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Quinn AE, Drummond R, Clement F, Columbus M, Moss SJ, Fitzgerald E, Daya R, Mastikhina L, Leigh JP, Stelfox HT. A North Star Vision: Results from a Deliberative Dialogue to Identify Policy Strategies to Improve Value in Healthcare. Healthc Policy 2023; 18:120-133. [PMID: 37486817 PMCID: PMC10370391 DOI: 10.12927/hcpol.2023.27089] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023] Open
Abstract
We hosted a deliberative dialogue with citizens (n = 3), policy researchers (n = 3), government decision makers (n = 3) and health system leaders (n = 3) to identify evidence-informed policy options to improve the value of Canadian healthcare. The analysis resulted in three themes: (1) the need for a vision to guide reforms, (2) community-based care and (3) community-engaged care. Results suggest the need for a new paradigm: community-focused health systems. Such a paradigm could serve as a North Star guiding healthcare transformation, improving value by aligning citizen and healthcare system goals, prioritizing spending on services that address the social determinants of health and improving quality and equity.
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Affiliation(s)
- Amity E Quinn
- Postdoctoral Fellow, Department of Medicine, Cumming School of Medicine, University of Calgary, Senior Research Associate, O'Brien Institute for Public Health, University of Calgary, Calgary, AB
| | - Rachelle Drummond
- Research Associate, O'Brien Institute for Public Health, University of Calgary, Calgary, AB
| | - Fiona Clement
- Professor, Department of Community Health Science, Cumming School of Medicine, University of Calgary, Member, O'Brien Institute for Public Health, University of Calgary, Calgary, AB
| | - Melanie Columbus
- Health Policy Manager, O'Brien Institute for Public Health, University of Calgary, Calgary, AB
| | - Stephana J Moss
- Banting Postdoctoral Fellow, Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS, CRISMA Center, University of Pittsburgh, Pittsburgh, PA
| | - Emily Fitzgerald
- Research Associate, Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS
| | - Rukhsaar Daya
- Community Engagement Specialist, O'Brien Institute for Public Health, University of Calgary, Calgary, AB, kARLA KREWULAK, PhD, Senior Research Associate, Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB
| | - Liza Mastikhina
- Unit Manager, Health Technology Assessment Unit, O'Brien Institute for Public Health, University of Calgary, Calgary, AB
| | - Jeanna Parsons Leigh
- Assistant Professor Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS
| | - Henry T Stelfox
- On behalf of the Health Policy Forum Panellists, Scientific Director, O'Brien Institute for Public Health, University of Calgary, Professor, Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB
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Leal J, Farkas B, Mastikhina L, Flanagan J, Skidmore B, Salmon C, Dixit D, Smith S, Tsekrekos S, Lee B, Vayalumkal J, Dunn J, Harrison R, Cordoviz M, Dubois R, Chandran U, Clement F, Bush K, Conly J, Larios O. Risk of transmission of respiratory viruses during aerosol-generating medical procedures (AGMPs) revisited in the COVID-19 pandemic: a systematic review. Antimicrob Resist Infect Control 2022; 11:102. [PMID: 35953854 PMCID: PMC9366810 DOI: 10.1186/s13756-022-01133-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 06/27/2022] [Indexed: 02/08/2023] Open
Abstract
Background In many jurisdictions healthcare workers (HCWs) are using respirators for aerosol-generating medical procedures (AGMPs) performed on adult and pediatric populations with all suspect/confirmed viral respiratory infections (VRIs). This systematic review assessed the risk of VRIs to HCWs in the presence of AGMPs, the role respirators versus medical/surgical masks have on reducing that risk, and if the risk to HCWs during AGMPs differed when caring for adult or pediatric patient populations. Main text We searched MEDLINE, EMBASE, Cochrane Central, Cochrane SR, CINAHL, COVID-19 specific resources, and MedRxiv for English and French articles from database inception to September 9, 2021. Independent reviewers screened abstracts using pre-defined criteria, reviewed full-text articles, selected relevant studies, abstracted data, and conducted quality assessments of all studies using the ROBINS-I risk of bias tool. Disagreements were resolved by consensus. Thirty-eight studies were included; 23 studies on COVID-19, 10 on SARS, and 5 on MERS/ influenza/other respiratory viruses. Two of the 16 studies which assessed associations found that HCWs were 1.7 to 2.5 times more likely to contract COVID-19 after exposure to AGMPs vs. not exposed to AGMPs. Eight studies reported statistically significant associations for nine specific AGMPs and transmission of SARS to HCWS. Intubation was consistently associated with an increased risk of SARS. HCWs were more likely (OR 2.05, 95% CI 1.2–3.4) to contract human coronaviruses when exposed to an AGMP in one study. There were no reported associations between AGMP exposure and transmission of influenza or in a single study on MERS. There was limited evidence supporting the use of a respirator over a medical/surgical mask during an AGMP to reduce the risk of viral transmission. One study described outcomes of HCWs exposed to a pediatric patient during intubation. Conclusion Exposure to an AGMP may increase the risk of transmission of COVID-19, SARS, and human coronaviruses to HCWs, however the evidence base is heterogenous and prone to confounding, particularly related to COVID-19. There continues to be a significant research gap in the epidemiology of the risk of VRIs among HCWs during AGMPs, particularly for pediatric patients. Further evidence is needed regarding what constitutes an AGMP. Supplementary Information The online version contains supplementary material available at 10.1186/s13756-022-01133-8.
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Milaney K, Haines-Saah R, Farkas B, Egunsola O, Mastikhina L, Brown S, Lorenzetti D, Hansen B, McBrien K, Rittenbach K, Hill L, O'Gorman C, Doig C, Cabaj J, Stokvis C, Clement F. A scoping review of opioid harm reduction interventions for equity-deserving populations. Lancet Reg Health Am 2022; 12:100271. [PMID: 36776426 PMCID: PMC9904129 DOI: 10.1016/j.lana.2022.100271] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Morbidity and mortality associated with opioid use has become a North American crisis. Harm reduction is an evidence-based approach to substance use. Targeted harm reduction strategies that consider the needs of specific populations are required. The objective of this scoping review was to document the range of opioid harm reduction interventions across equity-deserving populations including racialized groups, Indigenous peoples, LGBTQIA2S+, people with disabilities, and women. Methods Ten databases were searched from inception to July 5th, 2021. Terms for harm reduction and opioid use formed the central concepts of the search. We included studies that: (1) assessed the development, implementation, and/or evaluation of harm reduction interventions for opioid use, and (2) reported health-related outcomes or presented perspectives that directly related to experiences receiving or administering harm reduction interventions, (3) were completed within an equity-deserving population and (4) were completed in New Zealand, Australia, Canada or the US. A knowledge map was developed a-priori based on literature outlining different types of harm reduction interventions and supplemented by the expertise of the research team. Findings 12,958 citations were identified and screened, with 1373 reviewed in full-text screening. Of these, 15 studies were included in the final dataset. The most common harm reduction program was opioid agonist treatment (OAT) (n = 11, 73%). The remaining four studies included: overdose prevention; drug testing equipment; and outreach, peer support, and educational programs for safer use. Nine studies focused on women, primarily pregnant/post-partum women, three focused on Indigenous peoples, and three studies included racialized groups. No studies were identified that provided any information on persons with a disability or members of the LGBTQIA2S+ population. Interpretation The scant opioid specific harm reduction literature on equity-deserving populations to date has primarily focused on OAT programs and is focused primarily on women. There is a need for more targeted research to address the diverse social experiences of people who use drugs and the spectrum of harm reduction interventions that are needed. There is also a need to acknowledge the history of harm reduction as a drug-user activist movement aimed at challenging bio-medical paradigms of drug use. Further, there is a need to recognize that academic research may be contributing to health inequity by not prioritizing research with this lens. Funding This research was funded by the Canadian Institutes of Health Research.
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Affiliation(s)
- Katrina Milaney
- University of Calgary, Calgary, Alberta, Canada,Corresponding author.
| | | | | | | | | | - Sage Brown
- University of Alberta, Edmonton, Alberta, Canada
| | | | | | | | | | - Leslie Hill
- Community Partners, Calgary, Alberta, Canada
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Minion J, Egunsola O, Mastikhina L, Farkas B, Hofmeister M, Flanagan J, Salmon C, Clement F. PICO Portal (product review). J Can Health Libr Assoc 2021. [PMCID: PMC9327594 DOI: 10.29173/jchla29590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
PICO Portal is a Web-based systematic review management tool launched in September 2020 to better facilitate collaborative knowledge synthesis in biomedical research. Most notably, it uses machine learning and Natural Language Processing algorithms to continuously refine the screening process by analyzing decisions as made by the review team. PICO Portal was evaluated by researchers with the Health Assessment Technology team at the University of Calgary, who routinely undertake PICO-based systematic reviews, currently using an in-house manual system. The team appreciated many aspects of PICO Portal and felt it held considerable promise to better support the review process. At the same time, they found it wasn’t as user-friendly as expected and would benefit from additional refinement if it is to appeal to a wider range of users, particularly those less familiar with the systematic review process.
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Hofmeister M, Clement F, Patten S, Li J, Dowsett LE, Farkas B, Mastikhina L, Egunsola O, Diaz R, Cooke NCA, Taylor VH. The effect of interventions targeting gut microbiota on depressive symptoms: a systematic review and meta-analysis. CMAJ Open 2021; 9:E1195-E1204. [PMID: 34933877 PMCID: PMC8695538 DOI: 10.9778/cmajo.20200283] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Despite their popularity, the efficacy of interventions targeting gut microbiota to improve depressive symptoms is unknown. Our objective is to summarize the effect of microbiome-targeting interventions on depressive symptoms. METHODS We conducted a systematic review and meta-analysis. We searched MEDLINE, Embase, PsycINFO, Database of Abstracts of Reviews of Effects, Cochrane Database of Systematic Reviews and the Cochrane Controlled Register of Trials from inception to Mar. 5, 2021. We included studies that evaluated probiotic, prebiotic, synbiotic, paraprobiotic or fecal microbiota transplant interventions in an adult population (age ≥ 18 yr) with an inactive or placebo comparator (defined by the absence of active intervention). Studies must have measured depressive symptoms with a validated scale, and used a randomized controlled trial study design. We conducted a random effects meta-analysis of change scores, using standardized mean difference as the measure of effect. RESULTS Sixty-two studies formed the final data set, with 50 included in the meta-analysis. Probiotic, prebiotic, and synbiotic interventions on depressive symptoms showed statistically significant benefits. In the single studies evaluating each of fecal microbiota transplant and paraprobiotic interventions, neither showed a statistically significant benefit. INTERPRETATION Despite promising findings of benefit of probiotic, prebiotic and synbiotic interventions for depressive symptoms in study populations, there is not yet strong enough evidence to favour inclusion of these interventions in treatment guidelines for depression. Critical questions about species administered, dosage and timing relative to other antidepressant medications remain to be answered. STUDY REGISTRATION PROSPERO no. 143178.
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Affiliation(s)
- Mark Hofmeister
- Department of Community Health Sciences (Hofmeister, Clement, Patten, Li, Dowsett, Farkas, Mastikhina, Egunsola, Diaz), and O'Brien Institute for Public Health (Hofmeister, Clement, Patten, Li, Dowsett, Farkas, Mastikhina, Egunsola, Diaz), and Departments of Psychiatry (Patten, Taylor) and Biochemistry and Molecular Biology (Cooke), Teaching Research and Wellness Building, University of Calgary, Calgary, Alta
| | - Fiona Clement
- Department of Community Health Sciences (Hofmeister, Clement, Patten, Li, Dowsett, Farkas, Mastikhina, Egunsola, Diaz), and O'Brien Institute for Public Health (Hofmeister, Clement, Patten, Li, Dowsett, Farkas, Mastikhina, Egunsola, Diaz), and Departments of Psychiatry (Patten, Taylor) and Biochemistry and Molecular Biology (Cooke), Teaching Research and Wellness Building, University of Calgary, Calgary, Alta
| | - Scott Patten
- Department of Community Health Sciences (Hofmeister, Clement, Patten, Li, Dowsett, Farkas, Mastikhina, Egunsola, Diaz), and O'Brien Institute for Public Health (Hofmeister, Clement, Patten, Li, Dowsett, Farkas, Mastikhina, Egunsola, Diaz), and Departments of Psychiatry (Patten, Taylor) and Biochemistry and Molecular Biology (Cooke), Teaching Research and Wellness Building, University of Calgary, Calgary, Alta
| | - Joyce Li
- Department of Community Health Sciences (Hofmeister, Clement, Patten, Li, Dowsett, Farkas, Mastikhina, Egunsola, Diaz), and O'Brien Institute for Public Health (Hofmeister, Clement, Patten, Li, Dowsett, Farkas, Mastikhina, Egunsola, Diaz), and Departments of Psychiatry (Patten, Taylor) and Biochemistry and Molecular Biology (Cooke), Teaching Research and Wellness Building, University of Calgary, Calgary, Alta
| | - Laura E Dowsett
- Department of Community Health Sciences (Hofmeister, Clement, Patten, Li, Dowsett, Farkas, Mastikhina, Egunsola, Diaz), and O'Brien Institute for Public Health (Hofmeister, Clement, Patten, Li, Dowsett, Farkas, Mastikhina, Egunsola, Diaz), and Departments of Psychiatry (Patten, Taylor) and Biochemistry and Molecular Biology (Cooke), Teaching Research and Wellness Building, University of Calgary, Calgary, Alta
| | - Brenlea Farkas
- Department of Community Health Sciences (Hofmeister, Clement, Patten, Li, Dowsett, Farkas, Mastikhina, Egunsola, Diaz), and O'Brien Institute for Public Health (Hofmeister, Clement, Patten, Li, Dowsett, Farkas, Mastikhina, Egunsola, Diaz), and Departments of Psychiatry (Patten, Taylor) and Biochemistry and Molecular Biology (Cooke), Teaching Research and Wellness Building, University of Calgary, Calgary, Alta
| | - Liza Mastikhina
- Department of Community Health Sciences (Hofmeister, Clement, Patten, Li, Dowsett, Farkas, Mastikhina, Egunsola, Diaz), and O'Brien Institute for Public Health (Hofmeister, Clement, Patten, Li, Dowsett, Farkas, Mastikhina, Egunsola, Diaz), and Departments of Psychiatry (Patten, Taylor) and Biochemistry and Molecular Biology (Cooke), Teaching Research and Wellness Building, University of Calgary, Calgary, Alta
| | - Oluwaseun Egunsola
- Department of Community Health Sciences (Hofmeister, Clement, Patten, Li, Dowsett, Farkas, Mastikhina, Egunsola, Diaz), and O'Brien Institute for Public Health (Hofmeister, Clement, Patten, Li, Dowsett, Farkas, Mastikhina, Egunsola, Diaz), and Departments of Psychiatry (Patten, Taylor) and Biochemistry and Molecular Biology (Cooke), Teaching Research and Wellness Building, University of Calgary, Calgary, Alta
| | - Ruth Diaz
- Department of Community Health Sciences (Hofmeister, Clement, Patten, Li, Dowsett, Farkas, Mastikhina, Egunsola, Diaz), and O'Brien Institute for Public Health (Hofmeister, Clement, Patten, Li, Dowsett, Farkas, Mastikhina, Egunsola, Diaz), and Departments of Psychiatry (Patten, Taylor) and Biochemistry and Molecular Biology (Cooke), Teaching Research and Wellness Building, University of Calgary, Calgary, Alta
| | - Noah C A Cooke
- Department of Community Health Sciences (Hofmeister, Clement, Patten, Li, Dowsett, Farkas, Mastikhina, Egunsola, Diaz), and O'Brien Institute for Public Health (Hofmeister, Clement, Patten, Li, Dowsett, Farkas, Mastikhina, Egunsola, Diaz), and Departments of Psychiatry (Patten, Taylor) and Biochemistry and Molecular Biology (Cooke), Teaching Research and Wellness Building, University of Calgary, Calgary, Alta
| | - Valerie H Taylor
- Department of Community Health Sciences (Hofmeister, Clement, Patten, Li, Dowsett, Farkas, Mastikhina, Egunsola, Diaz), and O'Brien Institute for Public Health (Hofmeister, Clement, Patten, Li, Dowsett, Farkas, Mastikhina, Egunsola, Diaz), and Departments of Psychiatry (Patten, Taylor) and Biochemistry and Molecular Biology (Cooke), Teaching Research and Wellness Building, University of Calgary, Calgary, Alta.
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Egunsola O, Li JW, Mastikhina L, Akeju O, Dowsett LE, Clement F. A Qualitative Systematic Review of Facilitators of and Barriers to Community Pharmacists-Led Anticoagulation Management Service. Ann Pharmacother 2021; 56:704-715. [PMID: 34510918 PMCID: PMC9008548 DOI: 10.1177/10600280211045075] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective: To identify the facilitators of and barriers to the implementation of Community Pharmacists–Led Anticoagulation Management Services (CPAMS). Data Sources: MEDLINE, EMBASE, CINAHL, Cochrane Database of Systematic Reviews, and Cochrane CENTRAL Register of Controlled Trials were searched from inception until August 20, 2021. Study Selection and Data Extraction: All abstracts proceeded to full-text review, which was completed by 2 reviewers. Data extraction was completed by a single reviewer and verified. Analysis was completed using best-fit framework synthesis. Data Synthesis: A total of 17 articles reporting on CPAMS from 6 jurisdictions were included: 2 Canadian provincial programs (Nova Scotia, Alberta), a national program (New Zealand), and 3 cities in the United Kingdom (Whittington and Brighton and Hove) and Australia (Sydney). Facilitators of CPAMS included convenience for patients, accessibility for patients, professional satisfaction for pharmacists, increased efficiency in anticoagulation management, improved outcomes, enhanced collaboration, and scalability. Barriers included perceived poor quality of care by patients, resistance by general practitioners, organizational limits, capping of the number of eligible patients, and cost. Relevance to Patient Care and Clinical Practice: The barriers and facilitators identified in this review will inform health policy makers on the implementation and improvement of CPAMS for patients and health care practitioners. Conclusion and Relevance: CPAMS has been implemented in 6 jurisdictions across 4 countries, with reported benefits and challenges. The programs were structurally similar in most jurisdictions, with minor variations in implementation. New anticoagulation management programs should consider adapting existing frameworks to local needs.
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Affiliation(s)
| | - Joyce W Li
- University of Calgary, Calgary, Alberta, Canada
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Egunsola O, Clement F, Taplin J, Mastikhina L, Li JW, Lorenzetti DL, Dowsett LE, Noseworthy T. Immunogenicity and Safety of Reduced-Dose Intradermal vs Intramuscular Influenza Vaccines: A Systematic Review and Meta-analysis. JAMA Netw Open 2021; 4:e2035693. [PMID: 33560425 PMCID: PMC7873776 DOI: 10.1001/jamanetworkopen.2020.35693] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
IMPORTANCE Low-dose intradermal influenza vaccines could be a suitable alternative to full intramuscular dose during vaccine shortages. OBJECTIVE To compare the immunogenicity and safety of the influenza vaccine at reduced or full intradermal doses with full intramuscular doses to inform policy design in the event of vaccine shortages. DATA SOURCES MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched for studies published from 2010 until June 5, 2020. STUDY SELECTION All comparative studies across all ages assessing the immunogenicity or safety of intradermal and intramuscular influenza vaccinations were included. DATA EXTRACTION AND SYNTHESIS Data were extracted by a single reviewer and verified by a second reviewer. Discrepancies between reviewers were resolved through consensus. Random-effects meta-analysis was conducted. MAIN OUTCOMES AND MEASURES Primary outcomes included geometric mean titer, seroconversion, seroprotection, and adverse events. RESULTS A total of 30 relevant studies were included; 29 studies were randomized clinical trials with 13 759 total participants, and 1 study was a cohort study of 164 021 participants. There was no statistically significant difference in seroconversion rates between the 3-µg, 6-µg, 7.5-µg, and 9-µg intradermal vaccine doses and the 15-µg intramuscular vaccine dose for each of the H1N1, H3N2, and B strains, but rates were significantly higher with the 15-µg intradermal dose compared with the 15-µg intramuscular dose for the H1N1 strain (rate ratio [RR], 1.10; 95% CI, 1.01-1.20) and B strain (RR, 1.40; 95% CI, 1.13-1.73). Seroprotection rates for the 9-µg and 15-µg intradermal doses did not vary significantly compared with the 15-µg intramuscular dose for all the 3 strains, except for the 15-µg intradermal dose for the H1N1 strain, for which rates were significantly higher (RR, 1.05; 95% CI, 1.01-1.09). Local adverse events were significantly higher with intradermal doses than with the 15-µg intramuscular dose, particularly erythema (3-µg dose: RR, 9.62; 95% CI, 1.07-86.56; 6-µg dose: RR, 23.79; 95% CI, 14.42-39.23; 9-µg dose: RR, 4.56; 95% CI, 3.05-6.82; 15-µg dose: RR, 3.68; 95% CI, 3.19-4.25) and swelling (3-µg dose: RR, 20.16; 95% CI, 4.68-86.82; 9-µg dose: RR, 5.23; 95% CI, 3.58-7.62; 15-µg dose: RR, 3.47 ; 95% CI, 2.21-5.45). Fever and chills were significantly more common with the 9-µg intradermal dose than the 15-µg intramuscular dose (fever: RR, 1.36; 95% CI, 1.03-1.80; chills: RR, 1.24; 95% CI, 1.03-1.50) while all other systemic adverse events were not statistically significant for all other doses. CONCLUSIONS AND RELEVANCE These findings suggest that reduced-dose intradermal influenza vaccination could be a reasonable alternative to standard dose intramuscular vaccination.
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Affiliation(s)
- Oluwaseun Egunsola
- Department Community Health Sciences, University of Calgary Alberta, Canada
| | - Fiona Clement
- Department Community Health Sciences, University of Calgary Alberta, Canada
| | - John Taplin
- Department Community Health Sciences, University of Calgary Alberta, Canada
| | - Liza Mastikhina
- Department Community Health Sciences, University of Calgary Alberta, Canada
| | - Joyce W. Li
- Department Community Health Sciences, University of Calgary Alberta, Canada
| | - Diane L. Lorenzetti
- Department Community Health Sciences, University of Calgary Alberta, Canada
- Health Sciences Library, University of Calgary, Alberta, Canada
| | - Laura E. Dowsett
- Department Community Health Sciences, University of Calgary Alberta, Canada
| | - Tom Noseworthy
- Department Community Health Sciences, University of Calgary Alberta, Canada
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Affiliation(s)
- Liza Mastikhina
- Department of Clinical Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Keith Dobson
- Department of Clinical Psychology, University of Calgary, Calgary, Alberta, Canada
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