Richmond Hospital

As the number of older autistic adults and adults with intellectual disabilities grows, expanding capacity to meet their needs is crucial. On November 23-25, 2023, a Think Tank on aging in autism and/or intellectual disabilities was convened, with national and international delegates within this field. The Think Tank consisted of presentations focusing on key issues as well as a series of panel presentations addressing first-person lived experience, family caregiving, service provision in the community, and physical and mental health-based care. Discussion reflected lived experiences and care needs in this population, with an ultimate aim of advancing healthcare and community support. Delegates, who represent perspectives as self-advocates, family caregivers, service providers, clinicians and researchers, ranked guidelines and areas of focus identified in the literature in terms of the most important priorities for the near-term development of capacity building resources.

Childhood and adolescence are a critical period for the onset of mental and neurodevelopmental disorders and a time when many can be first identified. Research demonstrates that mental health literacy applied in school settings may be an effective approach to address these challenges. In contrast to many existing studies conducted in multicultural and multilingual settings that treated subjects’ language as a demographic feature, the present study recognizes English proficiency as a social-cognitive factor and views the school-based mental health literacy (MHL) intervention as a learning process. The present study aimed to assess the effectiveness of school-based mental health literacy intervention and explore how ethnicity and English proficiency as a social-cognitive factor, as a modified, rather than a fixed variable, impacted the intervention outcomes. Grade 9 students (n = 240) from schools in West Canada with diverse social/cultural background received the intervention in the classroom delivered by trained teachers and completed the pre-test and post-test over a 6-month period. The intervention was effective in improving knowledge and help-seeking attitudes among all students. Non-Chinese and native English-speaking students performed the best on all outcomes. Gender demonstrated an association with changes in stigma, stress and wellbeing. English proficiency was linked to knowledge acquisition, while ethnicity was connected to changes of attitude-related outcomes. These findings deepened our understanding of how demographic and social-cognitive factors underlie changes in mental health literacy outcomes, which will facilitate the development of mental health literacy interventions for diverse student populations.

Adverse drug events (ADEs) are a leading cause of emergency department visits and hospital admissions in Canada. ActionADE prevents repeat ADEs by enabling clinicians to document and communicate standardized ADE information across care settings. We used an external facilitation intervention to promote the uptake of ActionADE in four hospitals in British Columbia, Canada. This study examined whether, how and in what context external facilitation influenced the uptake of ActionADE. In this convergent-parallel mixed-methods study, an external facilitator used a four-step iterative process to support site champions using context-specific implementation strategies to increase the ADE reporting rate at their sites. We extracted archival data to assess implementation determinants before and after the implementation of the external facilitation and implementation strategies. We also retrieved data on the mean monthly counts of reported ADEs for each user from the ActionADE server. Zero-inflated Poisson models were used to examine changes in mean monthly counts of reported ADEs per user between pre-intervention (June 2021 to October 2021) and intervention (November 2021 to March 2022) periods. The external facilitator and site champions co-created three functions: (1) educate pharmacists about what and how to report in ActionADE, (2) educate pharmacists about the impact of ActionADE on patient outcomes, and (3) provide social support for pharmacists to integrate ADE reporting into clinical workflows. Site champions used eight forms to address the three functions. Peer support and reporting competition were the two common strategies used by all sites. Sites' responses to external facilitation varied. The rate of mean monthly counts of reported ADEs per user significantly increased during the intervention period compared to the pre-intervention period at LGH (RR: 3.74, 95% CI 2.78 to 5.01) and RH (RR: 1.43, 95% CI 1.23 to 1.94), but did not change at SPH (RR: 0.68, 95% CI: 0.43 to 1.09) and VGH (RR: 1.17, 95% CI 0.92 to 1.49). Leave of absence of the clinical pharmacist champion and failure to address all identified functions were implementation determinants that influenced the effectiveness of external facilitation. External facilitation effectively supported researchers and stakeholders to co-create context-specific implementation strategies. It increased ADE reporting at sites where clinical pharmacist champions were available, and where all functions were addressed.

Aviophobia, the fear of flying, is a prevalent type of situational-specific phobia categorized under anxiety disorders in The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Patients with aviophobia experience intense, irrational fear when traveling by air. Active avoidance of the phobic stimulus is a diagnostic feature that affects one's quality of life and commonly leads to significant functional limitations. Virtual reality based gradual exposure therapy is a treatment option for aviophobia due to its easy accessibility and low cost, but it may not be very effective. This case reports the effectiveness of using psychopharmacologic treatment in combination with real-life gradual exposure therapy to successfully treat a patient with aviophobia. Written consent from the patient was obtained prior to the writing and submission of this case report.

ABSTRACT Context: Emergency service and medical frontline workers are exposed to significant occupational stressors that may confer an increased risk of poor mental health, including posttraumatic stress disorder (PTSD). Emerging evidence suggests that physical activity and its structured subset, exercise, may be effective in improving symptoms of PTSD in veterans; however, the potential efficacy for other populations at high risk of occupational trauma exposure is currently unclear. Given the potential of physical activity interventions to improve both PTSD symptoms and physical comorbidities, there has been increasing interest in the potential role in the treatment of PTSD. Objective: The purpose of this review was to investigate the associations between physical activity levels and PTSD symptoms in emergency service and frontline medical workers. Design: A systematic review was conducted by searching major electronic databases for relevant studies published from database inception until February 2021. Eligibility Criteria: Studies among traditional emergency service occupations, e.g., police officers, firefighters, paramedics, and medical frontline workers, including doctors and nurses, were included. Study Selection: Experimental and observational studies with or without control groups were eligible for inclusion. Main Outcome Measure: The primary outcome measure was symptoms of PTSD. Results: The search identified eight eligible studies (four experimental and four observational). Three of the experimental studies showed that exercise significantly reduced symptoms of PTSD in emergency service personnel, including police and nurses. Based on the results of results of three studies, physical activity may be inversely associated with PTSD symptom severity among nurses and firefighters. Conclusions: Existing research suggests that physical activity may improve symptoms of PTSD in emergency service personnel and frontline workers. Considering physical activity promotion initiatives for occupations at high risk of trauma exposure may therefore be warranted to promote mental health. The existing research has several methodological limitations, and findings should therefore be interpreted with caution until further robust studies are available.

his educational void started with the lack of training in and exposure to seniors' health topics at the naturopathic medical school level, and it is our understanding that this still has not changed.For leaders in naturopathic gerontology to emerge, it requires exposure to this field within the core curriculum of the naturopathic educational program.In reviewing the curriculum of the Canadian naturopathic colleges there was a lack of content related to geriatrics, gerontology or seniors' health.The Canadian College of Naturopathic Medicine (CCNM) does not include geriatrics/ gerontology as part of the core curriculum. 1 When questioned about this deficit, we were informed that although geriatric topics are currently infused in many of the courses, there is no course that focuses on geriatrics specifically. 2However, the core and/or elective curriculum does include such special topics as: pregnancy, labour and newborn care; pediatrics; emergency medicine; mental health; and sexual and reproductive health. 1 Our opinion is that this is a serious deficit that needs to be fixed.Boucher Institute of Naturopathic Medicine (BINM), which will soon merge with CCNM, does include a survey course on geriatrics in its curriculum, but it is only 6 weeks long. 3 It is our experience that this is not sufficient to cover all the essential topics of aging in adequate detail, such as physiological changes, metabolism changes, polypharmacy, diseases of aging, caregiver stress, mental health, ageism, end of life topics, spirituality and meaning, and the list goes on.Upon graduation, we felt unprepared to deal with this patient population.Treating a condition is one aspect, but there

The coronavirus 2019 disease (COVID-19) pandemic is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Pre-existing cardiovascular disease (CVD) increases the morbidity and mortality of COVID-19, and COVID-19 itself causes serious cardiac sequelae. Strategies to minimise the risk of viral transmission to health care workers and uninfected cardiac patients while prioritising high quality cardiac care are urgently needed. We conducted a rapid literature appraisal and review of key documents identified by the Cardiac Society of Australia and New Zealand Board and Council members, the Australian and New Zealand Society of Cardiac and Thoracic Surgeons, and key cardiology, surgical and public health opinion leaders. Common acute cardiac manifestations of COVID-19 include left ventricular dysfunction, heart failure, arrhythmias and acute coronary syndromes. The presence of underlying CVD confers a five- to tenfold higher case fatality rate with COVID-19 disease. Special precautions are needed to avoid viral transmission to this population at risk. Adaptive health care delivery models and resource allocation are required throughout the health care system to address this need. Cardiovascular health services and cardiovascular health care providers need to recognise the increased risk of COVID-19 among CVD patients, upskill in the management of COVID-19 cardiac manifestations, and reorganise and innovate in service delivery models to meet demands. This consensus statement, endorsed by the Cardiac Society of Australia and New Zealand, the Australian and New Zealand Society of Cardiac and Thoracic Surgeons, the National Heart Foundation of Australia and the High Blood Pressure Research Council of Australia summarises important issues and proposes practical approaches to cardiovascular health care delivery to patients with and without SARS-CoV-2 infection.

BackgroundPatient-level surveillance (indication, appropriate choice, dosing, route, duration) of antimicrobial use in Canadian hospitals is needed to reduce antimicrobial overuse and misuse. Patient-level surveillance has not been performed on a national level in Canada. The Global Point Prevalence Survey of Antimicrobial Consumption and Resistance (Global-PPS) is an international collaborative to monitor antimicrobial use and resistance in hospitals worldwide. Global-PPS locally documents on a single day patient-level antimicrobial prescribing practices. This article presents the results of the 2017 Global-PPS in Canadian hospitals with established antimicrobial stewardship programs.MethodsHospitals part of the Canadian Nosocomial Infection Surveillance Program were invited to participate. Surveys could be performed any time in the 2017 calendar year. All in-patient wards in each hospital were surveyed by a physician, pharmacist or nurse with infectious disease training.ResultsFourteen Canadian hospitals participated in the survey. Of 4118 patients, 1400 patients (34.0%) received a total of 2041 antimicrobials. Overall, 73.1% (n = 1493) of antimicrobials were for therapeutic use, 14.2% (n = 288) were for medical prophylaxis, 8.3% (n = 170) were for surgical prophylaxis, 1.8% (n = 37) were for other reasons, and 0.2% (n = 3) were used as prokinetic agents. Only 2.5% (n = 50) were for unknown reasons. For antimicrobials for therapeutic use, 29.9% of patients were treated for lower respiratory tract (343/1147), 10.5% for intra-abdominal (120/1147), 9.3% for skin and soft tissue (107/1147) and 7.5% for gastro-intestinal (86/1147) infections.ConclusionsStandardized methodology amongst Global-PPSs allows the comparison of our results to the 2015 Global-PPS. The prevalence of antimicrobial use on medical, surgical, and intensive care wards are similar to those previously observed in North America. Indication of antimicrobials has not been previously reported on such a large scale in Canadian hospitals. This report serves as a comparison for further point prevalence surveys that are currently underway. It will be used for identifying opportunities and benchmarking in antibiotic stewardship.