of Cochrane Reviews complements the overview entitled 'High-dose opioids for chronic non-cancer pain: an overview of Cochrane Reviews'. OBJECTIVES To provide an overview of the occurrence and nature of adverse events associated with any opioid agent (any dose, frequency, or route of administration) used on a medium- or long-term basis for the treatment of CNCP in adults. METHODS We searched the Cochrane Database of Systematic Reviews (the Cochrane Library) Issue 3, 2017 on 8 March 2017 to identify all Cochrane Reviews of studies of medium- or long-term opioid use (2 weeks or more) for CNCP in adults aged 18 and over. We assessed the quality of the reviews using the AMSTAR criteria (Assessing the Methodological Quality of Systematic Reviews) as adapted for Cochrane Overviews. We assessed the quality of the evidence for the outcomes using the GRADE framework. MAIN RESULTS We included a total of 16 reviews in our overview, of which 14 presented unique quantitative data. These 14 Cochrane Reviews investigated 14 different opioid agents that were administered for time periods of two weeks or longer. The longest study was 13 months in duration, with most in the 6- to 16-week range. The quality of the included reviews was high using AMSTAR criteria, with 11 reviews meeting all 10 criteria, and 5 of the reviews meeting 9 out of 10, not scoring a point for either duplicate study selection and data extraction, or searching for articles irrespective of language and publication type. The quality of the evidence for the generic adverse event outcomes according to GRADE ranged from very low to moderate, with risk of bias and imprecision being identified for the following generic adverse event outcomes: any adverse event, any serious adverse event, and withdrawals due to adverse events. A GRADE assessment of the quality of the evidence for specific adverse events led to a downgrading to very low- to moderate-quality evidence due to risk of bias, indirectness, and imprecision.We calculated the equivalent milligrams of morphine per 24 hours for each opioid studied (buprenorphine, codeine, dextropropoxyphene, dihydrocodeine, fentanyl, hydromorphone, levorphanol, methadone, morphine, oxycodone, oxymorphone, tapentadol, tilidine, and tramadol). In the 14 Cochrane Reviews providing unique quantitative data, there were 61 studies with a total of 18,679 randomised participants; 12 of these studies had a cross-over design with two to four arms and a total of 796 participants. Based on the 14 selected Cochrane Reviews, there was a significantly increased risk of experiencing any adverse event with opioids compared to placebo (risk ratio (RR) 1.42, 95% confidence interval (CI) 1.22 to 1.66) as well as with opioids compared to a non-opioid active pharmacological comparator, with a similar risk ratio (RR 1.21, 95% CI 1.10 to 1.33). There was also a significantly increased risk of experiencing a serious adverse event with opioids compared to placebo (RR 2.75, 95% CI 2.06 to 3.67). Furthermore, we found significantly increased risk ratios with opioids compared to placebo for a number of specific adverse events: constipation, dizziness, drowsiness, fatigue, hot flushes, increased sweating, nausea, pruritus, and vomiting.There was no data on any of the following prespecified adverse events of interest in any of the included reviews in this overview of Cochrane Reviews: addiction, cognitive dysfunction, depressive symptoms or mood disturbances, hypogonadism or other endocrine dysfunction, respiratory depression, sexual dysfunction, and sleep apnoea or sleep-disordered breathing. We found no data for adverse events analysed by sex or ethnicity. AUTHORS' CONCLUSIONS A number of adverse events, including serious adverse events, are associated with the medium- and long-term use of opioids for CNCP. The absolute event rate for any adverse event with opioids in trials using a placebo as comparison was 78%, with an absolute event rate of 7.5% for any serious adverse event. Based on the adverse events identified, clinically relevant benefit would need to be clearly demonstrated before long-term use could be considered in people with CNCP in clinical practice. A number of adverse events that we would have expected to occur with opioid use were not reported in the included Cochrane Reviews. Going forward, we recommend more rigorous identification and reporting of all adverse events in randomised controlled trials and systematic reviews on opioid therapy. The absence of data for many adverse events represents a serious limitation of the evidence on opioids. We also recommend extending study follow-up, as a latency of onset may exist for some adverse events.
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Affiliation(s)
- Charl Els
- University of AlbertaDepartment of PsychiatryEdmontonAlbertaCanada
| | - Tanya D Jackson
- University of AlbertaDepartment of Medicine, Division of Preventive MedicineEdmontonAlbertaCanada
| | - Diane Kunyk
- University of AlbertaFaculty of NursingEdmontonAlbertaCanada
| | - Vernon G Lappi
- University of AlbertaDepartment of Medicine, Division of Preventive MedicineEdmontonAlbertaCanada
| | - Barend Sonnenberg
- Workers' Compensation Board of AlbertaMedical ServicesEdmontonAlbertaCanada
| | - Reidar Hagtvedt
- University of AlbertaAOIS, Alberta School of BusinessEdmontonAlbertaCanada
| | - Sangita Sharma
- Department of Medicine, University of AlbertaIndigenous and Global Health Research GroupEdmontonAlbertaCanada
| | - Fariba Kolahdooz
- Department of Medicine, University of AlbertaIndigenous and Global Health Research GroupEdmontonAlbertaCanada
| | - Sebastian Straube
- University of AlbertaDepartment of Medicine, Division of Preventive MedicineEdmontonAlbertaCanada
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Abstract
Background Vitamin D deficiency is prevalent worldwide, but some groups are at greater risk. We aim to evaluate vitamin D levels in different occupations and identify groups vulnerable to vitamin D deficiency. Methods An electronic search conducted in Medline, Embase, the Cochrane Central Register of Controlled Trials, and CINAHL Plus with Full Text generated 2505 hits; 71 peer-reviewed articles fulfilled the inclusion criteria. Occupations investigated included outdoor and indoor workers, shiftworkers, lead/smelter workers, coalminers, and healthcare professionals. We calculated the pooled average metabolite level as mean ± SD; deficiency/insufficiency status was described as % of the total number of subjects in a given category. Results Compared to outdoor workers, indoor workers had lower 25-hydroxyvitamin D (25-(OH)D) levels (40.6 ± 13.3 vs. 66.7 ± 16.7 nmol/L; p < 0.0001). Mean 25-(OH)D levels (in nmol/L) in shiftworkers, lead/smelter workers and coalminers were 33.8 ± 10.0, 77.8 ± 5.4 and 56.6 ± 28.4, respectively. Vitamin D deficiency (25-(OH)D < 50 nmol/L), was high in shiftworkers (80%) and indoor workers (78%) compared to outdoor workers (48%). Among healthcare professionals, medical residents and healthcare students had the lowest levels of mean 25-(OH)D, 44.0 ± 8.3 nmol/L and 45.2 ± 5.5 nmol/L, respectively. The mean 25-(OH)D level of practising physicians, 55.0 ± 5.8 nmol/L, was significantly different from both medical residents (p < 0.0001) and healthcare students (p < 0.0001). Nurses and other healthcare employees had 25-(OH)D levels of 63.4 ± 4.2 nmol/L and 63.0 ± 11.0 nmol/L, respectively, which differed significantly compared to practising physicians (p = 0.01), medical residents (p < 0.0001) and healthcare students (p < 0.0001). Rates of vitamin D deficiency among healthcare professionals were: healthcare students 72%, medical residents 65%, practising physicians 46%, other healthcare employees 44%, and nurses 43%. Combined rates of vitamin D deficiency or insufficiency (25-(OH)D < 75 nmol/L) were very high in all investigated groups. Potential confounders such as gender and body composition were not consistently reported in the primary studies and were therefore not analyzed. Furthermore, the descriptions of occupational characteristics may be incomplete. These are limitations of our systematic review. Conclusions Our review demonstrates that shiftworkers, healthcare workers and indoor workers are at high risk to develop vitamin D deficiency, which may reflect key lifestyle differences (e.g. sunlight exposure). This may help target health promotion and preventive efforts. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4436-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Daniel Sowah
- Division of Preventive Medicine, Department of Medicine, University of Alberta, 5-30 University Terrace, 8303-112 Street, Edmonton, AB, T6G 2T4, Canada
| | - Xiangning Fan
- Division of Preventive Medicine, Department of Medicine, University of Alberta, 5-30 University Terrace, 8303-112 Street, Edmonton, AB, T6G 2T4, Canada
| | - Liz Dennett
- JW Scott Health Sciences Library, University of Alberta, Edmonton, Canada
| | - Reidar Hagtvedt
- Department of Accounting, Operations and Information Systems, School of Business, University of Alberta, Edmonton, Canada
| | - Sebastian Straube
- Division of Preventive Medicine, Department of Medicine, University of Alberta, 5-30 University Terrace, 8303-112 Street, Edmonton, AB, T6G 2T4, Canada.
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Els C, Kunyk D, Lappi VG, Sonnenberg B, Hagtvedt R, Sharma S, Kolahdooz F, Straube S. Adverse events associated with medium- and long-term use of opioids for chronic non-cancer pain: an overview of Cochrane Reviews. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2017. [DOI: 10.1002/14651858.cd012509] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Els C, Hagtvedt R, Kunyk D, Sonnenberg B, Lappi VG, Straube S. High-dose opioids for chronic non-cancer pain: an overview of Cochrane reviews. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2016. [DOI: 10.1002/14651858.cd012299] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Abstract
BACKGROUND Despite the knowledge that contaminated hands play an important role in the transmission of healthcare-associated pathogens, and that hand hygiene (HH) reduces the transmission of these organisms, healthcare worker's adherence with HH is poor. OBJECTIVE To understand the common beliefs and attitudes held by paediatric residents about HH. DESIGN Qualitative study design. SETTING Tertiary care paediatric hospital in Edmonton, Canada. METHODS Semistructured interviews were conducted and themes were identified from interviews. PARTICIPANTS 22 paediatric residents. RESULTS Paediatric residents self-reported their HH adherence at 70-99% and perceived hospital-wide adherence at 45-80%. Four major themes were identified during interviews including the importance of role modelling, balancing time spent on HH with other competing factors, self-protection as a driving factor for HH and cues as an important part of habit that stimulate HH. CONCLUSIONS Staff physicians were viewed as integral to initiating group HH events, but at times, the first person in the room acted as a role model for the rest of the group. In certain instances, such as a cardiac arrest, decreased adherence with HH was viewed as acceptable. Residents engaged in HH to protect their own health. Residents relied on personal cues, which they integrated into their own HH habit. Future HH adherence strategies should ensure that the physician training environments permit the formation of good attitudes and habits towards HH. There are no additional data available.
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Affiliation(s)
- Devika Dixit
- Department of Paediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Reidar Hagtvedt
- Department of Accounting, Operations and Information Systems Alberta School of Business, University of Alberta, Edmonton, Canada
| | - Trish Reay
- Department of Strategic Management and Organization Alberta School of Business, University of Alberta, Edmonton, Canada
| | - Mark Ballermann
- Clinical Informatics North Alberta Health Services, Edmonton, Canada
| | - Sarah Forgie
- Department of Paediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
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Jones GT, Hagtvedt R. Marketing in Heterozygous Advantage. J Bus Ethics 2007; 77:85-97. [PMID: 32214562 PMCID: PMC7087662 DOI: 10.1007/s10551-006-9301-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
As the rapidly advancing possibilities of biotechnology have outstripped the adaptive capacity of current legal and ethical institutions, a vigorous debate has arisen that considers the boundaries of appropriate use of this technology, particularly when applied to humans. This article examines ethical concerns surrounding the development of markets in a particular form of human genetic engineering in which heterozygotes are fitter than both homozygotes, a condition known as heterozygous advantage. To begin, we present a generalized model of the condition, illuminated by the application to sickle-cell anemia. Next, we propose a typology of related markets, some of which are currently functioning with available products and services, and others that are widely viewed as imminent. We suggest the manner in which perverse incentives may arise for firms that market genetic intervention in circumstances where heterozygous advantage is possible. Finally, we propose that this misalignment of incentives with social welfare has arisen from both ill-conceived market intervention where markets are capable of achieving efficient outcomes and the lack of market intervention where markets have failed. We offer specific legal and regulatory approaches for reform.
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