Parental Leave Policies in Canadian Residency Education.

BACKGROUND: In recent decades, the gender makeup of Canadian medical residents has approached parity. As residency training years coincide closely with childbearing years and paid parental leave is associated with numerous benefits for both parents and children, it is important for there to be clarity about parental leave benefits. OBJECTIVES: We aimed to conduct a comprehensive review of maternity and parental leave policies in all residency education programs in Canada, to highlight gaps that might be improved or areas in which Canadian programs excel. METHODS: We searched websites of the 8 provincial housestaff organizations (PHOs) for information regarding pregnancy workload accommodations, maternity leave, and parental leave policies in each province in effect as of January 2020. We summarized the policies and analyzed their readability using the Flesch Reading Ease. RESULTS: All Canadian PHOs provide specific accommodations around maternity and parental leave for medical residents. All organizations offer at least 35 weeks of total leave, while only 3 PHOs offer extended leave of about 63 weeks, in line with federal regulations. All but 2 PHOs offer supplemental income to their residents, although not for the full duration of offered leave. All PHOs offer workplace accommodations for pregnant residents in their second and/or third trimester. CONCLUSIONS: Although all provinces had some form of leave, significant variability was found in the accommodations, duration of leave, and financial benefits provided to medical residents on maternity and parental leave across Canada. There is a lack of clarity in policy documents, which may be a barrier to optimal uptake.

BET 1: Follow-up phone calls and compliance with discharge instructions in elderly patients discharged from the emergency department.

A short-cut review was carried out to establish whether follow-up phone calls improved compliance with follow-up and discharge instructions given to the elderly on discharge from the emergency department. 211 papers were found using the reported searches, of which 5 presented the best available evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are tabulated. It is concluded that telephone follow-up can identify non-compliance with discharge instructions in the elderly, but there is currently no evidence to show that it actually improves it.

BET 1: Lenient or strict rate control for atrial fibrillation.

A short cut review was carried out to establish whether the degree of rate control influences mortality in patients with atrial fibrillation. 22 papers presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these papers are shown in the two tables. It is concluded that there is insufficient evidence to recommend any specific rate control target to decrease mortality in rate-controlled rapid atrial fibrillation.

Exploring Policy Change in the Emergency Department: A Qualitative Approach to Understanding Local Policy Creation and the Barriers to Implementing Change.

Introduction With thousands of new medical trials released every year, health care policymakers must work diligently to incorporate new evidence into clinical practice. Although there are some broad conceptual frameworks for knowledge translation in the emergency department (ED), there are few user-centered studies that illustrate how local policymakers develop and disseminate new policies. Objectives Our study sought to evaluate the process by which new departmental policies are formed in ED, how new evidence was integrated into this process, and to explore barriers to implementation. Methods Semi-structured interviews were conducted with local administrators from nine major hospitals in Ontario, Canada. Interviews were transcribed and qualitative data was analyzed using constructivist grounded theory. Results Five broad steps in the policy creation process were identified: 1) Problem identification and motivation for change; 2) building a policy team; 3) policy construction; 4) implementation and monitoring of new departmental policies; 5) actively addressing barriers to the ED policymaking process. Common sub-themes in each of these categories were highlighted. Four main themes also emerged regarding barriers experienced in policymaking: Education and knowledge transfer; lack of a change culture; resource limitations; and cumbersome bureaucratic structures. Conclusion Our study identified common facilitators and barriers that policymakers face in their ability to create health policy in the ED. While local context influences the policymaking process, a standardized framework would ensure a more systematic approach for policymakers and allow scientists to better understand how evidence is integrated at the local level.

A small-molecule screen for enhanced homing of systemically infused cells.

Poor homing of systemically infused cells to disease sites may limit the success of exogenous cell-based therapy. In this study, we screened 9,000 signal-transduction modulators to identify hits that increase mesenchymal stromal cell (MSC) surface expression of homing ligands that bind to intercellular adhesion molecule 1 (ICAM-1), such as CD11a. Pretreatment of MSCs with Ro-31-8425, an identified hit from this screen, increased MSC firm adhesion to an ICAM-1-coated substrate in vitro and enabled targeted delivery of systemically administered MSCs to inflamed sites in vivo in a CD11a- (and other ICAM-1-binding domains)-dependent manner. This resulted in a heightened anti-inflammatory response. This represents a new strategy for engineering cell homing to enhance therapeutic efficacy and validates CD11a and ICAM-1 as potential targets. Altogether, this multi-step screening process may significantly improve clinical outcomes of cell-based therapies.

Quantification of Mesenchymal Stem Cell (MSC) delivery to a target site using in vivo confocal microscopy.

The ability to deliver cells to appropriate target tissues is a prerequisite for successful cell-based therapy. To optimize cell therapy it is therefore necessary to develop a robust method of in vivo cell delivery quantification. Here we examine Mesenchymal Stem Cells (MSCs) labeled with a series of 4 membrane dyes from which we select the optimal dye combination for pair-wise comparisons of delivery to inflamed tissue in the mouse ear using confocal fluorescence imaging. The use of an optimized dye pair for simultaneous tracking of two cell populations in the same animal enables quantification of a test population that is referenced to an internal control population, thereby eliminating intra-subject variations and variations in injected cell numbers. Consistent results were obtained even when the administered cell number varied by more than an order of magnitude, demonstrating an ability to neutralize one of the largest sources of in vivo experimental error and to greatly reduce the number of cells required to evaluate cell delivery. With this method, we are able to show a small but significant increase in the delivery of cytokine pre-treated MSCs (TNF-α & IFN-γ) compared to control MSCs. Our results suggest future directions for screening cell strategies using our in vivo cell delivery assay, which may be useful to develop methods to maximize cell therapeutic potential.