Patients with Autism Spectrum or Intellectual Disability in the Psychiatric Emergency Department: Findings from a 10-year Retrospective Review.

Purpose: There is a dearth of information about patients with autism spectrum disorder (ASD) or intellectual disability (ID) who seek emergency psychiatric care. Given this backdrop, this retrospective study aims to explore clinical, demographic, and disposition-related information about this patient population over a 10-year period.

Methods: This study includes individuals with ASD or ID (n = 1461) and had presented to a psychiatric emergency department between 2012 and 2021.

Tackling Pharmaceutical Pollution Along the Product Lifecycle: Roles and Responsibilities for Producers, Regulators and Prescribers.

Pharmaceuticals produce considerable environmental harm. The industry's resource-intensive nature, coupled with high energy costs for manufacturing and transportation, contribute to the "upstream" harms from greenhouse gas emissions and ecosystem pollution, while factors such as overprescription, overuse, and pharmaceutical waste contribute to the "downstream" harms. Effectively addressing pharmaceutical pollution requires an understanding of the key roles and responsibilities along the product lifecycle.

Australian and Canadian clinicians' views and application of 'carbon health literacy': a qualitative study.

Background: Clinical care contributes to at least 50% of the greenhouse gas (GHG) emissions of healthcare. This includes the 40% of healthcare that is harmful or low value, adding avoidable emissions without improving health or quality of care. Clinicians are well-placed to mitigate emissions associated with the provision of clinical care.

Mapping the Environmental Co-Benefits of Reducing Low-Value Care: A Scoping Review and Bibliometric Analysis.

Reducing low-value care (LVC) and improving healthcare's climate readiness are critical factors for improving the sustainability of health systems. Care practices that have been deemed low or no-value generate carbon emissions, waste and pollution without improving patient or population health. There is nascent, but growing, research and evaluation to inform practice change focused on the environmental co-benefits of reducing LVC.

Considering planetary health in health guidelines and health technology assessments: a scoping review protocol.

Background: This protocol outlines a scoping review with the objective of identifying and exploring planetary health considerations within existing health guidelines and health technology assessments (HTA). The insights gained from this review will serve as a basis for shaping future Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) guidance on planetary health.

Methods: We will adhere to the JBI methodology for scoping reviews.

Bioplastics: No solution to healthcare's plastic pollution problem.

As Canadian policy-makers recognize the urgency for concerted actions to reduce plastics (e.g., Canada's involvement in the international plastics treaty negotiations, zero plastic waste strategy, and single-use plastics regulations), the healthcare sector must also consider a more sustainable plastics system.

Moving from intervention management to disease management: a qualitative study exploring a systems approach to health technology assessment in Canada.

Objectives: Health technology assessment (HTA) traditionally informs decision making for single health technologies, which could lead to ill-informed decisions, suboptimal care, and system inefficiencies. We explored opportunities for conceptualizing the decision space in HTA as a disease management question versus an intervention management question.

Methods: Semistructured interviews were conducted between April 2022 and October 2022 with purposefully selected individuals from national and provincial HTA agencies and related organizations in Canada.

Outsourcing practice-based education: The role of industry representatives and implications for clinical expertise.

In an era of significant human and fiscal constraints, hospitals increasingly rely on industry representatives to fill gaps related to practice-based education. Given their dual sales and support functions, the extent to which education and support functions are, or ought to be, fulfilled by industry representatives is unclear. We conducted an interpretive qualitative study at a large, academic medical centre in Ontario, Canada, during 2021-2022, interviewing 36 participants across the organization with direct and varied experiences with industry-delivered education.

Reusable personal protective equipment in Canadian healthcare: Safe, secure, and sustainable.

Personal Protective Equipment (PPE) that was intentionally designed and manufactured as reusable, including gowns, goggles, face shields, and elastomeric respirators, took on a heightened role during the pandemic. Healthcare workers who had access to these products and infrastructure for cleaning and sterilizing them had a greater sense of confidence to undertake their jobs due to an increased sense of personal safety. Using multiple data sources, including a literature review, roundtables, interviews, surveys, and Internet-based research, the project team investigated the impact of disposable PPE and role of reusable PPE during the pandemic in Canada.

Industry involvement in evidence production for genomic medicine: A bibliometric and funding analysis of decision impact studies.

Background: Decision impact studies have become increasingly prevalent in genomic medicine, particularly in cancer research. Such studies are designed to provide evidence of clinical utility for genomic tests by evaluating their impact on clinical decision-making. This paper offers insights into understanding of the origins and intentions of these studies through an analysis of the actors and institutions responsible for the production of this new type of evidence.

How can entrepreneurs experience inform responsible health innovation policies? A longitudinal case study in Canada and Brazil.

Aim: To foster equity and make health systems economically and environmentally more sustainable, Responsible Innovation in Health (RIH) calls for policy changes advocated by mission-oriented innovation policies. These policies focus, however, on instruments to foster the supply of innovations and neglect health policies that affect their uptake. Our study's aim is to inform policies that can support RIH by gaining insights into RIH-oriented entrepreneurs' experience with the policies that influence both the supply of, and the demand for their innovations.

Decision impact studies, evidence of clinical utility for genomic assays in cancer: A scoping review.

Background: Decision impact studies have become increasingly prevalent in cancer prognostic research in recent years. These studies aim to evaluate the impact of a genomic test on decision-making and appear to be a new form of evidence of clinical utility. The objectives of this review were to identify and characterize decision impact studies in genomic medicine in cancer care and categorize the types of clinical utility outcomes reported.

A comparative analysis of non-invasive prenatal testing in Ontario and Quebec: the role of governing style in health technology innovation & adoption.

Background: While processes of adoption and the impacts of various health technologies have been extensively studied by health services and policy researchers, the influence of policy makers' governing styles on these processes have been largely neglected. Through a comparative analysis of non-invasive prenatal testing (NIPT) in the Canadian provinces of Ontario and Quebec, this article examines how decisions about this technology were shaped by contrasting political ideologies, resulting in vastly different innovation and adoption strategies and outcomes.

Methods: A comparative qualitative investigation comprising of a document analysis followed by semi-structured interviews with key informants.

A qualitative study of what motivates and enables climate-engaged physicians in Canada to engage in health-care sustainability, advocacy, and action.

Increasing numbers of health-care professionals are aware of the need to deliver low-carbon sustainable health systems. We aimed to explore how physicians can be motivated and supported to pursue this ambition by conducting an exploratory qualitative descriptive study that involved individual in-depth interviews with climate-engaged Canadian physicians participating in health-care sustainability advocacy and action. Interview transcripts were analysed to identify themes related to the actions that physicians can take to promote sustainable health care, and the motivators and enablers of physician engagement in sustainable health care.

An urgent call for the environmental sustainability of health systems: A 'sextuple aim' to care for patients, costs, providers, population equity and the planet.

Health systems have a duty to protect the health and well-being of individuals and populations. Yet, healthcare contributes about 4.6% of global greenhouse gas emissions.

Antibias Efforts in United States Maternity Care: A Scoping Review of the Publicly Funded Health Equity Intervention Pipeline.

Antibias training is increasingly identified as a strategy to reduce maternal health disparities. Evidence to guide this work is limited. We conducted a community-guided scoping review to characterize new antibias research.

The Market in Noninvasive Prenatal Tests and the Message to Consumers: Exploring Responsibility.

The potential for bias in industry-developed information about noninvasive prenatal testing (NIPT), in addition to the lack of regulatory oversight for this type of product, raises questions about clinical communication and adoption. We identify NIPTs marketed globally and analyze their English-language consumer-oriented brochures to determine whether they meet existing policy and ethical guidance from the Nuffield Council on Bioethics on NIPT marketing, how they establish the legitimacy of the test given the lack of regulatory oversight for NIPT, and whether content differs between the brochures from for-profit and nonprofit entities. In many of these brochures, NIPTs are misrepresented as diagnostic tests, claims lack supporting evidence, regulatory bodies that do not evaluate the test itself are referenced, and clinicians are invoked as authorities on specific NIPTs.

Comparison of outpatient coverage in Canada: Assistive and medical devices.

Outpatient technologies are important for maintaining health and overall quality of life, yet the degree of access and coverage of these technologies remains variable within and across jurisdictions. In Canada, assistive technologies are not included in universal health coverage, and are not subject to the Canada Health Act's criteria and conditions that provinces and territories must fulfill to receive the full federal cash contribution under the Canada Health Transfer. As such, the thirteen Canadian provincial and territorial governments make separate decisions on programs and coverage.