Conversations in Complexity

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,

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.