Using implementation science to promote the use of the fascia iliaca blocks in hip fracture care.

PURPOSE: There is variable and suboptimal use of fascia iliaca compartment nerve blocks (FICBs) in hip fracture care. Our objective was to use an evidence-based and theory-informed implementation science approach to analyze barriers and facilitators to timely administration of FICB and select evidence-based interventions to enhance uptake. METHODS: We conducted a qualitative study at a single centre using semistructured interviews and site observations. We interviewed 35 stakeholders including health care providers, managers, patients, and caregivers. We mapped barriers and facilitators to the Theoretical Domains Framework (TDF) and Consolidated Framework for Implementation Research (CFIR). We compared the rate and timeliness of FICB administration before and after evidence-based implementation strategies were applied. RESULTS: The study identified 18 barriers and 11 facilitators within seven themes of influences of FICB use: interpersonal relationships between health care professionals; clinician knowledge and skills related to FICB; roles, responsibilities, and processes for delivering FICB; perceptions on using FICB for pain; patient and caregiver perceptions on using FICB for pain; communication of hip fracture care between departments; and resources for delivering FICBs. We mapped the behaviour change domains to eight implementation strategies: restructure the environment, create and distribute educational materials, prepare patients to be active participants, perform audits and give feedback, use local opinion leaders, use champions, train staff on FICB procedures, and mandate change. We observed an increase in the rates of FICBs administered (48% vs 65%) and a decrease in the median time to administration (1.63 vs 0.81 days). CONCLUSION: Our study explains why FICBs are underused and shows that the TDF and CFIR provide a framework to identify barriers and facilitators to FICB implementation. The mapped implementation strategies can guide institutions to improve use of FICB in hip fracture care.

RéSUMé: OBJECTIF: Il existe une utilisation variable et sous-optimale des blocs nerveux du compartiment fascia iliaca (FICB) dans les soins des fractures de la hanche. Notre objectif était d'utiliser une approche scientifique de la mise en œuvre fondée sur des données probantes et sur la théorie pour analyser les obstacles et les facilitateurs à l'administration opportune d'un FICB et pour sélectionner des interventions fondées sur des données probantes pour améliorer l'adoption de cette technique. MéTHODE: Nous avons mené une étude qualitative dans un seul centre à l'aide d'entrevues semi-structurées et d'observations sur place. Nous avons interviewé 35 intervenant·es, y compris des prestataires de soins de santé, des gestionnaires, des patient·es et des soignant·es. Nous avons cartographié les obstacles et les facilitateurs du cadre des domaines théoriques (Theoretical Domains Framework, TDF) et du cadre consolidé pour la recherche sur la mise en œuvre (Consolidated Framework for Implementation Research, CFIR). Nous avons comparé le taux et la rapidité d'administration d'un FICB avant et après l'application des stratégies de mise en œuvre fondées sur des données probantes. RéSULTATS: L'étude a identifié 18 obstacles et 11 facilitateurs dans sept thèmes d'influence de l'utilisation du FICB : les relations interpersonnelles entre les professionnel·les de la santé; les connaissances et les compétences des clinicien·nes liées au FICB; les rôles, responsabilités et processus d'exécution des FICB; les perceptions de l'utilisation des FICB pour soulager la douleur; les perceptions des patient·es et des soignant·es concernant l'utilisation de FICB pour soulager la douleur; la communication des soins des fractures de la hanche entre les services; et les ressources nécessaires à l'exécution des FICB. Nous avons mis en correspondance les domaines de changement de comportement avec huit stratégies de mise en œuvre : restructurer l'environnement, créer et distribuer du matériel éducatif, préparer les patient·es à participer activement, effectuer des audits et donner de la rétroaction, faire appel à des leaders d'opinion locales et locaux, utiliser des champion·nes, former le personnel sur les interventions de FICB et forcer au changement. Nous avons observé une augmentation des taux de FICB administrés (48% vs 65%) et une diminution du délai médian d'administration (1,63 vs 0,81 jour). CONCLUSION: Notre étude explique pourquoi les FICB sont sous-utilisés et montre que le TDF et le CFIR fournissent un cadre pour identifier les obstacles et les facilitateurs à la mise en œuvre des FICB. Les stratégies de mise en œuvre cartographiées peuvent aider les établissements à améliorer l'utilisation des FICB dans le traitement des fractures de la hanche.

Spontaneous gallbladder perforation in a man with gallstone disease without known anamnesis of cholecystitis: Case report.

INTRODUCTION: Spontaneous gallbladder perforation is a rare complication of gallstone disease. It causes acute peritonitis with potentially fatal outcome. CASE PRESENTATION: We present a case of spontaneous gallbladder perforation with challenging diagnosis. DISCUSSION: The diagnosis of gallbladder perforation should be considered in elderly patients presenting to the surgical emergency department with symptoms and signs of peritonitis even in the absence of pre-existing gallbladder disease. Spontaneous gallbladder perforation is a rare and potentially fatal diagnosis. In most reported cases, perforation occurred due to predisposing factors like acute cholecystitis, trauma or obstruction. In spite of rarity, spontaneous gallbladder perforation should be considered as differential diagnosis on examination of patients with sudden abdominal pain especially in cases of known cholecystolithiasis. Our patient had type 1 perforation according to Niemeier classification, the type associated with the highest mortality rate. The type of perforations has been reported as being difficult to recognize preoperatively, as with our patient with two inconclusive CT scans. This was due to the absence of classical symptoms of gallbladder perforation. CT is the modality of choice when gallbladder perforation is suspected. CONCLUSION: We believe the reason for the spontaneous gallbladder perforation in the presented case was the presence of cholecystolithiasis. We acknowledge the importance of considering this diagnosis also in patients without previous signs of cholecystitis.

Ontarians' Perceptions of Public Health Communications and Misinformation During the COVID-19 Pandemic: Survey Study.

BACKGROUND: Clear, accurate, and transparent risk communication is critical to providing policy makers and the public with directions to effectively implement public health strategies during a health emergency. OBJECTIVE: We aimed to explore the public's preferred sources of obtaining COVID-19 information, perceptions on the prevalence and drivers of misinformation during the pandemic, and suggestions to optimize health communications during future public health emergencies. METHODS: We administered a web-based survey that included Likert scale, multiple choice and open-ended response questions to residents of Ontario, Canada. We aimed to recruit a sample that reflected population diversity with respect to age and gender. Data were collected between June 10, 2020, and December 31, 2020, and were analyzed using descriptive statistics; open-ended data were analyzed using content analysis. Subgroup analyses to explore perceptions by age and gender were conducted using ordinal regression. RESULTS: A total of 1823 individuals participated in the survey (n=990, 54% women; n=703, 39% men; n=982, 54% aged 18-40 years; n=518, 28% aged 41-60 years; and n=215, 12% aged ≥61 years). Participants most commonly obtained COVID-19 information from local television news (n=1118, 61%) followed by social media (n=938, 51%), national or international television news (n=888, 49%), and friends and family (n=835, 46%). Approximately 55% (n=1010) of the participants believed they had encountered COVID-19-related misinformation; 70% (n=1284) of the participants reported high levels of trust in health authority websites and health care providers; 66% (n=1211) reported high levels of trust in health ministers or public health organizations. Sources perceived to be less trustworthy included friends and family, talk radio, social media, as well as blogs and opinion websites. Men were more likely to report encountering misinformation and to trust friends or family (odds ratio [OR] 1.49, 95% CI 1.24-1.79) and blogs or opinion websites (OR 1.24, 95% CI 1.03-1.50), compared to women. Compared to those aged 18-40 years, participants aged ≥41years were more likely to trust all assessed information sources, with the exception of web-based media sources, and less likely to report encountering misinformation. Of those surveyed, 58% (n=1053) had challenges identifying or appraising COVID-19 information. CONCLUSIONS: Over half of our participants perceived that they had encountered COVID-19 misinformation, and 58% had challenges identifying or appraising COVID-19 information. Gender and age differences in perceptions of misinformation and trust in information sources were observed. Future research to confirm the validity of these perceptions and to explore information-seeking patterns by population subgroups may provide useful insights on how to optimize health communication during public health emergencies.

Canadian public perceptions and experiences with information during the COVID-19 pandemic: strategies to optimize future risk communications.

BACKGROUND: The COVID-19 pandemic accelerated the spread of misinformation worldwide. The purpose of this study was to explore perceptions of misinformation and preferred sources of obtaining COVID-19 information from those living in Canada. In particular, we sought to explore the perceptions of East Asian individuals in Canada, who experienced stigma related to COVID-19 messaging. METHODS: We conducted a qualitative thematic analysis study. Interviews were offered in English, Mandarin and Cantonese. Interviewers probed for domains related to knowledge about COVID-19, preferred sources of information, perceived barriers and facilitators of misinformation, and preferences for communication during a health emergency. Interviews were recorded, translated, transcribed verbatim and analyzed using a framework approach. Transcripts were independently double-coded until > 60% agreement was reached. This study received research ethics approval. RESULTS: Fifty-five interviews were conducted. The majority of participants were women (67%); median age was 52 years. 55% of participants were of East-Asian descent. Participants obtained information about COVID-19 from diverse English and non-English sources including news media, government agencies or representatives, social media, and personal networks. Challenges to seeking and understanding information included: encountering misinformation, making sense of evolving or conflicting public health guidance, and limited information on topics of interest. 65% of participants reported encountering COVID-19  misinformation. East Asian participants called on government officials to champion messaging to reduce stigmatizing and racist rhetoric and highlighted the importance of having accessible, non-English language information sources. Participants provided recommendations for future public health communications guidance during health emergencies, including preferences for message content, information messengers, dissemination platforms and format of messages. Almost all participants preferred receiving information from the Canadian government and found it helpful to utilize various mediums and platforms such as social media and news media for future risk communication, urging for consistency across all platforms. CONCLUSIONS: We provide insights on Canadian experiences navigating COVID-19 information, where more than half perceived encountering misinformation on platforms when seeking COVID-19 information . We provide recommendations to inform public health communications during future health emergencies.

Exploring Canadian perceptions and experiences of stigma during the COVID-19 pandemic.

Background: The COVID-19 pandemic has led to stigmatization of individuals based on race/ethnicity, age, gender, and occupation, among other factors. We canvassed Canadian residents to explore perceptions of and experiences with stigma during the COVID-19 pandemic. Methods: We conducted an online survey between June 10 and December 31 2020. The survey was rooted in the Health Stigma and Discrimination Framework and included multiple choice, Likert and open-ended questions related to perceived and experienced stigma. Residents of Ontario, Canada were eligible to participate and we aimed to recruit a sample that was diverse by race/ethnicity and age. Results: A total of 1,823 individuals participated in the survey (54% women, 39% men; 54% 18-40 years old, 28% 41-60 years old, 12% 61+ years old; 33% White, 26% East/SouthEast Asian, 14% Black, 12% South Asian). Fifty-one percent of participants agreed/strongly agreed that racist views had increased toward certain racial/ethnic groups in Canada during the pandemic. Participants perceived that people in Canada were stigmatized during the pandemic because of race/ethnicity (37%), political beliefs (26%), older age (24%), being a healthcare worker (23%), younger age (22%), being an essential worker (21%), and gender (11%). Thirty-nine percent of respondents feared experiencing and 37% experienced stigmatization during the pandemic. Men, individuals aged 18-40, and racialized participants were more likely to fear or experience stigma. With respect to health behaviors, 74, 68, and 59% of respondents were comfortable masking in public, seeking medical care if they became ill, and getting tested for COVID-19, respectively. Men were less likely to indicate comfort with mask wearing or seeking medical care. Participants aged 18-40 and Black participants were less likely to indicate comfort with all three behaviors compared to those over age 41 and White participants, respectively. South Asian participants were less likely to be comfortable seeking medical care compared to White Participants. Discussion: Participants feared or experienced stigmatization towards various demographic characteristics during the COVID-19 pandemic. It is critical that the factors driving stigma during health emergencies in Canada be better understood in order to develop effective public health messaging and interventions.

Exploring perceptions and experiences of stigma in Canada during the COVID-19 pandemic: a qualitative study.

Background: The COVID-19 pandemic fueled stigmatization and discrimination, particularly towards individuals of Chinese or East Asian ethnicity. We conducted interviews with members of the public in Canada in order to describe and understand stigma perceptions and experiences during the COVID-19 pandemic. Methods: We used a phenomenological approach to describe stigma experiences of Canadian residents during the COVID-19 pandemic and compared the stigma perceptions and experiences of East Asian and non-East Asian individuals. Participants were invited to take part in a single, semi-structured interview. The interview guide was rooted in the Health Stigma and Discrimination Framework (HSDF). Interviews were conducted in English, Mandarin, and Cantonese. Following participant consent, interviews were audio recorded and transcribed verbatim. Data were double coded and analyzed using qualitative content analysis guided by a framework approach. Results: A total of 55 interviews were conducted between May and December 2020. Fifty-five percent of the sample identified as East Asian, 67.3% identified as women, and mean age was 52 years (range 20-76). Fear of infection, fear of social and economic ramifications, and blame for COVID-19 were reported drivers of stigma. Participants described preexisting perceptions on cultural norms and media influence as facilitators of stigma that propagated harmful stereotypes, particularly against Chinese and East Asian individuals. Participants observed or experienced stigmatization towards place of residence, race/ethnicity, culture, language, occupation, and age. Stigma manifestations present in the public and media had direct negative impacts on East Asian, particularly Chinese, participants, regardless of whether or not they personally experienced discrimination. Conclusions: We used the HSDF as a rooting framework to describe perceptions and impact of stigma, particularly as they related to race/ethnicity-based stigmatization in Canada. Participants reported a number of drivers and facilitators of stigma that impacted perceptions and experiences. These findings should be used to develop sustained strategies to mitigate stigma during public health emergencies or other major crises. Supplementary Information: The online version contains supplementary material available at 10.1186/s44263-023-00020-7.

An integrated knowledge translation approach to co-create and evaluate patient education tools on cholesterol management.

Context: The objective of CHOICES (Community Heart Outcomes Improvement and Cholesterol Education Study) is to understand how evidence-informed cholesterol management can prevent cardiovascular disease (CVD) in 14 health regions at higher risk in Ontario, Canada using a suite of educational interventions. An integrated knowledge translation (IKT) approach was used to co-create an educational tool on CVD risk, behaviour modifications for cholesterol management, and cholesterol-lowering medications. In order to further understand the needs of Ontario residents related to CVD prevention, a process evaluation was conducted through engagement with the public. Objective: To evaluate implementation quality including reach, responsiveness and usability of the patient-targeted educational tool for cholesterol management. Study Design: A 10-minute online survey was administered to users of the tool. Population: Adults aged 40-75 years who reside in one of the 14 identified regions in Ontario with higher-than-average CVD risk. The tool and survey were shared broadly in the targeted regions and participants were recruited through social media, stakeholder involvement, and market research organizations. Outcome Measures: Reach was measured by the number of participants who received the tool and completed the survey. The survey measured perceived usability of organization, layout and applicability of the tool (6-items). Responsiveness was measured by the level of receptivity and interest in sharing the tool (4-items). Respondents ranked their level of agreement to each question on a likert scale from 1 (Strongly Disagree) to 7 (Strongly Agree). Results: 230 users of the tool were recruited to participate, of which 104 completed the survey (response rate= 45.2%). Respondents indicated that the tool's content was clear (M = 6.00, SD = 1.05) and would support them as a patient seeking cholesterol related information (M = 6.00, SD = 0.99). Respondents indicated their high likelihood to recommend the tool to their personal networks (M = 5.37, SD = 1.19) and preference to receive similar information from their family physician (M = 5.92, SD = 1.15). Conclusion: Overall, participant responsiveness and receptivity to the co-created patient educational tool was high. This work enhances understanding of the benefits of co-created patient-targeted interventions to improve cholesterol management and ultimately inform the implementation of similar scalable strategies across Ontario.

Visits by pharmaceutical representatives in general practice as observed by fifth-year medical students. / Legemiddelkonsulentbesøk i allmennpraksis observert av femteårsstudenter.

BACKGROUND: Many general practitioners receive visits at their surgery from pharmaceutical representatives. The purpose of this study was to describe these visits, their framework and content (especially discussions of safety information), and to compare the findings with a corresponding study conducted in 2001­02. BACKGROUND: A total of 116 fifth-year medical students (2001­02: 144) at the University of Oslo in practical training at GP surgeries in the South-Eastern Norway Regional Health Authority in the period 2014­16 completed an electronic questionnaire after attending a visit by a pharmaceutical representative at the medical centre. RESULTS: A total of 116 visits took place during lunch breaks, when the representative paid for the food. In 90 % (2001­02: 81 %) of the visits, both doctors and their colleagues attended. Free samples were given out in 28 % (2001­02: 41 %) of the meetings, and small gifts in 5 % (2001­02: 44 %). Although the representative often refrained from raising the topic of safety information about the medication, this nevertheless happened less often than in 2001­02: adverse effects (42 % vs 55 %; p=0.04), interactions (53 % vs 64 %; p=0.07), contraindications (37 % vs 61 %; p= 0.0002) and precautions (30 % vs 56 %; p<0.0001). The medical students gave a below average score for their own learning outcome from the presentations (4.8 on a scale from 0­10) (2001­02: 4.2). INTERPRETATION: Although the study shows improvements since 2001­02, it is still common for information provided at visits by pharmaceutical representatives to be deficient with regard to discussion of adverse effects, interactions, contraindications and precautions. Doctors must base their judgement on independent sources of information in order to stay abreast of the latest safety data on the medications.