A comparison of self-reported chronic disease, health awareness and behaviours in social housing residents: cross-sectional study of communities in Ontario and Quebec.

Objective: Social housing programs are integral to making housing more affordable to Canadian seniors living in poverty. Although the programs are similar across Canada, there may be inter-provincial differences among the health of residents that could guide the development of interventions. This study explores the health of low-income seniors living in social housing in Quebec and compares it with previously reported data from Ontario.

Midwives' adaptation of their practice, role, and scope to ensure access to sexual and reproductive services during humanitarian crises: A scoping review.

Problem: Limited research has examined and synthesized the adaptation of midwives and midwife-led interventions during crises.

Background: Evidence suggests that midwives are essential to respond to sexual and reproductive health care needs during disruptive times, and that they adapt to continue to provide their services during those circumstances.

Aim: To map the adaptations of midwives when providing care during crises globally.

Assessing fragility of statistically significant findings from randomized controlled trials assessing pharmacological therapies for opioid use disorders: a systematic review.

Background: The fragility index is a statistical measure of the robustness or "stability" of a statistically significant result. It has been adapted to assess the robustness of statistically significant outcomes from randomized controlled trials. By hypothetically switching some non-responders to responders, for instance, this metric measures how many individuals would need to have responded for a statistically significant finding to become non-statistically significant.

Getting a "SMART START" to gestational diabetes mellitus education: a mixed-methods pilot evaluation of a knowledge translation tool in primary care.

Background: South Asian people living in Canada face higher rates of gestational diabetes mellitus (GDM) compared to national trends. The objective of this study was to design and pilot test a knowledge translation (KT) tool to support GDM prevention counselling in primary care.

Methods: This study is a mixed-methods pilot evaluation of the "SMART START" KT tool involving 2 family physicians in separate practices and 20 pregnant South Asians in Ontario, Canada.

Short-Term, Community-Based, Slow-Stream Rehabilitation Program for Older Adults Transitioning from Hospital to Home: A Mixed Methods Program Evaluation.

Introduction: Shortened hospital stays have shifted the burden of care for older adults to community, informal (ie, family, caregiver) and formal post-acute care and services, highlighting the need for effective post-hospital stay services and programs. As there is a dearth of information related to community-based, slow-stream rehabilitation program models for older adults transitioning from hospital to home in the Canadian context, the paper describes a mixed methods evaluation of such a program.

Materials And Methods: A mixed methods program evaluation, with process- and outcome-related elements, included 1) review and analysis of program documents; 2) observations to examine fidelity.

"They forgot about us": experiences of the COVID-19 pandemic among people deprived of housing in an urban centre in Ontario, Canada.

Objectives: People deprived of housing have been disproportionately affected by the COVID-19 pandemic and the public health mitigation measures implemented in response. Emerging evidence has shown the adverse health outcomes experienced by these communities due to SARS-CoV-2 infection; however, the voices of community members themselves have not been widely amplified in the published literature.

Methods: We conducted an interpretive qualitative study.

Evaluating the Construct Validity of Competencies: A Retrospective Analysis.

Background: A competency-based framework focuses on alignment between professional standards and assessment design. This alignment implies improved measurement validity, yet it has not been established that competence in one context predicts performance in another context. High-stakes competence assessments offer insights into the relationship between assessment design and competencies.

Enhancing end of life care on general internal medical wards: the 3 Wishes Project.

Background: Initially developed in the intensive care unit (ICU) at St. Joseph's Healthcare Hamilton (SJHH) the 3 Wishes Project (3WP) provides personalized, compassionate care to dying patients and their families. The objective of this study was to develop and evaluate 3WP expansion strategies for patients cared for on General Internal Medicine (GIM) wards in our hospital.

"I can't be the nurse I want to be": Counter-stories of moral distress in nurses' narratives of pediatric oncology caregiving.

As a term used in nursing and other health professions to describe when one is prevented by institutional constraints from pursuing the right course of action, moral distress has gained traction to examine the effects of restructuring on health and social care providers. Using a critical narrative methodology, this paper presents the counter-stories of nine pediatric oncology nurses in Ontario, Canada, whose stories illustrate the embeddedness of their caregiving and moral distress within institutional contexts that leave them stretched thin amongst multiple caregiving and administrative demands, and that limit their capacities to be the nurses they want to be. Informed by feminist philosophical theorizations of moral distress, we elucidate how the nurses' counter-stories: (i) re-locate the sources of their moral distress within institutional constraints that fracture their moral identities and moral relationships, and (ii) dis-locate dominant narratives of technological cure by ascribing value and meaning to the relational care through which they sustain moral responsibilities with patients and their families.

The implementation and validation of the NoMAD during a complex primary care intervention.

Background: Normalization process theory (NPT) has been widely used to better understand how new interventions are implemented and embedded. The NoMAD (Normalization Measurement Development questionnaire) is a 23-item NPT instrument based on NPT. As the NoMAD is a relatively new instrument, the objectives of this paper are: to describe the experience of implementing the NoMAD, to describe it being used as a feedback mechanism to gain insight into the normalization process of a complex health intervention, and to further explore the psychometric properties of the instrument.

Understanding how context and culture in six communities can shape implementation of a complex intervention: a comparative case study.

Background: Contextual factors can act as barriers or facilitators to scaling-up health care interventions, but there is limited understanding of how context and local culture can lead to differences in implementation of complex interventions with multiple stakeholder groups. This study aimed to explore and describe the nature of and differences between communities implementing Health TAPESTRY, a complex primary care intervention aiming to keep older adults healthier in their homes for longer, as it was scaled beyond its initial effectiveness trial.

Methods: We conducted a comparative case study with six communities in Ontario, Canada implementing Health TAPESTRY.

Using a self-directed workbook to support advance care planning with long term care home residents.

Background: While advance care planning (ACP) has been shown to improve the quality of end-of-life (EOL) communication and palliative care, it is rarely practiced in long term care (LTC) homes, where staff time to support the process is limited. This study examines the potential of a publicly available self-directed ACP workbook distributed to LTC residents to encourage ACP reflection and communication.

Methods: Recruitment took place across three LTC homes, between June 2018 and July 2019.

Frequency of providing a palliative approach to care in family practice: a chart review and perceptions of healthcare practitioners in Canada.

Background: Most patients nearing the end of life can benefit from a palliative approach in primary care. We currently do not know how to measure a palliative approach in family practice. The objective of this study was to describe the provision of a palliative approach and evaluate clinicians' perceptions of the results.

GRADE notes: How to use GRADE when there is "no" evidence? A case study of the expert evidence approach.

Objectives: One essential requirement of trustworthy guidelines is that they should be based on systematic reviews of the best available evidence. The GRADE Working Group has provided guidance for evaluating the certainty of evidence based on several domains. However, for many clinical questions, published evidence may be limited, too indirect or simply not exist.

Randomized Controlled Trial of a Decision Support Intervention About Cardiopulmonary Resuscitation for Hospitalized Patients Who Have a High Risk of Death.

Background: Many seriously ill hospitalized patients have cardiopulmonary resuscitation (CPR) as part of their care plan, but CPR is unlikely to achieve the goals of many seriously ill hospitalized patients.

Objective: To determine if a multicomponent decision support intervention changes documented orders for CPR in the medical record, compared to usual care.

Design: Open-label randomized controlled trial.

Screening for depression in children and adolescents: a protocol for a systematic review update.

Background: Major depressive disorder is common, debilitating, and affects feelings, thoughts, mood, and behaviors. Childhood and adolescence are critical periods for the development of depression and adolescence is marked by an increased incidence of mental health disorders. This protocol outlines the planned scope and methods for a systematic review update that will evaluate the benefits and harms of screening for depression in children and adolescents.

Health TAPESTRY: Exploring the Potential of a Nursing Student Placement Within a Primary Care Intervention for Community-Dwelling Older Adults.

The increasing prevalence of chronic diseases in aging places demands on primary care. Nurses are the major nonphysician primary care workforce. Baccalaureate nursing programs should expose students to primary care and older adults to support these demands and help recruit new graduates to this setting.

Older adults living in social housing in Canada: the next COVID-19 hotspot?

Older adults in social housing have high rates of chronic diseases and live in clustered housing, creating the ideal situation for a tragic outbreak in this vulnerable population, which has been largely unrecognized in the public health discourse. It is estimated that two thirds of this population have cardiometabolic conditions that put them at higher risk of poor outcomes from COVID-19. In addition, their social isolation, low mobility, low health literacy, and limited internet access are barriers to accessing basic needs, health information, and health care in a Canadian context where many services have moved to virtual platforms.

Transitions in Labour Force Participation over the Palliative Care Trajectory.

Background: Home-based palliative programs rely on family caregivers, who often miss time from employment. This article identified changes in caregivers' labour force participation over the palliative trajectory.

Methods: Family caregivers (n = 262) were interviewed biweekly to measure transitions across four employment categories.