Regulation Of Health Ai Chatbots In Ontario, Mingi Chu

Electronic Thesis and Dissertation Repository

Artificial Intelligence (AI) has made remarkable strides in healthcare, from revolutionizing medical imaging, patient support, research insight, and health education. However, a recent shift from query-based to interactive and regenerative AI presents a question of properly facilitating its development. Upon close inspection, regulations and policy adaptations lag behind the rapidly advancing field of medical AI which raises concerns over governance and societal implications. This paper explains some of the technical and ethical considerations surrounding the use of health AI applications with chatbots as a specific example. It evaluates the existing policies and regulations in Ontario, Canada, that govern the production …

The Population-Centered Medical Model: A Theory Of Practice For Public Health And Preventive Medicine, Sudit Ranade

Electronic Thesis and Dissertation Repository

Introduction

Public health physicians occupy a unique place in the fields of both medicine and public health. Trained in each field, and often holding positions of authority in public health systems, public health physicians are sometimes challenged to identify their roles in either field of practice. Public health physicians work to achieve population health, but there has been limited theoretical development in this field of practice.

Objectives

The objective of this research was to develop an empirical theory of practice for public health physicians.

Methods

A literature review of current practice models applicable to public health physicians was performed. A …

Sex And Gender Differences In Arthritis Health Information, Tania Al-Jilawi

Electronic Thesis and Dissertation Repository

Arthritis is a common disorder that may result in pain and inflammation, making it challenging to move or continue being active. Arthritis comes in a variety of forms. The two studies of this thesis aimed to identify the influence of intersectionality, especially sex and gender, in arthritis. The first study, a structured review, evaluated the inclusion of sex/gender and intersectional identities in patient resources of three arthritis societies: the Canadian Arthritis Society, the American Arthritis Foundation, and the National Rheumatoid Arthritis Society. The appraisal tool, the Sex/Gender and Intersectional Considerations in Patient/Consumer Health Information Appraisal Tool was used to evaluate …

Lbnp Reduces Cerebral Perfusion But Does Not Impact Executive Function, James Van Riesen

Electronic Thesis and Dissertation Repository

A growing body of literature has demonstrated that a single bout of aerobic exercise and/or hypercapnic manipulations increase cerebral blood flow (CBF) and are linked to a transient (i.e.,min) post-intervention executive function (EF) benefit. However, there are no direct studies examining whether a transient decrease in CBF elicits a post-intervention EF decrement. Accordingly, my thesis employed 10-min single bout manipulations of -30 mmHg and -50 mmHg lower-body negative pressure (LBNP) to determine whether a transient reduction in CBF impacts EF. LBNP was applied as it renders sub-atmospheric pressure to the lower limbs and redistributes blood from the upper to lower …

Jumping Ship And Going To The Other Side: Experiences Of Nurses Who Retrain As Doctors, Anne Robinson

Electronic Thesis and Dissertation Repository

Aim: To gain an understanding of the experience of medical training for nurses who retrain as doctors.

Methods: Using a Constructivist Grounded Theory design, semi-structured interviews were conducted with thirteen medical students and residents who had completed nursing training prior to entering medical school. Interviews were audiotaped and professionally transcribed. Transcripts were coded and analysis in an inductive manner to construct central themes.

Findings: Many left nursing due to negative effects of a hierarchal system. As preclinical medical students they felt both advantaged and burdened by their advanced clinical knowledge. During clinical placements, they experienced social distress and role confusion …

Transformational Leadership Approach For Encouraging Historically Marginalized Communities To Access Admission To Naturopathic Medicine, Baljit Khamba

The Dissertation in Practice at Western University

Many healthcare training institutions lack cultural diversity, including naturopathic medicine. One potential reason is a lack of historically marginalized individuals applying to these medical schools. Attracting communities of colour to healthcare professions, like naturopathic medicine is important for improving healthcare access and delivery across all individuals within North America. This OIP explores the lack of diversity in applicants to the naturopathic medical program at a large multi-centre institution. The role that education and mentorship of faculty members can play to improve implicit biases and eventually encourage historically marginalized individuals to apply to the program is explored. Moreover, the OIP presents …

The Role Of Patient And Rehabilitation Factors In The Recovery Of Home And Family Work Roles Following Distal Radius Fracture, Sheena Saju Philip Ms.

Electronic Thesis and Dissertation Repository

Background: Distal radius fracture (DRF) is a common upper extremity fracture that causes significant impairment and leads to difficulties in fulfilling important life roles such as indoor and outdoor cleaning, meal preparation, grocery shopping, caring for others, and earning and managing family income. However, clinicians do not routinely address home and family life roles after a DRF. Patient and rehabilitation factors are crucial in addressing home and family work roles (HFWRs). The HFWR questionnaire consists of tasks that are typically performed at home.

Objective: The overarching objective of this thesis is to explore the role of patient and rehabilitation …

"We Are The Living Dead": The Gendered Impacts Of Open-Pit Mining In The Dominican Republic, Klaire Gain

Electronic Thesis and Dissertation Repository

Despite a rhetorical commitment to enhancing community well-being, Canadian mining corporations have a history marked by ecological degradation and human rights violations, with women experience disproportionately negative impacts. While Latin America and the Caribbean (LAC) is a desired topography for open-pit mining, the geographical area of the Dominican Republic has been largely absent from the literature. As such, this dissertation, rooted in decolonial ecofeminism, enacted a critical narrative inquiry with 7 women from the Dominican Republic to explore the gendered impacts of open-pit mining on their health and well-being.

This thesis is composed of six chapters, with chapter one introducing …

Intimate Partner Violence, Mental Health Services And The Covid-19 Pandemic In Ontario: What Are The Differences, If Any, In Mental Health Service Accessibility And Service Satisfaction During Covid-19 Between Women In Abusive Relationships And Women In Non-Abusive Relationships?, Nokuzola Ncube

Electronic Thesis and Dissertation Repository

Introduction: Intimate partner violence (IPV) increased during the COVID-19 pandemic in Canada as a result of increased economic pressures and social isolation brought on by stay-at home orders. During the COVID-19 pandemic, women experiencing IPV experienced declines in mental health conditions and unique difficulties in accessing mental health services amid closures, shifts in service delivery, and inconsistent availabilities.

Methods: An online survey was administered to 44 women living in Ontario (23 who had not experienced IPV and 16 who had not) to explore their satisfaction and access to mental health services during the COVID-19 pandemic. Descriptive statistics were used to …

Developing An Online Questionnaire To Investigate The Covid-19 Pandemic’S Impacts On Social Isolation And Health In Older Adults Living With Multimorbidity: A Pilot Study, Patricia Nistor

Electronic Thesis and Dissertation Repository

Introduction. Social restrictions preventing the spread of COVID-19 possibly increased social isolation and loneliness. The validity and reliability of a questionnaire assessing the COVID-19 pandemic’s impact on social isolation and loneliness in community dwelling older adults with multimorbidity was investigated.

Methods. A conceptual framework was developed to guide questionnaire construction. Participants were recruited through professional networks, comprising a convenience sample. Feedback interviews assessed usability and face validity. Content validity was assessed using a Content Validity Matrix, and construct validity through tests of association. Reliability of validated scales was assessed using Cronbach’s ⍺. Descriptive statistics and logistic regression were computed. …

The Process Of Art Creation Among Mothers From Ontario Who Have Experienced Gender-Based Violence, Madison L. Broadbent

Electronic Thesis and Dissertation Repository

Mothers who have experienced gender-based violence (GBV) face physical, mental, and social health implications. Participating in artmaking has the potential to reduce these consequences. An arts-based study including in-depth interviews was conducted with 13 mothers with histories of GBV. The creative processes involved in artmaking amongst mothers with histories of GBV were explored. Mothers demonstrated using symbols, thoughtful colour selection, and choice of artistic medium when creating their artforms. Moreover, mothers’ experiences of storytelling experiences of GBV through art were examined. Mothers described using art as a means of communication, emotional processing and healing through art, and the process of …

Fracture Prediction And Prevention In Individuals With Chronic Kidney Disease, Andrea C.J. Cowan

Electronic Thesis and Dissertation Repository

Patients with chronic kidney disease (CKD) face increased fracture risk yet our understanding and management of this risk remains poor. We conducted three studies using retrospective cohort analysis in Ontario, Canada. We developed a 3-year fracture prediction model for patients receiving dialysis. Secondly, we contrasted fracture rates among patients on SGLT2i or DPP4i medications, stratified by kidney function. Lastly, we examined hypocalcemia incidence post-denosumab prescription, stratified by kidney function.

Findings: The fracture risk tool, incorporating demographic and lab data, performed well (AUC 0.72). SGLT2i did not elevate fracture risk vs. DPP4i (HR 0.95 [95% CI 0.79,1.13]). In those prescribed denosumab, …

Social Connectedness, Adolescent Mental Health And Well-Being At The Later Stages Of The Covid-19 Pandemic: A Mixed Methods Exploration, Sarah Abdunnabi

Electronic Thesis and Dissertation Repository

COVID-19 posed novel challenges by limiting in-person interactions and shifting interactions online. Effects of online and offline social connectedness on adolescent mental health and well-being, and the moderating role of the social determinants of health (SDoH) were explored. Canadian adolescents (n=1,586; M_age=15.3, range 13 to 18 years; surveyed summer 2022) reported their social connectedness, psychological distress, and mental well-being. An ordinal logistic regression was performed to examine the association between social connectedness (online and offline) and dual-factor mental health. Responses to two open-ended survey questions were analyzed. Social disconnection was associated with higher odds of being in a …

Association Of Fall-Related Injuries And Different Diagnoses In Older Adults Of Ontario: A Machine Learning Approach, Sorour Rostampour

Electronic Thesis and Dissertation Repository

Falls are the leading cause of injury-related hospitalizations among older adults in Canada. This study aimed to identify the most informative diagnostic categories associated with fall-related injuries (FRIs) using three machine learning algorithms: decision tree, random forest, and extreme gradient boosting tree (XGBoost). Secondary data from two Ontario health administrative databases (NACRS, DAD) covering the period 2006-2015 were analyzed. Older adults (aged ≥ 65 years) who sought treatment for FRIs in emergency departments (ED) or hospitals, as indicated by Canadian version of the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10-CA) codes for falls …

About Dying And Death: Thanatology's Place In Medical Curriculum, Jill Dombroski

Electronic Thesis and Dissertation Repository

This study explored how healthcare providers engage in advance care planning and end-of-life care conversations. The research explored what shapes their understanding and the extent to which concepts from thanatology they intuitively bring in, explicitly bring in, and maybe fail to recognize. To achieve this, constructivist grounded theory (CGT) methodology guided the design, data collection, analysis, and interpretation of the findings, which allowed for iteration across interviews and analysis with existing theories and data in the literature. The CGT design encouraged further engagement with the literature in an ongoing iterative fashion as well as with the analysis of the data. …

The Impact Of Access To Oral Health Care On Inadequate Oral Health And Multimorbidity, Luis Limo

Electronic Thesis and Dissertation Repository

The connection between oral health and other non-communicable chronic conditions—commonly referred in the dental literature as the oral-systemic health connection—emphasizes the role of oral health care on both oral diseases and chronic conditions, particularly in vulnerable populations like the elderly. This thesis comprises 2 studies: the first is a systematic review on the impact of oral health care interventions, as an indicator of access to oral health care, on chronic conditions of which their co-existence would result in multimorbidity; the second study is a cross-sectional investigation of the associations between oral health, access to oral health care, and multimorbidity among …

A Comparison Of The Thulium Fiber Laser Versus Holmium:Yag Laser Lithotripsy Of Upper Urinary Tract Calculi: Preliminary Results Of A Randomized Prospective Clinical Trial, Eduardo Gonzalez Cuenca

Electronic Thesis and Dissertation Repository

The Holmium:yttrium-aluminium-garnet (Ho:YAG) laser has become an indispensable tool in Endourology since its introduction in 1995, due to its safe and efficient urinary stone fragmentation capabilities. The Thulium Fiber Laser (TFL), is the latest innovation with early clinical experience suggesting improvements over the Ho:YAG. This prospective, randomized controlled study aims to compare clinical outcomes of Ho:YAG versus TFL lithotripsy for upper urinary tract calculi. Patients undergoing ureteroscopy for renal stones (size 8-20mm, density >600 HU) from a single institution were prospectively recruited.

Thirty-eight patients have been recruited (Ho:YAG=20, TFL=18). The laser-on time (p=.330), total operative time (p …

Understanding The Information Needs Of Clients And Caregivers Regarding Early Psychosis: A Conventional Content Analysis, Tanvin K. Juneja

Electronic Thesis and Dissertation Repository

A first episode of psychosis is defined by the first presentation of psychotic symptoms that have gone untreated, characterized by a loss of contact with reality and significant declines in functioning. Low psychosis literacy among clients and caregivers can result in a delay in receiving treatment. This study sought to understand the information needs of clients and caregivers regarding early psychosis. Using a conventional content analysis, we conducted a secondary analysis of 64 transcripts from clients, caregivers, family physicians, and early psychosis intervention clinicians. Clients and caregivers often described having difficulties recognizing symptoms of early psychosis until they became overt …

Exploring The Experience Of Sexuality And Gender During The Healthcare Transition Of The Youth With Cerebral Palsy, Umma Salma

Electronic Thesis and Dissertation Repository

Background: Transition from the pediatric to adult health care system is an important phase of healthcare for youth with cerebral palsy (CP). Sexuality and gender are two very important components of health that are mostly ignored in the healthcare transition process. It is possible that health care providers only see a client’s disability, and therefore, key aspects of sexuality and gender diversity may be ignored, or deemed irrelevant as a result of their disability status. Therefore, the purpose of our study is to explore how gender and sexuality may influence the experience of health care transition for youth with cerebral …

(In)Dependence, Socio-Sexual Relationships, And Sexual Health Among Adults With Mild Intellectual Disability (Mid): A Critical, Qualitative Exploration, Vanessa L.E. Cox Ms

Electronic Thesis and Dissertation Repository

The purpose of this critical, qualitative study was to explore how adults with mild intellectual disability navigate independent socio-sexual relationships in settings where they are highly dependent upon caregivers and family members who exert significant control over most aspects of their lives. Data were gathered during one-on-one interviews conducted with adults with MID (n=15), and parental caregivers (n=6). Theoretical insights from critical disability studies and sexual citizenship were used to analyze the findings, which are presented thematically by study population. Participants with MID faced challenges to establishing and maintaining meaningful relationships, including a lack of choice about where and how …

Disordered Eating Behaviours In Adolescents With And Without A Formal Ed Diagnosis: Comparing Individual And Contextual Factors, Eve G. Chapnik

Electronic Thesis and Dissertation Repository

This study explored various psychosocial factors associated with disordered eating in adolescents accessing mental health services across Ontario, Canada. Data were collected using the interRAI Child and Youth Mental Health (ChYMH) assessment tool and participants were categorized into three groups: individuals with diagnosed eating disorders (ED, n=207), disordered eating without a formal ED diagnosis (sub-ED, n=888), and other treatment-seeking youth (non-ED, n=3285). The ED and sub-ED groups did not differ in many ways, presenting with a similarly greater prevalence of mental health issues, and dysfunctional family and peer relationships, in comparison to non-ED youth. However, the ED …

Developing Rehabilitation Treatment Decision Aid For People Living With Complex Regional Pain Syndrome (Crps), Erfan Shafiee

Electronic Thesis and Dissertation Repository

This Ph.D. dissertation aimed to develop a treatment decision aid for people with Complex Regional Pain Syndrome (CRPS) using the Ottawa Decision Support Framework (ODSF). The decision aid was developed throughout a two-phase process.

The first phase involved understanding the existing evidence and the factors influencing decision-making in CRPS rehabilitation: priorities and preferences of patients and therapists were considered. This phase encompassed the integration of diverse sources of evidence, including systematic reviews, overview of systematic reviews, critical appraisal of guidelines, and a survey exploring patients' and therapists' priorities and preferences for CRPS rehabilitation interventions. All forms of evidence were used …

Decentering Whiteness In Nursing Education: The Pitfalls, Tensions, And Opportunities, Ivy Tran

Electronic Thesis and Dissertation Repository

Statement of Research Problem: The Truth and Reconciliation 94 Calls to Action (TRC) (2015) calls for the implementation of accessible and appropriate Indigenous health education. Schools of Nursing are increasingly implementing various approaches to teach Indigenous health. Limited research exists for Canadian nursing students' experiences of learning Indigenous health. This study explored undergraduate nursing students' experiences of learning Indigenous health from four Schools of Nursing across Canada. Particular attention is paid to the factors that shaped student and faculty experiences of learning and teaching Indigenous health, respectively, the facilitators and challenges, and what constitutes a safe and effective learning environment. …

A Community Dweller’S Perspective Of A Day Shoulder Arthroplasty Surgery., Bansari D. Patel Ms.

Electronic Thesis and Dissertation Repository

The following study was a qualitative interpretive descriptive study aimed at investigating immediate barriers or difficulties in the lives of the community dwellers as well as modifications occurring in the daily routine activities shortly after the out-patient total shoulder arthroplasty procedure. The personal and surgical factors affecting at-home recovery were focussed alongside exploring the coping mechanisms and adaptations in everyday day life. The study mainly focused on the initial three weeks' duration after the discharge. The study followed the constructivist paradigm, adopting the interpretive description methodology. A total of 19 subjects who underwent same/ single day discharge total shoulder arthroplasty …

Sleep And Multimorbidity In The Canadian Longitudinal Study On Aging, Shreni Patel

Electronic Thesis and Dissertation Repository

Sleep health is a latent construct comprising various sleep measures such as duration, quality, initiation, maintenance, and daytime sleepiness. This thesis compared the association of two measures of sleep health, a conventional summary score and a pooled index, with incident multimorbidity over a 3-year follow-up in 30,097 middle- to older-aged adults from the Canadian Longitudinal Study on Aging. At baseline, approximately 26% and 29% of participants with multimorbidity displayed poor sleep patterns according to additive and pooled indexing methods. Longitudinal analysis indicated that those with additive scores of 4 to 5 at baseline had a 1.54 (95% CI: 1.18, 2.03) …

Hidden In Plain Sight: Finding A Balance Between Assessment And Learning In Competency-Based Education In Canadian Health Care, Scott Murray

The Dissertation in Practice at Western University

Due to its emphasis on skill development and alignment with workforce demands, competency-based education (CBE) has garnered considerable attention in recent years. My organizational improvement plan (OIP) focuses on the potential benefits of incorporating learners’ voices into CBE in Canadian medical education and proposes a corresponding implementation framework. The traditional CBE model often lacks a critical component: the learner’s voice. My OIP reviews the literature and outlines its theoretical underpinnings (e.g., systems theory, adult education theory) within the scope of authentic leadership. The findings suggest incorporating learners’ voices into CBE to boost engagement, motivation, and agency. In response to such …

Balancing Nurture And Rigour: Seeking Effective Support For Nursing Students In Distress, Marti Harder

The Dissertation in Practice at Western University

As higher educational institutions face a growing demand to graduate more nurses, and mental health and life stresses are recognized as increasing obstacles to student success, the timing is right for nursing programs to evaluate their traditionally rigorous program cultures. At Sunrise University in Western Canada, nursing students make up a large population seeking support services, and there is an increasing need for capacity building in faculty to support learners who are in distress. In this organizational improvement plan (OIP), I explore what can be enhanced or further developed to create more effective support for students who are in distress …

Systemic, Institutional, And Teaching Factors In The Delivery Of Interprofessional Education Curriculum In Canada, Mohammad B. Azzam

Electronic Thesis and Dissertation Repository

The Canadian federal and several provincial governments are currently collaborating to establish ‘team-based’ primary healthcare—or interprofessional collaborative practice (IPCP), which can be effectively accomplished when interprofessional education (IPE) is sustainably delivered by health and social care (HASC) professional education programs. Indeed, achieving the intended patient/client-oriented outcomes of IPE and subsequent IPCP requires deliberate and purposeful considerations of several systemic, institutional, and teaching factors. Regrettably, the analyses of the extent to which these factors have influenced effective IPCP is currently under-researched. In this integrated-article dissertation, we took a purposeful and systematic approach to explore the extent to which these multi-tiered factors …

Malperfusion Syndrome In The Setting Of Type A Aortic Dissection, Karama Yaslam Karama Bayamin

Electronic Thesis and Dissertation Repository

Background: Acute Type A aortic dissection (TAAD) patients who experience malperfusion syndrome (MPS) are at the greatest risk of major morbidity and mortality. However, the appropriate timing for open proximal aortic repair in the presence of MPS is still uncertain due to variations in clinical manifestations and diverse treatment approaches.

Methods: We conducted a comprehensive literature review to understand the importance of MPS in the setting of TAAD. Then, we conducted a national survey to understand the perception of cardiovascular surgeons across Canada and their approach for those patients. Furthermore, we performed a retrospective analysis of our local data to …

Cerebral Hyperemia Is Not A Sole Modulator Of Postexercise Executive Function Benefit: Evidence From Hypercapnia And Passive Exercise, Mustafa Shirzad

Electronic Thesis and Dissertation Repository

A single bout of exercise improves executive function (EF); however, the physiological mechanism(s) contributing to this benefit are unclear. One candidate mechanism for the benefit is an exercised-mediated increase in cerebral blood flow (CBF) that improves neural efficiency. In my thesis, I conducted two experiments to assess the relationship between an increase in CBF and EF. In Experiment 1, I examined passive exercise, and in Experiment 2, I examined a 2.5% hypercapnic environment given that both interventions increase CBF independent of the metabolic demands of volitional muscle activity. Experiment 1 indicated that passive exercise increased CBF and was associated with …