bluuebunny/crossref_metadata_2025_split huggingface dataset:
Single-Entry Models in Surgical Services
Authors: Harris Jonathan 
Published: September 2021

In the health care system, common elements of SEMs include pooled referrals and waiting lists, centralized intake through a single-entry point, and triage for urgency and appropriateness.
Four programs including the use of SEMs from the Canadian context were examined: the Winnipeg Central Intake System for hip and knee replacements, the British Columbia Surgical Strategy, the Nova Scotia Hip and Knee Action Plan, and the Saskatchewan Surgical Initiative.
SEMs were generally implemented as 1 element of broader strategies to reduce surgical waits and enhance quality and safety of surgical services.Key success factors for implementation of SEMs included:

Concurrent investments in surgical capacity and health system resources.
The establishment of standardized clinical pathways to reduce care variation.
Strong leadership, including a focus on change management and use of clinician champions.
Standardized data collection and public reporting on key performance indicators.
Concurrent focus on quality improvement and patient-centred care.

Challenges for implementation of SEMs included:

Effectively managing change and resistance to change.
Challenges in other areas of the health system that could impact wait times.
Maintaining strategic focus and predictable funding, especially in the face of external shocks.
Abiraterone Acetate for Metastatic Castration-Sensitive Prostate Cancer
Authors: Shane Amanda , Walter Melissa 
Published: September 2021

The use of abiraterone acetate for the treatment of metastatic castration-sensitive prostate cancer is clinically effective.
Compared with standard of care, abiraterone acetate was associated with increased overall survival, increased prostate cancer–specific survival, increased progression-free survival, and improved quality of life.
Patients treated with abiraterone acetate were at higher risk for grade III to grade V adverse events (severe, life-threatening, or fatal) and were more likely to discontinue treatment compared with standard of care.
The incremental cost-effectiveness ratios for both brand and generic abiraterone acetate were estimated to be higher than common willingness-to-pay thresholds.
Treatment Programs for Substance Use Disorder
Authors: Tran Khai , McGill Sarah 
Published: September 2021

Moderate to weak evidence suggests that patients with substance use disorders who received residential treatment were more likely than outpatients to complete treatment and be considered abstinent. Comparisons between residential treatment and outpatient programs for other outcomes were unclear.
Strong- to weak-quality evidence showed that residential treatment services for patients with substance use disorders was effective in improving various outcomes including substance use, social, criminal activity, and mental health outcomes. However, residential treatment was likely associated with poorest survival outcomes after discharge compared to other treatments.
Managed alcohol programs in hospital settings appeared to be effective and safe in preventing and treating alcohol withdrawal syndrome in surgical patients, trauma patients, or hospitalized patients. The level of evidence was not assessed.
There was evidence that managed alcohol programs in community settings improved drinking patterns, alcohol-related harm, criminal activity, mental health, and social and physical well-being. The level of evidence was not assessed.
The American Society of Addiction Medicine clinical practice guideline provides recommendations for the identification and management of alcohol withdrawal in inpatient and ambulatory settings. Patients’ current signs and symptoms, levels of risk for developing severe or complicated withdrawal or complications of withdrawal, and other dimensions should be taken into consideration in the assessment process to determine the appropriate level of care. Strength of recommendations was not assessed.
The Canadian Coalition for Seniors’ Mental Health recommends that patients with cannabis use disorder should be considered for residential treatment if they are unable to effectively reduce or cease their cannabis use (level of evidence: Low; strength of recommendation: Strong).
An Overview of Direct-to-Patient Virtual Visits in Canada
Authors: Gray Casey , Mason Jeff , Loshak Hannah 
Published: September 2021

Direct-to-patient virtual visits are a way of providing health care to patients in their location of choice, using technology (e.g., phone, text messaging, video conferencing).
The use of virtual visits has the potential to overcome many of the barriers associated with in-person care, including improved access, convenience, and cost savings.
Many communities that are underserved by in-person care also face barriers to virtual care. There is a risk that current health inequities will be exacerbated if barriers such as, for example, reliable access to an internet-connected device, technology literacy, and language barriers are not addressed.
Virtual visits have been used safely and effectively for many types of health care visits.
There is a lack of evidence on the cost-effectiveness of virtual visits.
Regulations regarding the provision of virtual visits are needed to uphold equitable access to publicly funded health care as mandated by the Canada Health Act.
Smoke-Free Hospital Grounds
Authors: Harris Jonathan , Tucker Sheila 
Published: September 2021

Smoke-free campus policies at inpatient health facilities are most effective when situated within comprehensive smoking cessation programs that include cessation support for staff and patients and effective communications and signage for staff, patients, and visitors.

Canadian jurisdictions such as Ontario, New Brunswick, Prince Edward Island, Alberta, British Columbia, and Northwest Territories have provincial smoke-free legislation that applies to the grounds of health facilities. This approach permits public health inspectors and peace officers to enforce the smoke-free grounds rules with the option of issuing fines to individuals or hospital corporations for non-compliance. There is very little existing evidence on the effectiveness of issuing fines as a means of enforcing smoke-free policies.

There can be unique considerations associated with implementing smoke-free policies in inpatient psychiatric facilities or units, given the relationship between mental health and substance use issues and tobacco use. Evidence shows that smoke-free policies are feasible and result in positive health outcomes in psychiatric facilities or units.

Staff may require additional education and training in smoking cessation and tools to support productive conversations with patients, visitors, or colleagues who are not in compliance with smoke-free policies. Examples of tools and communications materials used in other jurisdictions are provided in Appendix 1.
Extracorporeal Membrane Oxygenation for Adults and Children With Severe Respiratory Failure
Authors: Smith Andrea , Loshak Hannah 
Published: September 2021

This review used a framework analysis to synthesize 9 included studies on the perspectives and experiences of patients, family members, and providers on extracorporeal membrane oxygenation (ECMO).
Patients’ perspectives on their experiences are limited due to their sedated status when treated with ECMO.
Supporting a relative treated with ECMO is stressful for family members. They feel anxious and worried about their relative because of the patient’s critical condition, and they struggle to juggle multiple roles at work and home while supporting their relative receiving ECMO.
Family members often have to travel to see their critically ill relative. Financial and logistical support for temporary relocation near the ECMO centre may ease the burden of travel.
Family members benefit from clear and frequent communication from health care providers as a source of support and reassurance while their loved ones are being treated with ECMO. There may be a role for informal or formal peer support for family members of patients receiving ECMO.
Clinicians’ decisions to offer, continue, and withdraw ECMO are based on their assessments of prognostic factors from patients’ medical histories and clinical conditions. Additional clinical research and/or refinements of prognostic guidance for ECMO may further support evidence-informed decision-making around ECMO.
Patients, family members, and clinical team members may differ in their assessment of the limits of ECMO treatment and the decision to transition from active treatment to the withdrawal of life support. These findings point to the role of ethical considerations and processes when engaging in transitioning to end-of-life support in the provision of ECMO.
After discharge, patients who had received ECMO and their family members continued to have feelings of anxiety, intrusive thoughts, and a need to process the event. ECMO programs that can offer continued or ongoing support or referral for patients and their family members’ mental health may help address these needs.
Wearable Respiratory Sensor for the Detection of Opioid-Induced Respiratory Depression
Authors: Farrell Keeley 
Published: September 2021

This Horizon Scanning report summarizes information regarding an emerging health technology — a wearable respiratory sensor for the detection of opioid-induced respiratory depression
Devices that detect opioid-induced respiratory depression such as RESPMETER could help to prevent opioid overdose deaths by alerting first responders so that they can intervene earlier and administer naloxone.
RESPMETER, or devices like it, could play a role in opioid overdose management. However, information on its effectiveness and safety for detecting opioid-induced respiratory depression is needed.
Interventions to Address and Prevent Violence Toward Health Care Workers in the Emergency Department
Authors: Banerjee Srabani , MacDougall Danielle 
Published: September 2021

Seven relevant systematic reviews (SRs) regarding interventions to address and prevent violence in the emergency department (ED) were identified. However, these SRs had a broad focus, and the included studies that were relevant for this current report were few and were generally of low quality.
Findings were inconsistent regarding education and training interventions for preventing violence in the ED; most relevant primary studies within identified SRs showed there was no difference in the occurrence of violence with interventions including education and training, and a few primary studies reported a reduction in the occurrence violence with interventions including education and training; however, statistical significance of the difference was not reported.
Pharmacological interventions with haloperidol, lorazepam, droperidol, risperidone, olanzapine, or quetiapine were effective in reducing aggressive behaviour and side effects were generally minimal.
Implementation of restraint documentation tools was associated with decrease in use of physical restraints to manage aggressive behaviour, and complications were minimal when physical restraints were used for a short duration.
These findings need to be interpreted with caution considering the limitations such as limited quantity and quality of evidence, and lack of details regarding the characteristics of the population.
No evidence-based guidelines were identified.
Hybrid Closed-Loop Insulin Delivery Systems for People With Type 1 Diabetes
Authors: Team Health Technology Assessment 
Published: September 2021

The CADTH Health Technology Expert Review Panel (HTERP) suggests that hybrid closed-loop insulin delivery (HCL) systems hold promise for the care of people with type 1 diabetes. HTERP considers that, at present, there are insufficient long-term data on clinically relevant and patient-important outcomes to recommend how extensive the role of HCL systems should be in care.
HTERP recommends the collection of robust and comparative data for consideration of future reassessments that compare HCL systems to existing insulin delivery and glucose monitoring methods in terms of glycated hemoglobin (hemoglobin A1C); time-in-range; time above and below range; glycemic variability; quality of life; patient, parent or caregiver, and health care provider satisfaction; diabetes-related complications; discontinuation rates; and health system impact. Robust data are collected in well-designed comparative studies that are, among other considerations, of sufficient duration to ensure a clinically meaningful outcome assessment.
Psychedelic-Assisted Psychotherapy for Post-Traumatic Stress Disorder, Anxiety Disorders, Mood Disorders, or Substance Use Disorders
Authors: Chao Yi-Sheng , Horton Jennifer 
Published: September 2021

Two systematic reviews, 3 randomized controlled trials, and 2 single-arm safety trials were identified that evaluated several combinations of psychedelic-assisted psychotherapy. Psilocybin was the psychedelic most tested. Other psychedelics identified in the systematic reviews and primary studies were 3,4-methylenedioxymethamphetamine (or MDMA), lysergic acid diethylamide (or LSD), ayahuasca (also named N,N-dimethyltryptamine [or DMT]), ibogaine, ketamine, and nitrous oxide.
Manualized therapy (not defined) and non-directive support (not defined) were the psychotherapies most studied in the relevant primary studies in the 2 systematic reviews. Other psychotherapies identified included integrative psychotherapy, cognitive behavioural therapy (CBT), CBT and motivational enhancement therapy, psychosocial interventions, non-directive support, group talk therapy, and guided support.
Clinical effectiveness lasting weeks to months was observed in 1 systematic review that reviewed primary studies examining various combinations of psychedelics and psychotherapy in patients with various mental health conditions. Significant improvement in symptom scores related to mental illnesses and no serious and long-term adverse events were reported in the other systematic review.
Various combinations of psychedelics and psychotherapies were evaluated in 3 randomized controlled trials (RCTs) and 2 safety studies. Ketamine-assisted psychotherapies were associated with improvements in the symptoms related to substance use disorder in 2 RCTs. Psilocybin-assisted psychotherapy was reported to be efficacious in treating MDD in 1 RCT. No serious adverse effects were reported in the RCTs or in 2 safety trials using MDMA-assisted psychotherapy.
There were several limitations to the included studies, including small sample sizes (less than 20 in the majority of primary studies), relatively short follow-ups (1 week to 3 years; less than or equal to 1 year in 27 out of 31 relevant publications), differences in psychotherapy classification between systematic reviews, considerable heterogeneity between studies, and unclear generalizability and availability of the interventions in Canadian contexts. Therefore, findings should be interpreted with caution. No relevant guidelines were identified.
Semaglutide (Rybelsus)
Authors: Team Reimbursement 
Published: September 2021

Clinical evidence suggests that Rybelsus should be reimbursed to treat type 2 diabetes in adults if it is used in addition to metformin or other antihyperglycemic agents and does not cost more than glucagon-like peptide-1 receptor agonists, dipeptidyl peptidase-4 inhibitors, and sodium-glucose cotransporter-2 inhibitors.
Rybelsus is more costly than most similar diabetes treatments.
Rybelsus is expected to increase budgets by more than $38 million over 3 years.
To account for the high treatment cost, the price of Rybelsus should be reduced.
If Rybelsus is not reimbursed as an add-on treatment for patients with type 2 diabetes, there are several other alternative treatments available for these patients.
Patiromer (Veltassa)
Authors: Team Reimbursement 
Published: September 2021

Clinical evidence suggests that Veltassa should be reimbursed to treat hyperkalemia in adult patients with chronic kidney disease and who are receiving renin-angiotensin-aldosterone system inhibitor therapy.
Economic evidence suggests that at least an 85% price reduction is needed to ensure Veltassa is cost-effective at a $50,000 per quality-adjusted life-year threshold.
Higher price reductions may be required if Veltassa is used long term, more patients use the maximum dose, and/or the benefit of renin-angiotensin-aldosterone system inhibitor administration is lower.
Based on public list prices, the 3-year budget impact is $86,948,298.
Luspatercept (Reblozyl)
Authors: Team Reimbursement 
Published: September 2021

Clinical evidence suggests that Reblozyl should be reimbursed to treat anemia associated with beta-thalassemia in adults who require blood transfusions on a regular basis if the cost is reduced.
Reblozyl is not cost-effective at the submitted price and would require a price reduction of at least 85% to be cost-effective at a $50,000 per quality-adjusted life-year (QALY) threshold.
Reblozyl is expected to increase budgets by at least $33,415,422 over 3 years.
If the price of Reblozyl is not reduced to a point that is affordable to public payers, this could delay access to the only treatment shown to reduce transfusion burden.
Implementation of Stereotactic Ablative Radiotherapy for the Treatment of Oligometastatic Cancer in Canada
Authors: Kumar Diksha , MacDougall Danielle 
Published: September 2021

The aim of this Environmental Scan is to identify and describe the use of stereotactic ablative radiotherapy in Canada, the systems in place to manage the treatment of patients with oligometastatic cancer, and the barriers and facilitators to the implementation of this treatment. The findings are based on a literature review, 22 survey responses from stakeholders, and email- and video call-based follow-up consultations with select stakeholders. Ten Canadian jurisdictions were represented by the survey respondents, who were primarily radiation oncologists.
Stereotactic ablative radiotherapy for the treatment of oligometastatic cancer is currently being accessed in all Canadian provinces as a standard treatment option. Centres are primarily treating oligometastases in the lungs, bones (non-spine), lymph nodes, spine, and liver. Some cancer care centres have the capacity for stereotactic ablative radiotherapy to treat localized primary tumours but do not treat oligometastatic sites.
There is a variation in patient selection criteria and treatment guidelines across Canadian jurisdictions, with most facilities following institutional guidance for the processes required for patient prioritization and treatment. There is a lack of standardized consensus guidelines with common criteria.
Reported facilitators for the implementation of stereotactic ablative radiotherapy for the treatment of oligometastatic cancer include access to dedicated equipment and teams. Reported barriers to its implementation include the lack of standardized patient selection and treatment guidelines, and constraints in equipment and staff resources (including time).
Brain-based learning model to explore students’ procedural fluency ability in learning quadrilateral 2D shapes
Authors: Ahmad Ahmad 
Published: September 2021

This study aims to determine the completion of student learning in procedural fluency through the Brain Based Learning model, along with their procedural fluency in flexibility, efficiency and accuracy in quadrilateral 2D shapes. It employed sequential explanatory research design. The research subjects were 7th graders (VII B) at SMP Negeri 2 Sokaraja, academic year 2019/2020. The data collection technique was procedural fluency test for students on quadrilateral 2D shapes; and the data analysis technique was the z-test. Results showed that students’ procedural fluency through BBL achieved learning mastery. In terms of flexibility, students were able to solve procedural fluency test questions in two ways. Students could perform each step of the method in terms of efficiency; and in terms of accuracy, it was shown that results were repeated consistently. These findings implied that procedural fluency through BBL along with students’ flexibility, efficiency, and accuracy belong to the fairly fluent category.
CONSIDERAÇÕES INICIAIS SOBRE LAOZI E O DAO DE JING E A SUA RELAÇÃO COM O ESTOICISMO DE EPICTETO
Authors: Capistrano Gama Santana André 
Published: September 2021

O presente artigo tem dois objetivos: o primeiro consiste em apresentar, mesmo que em linhas gerais, o pensamento expresso na obra de Laozi, Dao De Jing, considerado um dos maiores clássicos do pensamento chinês. O segundo objetivo é travar um diálogo inicial entre pressupostos apresentados pelo daoismo de Laozi e pelo estoicismo de Epicteto e, a partir daí, estabelecer espaços de discursão entre as duas tradições de pensamento.
REFLEXÕES ÉTICO-MUSICAIS EM DIÓGENES DA BABILÔNIA
Authors: Pereira de Almeida Marcos Vinicios 
Published: September 2021

Neste trabalho pretendemos fazer uma abordagem das implicações ético-musicais no pensamento do filósofo estoico Diógenes da Babilônia. O objetivo é analisar o pensamento de Diógenes a partir dos fragmentos lacunosos que chegaram até nós, mais precisamente através do De Musica do Filodemo de Gadara e do trabalho da Helen Woodward, e entender seu contexto histórico-filosófico. Portanto, nosso curso passa por uma contextualização de Diógenes e da sua abordagem estoica da música.
Palavras-chaves: Ética. Música. Estoicismo.
Needlestick injuries among healthcare personnel in Qatar: A retrospective study
Authors: Sofia Razzakh Shamja , Fazal Qureshi Muhammad 
Published: September 2021

Background: A needlestick injury (NSI) is a serious occupational hazard among healthcare personnel (HCP), as it can cause transmission of blood-borne pathogens such as human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV). This study aimed to determine the frequency and distribution of reported NSIs, associated factors, use of post-exposure prophylaxis (PEP), and percentage of seroconversion among HCP in a major tertiary care hospital in Qatar.
Methods: This retrospective study analyzed NSIs among HCP reported in Hamad Medical Corporation facilities in Doha between May 01, 2017, and May 01, 2018. A surveillance follow-up period of 6 months commenced after the 1-year study period.
Results: A total of 130 NSIs were reported during the study period, with an overall incidence of eight injuries per 1000 HCP. The mean age was 34.6 ± 7.9 years. Among the reported cases, the proportion of female HCP (n = 72, 55.4%) was greater than that of male HCP (n = 58, 44.6%). Of 130 NSIs, 79 (60.8%) occurred in nurses, followed by 35 (26.9%) cases in doctors and 16 (12.3%) in other HCP. The total healthcare population comprised 49.6% of nurses and 18% of doctors. NSIs occurred in 10.1 per 1000 nurses and in 12.4 per 1000 doctors. Exposures mainly occurred in the operating theater, 35 (31.5%); inpatient wards, 24 (21.6%); and emergency department, 20 (18%). Common modes of injury were after use or before disposal of the device in 44 (44.4%) cases and during surgical interventions in 35 (35.4%) cases. Hollow-bore needles (64/98, 65.3%) were the most common devices involved. Source serology was documented in 71 (54.6%) cases of which 52 (73.2%) were normal, 9 (12.7%) were abnormal, and 10 (14.1%) were incomplete. Among the exposed HCP, 124 (95.4%) had adequate immunity to HBV. PEP for HBV was indicated in 6 (4.6%) and received by 4 (3.1%) HCP. NSI cases were followed up for 6 months post-exposure, and during this surveillance period, no seroconversion to HBV, HCV, or HIV was detected.
Conclusion: NSIs are common among HCP. In this study, most of the exposed HCP had adequate immunity to HBV. There was no hepatitis B, hepatitis C, or HIV transmission among the study cohort. Adherence to proper needle/sharps disposal techniques and safe practices during procedures will help prevent NSIs.