Bridgepoint Active Healthcare

BackgroundThe generalizability of treatments examined in rehabilitation randomized controls trials (RCTs) partly depend on the similarity between trial subjects and a stroke rehabilitation inpatient population. The aim of this study was to determine the proportion of stroke rehabilitation inpatients that would have been eligible or ineligible to participate in published stroke RCTs.MethodsThis was a secondary analysis of chart review data collected as part of an independent quality improvement initiative. Data pertaining to the characteristics of stroke rehabilitation inpatients (e.g. age, cognitive impairment, previous stroke, comorbidities) were extracted from the medical charts of patients consecutively admitted to an inpatient stroke rehabilitation unit at a large urban rehabilitation hospital in Canada. Using the exclusion criteria categories of stroke RCTs identified from a systematic scoping review of 428 RCTs, we identified how many stroke rehabilitation inpatients would have been eligible or ineligible to participate in stroke RCTs based on their age, cognitive impairment, previous stroke and presence of comorbidities.ResultsIn total, 110 stroke rehabilitation inpatients were included. Twenty-four percent of patients were 80 years of age or older, 84.5% had queries or concerns regarding patient cognitive abilities, 28.0% had a previous stroke, and 31.8% had a severe stroke. Stroke rehabilitation inpatients had six comorbidities on average. Based on these factors, most stroke rehabilitation inpatients could have been excluded from stroke RCTs, with cognitive impairment the most common RCT exclusion criteria.ConclusionsChanges to the design of RCTs would support the development of clinical practice guidelines that reflect stroke rehabilitation inpatient characteristics, enhancing equity, diversity, and inclusion within samples and the generalizability of results.

ABSTRACT Research evidence demonstrates the negative effects of Whole-Body Vibration (WBV) and correlation between exposure to WBV and detriment to health. ISO Standard 2631-1 (1997) is the accepted standard for human exposure to WBV in vehicle vibration, and provides vibration guidelines for health and comfort. These standards have not been applied to power wheelchairs (PWC), and no clinical tool exists that measures vibration levels during live power wheelchair driving. This study measures WBV and shock levels during PWC driving, considering the impact of terrains, base configurations, and seat cushions. A sensor tag accelerometer was used to measure vibration and shock in three different PWC configurations driven over seven different terrains. Data was collected for two runs per wheelchair, per terrain type, per cushion type. Differences were significant (p < .001) for overall mean and median peak vibration compared across the seven terrains, and for overall mean vibration for basic and enhanced cushions. Differences were also noted in mean and peak vibration in the three different base configurations (p = .0052). Results were compared with ISO 2631-1 guidelines. Mechanical shock on certain terrains created peak vibration levels with likely health risk. Results from this study can inform PWC prescription process.

This workshop will provide participants a hands-on opportunity to explore and reflect on the relationship between evidence, and specifically evidence based medicine, and the contemporary North American opioid epidemics. EBM emerged through the late twentieth century to promote good (conscientious, explicit and judicious) use of best evidence to inform clinical decision making. By the 1990s it was an established and dominant paradigm informing North American clinical practice. The 1990s and 2000s also saw a massive increase in the use of prescribed opioids for the management of pain. This was despite there being little good evidence for their efficacy and safety for chronic pain management. Harms from opioids continued to mount through the 2000s, prompting increasing scholarship into their safety. By 2010, Canada had its first national clinical practice guideline (CPG) for the use of opioids for chronic pain management, followed in 2016 by the Centres for Disease Control in the United States and then by an update of the Canadian guidelines in 2017. Neither country has yet seen a comprehensive CPG for the management of chronic non-cancer pain. In this workshop, we will use first a historical perspective and then a population health perspective to critically examine the role of evidence, and specifically evidence synthesis in the form of CPGs, vis-à-vis opioid use and the population level opioid-related harms. From a historical perspective, we will draw on some of our current bibliometric research of a highly cited pre-EBM opioid prescribing guideline and compare this to the content of a contemporary (‘EBM-informed’) CPG. Participants will work individually and in small groups to examine, compare and contrast specific recommendations from these two guidelines, published more than 30 years apart. This will provide an opportunity to reflect on the value and utility of using current best evidence versus expert opinion to inform guideline development. The second half of this workshop will take a population health perspective and focus on a set of highly influential Canadian and American studies into the dose-related harms of prescribed opioids. Participants will trace the path from the publication of these studies to their synthesis in CPGs in the form of specific recommendations for opioid dosing. We will consider the particular form in which the study data were interpreted and how this influenced guideline recommendations. Participants will be offered the opportunity to use alternate modes of analysing the same data, for example from population health perspectives. We will then consider whether and how these different modes of analysis could influence clinical practice recommendations.

Neuropsychiatric symptoms (NPSs) in those with major neurocognitive disorder (MNCD) include the responsive behaviors of agitation and aggression. Electroconvulsive therapy (ECT) has shown some effectiveness based on retrospective studies and one open label prospective study. We hypothesized that ECT will reduce NPSs between baseline and after treatment in those with medication-refractory behaviors. This Canadian prospective multicenter study included MNCD patients admitted to geriatric psychiatry units for the management of refractory NPSs. All treatment-refractory participants suffered from advanced MNCD. We conducted the Neuropsychiatric Inventory-Clinician version and the Pittsburgh Agitation Scale at baseline, and during and after the ECT course. A bitemporal or bifrontal ECT series based on dose titration to 1.5 to 2.5 times seizure threshold was administered. Data were collected for 33 patients with a mean age of 73 and categorized with severe MNCD using the Functional Assessment Staging of Alzheimer's Disease scale (stages 6 and 7). The data showed a drop in mean Neuropsychiatric Inventory-Clinician version from 58.36 to 24.58 (P < 0.0001). Mean Neuropsychiatric Inventory agitation subscale dropped from 7.12 to 3.09 (P = 0.007). Mean Neuropsychiatric Inventory aggression subscale dropped from 6.94 to 0.97 (P < 0.0001). There was a concomitant significant decline in Pittsburgh Agitation Scale scores. No participants dropped out because of intolerance of ECT. One participant died from pneumonia, which did not appear related to ECT. In this naturalistic study, ECT was found to be a safe and effective treatment for certain NPSs in people with MNCD. This can translate into improving quality of life.

Rationale: Exposure to poor air quality is associated with increased morbidity and mortality in patients with chronic obstructive pulmonary disease (COPD), asthma and heart failure. A number of countries, including Canada, report utilization of the Air Quality Health Index (AQHI) and associated health messages tailored to different AQHI categories for the public and at-risk populations to reduce exposure, adjust physical activity and optimize clinical management. Studies indicate AQHI advisories may not adequately reach or inform at-risk populations. Objectives: The objectives of this study were to design a text alert system and evaluate the feasibility of delivering AQHI forecast alerts to participants when AQHI readings exceeded low health risk. Secondary and tertiary objectives were to determine the frequency and accuracy of the alerts. Methods: Feasibility was assessed by the following steps: recruiting older adults with asthma, COPD and heart failure from primary care practices; developing software for extracting AQHI data from the Health Canada database; registering patients on the automatic dispatch messages system; and automatically sending AQHI forecast alerts of moderate health risk or above to participants’ cell-phones the preceding night. Results: We successfully queried the Environment Canada database, detected AQHI alerts and delivered them to participants. Forecast alerts of moderate health risk were higher in summer and winter 2018-2019 in the study areas. The accuracy of AQHI forecast alerts for North Toronto versus Downtown Toronto were 81.7% (75.9 − 86.6%) and 80.7% (74.8 − 85.7%), respectively. Conclusions: Delivering AQHI alerts through text messages to patients in the primary care setting was feasible. Colder seasons should not be underestimated for moderate risk AQHI conditions.

BackgroundMyDiabetesPlan is a web-based, interactive patient decision aid that facilitates patient-centred, diabetes-specific, goal-setting and shared decision-making (SDM) with interprofessional health care teams.ObjectiveAssess the feasibility of (1) conducting a cluster randomized controlled trial (RCT) and (2) integrating MyDiabetesPlan into interprofessional primary care clinics.MethodsWe conducted a cluster RCT in 10 interprofessional primary care clinics with patients living with diabetes and at least two other comorbidities; half of the clinics were assigned to MyDiabetesPlan and half were assigned to usual care. To assess recruitment, retention, and resource use, we used RCT conduct logs and financial account summaries. To assess intervention fidelity, we used RCT conduct logs and website usage logs. To identify barriers and facilitators to integration of MyDiabetesPlan into clinical care across the IP team, we used audiotapes of clinical encounters in the intervention groups.ResultsOne thousand five hundred and ninety-seven potentially eligible patients were identified through searches of electronic medical records, of which 1113 patients met the eligibility criteria upon detailed chart review. A total of 425 patients were randomly selected; of these, 213 were able to participate and were allocated (intervention: n = 102; control: n = 111), for a recruitment rate of 50.1%. One hundred and fifty-one patients completed the study, for a retention rate of 70.9%. A total of 5745 personnel-hours and $6104 CAD were attributed to recruitment and retention activities. A total of 179 appointments occurred (out of 204 expected appointments—two per participant over the 12-month study period; 87.7%). Forty (36%), 25 (23%), and 32 (29%) patients completed MyDiabetesPlan at least twice, once, and zero times, respectively. Mean time for completion of MyDiabetesPlan by the clinician and the patient during initial appointments was 37 min. From the clinical encounter transcripts, we identified diverse strategies used by clinicians and patients to integrate MyDiabetesPlan into the appointment, characterized by rapport building and individualization. Barriers to use included clinician-related, patient-related, and technical factors.ConclusionAn interprofessional approach to SDM using a decision aid was feasible. Lower than expected numbers of diabetes-specific appointments and use of MyDiabetesPlan were observed. Addressing facilitators and barriers identified in this study will promote more seamless integration into clinical care.Trial registration Clinicaltrials.gov Identifier: NCT02379078. Date of Registration: February 11, 2015. Protocol version: Version 1; February 26, 2015.

This qualitative study aimed to understand occupational therapists’ experiences of providing home programs to stroke survivors in India. Using an interpretative phenomenological approach, eight practicing occupational therapists were interviewed in depth about home programs for individuals recovering from stroke. Two broad themes with subthemes emerged describing the organizational factors, sociocultural and economic influences on home program provision as well as describing how the occupational therapists addressed the challenges to facilitate home program provision and adherence. The findings can inform occupational therapy practice in lower- and middle-income countries like India and other countries where existing practice recommendations for stroke rehabilitation and core professional tenets may be challenged.

![Figure][1]</img> I was Alan’s doctor on the brain injury unit. In September, he’d had a fall, nothing major, just a slip in the rain taking the garbage out. It was nighttime; he didn’t see the puddle; he was wearing worn-out shoes. He got up and pretty much forgot about it. But in October,

Got, Tiffany BHSc; Bayley, Mark MT, MD; MacDonald, Shannon SL, MD, MSc Author Information

Biotechnology is the use of living systems and organisms to develop or make products, or any technological application that uses biological systems, living organisms or derivatives to make or modify products or processes for specific use. Biotechnology is a constantly evolving field of modern science. New tools and products developed by biotechnologists are useful in research, agriculture, industry and healthcare. Although it has many benefits including lowering our environmental footprint, and helping in diagnosis and treatment of diseases, it comes with its all-possible disadvantages. The four main societal concerns revolve around are ethical, safety, bioterrorism and environmental issues. This paper aims to describe those societal concerns raised by applications of biotechnology and possible regulations related to biotech innovations and policy implementation.