Humber River Regional Hospital

Abstract Purpose Considering traditionally poor uptake of video review to support operative skill acquisition, we studied surgical trainees’ perspectives during implementation of the BlackBox Explorer (BBX) video-based teaching and assessment system. Methods This interview study included residents and fellows completing their surgical rotations at a Community Hospital affiliated with the University of Toronto. We used a team-based approach to complete a reflexive thematic analysis. Results Analysis of 11 interviews ( N = 10 residents and N = 1 fellow) generated three themes: (i) Technology is merely a tool, and tools need to work well, (ii) Routinizing a new technology into clinical practice, and (iii) Motivating a new learning practice. Implementation challenges did not dissuade some participants from valuing the BBX. Conclusions We found that a relatively passive ‘implementation by diffusion’ strategy does not lead to uptake in a busy surgical training environment. No matter the potential benefits of any video-based teaching and assessment system, siloed implementation likely breeds inconsistent utilization.

BackgroundDigital health refers to the field of knowledge and practice associated with the development and use of digital technologies to improve clinical practice and health outcomes. Knowledge of digital health technology is becoming essential for all nurses and health providers.ObjectiveThis study aims to present the results of the systematic reviews that were used to inform the recommendations in a best practice guideline (BPG) following the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Reviews focused on digital health education for nurses and health providers, peer champion models, and the use of predictive analytics in digital health environments.MethodsThe BPG team, in collaboration with a panel of 17 experts, conducted 5 systematic reviews to address 5 recommendation questions. Systematic searches looked for relevant studies published in English from January 2017 to July 2022 from 10 databases. The GRADE approach was used to synthesize and evaluate the quality of evidence, ensuring the guideline aligned with international reporting standards.ResultsA total of 18 articles across 4 systematic reviews met the inclusion criteria. From these reviews, 4 corresponding recommendations were drafted for nurses and health providers. The strength of the recommendations was determined through discussion and consensus by the expert panel using the GRADE approach. Among all, 1 systematic review resulted in no recommendation due to insufficient evidence.ConclusionsThe BPG on digital health provides 4 evidence-based recommendations for nurses and health providers on how to incorporate digital health technologies into clinical practice. This BPG is intended to be used across all health care settings.

Purpose: As cancer treatments and survival rates continue to improve, integrating supportive complementary therapies into oncology practice is increasingly important. Identifying patient- and clinic-level considerations can guide the selection and integration of evidence-based and effective therapies. Using the Behavioural Design Space (BDS), this study illustrates how a design framework can facilitate the identification of patient needs, clinic requirements, and system-level constraints prior to implementing a digital meditation tool (DMT). Methods: A cross-sectional survey of cancer patients in active treatment to assess distress, attitudes, barriers, and knowledge of meditation. Descriptive statistics and binary multivariate logistic regressions examined associations between patient characteristics and interest in meditation or using a DMT. Findings were mapped onto the six elements of the BDS framework in consultation with clinic staff. Results: Among 148 patients surveyed, 65% had never meditated, yet 42% expressed interest in using a DMT. Greater engagement in stress-coping activities was the strongest predictor of interest in both learning meditation and using a DMT. Female sex increased, while age decreased, the odds of interest in using a DMT. Conclusions: Integrating complementary therapies into oncology care requires attention to patient, clinic, and system-level factors. The BDS framework can guide the therapy/tool selection process by highlighting patient needs, potential barriers, and implementation challenges. Future work should focus on operationalizing the BDS into a practical decision-making tool for healthcare providers.

BackgroundGiven the impact of inflammatory bowel disease (IBD) on both physical health and psychosocial functioning, the management of pediatric IBD requires a multidisciplinary approach that provides holistic care, rapid access, and health education to young patients with IBD. Yet despite recommendations, a formalized clinic model for holistic pediatric IBD care remains an unmet need for this population.ObjectiveThe objective of this study is to comprehensively evaluate the implementation of a new clinic model aimed at providing holistic care, rapid access, and health education for pediatric patients with IBD.MethodsThis study uses a multiperspective mixed methods design, incorporating both qualitative and quantitative data collected simultaneously from clinicians, parents or guardians, and pediatric patients. The quantitative component includes a pre-post implementation chart review, structured observations of clinical practices, and surveys tailored to pediatric patients and their parents or guardians. The qualitative aspect encompasses semistructured interviews with clinicians and parents or guardians as well as play-based interviews with patients. Triangulation will be used to converge these different methodologies and to produce a holistic evaluation of the IBD clinic.ResultsThis study was approved by the Humber River Health Research Ethics Board on December 23, 2024. Recruitment for this study began on January 30, 2025, and we anticipate a data collection end date of December 2025.ConclusionsGiven that this clinic model is relatively new, this protocol will provide sound methodological direction for other studies that aim to evaluate or implement this type of model in their setting. The evaluation itself will provide comprehensive insights into both the successes and challenges of implementing a multidisciplinary approach that provides a holistic model of care for pediatric patients with IBD. As such, this evaluation will be foundational in providing an applied understanding of the impact and effectiveness of this holistic approach in pediatric patients with IBD.International Registered Report Identifier (IRRID)PRR1-10.2196/72670

SARS-CoV-2 is now endemic and expected to remain a health threat, with new variants continuing to emerge and the potential for vaccines to become less effective. While effective vaccines and natural immunity have significantly reduced hospitalisations and the need for critical care, outpatient treatment options remain limited, and real-world evidence on their clinical and cost-effectiveness is lacking. In this paper, we present the design of the Canadian Adaptive Platform Trial of Treatments for COVID in Community Settings (CanTreatCOVID). By evaluating multiple treatment options in a pragmatic adaptive platform trial, this study will generate high-quality, generalisable evidence to inform clinical guidelines and healthcare decision-making. CanTreatCOVID is an open-label, individually randomised, multicentre, national adaptive platform trial designed to evaluate the clinical and cost-effectiveness of therapeutics for non-hospitalised SARS-CoV-2 patients across Canada. Eligible participants must present with symptomatic SARS-CoV-2 infection, confirmed by PCR or rapid antigen testing (RAT), within 5 days of symptom onset. The trial targets two groups that are expected to be at higher risk of more severe disease: (1) individuals aged 50 years and older and (2) those aged 18-49 years with one or more comorbidities. CanTreatCOVID uses numerous approaches to recruit participants to the study, including a multifaceted public communication strategy and outreach through primary care, outpatient clinics and emergency departments. Participants are randomised to receive either usual care, including supportive and symptom-based management, or an investigational therapeutic selected by the Canadian COVID-19 Outpatient Therapeutics Committee. The first therapeutic arm evaluates nirmatrelvir/ritonavir (Paxlovid), administered two times per day for 5 days. The second therapeutic arm investigates a combination antioxidant therapy (selenium 300 µg, zinc 40 mg, lycopene 45 mg and vitamin C 1.5 g), administered for 10 days. The primary outcome is all-cause hospitalisation or death within 28 days of randomisation. The CanTreatCOVID master protocol and subprotocols have been approved by Health Canada and local research ethics boards in the participating provinces across Canada. The results of the study will be disseminated to policy-makers, presented at conferences and published in peer-reviewed journals to ensure that findings are accessible to the broader scientific and medical communities. This study was approved by the Unity Health Toronto Research Ethics Board (#22-179) and Clinical Trials Ontario (Project ID 4133). NCT05614349.

BackgroundAllergic rhinitis (AR) affects up to 40% of children in the United States and Europe. AR is often associated with asthma and has a negative impact on quality of life for the children and their families.ObjectiveWe investigated the AR burden in children with moderate to severe perennial AR in Canada, Denmark, and the United Kingdom, focusing on the role of concomitant asthma. We assessed the health impact on the children, their receipt of allergy medication and health care services, and the impact on their families.MethodsAn online survey was distributed to caregivers of children aged 5 to 17 with moderate to severe perennial AR (both with and without asthma) and to a control group of caregivers of children without allergies.ResultsIn total, 877 and 855 caregivers of children with perennial AR and without allergies, respectively, completed the survey. Children with AR and asthma, compared with those without asthma, experienced more sleep disturbances (69% vs 58%), schoolwork limitations (33% vs 22%), daily activities restrictions (55% vs 41%), and missed school hours (7.2 vs 4.6 hours per month). Children with AR and asthma had a higher receipt of allergy medication compared with those without asthma, and they also visited their general practitioner more often (4.6 vs 3.5 times a year). Overall, 32% of all caregivers of children with AR expressed dissatisfaction with allergy medication.ConclusionPerennial AR, especially with concomitant asthma, imposes a substantial disease burden in children and their families, highlighting the need for long-term disease control.

In the last decade, clinical alert systems were developed for clinical use, including patient deterioration and other urgent clinical situations. However, investigations focusing on digital pain alert systems to assess and manage pain on time in in-hospital patients are scarce. The objective of the study was to assess the implementation of digital pain alerts in the various departments of a community hospital. Administrative data from the year 2020 to 2023 were collected. Only data from cases when pain alert was activated were included. Data included pain alert activation frequency, pain alert response duration (time from pain alert activation to alert stop when medication was administered), the department from which the pain alert was activated. There was a steady significant decrease in the mean pain alert response duration over time from 2020 to 2023. The department with the shortest pain alert response duration was the Department of Surgery, and Cardiology (252.76 ± 4.712). The longest time delay was in the ICU (463.27±2.73 min) and at the Mental Health Department (440.59± 5.46 min) (p < 0.01). The pain alert response duration gradually decreased from 2020 to 2023, with decreases from the first year in all of the units/departments, except for the ICU. NPS scores at the start of the alert to 30 minutes after alert stop decreased significantly. Management of pain improved over time across the hospital, and in most of the departments, suggesting that with experience, digital pain alert systems have the potential to improve pain management by providing timely pain intervention.

BackgroundMost Canadians receive their care in community hospitals, yet most clinical research is conducted in academic hospitals. This study aims to compare patients with community acquired pneumonia (CAP) treated in academic and community hospitals with respect to their demographics, clinical characteristics, treatments and outcomes.MethodsThis nested observational cohort substudy of the Community Acquired Pneumonia: Toward InnoVAtive Treatment (CAPTIVATE) trial included 1,329 hospitalized adults with CAP recruited between March 1st, 2018 and September 31st, 2023 from 15 Canadian hospitals. Unadjusted and adjusted analyses for age, sex and co-morbidities using logistic, Cox and censored quantile regressions were conducted.ResultsPatients in community hospitals were older (mean [SD] 75.0 [15.7] years vs. 68.3 [16.2] years; p < 0.001), were more likely to be female (49.7% vs. 41.0%, p = 0.002), and had more comorbidities (75.9% vs. 64.8%, p < 0.001). More patients in community hospitals received corticosteroids (49.2% vs. 37.4%, p < 0.001). Community hospital patients had a higher likelihood of developing acute respiratory distress syndrome (OR 3.13, 95% CI: 1.87, 5.24, p = < 0.001), and acute cardiac injury (OR 2.53, 95% CI: 1.33, 4.83, p = 0.005). In unadjusted and adjusted analyses, 28-day mortality difference did not meet statistical significance (OR 1.43, 95% CI: 0.98, 20.7, p = 0.062 and OR 1.23, 95% CI: 0.81, 1.87, p = 0.332, respective).ConclusionPatients with CAP in Canadian community and academic hospitals differed with respect to their age, clinical characteristics, treatments and outcomes, emphasizing the importance of including more community hospitals in clinical research studies to ensure the generalizability of results.

BackgroundIn recent studies, receipt of chiropractic care has been associated with lower odds of receiving prescription opioids and, among those already prescribed, reduced doses of opioids among patients with non-cancer spine pain. These findings suggest that access to chiropractic services may reduce reliance on opioids for musculoskeletal pain.ObjectiveTo assess the impact of chiropractic care on initiation, or continued use, of prescription opioids among patients with non-cancer spine pain.MethodsWe will search for eligible randomized controlled trials (RCTs) and observational studies indexed in MEDLINE, Embase, AMED, CINAHL, Web of Science, and the Index to Chiropractic Literature from database inception to June 2024. Article screening, data extraction, and risk-of-bias assessment will be conducted independently by pairs of reviewers. We will conduct separate analyses for RCTs and observational studies and pool binary outcomes (e.g. prescribed opioid receipt, long-term opioid use, and higher versus lower opioid dose) as odds ratios (ORs) with associated 95% confidence intervals (CIs). When studies provide hazard ratios (HRs) or relative risks (RRs) for time-to-event data (e.g. time-to-first opioid prescription) or incidence rates (number of opioid prescriptions over time), we will first convert them to an OR before pooling. Continuous outcomes such as pain intensity, sleep quality, or morphine equivalent dose will be pooled as weighted mean differences with associated 95% CIs. We will conduct meta-analyses using random-effects models and explore sources of heterogeneity using subgroup analyses and meta-regression. We will evaluate the certainty of evidence of all outcomes using the GRADE approach and the credibility of all subgroup effects with ICEMAN criteria. Our systematic review will follow the PRISMA statement and MOOSE guidelines.DiscussionOur review will establish the current evidence informing the impact of chiropractic care on new or continued prescription opioid use for non-cancer spine pain. We will disseminate our results through peer-reviewed publication and conference presentations. The findings of our review will be of interest to patients, health care providers, and policy-makers.Trial registrationSystematic review registration: PROSPERO CRD42023432277.