IntroductionFirearm-related injury and death are leading yet preventable causes of premature death in Canada. Our objective was to identify knowledge gaps and research priorities to inform a national research agenda to prevent firearm-related injury and death. MethodsIn a two-stage process, nominal group technique was used to encourage experts in firearm injury and death (N = 15) to generate ideas relevant to knowledge gaps in three areas: unintentional firearm injury, intimate partner violence (IPV)/femicide and other firearm-related assaults. Relevant parties (N = 43) subsequently voted on the identified gaps to determine top priorities for future research. ResultsIn Stage 1, the experts identified 22 knowledge gaps in unintentional firearm injury, 16 in IPV-related firearm injury/femicide and 33 in other assault-related firearm injuries. Based on their importance and feasibility as research projects, they then selected five, three and seven, respectively, of these knowledge gaps. In Stage 2, the top priorities for future research emerged: the economic cost of firearm injuries to victims’ families and communities and Canadian society; the impact of social policies and legislation aimed at reducing IPV/femicide-related firearm injuries and deaths; and a description of the available and required Canadian firearm-injury data. ConclusionThe top priorities highlight the large and diverse gaps in knowledge about firearm injury and death in Canada. This marks the first step toward developing a national research agenda for firearm-related injuries. Next steps include operationalizing these gaps into research questions, identifying data sources and methodological approaches, and choosing knowledge translation strategies.

BackgroundColorectal cancer (CRC) screening participation in Canada is lower than the national target, and interventions designed to increase screening participation are generally expensive and have limited impact. Social media can be used as an innovative strategy to increase participation in cancer screening, particularly Facebook (FB), as it is the most popular social media platform for the population eligible for CRC screening. ObjectiveThe aim of this study is to report on the protocol for a pragmatic cluster randomized controlled trial that will test the effectiveness of CRC social media advertisements on user engagement and screening intention. MethodsThe trial will target FB users aged 45 to 64 years who reside in the province of Ontario, Canada. There are 521 forward sortation areas (FSAs) in Ontario, and the randomization will be done at this level using the first 3 digits of the postal code. Rural and urban FSAs will be randomly allocated to one of the 6 study arms. In 4 arms, FB users will all receive one of 4 social media advertisements developed in previous studies, while in the fifth arm, a tailored strategy by sex will be tested. In the final arm, FB users will not be shown any advertisements. If users click on any of the advertisements, they will be directed to a webpage with more information on screening and a place to pledge their intention to screen for CRC. The study’s primary outcome will be tested as a count measure, defined as the number of people per FSA who pledge their intention to screen for CRC. User engagement metrics, including impressions, link clicks, cost per link click, link click-through rate, and user comments, will be tracked across the 5 trial arms with advertisements shown. ResultsThis cluster randomized controlled trial will provide evidence on the use of FB as a tool for delivering CRC screening messages and influencing screening intentions. The comparison of message types within a fixed campaign budget could identify which approaches promote user engagement in both urban and rural populations. ConclusionsThis study has the potential to show that social media offers a cost-efficient, scalable approach to promote CRC screening. This approach is adaptable to other cancer screening programs and could provide evidence-based digital strategies for the promotion of cancer screening. Trial RegistrationClinicalTrials.gov NCT04296630; https://tinyurl.com/5y5k7yjb International Registered Report Identifier (IRRID)DERR1-10.2196/86829

IntroductionLes blessures et les décès par arme à feu sont les principales causes, pourtant évitables, de décès prématurés au Canada. Nous avions pour objectif d’identifier les lacunes en matière de connaissances et les priorités de recherche afin de fournir de l’information destinée à un programme national de recherche visant à prévenir les blessures et les décès par arme à feu. MéthodologieDans le cadre d’un processus en deux étapes, nous avons utilisé la technique du groupe nominal pour aider les experts des blessures et des décès par arme à feu (N = 15) à générer des idées à propos des lacunes en matière de connaissances dans trois domaines : les blessures non intentionnelles par arme à feu, la violence entre partenaires intimes ou le féminicide et les autres agressions par arme à feu. Les parties concernées (N = 43) ont ensuite voté sur les lacunes repérées afin de déterminer les principales priorités pour la recherche future. RésultatsLors de l’étape 1, les experts ont cerné 22 lacunes dans les connaissances sur les blessures non intentionnelles par arme à feu, 16 concernant les blessures par arme à feu liées à la violence entre partenaires intimes et les féminicides et 33 concernant les autres blessures par arme à feu liées à des agressions. Les experts ont ensuite sélectionné, en fonction de leur importance et de leur faisabilité en tant que projets de recherche, respectivement 5, 3 et 7 de ces lacunes. L’étape 2 a permis de dégager les principales priorités pour les recherches futures : le coût économique des blessures par arme à feu pour les familles et les collectivités des victimes et pour la société canadienne; l’incidence des politiques sociales et de la législation visant à réduire les blessures et les décès par arme à feu liés à la violence entre partenaires intimes et aux féminicides et enfin une description des données disponibles et nécessaires pour la recherche sur les blessures par arme à feu au Canada. ConclusionLes principales priorités mettent en évidence les lacunes importantes et variées dans les connaissances sur les blessures et les décès par arme à feu au Canada. Il s’agit de la première étape vers l’élaboration d’un programme national de recherche sur les blessures par arme à feu. Les prochaines étapes consistent à traduire ces lacunes en questions de recherche, à sélectionner les sources de données et les approches méthodologiques et à choisir des stratégies de transfert des connaissances.

Objectives The COVID-19 pandemic resulted in rapid changes to the delivery of maternal and newborn care. Our aim was to gain an understanding from parents and healthcare professionals (HCPs) of how the pandemic and associated public health restrictions impacted the peripartum and postpartum experience, as well as longer-term health and well-being of families.Design Qualitative study through focus groups.Setting Ontario, Canada.Participants HCPs and parents who had a child born during the COVID-19 pandemic.Interventions Semistructured interview guide, with questions focused on how the pandemic impacted their care/their ability to provide care, and strategies to improve care and support now or in future situations with similar healthcare restrictions.Outcome measures Thematic analysis was used to describe participant experiences and recommendations.Results We included 11 HCPs and 15 parents in 6 focus groups. Participants described their experiences as ‘traumatic’, with difficulties in accessing prenatal and postpartum services, and feelings of distress and isolation. They also noted delays in speech and development in children born during the pandemic. Key recommendations included the provision of partner accompaniment throughout the course of care, expansion of available services for young families (particularly postpartum), and special considerations for marginalised groups, including access to technology for virtual care or the option of in-person visits.Conclusions Our findings may inform the development of healthcare system and organisational policies to ensure the provision of maternal and newborn care in the event of future public health emergencies. Of primary importance to the participants was the accommodation of antenatal, intrapartum and postpartum partner accompaniment, and the provision of postpartum services.

BACKGROUND:Surgical shutdowns related to the COVID-19 pandemic have resulted in prolonged wait times for nonemergency surgery. We aimed to understand informational needs and generate suggestions on management of the surgical backlog in the context of the ongoing COVID-19 pandemic through focus groups with key stakeholders.METHODS:We performed a qualitative study with focus groups held between Sept. 29 and Nov. 30, 2021, in Ontario, with patients who underwent or were awaiting surgery during the pandemic and their family members, and health care leaders with experience or influence overseeing the delivery of surgical services. We conducted the focus groups virtually; focus groups for patients and family members were conducted separately from health care leaders to ensure participants could speak freely about their experiences. Our goal was to elicit information on the impact of communication about the surgical backlog, how this communication may be improved, and to generate and prioritize suggestions to address the backlog. Data were mapped onto 2 complementary frameworks that categorized approaches to reduction in wait times and strategies to improve health care delivery.RESULTS:A total of 11 patients and family members and 20 health care leaders (7 nursing surgical directors, 10 surgeons and 3 administrators) participated in 7 focus groups (2 patient and family, and 5 health care leader). Participants reported receiving conflicting information about the surgical backlog. Suggestions for communication about the backlog included unified messaging from a single source with clear language to educate the public. Participants prioritized the following suggestions for surgical recovery: increase supply through focusing on system efficiencies and maintaining or increasing health care personnel; incorporate patient-centred outcomes into triage definitions; and refine strategies for performance management to understand and measure inequities between surgeons and centres, and consider the impact of funding incentives on "nonpriority" procedures.INTERPRETATION:Patients and their families and health care leaders experienced a lack of communication about the surgical backlog and suggested this information should come from a single source; key suggestions to manage the surgical backlog included a focus on system efficiencies, incorporation of patient-centred outcomes into triage definitions, and improving the measurement of wait times to monitor health system performance. The suggestions generated in this study that may be used to address surgical backlog recovery in the Canadian setting.

Objective To describe a conceptual framework that provides understanding of the challenges encountered and the adaptive approaches taken by organised colorectal cancer (CRC) screening programmes during the initial phase of the COVID-19 pandemic. Design This was a qualitative case study of international CRC screening programmes. Semi-structured interviews were conducted with programme managers/leaders and programme experts, researchers and clinical leaders of large, population-based screening programmes. Data analysis, using elements of grounded theory, as well as cross-cases analysis was conducted by two experienced qualitative researchers. Results 19 participants were interviewed from seven programmes in North America, Europe and Australasia. A conceptual framework (‘Nimble Approach’) was the key outcome of the analysis. Four concepts constitute this approach to managing CRC screening programmes during COVID-19: Fast (meeting the need to make decisions and communicate quickly), Adapting (flexibly and creatively managing testing/colonoscopy capacity, access and backlogs), Calculating (modelling and actively monitoring programmes to inform decision-making and support programme quality) and Ethically Mindful (considering ethical conundrums emerging from programme responses). Highly integrated programmes, those with highly integrated communication networks, and that managed greater portions of the screening process seemed best positioned to respond to the crisis. Conclusions The Nimble Approach has potentially broad applications; it can be deployed to effectively respond to programme-specific challenges or manage CRC programmes during future pandemics, other health crises or emergencies.

ObjectiveAlthough sedation improves patient experience during colonoscopy, there is great jurisdictional variability in sedative practices. The objective of this study was to develop practice recommendations for the use of moderate and deep sedation in routine hospital-based colonoscopy to facilitate standardisation of practice.DesignWe recruited 32 multidisciplinary panellists to participate in a modified Delphi process to establish consensus-based recommendations for the use of sedation in colonoscopy. Panel members participated in a values assessment survey followed by two rounds of anonymous online voting on preliminary practice recommendations. An inperson meeting was held between voting rounds to facilitate consensus-building. Consensus was defined as >60% agreement/disagreement with recommendation statements; >80% agreement/disagreement was considered indicative of strong consensus.ResultsTwenty-nine panellists participated in the values assessment survey. Panellists ranked all factors presented as important to the development of practice recommendations. The factor considered most important was patient safety. Patient satisfaction, procedural efficiency, and cost were considered less important. Strong consensus was achieved for all nine practice recommendations presented to the panel. These recommendations included that all endoscopists be able to perform colonoscopy with moderate sedation, that an endoscopist and a single trained nurse are sufficient for performing colonoscopy with moderate sedation, and that anaesthesia-provided deep sedation be used for select patients.ConclusionThe recommendations presented in this study were agreed on by a multidisciplinary group and provide guidance for the use of sedation in routine hospital-based colonoscopy. Standardised sedation practices will promote safe, effective, and efficient colonoscopy for all patients.

# Characteristics of early analgesia in adults presenting with acute trauma to a level 1 trauma centre. {#article-title-2} Acute pain is one of the most common symptoms experienced by patients following trauma, yet under two-thirds receive analgesic medication when presenting to the emergency

PurposePopulation-based reflex testing of colorectal tumors can identify individuals with Lynch syndrome (LS), but there is debate regarding the type of patient discretion such a program warrants. We examined health-care providers' views and experiences to inform the design of a reflex-testing program and their perspectives regarding an opt-out option.MethodsWe interviewed providers managing LS or colorectal cancer patients, including surgeons, genetic counselors, oncologists, primary-care physicians, and gastroenterologists. Qualitative data were analyzed thematically using constant comparison techniques.ResultsProviders supported a reflex-testing program because of the current lack of coordinated immunohistochemistry (IHC) testing and underascertainment of LS patients as well as the opportunity to standardize the increasing use of genomic tests in practice. Most supported an opt-out after reflex testing because they felt that IHC is akin to other pathology tests, which are not optional. Some favored an opt-out before testing because of concern for patients experiencing distress, insurance discrimination, or a diagnostic odyssey that may be inconclusive.ConclusionProviders support a reflex-testing program to improve the identification and management of suspected LS patients. However, how to support meaningful information provision to enable an opt-out without jeopardizing testing uptake and the anticipated public health benefits remains a policy challenge.Genet Med advance online publication 06 October 2016

The Advanced Trauma Care for Nurses (ATCN) course was designed to help nurses increase their knowledge in management of the multiple trauma patient. To determine whether the trauma-related knowledge of ATCN course takers differed from nontakers, assess the factors associated with ATCN content knowledge among course takers, and explore the extent to which the ATCN content was used by course takers in their clinical practice. A cross-sectional online survey of 78 ATCN takers (nurses who had successfully completed the ATCN course within the previous 3 years) and 58 ATCN nontakers (a control group of nurses who had not taken the course but who worked in comparable clinical settings) was conducted. The survey consisted of demographic questions and a 15-item knowledge test spanning the ATCN course content. ATCN takers were also asked about the frequency with which a specific ATCN content had been used in their practice since taking the course. ATCN takers had a significantly higher (mean ± SD = 10.6 ± 2.2) total score on the study test than the ATCN nontakers (mean ± SD = 6.4 ± 2.6); t (134) = −10.0, p < .001. A shorter time since course completion was associated with higher knowledge scores. ATCN takers rated the clinical relevance and applicability of the course content as high. The findings suggest that completing the ATCN course increases knowledge levels of trauma patient management and that the ATCN course content is clinically relevant to the nurses. However, higher knowledge scores were observed for the most recent study participants, suggesting that booster sessions for ATCN course participants may be warranted.

# Outcomes and opportunities for improvement in self-inflicted blunt and penetrating trauma {#article-title-2} Self-inflicted trauma (SIT) is a public health issue ranking 4th as leading cause of death and disability in young adults. Retrospective descriptive analysis of patients admitted to a

Background: The internationally recognized Advanced Trauma Operative Management (ATOM) course uses a 1: 1 student-to-faculty teaching model. This study examines a two student to one faculty ATOM teaching model.Materials and methods: We randomly assigned 16 residents to four experienced ATOM faculty members. Half started with the one-student model and the other half with the two-student model and then switched using the same faculty. Students and faculty completed forms on the educational value of the two models (1 very poor; 2 poor; 3 average; 4 good; and 5 excellent) and identified educational preferences and recommendations.Results: We assigned educational values for the 13 procedures as follows: All faculty rated the one-student model as excellent; six members rated the two-student model as excellent, and seven as good. Students rated 50%-75% as excellent and 12%-44% as good for the two-student model, and 56%-81% as excellent and 12%-44% as good for the one-student model. Given resource constraints, all faculty and 88% of students preferred the two-student model. With no resource constraints, 75% of students and 50% of faculty chose the two-student model. All faculty and students rated both models "acceptable." Overall, 81% of students and 50% of faculty rated the two-student model better. All faculty members recommended that the models be optional; 94% of students recommended that they be either optional (50%) or a two-student model (44%). Performing or assisting on each procedure twice was considered an advantage of the two-student model.Conclusions: The two-student teaching model was acceptable and generally preferred in this study. With appropriately trained faculty and students, the two-student model is feasible and should result in less animal usage and possibly wider promulgation. (C) 2013 Elsevier Inc. All rights reserved.

# Testing the reliability of tools for pediatric trauma teamwork evaluation in a North American high-resource simulation setting {#article-title-2} Literature suggests that teamwork and team performance greatly impact medical trauma outcomes. While trauma simulations have been shown to improve

OBJECTIVES:The advanced trauma life support (ATLS) course has become the international standard for teaching trauma resuscitation skills. The 2 to 2.5 days course is usually offered as an on-site teaching experience. The present project assesses the potential for applying telemedicine technology to teaching ATLS by distance learning. DESIGN:Two groups of equally trained first-year family practice residents were randomly assigned to a standard on-site ATLS course or one delivered by telemedicine. The 2 courses were compared by evaluating post-ATLS multiple-choice question test performance, instructor evaluation of student skill station performance, overall pass rate, participant rating of each component of the course, and overall feedback on the educational quality of the course (rating scale 1-4). RESULTS:The mean scores for the 2 groups (with the standard ATLS and with the telemedicine, respectively) were not statistically significantly different: post-ATLS multiple-choice question-89.69% vs 85.89%; pass rate for the course was the same for both models; instructor overall evaluation of student skill station performance-3.12 vs 3.00; and participant overall feedback on all components of the course-3.67 vs 3.91. CONCLUSIONS:Our results suggest that telemedicine technology could be successfully applied to teaching ATLS courses.

# Erythroopoietin resuscitated with normal saline, Ringer’s lactate and 7.5% hypertonic saline reduces small intestine injury in a hemorrhagic shock and resuscitation rat model. {#article-title-2} Bacterial translocation (BT) from the gut can develop and persist after short periods of hemorrhagic

Background. Traditionally, surgical skills in trauma resuscitation have been taught using animal models in the advanced trauma life support (ATLS) course. We compare one mechanical model (TraumaMan simulator) as an alternative teaching tool for these skills.Method. Eighteen providers and 14 instructors performed four surgical procedures on TraumaMan and compared educational effectiveness with the porcine model. Evaluation was conducted (Likert system 1: very poor to 5: excellent). The participants indicated if TraumaMan was a suitable (scale 1: not suitable to 4: excellent) ATLS teaching model considering cost, animal ethics concerns, and other factors. Comments were solicited for both models.Results. Overall ratings for educational effectiveness of the 4 skills ranged from 3.58 to 4.36 for the porcine and 3.48 to 4.29 for the TraumaMan model. TraumaMan suitability was rated 3-4 (mean 3.38) by 84% participants. TraumaMan as a substitute for the porcine model was recommended by 85% participants. With no ethical or cost concerns, 44% students and 71% instructors preferred TraumaMan. Considering all factors, TraumaMan was preferred by 78% students and 93% instructors.Conclusions. TraumaMan is a suitable alternative to the porcine model and considering all factors it may be the preferred method for teaching ATLS emergency trauma surgical skills.