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Hammond M, Law V, de Launay KQ, Cooper J, Togo E, Silveira K, MacKinnon D, Lo N, Ward SE, Chan SKW, Straus SE, Fahim C, Wong CL. Using implementation science to promote the use of the fascia iliaca blocks in hip fracture care. Can J Anaesth 2023:10.1007/s12630-023-02665-2. [PMID: 38085456 DOI: 10.1007/s12630-023-02665-2] [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: 02/17/2023] [Revised: 06/30/2023] [Accepted: 07/04/2023] [Indexed: 02/15/2024] Open
Abstract
PURPOSE There is variable and suboptimal use of fascia iliaca compartment nerve blocks (FICBs) in hip fracture care. Our objective was to use an evidence-based and theory-informed implementation science approach to analyze barriers and facilitators to timely administration of FICB and select evidence-based interventions to enhance uptake. METHODS We conducted a qualitative study at a single centre using semistructured interviews and site observations. We interviewed 35 stakeholders including health care providers, managers, patients, and caregivers. We mapped barriers and facilitators to the Theoretical Domains Framework (TDF) and Consolidated Framework for Implementation Research (CFIR). We compared the rate and timeliness of FICB administration before and after evidence-based implementation strategies were applied. RESULTS The study identified 18 barriers and 11 facilitators within seven themes of influences of FICB use: interpersonal relationships between health care professionals; clinician knowledge and skills related to FICB; roles, responsibilities, and processes for delivering FICB; perceptions on using FICB for pain; patient and caregiver perceptions on using FICB for pain; communication of hip fracture care between departments; and resources for delivering FICBs. We mapped the behaviour change domains to eight implementation strategies: restructure the environment, create and distribute educational materials, prepare patients to be active participants, perform audits and give feedback, use local opinion leaders, use champions, train staff on FICB procedures, and mandate change. We observed an increase in the rates of FICBs administered (48% vs 65%) and a decrease in the median time to administration (1.63 vs 0.81 days). CONCLUSION Our study explains why FICBs are underused and shows that the TDF and CFIR provide a framework to identify barriers and facilitators to FICB implementation. The mapped implementation strategies can guide institutions to improve use of FICB in hip fracture care.
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Affiliation(s)
- Marjorie Hammond
- St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Vivian Law
- St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Keelia Quinn de Launay
- St. Michael's Hospital, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
| | - Jeanette Cooper
- St. Michael's Hospital, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
| | - Elikem Togo
- St. Michael's Hospital, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
| | - Kyle Silveira
- St. Michael's Hospital, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
| | - David MacKinnon
- St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Nick Lo
- St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Sarah E Ward
- St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- St. Michael's Hospital, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
| | - Stephen K W Chan
- St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- St. Michael's Hospital, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
| | - Sharon E Straus
- St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- St. Michael's Hospital, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
| | - Christine Fahim
- St. Michael's Hospital, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada
| | - Camilla L Wong
- St. Michael's Hospital, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, ON, Canada.
- St. Michael's Hospital, Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
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Fahim C, Kasperavicius D, Beckett R, Quinn de Launay K, Chandraraj A, Crupi A, Theivendrampillai S, Straus SE. Funding change: An environmental scan of research funders’ knowledge translation strategic plans and initiatives across 10 high-income countries/regions. Facets (Ott) 2023. [DOI: 10.1139/facets-2022-0124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Knowledge translation (KT) is the science and practice of dissemination and implementation of evidence. We describe how research funders operationalize and evaluate KT initiatives, identify challenges and opportunities, and suggest strategic considerations for KT support. We conducted an environmental scan, which included a systematic search of published and grey literature and a focus group with Canadian funders. A total of 130 published articles and 2415 grey literature sources were screened; 212 unique data sources were included. Published literature commonly described KT initiatives related to “KT practice and science funding.” These initiatives commonly provided funds for infrastructure development (e.g., clinical technologies, database subscriptions) to facilitate translational or applied research to address regional health priorities. Of the articles, 44% outlined an evaluation plan; few provided validated KT metrics. In the grey literature, 364 initiatives were described; the most commonly described initiatives related to “exchange and integrated KT.” Focus group participants hoped to see increased resources to support KT, exchange opportunities with policy/decision-makers, and evaluate KT initiatives. Funders completed various KT initiatives, which tended to engage stakeholders to set research priorities, collaborate with a range of stakeholders, build KT capacity, and mandate KT requirements. We provide six considerations for funders to support KT.
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Affiliation(s)
- Christine Fahim
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, Unity Health Toronto, 30 Bond St, Toronto, M5B 1W8, Canada
| | - Danielle Kasperavicius
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, Unity Health Toronto, 30 Bond St, Toronto, M5B 1W8, Canada
| | - Robyn Beckett
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, Unity Health Toronto, 30 Bond St, Toronto, M5B 1W8, Canada
| | - Keelia Quinn de Launay
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, Unity Health Toronto, 30 Bond St, Toronto, M5B 1W8, Canada
| | - Arthana Chandraraj
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, Unity Health Toronto, 30 Bond St, Toronto, M5B 1W8, Canada
| | - Amanda Crupi
- Canadian Institutes of Health Research, 160 Elgin Street, 10th Floor, Ottawa, K1A 0W9, Canada
| | - Suvabna Theivendrampillai
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, Unity Health Toronto, 30 Bond St, Toronto, M5B 1W8, Canada
| | - Sharon E. Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, Unity Health Toronto, 30 Bond St, Toronto, M5B 1W8, Canada
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Sheikh-Mohamed S, Isho B, Chao GY, Zuo M, Cohen C, Lustig Y, Nahass GR, Salomon-Shulman RE, Blacker G, Fazel-Zarandi M, Rathod B, Colwill K, Jamal A, Li Z, de Launay KQ, Takaoka A, Garnham-Takaoka J, Patel A, Fahim C, Paterson A, Li AX, Haq N, Barati S, Gilbert L, Green K, Mozafarihashjin M, Samaan P, Budylowski P, Siqueira WL, Mubareka S, Ostrowski M, Rini JM, Rojas OL, Weissman IL, Tal MC, McGeer A, Regev-Yochay G, Straus S, Gingras AC, Gommerman JL. Systemic and mucosal IgA responses are variably induced in response to SARS-CoV-2 mRNA vaccination and are associated with protection against subsequent infection. Mucosal Immunol 2022; 15:799-808. [PMID: 35468942 PMCID: PMC9037584 DOI: 10.1038/s41385-022-00511-0] [Citation(s) in RCA: 124] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/02/2022] [Accepted: 03/23/2022] [Indexed: 02/04/2023]
Abstract
Although SARS-CoV-2 infects the upper respiratory tract, we know little about the amount, type, and kinetics of antibodies (Ab) generated in the oral cavity in response to COVID-19 vaccination. We collected serum and saliva samples from participants receiving two doses of mRNA COVID-19 vaccines and measured the level of anti-SARS-CoV-2 Ab. We detected anti-Spike and anti-Receptor Binding Domain (RBD) IgG and IgA, as well as anti-Spike/RBD associated secretory component in the saliva of most participants after dose 1. Administration of a second dose of mRNA boosted the IgG but not the IgA response, with only 30% of participants remaining positive for IgA at this timepoint. At 6 months post-dose 2, these participants exhibited diminished anti-Spike/RBD IgG levels, although secretory component-associated anti-Spike Ab were more stable. Examining two prospective cohorts we found that participants who experienced breakthrough infections with SARS-CoV-2 variants had lower levels of vaccine-induced serum anti-Spike/RBD IgA at 2-4 weeks post-dose 2 compared to participants who did not experience an infection, whereas IgG levels were comparable between groups. These data suggest that COVID-19 vaccines that elicit a durable IgA response may have utility in preventing infection. Our study finds that a local secretory component-associated IgA response is induced by COVID-19 mRNA vaccination that persists in some, but not all participants. The serum and saliva IgA response modestly correlate at 2-4 weeks post-dose 2. Of note, levels of anti-Spike serum IgA (but not IgG) at this timepoint are lower in participants who subsequently become infected with SARS-CoV-2. As new surges of SARS-CoV-2 variants arise, developing COVID-19 booster shots that provoke high levels of IgA has the potential to reduce person-to-person transmission.
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Affiliation(s)
| | - Baweleta Isho
- Department of Immunology, University of Toronto, Toronto, ON, Canada
| | - Gary Y.C. Chao
- Department of Immunology, University of Toronto, Toronto, ON, Canada
| | - Michelle Zuo
- Department of Immunology, University of Toronto, Toronto, ON, Canada
| | - Carmit Cohen
- Sheba Medical Center Tel Hashomer, Ramat Gan, Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Yaniv Lustig
- Sheba Medical Center Tel Hashomer, Ramat Gan, Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel,Central Virology Laboratory, Public Health Services, Ministry of Health, Sheba Medical Center, Tel-Hashomer, Tel-Aviv University, Tel Aviv-Yafo, Israel,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - George R. Nahass
- Institute for Stem Cell Biology and Regenerative Medicine and the Ludwig Cancer Center, Stanford University School of Medicine, Stanford, CA, USA,University of Illinois-Chicago, College of Medicine, Chicago, USA
| | - Rachel E. Salomon-Shulman
- Institute for Stem Cell Biology and Regenerative Medicine and the Ludwig Cancer Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Grace Blacker
- Institute for Stem Cell Biology and Regenerative Medicine and the Ludwig Cancer Center, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Bhavisha Rathod
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
| | - Karen Colwill
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
| | - Alainna Jamal
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
| | - Zhijie Li
- Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
| | - Keelia Quinn de Launay
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada,Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Alyson Takaoka
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada,Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Julia Garnham-Takaoka
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada,Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Anjali Patel
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada,Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Christine Fahim
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Aimee Paterson
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
| | - Angel Xinliu Li
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
| | - Nazrana Haq
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
| | - Shiva Barati
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
| | - Lois Gilbert
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
| | - Karen Green
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
| | | | - Philip Samaan
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Patrick Budylowski
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | | | - Samira Mubareka
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada,Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Mario Ostrowski
- Department of Immunology, University of Toronto, Toronto, ON, Canada,Department of Medicine, University of Toronto, Toronto, ON, Canada,Keenan Research Centre for Biomedical Science, Toronto, ON, Canada
| | - James M. Rini
- Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada,Department of Biochemistry, University of Toronto, Toronto, ON, Canada
| | - Olga L. Rojas
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Irving L. Weissman
- Institute for Stem Cell Biology and Regenerative Medicine and the Ludwig Cancer Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Michal Caspi Tal
- Institute for Stem Cell Biology and Regenerative Medicine and the Ludwig Cancer Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Allison McGeer
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
| | - Gili Regev-Yochay
- Sheba Medical Center Tel Hashomer, Ramat Gan, Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Sharon Straus
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Anne-Claude Gingras
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada,Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
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Quinn de Launay K, Cheung ST, Riggs L, Reed N, Beal DS. The effect of transcranial direct current stimulation on cognitive performance in youth with persistent cognitive symptoms following concussion: a controlled pilot study. Brain Inj 2022; 36:39-51. [PMID: 35157529 DOI: 10.1080/02699052.2022.2034179] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE Explore the feasibility, tolerability, and early efficacy of transcranial direct current stimulation (tDCS) as a therapeutic intervention for youth with cognitive persistent post-concussion symptoms (PPCS). HYPOTHESIS tDCS improves performance on a dual task working memory (WM) paradigm in youth with cognitive PPCS. PARTICIPANTS Twelve youth experiencing cognitive PPCS. DESIGN A quasi-randomized pilot trial was used to explore the tolerability of, and performance differences on, a dual N-Back WM task paired with active or sham tDCS over 3 sessions. MEASURES Accuracy and reaction time on WM task and self-report of tDCS tolerability. RESULTS Trends toward increases in accuracy from Day 1 to 3 seen in both groups. Active tDCS group performed better than sham on Day 2 in N-Back level N2 (p = .019), and marginally better than the sham group on Day 3 in level N3 (p = .26). Participants reported tDCS as tolerable; compared to the active tDCS group, the sham group reported more "considerable" (p = .078) and "strong" symptoms (p = .097). CONCLUSION tDCS is a promising tool for enhancing WM performance and is a feasible and tolerable adjunct to behavioral interventions in youth with cognitive PPCS. A clinical trial to demonstrate efficacy is warranted.
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Affiliation(s)
- Keelia Quinn de Launay
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, M4G 1R8, Toronto, Canada
| | - Stephanie T Cheung
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, M4G 1R8, Toronto, Canada
| | - Lily Riggs
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, M4G 1R8, Toronto, Canada
| | - Nick Reed
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, M4G 1R8, Toronto, Canada
| | - Deryk S Beal
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, M4G 1R8, Toronto, Canada
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Yau K, Abe KT, Naimark D, Oliver MJ, Perl J, Leis JA, Bolotin S, Tran V, Mullin SI, Shadowitz E, Gonzalez A, Sukovic T, Garnham-Takaoka J, de Launay KQ, Takaoka A, Straus SE, McGeer AJ, Chan CT, Colwill K, Gingras AC, Hladunewich MA. Evaluation of the SARS-CoV-2 Antibody Response to the BNT162b2 Vaccine in Patients Undergoing Hemodialysis. JAMA Netw Open 2021; 4:e2123622. [PMID: 34473256 PMCID: PMC8414193 DOI: 10.1001/jamanetworkopen.2021.23622] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
IMPORTANCE Patients undergoing hemodialysis have a high mortality rate associated with COVID-19, and this patient population often has a poor response to vaccinations. Randomized clinical trials for COVID-19 vaccines included few patients with kidney disease; therefore, vaccine immunogenicity is uncertain in this population. OBJECTIVE To evaluate the SARS-CoV-2 antibody response in patients undergoing chronic hemodialysis following 1 vs 2 doses of BNT162b2 COVID-19 vaccination compared with health care workers serving as controls and convalescent serum. DESIGN, SETTING, AND PARTICIPANTS A prospective, single-center cohort study was conducted between February 2 and April 17, 2021, in Toronto, Ontario, Canada. Participants included 142 patients receiving in-center hemodialysis and 35 health care worker controls. EXPOSURES BNT162b2 (Pfizer-BioNTech) COVID-19 vaccine. MAIN OUTCOMES AND MEASURES SARS-CoV-2 IgG antibodies to the spike protein (anti-spike), receptor binding domain (anti-RBD), and nucleocapsid protein (anti-NP). RESULTS Among the 142 participants undergoing maintenance hemodialysis, 94 (66%) were men; median age was 72 (interquartile range, 62-79) years. SARS-CoV-2 IgG antibodies were measured in 66 patients receiving 1 vaccine dose following a public health policy change, 76 patients receiving 2 vaccine doses, and 35 health care workers receiving 2 vaccine doses. Detectable anti-NP suggestive of natural SARS-CoV-2 infection was detected in 15 of 142 (11%) patients at baseline, and only 3 patients had prior COVID-19 confirmed by reverse transcriptase polymerase chain reaction testing. Two additional patients contracted COVID-19 after receiving 2 doses of vaccine. In 66 patients receiving a single BNT162b2 dose, seroconversion occurred in 53 (80%) for anti-spike and 36 (55%) for anti-RBD by 28 days postdose, but a robust response, defined by reaching the median levels of antibodies in convalescent serum from COVID-19 survivors, was noted in only 15 patients (23%) for anti-spike and 4 (6%) for anti-RBD in convalescent serum from COVID-19 survivors. In patients receiving 2 doses of BNT162b2 vaccine, seroconversion occurred in 69 of 72 (96%) for anti-spike and 63 of 72 (88%) for anti-RBD by 2 weeks following the second dose and median convalescent serum levels were reached in 52 of 72 patients (72%) for anti-spike and 43 of 72 (60%) for anti-RBD. In contrast, all 35 health care workers exceeded the median level of anti-spike and anti-RBD found in convalescent serum 2 to 4 weeks after the second dose. CONCLUSIONS AND RELEVANCE This study suggests poor immunogenicity 28 days following a single dose of BNT162b2 vaccine in the hemodialysis population, supporting adherence to recommended vaccination schedules and avoiding delay of the second dose in these at-risk individuals.
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Affiliation(s)
- Kevin Yau
- Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Division of Nephrology, Department of Medicine, Unity Health Toronto, Toronto, Ontario, Canada
| | - Kento T. Abe
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
- Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - David Naimark
- Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Matthew J. Oliver
- Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Jeffrey Perl
- Division of Nephrology, Department of Medicine, Unity Health Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Jerome A. Leis
- Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Shelly Bolotin
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Vanessa Tran
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Sarah I. Mullin
- Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Ellen Shadowitz
- Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Anny Gonzalez
- Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Tatjana Sukovic
- Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Julie Garnham-Takaoka
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Keelia Quinn de Launay
- Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Alyson Takaoka
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Sharon E. Straus
- Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | | | | | - Karen Colwill
- Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Anne-Claude Gingras
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
- Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Michelle A. Hladunewich
- Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Quinn de Launay K, Martino A, Riggs L, Reed N, Beal DS. Pediatric concussion working memory outcomes: a scoping review. Brain Inj 2021; 35:1121-1133. [PMID: 34506212 DOI: 10.1080/02699052.2021.1972148] [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] [Indexed: 10/20/2022]
Abstract
Objective: Characterize the working memory (WM) profile of children and youth who have experienced concussion by systematically synthesizing existing literature on the neuropsychological outcomes of these injuries.Methods: Implemented a peer-reviewed search strategy combining key concepts of concussion/mild traumatic brain injury (mTBI), WM, and pediatrics across MedLine, Embase, PsycINFO, and CINAHL. Included studies written in English with extractable results on a WM outcome measure in individuals aged 21 and under who experienced concussion. Applied narrative synthesis to identify trends in the literature. Assessed risk of bias and quality using the NHLBI's Quality Assessment of Observational Cohort and Cross-Sectional Studies.Results: 40 articles met inclusion criteria. 34/40 studies compared WM performance in children or youth with concussion to healthy controls, pre-injury performance, or normative values, of which 15 reported significantly lower WM performance in the concussion sample. Visual/spatial WM was more consistently impacted than verbal WM. Cognitive demanding dual-task conditions were also reliably impacted.Conclusion: Literature indicated that WM is vulnerable to negative outcomes following pediatric concussion, yet the nature of outcomes is variable. Clinicians and researchers should implement comprehensive and theoretically motivated WM assessments to better understand the WM components impacted by injury.
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Affiliation(s)
- Keelia Quinn de Launay
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Amanda Martino
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Lily Riggs
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Nick Reed
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Department of Occupational Science and Occupational Therapy, Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Deryk S Beal
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
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