Group 1: Tuesday, August 10, 2021
Hannah Trites
Patient navigation programs for people with dementia, their caregivers, and members of the care team: a scoping review
Other Authors: Dr. Shelley Doucet and Dr. Alison Luke
University of New Brunswick, Saint John
Other Authors: Dr. Shelley Doucet and Dr. Alison Luke
University of New Brunswick, Saint John
Dementia care is currently fragmented, which creates numerous barriers for those trying to navigate health and social care services. Patient navigation (PN) is a model of care that can improve the integration of dementia care. This scoping review seeks to explore the existing literature on the characteristics of PN programs for people with dementia, their caregivers and/or the care team. This review was conducted using Joanna Briggs Institute (JBI) methodology. Five databases were searched (Medline, CINAHL, PsycINFO, EMBASE, and ProQUEST) to retrieve peer-reviewed published papers. The search strategy was implemented and externally peer-reviewed using PRESS guidelines. A grey literature review was also conducted. A total of 5,198 articles were retrieved and 45 were included. Twenty-four different PN programs were found, with over half based in the United States. The majority were community-based and offered through a combination of in-person and phone. Most programs were intended for people with dementia and their caregivers. There was a lack of consistency in the professional titles of the navigator; however, most used variations of the term’s “coordinator” and “navigator”. The primary barrier associated with dementia PN programs is navigator burnout, with the most common facilitators being collaboration and communication between key stakeholders. These findings provide insight into how PN programs are operationalized and implemented and can be useful for individuals or organizations looking to implement a PN program of their own. In addition, this information will provide a framework for future reviews looking to explore the effectiveness of dementia navigation programs.
Allyson Lamont
Food Insecurity, Mental Health Service Use, and Medical Healthcare: The Role of Depression
Other Authors: Dr. David Speed
University of New Brunswick, Saint John
Other Authors: Dr. David Speed
University of New Brunswick, Saint John
Millions of Canadians report insufficient access to food, a situation that is described as ‘food insecurity’ (FI). Research suggests that FI is associated with increased use of medical healthcare services, but also decreased access to these same services. Importantly, people who are food insecure report a plethora of negative health consequences, such as depression which itself can affect healthcare access. Further, it is unclear how FI affects access to mental health services, as the literature is relatively lacking in this area. The current study aimed to clarify the relationships that FI exhibits with mental health service use, healthcare service use, and barriers to accessing healthcare, while also investigating the role of depression as a potential mediator, given its associations with all relevant factors. Data was obtained from the results of the nationally representative 2013-2014 Canadian Community Health Survey (minimum n = 397). Binary and logistic regression analyses were conducted using Stata software to investigate proposed mediational models. Results indicated that depression acted as a partial mediator between FI and several medical/mental healthcare outcomes: accessing medical services for a diagnosis or consultation, accessing mental health services, and visiting a general practitioner about mental health. Findings from the current study highlight the disadvantages that Canadians who are food insecure and/or depressed face in accessing both medical and mental healthcare services. Given that FI and mental illness are both current public health issues in Canada, this research is timely.
Twitter: @allysonlamont
Twitter: @allysonlamont
Dawson Nancekievill
The impact of sprint interval training with or without weight loss on substrate oxidation in adults
Other Authors: Dr. Benjamin Colpitts and Dr. Martin Senechal
University of New Brunswick, Fredericton
Other Authors: Dr. Benjamin Colpitts and Dr. Martin Senechal
University of New Brunswick, Fredericton
Endurance exercise training and weight loss (WL) has been associated with changes in fat oxidation (FO). However, there is limited evidence investigating the impact of sprint interval training (SIT) induced WL on FO in adults. Thus, the primary objective was to investigate the impact that four weeks of SIT with or without WL has on FO at rest and during a submaximal bout of exercise in adults. Thirty-four adults aged 19 to 60 years took part in four weeks of SIT consisting of repeated 30-second Wingates separated by four minutes of active recovery three times per week. Respiratory exchange ratio (RER) was measured with indirect calorimetry (VCO2/VO2), while FO (g/min) was estimated using the formula FO=1.695*VO2-1.701*VCO2. Outcome measures were quantified at rest and during submaximal exercise at baseline and post-intervention. Participants were classified to a WL group (weight change < 0kg) or a non-WL group (weight change ≥ 0 kg). A significant interaction effect was observed between time and WL groups for submaximal RER and FO (all ps<0.05). Submaximal RER (0.96 ± 0.08 to 0.92 ± 0.06; p=0.030) and FO (116.9 ± 223.7 g/min to 248.8 ± 165.3 g/min; p=0.008) were both significantly improved in the WL group and were significantly different from the non-WL group (all ps<0.05). Short-term SIT-induced WL elicited significant improvements in submaximal RER and estimated FO in adults and should be recommended as a time-efficient method of increasing FO in adults.
Jennifer Clarke
Trauma patient navigation models across Canada: an environmental scan
Other Authors: Dr. Shelley Doucet, Dr. Alison Luke and Taylor Fearon
University of New Brunswick, Saint John
Centre for Research in Integrated Care
Other Authors: Dr. Shelley Doucet, Dr. Alison Luke and Taylor Fearon
University of New Brunswick, Saint John
Centre for Research in Integrated Care
The care of injury-related trauma patients is often fragmented as patients make frequent transitions across a multitude of independent services and providers. Patient navigators within trauma programs provide a solution to many barriers by providing patient-centered care coordination. In this environmental scan we aimed to (1) to characterize the current state of patient navigation within trauma centres across Canada; (2) to inform the creation of a patient navigator position with the New Brunswick Trauma program. We interviewed individuals representing each of the 45 major trauma centres across the country. Interviews were transcribed and data was analyzed using content analysis. Data was categorized into the following roles: patient needs assessment and care planning; connecting patients/families to resources; care coordination in hospital; educating patient, families and/or the care team; navigation support following discharge; and advocacy. The majority of trauma programs in Canada reported having a position that performs all or most of the six defined roles of a trauma patient navigator. The title of the navigator varied, as did their professional background. Overall, there is variability across programs. This scan provides an overview of trauma patient navigation across the country. It is clear that most Canadian trauma centres have navigational support for their population. It must be taken into consideration that some trauma programs serve different types of populations, including rural, metropolitan, and northern. This information will inform the development of two patient navigator positions for the NB Trauma program.
Emma Manning
The rapid COVID-19 vaccine development: analyses of international process development and business models
Other Authors: Dr. Greg Fleet, Mr. Daniel Doiron and Dr. Alli Murugesan
University of New Brunswick, Saint John
BioHuntress Therapeutics Inc.
Other Authors: Dr. Greg Fleet, Mr. Daniel Doiron and Dr. Alli Murugesan
University of New Brunswick, Saint John
BioHuntress Therapeutics Inc.
Driven by need during the COVID-19 pandemic, the established timelines of vaccine research and development (R&D) have been accelerated. Traditionally, these timelines exceed 10 years and yet, a vaccine for SARS-CoV-2 was granted emergency authorization less than a year after the first infection. In this study, using a comprehensive literature search approach, we explored how key innovations allowed for such an accelerated timeline to be achieved. We found that this acceleration can be attributed to two main factors: scientific technological advancement, and novel strategic relationships between government and industry. Innovative technologies developed during SARS-CoV and MERS outbreaks enabled rapid translation of research to clinical trials. In addition, research efforts were supported by massive economic support exceeding $10 billion USD, a large population of clinical trial volunteers, and investment of large multinational companies. Furthermore, strategic adaptations of R&D timelines through collaboration with regulatory agencies, allowed for acceleration of clinical trial phases. Much shorter timelines were achieved as phases were run in parallel and were adapted as new data became available. In summary, we found that rapid vaccine development is possible in a modified R&D landscape although it does not come without risk generated by shorter clinical trial periods. These risks can be mitigated through optimization of development pathways, allowing for more data to be assessed rapidly. In the future, these strategies implemented in the development of COVID-19 vaccines will shape a faster and more efficient R&D landscape allowing for innovation in the development of new drugs for combating devastating human diseases.
Eric Plant
Use of radiography by nursing home residents in Saint John
Other Authors: Rose McCloskey, Jacqueline Fraser, Dr. Chola Shamputa, Dr. Kavish Chandra, Dr. Tushar Pishe, Dr. Paul Atkinson and Pat Price
University of New Brunswick, Saint John
Saint John Regional Hospital Emergency Medicine
Dalhousie University Medicine
Other Authors: Rose McCloskey, Jacqueline Fraser, Dr. Chola Shamputa, Dr. Kavish Chandra, Dr. Tushar Pishe, Dr. Paul Atkinson and Pat Price
University of New Brunswick, Saint John
Saint John Regional Hospital Emergency Medicine
Dalhousie University Medicine
Transfer of nursing home residents (NHRs) to hospital for diagnostic imaging is common and often requires an ambulance for transport. Questions about whether these transports are necessary have prompted some jurisdictions to implement mobile radiography services. Data on NHRs who receive imaging in New Brunswick is currently unavailable. Understanding these patterns is essential to determine whether mobile radiography would improve care locally and/or be cost effective. Retrospective data on the XR or CT investigation conducted on NHRs in one community over the period of one year was analyzed. Data on presenting complaint, specific diagnostic imaging order, and admission/discharge time, and date were also examined. There were 521 visits by NHRs involving imaging with 920 orders (688 XRs and 232 CTs). Most investigations were ordered in the emergency department (ED) (75.6%) with the remaining (24.4%) arranged and provided in outpatient departments. About half (52.1%) of the visits to the ED that required imaging resulted in a hospital admission. Of the NHRs who received imaging in the ED, 23.0% received only XR (no CT scan) and were discharged back to the nursing home. The ED is the primary means through which NHRs receive XR and CT scans and about a quarter (23.0%) of visits to the ED by NHRs fit the profile of visits that could potentially be avoided with a mobile radiography service.
Jennifer Splane
Programmes to support pediatric to adult healthcare transitions for youth with complex care needs: a scoping review
Other Authors: Dr. Shelley Doucet and Dr. Alison Luke
University of New Brunswick, Saint John
Other Authors: Dr. Shelley Doucet and Dr. Alison Luke
University of New Brunswick, Saint John
An increasing number of North American children have complex care needs (CCN) that impact their health and cause limitations in their lives. More of these youth are transitioning from pediatric to adult healthcare as a result of complex conditions being increasingly associated with survival into adulthood. Typically, the transition process is plagued by barriers which result in further adverse health consequences. As a result, there is an increased need for transitional care interventions when moving from pediatric to adult healthcare and to date, literature associated with this process has not been systematically examined. The objective of this scoping review is to map the range of programs in the literature that support youth with CCN between the ages 14 to 25, and their families as they transition from pediatric to adult healthcare. The review was conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews and followed the nine steps within this framework. An updated search from May 2021 located published articles using the PubMed, CINAHL, ERIC, PsycINFO, and Social Work Abstracts databases. The search yielded 1,523 studies, of which 51 articles were included. Study objectives included: transition program, intervention, or innovation descriptions; patient needs assessments; study protocols, and reviews of current guidelines and tools. This review consolidates available information about interventions designed to support youth with CCN through their successful transition from pediatric to adult care. The results will help to inform further research, as well as transition policy and practice advancement.
Group 2: Wednesday, August 11, 2021
Dr. Kathryn Asher
Canadian dietic professionals' impression of, and nutrition counselling around, the expanded federal guidelines on plant proteins and non-dairy sources of calcium.
Other Authors: Dr. Shelley Doucet and Dr. Alison Luke
University of New Brunswick
Other Authors: Dr. Shelley Doucet and Dr. Alison Luke
University of New Brunswick
The latest version of Canada’s Food Guide has an increased focus on plant-based proteins and eliminated the longstanding milk and alternatives food group. While these updates have received substantial media attention, there has been little evidence about dietitians’ views of these changes. In response, a study was undertaken to understand Canadian registered dietitians' attitudes and behaviors towards the food guide’s expanded plant-based recommendations. Between January and March 2020, a cross-sectional online survey was administered to practicing registered dietitians across Canada. The research was piloted, pre-registered, and received university ethics approval. Descriptive and inferential statistics were used for the quantitative data while the open-text responses were analyzed using thematic analysis. The sample consisted of N = 411 dietitians who represented 10 Canadian provinces. More than four-fifths of respondents (82.8%) considered the new guideline about selecting plant proteins more often to be evidence-based. In comparison to the previous food guide, dietitians reported that they encourage their patients and clients to select plant-based proteins (p < 0.001) and non-dairy calcium sources (p < 0.001) significantly more often under the new guide. Slightly more than half (57.7%) of participants were in favour of the elimination of the standalone milk and alternatives food group. Registered dietitians in Canada generally look positively on the expanded focus on plant proteins and non-dairy sources of calcium that is found in one of the most recognizable diet-related educational tools in Canada.
Dr. Lillian MacNeill
Caregiver experiences with transitions from pediatric to adult healthcare for youth with complex care needs in New Brunswick
Other Authors: Dr. Alison Luke and Dr. Shelley Doucet
University of New Brunswick, Saint John
Other Authors: Dr. Alison Luke and Dr. Shelley Doucet
University of New Brunswick, Saint John
Inadequate support during the transition from pediatric to adult care for youth with complex care needs can lead to negative outcomes. This transition is a pivotal event for caregivers as well as the youth themselves. The current study explores caregiver experiences with the transition from pediatric to adult care for youth with complex care needs in NB. We used a qualitative descriptive design involving semi-structured interviews with 17 caregivers of youth with complex care needs. Data was analysed using thematic analysis. Five key themes emerged from the data. Caregivers stressed the importance of continuity of care, as they experienced difficulty accessing support and resources during and after this transition. They also described the necessity of collaborative care; a team approach that includes caregivers and youth. Caregivers wanted help with the coordination and navigation of care during this period and expressed a need for care provider training around the transition from pediatric to adult care. Finally, there was a substantial caregiver burden associated with this transition, as caregivers expressed frustration and exhaustion over constantly advocating for their youth and fighting for services. An effective transition strategy would help to address the challenges experienced by youth with complex care needs and their caregivers during and after this transition in care. The transition should involve early and coordinated planning between the pediatric and adult care team, require continued communication across the care team throughout the transition process, and acknowledge the need for coordination between health, education, and social services.
Mario Jones
Rapid sequence intubation success rates at a Canadian community emergency department: An EM-AWARE study
Other Authors: Ms. Jillian Allan, Dr. Dr. Kavish Chandra and Dr. James French
Dalhousie University
Saint John Regional Hospital Department of Emergency Medicine
Other Authors: Ms. Jillian Allan, Dr. Dr. Kavish Chandra and Dr. James French
Dalhousie University
Saint John Regional Hospital Department of Emergency Medicine
Rapid sequence intubation involves quickly sedating, paralyzing, and introducing an artificial airway in a critically ill patient who requires emergent airway management. This high-risk and complex procedure requires extensive training for the operator and careful selection of sedative and paralytic medications. We are currently unaware of procedural success rates of emergency airway intubations, medications used, and complications that occur with emergency airway intubations among Canadian community emergency departments. Existing emergency airway registries focus on large, often American, academic medical centres. To meet these multiple goals, we have created the Emergency Medicine AirWAy REgistry (EM-AWARE). The first phase of our study determines the first-attempt success rate of emergency intubations at the Saint John Regional Hospital Emergency Department (SJRH-ED) and compares success rate based on use and choice of paralytic medication. All eligible patients requiring emergency intubation at the SJRH-ED from 2015-2019 were included retrospectively in the EM-AWARE registry. We hypothesize that there is a higher first-attempt success rate in emergency intubations performed with paralytic medications compared to intubations without paralysis and with rocuronium compared to succinylcholine. The findings of this study will allow us to determine the procedural success rate of emergency intubation at our institution and whether paralytic use and type improve intubation success rates.
Maya Willms
A practical and reliable method for volumetric assessment of brain tumour features on MRI,
Other Authors: Dr. Mathias Schmidt, Dr. Adrienne Weeks and Dr. Chris Bowen
Dalhousie University
Other Authors: Dr. Mathias Schmidt, Dr. Adrienne Weeks and Dr. Chris Bowen
Dalhousie University
Serial magnetic resonance imaging (MRI) is currently the only way to recognize progression of low-grade gliomas to glioblastoma multiforme (GBM) and to detect post-treatment recurrence of GBMs. Liquid biopsy can detect extracellular vesicles (EV) shed into the blood stream by GBMs, offering a complementary approach to tumour surveillance. However, it is not known how counts of EVs correlate with features of tumour progression and recurrence on MRI. Our ultimate goal is to determine this correlation in a cohort of patients with low-grade gliomas and GBMs. Standard Response Assessment in Neuro-oncology (RANO) uses bi-dimensional linear measurements as a surrogate for tissue volume. The goal of the present study is to develop a reliable volumetric assessment of MRI-based tumour features, using readily available clinical image post-processing software. We developed a protocol for volumetry of gadolinium-enhancing tumour tissue and FLAIR hyperintense tissue in untreated GBMs, using segmentation and quantification tools embedded in ReadyViewTM software (GE Healthcare, Chicago, IL). We then assessed reliability with triplicate measurements by two independent raters. Inter-rater reliability was excellent, with estimates of intraclass correlation coefficients (ICC) of 0.99 and 0.98 for the measurement of gadolinium-enhancing tumour tissue and FLAIR hyperintense tissue, respectively. Intra-rater reliability was also excellent, with estimates of ICC ranging from 0.91 to 0.99 across raters and features. The more practised rater consistently achieved coefficients of variation < 10%. We conclude that our protocol is reliable and that a practised rater can detect changes in the volume of gadolinium-enhancing tissue and FLAIR hyperintense tissue ≥ 10%.
Patrick Hickey
Access to healthcare and psychological wellness and distress in lesbian-gay-bisexual Canadians
Other Authors: Dr. Lisa Best and Dr. David Speed
University of New Brunswick, Saint John
Other Authors: Dr. Lisa Best and Dr. David Speed
University of New Brunswick, Saint John
Sexual minorities have been shown to face greater barriers to healthcare as well as increased discrimination, stigmatization, and negative experiences during healthcare visits compared to the general population. Given the limited research on sexual minorities in Canada, differences in healthcare access for LGB and non-LGB individuals are largely unknown. The purpose was to examine associations between sexual minority status and perceived healthcare access, and psychological wellness and distress. Data from the 2015-16 CCHS (Canadian Community Health Survey) was used to investigate perceptions of healthcare access and unmet needs as well as differences in psychological wellness (satisfaction with life) and distress (depression, anxiety, suicidality) among LGB and non-LGB Canadians. A series of hierarchical linear regressions were used to compare measures of healthcare access and psychological wellness and distress. Results indicated that although LGB and non-LGB Canadians reported comparable perceived access to healthcare services (M = 0.28 vs 0.24), LGB Canadians reported significantly higher unmet health needs (M = 0.12 vs 0.03). Depression and anxiety disorders were significantly higher for the LGB sample, which is consistent with previous research. However, non-significant differences were observed on the measure of suicidal thoughts and attempts. Further research is needed to address the continued inequalities in the healthcare system between LGB and non-LGB Canadians despite similar access to services as demonstrated through this study. In addition, future research must address the limitations of the CCHS as it does not include comprehensive measurements of sexuality and gender identity.
Poppy Jackson
Using readers theatre as an innovative knowledge translation approach for health research
Other Authors: Dr. Alison Luke, Dr. Shelley Doucet, Dr. Sandra Bell, Ore Alugo, and Amy Reid
University of New Brunswick, Saint John
Other Authors: Dr. Alison Luke, Dr. Shelley Doucet, Dr. Sandra Bell, Ore Alugo, and Amy Reid
University of New Brunswick, Saint John
Arts-based knowledge translation (KT) methods are increasingly being used in health research as an engaging approach for communicating research findings. The present study examines the effectiveness of Readers Theatre (RT) – short, theatrical vignettes presented by audience volunteers – as a tool to disseminate qualitative interview findings on the experiences of children with complex care needs, their caregivers, and care providers. Our team developed a series of RT scripts based on interview data which cover themes related to barriers to care, gaps in services, collaboration and coordination among care providers, navigating the system, and advocating for care. Scripts were piloted at a workshop for caregivers, where attendees volunteered to present the scripts and engaged in semi-structured discussion about key topics. Data was collected through a questionnaire completed by participants on the effectiveness of RT. A total of 30 workshop attendees completed the questionnaire, including informal caregivers, care providers, patients, and interested community members. Ninety percent of attendees indicated that this was their first experience with RT. A majority of respondents strongly agreed (65%) or agreed (31%) that observing the RT presentations helped them connect to the material, and 82% indicated that the scripts reflected their own experiences. Overall, 62% strongly agreed and 35% agreed that RT was a useful tool to transfer knowledge, with no participants disagreeing. This pilot project demonstrated that RT is an impactful way of sharing health research findings that brings the experiences of caregivers and care providers to life and provokes thought and discussion.
Sarah Malashevsky
Predicting well-being during the COVID-19 pandemic
Other Authors: Dr. Rico DiTommaso, Dr. Bryn Robinson and Dr. Caroline Brunelle
University of New Brunswick, Saint John
Horizon Health
Other Authors: Dr. Rico DiTommaso, Dr. Bryn Robinson and Dr. Caroline Brunelle
University of New Brunswick, Saint John
Horizon Health
Preventing the spread of Coronavirus disease (COVID-19) has put people’s well-being at risk. The availability of resources for positive coping with pandemic stress (PS), determines overall well-being. High pandemic stress increases the risk of reduced well-being. It is possible that resilience is a mechanism that mediates the relationship between pandemic stress and the degree to which people experience well-being. Flourishing is a tangible product and dimension of wellbeing. The current study examined the mediating role of resilience in the relationship between PS and well-being. Three hundred English-speaking North American participants completed measures assessing their experience of pandemic stress, positive and negative emotions, perceptions of psychological well-being, satisfaction with life, and resilience. Findings indicated that higher levels of PS are associated with less resilience and that less resilience leads to lower levels of well-being. The latter findings support the mediating role of resilience.
