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Hudon A, Augeard N, Tansey CM, Houston E, Bostick G, Wideman TH. Does feeling pain help prepare future clinicians to treat pain? A qualitative exploration of a novel experiential approach to teaching health professional students about pain. Physiother Theory Pract 2023:1-13. [PMID: 37682624 DOI: 10.1080/09593985.2023.2254367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 08/22/2023] [Accepted: 08/28/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND AND INTRODUCTION Pain is a subjective phenomenon, that is often misunderstood and invalidated. Despite recent advances in health professional training, it remains unclear how students should be taught about the subjectivity of pain. This study explored how a novel teaching activity that integrated physiotherapy students' first-hand experiences with laboratory-induced pain could address this gap. OBJECTIVE The study aimed to explore the experiences and perceptions of physiotherapy students in relation to a workshop where physiotherapy students experienced laboratory induced pain. METHODS We used a descriptive qualitative research design. Eighteen students participated in interviews. Transcripts were analyzed using an inductive conventional content analysis. RESULTS We identified four overarching themes: 1) First-hand pain experiences facilitated engagement in learning; 2) Reflecting on these personal and peer pain experiences helped students make sense of pain; 3) The learning activity helped students understand the inherent subjectivity and complexity of pain; and 4) Students saw benefits for clinical practice. CONCLUSION Integrating first-hand pain experiences within entry-level physiotherapy training appears to have novel value in helping students understand pain subjectivity. Future research should use robust and controlled designs to explore how this novel approach can be used to facilitate further understanding and empathy within clinical interactions with people living with pain.
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Affiliation(s)
- Anne Hudon
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, Québec, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux du Centre-Ouest de l'Ile-de-Montréal (CIUSSS COMTL) Constance-Lethbridge Rehabilitation Center, Montreal, Quebec, Canada
| | - Nathan Augeard
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, Québec, Canada
- School of Physiotherapy and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Catherine M Tansey
- Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
| | - Emilie Houston
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, Québec, Canada
- School of Physiotherapy and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Geoff Bostick
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Timothy H Wideman
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montréal, Québec, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux du Centre-Ouest de l'Ile-de-Montréal (CIUSSS COMTL) Constance-Lethbridge Rehabilitation Center, Montreal, Quebec, Canada
- School of Physiotherapy and Occupational Therapy, Faculty of Medicine, McGill University, Montreal, Quebec, Canada
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Wolfson C, Gauvin DE, Schulz J, Magalhaes S, Tansey CM, Feinstein A, Aiken A, Scarfo B, Middleton J, Raina P, VanTil L, Molnar-Szakacs I. The Canadian Longitudinal Study on Aging: A Vehicle for Research on Aging in Older Veterans. Mil Med 2023:usad012. [PMID: 36722191 DOI: 10.1093/milmed/usad012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 12/18/2022] [Accepted: 01/11/2023] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Research on the health of older Veterans in Canada is an emerging area. Few population-based studies in Canada have included older Veterans as a specific group of interest. This paper describes a cohort of self-identified Veterans within the Canadian Longitudinal Study on Aging (CLSA). MATERIALS AND METHODS Using data from the CLSA baseline assessment (2011-2015), we describe sociodemographic and health characteristics along with military-related variables in a cohort of Veterans in Canada. We also estimate the number of Canadian and non-Canadian Veterans living in Canada at the time of the CLSA baseline data collection. RESULTS We estimate that at the CLSA baseline, there were 718,893 (95% confidence interval [CI], 680,033-757,110) Canadian Veterans and 185,548 (95% CI, 165,713-205,100) non-Canadian Veterans aged 45-85 years living in Canada. Veterans were older and predominantly male compared to non-Veterans in the CLSA. Following age and sex adjustment, the distribution of sociodemographic and health characteristics was similar across all groups. The majority (> 85%) of participants in each comparison group reported self-rated general and mental health as excellent, very good, or good. Following age and sex adjustment, most characteristics across groups remained similar. One exception was mental health, where a greater proportion of Veterans screened positive for depression and anxiety relative to non-Veterans. CONCLUSIONS Using CLSA baseline data, we estimate the number of older Veterans in Canada and present descriptive data that highlight interesting differences and similarities between Veterans and non-Veterans living in Canada. Canadian and non-Canadian Veterans in the CLSA are presented separately, with the latter group having not been previously studied in Canada. This paper presents a snapshot of a cohort of self-identified Veterans within the CLSA at study baseline and highlights the potential of the CLSA as a vehicle for studying the aging Veteran population in Canada for years to come.
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Affiliation(s)
- Christina Wolfson
- Department of Epidemiology and Biostatistics and Occupational Health, McGill University, Montreal, QC H3A 1G1, Canada
- Department of Medicine, McGill University, Montreal, QC H4A 3J1, Canada
- Neuroepidemiology Research Unit, Research Institute of the McGill University Health Centre, Montreal, QC H3G 1A4, Canada
| | - Danielle E Gauvin
- Neuroepidemiology Research Unit, Research Institute of the McGill University Health Centre, Montreal, QC H3G 1A4, Canada
| | - Juliana Schulz
- Department of Decision Sciences, HEC Montréal, Montréal, QC H3T 2A7, Canada
| | - Sandra Magalhaes
- New Brunswick Institute for Research, Data and Training and Department of Sociology, University of New Brunswick, Fredericton, NB E3C 1N8, Canada
| | - Catherine M Tansey
- Neuroepidemiology Research Unit, Research Institute of the McGill University Health Centre, Montreal, QC H3G 1A4, Canada
| | - Anthony Feinstein
- Department of Psychiatry, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
| | - Alice Aiken
- Faculty of Health, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Brittany Scarfo
- Neuroepidemiology Research Unit, Research Institute of the McGill University Health Centre, Montreal, QC H3G 1A4, Canada
| | - Jason Middleton
- Neuroepidemiology Research Unit, Research Institute of the McGill University Health Centre, Montreal, QC H3G 1A4, Canada
| | - Parminder Raina
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Linda VanTil
- Research Directorate, Veterans Affairs Canada, Charlottetown, PEI C1A 8M9, Canada
| | - Istvan Molnar-Szakacs
- Neuroepidemiology Research Unit, Research Institute of the McGill University Health Centre, Montreal, QC H3G 1A4, Canada
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van der Braak K, Wald J, Tansey CM, Paes T, Sedeno M, Selzler AM, Stickland MK, Bourbeau J, Janaudis-Ferreira T. Implementation and maintenance of an enhanced pulmonary rehabilitation program in a single centre: An implementation study. Chron Respir Dis 2023; 20:14799731231179105. [PMID: 37471305 PMCID: PMC10363903 DOI: 10.1177/14799731231179105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Pulmonary rehabilitation (PR) has major benefits for patients with chronic obstructive pulmonary disease (COPD). An enhanced PR program was developed with a self-management education intervention. The objective of our study was to evaluate the implementation of the enhanced PR program into a single centre. METHODS Pre-post implementation study consisted of two evaluation periods: immediately after implementation and 18 months later. Guided by the RE-AIM framework, outcomes included: Reach, Effectiveness, Adoption, Implementation and Maintenance. RESULTS Reach: 70-75% of referred patients agreed to a PR program (n = 26). Effectiveness: Clinically important improvements occurred in some patients in functional exercise capacity (64% of the patients achieved clinical important difference in 6-min walk test in the first evaluation period and 44% in the second evaluation period), knowledge, functional status, and self-efficacy in both evaluation periods. Adoption: All healthcare professionals (HCPs) involved in PR (n = 8) participated. Implementation: Fidelity for the group education sessions ranged from 76 to 95% (first evaluation) and from 82 to 88% (second evaluation). Maintenance: The program was sustained over 18 months with minor changes. Patients and HCPs were highly satisfied with the program. CONCLUSIONS The enhanced PR program was accepted by patients and HCPs and was implemented and maintained at a single expert center with good implementation fidelity.
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Affiliation(s)
- Kim van der Braak
- Physical Therapy Sciences, Program in Clinical Health Sciences, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
- Respiratory Epidemiology and Clinical Research Unit, Centre for Health Outcomes Research, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Joshua Wald
- McMaster University Medical Centre, Hamilton, ON, Canada
| | - Catherine M Tansey
- Respiratory Epidemiology and Clinical Research Unit, Centre for Health Outcomes Research, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Thais Paes
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Londrina, Brazil
| | - Maria Sedeno
- Respiratory Epidemiology and Clinical Research Unit, Centre for Health Outcomes Research, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- RESPIPLUS, Mont-Royal, QC, Canada
- Respiratory Epidemiology and Clinical Research Unit (RECRU), Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Anne-Marie Selzler
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Michael K Stickland
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Jean Bourbeau
- Respiratory Epidemiology and Clinical Research Unit, Centre for Health Outcomes Research, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Respiratory Epidemiology and Clinical Research Unit (RECRU), Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Tania Janaudis-Ferreira
- Respiratory Epidemiology and Clinical Research Unit, Centre for Health Outcomes Research, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Laboratory of Research in Respiratory Physiotherapy (LFIP), Department of Physiotherapy, State University of Londrina, Londrina, Brazil
- Respiratory Epidemiology and Clinical Research Unit (RECRU), Research Institute of the McGill University Health Centre, Montreal, QC, Canada
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Janaudis-Ferreira T, Tansey CM, Mathur S, Blydt-Hansen T, Lamoureaux J, Räkel A, de Sousa Maia NP, Bussières A, Ahmed S, Boruff J. The effects of exercise training in adult solid organ transplant recipients: A systematic review and meta-analysis. Transpl Int 2021; 34:801-824. [PMID: 33608971 DOI: 10.1111/tri.13848] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/16/2020] [Accepted: 02/17/2021] [Indexed: 12/18/2022]
Abstract
Reduced exercise capacity can predispose solid organ transplant (SOT) recipients to higher risk of diabetes, cardiovascular complications, and mortality and impact their quality of life. This systematic review and meta-analysis investigated the effects of exercise training (versus no training) in adult SOT recipients. We conducted an electronic search of randomized controlled trials reporting on exercise interventions in SOT recipients. Primary outcomes were exercise capacity, quadriceps muscle strength, and health-related quality of life (HRQoL). Twenty-nine articles met the inclusion criteria. In 24 studies, there were either high risk of bias or some concerns about the potential risk of bias. There was an increase in exercise capacity (VO2 peak) (SMD: 0.40; 95%CI 0.22-0.57; P = 0.0) and quadriceps muscle strength (SMD: 0.38; 95%CI 0.16-0.60; P = 0.001) in the exercise vs control groups. There were also improvements in several domains of the SF-36. Diastolic blood pressure improved in the exercise group compared to controls (SMD: -0.22; 95%CI -0.41-0.03; P = 0.02). Despite the considerable variation in exercise training characteristics and high risk of bias in the included studies, exercise training improved maximal exercise capacity, quadriceps muscle strength, HRQoL, and diastolic blood pressure and should be an essential part of the post-transplant care.
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Affiliation(s)
- Tania Janaudis-Ferreira
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.,Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,Translational Research in Respiratory Diseases Program, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | - Catherine M Tansey
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Sunita Mathur
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada.,Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Tom Blydt-Hansen
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada.,British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Julie Lamoureaux
- Centre de Recherche Interdisciplinaire en Réadaptation du Montréal métropolitain, Montreal, QC, Canada
| | - Agnès Räkel
- Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | | | - André Bussières
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.,Centre de Recherche Interdisciplinaire en Réadaptation du Montréal métropolitain, Montreal, QC, Canada.,Département Chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Sara Ahmed
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.,Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,Centre de Recherche Interdisciplinaire en Réadaptation du Montréal métropolitain, Montreal, QC, Canada
| | - Jill Boruff
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montreal, QC, Canada
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Bednarczyk C, Tansey CM, Fontaine S, Baker S, Laberge É, Mathur S, Lambert H, Janaudis-Ferreira T. Community-based exercise program for solid organ transplant recipients: Views of exercise professionals and patients. Mcgill J Med 2021. [DOI: 10.26443/mjm.v19i1.218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose of the study: Although transplantation improves quality of life in solid organ transplant (SOT) recipients, recipients continue to have limitations in exercise capacity and decreased levels of physical activity (PA) years after transplant. Community Based Exercise (CBE) programs have been shown to successfully increase PA levels in other populations, however none exist for SOT recipients.
Objective: To identify important factors when developing and implementing a CBE program for SOT recipients.
Methods: We conducted a qualitative study using semi-structured interviews with seven SOT recipients, and six exercise professionals (EPs). The data was analyzed using thematic analysis.
Main findings: Six themes were identified: 1) Motivators to exercise; 2) Perceived barriers to exercise (financial vulnerability post-transplantation, fear of injury, lack of exercise recommendations and medication side effect); 3) Level of supervision (recipients wanted guidance without overprotective supervision, while EPs were torn between extensive monitoring, and promoting independence); 4) Required education and foundational knowledge in EPs; 5) The importance of CBE programs for the SOT population; and 6) Tailored program structure (group setting with individualized exercise prescription).
Principal conclusions: Recommendations may be used to develop an effective CBE program for SOT recipients, and thus improve PA levels among this population.
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Pesce de Souza F, Massierer D, Anand Raje U, Tansey CM, Boruff J, Janaudis-Ferreira T. Exercise interventions in solid organ transplant candidates: A systematic review. Clin Transplant 2020; 34:e13900. [PMID: 32391965 DOI: 10.1111/ctr.13900] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 05/02/2020] [Accepted: 05/04/2020] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Exercise training may be recommended to solid organ transplant (SOT) candidates to improve fitness and tolerance before surgery. We aimed to determine the acceptance, safety, and effectiveness of exercise interventions in SOT candidates. METHODS Online databases were searched. Studies of any design were included. Outcomes of interest were acceptance, safety, exercise capacity, and health-related quality of life. RESULTS Twenty-three articles were included. Acceptance ranged from 16% to 100%. In the fifteen studies that assessed adverse events, none mentioned any adverse events occurring during the study. Five out of seven studies reported an increase in maximal exercise capacity post-exercise in the intervention group (range of mean change: 0.45 to 2.9 mL/kg). Eight out of fourteen studies reported an increase in 6-minute walking distance in the intervention group after the training period (range of mean change: 40-105 m). Two articles showed an improvement in the mental composite scores as well as in the physical composite scores post-exercise in the intervention group. CONCLUSION There was a lack of significant findings among most randomized controlled trials. Exercise training is acceptable and safe for selective SOT candidates. The effects of exercise training on exercise capacity and quality of life in SOT candidates are unclear.
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Affiliation(s)
| | - Daniela Massierer
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.,Centre for Health Outcomes Research (CORE), Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
| | - Uma Anand Raje
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Catherine M Tansey
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | - Jill Boruff
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montreal, QC, Canada
| | - Tania Janaudis-Ferreira
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.,Centre for Health Outcomes Research (CORE), Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada.,Respiratory Epidemiology and Clinical Research Unit, Research Institute, McGill University Health Center Montreal, QC, Canada
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Janaudis-Ferreira T, Mathur S, Tansey CM, Blydt-Hansen T, Hartell D. Disseminating Knowledge to Providers on Exercise Training After Solid Organ Transplantation. Prog Transplant 2020; 30:125-131. [DOI: 10.1177/1526924820913506] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Introduction: The objectives of our dissemination project were (1) to disseminate the evidence supporting exercise training in solid organ transplantation to exercise professionals, health-care professionals, physicians, and directors of transplant programs in order to enhance their ability to apply evidence to practice and (2) to build a community of exercise professionals and researchers across Canada. Methods: We used the 5-step Patient-Centered Outcomes Research Institute model for knowledge translation to guide our project: (1) evidence assessment, (2) audience and partner identification, (3) dissemination, (4) implementation, and (5) evaluation. After meeting with experts in the field, conducting a literature review, and identifying an appropriate audience, we took our presentations on the road across Canada. Results: We visited 10 transplant centers and held interactive knowledge translation sessions in each center. To provide sustainability and to facilitate the adoption of the research evidence, we founded the Canadian Network for Rehabilitation and Exercise for Solid Organ Transplant Optimal Recovery network and created its website. Conclusions: Our project raised awareness of the importance of exercise among many health professionals in Canada and built a community of exercise professionals and researchers in the field of transplantation through the rehabilitation network. It also led to the creation of online resources that will facilitate the implementation of rehabilitation programs in transplant centers.
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Affiliation(s)
- Tania Janaudis-Ferreira
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
- Translational Research in Respiratory Diseases Program, Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada
- Centre for Health Outcomes Research (CORE) Research Institute of the McGill University Health Centre, McGill University, Montreal, Quebec, Canada
- Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada
| | - Sunita Mathur
- Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Catherine M. Tansey
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
| | - Tom Blydt-Hansen
- Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Hartell
- Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada
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Abstract
INTRODUCTION Health-related disaster research is a relatively small; but growing field of inquiry. A better understanding of the scope and scale of health-related disaster research that has occurred in low- and middle-income countries (LMICs) would be useful to funders, researchers, humanitarian aid organizations, and governments as they strive to identify gaps, disparities, trends, and needs of populations affected by disasters. METHODOLOGY We performed a scoping review using the process outlined by Arksey & O'Malley to assess the characteristics of peer-reviewed publications of empirical health-related disaster research conducted in LMICs and published in the years 2003-2012. RESULTS Five hundred and eighty-two relevant publications were identified. Earthquakes were by far the most commonly researched events (62% of articles) in the review's timeframe. More articles were published about disasters in China & South Asia/South East Asia than all other regions. Just over half of the articles (51%) were published by research teams in which all the authors' primary listed affiliations were with an institution located in the same country where the research was conducted. Most of the articles were classified as either mental health, neurology and stress physiology (35%) or as traumatology, wounds and surgery (19%). In just over half of the articles (54%), data collection was initiated within 3 months of the disaster, and in 13% research was initiated between 3 and 6 months following the disaster. The articles in our review were published in 282 different journals. DISCUSSION The high number of publications studying consequences of an earthquake may not be surprising, given that earthquakes are devastating sudden onset events in LMICs. Researchers study topics that require immediate attention following a disaster, such as trauma surgery, as well as health problems that manifest later, such as post-traumatic stress disorder. One neglected area of study during the review's timeframe was the impact of disasters on non-communicable and chronic diseases (excluding mental health), and the management of these conditions in the aftermath of disasters. Strengthening disaster research capacity is critical for fostering robust research in the aftermath of disasters, a particular need in LMICs.
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Affiliation(s)
- Catherine M Tansey
- Humanitarian Health Ethics Research Group, McGill University, Montréal, Québec, Canada and McMaster University, Montréal, Québec, Canada
| | - John Pringle
- Assistant Professor at the Ingram School of Nursing, McGill University, Montréal, Québec, Canada; Humanitarian Health Ethics Research Group, McGill University, Montréal, Québec, Canada and McMaster University, Hamilton, Canada
| | | | | | - Matthew Hunt
- Centre for Interdisciplinary Research in Rehabilitation, School of Physical and Occupational Therapy, McGill University, Montréal, Québec, Canada
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Magalhaes S, Banwell B, Bar-Or A, Fortier I, Hanwell HE, Lim M, Matt GE, Neuteboom RF, O'Riordan DL, Schneider PK, Pugliatti M, Shatenstein B, Tansey CM, Wassmer E, Wolfson C. A framework for measurement and harmonization of pediatric multiple sclerosis etiologic research studies: The Pediatric MS Tool-Kit. Mult Scler 2018; 25:1170-1177. [PMID: 29932341 PMCID: PMC6572633 DOI: 10.1177/1352458518783345] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background: While studying the etiology of multiple sclerosis (MS) in children has several methodological advantages over studying etiology in adults, studies are limited by small sample sizes. Objective: Using a rigorous methodological process, we developed the Pediatric MS Tool-Kit, a measurement framework that includes a minimal set of core variables to assess etiological risk factors. Methods: We solicited input from the International Pediatric MS Study Group to select three risk factors: environmental tobacco smoke (ETS) exposure, sun exposure, and vitamin D intake. To develop the Tool-Kit, we used a Delphi study involving a working group of epidemiologists, neurologists, and content experts from North America and Europe. Results: The Tool-Kit includes six core variables to measure ETS, six to measure sun exposure, and six to measure vitamin D intake. The Tool-Kit can be accessed online (www.maelstrom-research.org/mica/network/tool-kit). Conclusion: The goals of the Tool-Kit are to enhance exposure measurement in newly designed pediatric MS studies and comparability of results across studies, and in the longer term to facilitate harmonization of studies, a methodological approach that can be used to circumvent issues of small sample sizes. We believe the Tool-Kit will prove to be a valuable resource to guide pediatric MS researchers in developing study-specific questionnaire
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Affiliation(s)
- Sandra Magalhaes
- Royal Victoria Hospital, Allan Memorial Institute and Neuroepidemiology Research Unit, Research Institute of the McGill University Health Centre, Montreal, QC, Canada/Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Brenda Banwell
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Amit Bar-Or
- Center for Neuroinflammation and Experimental Therapeutics and Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Isabel Fortier
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Heather E Hanwell
- Dalla Lana School of Public Health, The University of Toronto, Toronto, ON, Canada
| | - Ming Lim
- Children's Neurosciences, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundations Trust, King's Health Partners Academic Health Sciences Centre, London, UK/ Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Georg E Matt
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Rinze F Neuteboom
- Department of Pediatric Neurology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - David L O'Riordan
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Paul K Schneider
- Royal Victoria Hospital, Allan Memorial Institute and Neuroepidemiology Research Unit, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Maura Pugliatti
- Department of Medicine, McGill University, Montreal, QC, Canada/ Unit of Clinical Neurology, Department of Biomedical and Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Bryna Shatenstein
- Département de nutrition, Université de Montréal, Montreal, QC, Canada/ Centre de recherche, Institut universitaire de gériatrie de Montréal, CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, QC, Canada
| | - Catherine M Tansey
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada
| | | | - Christina Wolfson
- Royal Victoria Hospital, Allan Memorial Institute and Neuroepidemiology Research Unit, Research Institute of the McGill University Health Centre, Montreal, QC, Canada/ Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC, Canada/ Department of Medicine, McGill University, Montreal, QC, Canada
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10
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Janaudis-Ferreira T, Mathur S, Konidis S, Tansey CM, Beaurepaire C. Outcomes in randomized controlled trials of exercise interventions in solid organ transplant. World J Transplant 2016; 6:774-789. [PMID: 28058230 PMCID: PMC5175238 DOI: 10.5500/wjt.v6.i4.774] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 09/29/2016] [Accepted: 10/24/2016] [Indexed: 02/05/2023] Open
Abstract
AIM To identify the outcome measures that have been used in randomized controlled trials (RCTs) of exercise training in solid organ transplant (SOT) recipients and to link these outcomes to the International Classification of Functioning, Disability and Health (ICF) framework.
METHODS Electronic literature searches of MEDLINE, EMBASE, CINAHL, Cochrane, Scopus, and Web of Science were performed. We sought RCTs that investigated the effect of exercise training in SOT recipients. Reference lists of all eligible publications were searched for other appropriate studies not identified by the electronic search. A complete list of outcome measures used in the RCTs was generated and each of these was linked to an ICF category.
RESULTS Four hundred and thirteen articles were retrieved, of which 35 met our inclusion criteria. The studies included were designed to compare the effects of exercise training programs to usual care or to another exercise training program and reported on recipients of heart (n = 21), kidney (n = 9), lung (n = 3) or liver (n = 2) transplant. Of the 126 outcome measures identified, 62 were used as primary outcome measures. The most commonly occurring primary outcomes were aerobic capacity using the peak VO2 (n = 13), quality of life using the short-form-36 (n = 8), and muscle strength (n = 7). These outcome measures were linked to 113 ICF categories and the majority of outcomes fall into the body function domain (n = 93).
CONCLUSION There is little standardization in outcome measures used in RCTs of exercise interventions in SOT recipients. The ICF framework can be used to select a core set of outcomes that cross all domains of ICF and that would be appropriate to all SOT recipients.
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Hunt M, Tansey CM, Anderson J, Boulanger RF, Eckenwiler L, Pringle J, Schwartz L. The Challenge of Timely, Responsive and Rigorous Ethics Review of Disaster Research: Views of Research Ethics Committee Members. PLoS One 2016; 11:e0157142. [PMID: 27327165 PMCID: PMC4915681 DOI: 10.1371/journal.pone.0157142] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 05/25/2016] [Indexed: 11/22/2022] Open
Abstract
Background Research conducted following natural disasters such as earthquakes, floods or hurricanes is crucial for improving relief interventions. Such research, however, poses ethical, methodological and logistical challenges for researchers. Oversight of disaster research also poses challenges for research ethics committees (RECs), in part due to the rapid turnaround needed to initiate research after a disaster. Currently, there is limited knowledge available about how RECs respond to and appraise disaster research. To address this knowledge gap, we investigated the experiences of REC members who had reviewed disaster research conducted in low- or middle-income countries. Methods We used interpretive description methodology and conducted in-depth interviews with 15 respondents. Respondents were chairs, members, advisors, or coordinators from 13 RECs, including RECs affiliated with universities, governments, international organizations, a for-profit REC, and an ad hoc committee established during a disaster. Interviews were analyzed inductively using constant comparative techniques. Results Through this process, three elements were identified as characterizing effective and high-quality review: timeliness, responsiveness and rigorousness. To ensure timeliness, many RECs rely on adaptations of review procedures for urgent protocols. Respondents emphasized that responsive review requires awareness of and sensitivity to the particularities of disaster settings and disaster research. Rigorous review was linked with providing careful assessment of ethical considerations related to the research, as well as ensuring independence of the review process. Conclusion Both the frequency of disasters and the conduct of disaster research are on the rise. Ensuring effective and high quality review of disaster research is crucial, yet challenges, including time pressures for urgent protocols, exist for achieving this goal. Adapting standard REC procedures may be necessary. However, steps should be taken to ensure that ethics review of disaster research remains diligent and thorough.
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Affiliation(s)
- Matthew Hunt
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
- Center for Interdisciplinary Research in Rehabilitation, Montreal, Quebec, Canada
- Humanitarian Health Ethics Research Group, McGill University, Montreal, Quebec, Canada, McMaster University, Hamilton, Ontario, Canada
- * E-mail:
| | - Catherine M. Tansey
- Humanitarian Health Ethics Research Group, McGill University, Montreal, Quebec, Canada, McMaster University, Hamilton, Ontario, Canada
| | - James Anderson
- Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Renaud F. Boulanger
- Humanitarian Health Ethics Research Group, McGill University, Montreal, Quebec, Canada, McMaster University, Hamilton, Ontario, Canada
- Biomedical Ethics Unit, McGill University, Montreal, Quebec, Canada
| | - Lisa Eckenwiler
- Department of Philosophy & Department of Health Administration and Policy, George Mason University, Fairfax, Virginia, United States of America
| | - John Pringle
- Humanitarian Health Ethics Research Group, McGill University, Montreal, Quebec, Canada, McMaster University, Hamilton, Ontario, Canada
| | - Lisa Schwartz
- Humanitarian Health Ethics Research Group, McGill University, Montreal, Quebec, Canada, McMaster University, Hamilton, Ontario, Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
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Wilcox ME, Patsios D, Murphy G, Kudlow P, Paul N, Tansey CM, Chu L, Matte A, Tomlinson G, Herridge MS. Radiologic Outcomes at 5 Years After Severe ARDS. Chest 2013. [DOI: 10.1378/chest.12-0685] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Abstract
How individuals age is affected by life experiences. What we know today about aging has been largely shaped by a generation who experienced the special circumstances of wartime in their formative years. In this review, we investigate the research question, "What is known about the physical health of Canadian veterans?" In answering this question, we summarize the literature on Canadian Veterans but also include international literature on the physical health of American and Australian Veterans, along with some information from reports from Great Britain and other parts of Europe. Areas in which veterans perhaps fare worse than civilians of similar age include general health, hearing loss, musculoskeletal disorders, infections, cirrhosis, skin conditions, stomach conditions, neurologic conditions, and cardiovascular disease. The differing effects of combat on female veterans are also summarized. The healthy warrior effect is discussed along with its impact on research findings and the importance of choosing an appropriate control group.
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Adhikari NKJ, Tansey CM, McAndrews MP, Matté A, Pinto R, Cheung AM, Diaz-Granados N, Herridge MS. Self-reported depressive symptoms and memory complaints in survivors five years after ARDS. Chest 2011; 140:1484-1493. [PMID: 21998261 DOI: 10.1378/chest.11-1667] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Survivors of ARDS report depressive symptoms and memory complaints, the prevalence of which after 5 years is unknown. METHODS We administered instruments assessing symptoms of depression (Beck Depression Inventory II [BDI-II]) and memory complaints (Memory Assessment Clinics Self-Rating Scale [MAC-S]) to 64 survivors of ARDS from four university-affiliated ICUs 5 years after ICU discharge. We compared BDI-II scores to quality of life (Medical Outcomes Study 36-Item Short Form [SF-36]) mental health domains (role emotional, mental health, mental component summary), compared BDI-II and MAC-S scores to earlier scores (median, 22 months postdischarge), and examined return to work. RESULTS Forty-three (67.2%), 46 (71.9%), and 38 (59.4%) patients fully completed the BDI-II, MAC-S ability subscale, and MAC-S frequency of occurrence subscale, respectively. Responders were young (median, 48 years; first-third quartile [Q1-Q3], 39-61 years) with high illness severity. The median BDI-II score was 10 (Q1-Q3, 3-18); eight of 43 (18.6%) had moderate to severe depressive symptoms compared with 14 of 43 (32.6%) earlier (P = .15, n = 38 with paired data). Median MAC-S ability and MAC-S frequency scores were 81 (Q1-Q3, 57-92) and 91.5 (Q1-Q3, 76-105), respectively, similar to earlier scores (P = .67 and P = .64, respectively); 0% to 4.3% scored > 2 SDs below population norms. Higher BDI-II score was predicted by higher earlier BDI-II score, slower recovery of organ function, and longer duration of mechanical ventilation and ICU stay. Higher MAC-S score was predicted by higher earlier MAC-S score. SF-36 mental health domain scores were very stable (P = .57-.83). BDI-II and SF-36 mental health domains were negatively correlated (Spearman coefficient, -0.50 to -0.82). Most patients returned to work regardless of depressive symptoms (minimal to mild, 31 of 35 [88.6%]; moderate to severe, five of eight [62.5%]; P = .12). CONCLUSIONS Compared with ∼ 2 years postdischarge from the ICU, depressive symptoms and memory complaints were similar at 5 years. Mental health domains of the SF-36 may not be sensitive to small changes in mood symptoms.
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Affiliation(s)
- Neill K J Adhikari
- Interdepartmental Division of Critical Care, University of Toronto, Toronto; Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto.
| | | | | | - Andrea Matté
- Department of Medicine, University Health Network, Toronto
| | - Ruxandra Pinto
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto
| | - Angela M Cheung
- Department of Medicine, University Health Network, Toronto; Women's Health Program, University Health Network, Toronto; Department of Medicine, University of Toronto, Toronto; Department of Health Policy, Management and Evaluation and the Dalla Lana School of Public Health, University of Toronto, Toronto
| | - Natalia Diaz-Granados
- Women's Health Program, University Health Network, Toronto; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Margaret S Herridge
- Interdepartmental Division of Critical Care, University of Toronto, Toronto; Department of Medicine, University Health Network, Toronto; Department of Medicine, University of Toronto, Toronto
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Herridge MS, Tansey CM, Matté A, Tomlinson G, Diaz-Granados N, Cooper A, Guest CB, Mazer CD, Mehta S, Stewart TE, Kudlow P, Cook D, Slutsky AS, Cheung AM. Functional disability 5 years after acute respiratory distress syndrome. N Engl J Med 2011; 364:1293-304. [PMID: 21470008 DOI: 10.1056/nejmoa1011802] [Citation(s) in RCA: 1804] [Impact Index Per Article: 138.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND There have been few detailed, in-person interviews and examinations to obtain follow-up data on 5-year outcomes among survivors of the acute respiratory distress syndrome (ARDS). METHODS We evaluated 109 survivors of ARDS at 3, 6, and 12 months and at 2, 3, 4, and 5 years after discharge from the intensive care unit. At each visit, patients were interviewed and examined; underwent pulmonary-function tests, the 6-minute walk test, resting and exercise oximetry, chest imaging, and a quality-of-life evaluation; and reported their use of health care services. RESULTS At 5 years, the median 6-minute walk distance was 436 m (76% of predicted distance) and the Physical Component Score on the Medical Outcomes Study 36-Item Short-Form Health Survey was 41 (mean norm score matched for age and sex, 50). With respect to this score, younger patients had a greater rate of recovery than older patients, but neither group returned to normal predicted levels of physical function at 5 years. Pulmonary function was normal to near-normal. A constellation of other physical and psychological problems developed or persisted in patients and family caregivers for up to 5 years. Patients with more coexisting illnesses incurred greater 5-year costs. CONCLUSIONS Exercise limitation, physical and psychological sequelae, decreased physical quality of life, and increased costs and use of health care services are important legacies of severe lung injury.
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Affiliation(s)
- Margaret S Herridge
- Department of Medicine, University Health Network, University of Toronto, Toronto, ON, Canada.
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Adhikari NKJ, McAndrews MP, Tansey CM, Matté A, Pinto R, Cheung AM, Diaz-Granados N, Barr A, Herridge MS. Self-reported symptoms of depression and memory dysfunction in survivors of ARDS. Chest 2009; 135:678-687. [PMID: 19265087 PMCID: PMC5233444 DOI: 10.1378/chest.08-0974] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Survivors of ARDS have well documented physical limitations, but psychological effects are less clear. We determined the prevalence of self-reported depression and memory dysfunction in ARDS survivors. METHODS Six to 48 (median 22) months after ICU discharge, we administered instruments assessing depression symptoms (Beck Depression Inventory-II [BDI-II]) and memory dysfunction (Memory Assessment Clinics Self-Rating Scale [MAC-S]) to 82 ARDS patients who were enrolled in a prospective cohort study in four university-affiliated ICUs. RESULTS Sixty-one (74%), 64 (78%), and 61 (74%) patients fully completed the BDI-II, MAC-S (Ability subscale), and MAC-S (Frequency of Occurrence subscale) instruments. Responders (similar to nonresponders) were young (median 42 years, interquartile range [IQR] 35 to 56), with high admission illness severity and organ dysfunction. The median BDI-II score was 12 (IQR 5 to 25). Twenty-five (41%) patients reported moderate-severe depression symptoms and were less likely to return to work than those with minimal-mild symptoms (8/25 [32%] vs 25/36 [69%]; p = 0.005). Median MAC-S (Ability) and MAC-S (Frequency of Occurrence) scores were 76 (IQR 61 to 93) and 91 (IQR 77 to 102), respectively; 8%, 16%, and 20% scored > 2, > 1.5, and > 1 SD(s), respectively, below age-adjusted population norms for each subscale. BDI-II and MAC-S scores were negatively correlated (Spearman coefficient -0.58 and -0.50 for Ability and Frequency of Occurrence subscales, respectively; p < 0.0001). Univariable analyses showed no demographic or illness-severity predictors of BDI-II (including the Cognitive subscale) or MAC-S (both subscales); results were similar when restricted to patients whose primary language was English. CONCLUSIONS ARDS survivors report a high prevalence of depression symptoms and a lower prevalence of memory dysfunction 6 to 48 months after ICU discharge. Depression symptoms may hinder the return to work, or patients may report these symptoms because of inability to re-enter the workforce.
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Affiliation(s)
- Neill K J Adhikari
- Interdepartmental Division of Critical Care and Department of Medicine, University of Toronto, Toronto, ON, Canada.
| | - Mary Pat McAndrews
- Krembil Neuroscience Program, University Health Network, Toronto, ON, Canada
| | - Catherine M Tansey
- Medical-Surgical Intensive Care Unit, University Health Network, Toronto, ON, Canada
| | - Andrea Matté
- Medical-Surgical Intensive Care Unit, University Health Network, Toronto, ON, Canada
| | - Ruxandra Pinto
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Angela M Cheung
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Aiala Barr
- Department of Public Health Sciences, University of Toronto, Toronto, ON, Canada
| | - Margaret S Herridge
- Interdepartmental Division of Critical Care and Department of Medicine, University of Toronto, Toronto, ON, Canada
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Lee CM, Herridge MS, Gabor JY, Tansey CM, Matte A, Hanly PJ. Chronic sleep disorders in survivors of the acute respiratory distress syndrome. Intensive Care Med 2008; 35:314-20. [PMID: 18802684 DOI: 10.1007/s00134-008-1277-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2007] [Accepted: 07/19/2008] [Indexed: 11/25/2022]
Abstract
PURPOSE Sleep disruption is well recognized in the Intensive Care Unit. Poor sleep quality likely continues following discharge from hospital in several patients and becomes a chronic disorder in some. The aim of this study was to describe the etiology of chronic sleep complaints in survivors of ARDS. METHODS Seven ARDS survivors with no previous sleep complaints who reported difficulty sleeping 6 months or more following discharge from hospital were evaluated. Sleep quality was assessed subjectively with a sleep history and the Insomnia Severity Index and objectively with polysomnography. Daytime sleepiness was assessed with the Epworth Sleepiness Scale. RESULTS A chronic sleep disorder was identified in each patient who reported difficulty sleeping. The primary sleep disorder was chronic conditioned insomnia (5 patients), parasomnia (1 patient) and obstructive sleep apnea (1 patient). In addition, 4 patients had periodic leg movements, which was of uncertain clinical significance. CONCLUSION Chronic sleep disorders, which originate during the acute illness, are present in some ARDS survivors several months after discharge from hospital. If unrecognized, lack of treatment may contribute to impaired quality of life and incomplete rehabilitation from their critical illness.
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Affiliation(s)
- Christie M Lee
- Department of Medicine, University of Toronto, Toronto, Canada
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Tansey CM, Matté AL, Needham D, Herridge MS. Review of retention strategies in longitudinal studies and application to follow-up of ICU survivors. Intensive Care Med 2007; 33:2051-7. [PMID: 17701161 DOI: 10.1007/s00134-007-0817-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2006] [Accepted: 07/11/2007] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To review the literature on retention strategies in follow-up studies and their relevance to critical care and to comment on the Toronto experience with the acute respiratory distress syndrome (ARDS) and severe acute respiratory syndrome (SARS) follow-up studies. DESIGN AND SETTING Literature review and two cohort studies in a tertiary care hospital in Toronto, Canada. PATIENTS AND PARTICIPANTS ARDS and SARS patients. MEASUREMENTS AND RESULTS Review articles from the social sciences and medicine are summarized and our own experience with two longitudinal studies is drawn upon to elucidate strategies that can be successfully used to attenuate participant drop-out from longitudinal studies. Three key areas for retention of subjects are identified from the literature: (a) respect for patients: respect for their ideas and their time commitment to the research project; (b) tracking: collect information on many patient contacts at the initiation of the study and outline tracking procedures for subjects lost to follow-up; and (c) study personnel: interpersonal skills must be reinforced, flexible working hours mandated, and support offered. Our 5-year ARDS and 1-year SARS study retention rates were 86% and 91%, respectively, using these methods. CONCLUSIONS Strategies to reduce patient attrition are time consuming but necessary to preserve internal and external validity. When the follow-up system is working effectively, researchers can acquire the necessary data to advance knowledge in their field and patients are satisfied that they have an important role to play in the research project.
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Affiliation(s)
- Catherine M Tansey
- Department of Medicine, Toronto General Hospital, University Health Network, 585 University Ave, ON M5G 2N2, Toronto, Canada.
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Tansey CM, Louie M, Loeb M, Gold WL, Muller MP, de Jager J, Cameron JI, Tomlinson G, Mazzulli T, Walmsley SL, Rachlis AR, Mederski BD, Silverman M, Shainhouse Z, Ephtimios IE, Avendano M, Downey J, Styra R, Yamamura D, Gerson M, Stanbrook MB, Marras TK, Phillips EJ, Zamel N, Richardson SE, Slutsky AS, Herridge MS. One-year outcomes and health care utilization in survivors of severe acute respiratory syndrome. ACTA ACUST UNITED AC 2007; 167:1312-20. [PMID: 17592106 DOI: 10.1001/archinte.167.12.1312] [Citation(s) in RCA: 195] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Severe Acute Respiratory Syndrome (SARS) became a global epidemic in 2003. Comprehensive information on 1-year outcomes and health care utilization is lacking. Research conducted during the SARS outbreak may help inform research planning for future public health emergencies. The objective of this study was to evaluate the 1-year outcomes in survivors of SARS and their family caregivers. METHOD The study was prospective and observational. We evaluated 117 SARS survivors from Toronto, Ontario. Patients were interviewed and underwent physical examination, pulmonary function testing, chest radiography, a 6-minute-walk test, quality-of-life measures, and self-report of health care utilization. At 1 year, informal caregivers were identified for a survey on caregiver burden. RESULTS The enrolled survivors of SARS were young (median age, 42 years), and most were women (67%) and health care workers (65%). At 1 year after hospital discharge, pulmonary function measures were in the normal range, but 18% of patients had a significant reduction in distance walked in 6 minutes. The Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) domains were 0.3 to 1.0 SD below normal at 1 year. Of the patients, 17% had not returned to work by 1 year. Fifty-one patients required 668 visits to psychiatry or psychology practitioners. During the SARS epidemic, informal caregivers reported a decline of 1.6 SD below normal on the mental component score of the SF-36. CONCLUSIONS Most SARS survivors had good physical recovery from their illness, but some patients and their caregivers reported a significant reduction in mental health 1 year later. Strategies to ameliorate the psychological burden of an epidemic on the patient and family caregiver should be considered as part of future pandemic planning.
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Affiliation(s)
- Catherine M Tansey
- Department of Medicine, University Health Network, and Mount Sinai Hospital, Toronto, Ontario, Canada
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Scales DC, Tansey CM, Matte A, Herridge MS. Difference in reported pre-morbid health-related quality of life between ARDS survivors and their substitute decision makers. Intensive Care Med 2006; 32:1826-31. [PMID: 16957904 DOI: 10.1007/s00134-006-0333-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2005] [Accepted: 06/09/2006] [Indexed: 10/24/2022]
Abstract
CONTEXT Substitute decision makers may consider the pre-morbid health status of their critically ill loved one when making treatment decisions on her/his behalf. OBJECTIVE To compare estimates of pre-morbid health-related quality of life (HRQOL) obtained from survivors of the acute respiratory distress syndrome (ARDS) with those of their substitute decision makers using the Short Form 36 (SF-36). DESIGN Prospective cohort study. SETTING University-affiliated intensive care unit in Toronto, Canada. PATIENTS A sample of 46 ARDS survivors and their substitute decision makers drawn from a previously described cohort. INTERVENTIONS We measured agreement and differences between responses on the SF-36 obtained from survivors (at 3 months after ICU discharge) and their substitute decision makers (at study entry). MEASUREMENTS AND RESULTS Agreement was poor for all SF-36 components and differences reached significance in three domains. In multivariable analysis considering age; sex; Acute Physiology, Age, and Chronic Health Evaluation II score; and Lung Injury Score, only patient age was associated with the mean difference between estimates for the 'Mental Health' domain. On average, estimates of pre-morbid HRQOL obtained from substitute decision makers were lower than those obtained from survivors. CONCLUSION Agreement between estimates of pre-morbid HRQOL provided by ARDS survivors and their substitute decision makers was poor. Compared with survivors, proxies tended to provide lower estimates of pre-morbid HRQOL. Substitute decision making for incapacitated patients is an imperfect process during which family members may underestimate their loved ones' own perception of pre-morbid health status. Alternatively, survivors of critical illness may overestimate pre-morbid HRQOL.
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Affiliation(s)
- Damon C Scales
- Department of Critical Care Medicine, Sunnybrook and Women's Health Sciences Centre, 2075 Bayview Avenue, M4N 3M5, Toronto, Canada.
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Cheung AM, Tansey CM, Tomlinson G, Diaz-Granados N, Matté A, Barr A, Mehta S, Mazer CD, Guest CB, Stewart TE, Al-Saidi F, Cooper AB, Cook D, Slutsky AS, Herridge MS. Two-year outcomes, health care use, and costs of survivors of acute respiratory distress syndrome. Am J Respir Crit Care Med 2006; 174:538-44. [PMID: 16763220 DOI: 10.1164/rccm.200505-693oc] [Citation(s) in RCA: 311] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
RATIONALE Little is known about the long-term outcomes and costs of survivors of acute respiratory distress syndrome (ARDS). OBJECTIVES To describe functional and quality of life outcomes, health care use, and costs of survivors of ARDS 2 yr after intensive care unit (ICU) discharge. METHODS We recruited a cohort of ARDS survivors from four academic tertiary care ICUs in Toronto, Canada, and prospectively monitored them from ICU admission to 2 yr after ICU discharge. MEASUREMENTS Clinical and functional outcomes, health care use, and direct medical costs. RESULTS Eighty-five percent of patients with ARDS discharged from the ICU survived to 2 yr; overall 2-yr mortality was 49%. At 2 yr, survivors continued to have exercise limitation although 65% had returned to work. There was no statistically significant improvement in health-related quality of life as measured by Short-Form General Health Survey between 1 and 2 yr, although there was a trend toward better physical role at 2 yr (p = 0.0586). Apart from emotional role and mental health, all other domains remained below that of the normal population. From ICU admission to 2 yr after ICU discharge, the largest portion of health care costs for a survivor of ARDS was the initial hospital stay, with ICU costs accounting for 76% of these costs. After the initial hospital stay, health care costs were related to hospital readmissions and inpatient rehabilitation. CONCLUSIONS Survivors of ARDS continued to have functional impairment and compromised health-related quality of life 2 yr after discharge from the ICU. Health care use and costs after the initial hospitalization were driven by hospital readmissions and inpatient rehabilitation.
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Affiliation(s)
- Angela M Cheung
- Department of Medicine, University Health Network, Toronto, ON, Canada.
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Abstract
OBJECTIVE With limited community services, the complex rehabilitation period after critical illness is often the responsibility of family members who, as a result, may experience negative health outcomes. The objectives of this research were to a) identify aspects of the caregiving situation that are associated with caregivers' experiences of emotional distress and psychological well-being; and b) compare health-related quality of life of informal caregivers to survivors of acute respiratory distress syndrome (ARDS) with age- and gender-matched population values. DESIGN Cross-sectional survey of informal caregivers to ARDS survivors. SETTING Toronto, Ontario, Canada. PATIENTS Informal caregivers were individuals who were primarily responsible for providing and/or coordinating ARDS survivors' posthospital care and were not paid to do so. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The dependent variables were emotional distress, psychological well-being, and health-related quality of life. They were evaluated by the Center for Epidemiologic Studies Depression Scale, the Positive Affect Scale, and Medical Outcomes Study Short Form 36, respectively. Independent variables included severity of illness indicators, patient depression (Beck Depression Inventory II), aspects of the caregiving experience (care provided, lifestyle interference, personal gain), and psychosocial resources (mastery and social support). Caregivers experienced more emotional distress when they experienced more lifestyle interference, had lower levels of mastery, and were caring for ARDS survivors with more depressive symptoms (F3,42 = 15.69, p < .001, adjusted R = .50). In contrast, caregiver psychological well-being was associated with personal gains as a result of providing care and having more mastery and social support (F4,41 = 9.40, p < .001, adjusted R = .43). Caregivers reported poorer health-related quality of life across all domains of the Medical Outcomes Study Short Form 36 compared with age- and gender-matched population values. CONCLUSIONS Informal caregivers experience negative health outcomes that persist almost 2 yrs after ARDS. New approaches, such as family-centered rehabilitation, caregiver education, improved respite, and home care, may benefit informal caregivers.
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Affiliation(s)
- Jill I Cameron
- University Health Network, Women's Health Program, Toronto, ON
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Herridge MS, Cheung AM, Tansey CM, Matte-Martyn A, Diaz-Granados N, Al-Saidi F, Cooper AB, Guest CB, Mazer CD, Mehta S, Stewart TE, Barr A, Cook D, Slutsky AS. One-year outcomes in survivors of the acute respiratory distress syndrome. N Engl J Med 2003; 348:683-93. [PMID: 12594312 DOI: 10.1056/nejmoa022450] [Citation(s) in RCA: 1536] [Impact Index Per Article: 73.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND As more patients survive the acute respiratory distress syndrome, an understanding of the long-term outcomes of this condition is needed. METHODS We evaluated 109 survivors of the acute respiratory distress syndrome 3, 6, and 12 months after discharge from the intensive care unit. At each visit, patients were interviewed and underwent a physical examination, pulmonary-function testing, a six-minute-walk test, and a quality-of-life evaluation. RESULTS Patients who survived the acute respiratory distress syndrome were young (median age, 45 years) and severely ill (median Acute Physiology, Age, and Chronic Health Evaluation score, 23) and had a long stay in the intensive care unit (median, 25 days). Patients had lost 18 percent of their base-line body weight by the time they were discharged from the intensive care unit and stated that muscle weakness and fatigue were the reasons for their functional limitation. Lung volume and spirometric measurements were normal by 6 months, but carbon monoxide diffusion capacity remained low throughout the 12-month follow-up. No patients required supplemental oxygen at 12 months, but 6 percent of patients had arterial oxygen saturation values below 88 percent during exercise. The median score for the physical role domain of the Medical Outcomes Study 36-item Short-Form General Health Survey (a health-related quality-of-life measure) increased from 0 at 3 months to 25 at 12 months (score in the normal population, 84). The distance walked in six minutes increased from a median of 281 m at 3 months to 422 m at 12 months; all values were lower than predicted. The absence of systemic corticosteroid treatment, the absence of illness acquired during the intensive care unit stay, and rapid resolution of lung injury and multiorgan dysfunction were associated with better functional status during the one-year follow-up. CONCLUSIONS Survivors of the acute respiratory distress syndrome have persistent functional disability one year after discharge from the intensive care unit. Most patients have extrapulmonary conditions, with muscle wasting and weakness being most prominent.
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Trojan DA, Cashman NR, Shapiro S, Tansey CM, Esdaile JM. Predictive factors for post-poliomyelitis syndrome. Arch Phys Med Rehabil 1994; 75:770-7. [PMID: 8024423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Post-poliomyelitis syndrome (PPS) is generally defined as a clinical syndrome of new weakness, fatigue, and pain in individuals who have previously recovered from acute paralytic poliomyelitis. The purpose of this study was to identify, through a case-control study design, factors that predict subsequent PPS in patients with prior paralytic poliomyelitis. Among patients attending a university-affiliated hospital post-polio clinic, "cases" were patients with new weakness and fatigue, and "controls" were patients without these complaints. A chart review of 353 patients identified 127 cases and 39 controls. Logistic regression modeling was used to calculate adjusted and unadjusted odds ratios. In univariate analyses, significant risk factors for PPS were a greater age at time of presentation to clinic (p = 0.01), a longer time since acute polio (p = 0.01), and more weakness at acute polio (p = 0.02). Other significant associated, but not necessarily causal factors were a recent weight gain (p = 0.005), muscle pain (p = 0.01) particularly that associated with exercise (p = 0.005), and joint pain (p = 0.04). Multivariate analyses revealed that a model containing age at presentation to clinic, severity of weakness at acute polio, muscle pain with exercise, recent weight gain, and joint pain best distinguished cases from controls. Age at acute polio, degree of recovery after polio, weakness at best point after polio, physical activity, and sex were not contributing factors. These findings suggest that the degree of initial motor unit involvement as measured by weakness at acute polio, and possibly the aging process and overuse are important in predicting PPS.
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Affiliation(s)
- D A Trojan
- Department of Neurology, Montreal Neurological Institute, Quebec, Canada
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Mushlin AI, Detsky AS, Phelps CE, O'Connor PW, Kido DK, Kucharczyk W, Giang DW, Mooney C, Tansey CM, Hall WJ. The accuracy of magnetic resonance imaging in patients with suspected multiple sclerosis. The Rochester-Toronto Magnetic Resonance Imaging Study Group. JAMA 1993; 269:3146-51. [PMID: 8505818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To design and implement a methodologically rigorous study to examine the accuracy of magnetic resonance imaging (MRI) in a patient population clinically suspected of having multiple sclerosis (MS). DESIGN AND SETTING Three hundred three patients, who were referred to two university medical centers because of the suspicion of MS, underwent MRI of the head and double-dose, contrast-enhanced computed tomography (CT) of the head. The images were read by two observers individually and without knowledge of the clinical course or final diagnosis. Patients were followed up for at least 6 months and reevaluated clinically with subsequent neurological examination. Final diagnosis (MS or not MS) was made by a panel of neurologists on the basis of the clinical findings at presentation, those that developed during follow-up, and other diagnostic tests. The results of the imaging procedures were excluded to avoid incorporation bias. Diagnostic accuracy was assessed using receiver-operating characteristic analysis and likelihood ratios. RESULTS Magnetic resonance imaging of the head was considerably more accurate than CT in diagnosing MS. The area under the receiver-operating characteristic curve for MS was 0.82 (compared with 0.52 for CT) indicating that MRI was a good but not definitively accurate test for MS. A "definite MS" reading on an MRI of the head was specific for MS (likelihood ratio, 24.9) and essentially established the diagnosis, especially in patients clinically designated as "probable MS" before testing. However, MRI of the head was negative for MS in 25% and equivocal in 40% of the patients considered to have MS by the diagnostic review committee (sensitivity, 58%). CONCLUSIONS Magnetic resonance imaging of the head provided assistance in the diagnosis of MS when lesions were visualized. Its ability far exceeded imaging with double-contrast CT. The sensitivity and, therefore, the predictive value of a negative MRI result for MS were, however, not sufficiently high for a normal MRI to be used to conclusively exclude the diagnosis of MS.
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Affiliation(s)
- A I Mushlin
- Department of Community and Preventive Medicine, University of Rochester, NY
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