1
|
Pitzul KB, Wodchis WP, Kreder HJ, Carter MW, Jaglal SB. Discharge destination following hip fracture: comparative effectiveness and cost analyses. Arch Osteoporos 2017; 12:87. [PMID: 28965297 DOI: 10.1007/s11657-017-0382-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 09/20/2017] [Indexed: 02/03/2023]
Abstract
UNLABELLED This study determines outcomes and costs of similar hip fracture patients that were discharged from hospital to a rehabilitation facility or to the community within 1 year. Community patients had worse outcomes and lower costs compared to rehabilitation facility patients. This study contributes to understanding hip fracture quality of care. PURPOSE The purpose of this study is to determine the impact on mortality and rehospitalization, as well as health system cost, of similar hip fracture patients being discharged to an inpatient rehabilitation facility or directly to the community within 1 year in Ontario, Canada. METHODS This was a retrospective study of a propensity-matched cohort completed from the health system perspective. Administrative databases were used to identify and match two groups of older adults (total n = 18,773) discharged alive from acute care for hip fracture repair: patients discharged to inpatient rehabilitation were matched to patients discharged to the community. RESULTS A higher proportion of patients discharged to the community (27-42%) died or were rehospitalized (SDhighipr = 0.21, SDlowipr = 0.33) and had substantially lower health system costs (SDhighipr = 0.65, SDlowipr = 0.42) up to 1 year post-acute discharge compared to similar patients discharged to inpatient rehabilitation facilities (IPR) (10-11%). CONCLUSIONS This study demonstrates that similar hip fracture patients are discharged to different post-acute settings (i.e., home-based rehabilitation and inpatient rehabilitation) and have different outcomes, thereby calling into question the appropriateness of post-acute rehabilitation delivery in Ontario, Canada. Future research should focus on determining how trade-offs in resource allocation between settings would impact patient outcomes.
Collapse
Affiliation(s)
- Kristen B Pitzul
- Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, Ontario, M5T2M6, Canada.
| | - Walter P Wodchis
- Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, Ontario, M5T2M6, Canada.,Institute for Clinical Evaluative Sciences, G1 06 2075 Bayview Avenue, Toronto, Ontario, M4N3M5, Canada.,Toronto Rehabilitation Institute-University Health Network, 190 Elizabeth Street, Toronto, Ontario, M5G2C4, Canada
| | - Hans J Kreder
- Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, Ontario, M5T2M6, Canada.,Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, M4N3M5, Canada
| | - Michael W Carter
- Department of Mechanical and Industrial Engineering, University of Toronto, 5 King's College Road, Toronto, Ontario, M5S3G8, Canada
| | - Susan B Jaglal
- Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, Ontario, M5T2M6, Canada.,Institute for Clinical Evaluative Sciences, G1 06 2075 Bayview Avenue, Toronto, Ontario, M4N3M5, Canada.,Toronto Rehabilitation Institute-University Health Network, 190 Elizabeth Street, Toronto, Ontario, M5G2C4, Canada.,Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, Ontario, M5G1V7, Canada
| |
Collapse
|
2
|
Abstract
OBJECTIVE The purpose of this study is to identify existing or potential quality of care indicators (ie, current indicators as well as process and outcome measures) in the acute or postacute period, or across the continuum of care for older adults with hip fracture. DESIGN Scoping review. SETTING All care settings. SEARCH STRATEGY English peer-reviewed studies published from January 2000 to January 2016 were included. Literature search strategies were developed, and the search was peer-reviewed. Two reviewers independently piloted all forms, and all articles were screened in duplicate. RESULTS The search yielded 2729 unique articles, of which 302 articles were included (11.1%). When indicators (eg, in-hospital mortality, acute care length of stay) and potential indicators (eg, comorbidities developed in hospital, walking ability) were grouped by the outcome or process construct they were trying to measure, the most common constructs were measures of mortality (outcome), length of stay (process) and time-sensitive measures (process). There was heterogeneity in definitions within constructs between studies. There was also a paucity of indicators and potential indicators in the postacute period. CONCLUSIONS To improve quality of care for patients with hip fracture and create a more efficient healthcare system, mechanisms for the measurement of quality of care across the entire continuum, not just during the acute period, are required. Future research should focus on decreasing the heterogeneity in definitions of quality indicators and the development and implementation of quality indicators for the postacute period.
Collapse
Affiliation(s)
- Kristen B Pitzul
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Sarah E P Munce
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Laure Perrier
- Gerstein Science Information Centre, University of Toronto, Toronto, Ontario, Canada
| | - Lauren Beaupre
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Suzanne N Morin
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | | | - Susan B Jaglal
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
3
|
Beaton DE, Vidmar M, Pitzul KB, Sujic R, Rotondi NK, Bogoch ER, Sale JEM, Jain R, Weldon J. Addition of a fracture risk assessment to a coordinator's role improved treatment rates within 6 months of screening in a fragility fracture screening program. Osteoporos Int 2017; 28:863-869. [PMID: 27770155 DOI: 10.1007/s00198-016-3794-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 09/27/2016] [Indexed: 12/26/2022]
Abstract
UNLABELLED We evaluated the impact of a more intensive version of an existing post-fracture coordinator-based fracture prevention program and found that the addition of a full-risk assessment improved treatment rates. These findings provide additional support for more intensive programs aimed at reducing the risk of re-fractures. INTRODUCTION Evidence-based guidelines support coordinator-based programs to improve post-fracture osteoporosis guideline uptake, with more intensive programs including bone mineral density (BMD) testing and/or treatment being associated with better patient outcomes. The purpose of this study was to evaluate the impact of a more intensive version (BMD "fast track") of an existing provincial coordinator-based program. METHODS We compared two versions of the program that screened treatment naïve fragility fracture patients (>50 years). Cases came from the BMD fast track program that included full fracture risk assessment and communication of relevant guidelines to the primary care provider (PCP). Matched controls were selected from the usual care program matching according to age, sex, fracture type, and date. Two matching techniques were used: traditional (hard) matching (TM) and propensity score matching (PS). The outcomes were treatment initiation with bone sparing medication, BMD testing rate, and the rate of returning to discuss the test results with a PCP. RESULTS The program improvements led to a significant improvement in treatment initiation within 6 months from 16 % (controls based on PS) or 21 % (controls based on TM) to 32 % (cases). Ninety percent of patients in the BMD fast track program returned to their PCP to discuss bone health in the cases versus 60 % of the controls (for TM and PS). BMD testing occurred in 96 % of cases compared to the 66 (TM) or 65 % (PS) of the matched controls. CONCLUSIONS Addition of a full-risk assessment to a coordinator-based program significantly improved treatment rates within 6 months of screening.
Collapse
Affiliation(s)
- D E Beaton
- Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St Michael's Hospital, 30 Bond St, Toronto, ON, M5B 1W8, Canada.
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
| | - M Vidmar
- Analytics & Informatics: Access to Care, Cancer Care Ontario, Toronto, ON, Canada
| | - K B Pitzul
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - R Sujic
- Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St Michael's Hospital, 30 Bond St, Toronto, ON, M5B 1W8, Canada
| | - N K Rotondi
- Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St Michael's Hospital, 30 Bond St, Toronto, ON, M5B 1W8, Canada
| | - E R Bogoch
- Mobility Program, St. Michael's Hospital, Toronto, ON, Canada
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - J E M Sale
- Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St Michael's Hospital, 30 Bond St, Toronto, ON, M5B 1W8, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - R Jain
- Osteoporosis Canada, Toronto, ON, Canada
| | - J Weldon
- Osteoporosis Canada, Toronto, ON, Canada
| |
Collapse
|
4
|
Pitzul KB, Wodchis WP, Carter MW, Kreder HJ, Voth J, Jaglal SB. Post-acute pathways among hip fracture patients: a system-level analysis. BMC Health Serv Res 2016; 16:275. [PMID: 27430219 PMCID: PMC4950780 DOI: 10.1186/s12913-016-1524-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 07/07/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Hip fractures among older adults are one of the leading causes of hospitalization and result in significant morbidity, mortality, and health care use. Guidelines suggest that rehabilitation after surgery is imperative to return patients to pre-morbid function. However, post-acute care (which encompasses rehabilitation) is currently delivered in a multitude of settings, and there is a lack of evidence with regards to which hip fracture patients should use which post-acute settings. The purpose of this study is to describe hip fracture patient characteristics and the most common post-acute pathways within a 1-year episode of care, and to examine how these vary regionally within a health system. METHODS This study took place in the province of Ontario, Canada, which has 14 health regions and universal health coverage for all residents. Administrative health databases were used for analyses. Community-dwelling patients aged 66 and over admitted to an acute care hospital for hip fracture between April 2008 and March 2013 were identified. Patients' post-acute destinations within each region were retrieved by linking patients' records within various institutional databases using a unique encoded identifier. Post-acute pathways were then characterized by determining when each patient went to each post-acute destination within one year post-discharge from acute care. Differences in patient characteristics between regions were detected using standardized differences and p-values. RESULTS Thirty-six thousand twenty nine hip fracture patients were included. The study cohort was 71.9 % female with a mean age of 82.9 (±7.5SD). There was significant variation between regions with respect to the immediate post-acute discharge destination: four regions discharged a substantially higher proportion of their patients to inpatient rehabilitation compared to all others. However, the majority of patient characteristics between those four regions and all other regions did not significantly differ. There were 49 unique post-acute pathways taken by patients, with the largest proportion of patients admitted to either community-based or short-term institutionalized rehabilitation, regardless of region. CONCLUSIONS The observation that similar hip fracture patients are discharged to different post-acute settings calls into question both the appropriateness of care delivered in the post-acute period and health system expenditures. As policy makers continue to develop performance-based funding models to increase accountability of institutions in the provision of quality care to hip fracture patients, ensuring patients receive appropriate rehabilitative care is a priority for health system planning.
Collapse
Affiliation(s)
- Kristen B. Pitzul
- />Institute of Health Policy, Management, and Evaluation, University of Toronto, 160-500 University Avenue, Toronto, Ontario M5G1V7 Canada
| | - Walter P. Wodchis
- />Institute of Health Policy, Management, and Evaluation, University of Toronto, 160-500 University Avenue, Toronto, Ontario M5G1V7 Canada
- />Institute for Clinical Evaluative Sciences, 155 College Street, Suite 425, Toronto, Ontario M5T3M6 Canada
- />Toronto Rehabilitation Institute, University Health Network, 160-500 University Avenue, Toronto, Ontario M561V7 Canada
| | - Michael W. Carter
- />Institute of Health Policy, Management, and Evaluation, University of Toronto, 160-500 University Avenue, Toronto, Ontario M5G1V7 Canada
- />Institute for Clinical Evaluative Sciences, 155 College Street, Suite 425, Toronto, Ontario M5T3M6 Canada
- />Department of Mechanical and Industrial Engineering, University of Toronto, 5 King’s College Road, Toronto, Ontario M5S3G8 Canada
| | - Hans J. Kreder
- />Institute of Health Policy, Management, and Evaluation, University of Toronto, 160-500 University Avenue, Toronto, Ontario M5G1V7 Canada
- />Institute for Clinical Evaluative Sciences, 155 College Street, Suite 425, Toronto, Ontario M5T3M6 Canada
- />Department of Surgery, University of Toronto, 2075 Bayview Avenue., MG-365, Toronto, Ontario M4N3M5 Canada
| | - Jennifer Voth
- />Institute for Clinical Evaluative Sciences, 155 College Street, Suite 425, Toronto, Ontario M5T3M6 Canada
- />Toronto Rehabilitation Institute, University Health Network, 160-500 University Avenue, Toronto, Ontario M561V7 Canada
| | - Susan B. Jaglal
- />Institute of Health Policy, Management, and Evaluation, University of Toronto, 160-500 University Avenue, Toronto, Ontario M5G1V7 Canada
- />Institute for Clinical Evaluative Sciences, 155 College Street, Suite 425, Toronto, Ontario M5T3M6 Canada
- />Toronto Rehabilitation Institute, University Health Network, 160-500 University Avenue, Toronto, Ontario M561V7 Canada
- />Department of Physical Therapy, University of Toronto, 160-500 University Avenue, Toronto, Ontario M5G1V7 Canada
| |
Collapse
|
5
|
Pitzul KB, Lane NE, Voruganti T, Khan AI, Innis J, Wodchis WP, Baker GR. Role of context in care transition interventions for medically complex older adults: a realist synthesis protocol. BMJ Open 2015; 5:e008686. [PMID: 26586323 PMCID: PMC4654392 DOI: 10.1136/bmjopen-2015-008686] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 08/21/2015] [Accepted: 09/21/2015] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Approximately 30-50% of older adults have two or more conditions and are referred to as multimorbid or complex patients. These patients often require visits to various healthcare providers in a number of settings and are therefore susceptible to fragmented healthcare delivery while transitioning to receive care. Care transition interventions have been implemented to improve continuity of care, however, current evidence suggests that some interventions or components of interventions are only effective within certain contexts. There is therefore a need to unpack the mechanisms of how and within which contexts care transition interventions and their components are effective. Realist review is a synthesis method that explains how complex programmes work within various contexts. The purpose of this study is to explain the effect of context on the activities and mechanisms of care transition interventions in medically complex older adults using a realist review approach. METHODS AND ANALYSIS This synthesis will be guided by Pawson and colleagues' 2004 and 2005 protocols for conducting realist reviews. The underlying theories of care transition interventions were determined based on an initial literature search using relevant databases. English language peer-reviewed studies published after 1993 will be included. Several relevant databases will be searched using medical subject headings and text terms. A screening form will be piloted and titles, abstracts and full text of potentially relevant articles will be screened in duplicate. Abstracted data will include study characteristics, intervention type, contextual factors, intervention activities and underlying mechanisms. Patterns in Context-Activity-Mechanism-Outcome (CAMO) configurations will be reported. ETHICS AND DISSEMINATION Internal knowledge translation activities will occur throughout the review and existing partnerships will be leveraged to disseminate findings to frontline staff, hospital administrators and policymakers. Finalised results will be presented at local, national and international conferences, and disseminated via peer-reviewed publications in relevant journals.
Collapse
Affiliation(s)
- Kristen B Pitzul
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Natasha E Lane
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Teja Voruganti
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Anum I Khan
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Jennifer Innis
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Walter P Wodchis
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - G Ross Baker
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| |
Collapse
|
6
|
Pearsall EA, Meghji Z, Pitzul KB, Aarts MA, McKenzie M, McLeod RS, Okrainec A. A Qualitative Study to Understand the Barriers and Enablers in Implementing an Enhanced Recovery After Surgery Program. Ann Surg 2015; 261:92-6. [DOI: 10.1097/sla.0000000000000604] [Citation(s) in RCA: 150] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
|
7
|
Abstract
INTRODUCTION Hip fractures are a significant cause of morbidity and mortality and care of hip fracture patients places a heavy burden on healthcare systems due to prolonged recovery time. Measuring quality of care delivered to hip fracture patients is important to help target efforts to improve care for patients and efficiency of the health system. The purpose of this study is to synthesise the evidence surrounding quality of care indicators for patients who have sustained a hip fracture. Using a scoping review methodology, the research question that will be addressed is: "What patient, institutional, and system-level indicators are currently in use or proposed for measuring quality of care across the continuum for individuals following a hip fracture?". METHODS AND ANALYSIS We will employ the methodological frameworks used by Arksey and O'Malley and Levac et al. The synthesis will be limited to quality of care indicators for individuals who suffered low trauma hip fracture. All English peer-reviewed studies published from the year 2000-most recent will be included. Literature search strategies will be developed using medical subject headings and text words related to hip fracture quality indicators and the search will be peer-reviewed. Numerous electronic databases will be searched. Two reviewers will independently screen titles and abstracts for inclusion, followed by screening of the full text of potentially relevant articles to determine final inclusion. Abstracted data will include study characteristics and indicator definitions. DISSEMINATION To improve quality of care for patients and create a more efficient healthcare system, mechanisms for the measurement of quality of care are required. The implementation of quality of care indicators enables stakeholders to target areas for improvement in service delivery. Knowledge translation activities will occur throughout the review with dissemination of the project goals and findings to local, national, and international stakeholders.
Collapse
Affiliation(s)
- Kristen B Pitzul
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Sarah E P Munce
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
| | - Laure Perrier
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Lauren Beaupre
- Department of Physical Therapy, University of Alberta, Edmonton, Canada
- Department of Surgery, University of Alberta, Edmonton, Canada
| | | | | | - Susan B Jaglal
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Canada
| |
Collapse
|
8
|
Jaglal SB, Guilcher SJT, Bereket T, Kwan M, Munce S, Conklin J, Versnel J, Packer T, Verrier M, Marras C, Pitzul KB, Riopelle R. Development of a Chronic Care Model for Neurological Conditions (CCM-NC). BMC Health Serv Res 2014; 14:409. [PMID: 25236443 PMCID: PMC4262116 DOI: 10.1186/1472-6963-14-409] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [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: 02/14/2014] [Accepted: 09/15/2014] [Indexed: 11/15/2022] Open
Abstract
Background Persons with neurological conditions and their families face a number of challenges with the provision of health and community-based services. The purpose of this study was to understand the existing health and community service needs and gaps in care and to use this information to develop a model to specify factors and processes that may improve the quality of care and health and well-being for persons with neurological conditions. Methods We conducted semi-structured interviews with health care professionals, community-based non-health care professionals working with individuals with neurological conditions, and policy makers –from the Ministries of Health, Community and Social Services, Transportation and Education– across Canada. We used a purposive sampling and snowballing approach to obtain maximum variation across professions, sector and geography (provinces and territories, rural and urban). Data analysis was an iterative, constant comparative process involving descriptive and interpretive analyses and was initially guided by the components of the Expanded Chronic Care Model. Results A total of 180 individuals completed the interviews: 39% (n = 70) health care professionals, 47% (n = 85) community-based non-health care professionals, and 14% (n = 25) policy makers. Based on the data we developed the Chronic Care Model for Neurological Conditions (CCM-NC). The major needs/gaps are represented by the following themes: acceptance and openness to neurological conditions, evidence informed policy, investments and funding, supported transitions, caregiver support, and life enhancing resources (education, employment, housing and transportation), knowledge and awareness of neurological conditions and availability and access to health services. The model maintains that intersectoral collaboration across the health system, community and policy components is needed. It recognizes that attitudes, policies, enhanced community integration and health system changes are needed to develop activated patients and families, proactive service delivery teams, a person-centred health system and healthy public policy for persons with neurological conditions. Conclusion The CCM-NC will generate debate and discussion about the actions needed in each of the model components to enable people with neurological conditions to sustain healthier lives. Next steps include validating the model with persons with neurological conditions, in and outside of the Canadian context and developing and evaluating interventions to test the model. Electronic supplementary material The online version of this article (doi:10.1186/1472-6963-14-409) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Susan B Jaglal
- Department of Physical Therapy, University of Toronto, Toronto, Canada.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
McKellar KA, Pitzul KB, Yi JY, Cole DC. Evaluating communities of practice and knowledge networks: a systematic scoping review of evaluation frameworks. Ecohealth 2014; 11:383-399. [PMID: 25023411 DOI: 10.1007/s10393-014-0958-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 05/26/2014] [Accepted: 06/11/2014] [Indexed: 06/03/2023]
Abstract
Communities of Practice (CoPs) are increasingly considered a part of ecohealth and other sectors such as health care, education, and business. However, there is little agreement on approaches to evaluate the influence and effectiveness of CoPs. The purpose of this review was to understand what frameworks and methods have been proposed or used to evaluate CoPs and/or knowledge networks. The review searched electronic databases in interdisciplinary, health, education, and business fields, and further collected references and forward citations from relevant articles. Nineteen articles with 16 frameworks were included in the synthesis. The purposes of the evaluation frameworks varied; while some focused on assessing the performance of CoPs, several frameworks sought to learn about CoPs and their critical success factors. Nine of the frameworks had been applied or tested in some way, most frequently to guide a case study. With limited applications of the frameworks, strong claims about generalizability could not be made. The review results can inform the development of tailored frameworks. However, there is a need for more detailed and targeted CoP evaluation frameworks, as many imperative CoP evaluation needs would be unmet by the available frameworks.
Collapse
Affiliation(s)
- Kaileah A McKellar
- Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, 155 College Street, Suite 425, Toronto, ON, M5T 3M6, Canada,
| | | | | | | |
Collapse
|
10
|
Ambacher KK, Pitzul KB, Karajgikar M, Hamilton A, Ferguson SS, Cregan SP. The JNK- and AKT/GSK3β- signaling pathways converge to regulate Puma induction and neuronal apoptosis induced by trophic factor deprivation. PLoS One 2012; 7:e46885. [PMID: 23056511 PMCID: PMC3463558 DOI: 10.1371/journal.pone.0046885] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [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: 05/16/2012] [Accepted: 09/07/2012] [Indexed: 12/17/2022] Open
Abstract
The AKT, GSK3 and JNK family kinases have been implicated in neuronal apoptosis associated with neuronal development and several neurodegenerative conditions. However, the mechanisms by which these kinase pathways regulate apoptosis remain unclear. In this study we have investigated the role of these kinases in neuronal cell death using an established model of trophic factor deprivation induced apoptosis in cerebellar granule neurons. BCL-2 family proteins are known to be central regulators of apoptosis and we have determined that the pro-apoptotic family member Puma is transcriptionally up-regulated in trophic factor deprived neurons and that Puma induction is required for apoptosis in vitro and in vivo. Importantly, we demonstrate that Puma induction is dependent on both JNK activation and AKT inactivation. AKT is known to regulate a number of downstream pathways, however we have determined that PI3K-AKT inactivation induces Puma expression through a GSK3β-dependent mechanism. Finally we demonstrate that the JNK and AKT/GSK3β pathways converge to regulate FoxO3a-mediated transcriptional activation of Puma. In summary we have identified a novel and critical link between the AKT, GSK3β and JNK kinases and the regulation of Puma induction and suggest that this may be pivotal to the regulation of neuronal apoptosis in neurodegenerative conditions.
Collapse
Affiliation(s)
- Kristin K. Ambacher
- Robarts Research Institute and Department of Physiology and Pharmacology, University of Western Ontario, London, Ontario, Canada
| | - Kristen B. Pitzul
- Robarts Research Institute and Department of Physiology and Pharmacology, University of Western Ontario, London, Ontario, Canada
| | - Meera Karajgikar
- Robarts Research Institute and Department of Physiology and Pharmacology, University of Western Ontario, London, Ontario, Canada
| | - Alison Hamilton
- Robarts Research Institute and Department of Physiology and Pharmacology, University of Western Ontario, London, Ontario, Canada
| | - Stephen S. Ferguson
- Robarts Research Institute and Department of Physiology and Pharmacology, University of Western Ontario, London, Ontario, Canada
| | - Sean P. Cregan
- Robarts Research Institute and Department of Physiology and Pharmacology, University of Western Ontario, London, Ontario, Canada
- * E-mail:
| |
Collapse
|
11
|
Pitzul KB, Grantcharov TP, Okrainec A. Validation of three virtual reality Fundamentals of Laparoscopic Surgery (FLS) modules. Stud Health Technol Inform 2012; 173:349-355. [PMID: 22357016] [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: 05/31/2023]
Abstract
The Fundamentals of Laparoscopic Surgery (FLS) box trainer is the gold standard for development of laparoscopic technical skills however the scoring metrics require a trained proctor and do not allow for immediate feedback. The Lap Mentor™ virtual-reality (LMVR) FLS tasks, with automated scoring metrics and haptic feedback, may be a suitable alternative. We determined the construct and concurrent validity of LMVR-FLS. Participants with a range of laparoscopic experience performed 3 FLS tasks on both simulators. The LMVR-FLS demonstrated moderate concurrent validity and evidence for construct validity. Further research is required to determine if skill acquisition on these modules is transferable to the operating room.
Collapse
Affiliation(s)
- Kristen B Pitzul
- Division of General Surgery, University Health Network, 190 Elizabeth Street, Toronto, Ontario, Canada, M5G2C4
| | | | | |
Collapse
|
12
|
Vaillancourt M, Liberman AS, Okrainec A, Charlebois P, Stein BL, Pitzul KB, Hoover ML, Feldman LS, Fried GM. Development and validation of a tool for training and assessment of laparoscopic colectomy. J Am Coll Surg 2011. [DOI: 10.1016/j.jamcollsurg.2011.06.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|