Penticton Regional Hospital

Pharmacy residents are at risk of burnout, which can affect their well-being and performance and reduce their sense of satisfaction. Support interventions, specifically peer support, mentorship, and connectedness, may help to alleviate stress and improve well-being. To describe the current opportunities for and perceptions of support available to Canadian year 1 (Y1) pharmacy residents and to identify their interest in and desire for additional support opportunities. A cross-sectional national online survey of Canadian Y1 residents from the 2021/22, 2022/23, and 2023/24 residency years was conducted. A subset of survey respondents participated in an online focus group designed to further explore themes identified in the survey. A total of 109 residents participated in the survey, and 7 participated in the focus group. Participants reported that support was available to them in the forms of mentorship (n = 99, 90.8%), wellness or self-care opportunities (n = 45, 41.3%), and peer connection (n = 94, 86.2%). Mentorship and peer connection were highly valued, yet just over half of participants reported being satisfied with the level of mentorship and peer connection they experienced. Identified opportunities for improvement included formalizing mentorship programs, with clear roles, protected time, intentional matching, and paid training for mentors; enhancing access to health and wellness resources; and designating site-based support for residents. Mentorship and peer connection were the most commonly provided and highly valued supports for the Canadian Y1 pharmacy residents who participated in this study. Opportunities exist to enhance all forms of support offered to Y1 pharmacy residents, which ultimately may help to reduce resident burnout and improve resident well-being.

BackgroundCommunity organizations play a crucial role in dementia‐focused programs, yet funding uncertainty remains a challenge. This study examines the Memory Café, a community‐led initiative in rural British Columbia that fosters social engagement, education, and support for individuals with dementia and their caregivers.Over two years, Medical Arts Research and DB Foundation for Health Research, in partnership with a local university, hosted 10 Memory Café events in rural communities, including Cawston, Keremeos, and Princeton. These events, supported by local government funding, engaged diverse partners—Indigenous leaders, musicians, artists, businesses, and healthcare professionals. Activities included musical performances, calligraphy workshops, Tai Chi, and interactive “memory box” sessions. Keynote speakers, including caregivers with lived experience, provided education and social support.The initiative catalyzed long‐term community projects, including:Forget‐Me‐Not Café (Penticton): Inspired a weekly dementia‐friendly café.Stretching Group (Keremeos): Led by a retired therapist, promoting movement for cognitive health.Community Benches (Cawston): Installed by a local carpenter to create dementia‐friendly spaces.MethodThe research team employed a community‐based participatory action research (CBPAR) approach, collaborating with local stakeholders to design and implement the Memory Café events. They conducted survey with key community partners, volunteers, and participants to assess the program's impact. as well as to evaluate their experiences and gather feedback for improving future initiatives. Observational data were also collected during the events to document engagement levels and interactions among participants.ResultsFour key sustainability factors were identified:· Engaging Community Stakeholders: Collaborative meetings fostered shared ownership, identifying volunteers and funding sources.· Leveraging Local Resources: Partnerships with businesses and organizations provided funding, venues, and services.· Incorporating Community Feedback: Surveys informed program improvements, increasing engagement.· Removing Barriers to Participation: Transportation support, free events, and sensory‐friendly spaces enhanced accessibility.ConclusionThe Memory Café model demonstrates a scalable, community‐driven approach to dementia‐friendly initiatives. By fostering partnerships, leveraging resources, and engaging stakeholders, community organizations can build sustainable support systems for individuals with dementia and their caregivers. Future efforts will explore digital engagement and volunteer training to expand impact.

BackgroundIn 2011, the province of British Columbia (BC) moved to allow patients with complex rheumatic disease to be seen by nurses along with their rheumatologist by introducing a ‘Multidisciplinary Care Assessments’ (MCA) billing code (G31060).ObjectiveTo describe multidisciplinary care introduced as part of MCAs across BC and investigate the perceived impact of this intervention, the addition of nurses to the care team, on patient care from the perspective of patients, nurses, and rheumatologists.MethodsWe conducted semi-structured interviews, informed by a qualitative evaluation approach with patients, nurses, and rheumatologists from September 2019 – August 2020. Interviews investigated 1) the experiences of all stakeholders with adopting the multidisciplinary care billing code, 2) the perceived role of the nurse in the care team, and 3) the perceived impact of multidisciplinary care on patient experience and outcomes. We purposefully sampled practices for maximum variation of geographical location (rural vs. urban), size of practice (i.e., patient caseload), and number of nurses employed.ResultsWe interviewed 21 patients, 13 nurses, and 12 rheumatologists from across BC. Our analysis identified variation in the way rheumatologists adopted multidisciplinary care across BC. Our analysis showed some heterogeneity in the way the MCA was delivered in rheumatology practices; however, patient education was identified as the core role of nurses across practices. We identified six core themes describing the impact of this model of care, all representing improvements in the way practices functioned, from improved efficiency to access, patient experience, time management, clinician experience, and patient health outcomes. Contextual factors that influenced the presence of these themes were related to the time the nurses spent with patients and the professional roles they performed.ConclusionOur results suggest nurse care can complement physician care by extending contact time for patients and promoting the efficient use of health care professionals’ skills, time, and resources. These data may encourage future uptake of the billing code to help ensure the policy delivers maximum benefits to patients given the wide range of perceived benefits described by clinicians and patients.

This chapter covers some interesting areas of both Flybase and Twilio. We're going to build a "click-to-call'' call center, where visitors can click a product on a page and begin a Twilio Client call with agents on another web page. To do this, we are going to use Flybase's custom events.

Dynamic hyperinflation (DH) is common in COPD and is often associated with exertional dyspnea. However, there is increasing evidence that DH may also impair hemodynamics via adverse cardiopulmonary interaction, though the mechanisms responsible remain unclear. As such, we examined the effect of incremental DH on left ventricular (LV) filling and ejection, and the role of direct ventricular interaction (DVI). We hypothesized that increasing DH would reduce LV end diastolic volume (LVEDV) and stroke volume (LVSV) due to DVI. 23 healthy subjects were randomly exposed to varying degrees of expiratory loading to induce DH such that end-expiratory lung volumes were increased by 25, 50, 75 and 100%, where 100% corresponded to an inspiratory reserve volume (IRV) of <0.5L. LV volumes, LV geometry, IVC collapsibility (cIVC) and LV end-systolic wall-stress (LVESWS) were assessed by tri-plane echocardiography. 25% DH reduced LVEDV (-6±5%) and LVSV (-9±8%). 50% DH elicited a similar response in LVEDV (-6±7%) and LVSV (-11±10%). 75% DH caused a larger reduction (-9±7% and -16±10%, respectively), which was associated with significant septal flattening as indicated by a 49±70% increase in the radius of septal curvature at end-diastole (RSC-ED). 100% DH caused the largest reduction in LVEDV and LVSV (-13±9% and -18±9%). 100% DH also caused the largest increase in RSC-ED (56±63%). cIVC, MAP and LV afterload (LVESWS) were unchanged at all levels of DH. Modest DH reduces LVSV due to under-filling of the LV, likely due to increased PVR. At higher levels of DH, DVI may be the primary cause of reduced LVSV, as indicated by septal flattening due to a greater relative increase in RV pressure and/or mediastinal constraint.

Background: End-stage kidney disease is associated with poor prognosis. Health care professionals must be prepared to address end-of-life issues and identify those at high risk for dying. A 6-month mortality prediction model for patients on dialysis derived in the United States is used but has not been externally validated. Aim: We aimed to assess the external validity and clinical utility in an independent cohort in Canada. Design: We examined the performance of the published 6-month mortality prediction model, using discrimination, calibration, and decision curve analyses. Setting/participants: Data were derived from a cohort of 374 prevalent dialysis patients in two regions of British Columbia, Canada, which included serum albumin, age, peripheral vascular disease, dementia, and answers to the “the surprise question” (“Would I be surprised if this patient died within the next year?”). Results: The observed mortality in the validation cohort was 11.5% at 6 months. The prediction model had reasonable discrimination (c-stat = 0.70) but poor calibration (calibration-in-the-large = −0.53 (95% confidence interval: −0.88, −0.18); calibration slope = 0.57 (95% confidence interval: 0.31, 0.83)) in our data. Decision curve analysis showed the model only has added value in guiding clinical decision in a small range of threshold probabilities: 8%–20%. Conclusion: Despite reasonable discrimination, the prediction model has poor calibration in this external study cohort; thus, it may have limited clinical utility in settings outside of where it was derived. Decision curve analysis clarifies limitations in clinical utility not apparent by receiver operating characteristic curve analysis. This study highlights the importance of external validation of prediction models prior to routine use in clinical practice.

A Review of:
 Sung, H. Y., Hepworth, M., & Ragsdell, G. (2013). Investigating essential elements of community engagement in public libraries: An exploratory qualitative study. Journal of Librarianship and Information Science 45(3), 206-218. doi: 10.1177/0961000612448205
 
 Objective – To examine characteristics of a community engagement (CE) initiative in a public library in order to identify and describe essential elements of CE and develop a model for CE in public libraries.
 
 Design – Case study.
 
 Setting – A public library in a mid-sized city in England, United Kingdom.
 
 Subjects – An unspecified number of community members, library staff, and external agency staff participating in a community news program.
 
 Methods – There were 12 semi-structured interviews conducted with library staff, community members, and participants from 12 community news agencies operating under the umbrella of a larger community news organization. The authors directly observed an unknown number of undescribed program meetings and events. They also performed document analysis on unspecified government policies, media reports, and program publications to corroborate the information gathered from their interviews and observations. 
 
 Main Results – The data were analyzed in an inductive manner using ATLAS qualitative data analysis software. Results are described in a qualitative manner and do not correspond directly to the individual methods used. The coding of data from interviews and observations (which are not analyzed separately) resulted in the identification of seven themes related to community engagement in libraries: belonging, commitment, communication, flexibility, genuineness, relevance, and sustainability.
 
 Conclusion – The “essential elements” model that was developed from this case study can be applied by other public libraries in their processes and practices, and can contribute to the creation of a more genuinely community-driven approach to service.

Resource allocation decisions have become increasingly necessary as the cost of health care habitually increases. Bilateral (second side) adult cochlear implantation (CI) is an example of a novel technology with accruing evidence of benefit, yet expense has limited universal employ. Currently at our centers, bilateral implantation is only provided under research protocol. In this article, we discuss the need for a principled approach concerning the distribution of a second device, both during this period of investigation and if ultimately an insured service. Allocation strategies, while extensively addressed in some arenas, have yet to be developed for second-side sequential adult CI. We advocate that physicians must assume an explicit role when both caring for individual patients as well as administering health care programs. We review social justice theories that inform resource allocation macrodecisions, and include a defence of age-based considerations. Our approach to patient selection for adult second-side CI sequentially considers clinical criteria (directly addressed in the article), a willingness to participate in rigorous research, and a 65 year cut-off. Ultimately, we employ random blinded selection for allocating bilateral CI among the remaining similarly situated individuals. This approach functions impartially and in a manner that is transparent for both patient and physician.

Robert (Bob) Bandoni was born November 9, 1926, in Weeks, Nevada, to Giuseppe and Albina Bandoni. He graduated from high school in Hawthorne, Nevada, and in 1953, after receiving a bachelor of scie...