Background: People transitioning from incarceration into the community often experience adverse health outcomes driven by the social determinants of health. This study aimed to compare the prevalence of mental health and substance use disorders and their associations with poverty and housing instability among people incarcerated in British Columbia provincial correctional centres versus the general community population. Methods: We used linked administrative data on a random 20% sample of BC residents enrolled in public health insurance. Individuals with any provincial incarceration in 2015 or 2021 were identified and compared with nonincarcerated individuals in those years. Prevalence of mental illness, substance use disorders, and indicators of social disadvantage (income assistance, no fixed address) were calculated for both groups. In 2021, the sample included 1933 incarcerated people and 962 421 nonincarcerated people. Results: Incarcerated people had significantly higher rates of mental illness and substance use disorder (including opioid and stimulant use disorders) than the community population. In 2021, 51.1% of incarcerated people had a diagnosed mental illness, 58.9% had a substance use disorder, and 41.0% had both. Co-occurring mental illness and substance use disorder were frequently associated with extreme poverty and housing instability. Nearly one-third (32.5%) of incarcerated people in 2021 had co-occurring mental illness and substance use disorder and either received income assistance or had no fixed address. Mental illness, substance use disorder, and poverty were much less common in the community cohort. Conclusions: Incarcerated people in BC experiencea triple burden of mental illness, substance use disorders, and socioeconomic marginalization (poverty and homelessness). There is an urgent need for targeted interventions during incarceration (e.g., evidence-based mental health and substance use disorder treatment) and greater postrelease support (housing, social services, and employment opportunities) to reduce health inequities and break the cycle of recidivism.
Inappropriate use of diagnostic tests is common in medical practice. There is a tendency for clinicians to overinvestigate or order unnecessary tests that either do not impact medical care or potentially harm the patient. Excessive testing is common for several reasons, including fear of missing a diagnosis, limited time during patient visits, patient expectations, and institutional pressures. However, overtesting generates superfluous and misleading clinical data, leads us down the wrong path, causes unnecessary anxiety, and produces extra medical waste. I review my top five recommendations from Choosing Wisely relevant to both outpatient and inpatient management of infection.
Background: Inhaler medications are a corner-stone of treatment for respiratory diseases but are associated with substantial greenhouse gas emissions. Methods: In this quality improvement project, we implemented pharmacist-led screening of inhaler regimens at our outpatient respirology clinic to assess for more environmen-tally friendly modifications. Patients were first screened by a pharmacist, who flagged them for respirologist review if potential modifica-tions to their regimens were identified. The respirologist then intervened as appropriate. Results: In total, 106 patients were pre-screened by a pharmacist, 88 were flagged for respirologist review, and 68 had changes -made to their inhaler regimen. The average reduction in greenhouse gas emissions per patient screened was 200 gCO e per day. The total reduction in greenhouse gas emissions for all screened patients was 19 208 gCO,e per day, the equivalent of driving 79 km per day in a standard gasoline-powered passenger car. Conclusions: This project highlights the sub- stantial reductions in greenhouse gas emissions that can be achieved through pharmacist-led -screening of inhaler regimens.
Background: Physician burnout is increasingly recognized as a critical issue with serious consequences for physician well-being, patient care, and the health care system. Orthopaedic surgeons are particularly susceptible to burnout due to numerous stressors surrounding work and personal obligations. The objective of this study was to determine the prevalence of, and risk factors for, burnout in Canadian orthopaedic surgeons. Methods: Anonymous online surveys were administered to orthopaedic surgeons identified via the senior author's university and the Canadian Orthopaedic Association's mailing list. The survey included the Maslach Burnout Inventory, the Measure of Moral Distress for Health Care Professionals, and demographic questions. Risk factors for burnout were identified using a multivariate logistic regression model. Associations between risk factors and depersonalization and emotional exhaustion were assessed using a multivariate linear regression model. Results: In total, 215 participants responded to the survey (response rate of 19.6%). Of those, 62.8% (135/215) screened positive for burnout. When adjusting for other factors, moral distress was identified as a riskfactor for burnout (odds ratio = 1.03, 95% CI, 1.02-1.05, P < .001). Older age was negatively associated with burnout (odds ratio = 0.97, 95% CI, 0.94-0.99, P = .02). There was no association between burnout and work hours, administrative burden, sex, or level of training. Conclusions: This is the first national study to quantify burnout and moral distress among Canadian orthopaedic surgeons using fulllength validated instruments. The high prevalence of burnout, along with the strong association with moral distress, highlights the urgent need for systemic interventions targeting physician wellness.
Diagnosing infectious diseases is often not straightforward. Clinicians may be misled by nonspecific or irrelevant symptoms and signs, and they may misinterpret test results. The appropriateness of the prescribed treatment hinges entirely on the accuracy of the working diagnosis. Even when the diagnosis is correct, pitfalls are frequently encountered during the management stage of the infection. This review of the literature shows how clinicians mayfall victim to cognitive traps when working through the diagnostic and therapeutic process and provides guidance on how to avoid these pitfalls when managing adult patients with suspected infections.
