Study: On Patient Ownership

Introduction

Patient ownership is an important element of physicians’ professional responsibility, but important gaps remain in our understanding of this concept. We sought to develop a theory of patient ownership by studying it in continuity clinics from the perspective of residents, attending physicians, and patients.

Methods

Using constructivist grounded theory, we conducted 27 semi-structured interviews of attending physicians, residents, and patient families within two pediatric continuity clinics to examine definitions, expectations, and experiences of patient ownership from March–August 2019. We constructed themes using constant comparative analysis and developed a theory describing patient ownership that takes into account a diversity of perspectives.

Results

Patient ownership was described as a bi-directional, relational commitment between patient/family and physician that includes affective and behavioral components. The experience of patient ownership was promoted by continuity of care and constrained by logistical and other systems-based factors. The physician was seen as part of a medical care team that included clinic staff and patient families. Physicians adjusted expectations surrounding patient ownership for residents based on scheduling limitations.

Discussion

Our theory of patient ownership portrays the patient/family as an active participant in the patient–physician relationship, rather than a passive recipient of care. While specific expectations and tasks will vary based on the practice setting, our findings reframe the way in which patient ownership can be viewed and studied in the future by attending to a diversity of perspectives.

Learn more on “It is you, me on the team together, and my child”: Attending, resident, and patient family perspectives on patient ownership via Perspectives on Medical Education.

Is Monkeypox Airborne?

Could masks help prevent the spread of monkeypox?

PHAC is recommending healthcare settings adopt precautions against airborne, droplet, and contact transmission until more information is available.

The federal government is also generally encouraging “good hand hygiene and respiratory etiquette,” including wearing a mask or covering coughs, along with limiting sexual partners and practising safer sex.

Other public health authorities have emphasized avoiding close physical contact without much reference to spraying droplets or inhaling aerosols.

The United States Centers for Disease Control and Prevention initially warned travellers to wear face masks to prevent the spread of monkeypox but later dropped the recommendation, noting it “caused confusion.”

Now, the agency only suggests masks for those in close contact with infected people.

‘For people out and about, or travelling, the individual risk of having any contact with somebody with monkeypox remains incredibly low,’ Hugh Adler of the Respiratory Infections Group at the Liverpool School of Tropical Medicine told Reuters.”

Read more on Is monkeypox airborne? via CMAJ.

Unexplained Pediatric Hepatitis

“Earlier this year, physicians in the United Kingdom raised alarm over an apparent surge in cases of unexplained severe acute hepatitis in children.

By late June, the U.K. reported 258 cases, 12 of which required liver transplants, up from about 20 in a normal year.

As of mid-July, 35 countries reported more than 1000 probable cases, including 22 deaths, with most cases occurring in Europe.

Canada has reported 23 cases so far, two of which required liver transplants. An expert told CMAJ that’s roughly the number you would expect to see given the size of Canada’s population.

It’s not unusual for the causes of severe liver inflammation in children to be unknown – by some estimates, up to half of such cases are unexplained. And it’s still unclear whether the numbers reported globally reflect a true uptick in unexplained cases versus increased attention to the issue.”

More on Emerging clues to unexplained pediatric hepatitis via CMAJ.

COVID-19 Vaccine & Young Children

Thanks to a recent decision by Health Canada, children in British Columbia over the age of six months are now eligible for COVID-19 vaccinations. And a recent study by UBC researchers reveals some surprising attitudes about child vaccination from parents who remain unvaccinated.

Dr. Ran Goldman, professor of pediatrics at UBC, answers some questions for parents looking for more information before vaccinating their children.

What did your new study find?

In collaboration with 21 hospitals across four countries including Canada, we interviewed 4,500 parents and caregivers—19 per cent were unvaccinated, but among the unvaccinated, seven per cent still said they planned to vaccinate their kids. While that may seem like a small percentage, it proves that even some parents who do not get vaccinated understand the vaccine’s importance for children.

Some parents are worried about side-effects—should they be?

Any vaccine will have some side effects, not just COVID vaccines. But many studies have shown that most side effects, including soreness or redness where the shot was given, are mild. And that the risks associated with COVID far outweigh any risks associated with getting the vaccine.

If parents remain skeptical of the vaccine for their child, who should they talk to?

They should speak to someone with firsthand knowledge—family physicians, pediatricians, nurses or pharmacists. Ask questions about the vaccine, its efficacy and the risks of COVID. It’s important to arm yourself with knowledge to protect your family from the virus.

Learn more on COVID-19 vaccine and young children via UBC Faculty of Medicine.

Mosquitoes Seeing Red

“Beating the bite of mosquitoes this spring and summer could hinge on your attire and your skin. New research led by scientists at the University of Washington indicates that a common mosquito species — after detecting a telltale gas that we exhale — flies toward specific colors, including red, orange, black and cyan. The mosquitoes ignore other colors, such as green, purple, blue and white. The researchers believe these findings help explain how mosquitoes find hosts, since human skin, regardless of overall pigmentation, emits a strong red-orange “signal” to their eyes.

‘Mosquitoes appear to use odors to help them distinguish what is nearby, like a host to bite,’ said Jeffrey Riffell, a UW professor of biology. ‘When they smell specific compounds, like CO2 from our breath, that scent stimulates the eyes to scan for specific colors and other visual patterns, which are associated with a potential host, and head to them.’

The results, published Feb. 4 in Nature Communications, reveal how the mosquito sense of smell — known as olfaction — influences how the mosquito responds to visual cues. Knowing which colors attract hungry mosquitoes, and which ones do not, can help design better repellants, traps and other methods to keep mosquitoes at bay.”

More on Mosquitoes are seeing red: Why new findings about their vision could help you hide from these disease vectors via UW.

Canada: Testing Wastewater for Polio

“After new reports of polio cases abroad, and virus samples in the wastewater of several other developed countries, Canada intends to start testing wastewater from a number of cities ‘as soon as possible,’ CBC News has learned.

The Public Health Agency of Canada (PHAC) already works to monitor polio activity around the world, a spokesperson said in an email response to CBC News questions.

Currently, PHAC’s National Microbiology Laboratory in Winnipeg does have the diagnostic tools available to test samples for poliovirus. Any suspected positive Canadian samples of poliovirus will be sent to that lab for further laboratory analysis and confirmation, with results shared with the respective local health authorities “so appropriate public health measures can be taken if necessary.”

According to the statement, PHAC has been communicating with national and international partners who are experts in this field to finalize a wastewater testing strategy. It will be testing wastewater samples that were collected earlier this year from ‘key high-risk municipalities’ to determine if polio was present prior to the reported international cases.

Read more on Wastewater tests will focus on ‘key high-risk municipalities,’ says Public Health Agency of Canada via CBC.

Sepsis Awareness Is Good

Sepsis Steps. Training tool for teaching the progression of sepsis stages via Wikipedia.

“Despite significant progress over the last 20 years in increasing awareness of sepsis (infection induced organ dysfunction) among healthcare providers (HCPs), the public, and patients/families, there remains much to be accomplished, with sepsis morbidity and mortality remaining unacceptably high. For HCPs, early identification of sepsis is paramount for initiating early appropriate therapy. For the lay person, recognizing when they or a family member are at significant risk for sepsis requiring prompt evaluation by a HCP may be life-saving. And for patients hospitalized with sepsis, patient and family understanding of the sepsis disease process is important not only for the provider patient/family relationship but also for the postdischarge period since repeat admission after discharge is common. The primary reason for hospital readmission after a sepsis diagnosis is infection, often resulting in poor outcomes. In this issue of Critical Care Medicine, Fiest et al. provide the reader with a scoping review of the literature to establish what is known as to the degree of sepsis awareness and education among the three aforementioned groups, as well as the vehicles that provide that awareness and education.”

More on Sepsis Awareness Is Good, Please Do Not Let It Be Misunderstood* via Critical Care Medicine.

Art Museum-Based Teaching

J. Bond Francisco, The Sick Child, 1893, oil on canvas, via Smithsonian American Art Museum, Museum Purchase, 1991.9

The Association of American Medical Colleges recently launched an initiative to explore the role of the arts and humanities in physician development, a topic gaining recognition in health professions education. This Last Page focuses on the most established and studied of the art museum-based teaching methods: visual thinking strategies (VTS), an open-ended facilitated discussion centered around a preselected work of art, such as painting.

Learn more here Art Museum-Based Teaching: Visual Thinking Strategies via Academic Medicine.

Hybrid Brains & Ethics

Leonardo da Vinci depiction of the cavities of the brain.

“In a darkened room in a laboratory in London, a group of students and researchers watch a clump of human brain cells settle into their new home: a living mouse brain. On a computer monitor next to a microscope, the human cells light up in flashes of simultaneous activity. Over time, the cells sprout new connections a few centimetres long, and form networks with each other. It’s captivating viewing for his students, says Vincenzo De Paola, who runs the lab at Imperial College London. ‘It’s all they want to do. I can’t tear them away,’ he says.

They have front-row seats to an unusual show. De Paola’s group is one of just a handful of labs able to study human neural cells at work in a live, developing brain — a system that is otherwise largely off limits for both ethical and technical reasons. ‘We cannot study these processes as they unfold in a fetal human brain,’ he says. ‘Instead, we wanted to watch human cortical neurons mature and form active networks in a live animal.’”

More on Hybrid brains: the ethics of transplanting human neurons into animals via Nature.

Health Effects of Electronic Cigarettes

ABSTRACT: The use of electronic cigarettes (e-cigarettes) is rapidly growing. Recent surveys demonstrate particularly high uptake among young never-smokers and a possible association with increased uptake of combustible cigarette smoking. E-cigarettes may be associated with increased risk of cardiovascular disease, including myocardial infarction, stroke, coronary artery disease, hypertension, and elevated heart rate. However, there is a paucity of long-term clinical data to show the cardiovascular disease implications of these changes. With regard to pulmonary disease, e-cigarettes appear to be strongly implicated in the recent outbreak of acute e-cigarette, or vaping, product use–associated lung injury. The relationship between e-cigarettes and chronic pulmonary disease is less clear, though possible associations with obstructive spirometric changes, chronic obstructive pulmonary disease, asthma, and chronic cough have been demonstrated. Nonetheless, the literature suggests that e-cigarettes are likely less harmful to the cardiovascular and respiratory systems than combustible cigarettes, and emerging evidence suggests that e-cigarettes can be an effective smoking cessation aid for smokers who are motivated to quit.