Ross Upshur's research while affiliated with University of Toronto and other places

Publications (67)

Preprint
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Background: Given the increasing integration of digital health technologies in team-based primary care, this review aimed at understanding the impact of eHealth on patient-provider and provider-provider relationships. Methods: A review of reviews was conducted on three databases to identify papers published in English from 2008 onwards. The impact...
Article
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Deprescribing involves reducing or stopping medications that are causing more harm than good or are no longer needed. It is an important approach to managing polypharmacy, yet healthcare professionals identify many barriers. We present a proposed pre-licensure competency framework that describes essential knowledge, teaching strategies, and assessm...
Article
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Background Post-traumatic stress disorder (PTSD) remains a significant treatment challenge among Canadian veterans. Currently accessible pharmacological and non-pharmacological interventions for PTSD often do not lead to resolution of PTSD as a categorical diagnosis and have significant non-response rates. Sudarshan Kriya Yoga (SKY), a complementar...
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There have been several recent calls to “re-think chronic pain” in response to the growing awareness of social inequities that impact the prevalence of chronic pain and its management. This in turn has resulted in new explorations of suffering as it relates to pain. While laudable, many of these clinically oriented accounts are abstract and often f...
Article
Introduction Une collaboration efficace et soutenue entre cliniciens et professionnels en santé publique peut améliorer la santé des individus et la santé de la population. Le concept de santé publique clinique favorise cette collaboration entre médecine clinique et santé publique et permet de relever des défis complexes en matière de santé. Dans c...
Article
Introduction Effective, sustained collaboration between clinical and public health professionals can lead to improved individual and population health. The concept of clinical public health promotes collaboration between clinical medicine and public health to address complex, real­world health challenges. In this commentary, we describe the concept...
Article
Goal-oriented care is an approach to care delivery that uses patient-identified goals to drive care planning. Implementing goal-oriented care requires team members to cognitively shift the focus from “what is the matter” to “what matters to patients,” and align their mental models of what it means to care for patients. Yet, no empirical studies of...
Conference Paper
This workshop will provide participants a hands-on opportunity to explore and reflect on the relationship between evidence, and specifically evidence based medicine, and the contemporary North American opioid epidemics. EBM emerged through the late twentieth century to promote good (conscientious, explicit and judicious) use of best evidence to inf...
Article
There is growing emphasis for primary care clinicians to initiate and engage in end-of-life (EOL) conversations with medically frail older adults. However, EOL conversations happen most often when death is imminent or are avoided altogether. The objective of this study was to understand the socio-political forces shaping EOL conversations between c...
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The compassionate community movement as both a public health approach and a social model of care for various life stages is gaining traction in Canada and elsewhere. One example is the Windsor-Essex Compassion Care Community (WECCC), an evidence-based model and set of tools to improve the quality of life, health and wellness of vulnerable and aging...
Conference Paper
This workshop will provide participants a hands-on opportunity to explore and reflect on the relationship between evidence, and specifically evidence based medicine, and the contemporary North American opioid epidemics. EBM emerged through the late twentieth century to promote good (conscientious, explicit and judicious) use of best evidence to inf...
Article
Full-text available
Increasing job market demand for and availability of Canadian and U.S. global academic health programs in post-secondary education increases student demand to participate in internationally based fieldwork, while supportive resources remain weakly developed. Previous studies indicate provisions to protect the health, safety, and well-being of women...
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Background: The field of oncology is at the forefront of advances in artificial intelligence (AI) in healthcare, providing an opportunity to examine the early integration of these technologies in clinical research and patient care. Hope that AI will revolutionize healthcare delivery and improve clinical outcomes has been accompanied by concerns ab...
Article
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Rationale: Exposure to poor air quality is associated with increased morbidity and mortality in patients with chronic obstructive pulmonary disease (COPD), asthma and heart failure. A number of countries, including Canada, report utilization of the Air Quality Health Index (AQHI) and associated health messages tailored to different AQHI categories...
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Introduction: The exceptional production of research evidence during the COVID-19 pandemic required deployment of scientists to act in advisory roles to aid policy-makers in making evidence-informed decisions. The unprecedented breadth, scale and duration of the pandemic provides an opportunity to understand how science advisors experience and mit...
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Introduction: Although most asthma is mild to moderate, severe asthma accounts for disproportionate personal and societal costs. Poor co-ordination of care between primary care and specialist settings is recognised as a barrier to achieving optimal outcomes. The Primary Care Severe Asthma Registry and Education (PCSAR-EDU) project aims to address...
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During the COVID-19 pandemic, many jurisdictions experienced surges in demand for critical care that strained or overwhelmed their healthcare system's ability to respond. A major surge necessitates a deviation from usual practices, including difficult decisions about how to allocate critical care resources. We present a framework to guide these dec...
Preprint
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BACKGROUND Although mobile health (mHealth) applications are increasingly being used to support patients with multiple chronic conditions (multimorbidity), the majority of mHealth apps experience low interaction and eventual abandonment. To tackle this engagement issue, it is important to understand social-behavioral factors that impact patients’ u...
Article
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Background Although mobile health (mHealth) apps are increasingly being used to support patients with multiple chronic conditions (multimorbidity), most mHealth apps experience low interaction and eventual abandonment. To tackle this engagement issue, when developing an mHealth program, it is important to understand the social-behavioral factors th...
Article
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Background Opioid agonist therapy (OAT) has been severely disrupted by the COVID-19 pandemic. The risks of opioid withdrawal, overdose, and diversion have increased, so there is an urgent need to adapt OAT to best support people who use drugs (PWUD). This review examines the views and experiences of PWUD, health care providers, and health system ad...
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In January 2021, Dr Tedros Adhanom Ghebreyesus, director–general of the WHO, warned that the world was ‘on the brink of a catastrophic moral failure [that] will be paid with lives and livelihoods in the world’s poorest countries’. We are now past the brink. Many high-income countries have vaccinated their populations (which, in some cases, includes...
Article
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Background: Older adults (≥65 years) with diabetes and multiple chronic conditions (MCC) (> 2 chronic conditions) experience reduced function and quality of life, increased health service use, and high mortality. Many community-based self-management interventions have been developed for this group, however the evidence for their effectiveness is l...
Article
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Background Digital health technologies can support primary care delivery, but clinical uptake in primary care is limited. This study explores enablers and barriers experienced by primary care providers when adopting new digital health technologies, using the example of the electronic Patient Reported Outcome (ePRO) tool; a mobile application and we...
Article
The Access to COVID-19 Tools Accelerator (ACT-A) is a multistakeholder initiative quickly constructed in the early months of the COVID-19 pandemic to respond to a catastrophic breakdown in global cooperation. ACT-A is now the largest international effort to achieve equitable access to COVID-19 health technologies, and its governance is a matter of...
Article
Introduction: The expanding use of Artificial Intelligence (AI) in hematology and oncology research and practice creates an urgent need to consider the potential impact of these technologies on health equity at both local and global levels. Fairness and equity are issues of growing concern in AI ethics, raising problems ranging from bias in dataset...
Article
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Background Researchers often use survey data to study the effect of health and social variables on physician use, but how self-reported physician use compares to administrative data, the gold standard, in particular within the context of multimorbidity and functional limitations remains unclear. We examine whether multimorbidity and functional limi...
Article
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Bibliometric analyses of systematic reviews offer unique opportunities to explore the character of specific scientific fields. In this time series-based analysis, dynamics of multidisciplinary care for chronic pain and opioid prescribing are analyzed over a forty-four year time span. Three distinct periods are identified, each defined by distinct r...
Article
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Issue Health systems have been increasingly called upon to address population health concerns and continuing medical education (CME) is an important means through which clinical practices can be improved. This manuscript elaborates on existing conceptual frameworks in order to support CME practitioners, funders, and policy makers to develop, implem...
Article
Purpose: To solve complex health issues, an innovative and multidisciplinary framework is necessary. The Clinical Public Health (CPH) Division was established at the University of Toronto (UofT), Canada to foster inte-gration of primary care, preventive medicine and public health in education, practice and research. To better understand how the co...
Preprint
Evidence-Based Medicine proposes a prescriptive model of physician decision-making in which “best evidence” is used to guide best practice. And yet, proponents of EBM acknowledge that EBM fails to offer a systematic theory of physician decision-making. In this paper, we explore how physicians from the neurology and emergency medicine communities ha...
Article
Objectives To ask all clinical, administrative and support staff affiliated with a large network of healthcare facilities to identify the conditions that they consider as non-negotiable for their own deaths to be regarded as good. Methods All 3495 staff of a healthcare network were asked to rank 10 conditions according to how non-negotiable they w...
Article
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Objective The aim of the following study was to examine whether there was an increased risk for multimorbidity for those living in less walkable neighbourhoods. It was hypothesised that participants residing in less walkable neighbourhoods would have a higher risk for multimorbidity.Setting City of Toronto and 14 neighbouring regions/municipalities...
Preprint
Full-text available
BACKGROUND Goal-oriented care is being adopted to deliver person-centred primary care to older adults with multimorbidity and complex care needs. While this model holds promise, implementation remains a challenge. Digital health solutions may enable processes to improve adoption, however, they require evaluation to determine feasibility and impact....
Article
Full-text available
Background Goal-oriented care is being adopted to deliver person-centered primary care to older adults with multimorbidity and complex care needs. Although this model holds promise, its implementation remains a challenge. Digital health solutions may enable processes to improve adoption; however, they require evaluation to determine feasibility and...
Article
Full-text available
Background Artificial intelligence (AI) has been described as the “fourth industrial revolution” with transformative and global implications, including in healthcare, public health, and global health. AI approaches hold promise for improving health systems worldwide, as well as individual and population health outcomes. While AI may have potential...
Article
Full-text available
Restrictive measures imposed because of the coronavirus disease 2019 (COVID-19) pandemic have resulted in severe social, economic and health effects. Some countries have considered the use of immunity certification as a strategy to relax these measures for people who have recovered from the infection by issuing these individuals a document, commonl...
Article
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Background This study explores how socio-demographic and health factors shape the relationship between multimorbidity and one-year acute care service use (i.e., hospital, emergency department visits) in older adults in Ontario, Canada. Methods We linked multiple cycles (2005–2006, 2007–2008, 2009–2010, 2011–2012) of the Canadian Community Health S...
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This report of WHO Working Group for Guidance on Human Challenge Studies in COVID-19 outlines ethical standards for COVID-19 challenge studies. It includes eight Key Criteria related to scientific justification, risk-benefit assessment, consultation and engagement, co-ordination of research, site selection, participant selection, expert review, and...
Article
The common practice of delaying and/or avoiding end-of-life conversations with medically frail older adults is an important clinical issue. Most research investigating this practice focuses on clinician training and developing conversation skills. Little is known about the socio-political factors shaping the phenomenon of end-of-life conversations...
Article
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Context Opioid related deaths are at epidemic levels in many developed nations globally. Concerns about the contribution of prescribed opioids, and particularly high-dose opioids, continue to mount as do initiatives to reduce prescribing. Evidence around opioid tapering, which can be challenging and potentially hazardous, is not well developed. A r...
Preprint
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Background: This study explores how a broad-range of socio-demographic factors shape the relationship between multimorbidity and one-year acute care service use (i.e., hospital, emergency department visits) among older adults in Ontario, Canada. Methods: We linked multiple cycles (2005-2006, 2007-2008, 2009-2010, 2011-2012) of the Canadian Communit...
Preprint
Full-text available
Background: This study explores how socio-demographic and health factors shape the relationship between multimorbidity and one-year acute care service use (i.e., hospital, emergency department visits) in older adults in Ontario, Canada. Methods: We linked multiple cycles (2005-2006, 2007-2008, 2009-2010, 2011-2012) of the Canadian Community Health...
Preprint
Full-text available
Background: This study explores how socio-demographic and health factors shape the relationship between multimorbidity and one-year acute care service use (i.e., hospital, emergency department visits) in older adults in Ontario, Canada. Methods: We linked multiple cycles (2005-2006, 2007-2008, 2009-2010, 2011-2012) of the Canadian Community Health...
Article
Full-text available
Objective To examine agreement between administrative and self-reported data on the number of and constituent chronic conditions (CCs) used to measure multimorbidity. Study Design and Setting Cross-sectional self-reported survey data from four Canadian Community Health Survey waves were linked to administrative data for residents of Ontario, Canad...
Preprint
Full-text available
Background: Artificial intelligence (AI) has been described as the “fourth industrial revolution” with transformative and global implications, including in healthcare, public health, and global health. AI approaches hold promise for improving health systems worldwide, as well as individual and population health outcomes. While AI may have potential...
Preprint
Full-text available
Background: Artificial intelligence (AI) has been described as the “fourth industrial revolution” with transformative and global implications, including in healthcare, public health, and global health. AI approaches hold promise for improving health systems worldwide, as well as individual and population health outcomes. While AI may have potential...
Preprint
Full-text available
Background Artificial intelligence (AI) has been described as the “fourth industrial revolution” with transformative and global implications, including in healthcare, public health, and global health. AI approaches hold promise for improving health systems worldwide, as well as individual and population health outcomes. While AI may have the potent...
Preprint
BACKGROUND Older adults with multi-morbidity and complex care needs (CCN) are among those most likely to experience frequent care transitions between settings, particularly from hospital to home. Transition periods mark vulnerable moments in care for individuals with CCN. Poor communication and incomplete information transfer between the various cl...
Article
Background Older adults with multimorbidity and complex care needs (CCN) are among those most likely to experience frequent care transitions between settings, particularly from hospital to home. Transition periods mark vulnerable moments in care for individuals with CCN. Poor communication and incomplete information transfer between clinicians and...
Article
Full-text available
Background: Type II diabetes mellitus (T2DM) affects upwards of 25% of Canadian older adults and is associated with high comorbidity and burden. Studies show that lifestyle factors and self-management are associated with improved health outcomes, but many studies lack rigour or exclude older adults, particularly those with multimorbidity. More evi...
Article
Clinical practice guidelines (CPGs) often include a recommendation regarding how to approach a clinical encounter and which decision-making model should be used. The GRADE framework, a popular method for developing CPGs suggests a paternalistic model when recommendations are “strong” and shared decision making (SDM) when recommendations are “weak”....
Article
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Background Despite the high prevalence of comorbid chronic pain and depression, this comorbidity remains understudied. Meditation has demonstrated efficacy for both chronic pain and depression independently, yet there have been few studies examining its effectiveness when both conditions are present concurrently. Furthermore, while meditation is ge...
Article
Objective To compare multimorbidity prevalence using self-reported and administrative data and identify factors associated with agreement between data sources. Study Design and Setting Self-reported cross-sectional data from four Canadian Community Health Survey waves were linked to administrative data in Ontario, Canada. Multimorbidity prevalence...
Article
Objective To describe agreement between administrative and self-report data on the number and type of chronic conditions (CCs) and determine whether associations between CC count and health service use differ by data source. Study Design and Setting We linked Canadian Community Health Survey and administrative data for a cohort of adults aged 45+...
Preprint
Full-text available
Background: Despite the high prevalence of comorbid chronic pain and depression, this comorbidity remains understudied. Meditation has demonstrated efficacy for both chronic pain and depression independently, yet there have been few studies examining its effectiveness when both conditions are present concurrently. Furthermore, while meditation is g...
Preprint
Full-text available
Background: Despite the high prevalence of comorbid chronic pain and depression, this comorbidity remains understudied. Meditation has demonstrated efficacy for both chronic pain and depression independently, yet there have been few studies examining its effectiveness when both conditions are present concurrently. Furthermore, while meditation is g...
Preprint
Full-text available
Background: Despite the high prevalence of comorbid chronic pain and depression, this comorbidity remains understudied. Meditation has demonstrated efficacy for both chronic pain and depression independently, yet there have been few studies examining its effectiveness when both conditions are present concurrently. Furthermore, while meditation is g...
Article
Full-text available
Objective: To assess family medicine residents' knowledge of, attitudes toward, and clinical practices related to environmental health (EH). Design: Two-part study with questionnaire construction using a modified Delphi method, and a Web-based questionnaire administered to family medicine residents between November 2015 and January 2016. Settin...
Article
Infectious disease pandemics raise significant and novel ethical challenges to the organization and practice of public health. This chapter provides an overview of the salient ethical issues involved in preparing for and responding to pandemic disease, including those arising from deploying restrictive public health measures to contain and curb the...

Citations

... Such alternative problem/solution constructions represent potentially important missed opportunities for evidence-informed policy learning across jurisdictions, perhaps reflecting constructions that favour the expediency and feasibilityof regulatory change over more challenging, but also potentially more impactful, changes to the values and financing that structure health service delivery. Such expediency may, in part, be driven by the pressures of ʻcrisisʼ responses.84 ...
... In the context of developing nations, gender inequality in healthcare is still evident in rural and urban areas (Hamiduzzaman et al., 2023). In the developing countries of Asia, government-run hospitals are seen to be overcrowded and understaffed due to a limited healthcare options (Tahsin et al., 2022). Thus, the introduction of smart health technology is one of the potential strategies by the local healthcare services entrepreneurs to fill the gap in healthcare markets and facilitate healthcare services to female in particular and changes the behaviour of the local population to reach more healthcare-relevant services from the smart healthcare technology-driven platform (Redfern, 2017;Kher and Mistry, 2022). ...
... 4 Pearce Cusack takes a deep dive into the medical humanities with an anthology of literary writing by Iain Bamford. 5 All remind us of the holistic approach considered an essential feature of family medicine by WONCA. 2 This approach must have time and space for dreams and logic. ...
... Then the impacts are managed to preserve healthcare system access and quality as well as dealing with legacy issues thereafter (7). Such approaches need an appropriate evidence-based decision-making mechanism based on strong research skills, the capacity to conduct accurate and rapid research, evidence evaluation, as well as structures for informed decision-making (12). Along with the set of solutions and approaches to increase the responsiveness of the healthcare systems, measuring, monitoring, and reporting performance can lead to a balanced responding mechanism to COVID-19 pandemic (13). ...
... The most commonly used evaluation method is to establish an employee evaluation model, including employee self-evaluation, superior evaluation, and other factors. The performance quality model of employees includes indicators such as employee performance, attendance rate, and rank [7]. Based on the evaluation of employees and the analysis of their skills, the matching degree between the company's main personnel and their positions is obtained as follows: ...
... FHTs are designed to provide integrated, multidisciplinary primary care and are typically led by physicians or nurse practitioners [29]. A purposeful sampling strategy [30] was used to recruit 6 FHTs across geographically diverse areas (urban, rural, and suburban) of Ontario, Canada, from 2018 to 2019; this FHT recruitment process is described in detail in another publication [23,30]. The categorization of sites into rural, urban, and suburban settings was consistent with Statistics Canada's definition of rurality [31]. ...
... This moral imperative to intervene is strengthened by the systemic marginalisation and manufactured vulnerabilities of people who use opioids. 54 Namely, intervention-irrespective of the risks of industry involvement-may be deemed as required since the populations that may most benefit have historically been denied access to appropriate harm-reducing services and therapies. 55 56 Thus, we see a normalisation of industry promotion of harm reduction interventions such as increasing naloxone uptake 57 and reducing opioid-related stigma. ...
... The three SAGE framework principles analyzed above all demand the prioritization of LMICs, for whom preventative measures, such as vaccines, might even be the most efficient tool to fight the pandemic [34]. This underlines once again the unique selling proposition of the COVAX Facility-the main international organization distributing vaccine doses globally. ...
... 9 AI-assisted clinical decision-support has the potential to improve equity in surgical outcomes for patients treated at these institutions. 34 However, further development of the current models is needed, including collection of a larger, multi-institutional training set and mammogram-specific transfer learning. This project has several limitations. ...
... Several studies have increasingly explored the association of lifestyle and sociodemographic factors with multimorbidity, given the important relationship that they have and their impact on multimorbidity [7,[11][12][13][14]. In Portugal, however, there seem to be no studies on these associations. ...