Conversations in Complexity

In this podcast, Ross Upshur interviews Gail Elliot about dementia care and the state of dementia care and how it can measure up to expectations that will provide the kind of care which takes into account the individual’s entirety as a human, focusing on personal narrative, brain, environment, needs, abilities and disease. In this podcast, Ross Upshur interviews Gail Elliot about dementia care and how it needs to measure up to societal expectations, providing the kind of care that takes into account the individual’s entirety as a human, focusing on personal narrative, brain, environment, needs, abilities, interests and disease. Most importantly they will discuss the importance of helping each person to live with meaning, purpose, joy, higher self-esteem (by enabling abilities), choice and dignity. In the interview, Gail believes we have enough science, and the ability, to deliver good (non-pharmacological) dementia care.  Using research from diverse disciplines, she talks about how the science/the research clearly shows that we can enable the abilities of each individual (combating excess disability that comes from taking over tasks and contributing to disuse), thereby enabling the person with dementia and their families and service providers alike. We need, as she puts it, to borrow all the small bits and pieces of precious science found in the books, academic journals and best practice guidelines and build the basics based on this multidisciplinary evidence that focuses on both the person and the environment, including a team approach that involves organizational support and commitment. These fundaments provide the basics, and “how-tos” of good dementia care. Gail provides practical examples of how to incorporate science into practice and how to equip care providers for their job. In doing so, those with dementia have a sense of purpose in their daily lives and needs are met (such as boredom, loneliness and lack of success), thus preventing the behaviours commonly seen in dementia, such as agitation, wandering or exit seeking. Rather than thinking of this as “extra work”, carers are equipped with the tools they need – including new ways of thinking – and spend more time enriching the lives of those in their care and spending less time writing reports about the behavioural upsets. Moreover, families are comforted knowing that their loves ones are happier and not only cared for, but enabled, engaged and enriched in their care environments. You might say, with good care, our mission is accomplished. Gail bases her model on preparing the environment. This involves setting each person up for success, based on understanding the plethora of research that is already available from diverse disciplines. When staff are educated and supported, and share the details related to each person in their care, including their history, and details about their needs, interests, preferences, abilities and each individual’s life story, needs are addressed, and generally, we see higher levels of functioning and enhanced social engagement.  The physical environment must look, feel and smell like home, with each space looking like its purpose.  The feel of home includes the roles and routines that were familiar to each person with opportunities to be engaged in activities that have been adapted for successful outcomes and things to do, tailored to needs, interests and abilities that are available and accessible throughout each day.  The goal is to help each person to be the best he or she can be, and this can only be achieved when individuals, teams and organizations work together (Caspar, Cooke, Phinney, & Ratner, 2016). Gail Elliot is a Gerontologist, Author, Educator and Dementia Specialist. She retired from McMaster University, Ontario, Canada, in 2012 with the purpose of changing the face of dementia from one of loss to one of enabled abilities. Her goal is to move the science, the research,

The academic research environment is changing and researchers report struggling to adapt in order to be successful. Funding shortfalls are perennial, but what systemic shifts should occur to enable researchers at all career stages to be productive and successful? Upon publishing “Healthy research ecosystem – healthy researchers? The researcher as an organism of focus within a ‘research ecosystem’” in Academic Matters in Fall 2019 issue, Ross Upshur and Michelle Nelson, convened to discuss themes from their paper as well as a number of other academic matters that have been issues of concern for academics far and wide for a long time. In the first part of the podcast, Ross and Michelle discussed some of the themes from the paper and the conversation focused on issues such as committee and panel memberships, reviewing manuscripts and grants, research funding, research as a career, training PhD students, self-interest vs. community interest in research, paper citations, academic citizenship, research ecosystem management, ways to retire from clinical practice and research, research culture, and more. In this second part of the podcast on academic citizenship, Ross and Michelle, explore the opportunities and challenges of academic citizenship in a changing research ecosystem. They also touch upon subjects such as equity within the research ecosystem, gender, career advancement, successful PhD programs, mentorship, being a principal investigator, and much more. These issues are experienced by researchers on a daily basis, whether they are at early-, mid- or late-research-career stages. Furthermore, their conversation highlights a number of pressing issues, including but not limited to, the importance of explicitly training early career scholars as what constitutes a successful research career and extending it to create a culture that values contributions throughout the research life cycle. The entire field of research metrics used for evaluating research performance, (e.g. counting published papers, citations and article level metrics such as the H-index etc.), seems to require rethinking. Link to "What it Means to be a Good Academic Citizen - Part 1".

Upon publishing “Healthy research ecosystem – healthy researchers? The researcher as an organism of focus within a ‘research ecosystem’ in Academic Matters in mid-March 2019, Ross Upshur and Michelle Nelson, convened to critique themes from their paper and discuss a number of other academic matters not originally mentioned in the paper but have boggled the minds of many academics far and wide for a long time. In mid-March 2019, Ross Upshur and Michelle Nelson published “Healthy research ecosystem – healthy researchers? The researcher as an organism of focus within a ‘research ecosystem’” in Academic Matters. The paper, as themselves put it “explores issues of relevance to higher education and is a forum for thoughtful and thought-provoking” discussions and consideration of academia’s future direction. The paper is a response to the ever-changing research environment that researchers find rather difficult to adapt in order to thrive and maintain a solid research. In the podcast, the duo try to discuss some of the subjects mentioned in the report by David Naylor titled: Investing in Canada's Future: Strengthening the Foundations of Canadian Research such as “research ecosystem”, “life-cycle approach” and also elaborate on other relevant subjects that matter most to the academia and researchers alike. In part one of the podcast, subjects such as committee and panel memberships, reviewing manuscripts and grants, research funding, research as a carrier, training PhD students, self-interest vs. community interest in research, paper citations, academic citizenship, research ecosystem management, ways to retire from clinical practice and research, research culture, and more are all discussed modestly. Link to "What it Means to be a Good Academic Citizen – Part 2"

In this podcast, Ross Upshur, interviews Marco Inzitari, discussing the mechanisms and nuts and bolts of integrated care provided to the elderly population in Barcelona, Catalonia, Spain. Dr. Inzitari is the current President of the Catalan Society of Geriatrics and Gerontology and the Director of Intermediate Care, Research and Teaching of Parc Sanitari Pere Virgili in Barcelona. In this podcast, Dr. Marco Inzitari gives his first-hand account of the health and social care services provided to the elderly population in Barcelona and Catalonia, and elaborates how these services address the issues of frailty, chronic diseases, loneliness, etc. In doing so, Dr. Inzitari sets an example of a healthcare system that has traversed academic, public and private sectors and even has integrated a coherent and uniform internet-based repository of medical records into the healthcare system to provide a seamless health and social care to its elderly population. Work and Education Marco Inzitari, MD, PhD, a specialist in geriatrics, was trained in epidemiology of aging at the Universities of Florence, Italy, and University of Pittsburgh, USA, and in management and leadership at ESADE Business School in Barcelona. He currently serves as the Director of Intermediate Care, Research and Teaching of Parc Sanitari Pere Virgili, and as an Associate Professor of Medicine at the Universitat Autònoma de Barcelona (UAB). He is also the PI of the Research on Aging, Frailty and Transitions in Barcelona (RE-FiT Barcelona) part of the Vall d’Hebrón Institute of Research (VHIR). He is the current President of the Catalan Society of Geriatrics and Gerontology. Moreover, Dr. Inzitari serves as an expert advisor for different master-plans related to chronic diseases and integrated care of the Catalan Government, and is part of the Clinical Management Section of the Catalan Society for Healthcare Management and board member of the European Delirium Association. Publications Being the principal investigator of a number of ongoing publicly-funded research projects, Dr. Inzitari has authored a considerable number of international publications on frailty, cognitive and physical functions in the elderly, and on care models and organization for older adults with chronic conditions. He is also a member of the editorial board of The Frailty and Aging Journal. Here are some of Marco’s publications indexed in PubMed, so far.

Gordon MacGregor, a member of the Alternate Level of Care Patient and Caregiver Council, in an interview with Ross Upshur reflects upon his personal experience taking care of his wife in a span of nearly 30 years. His experience with the health system is what thousands of patients and family caregivers undergo on daily basis. The interview highlights both positive and not so positive aspects of care and the need to take care of the instances that patients might find rather inconvenient or challenging to overcome.  Mr. Gordon MacGregor has personal experience with ALC as a bereaved caregiver. His devotion to a life taking care of his wife struggling with a severe type of mental disorder throughout the years, as well as his experiences as an advisor for different hospital councils, makes his experience indispensable in helping us understand the caregiver experience. In his ‘‘Books and Men’’1, Sir William Osler (1849–1919) wrote that “ To study the phenomenon of disease without books is to sail an uncharted sea, while to study books without patients is not to go to sea at all. The same analogy could hold strong in patients and patient caregivers’ relation with the healthcare system and efforts to improve it. Gordon’s experience with the health care system is what Canadians might undergo at some point in their life when they seek professional help to regain their health. To make this experience positive for all of us at all times, stakeholders within and outside the healthcare system may take opportunities like this to examine the nature of patients and patient caregiver experience. References and footnotes: 1- "Books and Men" in Boston Medical and Surgical Journal (1901) 2- “Justice of the Peace”: This term is named a couple of times in the audio file and it refers to the body of law in Ontario that has the authority to override the decision of a patient with mental illness who refuses to receive medical care and might have the potential to be danger to self or others. In such circumstances, The Justice of Peace can issue a Form 1 which is taken to the police and they act upon it and take the ill person to the hospital. It does not get the patient admitted; that decision is made by the attending physicians in the hospital. 3- “Beyond the Cuckoo’s Nest” is the Centre for Addiction and Mental Health’s (CAMH) longest-standing educational outreach program to high school students and it aims to increase awareness among youth of the causes, treatments, signs, symptoms, and interventions for mental illness, including addiction. The program was developed in 1987 by nurse case managers at the former Clarke Institute of Psychiatry—one of the founding partners of CAMH. 4- The names of the hospitals and long-term care facilities that had been named in the podcast file have been replaced by a soft background noise for ethical concerns.

Jane Barratt in an interview with Ross Upshur reflects on different aspects of elderly care and explains how it could be improved in Canada. In the interview, she gives an example of other countries and how they have been successful in laying the foundation for a more robust elderly care. In this interview, Jane Barratt, the Secretary General of the International Federation (IFA) on Ageing, describes how her interest in roams of care and allocation of services engaged her in the area of ageing and caregiving. She later highlights the sources of the problems that impact decision-making around the allocation of services and says they arise from different understanding and outlooks in the conversations among different health sectors although they all seem to be talking about the same topic. On equitable allocation of services, she exemplifies Australia’s age-care system and compares it to that of Canada and how they are different in this respect. Jane Barratt is one of the IFA’s 15 international directors. Currently, she runs IFA’s Toronto-based office in Bridgepoint Active Healthcare, Sinai Health System. Jane has over 35 years of public and private sector experience in ageing and disability, aged care, public health and community services. Dr. Barratt tries to strengthen relationships between government, NGOs, academia, and industry to influence policy and improve the quality of life of older people. She is a strong contributor to international dialogue on the social, political, cultural and physical environments that impact the lives and human rights of older people. Dr. Barratt represents the IFA at the United Nations Economic and Social Council. For a full bio, please follow this link. Dr. Barratt is a Churchill Fellow, and she was recently awarded the Queen Elizabeth II Diamond Jubilee Medal in Canada in recognition of her efforts to enhance understanding of ageing, engage governments and the private sector, and improve the quality of life of older people. To listen to a public lecture by Jane Barratt published on the University of Western Australia website, please follow this link. The lecture is titled: How to Age Well: creating age-friendly environments to support healthy ageing. To view a selection of presentations by Dr. Jane Barratt, please follow this link.

ST: A Palliative Approach to Decision Aids to Help Improve Patients’ Medical Choices Pete Wegier in this interview with Ross Upshur discusses complexities of the end of life care and how coordination in this care setting could be optimized by the use of new communication technologies. Interestingly, his journey from computer science to cognitive psychology, to medical decision making and later to the space of palliative care has equipped Pete with tools that could help untangle some of the problems in this most complex area in health care.   In the podcast, Pete also discusses how his research interests concern medical decision making, focusing on the effective communication of information to both patients and physicians to improve understanding in medical choices. Specifically, he focuses on the use of simulated experience as a decision aid for medical decision making; the effective communication of quantitative information in healthcare, specifically through data visualization; and how healthcare teams collaborate in distributed settings via online communication platforms. Dr. Pete Wegier is a medical decision scientist at the Temmy Latner Centre for Palliative Care and the Lunenfeld Tanenbaum Research Institute at Mount Sinai Hospital in Toronto, and an assistant professor in the Department of Family and Community Medicine at the University of Toronto. A cognitive psychologist by training, Dr. Wegier’s work focuses on techniques for the early identification of patients that may benefit from a palliative approach to their care, as well as the design and creation of patient education materials and decision aids to help improve patients’ medical choices. Pete holds a PhD in psychological science and a BSc and MSc in computer science. He has undertaken postdoctoral training at the University of Missouri. Here are some of Pete Wegier’s publications indexed in ResearchGate, so far.

Michelle Nelson in an interview with Ross Upshur discusses the importance of intra- and inter-sectoral collaboration in healthcare and explains how the voluntary sector could be engaged to support improved patient and family experiences and the outcomes. In a recent interview with Ross Upshur, Michelle Nelson, a Research Scientist at Research Collaboratory, Lunenfeld-Tanenbaum Research Institute, explained about her research, the importance of intra- and inter-sectoral collaboration in health care, engagement of the voluntary sector to support improved patient and family experience and the patient outcomes. Michelle has been actively pursuing development of a complexity and stroke rehabilitation research network. Her tireless efforts recently led to holding a meeting attended by 43 researchers, policy-makers and clinicians. The meeting initially generated 120 potential research questions, from which 16 high-priority questions were identified focusing on complexity characteristics including multimorbidity, social determinants, patient characteristics, social support and system factors (1). In this recent work, Michelle and her colleagues put the emphasis on expanding the kind of research that focuses beyond the single disease approach, and try to help understand complex patients and their care needs. This approach, as they put it, will not only help stakeholders to better understand and provide integrated stroke rehab care for complex patients but it will also help improve patient outcomes that would ultimately lead to a more developed and advanced health care system. Dr. Nelson is a Research Scientist within the Lunenfeld-Tanenbaum Research Institute in Toronto, Canada. She also holds academic appointments in the Institute of Health Policy, Management and Evaluation at the University of Toronto, and Ryerson University in the School of Nursing. Her research is concentrated on patient complexity (the intersection of health conditions and social determinants); specifically examining issues related to the management of patient complexity, health profession education/collaborative practice, and community reintegration. From 2005 – 2009 she was the Research Director for a Health Canada funded Interprofessional Education program within geriatrics. She was the Principal Investigator for two Canadian Institutes of Health Research grants focused on patient complexity and rehabilitation. As a result, she convened national rehabilitation experts and stakeholders to develop a multidisciplinary, multisectoral research agenda specific to patient complexity in stroke rehabilitation. In 2014, Dr. Nelson received a $600,000 grant to examine how the voluntary sector could be engaged to support improved patient/family experiences and outcomes. So far, she has published over 40 articles and reports specific to issues of complexity, clinical practice, rehabilitation, collaboration, and the role of the voluntary sector in meeting patient needs. She is a sought after committee member for rehabilitation strategic planning, clinical guideline development and knowledge translation. In 2017, she was a visiting professor at the Queensland University of Technology, engaging colleagues in collaborative work related to patient complexity. Michelle was elected to the Board of Governors for the World Stroke Organization and nominated to the Executive in August 2018. Some of Michelle’s papers indexed in Google Scholar by September 2018. Reference: Nelson ML, McKellar KA, Munce S, Kelloway L, Hans PK, Fortin M, et al. Addressing the Evidence Gap in Stroke Rehabilitation for Complex Patients: A Preliminary Research Agenda. Arch Phys Med Rehabil. 2018;99(6):1232-41.

Jeff Myers, in this interview with Ross Upshur, discusses the evolution of palliative care and the evidence that has accumulated outlining its impact on outcomes for patients, families, and systems. With early efficacy studies having focused on end-of-life experiences for patients with cancer, strong evidence now clearly delineates a role for palliative care from the time of diagnosis for any person with serious illness and their family. Serious illnesses are those that are incurable and progressive and include but not limited to heart failure, COPD, chronic kidney disease, neurodegenerative diseases, dementia, frailty as well as metastatic cancer. No longer should palliative care be thought of as the alternative to disease-focused care, it is as an added layer of support that must be provided alongside disease-focused care. This expansion of relevance raises several questions and creates both opportunities and challenges for the growing discipline. What is it about the palliative care approach that makes such a difference in the experience of patients and families? Can the palliative care needs of patient populations be met by a limited number of palliative care clinicians? What changes in our medical training programs as well as those of other professions would better prepare our clinicians of the future to address complex palliative care needs?  Jeff and Ross discuss these and other questions as they address the complex nature of palliative care clinical service and educational delivery. Dr. Jeff Myers, MD, MSEd, CCFP(PC), is a palliative medicine physician who joined the Sinai Health System Toronto in July 2017 as Site Lead for the Bridgepoint Palliative Care Unit. He is an Associate Professor at the University of Toronto and for the past five years has been Head of the Division of Palliative Care within the Department of Family and Community Medicine. He currently holds the W. Gifford-Jones Professorship in Palliative Care and his academic interests include complexity theory in palliative care, person-centered decision-making and learner assessment in competency-based education. This is the link to Dr. Jeff Myers academic biography, research interests, publications, and awards.

Abhimanyu Sud, in an interview with Ross Upshur, talks about the current opioid crisis, the challenges and the opportunities to respond to the crisis at different levels including improved prescriber education and use of evidence-based non-opioid alternatives for chronic pain. Abhimanyu Sud is the Academic Director of Safer Opioid Prescribing at Continuing Professional Development at the University of Toronto. A graduate of Yale University and the University of Toronto, he is a community-based family doctor who also has a focused practice in comprehensive chronic pain medicine. He has played an active role in advocating for comprehensive and effective solutions for Canada’s opioid crisis and in particular for the role of evidence-informed education in chronic pain and opioid prescribing at all levels of medical training. He is a Lecturer at the Department of Family and Community Medicine at the University of Toronto’s Faculty of Medicine. Sud’s current work is focused on educational and research interventions around opioid prescribing in the context of chronic pain. He is also working on projects around non-opioid alternatives for the management of chronic pain. The podcast is greatly informative of what exactly Dr. Sud is currently doing, especially on the use of non-opioid alternatives for the management of chronic pain. A glance at Abhimanyu’s article on the National Opioid Crisis in PubMed.

Maya Goldenberg, in an interview with Ross Upshur, talks about her academic journey from a close look at evidence-based medicine and its philosophical issues to a feminist approach to the philosophy of science. Later on, Maya will discuss her research interest in fundamental issues related to public health policy such as vaccine hesitancy. The interview culminates to a very fascinating view on the state of science in the current political world. Maya Goldenberg is an Associate Professor of Philosophy at the University of Guelph. Her research in philosophy of medicine and philosophy of science examines the intersection between science and values, and puts the fundamental epistemic question “How do we know what to believe?” in social and political context. She is currently writing a book on vaccine hesitancy and public understanding of science. Dr. Goldenberg is also a Graduate Faculty Member at the Institute for the History and Philosophy of Science and Technology at the University of Toronto. Here are some of Maya’s articles indexed on PubMed so far. For a more complete list of Maya’s publications, including articles and books, please click here.

Sarina Isenberg, interviewed by Ross Upshur, discusses palliative care from the lens of a scientist and health researcher committed to making a difference for those who receive such care in the course of their disease. Sarina’s first experience with palliative care was at a relatively young age when two loved ones were in palliative care in the course of their terminal illnesses. Later, her studies in health-related subjects landed Sarina in palliative care study and research, which is a subject area with great challenges in any health system in the world in terms of complexity, cost and degree of needed care. As mentioned in the podcast, palliative care is no longer limited to end-of-life care. The shifting face of palliative care, in light of the aging population in Canada, is a great opportunity for Sarina and others to research palliative care with the intent of improving access to, and the quality of palliative care. Sarina Isenberg is a Scientist at the Temmy Latner Centre for Palliative Care and the Lunenfeld-Tanenbaum Research Institute (both at Sinai Health System), as well as an Assistant Professor in the Department of Family and Community Medicine – Division of Palliative Care at the University of Toronto. Her research has leveraged  varied health services approaches—both quantitative and qualitative—to assess access to and quality of palliative care,(1, 2) evaluate the cost effectiveness of palliative care inpatient services,(3, 4) and test interventions for improving advance care planning discussions.(5-7) Sarina’s ongoing work also relates to evaluating the cost effectiveness of home-based palliative care, assessing the patient and caregiver experience of receiving palliative care, transitioning across palliative care settings, and designing and implementing quality improvement initiatives in palliative care. Sarina’s central research goal is to apply a public health approach to palliative care research that is translatable to decision-makers, practitioners, patients, and their companions. Sarina has worked with knowledge users translating research into practice and policy through collaborations with Ontario Palliative Care Network, Veterans Affairs Canada,(8) the American Society of Clinical Oncology,(9) and the Agency for Health Research and Quality. (10) Sarina received her PhD in Social and Behavioral Sciences at the Johns Hopkins Bloomberg School of Public Health. She has previously worked as a management consultant on Deloitte’s National Health Services Team (Canada). Prior to consulting, Sarina received her MA in English Literature from Queen’s University and her BA in English Literature from McGill University. Find out how she puts those humanities degrees to work in her role as a scientist in this podcast. Link to some of Sarina’s articles on PubMed, so far.  References in this article: 1. Aslakson R, Dy SM, Wilson RF, et al. Patient and caregiver-reported assessment tools for palliative care: summary of the 2017 AHRQ Technical Brief. J Pain Symptom Manage. 2017 Aug 14. PubMed PMID: 28818633. Epub 2017/08/19. eng. 2. Dy SM, Al Hamayel NA, Hannum SM, et al. A survey to evaluate facilitators and barriers to quality measurement and improvement: Adapting tools for implementation research in palliative care programs. J Pain Symptom Manage. 2017 Aug 08. PubMed PMID: 28801007. Epub 2017/08/13. eng. 3. Isenberg SR, Lu C, McQuade J, et al. Impact of a New Palliative Care Program on Health System Finances: An Analysis of the Palliative Care Program Inpatient Unit and Consultations at Johns Hopkins Medical Institutions. Journal of Oncology Practice. 2017;epub ahead of print. 4. Isenberg SR, Lu C, McQuade J, et al. Economic Evaluation of a Hospital-Based Palliative Care Program. Journal of Oncology Practice. 2017;epub ahead of print. 5. Aslakson RA, Isenberg SR, Crossnohere NL, et al. Utilizing Advance Care Planning Videos to Empower Perioperative Patients and Families: The Protocol...

Gary Newton, in an interview with Ross Upshur, discusses his agenda as the Chief Executive Officer of the Toronto Sinai Health System while explaining his views on complex care and how he is trying to bring about change in Sinai Health System in Toronto. In this fascinating and  candid interview, Dr. Gary Newton talks about his views towards complexity, his aha moments, his involvement in health administration, his experience of running a hospital based Division of Cardiology,  the Department of Medicine and ultimately to his role as the CEO of Sinai Health System after the merger of Bridgepoint Active Healthcare and Mount Sinai Hospital in 2015. Dr. Newton discusses the challenges of managing the process delivering care to individual patients to managing populations of patients with complexity, while helping complex health systems evolve. He further explains the shortcomings with the current “non-system system”. Gary Newton assumed the role of President and CEO of Sinai Health System in October 20161. He previously held the position of Physician-in-Chief of Mount Sinai Hospital from 2013 to 2015, and was appointed to the role of Chief Medical Strategy Officer and Physician-in-Chief of the newly formed Sinai Health System in 2015. As a practicing Cardiologist, he was Head of the Division of Cardiology, University Health Network and Mount Sinai Hospital from 2009 through 2013. He has had an active research program in human physiology, focusing on congestive heart failure, most recently investigating nutritional issues in patients with heart failure. He currently serves as Vice-Chair of the Scientific Research Committee of the Heart and Stroke Foundation of Canada. Gary is a graduate of the University of Toronto Medical School. He completed internal medicine at the University of Toronto, and trained in adult cardiology at the University of Ottawa Heart Institute. He has worked at Mount Sinai Hospital since 19872. For a full bio, please click here. Some of the articles authored by Gary Newton indexed in PubMed. “There is just no better place to work” Dr. Gary Newton reflects on his first year as President and CEO Courtesy of Sinai Health System website.

Carolyn Steele Gray, in interview with Ross Upshur, discusses how her academic journey shaped her perspectives in understanding patient needs, health policy, organization and provider level issues and how to use that understanding to deliver a better care. The latter, she adds, necessitates a realistic approach of how to harness e-health technologies to deliver care, especially to patients with complex care needs. Carolyn discusses how technology in health is not the silver bullet to healthcare questions and its implementation is embedded within complex social layers, affected by people’s feelings about it; policy issues surrounding it; and how organizations treat it. Carolyn describes the value of adopting a user-centred design evaluation approach used to develop the ePRO tool; describing how it evolved from a tool intended to collect patient-reported outcome measures to one that enables patient-centred goal-oriented care within primary care settings. The talk addresses some of the current challenges in the use of e-health technologies in the healthcare system highlighting tensions faced by researchers and adopters. Carolyn is a Scientist at the Bridgepoint Collaboratory for Research and Innovation at the Lunenfeld-Tanenbaum Research Institute, Assistant Professor at the Institute of Health Policy, Management and Evaluation (University of Toronto), as well as an investigator with the Health System Performance Research Network (University of Toronto). Carolyn’s research focuses on the role of health information technology in supporting person-centred care delivery for individuals with complex care needs. Her research explores how technology can be leveraged to enable implementation and sustainability of innovative models of care as a means to support health system transformation. Carolyn received her PhD in Health Policy from the University of Toronto (2013), and a Master’s in Public Policy and Administration from Ryerson University (2008). Prior to her current role as a Scientist, she was a postdoctoral fellow working at the University of Toronto and the Health System Performance Research Network. For a full bio, please follow this link. Carolyn has published work in the areas of eHealth and mHealth, organizational change, health policy and patient-centred care delivery. Some of Carolyn’s papers indexed in PubMed so far.

Kerry Kuluski, in interview with Ross Upshur, discusses her undertakings in her journey from being a social worker to a scientist. Her goal is to improve health system performance for people with multimorbidity and their caregivers. This is a fascinating talk as it explains how looking at data sets and trying to analyze them is not the only way to meet the needs of people, especially the ones who are “stuck in transition”.  She also draws interesting parallels between marathon training and grant writing! Kerry’s research focuses on quality and health system performance through the eyes of people with multimorbidity and their caregivers in the contexts of community based primary health care, homecare, hospital care, delayed discharge and transitions between care settings. She draws on both quantitative and qualitative methods to uncover population level trends in care utilization as well as patient and caregiver experiences in the health care system. Her ultimate research goal is to use patient and caregiver experiences to inform quality improvements in the health care system including approaches to care delivery and performance measurement. Kerry is an investigator at the Lunenfeld-Tanenbaum Research Institute, Sinai Health System (Bridgepoint Hospital site: Bridgepoint Collaboratory for Research and Innovation), Assistant Professor at the Institute of Health Policy, Management and Evaluation (University of Toronto) and Research Affiliate at the Centre for Education and Research on Aging and Health (Lakehead University). She is an Applied Health Services Researcher and a Social Worker by training. At the University of Toronto she teaches a foundational course on Canada’s Health Care System and supervises a number of Masters and PhD students. Kerry received her PhD in Health Services and Policy Research from the University of Toronto in 2010 followed by a Postdoctoral Visiting Fellowship at the University of Oxford where she worked with the Health Experiences Research Group. She has funding from the Canadian Institutes of Health Research, has given over 60 invited talks and has over 35 publications in peer-reviewed journals. Some of Kerry's articles in PubMed.

Jon Glasby in interview with Ross Upshur, discusses his research focused on understanding and responding to “inappropriate” emergency hospital admissions of older people. In the interview, he discusses how his research took up the challenge of hospital admissions of frail older people with multiple chronic conditions and how many of the admissions could be prevented. His work expands the debate from merely one of how to allocate scarce resources in hospital settings to one of organizing better, not “appropriate” care for older patients in alternative settings closer to their homes. This fascinating discussion covers topics such as delayed hospital discharge, the notion of the “deep hospital” and “preventable moments”. Using different sources of evidence from his work with patients and front-life staff, from admission data to real patient narratives, he makes a powerful case of the need for culture change in the health and social system, attitudes to care for the elderly, and how we can learn from patients and caregivers. Jon was at Bridgepoint Active Healthcare, part of the Sinai Health System, in Toronto in June 2017, participating in the workshop “Patient and Caregiver Experience, Alternative Level of Care and Performance Measurement”, where he delivered his the keynote presentation: “Lessons from the UK”. Jon is a qualified social worker by background and Head of the School of Social Policy at the University of Birmingham. Specialising in joint work between health and social care, Jon is involved in regular policy analysis and advice. He is the author of a series of leading textbooks on health and social services, sits on the advisory board of The Policy Press, and is Editor-in-Chief of the Journal of Integrated Care. He is currently a Non-Executive Director (NED) of Heart of England NHS Foundation Trust, and is also a Fellow of the RSA, a Fellow of the Academy of Social Sciences, a Senior Fellow of the NIHR School for Social Care Research and Adjunct Professor at the School of Public Health, Curtin University, Western Australia. He specializes in research, teaching, consultancy and policy advice around: Partnership working in health and social care, Strategic commissioning, Personalization and Community Care services for older people. Some related articles by Jon Glasby: The holy grail of health and social care integration. Glasby J. BMJ. 2017 Feb 16;356:j801. doi: 10.1136/bmj.j801. Key lessons from integrated care in Europe. Glasby J. Int J Integr Care. 2012 Jan-Mar;12:e6. New horizons: Reablement - supporting older people towards independence. Aspinal F, Glasby J, Rostgaard T, Tuntland H, Westendorp RG. Age Ageing. 2016 Sep;45(5):572-6. doi: 10.1093/ageing/afw094. Room for one more? A review of the literature on 'inappropriate' admissions to hospital for older people in the English NHS. Thwaites R, Glasby J, le Mesurier N, Littlechild R. Health Soc Care Community. 2017 Jan;25(1):1-10. doi: 10.1111/hsc.12281. Older people. Never too old to make an impact. Allen K, Glasby J. Health Serv J. 2010 Nov 25;120(6234):26. All dressed up but nowhere to go? Delayed hospital discharges and older people. Glasby J, Littlechild R, Pryce K. J Health Serv Res Policy. 2006 Jan;11(1):52-8. More articles by Jon Glasby.

Julia Ho in interview with Ross Upshur talks about her recent article “It’s a fight to get anything you need”—accessing care in the community from the perspectives of people with multimorbidity, published in the Open Access journal of Health Expectations.

Ross Upshur further examines evidence from a scientific, philosophical and ethical viewpoint in the second part of the podcast “Concept of Evidence in Healthcare”. Throughout the discussion, he presents practical examples of how the provisional nature of evidence has played a role in justifying the practice of medicine as it has evolved over time. The talk is intriguing as is the subject itself. Some of the articles mentioned in the podcast: We need both evidence and values to navigate uncertainty. Upshur RE. Hastings Cent Rep. 2014 Sep;44(5):4. doi: 10.1002/hast.347. Grey zones of clinical practice: some limits to evidence-based medicine. C.D. Naylor The Lancet, Volume 345, Issue 8953, 1 April 1995, Pages 840-842 Tolerating Uncertainty — The Next Medical Revolution? Arabella L. Simpkin and Richard M. Schwartzstein N Engl J Med 2016; 375:1713-1715 November 3, 2016 DOI: 10.1056/NEJMp1606402   More related articles on evidence: Renaissance or reformation for evidence based medicine? Fuller J, Flores LJ, Upshur RE, Goldenberg MJ. BMJ. 2014 Jul 30;349:g4902. Rebuttal: Is evidence-based medicine overrated in family medicine?: Yes. Upshur RE, Tracy CS. Can Fam Physician. 2013 Nov;59(11):e475. A call to integrate ethics and evidence-based medicine. Upshur RE. Virtual Mentor. 2013 Jan 1;15(1):86-9. Making the grade: assuring trustworthiness in evidence. Upshur R. Perspect Biol Med. 2009 Spring;52(2):264-75.

Ross Upshur explores a very important concept in modern healthcare: "The Concept of Evidence" in this and the next podcast. He talks about evidence and what it means to base decision on evidence. He would also dig into its evolution; attempts made to orient clinical decision making to the literature; its new dimensions and hierarchy of evidence; “what it is and what it isn’t”; and how it relates to patients values and expectations; and more. Links to some of the articles mentioned in the first podcast: Evidence-based medicine: A New Approach to Teaching the Practice of Medicine JAMA. 1992;268(17):2420-2425. Evidence –based Medicine; what it is and what it isn’t BMJ 1996;312:71

Ross Upshur discusses the problems with polypharmacy and looks at some proposed solutions to the problem in the second part of the two podcasts on the subject.    

Ross Upshur is examining the issues related to medications use, polypharmacy and deprescribing in patients with multiple chronic conditions in this and the next podcast. He examines some of the issues that arise in clinical practice and tries to explain the phenomenon. In the second podcast he looks at some proposed solutions to the problem.

Ross Upshur discusses how the care of patients with multiple concurrent chronic conditions and social determinants pose substantial challenges for both primary care providers and health systems and how his research lead to the creation and implementation of an inter-professional model of care to address the issue.