St Joseph's Health Centre

BackgroundHospital environments can be harmful to older adults and contribute to hospitalization‐associated disability. To improve health outcomes, guidelines recommend more emphasis on non‐pharmacological care to better address physical, emotional, cognitive, and rehabilitative needs of older adults. We sought to develop, implement and evaluate the use of standardized mobile ‘Comfort Carts’ containing non‐pharmacological resources to enhance patient comfort, increase cognitive and physical stimulation, and help manage responsive behaviours associated with delirium and dementia.MethodsA ‘Comfort Cart’ containing a standardized set of non‐pharmacological resources for hospitalized older adults at risk of delirium and responsive behaviours associated with dementia was developed through multidisciplinary stakeholder consultations and a needs assessment survey of clinicians, patients, and hospital volunteers. Hospital volunteers were trained to use the ‘Comfort Cart’ to facilitate patient interactions and non‐pharmacological care to all patients admitted to an orthopedic unit at a tertiary care academic hospital. We conducted daily program audits over a 1‐year period and post‐implementation surveys to evaluate its effectiveness and acceptability.ResultsThe ‘Comfort Cart’ program has facilitated over 669 patient visits to date by hospital volunteers, including 50 with patients with dementia or those at high‐risk for delirium and/or responsive behaviours. Over 168 hours of patient‐volunteer interactions were logged with a mean visit duration per patient of 16.5 (SD 19.5) minutes. More than half of visits (58.1%) improved patients’ mood or behaviour. The longer the duration of a visit, the higher the likelihood that it would improve a patient's mood or behaviour. In post‐program implementation surveys, 76% of healthcare staff agreed that the ‘Comfort Cart’ addressed barriers for implementing non‐pharmacological care and 80% of volunteers stated that the ‘Comfort Cart’ helped them have meaningful visits with patients. All patients and caregivers surveyed felt that the program was important to meet the needs of hospitalized older adults, and 91% reported that it positively contributed to the perceived level of compassionate and overall patient care that they received in hospital.ConclusionsStandardized mobile ‘Comfort Carts’ satisfy unmet non‐pharmacological needs in the care of older adults and positively impact patient experience in hospital.

Background:Admission to shared hospital rooms are a risk factor of healthcare-associated (HA) SARS-CoV-2. Quantifying the impact of engineering controls such as ventilation and filtration is essential to informing resource utilization and infection prevention guidelines.Methods:Multicenter test-negative study of patients exposed to SARS-CoV-2 in shared rooms across five hospitals between January and October, 2022. Independent variables tested were measured air changes per hour (ACH), presence of any room mechanical ventilation (RMV), or portable high-efficiency particulate air (HEPA) filter. Covariates included facility (number of beds in room, outbreak status of unit), source patient (presence of symptoms, RT-PCR cycle threshold (Ct) value), and exposed patient factors (age, sex, time from last SARS-CoV-2 vaccine, previous SARS-CoV-2 infection, exposure duration). Multilevel logistic mixed models used to estimate the impact of engineering controls on transmission.Results:Among 468 exposed patients, secondary attack rate was 26.3% (range 7.5–33.3% across hospitals). In multivariable analysis, increased ACH was associated with decreased odds of infection (adjusted odds ratio (aOR) 0.88, 95% CI 0.78–1.00; p=.046) as were exposure duration and Ct value of source patient. Presence of RMV was also associated with decreased odds of infection (aOR 0.51, 95% CI 0.27–0.95; p=.034) while use of portable HEPA filter was not significant (aOR 0.58, 95% CI 0.26–1.31; p=.18).Conclusions:Improved ventilation was independently associated with lower odds of SARS-CoV-2 infection among exposed roommates. Ensuring RMV is present and optimizing ACH may significantly mitigate the risk of HA-SARS-CoV-2. Future prospective studies should assess optimal ACH thresholds and the impact of portable HEPA filters.

The treatment of inner and middle ear diseases remains a significant challenge, often requiring surgical intervention as the only option. In this study, we investigated porphysomes, self-assembled porphyrin-based nanoparticles, as a minimally invasive drug delivery platform for inner ear applications and as photothermal agents for cholesteatoma ablation. Three porphysome formulations were evaluated: parent porphysomes (PS), porphyrin-stabilized nanoemulsions (nPS), and EDTA-lipid incorporated porphysomes (ePS). Rats received intratympanic injections of each formulation, and fluorescence imaging performed 1 h postinjection demonstrated concentration-dependent inner ear penetration for all formulations. Notably, no signs of ototoxicity were observed based on histological and functional assessments of hearing and balance. Among ePS-treated rats, the 250 and 1,000 μM groups showed significantly higher inner ear fluorescence compared with the 50 μM group. Auditory brainstem response (ABR) and distortion product otoacoustic emission (DPOAE) tests were performed at baseline and 2 and 6 weeks postinjection. No significant threshold shifts were detected in PS and ePS groups compared with controls. In contrast, nPS-treated rats exhibited a significant ABR threshold elevation at 6 weeks (p < 0.02). At 6 weeks, minor yet statistically significant DPOAE threshold differences were observed at 16 kHz (PS group) and 32 kHz (all porphysome groups); however, all shifts remained below 0 dB, indicating no functional hearing loss. Vestibular assessments, including swim and beam tests, revealed no significant impairments. Upon laser activation, all porphysome formulations induced substantial temperature elevation (ΔT = 31 ± 3.76°C, p < 0.05) and histological burn effects in cholesteatoma tissues. These findings support the potential of porphysomes as a safe, minimally invasive drug delivery system and photothermal agent for the treatment of inner and middle ear disorders.

Many national medical governing bodies encourage physicians to engage in continuing professional development (CPD) activities to cultivate their knowledge and skills to ensure their clinical practice reflects the current standards and evidence base. However, physicians often encounter various barriers that hinder their participation in CPD programs, such as time constraints, a lack of centralized coordination, and limited opportunities for self-assessment. The literature has highlighted the strength of using question-based learning interventions to augment physician learning and further enable change in practice. CPD By the Minute (CPD-Min) is a smartphone-enabled web-based app that was developed to address self-assessment gaps and barriers to engagement in CPD activities. This study aimed to assess the app using four objectives: (1) engagement and use of the app throughout the study, (2) effectiveness of this tool as a CPD activity, (3) relevance of the disseminated information to physicians' practice, and (4) acceptability to physicians of this novel tool as an educational initiative. The CPD-Min app disseminated 2 multiple-choice questions (1-min each) each week with feedback and references. Participants included licensed staff physicians, fellows, and residents across Canada. A concurrent multimethods study was conducted, consisting of preintervention and postintervention surveys, semistructured interviews, and app analytics. Guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework, the qualitative data were analyzed deductively and inductively. Of the 105 Canadian anesthesiologists participating in the study, 89 (84.8%) were staff physicians, 12 (11.4%) were fellows, and 4 (3.8%) were residents. Participants completed 110 questions each over the course of 52 weeks, with an average completion rate of 75% (SD 33%). In total, 40.9% (43/105) of participants answered >90% of the questions, including 15.2% (16/105) who completed all questions. Moreover, 69% (52/75) of participants reported the app to be an effective and valuable resource for their practice and to enhance continuous learning. Most participants (63/75, 84%) who completed the postsurveys reported that they would likely continue using the app as a CPD tool. These findings were further supported by the interview data. Three key themes were identified: the practical design of the novel educational app facilitates its adoption by clinicians, the app was perceived as a useful knowledge tool for continuous learning, and the app's low-stakes testing environment cultivated independent learning attitudes. The findings suggest the potential of the app to improve longitudinal assessments that promote lifelong learning among clinicians. The positive feedback and increased acceptance of the app supports it as an innovative tool for knowledge retention and CPD. Future research efforts should prioritize evaluating the app's long-term sustainability and its impact on physicians' practice, as well as exploring alternative approaches (such as artificial intelligence-based tools) for generating questions.

People who use drugs (PWUD) frequently seek care in the emergency department (ED). Little is known about ED physician perspectives and experiences integrating a harm reduction approach into care, including interventions that reduce the health, social and legal consequences of drug use without requiring a reduction in drug use. This study aimed to describe the experiences of Canadian emergency physicians caring for PWUD, and facilitators and barriers to implementing harm reduction interventions in the ED. Purposive sampling, using an existing national network, and snowball sampling techniques were used to recruit practicing emergency physicians. Semi-structured, one-on-one telephone interviews were conducted until theoretical data saturation was achieved. Interview recordings were transcribed and analyzed using latent content analysis. Interviews took place between June 2019 and February 2020. This work is a secondary analysis specifically focused on harm reduction approaches to care. 32 physician interviews were included. Participants had a median of 10 years of experience (range 1-33) and most (29/32) worked in urban EDs. Participants highlighted the complexities of caring for PWUD, including the intersection of structural vulnerability with substance use. The ED environment varied across Canada and either facilitated or hindered the adoption of harm reduction interventions. Additional barriers included a lack of training and experience; lack of community follow-up care; insufficient ED funding and staffing resources; and, tensions over the appropriate scope of emergency medicine practice. Facilitators included tailored education and training; specialized multidisciplinary teams; ED harm reduction champions; and standardized protocols. Though variability existed in the adoption and practice of harm reduction in Canadian EDs, most interviewed physicians supported a harm reduction approach to care. To facilitate widespread ED adoption of harm reduction interventions, there is a need for standardized guidance, supplemental resources, facilitated culture change, and sufficient community-based services.

BackgroundFood insecurity is common in Canada and impacts children more than any other age group. This study aimed to evaluate the association between participation in school food programs and food insecurity among students attending Canada’s largest urban school-based health centre program, the REACH School Network.MethodsThis is a cross-sectional observational study from April 2022 to June 2024 at the REACH School Network. We administered the Growth and Nutrition Questionnaire to parents of children aged 3–17 years. Questions were related to dietary intake and participation in school food programs. Our primary outcome was food insecurity, using the Hunger Vital Sign. Logistic regression estimated the association between regular school food program participation and food insecurity, adjusting for covariates.ResultsOf 477 eligible participants, 316 consented (66.2% response rate), and 223 were included in the analysis. The mean age was 9.21 years (SD = 3.08); 69.1% identified as male. Overall, 134 (60.1%) regularly participated in a school food program. Food insecurity was reported by 97 (43.5%) participants, with similar prevalence among participants (44.8%) and non-participants (41.6%). Logistic regression, both unadjusted (OR = 1.14; 95% CI 0.66–1.97; P = 0.637) and adjusted (OR = 0.82; 95% CI 0.42–1.63; P = 0.579) found no significant association between school food program participation and food insecurity.ConclusionOur study highlights the complex relationship between food insecurity and school food program participation among an at-risk, urban children. Future research is needed, with larger sample sizes and longitudinal designs to better understand these complex relationships.