Clinical reporting for personalized cancer genomics requires extensive access to subscription-only literature.

Objective: Medical care for cancer is increasingly directed by genomic laboratory testing for alterations in the tumor genome that are significant for diagnosis, prognosis and therapy. Uniquely in medicine, providers must search the biomedical literature for each patient to determine the clinical significance of these alterations. Access to published scientific literature is frequently subject to high fees, with access limited to institutional subscriptions. We sought to investigate the degree to which the scientific literature is accessible to clinical cancer genomics providers, and the potential role of university and hospital system libraries in information access for cancer care. Methods: We identified 265 journals that were accessed during the interpretation and reporting of clinical test results from 1,842 cancer patients at the University Health Network (Toronto, Canada). We determined the degree of open access for this set of clinically important literature, and for any journals not available through open access we surveyed subscription access at seven academic hospital systems and at their affiliated universities. Results: This study found that nearly half (116/265) of journals have open access mandates that make articles freely available within one year of release. For the remaining subscription access journals, universities provided a uniformly high level of access, but access available through hospital system collections varied widely. Conclusion: This study highlights the importance of different modes of access to the use of the scientific literature in clinical practice and points to challenges that must be overcome as genomic medicine grows in scale and complexity.

Canadian academics' use of predatory journals.

Introduction: Predatory journals have been acknowledged as an increasing concern in the scholarly literature over the last decade, but research on the subject has been sparse. Research that has focused on predatory journals in the Canadian context has been even rarer, and limited to work focused on a single university. This study explores publishing trends in predatory journals by authors affiliated with Canadian universities. Methods: Articles published by authors at 30 Canadian universities, including all universities in the U15, were pulled from select predatory journals. Key data including author affiliation, article type, discipline, and grant information were extracted from the articles. Results: All universities in the study were found to have publications in predatory journals. The health sciences accounted for 72% of the publications, and the sciences for 20%. Research articles accounted for 50% of the articles. Opinion, editorial, or commentary pieces accounted for 24% and 19% were review articles. Grant funding was indicated in 34% of the articles, with NSERC and CIHR being top funders. The research-intensive U15 universities were found to publish more in predatory journals than their non-U15 compatriots, even when the universities were of similar size. Discussion: Canadian scholars were found to publish in predatory journals, particularly those scholars from the health sciences and research-intensive U15 universities. Grant funding was common, and often came from high profile funders like NSERC and CIHR. This study suggests that policy and education initiatives may be warranted in Canadian contexts, especially in the health sciences and at research-intensive universities.

Balancing safety and harm for older adults with dementia in rural emergency departments: healthcare professionals' perspectives.

INTRODUCTION: The emergency department (ED) is a potentially harmful environment for older adults with dementia, and rural EDs face unique challenges in providing care to this population. The purpose of this study was to understand safety and harm in rural ED transitional care for community dwelling older adults with dementia from the perspective of healthcare professionals (HCPs). METHODS: An interpretive, descriptive exploratory design from a social ecological perspective was used. Using purposive and snowball sampling, HCPs were recruited from two rural hospital EDs in two Canadian provinces. Data collection involved participant interviews using a semi-structured interview guide. Audio-recorded interviews were transcribed, transcripts coded, and themes identified using constant comparative analysis with thematic coding. RESULTS: A total of 12 HCPs, seven from one province and five from the other, participated in the study. HCPs worked directly in the ED or consulted in the ED from hospital-based social work, rehabilitation and community liaison services. Three themes were identified: physical environment (space, design and equipment), work environment (pressure to perform) and practice environment (family, knowledge and processes). A conceptual model was developed to illustrate how HCPs worked to balance safety and harm for older patients with dementia within a milieu created by the overlapping and synergistically interacting environments. CONCLUSIONS: HCPs in rural EDs working at the interface of hospital and community constantly attempt to balance promoting safety and avoiding harm for older adults with dementia. Participants perceived safety broadly, understanding that the consequences of the milieu were created through an interaction between physical, work and practice environments. These consequences related to the physical, cognitive and emotional wellbeing of older adults with dementia and their caregivers. Within the practice environment, participants identified a 'rural advantage' that was tied to their knowledge of community and the people with dementia and their caregivers who sought care in the participating EDs. However, familiarity can be a double-edged sword and to minimize potential harm healthcare professionals must seek input from caregivers regarding altered functional status, and policies to change triage to include gerontological knowledge and create elder-friendly rural ED environments are needed.

Benefits and Challenges Faced by a Nurse Practitioner Working in an Interprofessional Setting in Rural Alberta.

The study aim was to determine benefits and challenges of a community initiative to introduce the nurse practitioner (NP) role in rural primary care. We used a mixed-methods, participatory action research design. Data collection included surveys, interviews, patient record data and shadow billing data. Patient, physician and healthcare professional (HCP) surveys were followed by interviews of survey participants and key local informants. Descriptive statistics were used to summarize survey and patient record data, and content analysis was used to analyze interview data. Benefits, challenges and recommendations were the result of mixed-methods synthesis. Forty-one patients, one HCP and four physicians returned surveys, with 14 patients, one HCP, two local leaders and the NP participating in interviews. The NP provided primary care to 10% of clinic patients in a flexible service delivery model. A high proportion of patients had chronic health concerns. Patient outcomes were generally positive, and patients expressed satisfaction with care. Being connected to the community was important to role implementation. Benefits included increased access to cost-effective, quality primary care. Challenges were funding, limited role understanding and potential for role isolation. Recommendations highlight the need for local community buy-in and provincial support in sustaining the innovation.