Association of ever use of e-cigarettes with health and lifestyle variables among young adults: a Canadian health measure survey study.

Research suggests that vaping raises oxidative stress levels and has been implicated in poor mental health. The objective of this study is to assess cross-sectional associations between quality of life (QOL) indicators and e-cigarette (EC) use in young Canadian adults. We used data from the 2016-2017 Canadian Health Measures Survey. We compared physical activity (daily steps), physiological measurements (high-density lipoprotein for cholesterol level), self-perceived life stress, mental health, and QOL between ever-use EC users and non-users. Multivariable binary or ordinal logistic regressions were used to calculate odds ratios (OR) with 95% confidence intervals (CI). Analyses included 905 participants (15-30 years) with 115 (12.7%) reporting EC use and 790 non-users. After adjusting for confounders, compared to non-users, EC users had significantly higher odds of being physically active (OR = 2.19, 95%CI: 1.14-4.20) but also with self-reported extreme life stress (OR = 2.68, 95%CI: 1.45-4.92). Albeit statistically non-significant, EC users also had higher odds of poorer QOL (OR = 1.12, 95%CI: 0.64-1.95). No statistically significant interactions between EC use, cigarette smoking, cannabis consumption and health outcomes were observed. CONCLUSION: Our study found that EC use was independently and significantly associated with increased odds of life stress and an indication of poorer QOL. Ongoing surveillance on young EC users is important to measure the long-term impact of vaping on their physical, mental health and quality of life to target for interventions. WHAT IS KNOWN: • E-cigarette use has been associated with high-risk behaviours and adverse mental health outcomes, such as depression and anxiety. WHAT IS NEW: • E-cigarette users had significantly higher odds of being physically active and higher amounts of life stress.

Innovation management involvement among persons with disabilities in Malaysia.

BACKGROUND: As Malaysia struggles with the battle to retain talented workers, the retention of persons with disabilities (PWDs) remains a major challenge in innovation management. Malaysia currently has the lowest retention of PWDs in innovation management in The Association of Southeast Asian Nations (ASEAN). The purpose of this study is to develop a unique framework to enhance the inclusion of PWDs in Malaysia.  Methods: A questionnaire was distributed to 200 PWDs in the central region of Malaysia.   Results: Based on the results of this research, four crucial variables (salary, compensation, career advancement and reward management) contributed to the lack of involvement in innovation management among PWDs in Malaysia.  Conclusions: This study only focuses on 200 PWDs in Malaysia. Despite the fact that PWDs' involvement in innovation management is the lowest, there is a lack of research initiative and practitioner commitment to address this issue. Serving as preliminary research in Malaysia, this study develops a unique framework to fill the gap.

Primary care performance of alternatively licenced physicians in Ontario, Canada: a cross-sectional study using administrative data.

OBJECTIVES: Medical Regulatory Authorities (MRAs) provide licences to physicians and monitor those physicians once in practice to support their continued competence. In response to physician shortages, many Canadian MRAs developed alternative licensure routes to allow physicians who do not meet traditional licensure criteria to obtain licences to practice. Many physicians have gained licensure through alternative routes, but the performance of these physicians in practice has not been previously examined. This study compared the performance of traditionally and alternatively licenced physicians in Ontario using quality indicators of primary care. The purpose of this study was to examine the practice performance of alternatively licenced physicians and provide evaluative evidence for alternative licensure policies. DESIGN: A cross-sectional retrospective examination of Ontario health administrative data was conducted using Poisson regression analyses to compare the performance of traditionally and alternatively licenced physicians. SETTING: Primary care in Ontario, Canada. PARTICIPANTS: All family physicians who were licenced in Ontario between 2000 and 2012 and who had complete medical billing data in 2014 were included (n=11 419). OUTCOME MEASURES: Primary care quality indicators were calculated for chronic disease management, preventive paediatric care, cancer screening and hospital readmission rates using Ontario health administrative data. RESULTS: Alternatively licenced physicians performed similarly to traditionally licenced physicians in many primary care performance measures. Minimal differences were seen across groups in indicators of diabetic care, congestive heart failure care, asthma care and cancer screening rates. Larger differences were found in preventive care for children less than 2 years of age, particularly for alternatively licenced physicians who entered Ontario from another Canadian province. CONCLUSIONS: Our findings demonstrate that alternatively licenced physicians perform similarly to traditionally licenced physicians across many indicators of primary care. Our study also demonstrates the utility of administrative data for examining physician performance and evaluating medical regulatory policies and programmes.

Experiential knowledge of risk and support factors for physician performance in Canada: a qualitative study.

OBJECTIVE: To identify, understand and explain potential risk and protective factors that may influence individual and physician group performance, by accessing the experiential knowledge of physician-assessors at three medical regulatory authorities (MRAs) in Canada. DESIGN: Qualitative analysis of physician-assessors' interview transcripts. Telephone or in-person interviews were audio-recorded on consent, and transcribed verbatim. Interview questions related to four topics: Definition/discussion of what makes a 'high-quality physician;' factors for individual physician performance; factors for group physician performance; and recommendations on how to support high-quality medical practice. A grounded-theory approach was used to analyse the data. SETTING: Three provinces (Alberta, Manitoba, Ontario) in Canada. PARTICIPANTS: Twenty-three (11 female, 12 male) physician-assessors from three MRAs in Canada (the College of Physicians & Surgeons of Alberta, the College of Physicians and Surgeons of Manitoba and the College of Physicians and Surgeons of Ontario). RESULTS: Participants outlined various protective factors for individual physician performance, including: being engaged in continuous quality improvement; having a support network of colleagues; working in a defined scope of practice; maintaining engagement in medicine; receiving regular feedback; and maintaining work-life balance. Individual risk factors included being money-oriented; having a high-volume practice; and practising in isolation. Group protective factors incorporated having regular communication among the group; effective collaboration; a shared philosophy of care; a diversity of physician perspectives; and appropriate practice management procedures. Group risk factors included: a lack of or ineffective communication/collaboration among the group; a group that doesn't empower change; or having one disruptive or 'risky' physician in the group. CONCLUSIONS: This is the first qualitative inquiry to explore the experiential knowledge of physician-assessors related to physician performance. By understanding the risk and support factors for both individual physicians and groups, MRAs will be better-equipped to tailor physician assessments and limited resources to support competence and enhance physician performance.

A Call to Investigate the Relationship Between Education and Health Outcomes Using Big Data.

There exists an assumption that improving medical education will improve patient care. While seemingly logical, this premise has rarely been investigated. In this Invited Commentary, the authors propose the use of big data to test this assumption. The authors present a few example research studies linking education and patient care outcomes and argue that using big data may more easily facilitate the process needed to investigate this assumption. The authors also propose that collaboration is needed to link educational and health care data. They then introduce a grassroots initiative, inclusive of universities in one Canadian province and national licensing organizations that are working together to collect, organize, link, and analyze big data to study the relationship between pedagogical approaches to medical training and patient care outcomes. While the authors acknowledge the possible challenges and issues associated with harnessing big data, they believe that the benefits supersede these. There is a need for medical education research to go beyond the outcomes of training to study practice and clinical outcomes as well. Without a coordinated effort to harness big data, policy makers, regulators, medical educators, and researchers are left with sometimes costly guesses and assumptions about what works and what does not. As the social, time, and financial investments in medical education continue to increase, it is imperative to understand the relationship between education and health outcomes.

The influence of globalization on medical regulation: a descriptive analysis of international medical graduates registered through alternative licensure routes in Ontario.

The increasing globalization of the medical profession has influenced health policy, health human resource planning, and medical regulation in Canada. Since the early 2000s, numerous policy initiatives have been created to facilitate the entry of international medical graduates (IMGs) into the Canadian workforce. In Ontario, the College of Physicians and Surgeons of Ontario (CPSO) developed alternative licensure routes to increase the ability of qualified IMGs to obtain licenses to practice. The current study provides demographic and descriptive information about the IMGs registered through the CPSO's alternative licensure routes between 2000 and 2012. An analysis of the characteristics and career trajectories of all IMGs practicing in the province sheds light on broader globalization trends and raises questions about the future of health human resource planning in Canada. As the medical profession becomes increasingly globalized, health policy and regulation will continue to be influenced by trends in international migration, concerns about global health equity, and the shifting demographics of the Canadian physician workforce. Implications for future policy development in the complex landscape of medical education and practice are discussed.

Facilitated Reflective Performance Feedback: Developing an Evidence- and Theory-Based Model That Builds Relationship, Explores Reactions and Content, and Coaches for Performance Change (R2C2).

PURPOSE: To develop and conduct feasibility testing of an evidence-based and theory-informed model for facilitating performance feedback for physicians so as to enhance their acceptance and use of the feedback. METHOD: To develop the feedback model (2011-2013), the authors drew on earlier research which highlights not only the factors that influence giving, receiving, accepting, and using feedback but also the theoretical perspectives which enable the understanding of these influences. The authors undertook an iterative, multistage, qualitative study guided by two recognized research frameworks: the UK Medical Research Council guidelines for studying complex interventions and realist evaluation. Using these frameworks, they conducted the research in four stages: (1) modeling, (2) facilitator preparation, (3) model feasibility testing, and (4) model refinement. They analyzed data, using content and thematic analysis, and used the findings from each stage to inform the subsequent stage. RESULTS: Findings support the facilitated feedback model, its four phases-build relationship, explore reactions, explore content, coach for performance change (R2C2)-and the theoretical perspectives informing them. The findings contribute to understanding elements that enhance recipients' engagement with, acceptance of, and productive use of feedback. Facilitators reported that the model made sense and the phases generally flowed logically. Recipients reported that the feedback process was helpful and that they appreciated the reflection stimulated by the model and the coaching. CONCLUSIONS: The theory- and evidence-based reflective R2C2 Facilitated Feedback Model appears stable and helpful for physicians in facilitating their reflection on and use of formal performance assessment feedback.

An exploration of the relationship between emotional intelligence (EI) and the Multiple Mini-Interview (MMI).

The present study explored the relationship between the Multiple Mini-Interview (MMI) admissions process and the Bar-On EQ-i emotional intelligence (EI) instrument in order to investigate the potential for the EQ-i to serve as a proxy measure to the MMI. Participants were 196 health science candidates who completed both the MMI and the EQ-i as part of their admissions procedure at the Michener Institute for Applied Health Sciences. Three types of analyses were conducted to examine the relationship between the two tools: reliability analyses, correlational analyses, and a t-test. The tools were found to be moderately reliable. No significant relationships were found between the MMI and the EQ-i at the total or subscale level. The ability of the EQ-i to discriminate between accepted and not-accepted students was also not supported. These findings do not support the use of the EQ-i as a potential pre-screening tool for the MMI, but rather highlight the need to exercise caution when using emotional intelligence instruments for high-stakes admissions purposes.