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Canadian nurses are familiar with biosimilars in general, but may have knowledge gaps in their specific understanding, resulting in a significant unmet need for education. To assist Canadian nurses in gaining a greater understanding of biosimilars within the oncology treatment landscape and to alleviate certain concerns regarding biosimilar agents, the objectives of this Supplement are to discuss:* biologic drugs in general with an overview of their production* biosimilarity and biosimilars relative to reference biologic drugs* mechanisms of action: biosimilars versus reference biologic drugs* steps to biosimilar development* extrapolation of indications for biosimilars\"”\"œtotality of evidence\" for biosimilars* interchangeability and substitution* Health Canada's approval process for biosimilars* the role of nurses in introducing biosimilars and monitoring patients

The objective of this study was to understand gynecological cancer (GC) survivors’ and their informal caregivers’ perceptions about the usability of an educational resource to support their transition from primary cancer treatment into surveillance and/or recovery. After developing an empirical- and experiential-informed educational resource, we used a semi-structured questioning process to understand GC survivors and their caregivers’ perceptions about its usability. Data were collected via online focus groups or 1:1 interviews that were audio recorded and transcribed. We used thematic analysis to analyze the data. Ten participants who were survivors or informal caregivers of cervical, ovarian, or uterine/endometrial cancer participated in two rounds of data collection. We grouped qualitative data into two themes: (1) reputable, relevant, and accessible education reduces uncertainty and promotes connection, and (2) individualized delivery of education provided by trusted cancer clinicians. The transition from treatment to surveillance is a challenging time for which reputable, relevant, and accessible educational resources are useful to facilitate an understanding about and self-management of survivorship-related concerns. Survivors and caregivers look to clinicians to provide reputable education to address their needs. This education should be diverse in content and referred to repeatedly throughout the cancer trajectory.

Background Scholarship cites health care managers (HCMs) as not using research evidence in their management practice. The purpose of this review was to evaluate the effectiveness of interventions to enhance HCMs use of research evidence in practice. Methods We carried out a systematic review and focus groups to validate the review findings. We searched 10 electronic databases for studies reporting on interventions for HCMs to enhance research utilization in their practice. Qualitative studies were analysed using Hoon’s approach to meta-synthesis. Results Seven, primarily qualitative, studies of varying quality (reported in 11 articles) met our inclusion criteria. Interventions to enhance research use by HCMs included: informal and formal training, computer-based application, executive-level knowledge translation activities and residency programmes. Studies did not report efficacy of interventions or impacts of increasing managers’ use of research on staff or patient outcomes. Meta-synthesis yielded four contextual factors influencing the perceived effectiveness of interventions to enhance research use by HCMs: organizational culture, competing priorities, time as a resource and capacity building. Included studies differed in how they defined research and demonstrated varying understandings of research among HCMs, limiting the generalizability of work in this field. Conclusions Healthcare managers are increasingly called upon to make evidence-based decisions in practice, but the small number of studies and diverse strategies employed hinder our ability to identify any intervention to increase use of evidence as superior. Future studies in this area should clearly articulate the definition of research evidence they base their decisions on. Registration: PROSPERO (CRD42014006256)

CANO/ACIO POSITION ?All Canadians living with or at risk for cancer are entitled to receive care from nurses across all practice settings who possess foundational oncology knowledge, skill and judgment. ?Nurses working in cancer care settings require specialized knowledge, skill and judgment. Post-basic oncology nursing education programs assist nurses to acquire the specialized knowledge and competencies required to provide care in cancer settings. ?Lifelong learning enhances continuing competence and contributes to both high quality patient outcomes and evidence-informed practice. ?Cancer care settings and organizations play a fundamental part in supporting nurses with professional development by providing equitable and accessible resources to promote lifelong learning. Such resources may include, but are not limited to, the development of mentorship programs and various activities to promote learning (e.g., space, time and resources). References

Les infirmières canadiennes connaissent les médicaments biosimilaires de manière générale, mais leur compréhension de certains aspects spécifiques peut être morcelée; un important besoin de formation existe donc à l'heure actuelle. Pour aider les infirmières canadiennes à mieux comprendre les médicaments biosimilaires dans le paysage du traitement oncologique et pour répondre à certaines préoccupations liées aux agents biosimilaires, ce Supplément vise à :* présenter les médicaments biologiques en général, avec leur mode de production;* décrire la biosimilarité et les médicaments biosimilaires en les comparant aux médicaments biologiques de référence;* expliquer les mécanismes d'action des médicaments biosimilaires comparativement aux médicaments biologiques de référence;* détailler les étapes conduisant au développement d'un médicament biosimilaire;* discuter de l'extrapolation des indications pour les médicaments biosimilaires (« totalité des preuves » pour les médicaments biosimilaires);* aborder l'interchangeabilité et la substitution des médicaments biosimilaires;* présenter le processus d'approbation des médicaments biosimilaires par Santé Canada;* parler du rôle des infirmières dans l'introduction des médicaments biosimilaires et la surveillance des patients.

An empirical approach was used to test the applicability of Holtzworth-Munroe and Stuart's (1994) typology of marital violence perpetrators to a dating violence population. Two hundred and forty-five male college students admitted to perpetrating some form of violence against their dating partners, with a total sample size of 417. Three types of perpetrators emerged from cluster analysis. These types were basically as hypothesized: Relationship Only perpetrators were the least pathological and aggressive, Dysphoric/Borderline perpetrators had the most borderline and dependent personality features and were the most depressed, and Generally Violent/Antisocial perpetrators were the most antisocial and narcissistic overall, committed the most extra-relationship aggression, and were involved in the most illegal activities. An unexpectedly high amount of alcohol consumption was reported across all subtypes, including Non Perpetrators. Overall, there was support for a similar typology among dating violence perpetrators as marital perpetrators.

The Strait of Georgia, Canada, is an important region for numerous commercially and culturally important species (e.g., herring, salmon, and orcas), yet little is known about the links between lower trophic level (e.g. phytoplankton and zooplankton) phenology due to historical sampling gaps. Here, we present fourteen years (2003-2016) of data linking interannual variability in phytoplankton and zooplankton phenology in the Central Strait of Georgia, BC. Satellite-derived chlorophyll a (Chl a ) data were used to calculate spring bloom dynamics (bloom initiation, bloom intensity, and bloom magnitude). Average spring bloom initiation occurred during the last week of March in the Central Strait of Georgia. Bloom initiation occurred in mid-to-late February/early March during “early” Chl a bloom years (2004, 2005, and 2015) whereas initiation did not occur until the end of April during “late” bloom years (2007, 2008). Spring Chl a bloom initiation was significantly correlated with the North Pacific Gyre Oscillation (NPGO; r = 0.75, p < 0.01) and spring sea surface temperature (SST; r = -0.70, p < 0.01); spring blooms occurred earlier during warm years. When all environmental variables were considered together, NPGO best explained variations in spring bloom initiation (Adj R 2 = 0.53, p < 0.01) and bloom magnitude (Adj R 2 = 0.57, p < 0.01), whereas stratification best explained variations in bloom intensity (Adj R 2 = 0.38, p < 0.05). Early Chl a blooms were associated with high crustacean abundance (maximum of > 1000 ind m -3 ) but low biomass (37.5 mg m -3 ). Independent of the Chl a data, hierarchical cluster analysis revealed similar groupings of years for crustacean abundance data. Most notably, community composition in cluster Group 2 (2004, 2005, and 2015; early Chl a bloom years), was comprised of a higher proportion of small crustaceans (e.g. non-calanoid copepods) compared to the other cluster groups. To our knowledge, this study provides the first evidence linking early spring Chl a bloom timing to a shift in the crustacean community towards smaller taxa in response to multiple warm events in the Strait of Georgia. Our results show that early Chl a blooms may potentially result in a mismatch between phytoplankton and large energy-rich crustacean zooplankton, with lower abundances of the latter. In contrast, average Chl a bloom years were optimal for large-bodied euphausiids, whereas late Chl a blooms were a match for some crustaceans (e.g., medium calanoid copepods), but not others (e.g., large calanoid copepods and amphipods). We hypothesize that early bloom years may result in poorer feeding conditions for juvenile salmon and other predators in the region.

The cost of healthcare in the United States has increased over time. However, patient health outcomes have not trended with spending. There is a need to better comprehend the association between healthcare costs in the United States and hospital quality outcomes. Medicare spending per beneficiary (MSPB), a homogeneous metric across providers, can be used to evaluate the association between episodic Medicare spending and quality of care. Fifteen inpatient outcome measures were selected from Hospital Compare data among all (n = 4758) facilities and transformed to quintiles to ensure comparability across measures and to reduce the influence of outliers on the analysis. Both univariate and multiresponse multinomial ordered probit regression models were utilized across outcome domains to quantify associations between outcomes and spending. We found that MSPB was not associated with quality of care in most cases, adding evidence of a lack of outcome accountability among Medicare-funded facilities. Furthermore, worse outcomes were found to be associated with increased spending for some metrics. Policies are needed to align quality of care outcomes with the increasing costs of U.S. healthcare.