Digital Commons Network^™

Quantifying Sustained Health System Benefits Of Primary Care-Based Integrated Disease Management For Copd: A 6-Year Interrupted Time Series Study., Christopher Licskai, Anna Hussey, Véronique Rowley, Madonna Ferrone, Zihang Lu, Kimball Zhang, Emilie Terebessy, Andrew Scarffe, Shannon Sibbald, Cathy Faulds, Tim O'Callahan, Teresa To

Health Studies Publications

BACKGROUND: Severe exacerbation of chronic obstructive pulmonary disease (COPD) is a trajectory-changing life event for patients and a major contributor to health system costs. This study evaluates the real-world impact of a primary care, integrated disease management (IDM) programme on acute health service utilisation (HSU) in the Canadian health system.

METHODS: Interrupted time series analysis using retrospective health administrative data, comparing monthly HSU event rates 3 years prior to and 3 years following the implementation of COPD IDM. Primary outcomes were COPD-related hospitalisation and emergency department (ED) visits. Secondary outcomes included hospital bed days and all-cause HSU.

RESULTS: There were …

Evaluation Of A Unique And Innovative Diabetes Care Model In Primary Care In Ontario, Canada: Protocol For A Multiple-Methods Study With A Convergent Parallel Design, Maria Mathews, Rhiannon Lyons, Stewart Harris, Lindsay Hedden, Yun-Hee Choi, Jennifer Donnan, Michael E Green, Elisabeth Harvey, Sonja M Reichert, Bridget Ryan, Shannon Sibbald, Leslie Meredith

Health Studies Publications

INTRODUCTION: The growth and complexity of diabetes are exceeding the capacity of family physicians, resulting in the demand for community-based, interprofessional, primary care-led transition clinics. The Primary Care Diabetes Support Programme (PCDSP) in London, Ontario, is an innovative approach to diabetes care for high-risk populations, such as medically or socially complex and unattached patients. In this study, we will employ a quadruple-aim approach to evaluate the health system impacts of the PCDSP.

METHODS AND ANALYSIS: We will use multiple methods through a convergent parallel design in this project across five unique studies: a case study, a patient study, a provider …

Precision Of Metabolite-Selective Mrs Measurements Of Glutamate, Gaba And Glutathione: A Review Of Human Brain Studies., Kesavi Kanagasabai, Lena Palaniyappan, Jean Theberge

Department of Medicine Publications

Single-voxel proton magnetic resonance spectroscopy (SV 1 H-MRS) is an in vivo noninvasive imaging technique used to detect neurotransmitters and metabolites. It enables repeated measurements in living participants to build explanatory neurochemical models of psychiatric symptoms and testing of therapeutic approaches. Given the tight link among glutamate, gamma-amino butyric acid (GABA), glutathione and glutamine within the cellular machinery, MRS investigations of neurocognitive and psychiatric disorders must quantify a network of metabolites simultaneously to capture the pathophysiological states of interest. Metabolite-selective sequences typically provide improved metabolite isolation and spectral modelling simplification for a single metabolite at a time. Non-metabolite-selective sequences provide …

Physical Functioning In The Lumbar Spinal Surgery Population: A Systematic Review And Narrative Synthesis Of Outcome Measures And Measurement Properties Of The Physical Measures, Katie L. Kowalski, Jai Mistry, Anthony Beilin, Maren Goodman, Michael J. Lukacs, Alison Rushton

Physical Therapy Publications

BACKGROUND: International agreement supports physical functioning as a key domain to measure interventions effectiveness for low back pain. Patient reported outcome measures (PROMs) are commonly used in the lumbar spinal surgery population but physical functioning is multidimensional and necessitates evaluation also with physical measures.

OBJECTIVE: 1) To identify outcome measures (PROMs and physical) used to evaluate physical functioning in the lumbar spinal surgery population. 2) To assess measurement properties and describe the feasibility and interpretability of physical measures of physical functioning in this population.

STUDY DESIGN: Two-staged systematic review and narrative synthesis.

METHODS: This systematic review was conducted according to …

Identifying Canonical And Replicable Multi-Scale Intrinsic Connectivity Networks In 100k+ Resting-State Fmri Datasets., A Iraji, Z Fu, A Faghiri, M Duda, J Chen, S Rachakonda, T Deramus, P Kochunov, B M Adhikari, A Belger, J M Ford, D H Mathalon, G D Pearlson, S G Potkin, A Preda, J A Turner, T G M Van Erp, J R Bustillo, K Yang, K Ishizuka, A Faria, A Sawa, K Hutchison, E A Osuch, Jean Theberge, C Abbott, B A Mueller, D Zhi, C Zhuo, S Liu, Y Xu, M Salman, J Liu, Y Du, J Sui, T Adali, V D Calhoun

Department of Medicine Publications

Despite the known benefits of data-driven approaches, the lack of approaches for identifying functional neuroimaging patterns that capture both individual variations and inter-subject correspondence limits the clinical utility of rsfMRI and its application to single-subject analyses. Here, using rsfMRI data from over 100k individuals across private and public datasets, we identify replicable multi-spatial-scale canonical intrinsic connectivity network (ICN) templates via the use of multi-model-order independent component analysis (ICA). We also study the feasibility of estimating subject-specific ICNs via spatially constrained ICA. The results show that the subject-level ICN estimations vary as a function of the ICN itself, the data length, …

Models Of Shared Care For The Management Of Psychotic Disorder After First Diagnosis In Ontario., Joshua C. Wiener, Rebecca Rodrigues, Jennifer N S Reid, Kelly K. Anderson

Epidemiology and Biostatistics Publications

OBJECTIVE: To describe the provision of care for young people following first diagnosis of psychotic disorder.

DESIGN: Retrospective cohort study using health administrative data.

SETTING: Ontario.

PARTICIPANTS: People aged 14 to 35 years with a first diagnosis of nonaffective psychotic disorder in Ontario between 2005 and 2015 (N=39,449).

MAIN OUTCOME MEASURES: Models of care, defined by psychosis-related service contacts with primary care physicians and psychiatrists during the 2 years after first diagnosis of psychotic disorder.

RESULTS: During the 2-year follow-up period, 29% of the cohort received only primary care, 30% received only psychiatric care, and 32% received both primary and …

Neuroimaging-Based Classification Of Ptsd Using Data-Driven Computational Approaches: A Multisite Big Data Study From The Enigma-Pgc Ptsd Consortium., Xi Zhu, Yoojean Kim, Orren Ravid, Xiaofu He, Benjamin Suarez-Jimenez, Sigal Zilcha-Mano, Amit Lazarov, Seonjoo Lee, Chadi G Abdallah, Michael Angstadt, Christopher L Averill, C Lexi Baird, Lee A Baugh, Jennifer U Blackford, Jessica Bomyea, Steven E Bruce, Richard A Bryant, Zhihong Cao, Kyle Choi, Josh Cisler, Andrew S Cotton, Judith K Daniels, Nicholas D Davenport, Richard J Davidson, Michael D Debellis, Emily L Dennis, Maria Densmore, Terri Deroon-Cassini, Seth G Disner, Wissam El Hage, Amit Etkin, Negar Fani, Kelene A Fercho, Jacklynn Fitzgerald, Gina L Forster, Jessie L Frijling, Elbert Geuze, Atilla Gonenc, Evan M Gordon, Staci Gruber, Daniel W Grupe, Jeffrey P Guenette, Courtney C Haswell, Ryan J Herringa, Julia Herzog, David Bernd Hofmann, Bobak Hosseini, Anna R Hudson, Ashley A Huggins, Jonathan C Ipser, Neda Jahanshad, Meilin Jia-Richards, Tanja Jovanovic, Milissa L Kaufman, Mitzy Kennis, Anthony King, Philipp Kinzel, Saskia B J Koch, Inga K Koerte, Sheri M Koopowitz, Mayuresh S Korgaonkar, John H Krystal, Ruth Lanius, Christine L Larson, Lauren A M Lebois, Gen Li, Israel Liberzon, Guang Ming Lu, Yifeng Luo, Vincent A Magnotta, Antje Manthey, Adi Maron-Katz, Geoffery May, Katie Mclaughlin, Sven C Mueller, Laura Nawijn, Steven M Nelson, Richard W J Neufeld, Jack B Nitschke, Erin M O'Leary, Bunmi O Olatunji, Miranda Olff, Matthew Peverill, K Luan Phan, Rongfeng Qi, Yann Quidé, Ivan Rektor, Kerry Ressler, Pavel Riha, Marisa Ross, Isabelle M Rosso, Lauren E Salminen, Kelly Sambrook, Christian Schmahl, Martha E Shenton, Margaret Sheridan, Chiahao Shih, Maurizio Sicorello, Anika Sierk, Alan N Simmons, Raluca M Simons, Jeffrey S Simons, Scott R Sponheim, Murray B Stein, Dan J Stein, Jennifer S Stevens, Thomas Straube, Delin Sun, Jean Theberge, Paul M Thompson, Sophia I Thomopoulos, Nic J A Van Der Wee, Steven J A Van Der Werff, Theo G M Van Erp, Sanne J H Van Rooij, Mirjam Van Zuiden, Tim Varkevisser, Dick J Veltman, Robert R J M Vermeiren, Henrik Walter, Li Wang, Xin Wang, Carissa Weis, Sherry Winternitz, Hong Xie, Ye Zhu, Melanie Wall, Yuval Neria, Rajendra A Morey

Department of Medicine Publications

BACKGROUND: Recent advances in data-driven computational approaches have been helpful in devising tools to objectively diagnose psychiatric disorders. However, current machine learning studies limited to small homogeneous samples, different methodologies, and different imaging collection protocols, limit the ability to directly compare and generalize their results. Here we aimed to classify individuals with PTSD versus controls and assess the generalizability using a large heterogeneous brain datasets from the ENIGMA-PGC PTSD Working group.

METHODS: We analyzed brain MRI data from 3,477 structural-MRI; 2,495 resting state-fMRI; and 1,952 diffusion-MRI. First, we identified the brain features that best distinguish individuals with PTSD from controls …

Rehabilitation Interventions For Physical Capacity And Quality Of Life In Adults With Post-Covid-19 Condition: A Systematic Review And Meta-Analysis., Dimitra V Pouliopoulou, Joy C Macdermid, Emily Saunders, Sue Peters, Laura Brunton, Erin Miller, Kieran L Quinn, Tiago V Pereira, Pavlos Bobos

Physical Therapy Publications

IMPORTANCE: Current rehabilitation guidelines for patients with post-COVID-19 condition (PCC) are primarily based on expert opinions and observational data, and there is an urgent need for evidence-based rehabilitation interventions to support patients with PCC.

OBJECTIVE: To synthesize the findings of existing studies that report on physical capacity (including functional exercise capacity, muscle function, dyspnea, and respiratory function) and quality of life outcomes following rehabilitation interventions in patients with PCC.

DATA SOURCES: A systematic electronic search was performed from January 2020 until February 2023, in MEDLINE, Scopus, CINAHL, and the Clinical Trials Registry. Key terms that were used to identify potentially …

Designing Systems For The Care We Need: A Transformation Journey In Southwestern Ontario., Shannon L. Sibbald, Jacobi Elliott, Alexander Smith, Mulugeta B. Chala, Nancy Dool Kontio, Amber Alpaugh-Bishop, Sarah Jarmain, Atharv Joshi, Mike Mcmahon, Matthew Meyer

Health Studies Publications

Primary care is considered the foundation of any health system. In Ontario, Canada Bills 41 and 74 introduced in 2016 and 2019, respectively, aimed to move towards a primary care-focused and sustainable integrated care approach designed around the needs of local populations. These bills collectively set the stage for integrated care and population health management in Ontario, with Ontario Health Teams (OHTs) introduced as a model of integrated care delivery systems. OHTs aim to streamline patient connectivity through the healthcare system and improve outcomes aligned with the Quadruple Aim. When Ontario released a call for health system partners to apply …

Differences In Clinical Presentation At First Hospitalization And The Impact On Involuntary Admissions Among First-Generation Migrant Groups With Non-Affective Psychotic Disorders., Kelly K Anderson, Rebecca Rodrigues

Epidemiology and Biostatistics Publications

BACKGROUND: Some migrant and ethnic minority groups have a higher risk of coercive pathways to care; however, it is unclear whether differences in clinical presentation contribute to this risk. We sought to assess: (i) whether there were differences in clinician-rated symptoms and behaviours across first-generation immigrant and refugee groups at the first psychiatric hospitalization after psychosis diagnosis, and (ii) whether these differences accounted for disparities in involuntary admission.

METHODS: Using population-based health administrative data from Ontario, Canada, we constructed a sample (2009-2013) of incident cases of non-affective psychotic disorder followed for two years to identify first psychiatric hospitalization. We compared …

Designing Systems For The Care We Need: A Transformation Journey In Southwestern Ontario, Shannon L Sibbald, Jacobi Elliott, Alexander Smith, Mulugeta B Chala, Nancy Dool Kontio, Amber Alpaugh-Bishop, Sarah Jarmain, Atharv Joshi, Mike Mcmahon, Matthew Meyer

Health Studies Publications

Primary care is considered the foundation of any health system. In Ontario, Canada Bills 41 and 74 introduced in 2016 and 2019, respectively, aimed to move towards a primary care-focused and sustainable integrated care approach designed around the needs of local populations. These bills collectively set the stage for integrated care and population health management in Ontario, with Ontario Health Teams (OHTs) introduced as a model of integrated care delivery systems. OHTs aim to streamline patient connectivity through the healthcare system and improve outcomes aligned with the Quadruple Aim. When Ontario released a call for health system partners to apply …

Students' Attitudes, Beliefs And Perceptions Surrounding 2slgbtqia + Health Education And Inclusiveness In Canadian Physiotherapy Programs, Codie A Primeau, Holly T Philpott, Kyle Vader, Janelle Unger, Christina Y Le, Trevor B Birmingham, Joy C Macdermid

Physical Therapy Publications

BACKGROUND: Patients who identify as 2SLGBTQIA + report negative experiences with physiotherapy. The objectives were to evaluate student attitudes, beliefs and perceptions related to 2SLGBTQIA + health education and working with individuals who identify as 2SLGBTQIA + in entry-level physiotherapy programs in Canada and to evaluate physiotherapy program inclusiveness towards 2SLGBTQIA + persons.

METHODS: We completed a nationwide, cross-sectional survey of physiotherapy students from Canadian institutions. We recruited students via email and social media from August-December 2021. Frequency results are presented with percentages. Logistic regression models (odds ratios [OR], 95%CI) were used to evaluate associations between demographics and training hours …

Knowledge, Behaviours, And Training Related To 2slgbtqia+ Health Education Amongst Entry-Level Physiotherapy Students In Canada: Results Of A Nationwide, Cross-Sectional Survey, Codie A Primeau, Holly T Philpott, Kyle Vader, Janelle Unger, Christina Y Le, Trevor B Birmingham, Joy C Macdermid

Physical Therapy Publications

BACKGROUND: Individuals who identify as 2SLGBTQIA+ report worse health outcomes than heterosexual/cisgender counterparts, in part due to poor experiences with healthcare professionals. This may stem from inadequate 2SLGBTQIA+ health and inclusiveness training in health professional student education. The purpose of the study was to evaluate knowledge, behaviours, and training related to 2SLGBTQIA+ health education and inclusiveness for entry-level physiotherapy students in Canada.

METHODS: We conducted a nationwide, cross-sectional survey with physiotherapy students from accredited Canadian physiotherapy programs. We administered the survey through Qualtrics and recruited students through targeted recruitment emails and social media posts on Twitter and Instagram between August …

Female Athlete Health Domains: A Supplement To The International Olympic Committee Consensus Statement On Methods For Recording And Reporting Epidemiological Data On Injury And Illness In Sport., Isabel S Moore, Kay M Crossley, Kari Bo, Margo Mountjoy, Kathryn E Ackerman, Juliana Da Silva Antero, Jorunn Sundgot Borgen, Wendy J Brown, Caroline S Bolling, Benjamin Clarsen, Wayne Derman, Paul Dijkstra, Amber Donaldson, Kirsty J Elliott-Sale, Carolyn A Emery, Lene Haakstad, Astrid Junge, Nonhlanhla S Mkumbuzi, Sophia Nimphius, Debbie Palmer, Mireille Van Poppel, Jane S Thornton, Rita Tomás, Phathokuhle C Zondi, Evert Verhagen

Family Medicine Publications

The IOC made recommendations for recording and reporting epidemiological data on injuries and illness in sports in 2020, but with little, if any, focus on female athletes. Therefore, the aims of this supplement to the IOC consensus statement are to (i) propose a taxonomy for categorisation of female athlete health problems across the lifespan; (ii) make recommendations for data capture to inform consistent recording and reporting of symptoms, injuries, illnesses and other health outcomes in sports injury epidemiology and (iii) make recommendations for specifications when applying the Strengthening the Reporting of Observational Studies in Epidemiology-Sport Injury and Illness Surveillance (STROBE-SIIS) …

Sex Differences In The Clinical Presentation Of Early Psychosis In A Primary Care Setting, Brooke Carter, Rebecca Rodrigues, Jennifer Reid, Suzanne Archie, Amanda L Terry, Lena Palaniyappan, Arlene G Macdougall, Aristotle Voineskos, Saadia Hameed Jan, Liisa Jaakkimainen, Branson Chen, Neo Sawh, Kelly K. Anderson

Epidemiology and Biostatistics Publications

Primary care is an important part of the help-seeking pathway for young people experiencing early psychosis, but sex differences in clinical presentation in these settings are unexplored. We aimed to identify sex differences in clinical presentation to primary care services in the 1-year period prior to a first diagnosis of psychotic disorder. We identified first-onset cases of non-affective psychotic disorder over a 10-year period (2005-2015) using health administrative data linked with electronic medical records (EMRs) from primary care (n = 465). Detailed information on encounters in the year prior to first diagnosis was abstracted, including psychiatric symptoms, other relevant behaviours, …

Exploring Quality Improvement For Diabetes Care In First Nations Communities In Canada: A Multiple Case Study., Meghan Fournie, Shannon L. Sibbald, Stewart B. Harris

Health Studies Publications

BACKGROUND: Indigenous peoples in Canada experience higher rates of diabetes and worse outcomes than non-Indigenous populations in Canada. Strategies are needed to address underlying health inequities and improve access to quality diabetes care. As part of the national FORGE AHEAD Research Program, this study explores two primary healthcare teams' quality improvement (QI) process of developing and implementing strategies to improve the quality of diabetes care in First Nations communities in Canada.

METHODS: This study utilized a community-based participatory and qualitative case study methodology. Multiple qualitative data sources were analyzed to understand: (1) how knowledge and information was used to inform …

The Impact Of Maternal Diabetes On Birth To Placental Weight Ratio And Umbilical Cord Oxygen Values With Implications For Fetal-Placental Development, Sheryl Choo, Barbra De Vrijer, Timothy R H Regnault, Hilary K Brown, Larry Stitt, Bryan S Richardson

Obstetrics & Gynaecology Publications

Introduction

We determined the impact of gestational diabetes (GDM) and pre-existing diabetes (DM) on birth/placental weight and cord oxygen values with implications for placental efficiency and fetal-placental growth and development.

Methods

A hospital database was used to obtain birth/placental weight, cord PO₂ and other information on patients delivering between Jan 1, 1990 and Jun 15, 2011 with GA >34 weeks (N = 69,854). Oxygen saturation was calculated from the cord PO₂ and pH data, while fetal O₂ extraction was calculated from the oxygen saturation data. The effect of diabetic status on birth/placental weight and cord oxygen values …

Variability And Magnitude Of Brain Glutamate Levels In Schizophrenia: A Meta And Mega-Analysis., Kate Merritt, Robert A Mccutcheon, André Aleman, Sarah Ashley, Katherine Beck, Wolfgang Block, Oswald J N Bloemen, Faith Borgan, Christiana Boules, Juan R Bustillo, Aristides A Capizzano, Jennifer M Coughlin, Anthony David, Camilo De La Fuente-Sandoval, Arsime Demjaha, Kara Dempster, Kim Q Do, Fei Du, Peter Falkai, Beata Galińska-Skok, Jürgen Gallinat, Charles Gasparovic, Cedric E Ginestet, Naoki Goto, Ariel Graff-Guerrero, Beng-Choon Ho, Oliver Howes, Sameer Jauhar, Peter Jeon, Tadafumi Kato, Charles A Kaufmann, Lawrence S Kegeles, Matcheri S Keshavan, Sang-Young Kim, Bridget King, Hiroshi Kunugi, J Lauriello, Pablo León-Ortiz, Edith Liemburg, Meghan E Mcilwain, Gemma Modinos, Elias Mouchlianitis, Jun Nakamura, Igor Nenadic, Dost Öngür, Miho Ota, Lena Palaniyappan, Christos Pantelis, Tulsi Patel, Eric Plitman, Sotirios Posporelis, Scot E Purdon, Jürgen R Reichenbach, Perry F Renshaw, Francisco Reyes-Madrigal, Bruce R Russell, Akira Sawa, Martin Schaefer, Dikoma C Shungu, Stefan Smesny, Jeffrey A Stanley, James Stone, Agata Szulc, Reggie Taylor, Katharine N Thakkar, Jean Theberge, Philip G Tibbo, Thérèse Van Amelsvoort, Jerzy Walecki, Peter C Williamson, Stephen J Wood, Lijing Xin, Hidenori Yamasue, Philip Mcguire, Alice Egerton

Department of Medicine Publications

Glutamatergic dysfunction is implicated in schizophrenia pathoaetiology, but this may vary in extent between patients. It is unclear whether inter-individual variability in glutamate is greater in schizophrenia than the general population. We conducted meta-analyses to assess (1) variability of glutamate measures in patients relative to controls (log coefficient of variation ratio: CVR); (2) standardised mean differences (SMD) using Hedges g; (3) modal distribution of individual-level glutamate data (Hartigan's unimodality dip test). MEDLINE and EMBASE databases were searched from inception to September 2022 for proton magnetic resonance spectroscopy (1H-MRS) studies reporting glutamate, glutamine or Glx in schizophrenia. 123 studies reporting on …

Spatial Characteristics Of Reactive Stepping Among People Living With Chronic Incomplete Spinal Cord Injury, Matthew G Heffernan, Jae Woung Lee, Katherine Chan, Janelle Unger, Susan Marzolini, Timothy N Welsh, Kei Masani, Kristin E Musselman

Physical Therapy Publications

Objective: Compare the spatial characteristics of reactive stepping between individuals with chronic motor incomplete spinal cord injuries (iSCI) and able-bodied (AB) individuals.

Design: Cross sectional.

Setting: Lyndhurst Centre.

Participants: Twelve individuals with iSCI (3 males, 53.6 ± 15.2 years old) and 11 age- and sex-matched AB individuals (3 males, 54.8 ± 14.0 years old).

Interventions: The Lean-and-Release test was used to elicit reactive stepping. A horizontal cable, attached at waist height, was released when 8-12% body weight was supported in a forward lean position. Participants underwent up to 10 Lean-and-Release trials in a session. Kinematic and …

Spatiotemporally Dynamic Electric Fields For Brain Cancer Treatment: An In Vitro Investigation, Erin Iredale, Abdulla Elsaleh, Hu Xu, Paul Christiaans, Andrew Deweyert, John Ronald, Susanne Schmid, Matthew O Hebb, Terry M Peters, Eugene Wong

Anatomy and Cell Biology Publications

Objective. The treatment of glioblastoma (GBM) using low intensity electric fields (∼1 V cm^-1) is being investigated using multiple implanted bioelectrodes, which was termed intratumoral modulation therapy (IMT). Previous IMT studies theoretically optimized treatment parameters to maximize coverage with rotating fields, which required experimental investigation. In this study, we employed computer simulations to generate spatiotemporally dynamic electric fields, designed and purpose-built an IMT device for in vitro experiments, and evaluated the human GBM cellular responses to these fields. Approach. After measuring the electrical conductivity of the in vitro culturing medium, we designed experiments to evaluate the …

An Evaluation Of The Carl Manikin For Use In "Patient-Free" Real Ear Measurement: Consistency And Comparison To Normative Data., Paula Folkeard, Muneeb Alam, Robert Koch, Parvaneh Abbasalipour, Susan Scollie

Communication Sciences and Disorders Publications

OBJECTIVE: Simulation-based learning experiences provide low-risk opportunities for procedural training and practice in audiology. A series of real ear measurements (REM) were completed using Clinical Assistant for Research and Learning (CARL) manikins to determine expected responses and to compare to normative data.

DESIGN: (1) Real-ear Unaided Response (REUR) curves were measured with one CARL and each of three ear styles. (2) Test/retest reliability was evaluated by repeating each REUR. (3) Real ear to coupler difference (RECD) values for foam-tip and custom earmolds were calculated. (4) The reliability across copies of the CARL heads was evaluated by comparing REUR measurement from …

Evaluating The Feasibility And Potential Impacts Of A Recovery-Oriented Psychosocial Rehabilitation Toolkit In A Health Care Setting In Kenya: A Mixed-Methods Study, Regina Casey, Joshua C. Wiener, Terry Krupa, Rosemary Lysaght, Marlene Janzen Le Ber, Ruth Ruhara, Elizabeth Price, Romaisa Pervez, Sean Kidd, Victoria Mutiso, David M Ndetei, Arlene G Macdougall

Epidemiology and Biostatistics Publications

OBJECTIVES: This pilot study evaluated the feasibility and potential impacts of delivering the Psychosocial Rehabilitation (PSR) Toolkit for people with serious mental illness within a health care setting in Kenya.

METHOD: This study used a convergent mixed-methods design. Participants were people with serious mental illness (n = 23), each with an accompanying family member, who were outpatients of a hospital or satellite clinic in semirural Kenya. The intervention consisted of 14 weekly group sessions of PSR cofacilitated by health care professionals and peers with mental illness. Quantitative data were collected from patients and family members using validated outcome measures before …

Patient And Physician Factors Associated With First Diagnosis Of Non-Affective Psychotic Disorder In Primary Care, Joshua C. Wiener, Rebecca Rodrigues, Jennifer N S Reid, Suzanne Archie, Richard G Booth, Chiachen Cheng, Saadia Hameed Jan, Paul Kurdyak, Arlene G Macdougall, Lena Palaniyappan, Bridget L Ryan, Kelly K. Anderson

Epidemiology and Biostatistics Publications

Primary care physicians play a central role in pathways to care for first-episode psychosis, and their increased involvement in early detection could improve service-related outcomes. The aim of this study was to estimate the proportion of psychosis first diagnosed in primary care, and identify associated patient and physician factors. We used linked health administrative data to construct a retrospective cohort of people aged 14-35 years with a first diagnosis of non-affective psychosis in Ontario, Canada between 2005-2015. We restricted the sample to patients with help-seeking contacts for mental health reasons in primary care in the six months prior to first …

Family Physicians' Responses To Personal Protective Equipment Shortages In Four Regions In Canada: A Qualitative Study., Maria Mathews, Dana Ryan, Lindsay Hedden, Julia Lukewich, Emily Gard Marshall, Shabnam Asghari, Amanda Lee Terry, Richard Buote, Leslie Meredith, Lauren Moritz, Sarah Spencer, Judith B. Brown, Erin Christian, Thomas R. Freeman, Paul S. Gill, Shannon L. Sibbald, Eric Wong

Health Studies Publications

BACKGROUND: Despite well-documented increased demands and shortages of personal protective equipment (PPE) during previous disease outbreaks, health systems in Canada were poorly prepared to meet the need for PPE during the COVID-19 pandemic. In the primary care sector, PPE shortages impacted the delivery of health services and contributed to increased workload, fear, and anxiety among primary care providers. This study examines family physicians' (FPs) response to PPE shortages during the first year of the COVID-19 pandemic to inform future pandemic planning.

METHODS: As part of a multiple case study, we conducted semi-structured qualitative interviews with FPs across four regions in …

Family Physicians' Responses To Personal Protective Equipment Shortages In Four Regions In Canada: A Qualitative Study., Maria Mathews, Dana Ryan, Lindsay Hedden, Julia Lukewich, Emily Gard Marshall, Shabnam Asghari, Amanda L. Terry Dr., Richard Buote, Leslie Meredith, Lauren Moritz, Sarah Spencer, Judith B Brown, Erin Christian, Thomas R Freeman, Paul S Gill, Shannon L Sibbald, Eric Wong

Health Studies Publications

BACKGROUND: Despite well-documented increased demands and shortages of personal protective equipment (PPE) during previous disease outbreaks, health systems in Canada were poorly prepared to meet the need for PPE during the COVID-19 pandemic. In the primary care sector, PPE shortages impacted the delivery of health services and contributed to increased workload, fear, and anxiety among primary care providers. This study examines family physicians' (FPs) response to PPE shortages during the first year of the COVID-19 pandemic to inform future pandemic planning.

METHODS: As part of a multiple case study, we conducted semi-structured qualitative interviews with FPs across four regions in …

Association Between Measures Of Cognitive Function On Physical Function In Novice Users Of A Lower Limb Prosthesis, Humberto Omana, Courtney Frengopoulos, Manuel Montero-Odasso, Michael W. Payne, Ricardo Viana, Susan W. Hunter

Physical Therapy Publications

BACKGROUND: Cognitive impairment is prevalent in people with lower limb amputations (PLLA) and is associated with adverse outcomes, such as falls and worse rehabilitation outcomes. Physical function tests are essential to examine abilities; however, no research in PLLA has clarified the magnitude of cognitive demands amongst available tests in users novice at walking with a prosthesis.

METHODS: People from inpatient prosthetic rehabilitation were recruited. Inclusion criteria were: age ≥ 50 years, unilateral transtibial amputation and able to walk independently. Gait velocity and the L Test under single-task (usual) and dual-task (walking while counting backwards) conditions assessed functional mobility. The Four …

Premotor And Posterior Parietal Cortex Activity Is Increased For Slow, As Well As Fast Walking Poststroke: An Fnirs Study, Shannon B Lim, Sue Peters, Chieh-Ling Yang, Lara A Boyd, Teresa Liu-Ambrose, Janice J Eng

Physical Therapy Publications

Background and Purpose. The ability to change gait speeds is important for interacting with the surrounding environment. Gait speed modulation poststroke is often impaired and is related to decreased walking independence after stroke. Assessment of brain activation during walking at different speeds can provide insight into important regions for facilitating gait recovery. The purpose is to determine: (1) the symmetry of brain activation as individuals increase or decrease their gait speed, (2) the activation levels in frontal to parietal brain regions during walking at different speeds, and (3) the relationship between an individual’s stroke impairment or their ability to modulate …

Implementation Of Increased Physical Therapy Intensity For Improving Walking After Stroke: Walk 'N Watch Protocol For A Multisite Stepped-Wedge Cluster-Randomized Controlled Trial, Sue Peters, Shannon B Lim, Mark T Bayley, Krista Best, Louise A Connell, Hélène Corriveau, Sarah J Donkers, Sean P Dukelow, Tara D Klassen, Marie-Hélène Milot, Brodie M Sakakibara, Lisa Sheehy, Hubert Wong, Jennifer Yao, Janice J Eng

Physical Therapy Publications

RATIONALE: Clinical practice guidelines support structured, progressive protocols for improving walking after stroke. Yet, practice is slow to change, evidenced by the little amount of walking activity in stroke rehabilitation units. Our recent study (n = 75) found that a structured, progressive protocol integrated with typical daily physical therapy improved walking and quality-of-life measures over usual care. Research therapists progressed the intensity of exercise by using heart rate and step counters worn by the participants with stroke during therapy. To have the greatest impact, our next step is to undertake an implementation trial to change practice across stroke units where …

Increased Top-Down Control Of Emotions During Symptom Provocation Working Memory Tasks Following A Rct Of Alpha-Down Neurofeedback In Ptsd., Saurabh Bhaskar Shaw, Andrew A Nicholson, Tomas Ros, Sherain Harricharan, Braeden Terpou, Maria Densmore, Jean Theberge, Paul Frewen, Ruth A Lanius

Department of Medicine Publications

BACKGROUND: Posttraumatic stress disorder (PTSD) has been found to be associated with emotion under-modulation from the prefrontal cortex and a breakdown of the top-down control of cognition and emotion. Novel adjunct therapies such as neurofeedback (NFB) have been shown to normalize aberrant neural circuits that underlie PTSD psychopathology at rest. However, little evidence exists for NFB-linked neural improvements under emotionally relevant cognitive load. The current study sought to address this gap by examining the effects of alpha-down NFB in the context of an emotional n-back task.

METHODS: We conducted a 20-week double-blind randomized, sham-controlled trial of alpha-down NFB and collected …

The Roles Of Family Physicians During A Pandemic., Maria Mathews, Leslie Meredith, Dana Ryan, Lindsay Hedden, Julia Lukewich, Emily G Marshall, Richard Buote, Lauren Moritz, Sarah Spencer, Shabnam Asghari, Judith B Brown, Thomas R Freeman, Paul S Gill, Rita K Mccracken, Madeleine Mckay, Bridget Ryan, Shannon L Sibbald, Stephen Wetmore, Eric Wong

Health Studies Publications

Family physicians play important roles throughout all stages of a pandemic response; however, actionable descriptions outlining these roles are absent from current pandemic plans. Using a multiple case study design, we conducted a document analysis and interviewed 68 family physicians in four Canadian regions. We identified roles performed by family physicians in five distinct stages of pandemic response: pre-pandemic, phased closure and re-opening, acute care crisis, vaccination, and pandemic recovery. In addition to adopting public health guidance to ensure continued access to primary care services, family physicians were often expected to operationalize public health roles (eg, staffing assessment centres), modulate …