Maria Mathews

National and provincial retention of medical graduates of Memorial University of Newfoundland

Background: Memorial University of Newfoundland (MUN) established its medical school in 1967 to meet the growing demand for physicians and alleviate the reliance on other Canadian and international medical schools for physicians. However, it is unclear how many of the graduates remained to practise in Canada and in Newfoundland and Labrador (NL). We conducted this study to identify the characteristics and predictors of MUN medical graduates working in Canada and NL after residency training. Methods: We linked data from class lists, and alumni and postgraduate databases with data from the Southam Medical Database to determine 2004 practice locations for MUN graduates from 1973 to 1998. Multiple logistic regression analysis was used to identify predictors for working in Canada and in NL. Results: Of the 1322 MUN graduates in our study, 1147 (86.8%) were working in Canada and 406 (30.7%) in NL in 2004. Predictors of physicians working in Canada included female sex (odds ratio [OR] 1.44, 95% confidence interval [CI] 1.01–2.04), being from Canada (OR 3.71, 95% CI 1.15–2.21), graduating in the 1980s (OR 1.52, 95% CI 1.02–2.24) and 1990s (OR 2.01, 95% CI 1.31–3.09) and having done some or all residency training at MUN (OR 1.59, 95% CI 1.53–9.01). Predictors of physicians working in NL included having a rural background (OR 1.37, 95% CI 1.04–1.81), being from NL (OR 9.23, 95% CI 5.52–15.44) and having done some or all residency training at MUN (OR 5.28, 95% CI 3.80–7.34). Interpretation: The MUN medical school has made a substantial contribution to the local physician supply, producing over half the physicians working in the province in 2004. Initiatives to increase national and provincial retention of medical graduates include attracting rural students to medical careers, increasing admission of local students and providing incentives for graduates to complete their residency training in the province.

A cost effectiveness analysis of thiopurine methyltransferase testing for guiding 6-mercaptopurine dosing in children with acute lymphoblastic leukemia.

An increased understanding of the genetic basis of disease creates a demand for personalized medicine and more genetic testing for diagnosis and treatment. The objective was to assess the incremental cost‐effectiveness per life‐month gained of thiopurine methyltransferase (TPMT) genotyping to guide doses of 6‐mercaptopurine (6‐MP) in children with acute lymphoblastic leukemia (ALL) compared to enzymatic testing and standard weight‐based dosing.

Cost-Effectiveness of Positron Emission Tomography in Breast Cancer

PurposeIn this study, we used quantitative decision tree modeling to assess the cost-effectiveness of a positron emission tomography (PET)-based management scenario for breast cancer in Canada.ProceduresTwo patient management scenarios were compared (with and without PET). A metaanalysis of studies for the accuracy of PET in staging breast cancer was conducted. Life expectancies were calculated. Management costs were determined from previous cost-effective analyses, management costs from our institutions, and recently published Canadian cost estimates of various procedures.ResultsA cost savings of

Awareness and Use of Maternal Serum Screening Among Women From the St. John’s Region of Newfoundland and Labrador

695 per person is expected for the PET strategy, with an increase in life expectancy (7.4 days), when compared with the non-PET strategy. This cost savings remained in favor of the PET strategy when subjected to a sensitivity analysis.ConclusionsThe use of a PET management strategy for the staging of breast cancer is expected to remain economically viable in Canada under various economic conditions.

Work locations in 2014 of medical graduates of Memorial University of Newfoundland: a cross-sectional study

OBJECTIVES To examine the awareness and use of maternal serum screening (MSS) among women from the St. Johns region of Newfoundland and Labrador. METHOD We surveyed 300 women who had recently given birth. Our main outcomes were whether the woman had heard of MSS (prior to the study) and whether she had MSS during her pregnancy. RESULTS Among the 200 respondents (response rate 66.7%), 139 (69.5%) had heard of MSS and 53 (26.5%) had MSS (38.1% of those who had heard of it). A larger proportion of women over 35 years (59.0%) had heard of MSS than younger women (31.5%) (P = 0.001). Among those who had heard of MSS, a larger proportion of women who had MSS (96.2%) than those who did not have MSS (72.1%) discussed the test with their physician (P 0.001); 54.9% of the women who discussed MSS with their physicians decided not to have MSS. Most discussions regarding MSS (82.6%) lasted 10 minutes or less; discussion length was not related to use of MSS. CONCLUSION Almost two thirds of women surveyed were aware of MSS, and roughly one quarter had MSS. These findings confirm that most physicians offer MSS to their patients and suggest that patient preference accounts for the low use of MSS in the province. Understanding why women do not have MSS may lead to strategies to improve screening rates.

Keeping Community Health Care Workers Safe

BACKGROUND Part of the mandate for social accountability of medical schools is to address physician needs at the local, regional and national levels. We determined the work locations in 2014 of medical graduates of Memorial University of Newfoundland (MUN) and identified the characteristics and predictors of working in urban and rural areas of Canada and the province of Newfoundland and Labrador (NL). METHODS We linked data from class lists, and alumni and postgraduate databases with data from the Scotts Medical Database to determine work locations in 2014 of MUN medical graduates from 1973 to 2008. Multiple logistic regression analysis was used to identify predictors of working in urban and rural areas of Canada and NL. RESULTS Of the 1864 graduates in our study, 1642 (88.1%) were working in Canada, 638 (34.2%) in NL, 217 (11.6%) in rural Canada and 92 (4.9%) in rural NL in 2014. Predictors of physicians working in Canada included having a rural background, being from NL and graduating in the 1980s, 1990s or 2000s. Predictors of physicians working in NL included having a rural background, being from NL, graduating in the 2000s and having done some or all of their residency training at MUN. Having a rural background and being a family physician were predictors of working in rural Canada. Having a rural background, being from NL, having done some or all residency training at MUN and being a family physician were predictors of working in rural NL. INTERPRETATION Most MUN graduates were working in Canada in 2014, with about one-third remaining in NL and much smaller percentages working in rural communities, especially in rural NL. These findings have implications for the physician supply in NL.

A Risk Assessment Screening Tool for Community Health Care Workers

Organizations have a responsibility to ensure the safety of staff who provide care in the community. In a survey conducted within a regional health authority in Newfoundland, health care providers reported feeling unsafe while conducting home visits. Safety initiatives were explored, and a safety program was implemented within this region to address safety concerns. The safety program includes three key components: a risk assessment screening tool, a sign-in/sign-out system, and a buddy system. This article describes the evaluation process and outcomes of these three components. The evaluation process and outcomes may be useful to other health care organizations interested in promoting workplace safety.

Patient-expressed perceptions of wait-time causes and wait-related satisfaction

Given the shift to community-based care, health care providers are facing an increased risk of workplace violence. The process of minimizing risk for staff providing home visits is a challenge and has not been extensively studied. The authors describe the development and implementation of a risk assessment instrument in a regional health authority in Newfoundland. The instrument aids community workers to identify and manage potential workplace violence risks. The process and risk assessment instrument may be useful to other health care organizations interested in promoting workplace safety.

HIV testing in pregnancy: Using women's voices to inform policy

BACKGROUND This study set out to identify patterns in the causes of waits and wait-related satisfaction. METHODS We conducted qualitative interviews with urban, semi-urban, and rural patients (n = 60) to explore their perceptions of the waits they experienced in the detection and treatment of their breast, prostate, lung, or colorectal cancer. We asked participants to describe their experiences from the onset of symptoms to the start of treatment at the cancer clinic and their satisfaction with waits at various intervals. Interview transcripts were coded using a thematic approach. RESULTS Patients identified five groups of wait-time causes: Patient-related (beliefs, preferences, and non-cancer health issues)Treatment-related (natural consequences of treatment)System-related (the organization or functioning of groups, workforce, institution, or infrastructure in the health care system)Physician-related (a single physician responsible for a specific element in the patients care)Other causes (disruptions to normal operations of a city or community as a whole) With the limited exception of physician-related absences, the nature of the cause was not linked to overall satisfaction or dissatisfaction with waits. CONCLUSIONS Causes in themselves do not explain wait-related satisfaction. Further work is needed to explore the underlying reasons for wait-related satisfaction or dissatisfaction. Although our findings shed light on patient experiences with the health system and identify where interventions could help to inform the expectations of patients and the public with respect to wait time, more research is needed to understand wait-related satisfaction among cancer patients.

Responses by breast and prostate cancer patients to out-of-pocket costs in Newfoundland and Labrador

BACKGROUND In Canadian provinces with opt-out policies for maternal HIV screening, pregnant women are told HIV screening is routine and are provided with the opportunity to refuse. In Newfoundland and Labrador an opt-out screening policy has been in place since 1997. PURPOSE This research study aimed to (1) obtain an increased understanding of the information women receive about HIV/AIDS during the opt-out screening process and (2) to advance the policy related dialogue around best practices in HIV screening within the province of Newfoundland and Labrador. METHODS Twelve women who were between 14 and 35 weeks gestation participated. Interviews were transcribed verbatim and a thematic analysis was carried out. FINDINGS The major themes are that women have difficulty obtaining clear information about maternal HIV screening, are often not told they have the right to refuse maternal screening, and experience paternalism from physicians. CONCLUSION We recommend that physicians and other health care providers in be reminded that that current opt-out testing requires womens consent and that women must be given the option to refuse the test.