Browsing by Author "Barnabé, Cheryl Carmelle Marie"

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    Development and Acceptability of an Adolescent Self-Management Program for Juvenile Idiopathic Arthritis
    (2020-09-04) Chomistek, Kelsey; Schmeling, Heinrike; Barnabé, Cheryl Carmelle Marie; Santana, Maria Jose; Stinson, Jennifer N.
    Juvenile idiopathic arthritis (JIA) is a chronic inflammatory disease in children diagnosed under the age of 16 years. The overarching aim of this thesis was to develop and evaluate the acceptability of a self-management program (SMP) for adolescents with JIA. A systematized review of literature was conducted to understand the effectiveness of pre-existing self-management interventions for adolescents with JIA. The findings of this review provided insight into the key elements of our SMP, including the creation of a multicomponent and multisession intervention. In the development phase, the content, format, and structure of our program was determined using a previously completed needs assessment for adolescents with JIA and additional input from adolescents with JIA and interdisciplinary pediatric rheumatology health professionals at the Alberta Children’s Hospital. The program incorporated knowledge from the Public Health Ontario Program Planner framework and Lorig’s self-management theory. Semi-structured focus groups were conducted with adolescents with JIA and healthcare providers to examine the acceptability of the SMP. Finally, thematic analysis of the focus groups was performed to evaluate the acceptability of the program. Findings from the qualitative phase revealed that adolescents and healthcare providers appreciated the program. Participants provided valuable recommendations to improve its structure, design aesthetics, and content prior to conducting future feasibility and effectiveness trials. The findings from this thesis contribute to existing research on the development and acceptability of group-based, in-person, and videoconference SMP for adolescents with JIA and could inform future feasibility and effectiveness trials.
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    Using Advanced Medical Imaging to Study Bone and Joint Changes in Rheumatoid Arthritis
    (2019-06-18) Brunet, Scott Cameron; Manske, Sarah Lynn; Barnabé, Cheryl Carmelle Marie; Salat, Peter
    Inflammatory processes in rheumatoid arthritis (RA) lead to the damage of joints which results in functional decline. Medical imaging plays an important role in evaluating the onset and progression of RA. High resolution peripheral quantitative computed tomography (HR-pQCT) permits 3-dimensional visualization of the bony microarchitecture allowing for improved erosion detection, joint space width, and bone microstructure measurements. The purpose of this research was to use HR-pQCT and other advanced imaging techniques to visualize and quantify bone changes in the metacarpophalangeal (MCP) joints in RA patients. First, the reproducibility of a semi-automated erosion segmentation program was assessed using intra-rater and scan-rescan measurements on a cohort of early RA participants. HR-pQCT was used to assess possible erosion healing in participants’ initiating a new biologic therapy. We observed that the majority of participants maintained stable joints space, bone mineral density, and erosion volume over a 9-month follow-up period, but 17% of the joints showed a significant decrease in total erosion volume suggesting potential erosion healing. Finally, the impact of subclinical inflammation on bone damage progression for patients in clinical remission was assessed using a combination of HR-pQCT and Magnetic Resonance Imaging (MRI). All 9 of the participants assessed in this study had evidence of subclinical inflammation on MRI, but there was no progression of joint damage seen on HR-pQCT. One participant had a significant decrease in erosion volume. An image registration algorithm, applied for the first time for MCP joints, was used to successfully localize areas of inflammation as seen on MRI with bone damage seen on HR-pQCT. It is demonstrated that even with a sensitive measure of bone damage, healing and progression can be difficult to visualize and quantify due to the heterogeneity of the disease. However, applying other imaging modalities that can provide information on inflammation, as displayed in this thesis, could allow us to gain further insight on the individual characteristics that lead to bone change. The imaging findings and techniques described in this thesis will provide a novel insight into the progression of bone damage in RA to help evaluate current treatment targets and improve patient outcomes in future research.
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    “We Are Bridging That Gap”: Insights from Indigenous Hospital Liaisons for Improving Health Care for Indigenous Patients in Alberta
    (2020-06-30) Link, Claire MacKinnon; Voyageur, Cora Jane; Ducey, Ariel; Barnabé, Cheryl Carmelle Marie
    This thesis explores the insights of five Indigenous Hospital Liaisons working in Alberta Health Services hospitals to improve health care for Indigenous patients. Indigenous people in Canada often encounter difficulties and obstacles when accessing health care. Previous studies have described the negative experiences that many Indigenous people encounter within hospitals and other health care facilities. Limited research in Alberta prevents an understanding of context-specific barriers that may exist. Additionally, the insights of Indigenous Hospital Liaisons are a new area of research. These frontline employees work directly with Indigenous patients to help them navigate barriers and ultimately improve their hospital experiences. This research uses a strength-based approach to highlight the dedication that Indigenous Hospital Liaisons have to Indigenous patients and provide a more positive image of Indigenous people. In addition to pointing out barriers they believe are commonly encountered by Indigenous people in Alberta, the Indigenous Hospital Liaisons in this research highlight existing resources that can benefit Indigenous patients. They also share their suggestions for changes that may improve hospital experiences for Indigenous people. The findings of this research provide a welcome contrast to the mass of negative and often deficit-based research that dominates the Indigenous health literature and suggest a more positive and optimistic view of the future of health care for Indigenous people in Alberta. Specific recommendations are provided based upon the findings and suggestions for future research involving Indigenous Hospital Liaisons are discussed.