Metabolic cost of external work: a novel CPET parameter optimises characterisation of exercise performance in obese individuals.

Purpose: Both obesity and cardiorespiratory fitness are crucial determinants of symptoms and prognosis. However, interpreting the gold-standard cardiopulmonary exercise test (CPET) is complicated by increasing body size and varying body composition. We hypothesised that the 'metabolic cost of external work' (or oxygen uptake (ml/min)/workload (Watts); V̇O/W), a body weight-independent determinant of endurance capacity, would reflect metabolic health more accurately than V̇O alone.

Integrating and Defragmenting Multi-Specialty Care for People With Multiple Long-Term Conditions.

There is an increasing prevalence of people living with multiple long-term conditions (MLTC), defined as two or more long-term conditions. People with MLTC have reduced life expectancy and increased healthcare usage compared to people without MLTC. Most hospital healthcare systems have developed to deal with single conditions in isolation.

Canadian Adaptive Platform Trial of Treatments for COVID in Community Settings (CanTreatCOVID): protocol for a randomised controlled adaptive platform trial of treatments for acute SARS-CoV-2 infection in community settings.

Introduction: SARS-CoV-2 is now endemic and expected to remain a health threat, with new variants continuing to emerge and the potential for vaccines to become less effective. While effective vaccines and natural immunity have significantly reduced hospitalisations and the need for critical care, outpatient treatment options remain limited, and real-world evidence on their clinical and cost-effectiveness is lacking. In this paper, we present the design of the Canadian Adaptive Platform Trial of Treatments for COVID in Community Settings (CanTreatCOVID).

Obesity and heart failure: exploring the cardiometabolic axis.

Obesity is one of the biggest risks to public health in both developed and developing countries, and yet incidence continues to skyrocket. Being the main risk factor for a large number of life-limiting conditions, obesity has the potential to cause enormous damage unless addressed urgently. Heart failure (HF) is the most common cardiovascular disease associated with obesity.

Development and evaluation of an integrated multispecialty clinic for people with multiple long-term conditions.

Introduction: The number of people with multiple long-term conditions (MLTC) is increasing. People with MLTC experience fragmentation of care due to single-disease-orientated healthcare organisation and have increased morbidity and mortality. We developed an innovative clinic model whereby people with MLTC are assessed by a team of specialists together in one appointment to form a consensus management plan in real time.

Health promotion activities in Ontario Community Health Centres: a descriptive report.

Background Community Health Centres (CHCs) in Ontario, Canada have been delivering health promotion programming as part of their model of comprehensive primary health care to communities for decades. The purpose of this paper is to describe how health promotion programming is delivered within the context of Ontario CHCs. Methods This report used both quantitative and qualitative methods.

Navigating Equitable Access to Cancer and Mental Health Services During Pandemics: Stakeholder Perspectives on COVID-19 Challenges and Community-Based Solutions for Immigrants and Refugees-Proceedings from Think Tank Sessions.

Increasing evidence shows that the COVID-19 pandemic has disproportionately impacted certain populations, particularly those facing structural marginalization, such as immigrants and refugees. Additionally, research highlights that structurally marginalized populations living with chronic conditions, such as cancer and/or mental health and addiction (MH&A) disorders, are more vulnerable to the adverse effects of COVID-19. These individuals face higher susceptibility to infection and worse health outcomes, including increased rates of hospitalization, severe illness, and death.

Data-Driven Decision Support Tool Co-Development with a Primary Health Care Practice Based Learning Network.

Background: The Alliance for Healthier Communities is a learning health system that supports Community Health Centres (CHCs) across Ontario, Canada to provide team-based primary health care to people who otherwise experience barriers to care. This case study describes the ongoing process and lessons learned from the first Alliance for Healthier Communities' Practice Based Learning Network (PBLN) data-driven decision support tool co-development project.

Methods: We employ an iterative approach to problem identification and methods development for the decision support tool, moving between discussion sessions and case studies with CHC electronic health record (EHR) data.

The development and implementation of an innovative community-based intervention to strengthen community capacity for HIV prevention and care among Canadians of African Caribbean and Black (ACB) women in Ontario: a research protocol.

African, Caribbean, and Black (ACB) women are overrepresented among new HIV diagnoses due to social and structural factors. This study seeks to create, implement, and evaluate a community-based peer-led intervention to improve access to HIV prevention and care for ACB women in Canada. This multisite, five-year project, using community-based participatory research, implementation science and evaluation frameworks, will be implemented in five non-iterative phases.

Primary care in the COVID-19 pandemic and beyond: Lessons from Ontario.

Objective: To understand the role of primary care in the COVID-19 pandemic to provide insight into its functioning and inform potential reforms.

Composition Of The Committee: The now dissolved Ontario COVID-19 Science Advisory Table (Science Table) was formed in July 2020 to provide decision makers and the public with a synthesis of rapidly evolving evidence related to COVID-19. The Science Table was based at the Dalla Lana School of Public Health at the University of Toronto, and supported by Public Health Ontario.

Scoping review of social workers' professional roles in primary care.

Objectives: Maximising social workers' contributions to primary care requires clarity about their scope of practice in this context. This scoping review sought to clarify what is known about social work's scope of practice in primary care settings.

Design: A scoping review design guided by the five-stage scoping review framework developed by Arksey and O'Malley and the updated JBI Manual for Evidence Synthesis.

The association of combinations of social factors and SARs-CoV-2 infection: A retrospective population-based cohort study in Ontario, 2020-2021.

Objective: The COVID-19 pandemic highlighted and exacerbated health inequities worldwide. While several studies have examined the impact of individual social factors on COVID infection, our objective was to examine how interactions of social factors were associated with the risk of testing positive for SARS-CoV-2 during the first two years of the pandemic.

Study Design And Setting: We conducted an observational cohort study using linked health administrative data for Ontarians tested for SARS-CoV-2 between January 1st, 2020, and December 31st, 2021.

Evaluation of an integrated variable flip angle protocol to estimate coil B for hyperpolarized MRI.

Purpose: The purpose of this work is to validate a simple and versatile integrated variable flip angle (VFA) method for mapping B in hyperpolarized MRI, which can be used to correct signal variations due to coil inhomogeneity.

Theory And Methods: Simulations were run to assess performance of the VFA B mapping method compared to the currently used constant flip angle (CFA) approach. Simulation results were used to inform the design of VFA sequences, validated in four volunteers for hyperpolarized xenon-129 imaging of the lungs and another four volunteers for hyperpolarized carbon-13 imaging of the human brain.

Factors influencing nurse practitioner panel size in team-based primary care: a qualitative case study.

Background: Lack of access to health care is a worldwide public health crisis. In primary care it has led to increases in the implementation of nurse practitioners and heightened interest in their patient panel capacity. The aim of this study was to examine factors influencing nurse practitioner patient panel size in team-based primary care in Ontario, Canada.

Black-focused social prescribing: the importance of an Afrocentric approach.

The Black-Focused Social Prescribing (BFSP) project is a unique initiative by the Alliance for Healthier Communities that intertwines Afrocentric principles with social prescribing. Going beyond conventional social prescribing models, BFSP addresses specific health needs within Black communities. It is rooted in the Alliance Black Health Strategy, advocates for Black health, and is guided by Afrocentric principles.

The impact of leadership style in team-based primary care - staff satisfaction and motivation.

Background: Leadership styles, beliefs, and behaviours are an important and critical component to the delivery of quality care in any primary care organisation. The human resource crisis in health care has resulted in greater investments in team-based care; however, some leaders may not have experience working in team-based settings.

Aim: To explore what leadership characteristics, styles, and behaviours were most conducive to employee satisfaction, motivation, and delivery of care in a team-based primary care setting.

Pharmacists' role and experiences with delivering mental health care within team-based primary care settings during the COVID-19 pandemic.

Objectives: Pharmacists have been increasingly integrated into primary care teams, leading to improved health outcomes for patients. The two objectives of this study were (i) to describe how the COVID-19 pandemic impacted pharmacists' role in mental health care within Canadian primary care teams and (ii) to describe Canadian pharmacists' experiences collaborating with other healthcare providers in the delivery of mental health services during the COVID-19 pandemic.

Methods: Cross-sectional observational study utilizing an online survey consisting of closed-ended and open-ended questions.

Describing a complex primary health care population to support future decision support initiatives.

Introduction: Developing decision support tools using data from a health care organization, to support care within that organization, is a promising paradigm to improve care delivery and population health. Descriptive epidemiology may be a valuable supplement to stakeholder input towards selection of potential initiatives and to inform methodological decisions throughout tool development. We additionally propose that to properly characterize complex populations in large-scale descriptive studies, both simple statistical and machine learning techniques can be useful.

Primary health care utilization in the first year after arrival by refugee sponsorship model in Ontario, Canada: A population-based cohort study.

Background: Canada's approach to refugee resettlement includes government sponsorship, a pioneering private sponsorship model and a third blended approach. Refugees are selected and supported differently in each approach including healthcare navigation. Little is known about how well private sponsors facilitate primary care navigation and whether this changed during the large-scale 2015 Syrian resettlement initiative characterized by civic and healthcare systems engagement.

Social workers' formal and informal leadership in interprofessional primary care teams in Ontario, Canada.

The development of interprofessional teams in primary care presents opportunities for social workers to take on new leadership positions. This study seeks to describe how social workers engaged in leadership roles in primary care during the COVID-19 pandemic. A cross-sectional on-line survey was disseminated to primary care social workers across Ontario, Canada, with a total of 159 respondents.

The Benefits and Challenges of Precepting Pharmacy Students Virtually in Interprofessional Primary Care Teams.

Objective: The objective of this study was to identify pharmacists' perspectives on the benefits and challenges of precepting pharmacy students during circumstances that require using virtual care in team-based primary care practices.

Methods: A cross-sectional online survey was disseminated through Qualtrics software from July 5, 2021, to October 13, 2021. We used a convenience sampling technique to recruit a sample of pharmacists working in primary care teams across Ontario, Canada, who were able to complete a web-based survey in English.

"Can you hear me now?": a qualitative exploration of communication quality in virtual primary care encounters for patients with intellectual and developmental disabilities.

Background: High quality communication is central to effective primary care. The COVID-19 pandemic led to a dramatic increase in virtual care but little is known about how this may affect communication quality. Adults with intellectual and developmental disabilities (IDD) can experience challenges communicating or communicate in non-traditional ways.

Perceptions of Artificial Intelligence Use in Primary Care: A Qualitative Study with Providers and Staff of Ontario Community Health Centres.

Purpose: To understand staff and health care providers' views on potential use of artificial intelligence (AI)-driven tools to help care for patients within a primary care setting.

Methods: We conducted a qualitative descriptive study using individual semistructured interviews. As part of province-wide Learning Health Organization, Community Health Centres (CHCs) are a community-governed, team-based delivery model providing primary care for people who experience marginalization in Ontario, Canada.

Recommendations for virtual care in primary care practices: a survey of patients across Ontario, Canada.

Context: The onset of COVID-19 has required the rapid adoption of virtual services in primary care (PC) practices, and virtual care delivery is likely to continue to some extent post-pandemic. Objective: To understand patient experience with synchronous virtual (telephone (Tel)/Video) appointments and elicit recommendations for its future use. Design: Mixed method, including patient survey co-developed with stakeholders and implemented online Feb-Mar 2021 with large promotional efforts through social media, patient and caregiver organizations, and other networks.