Dax Bourcier

Introduction: Wernicke encephalopathy (WE) is a neurological emergency characterized by acute encephalopathy, oculomotor dysfunction, and ataxia, and may progress to Korsakoff syndrome – a disorder characterized by irreversible global episodic amnesia. Although classically linked to alcohol misuse, WE also arises in medical and psychiatric conditions associated with nutritional deficiency. Case Presentation: We report an 18-year-old male with schizophrenia, non-adherent to antipsychotic treatment, who was admitted with disorganization, catatonia, and dehydration. After several days of minimal nutrition (including dextrose-containing fluids), oral lorazepam, and intramuscular olanzapine, he developed acute WE with worsening catatonia. Intravenous thiamine and continued lorazepam rapidly improved his level of consciousness. Laboratory testing revealed undetectable thiamine, and MRI findings were consistent with WE. Despite oral multivitamin supplementation, catatonia improved only after escalation to intravenous lorazepam and electroconvulsive therapy. As catatonia improved, symptomatology of schizophrenia emerged and improved significantly with paliperidone therapy. As schizophrenia symptoms improved, complete anterograde and partial retrograde amnesia, apathy, and anosognosia emerged, consistent with Korsakoff syndrome. He continued to meet diagnostic criteria at three-year follow-up. Conclusion: This complex case demonstrates the importance of maintaining a suspicion of thiamine deficiency in patients with a history of nutritional depletion of greater or equal to two weeks. Prompt initiation and continuation of thiamine therapy while investigating and treating concurrent diagnoses can reduce the risk of WE and Korsakoff syndrome.

Background. High-quality data on the health workforce are critically needed across Canadian jurisdictions for effective health workforce analysis and planning in support of care delivery and strengthened health systems. This is particularly in the context of mobility across a uniquely decentralized health system. Objective. To describe the pan-Canadian data sources and identify key challenges and opportunities for optimizing data use for health workforce analysis and planning. Methods. We undertook an environmental scan of the literature and publicly available information on pan-Canadian data pathways to identify data sources, coverage, and alignment. We identify challenges associated with using these data for health workforce research and planning and provide insight into promising opportunities for improvement. Results. Two data custodians collate pan-Canadian health workforce data from administrative health sources (Canadian Institute for Health Information) and population survey sources with questions on labour activities (Statistics Canada). Both custodians maintain multiple datasets, each with notable strengths and limitations reflecting the breadth and depth of health workforce information. No sources were identified as having been designed primarily to inform health workforce planning, resulting in data silos, varying coverage, and often inadequate metadata standards. Despite the policy priority of enhancing interprofessional collaborations, when data have been used for health workforce analysis it often remains focused on a single sector or profession. Conclusions. Targeted investments into data standardization and interoperability, with more common data elements are among the key areas of improvement for enhancing cross-occupational and cross-jurisdictional health workforce analysis and planning.

Robust health data ecosystems require frameworks that clearly define how data flow through and across systems. Despite their widespread adoption in other sectors, data architecture frameworks remain underutilized in healthcare, limiting the sector’s ability to harness data for system improvement. This study presents the development of a data architecture framework designed to enhance health data ecosystems, illustrated through the use case of health workforce planning. To inform the development of the framework, we conducted an environmental scan to identify leading practices, principles, standards, guidelines, existing frameworks, and persistent challenges in health workforce data and planning. Using an iterative development process, we created a comprehensive description and visual representation of the framework. We then assessed its applicability to the Canadian context, implementation considerations, potential remediations, and added value to health systems. The resulting data architecture framework features four fundamental components: data ingestion, integration, storage, and fit-for-purpose use. The framework directly addresses key data challenges, including lack of comprehensiveness, granularity, standardization, interoperability, timeliness, usability, and accessibility. The assessment of the applicability of the framework to the Canadian context revealed that added value stems primarily from its promotion of comprehensiveness, interoperability, compatibility with artificial intelligence and accessibility of data to decision-makers. This data architecture framework addresses persistent challenges in health workforce data by enabling more consistent, timely, and actionable insights. It provides policymakers, planners, and researchers with fit-for-purpose data to improve resource allocation, forecasting, and innovation. Ultimately, it establishes health data ecosystems that support evidence-informed decision-making, workforce optimization, and sustainable health care delivery.

A framework that articulates the connections, interdependencies and flow of data can help to promote more robust data ecosystems. And yet, the use of data architecture frameworks in healthcare has lagged compared to other industries. In this study, we describe the development of a data architecture framework designed to enhance health data ecosystems, illustrated with an explicit focus on health workforce planning. To inform the development of the framework, we first conducted an environmental scan to identify leading practices, principles, standards, guidelines, existing frameworks and current challenges with respect to health workforce data and planning. Next, through an iterative development process, we produced a comprehensive description and visual representation of a data architecture framework focused on enhancing health data ecosystems and workforce planning. We then assessed the applicability of the framework to the Canadian context, implementation considerations and possible remediations, and the added value of the framework to health systems. The resulting data architecture framework features four fundamental components: data ingestion, integration, storage, and fit-for-purpose use. The framework directly addresses key data challenges, including lack of comprehensiveness, granularity, standardization, interoperability, timeliness, usability, and accessibility. The assessment of the applicability of the framework to the Canadian context revealed that added value stems primarily from its promotion of comprehensiveness, interoperability, compatibility with artificial intelligence and accessibility of data to decision-makers. This data architecture framework is a representation of the foundational health data ecosystem capable of supporting decision-making to optimize the health workforce and to improve and sustain health care delivery.

Background: Lyme borreliosis, a tick-borne illness caused by Borrelia burgdorferi, is increasingly prevalent in Nova Scotia, Canada, which has the highest incidence in North America. While most cases present as early localized disease, approximately 20% develop early disseminated disease, which can include neurological symptoms, an entity called Lyme neuroborreliosis (LNB). This case report describes an unusual LNB presentation with isolated intracranial hypertension (IH). Case Presentation: A 6-year-old female presented to our pediatric hospital with binocular horizontal diplopia, headache, fever, malaise, and suspected papilledema 47 days after an embedded tick bite. A diagnosis of Lyme disease had been made 10 days prior in the community based on positive serologies and erythema migrans, but she developed a Jarisch-Herxheimer reaction within 24 h of oral doxycycline, leading to an antibiotic change to amoxicillin. During the hospital admission, an ophthalmological examination revealed papilledema and IH was evidenced by an opening pressure of 36 mm Hg and brain MRI findings. The lumbar puncture revealed pleocytosis and positive cerebrospinal fluid antibodies for Borrelia. The patient was initially treated with 2 days of ceftriaxone, followed by a 12-day outpatient course of doxycycline for LNB. High doses of acetazolamide (500 mg TID) were needed to achieve symptom control. Two months after her hospital discharge, there was resolution of papilledema and the acetazolamide was weaned. Conclusion: This case highlights the importance of considering Lyme disease in the differential diagnosis of IH, particularly in endemic regions. Early recognition, diagnostic workup, and appropriate treatment are crucial for optimal outcomes in LNB.

Background: Healthcare systems rely heavily upon human resources to ensure high-quality access to care for the general population. With significant health worker shortages predicted worldwide in the coming decades, maximizing the current workforce by means of a physician resource planning (PRP) strategy that ensures the right number, mix, and distribution of physicians to meet population needs is warranted. In Canada, there is an insufficient number of primary care providers, and disproportionately low numbers of specialist physicians in rural compared to urban regions. Currently, Canadian medical students are not effectively included in PRP strategy and lack the required information for career orientation to help rebalance the population’s workforce needs. This paper present theHealth Human Resource (HHR) Platform, a comprehensive web tool that includes relevant workforce data to empower medical students in choosing a discipline based on both personal interests and social accountability.Results: Physician workforce data, comments from Canadian residency program directors, and career planning resources were collected by the Canadian Federation of Medical Student’s (CFMS) HHR Task Force. This information was consolidated to create a national interactive platform that uses a map, comparison table, and trend graphs to illustrate over 500,000 unique data points from 37 datasets, including specific information and resources spanning 62 medical specialties from 2015 onwards. There was a 24.6% response rate for program director comments. During the first 4 months of theHHR Platformlaunch, there were 2434 different users, of which 985 were returning, with an average of 20.0 users per day spending on average 3 min on the platform.Conclusions: TheHHR Platformconstitutes a national approach to PRP informing medical students on the mix and distribution of physicians needed to meet the future healthcare demands of the Canadian population.

There is substantial evidence showing that medical student wellness is a worsening problem in Canada. It is apparent that medical students’ wellness deteriorates throughout their training. Medical schools and their governing bodies are responding by integrating wellness into competency frameworks and accreditation standards through a combination of system- and individual-level approaches. System-level strategies that consider how policies, medical culture, and the “hidden curriculum” impact student wellness, are essential for reducing burnout prevalence and achieving optimal wellness outcomes. Individual-level initiatives such as wellness programming are widespread and more commonly used. These are often didactic, placing the onus on the student without addressing the learning environment. Despite significant progress, there is little programming consistency across schools or training levels. There is no wellness curriculum framework for Canadian undergraduate medical education that aligns with residency competencies. Creating such a framework would help align individual- and system-level initiatives and smooth the transition from medical school to residency. The framework would organize goals within relevant wellness domains, allow for local adaptability, consider basic learner needs, and be learner-informed. Physicians whose wellness has been supported throughout their training will positively contribute to the quality of patient care, work environments, and in sustaining a healthy Canadian population. Nous disposons d’un grand nombre de données concrètes démontrant que le bien-être des étudiants en médecine au Canada se détériore tout au long de leur cheminement universitaire et que le problème s’aggrave. Alliant les approches systémique et individuelle, les facultés de médecine et leurs directions réagissent en intégrant le bien-être dans les cadres de compétences et les normes d’agrément. Les stratégies systémiques, qui tiennent compte de l’impact des politiques, de la culture médicale et du « curriculum caché » sur le bien-être des étudiants, sont indispensables pour prévenir l’épuisement professionnel et pour obtenir des résultats optimaux en matière de bien-être. Les initiatives au niveau individuel, comme les programmes axés sur le bien-être, sont de plus en plus répandues. Ces programmes sont souvent didactiques et ils sollicitent l’étudiant sans tenir compte de l’environnement d’apprentissage. Bien que ces initiatives aient marqué des progrès importants, il y a peu d’uniformité entre les programmes des diverses facultés et entre les niveaux de formation. Il n’y a pas de cadre pédagogique pour les programmes d’études de premier cycle axés sur le bien-être au Canada s’alignant aux compétences visées dans les programmes de résidence. La création d’un tel cadre permettrait d’harmoniser les initiatives de niveau individuel et celles de niveau systémique et de faciliter la transition de la faculté de médecine vers la résidence. Il comporterait des objectifs organisés selon les domaines de bien-être pertinents, une souplesse permettant son adaptation aux divers milieux, il tiendrait compte des besoins fondamentaux des apprenants et il serait fondé sur une consultation de ces derniers. Les médecins dont le bien-être a été soutenu tout au long de leur formation contribueront de façon positive à la qualité des soins aux patients, à leur environnement de travail et au maintien d’une population canadienne en bonne santé.

Background: Healthcare systems rely heavily upon human resources to ensure high-quality access to care for the general population. With significant health worker shortages predicted worldwide in the coming decades, maximizing the current workforce by means of a physician resource planning (PRP) strategy that ensures the right number, mix, and distribution of physicians to meet population needs is warranted. In Canada, there is an insufficient number of primary care providers, and disproportionately low numbers of specialist physicians in rural compared to urban regions. Currently, Canadian medical students are not effectively included in PRP strategy and lack the required information for career orientation to help rebalance the population’s workforce needs. This paper aims to present the Health Human Resource (HHR) Platform, a comprehensive web tool that includes relevant workforce data to empower medical students in choosing a discipline based on both personal interests and social accountability.Results: Physician workforce data, comments from Canadian residency program directors, and career planning resources were collected by the Canadian Federation of Medical Student’s (CFMS) HHR Task Force. This information was consolidated to create a national interactive platform that uses a map, comparison table, and trends graph to illustrate over 500,000 unique data points from 37 datasets, including specific information and resources spanning 62 medical specialties from 2015 onwards. There was a 24.6% response rate for program director comments. During the first four months of the HHR Platform launch, there were 2463 different users, of which 998 were returning, with an average of 20.2 users per day spending on average 3 minutes and 4 seconds on the platform.Conclusions: The HHR Platform constitutes a bottom-up national approach to PRP informing medical students on the mix and distribution of physicians needed for a better alignment with residency positions, and ultimately meet the future healthcare demands of the Canadian population.