Opioid use disorder is often a chronic, relapsing condition associated with increased morbidity and death; however, with appropriate treatment and follow-up, individuals can reach sustained long-term ...remission. This guideline strongly recommends opioid agonist treatment with buprenorphine-naloxone as the preferred first-line treatment when possible, because of buprenorphine's multiple advantages, which include a superior safety profile in terms of overdose risk. Withdrawal management alone is not recommended, because this approach has been associated with elevated risks (e.g., syringe sharing) and death from overdose in comparison to providing no treatment, and high rates of relapse when implemented without immediate transition to long-term evidence-based treatment. Here, Bruneau et al discuss management of opioid use disorders.
Tobe et al cite that the Canadian Cardiovascular Harmonized National Guideline Endeavor (C-CHANGE) is a nationally endorsed guideline process, targeting primary care health care practitioners. ...C-CHANGE promotes patient care by bringing nine guideline groups together, to provide a composite set of recommendations to help clinicians formulate a comprehensive treatment plan directed toward patient priorities. The 2018 update to the C-CHANGE guideline includes a total of 77 recommendations and 52 recommendations that are newly added or updated. A new category for hypertension for high-risk individuals has been developed with a new lower threshold for treatment (130 mm Hg systolic) and target blood pressure (< 120 mm Hg systolic). Multifaceted care for patients with cardiovascular risks includes the cornerstones of health behavior change, such as healthy eating and regular physical activity.
Qualitative evaluations of courses prove difficult due to low response rates. Online courses may permit the analysis of qualitative feedback provided by health care providers (HCPs) during and after ...the course is completed. This study describes the use of qualitative methods for an online continuing medical education (CME) course through the analysis of HCP feedback for the purpose of quality improvement. We used formative and summative feedback from HCPs about their self-reported experiences of completing an online expert-facilitated course on tobacco dependence treatment (the Training Enhancement in Applied Cessation Counselling and Health TEACH Project). Phenomenological, inductive, and deductive approaches were applied to develop themes. QSR NVivo 11 was used to analyze the themes derived from free-text comments and responses to open-ended questions. A total of 277 out of 287 participants (96.5%) completed the course evaluations and provided 690 comments focused on how to improve the program. Five themes emerged from the formative evaluations: overall quality, content, delivery method, support, and time. The majority of comments (22.6%) in the formative evaluation expressed satisfaction with overall course quality. Suggestions for improvement were mostly for course content and delivery method (20.4% and 17.8%, respectively). Five themes emerged from the summative evaluation: feedback related to learning objectives, interprofessional collaboration, future topics of relevance, overall modifications, and overall satisfaction. Comments on course content, website function, timing, and support were the identified areas for improvement. This study provides a model to evaluate the effectiveness of online educational interventions. Significantly, this constructive approach to evaluation allows CME providers to take rapid corrective action.
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