PRISM :: Browsing by Author "Holroyd-Leduc, Jayna"

Browsing by Author "Holroyd-Leduc, Jayna"

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Open Access
A logic framework for addressing medical racism in academic medicine: an analysis of qualitative data
(2024-04-15) Roach, Pamela; Ruzycki, Shannon M.; Lithgow, Kirstie C.; McFadden, Chanda R.; Chikwanha, Adrian; Holroyd-Leduc, Jayna; Barnabe, Cheryl
Abstract Background Despite decades of anti-racism and equity, diversity, and inclusion (EDI) interventions in academic medicine, medical racism continues to harm patients and healthcare providers. We sought to deeply explore experiences and beliefs about medical racism among academic clinicians to understand the drivers of persistent medical racism and to inform intervention design. Methods We interviewed academically-affiliated clinicians with any racial identity from the Departments of Family Medicine, Cardiac Sciences, Emergency Medicine, and Medicine to understand their experiences and perceptions of medical racism. We performed thematic content analysis of semi-structured interview data to understand the barriers and facilitators of ongoing medical racism. Based on participant narratives, we developed a logic framework that demonstrates the necessary steps in the process of addressing racism using if/then logic. This framework was then applied to all narratives and the barriers to addressing medical racism were aligned with each step in the logic framework. Proposed interventions, as suggested by participants or study team members and/or identified in the literature, were matched to these identified barriers to addressing racism. Results Participant narratives of their experiences of medical racism demonstrated multiple barriers to addressing racism, such as a perceived lack of empathy from white colleagues. Few potential facilitators to addressing racism were also identified, including shared language to understand racism. The logic framework suggested that addressing racism requires individuals to understand, recognize, name, and confront medical racism. Conclusions Organizations can use this logic framework to understand their local context and select targeted anti-racism or EDI interventions. Theory-informed approaches to medical racism may be more effective than interventions that do not address local barriers or facilitators for persistent medical racism.
Open Access
A mixed-method evaluation of a volunteer navigation intervention for older persons living with chronic illness (Nav-CARE): findings from a knowledge translation study
(2020-10-15) Pesut, Barbara; Duggleby, Wendy; Warner, Grace; Bruce, Paxton; Ghosh, Sunita; Holroyd-Leduc, Jayna; Nekolaichuk, Cheryl; Parmar, Jasneet
Abstract Background Volunteer navigation is an innovative way to help older persons get connected to resources in their community that they may not know about or have difficulty accessing. Nav-CARE is an intervention in which volunteers, who are trained in navigation, provide services for older persons living at home with chronic illness to improve their quality of life. The goal of this study was to evaluate the impact of Nav-CARE on volunteers, older persons, and family participating across eight Canadian sites. Methods Nav-CARE was implemented using a knowledge translation approach in eight sites using a 12- or 18-month intervention period. A mixed method evaluation was used to understand the outcomes upon older person engagement; volunteer self-efficacy; and older person, family, and volunteer quality of life and satisfaction with the intervention. Results Older persons and family were highly satisfied with the intervention, citing benefits of social connection and support, help with negotiating the social aspects of healthcare, access to cost-effective resources, and family respite. They were less satisfied with the practical help available for transportation and errands. Older persons self-reported knowledge of the services available to them and confidence in making decisions about their healthcare showed statistically significant improvements (P < .05) over 12–18 months. Volunteers reported satisfaction with their role, particularly as it related to building relationships over time, and good self-efficacy. Volunteer attrition was a result of not recruiting older persons in a timely manner. There was no statistically significant improvement in quality of life for older persons, family or volunteers from baseline to study completion. Conclusions Findings from this study support a developing body of evidence showing the contributions volunteers make to enhanced older person and family well-being in the context of chronic illness. Statistically significant improvements were documented in aspects of client engagement. However, there were no statistically significant improvements in quality of life scores even though qualitative data illustrated very specific positive outcomes of the intervention. Similar findings in other volunteer-led intervention studies raise the question of whether there is a need for targeted volunteer-sensitive outcome measures.
Open Access
A scoping review of full-spectrum knowledge translation theories, models, and frameworks
(2020-02-14) Esmail, Rosmin; Hanson, Heather M; Holroyd-Leduc, Jayna; Brown, Sage; Strifler, Lisa; Straus, Sharon E; Niven, Daniel J; Clement, Fiona M
Abstract Background Application of knowledge translation (KT) theories, models, and frameworks (TMFs) is one method for successfully incorporating evidence into clinical care. However, there are multiple KT TMFs and little guidance on which to select. This study sought to identify and describe available full-spectrum KT TMFs to subsequently guide users. Methods A scoping review was completed. Articles were identified through searches within electronic databases, previous reviews, grey literature, and consultation with KT experts. Search terms included combinations of KT terms and theory-related terms. Included citations had to describe full-spectrum KT TMFs that had been applied or tested. Titles/abstracts and full-text articles were screened independently by two investigators. Each KT TMF was described by its characteristics including name, context, key components, how it was used, primary target audience, levels of use, and study outcomes. Each KT TMF was also categorized into theoretical approaches as process models, determinant frameworks, classic theories, implementation theories, and evaluation frameworks. Within each category, KT TMFs were compared and contrasted to identify similarities and unique characteristics. Results Electronic searches yielded 7160 citations. Additional citations were identified from previous reviews (n = 41) and bibliographies of included full-text articles (n = 6). Thirty-six citations describing 36 full-spectrum were identified. In 24 KT TMFs, the primary target audience was multi-level including patients/public, professionals, organizational, and financial/regulatory. The majority of the KT TMFs were used within public health, followed by research (organizational, translation, health), or in multiple contexts. Twenty-six could be used at the individual, organization, or policy levels, five at the individual/organization levels, three at the individual level only, and two at the organizational/policy level. Categorization of the KT TMFs resulted in 18 process models, eight classic theories, three determinant frameworks, three evaluation frameworks, and four that fit more than one category. There were no KT TMFs that fit the implementation theory category. Within each category, similarities and unique characteristics emerged through comparison. Conclusions A systematic compilation of existing full-spectrum KT TMFs, categorization into different approaches, and comparison has been provided in a user-friendly way. This list provides options for users to select from when designing KT projects and interventions. Trial registration A protocol outlining the methodology of this scoping review was developed and registered with PROSPERO (CRD42018088564).
Open Access
An evaluation of the comparative effectiveness of geriatrician-led comprehensive geriatric assessment for improving patient and healthcare system outcomes for older adults: a protocol for a systematic review and network meta-analysis
(2017-03-24) Soobiah, Charlene; Daly, Caitlin; Blondal, Erik; Ewusie, Joycelyne; Ho, Joanne; Elliott, Meghan J; Yue, Rossini; Holroyd-Leduc, Jayna; Liu, Barbara; Marr, Sharon; Basran, Jenny; Tricco, Andrea C; Hamid, Jemila; Straus, Sharon E
Abstract Background Comprehensive geriatric assessment (CGA) is an integrated model of care involving a geriatrician and an interdisciplinary team and can prioritize and manage complex health needs of older adults with multimorbidity. CGAs differ across healthcare settings, ranging from shared care conducted in primary care settings to specialized inpatient units in acute care. Models of care involving geriatricians vary across healthcare settings, and it is unclear which CGA model is most effective. Our objective is to conduct a systematic review and network meta-analysis (NMA) to examine the comparative effectiveness of various geriatrician-led CGAs and to identify which models improve patient and healthcare system level outcomes. Methods An integrated knowledge translation approach will be used and knowledge users (KUs) including patients, caregivers, geriatricians, and healthcare policymakers will be involved throughout the review. Electronic databases including MEDLINE, EMBASE, Cochrane library, and Ageline will be searched from inception to November 2016 to identify relevant studies. Randomized controlled trials of older adults (≥65 years of age) that examine geriatrician-led CGAs compared to any intervention will be included. Primary and secondary outcomes will be selected by KUs to ensure the results are relevant to their decision-making. Two reviewers will independently screen the search results, extract data, and assess risk of bias. Data will be synthesized using an NMA to allow for multiple comparisons using direct (head-to-head) as well as indirect evidence. Interventions will be ranked according to their effectiveness using surface under the cumulative ranking curve (SUCRA). Discussion As the proportion of older adults grows worldwide, the demand for specialized geriatric services that help manage complex health needs of older adults with multimorbidity will increase in many countries. Results from this systematic review and NMA will enhance decision-making and the efficient allocation of scarce geriatric resources. Moreover, active involvement of KUs throughout the review process will ensure the results are relevant to different levels of decision-making. Systematic review registration PROSPERO CRD42014014008
Open Access
Barriers and facilitators to care for agitation and/or aggression among persons living with dementia in long-term care
(2024-04-11) Wong, Britney; Ismail, Zahinoor; Watt, Jennifer; Holroyd-Leduc, Jayna; Goodarzi, Zahra
Abstract Background Agitation and/or aggression affect up to 60% of persons living with dementia in long-term care (LTC). It can be treated via non-pharmacological and pharmacological interventions, but the former are underused in clinical practice. In the literature, there is currently a lack of understanding of the challenges to caring for agitation and/or aggression among persons living with dementia in LTC. This study assesses what barriers and facilitators across the spectrum of care exist for agitation and/or aggression among people with dementia in LTC across stakeholder groups. Methods This was a qualitative study that used semi-structured interviews among persons involved in the care and/or planning of care for people with dementia in LTC. Participants were recruited via purposive and snowball sampling, with the assistance of four owner-operator models. Interviews were guided by the Theoretical Domains Framework and transcribed and analyzed using Framework Analysis. Results Eighteen interviews were conducted across 5 stakeholder groups. Key identified barriers were a lack of agitation and/or aggression diagnostic measures, limited training for managing agitation and/or aggression in LTC, an overuse of physical and chemical restraints, and an underuse of non-pharmacological interventions. Facilitators included using an interdisciplinary team to deliver care and having competent and trained healthcare providers to administer non-pharmacological interventions. Conclusions This study advances care for persons living with dementia in LTC by drawing attention to unique and systemic barriers present across local and national Canadian LTC facilities. Findings will support future implementation research endeavours to eliminate these identified barriers across the spectrum of care, thus improving care outcomes among people with dementia in LTC.
Open Access
Barriers and facilitators to diagnosing and managing apathy in Parkinson’s disease: a qualitative study
(2019-05-24) Mele, Bria; Goodarzi, Zahra; Hanson, Heather M; Holroyd-Leduc, Jayna
Abstract Background Apathy is a prominent non-motor symptom in Parkinson’s disease (PD). People with apathy show a lack of emotion, passion, and motivation. Between 17 and 70% of persons with PD have apathy; the extreme heterogeneity in these estimates is due to limited heterogeneous knowledge concerning how to diagnose PD. The lack of a widely utilized diagnostic process limits understandings on how to treat and manage apathy in PD. A scoping review of apathy in PD identified only one qualitative study investigating this symptom. It was our objective to assess perceived barriers and facilitators to diagnosing, treating, and managing apathy in PD, as described by key stakeholders. Methods This research applied qualitative methodology, utilizing focus groups and interviews with health care practitioners (HCPs), persons with PD, and caregivers. Evidence gathered from a scoping review on apathy in PD informed discussions that took place with participants. Data collection and analysis was conducted using framework analysis, applying the Theoretical Domains Framework and Behaviour Change Wheel. Results Eleven HCPs and five persons with PD/caregivers participated. Themes included interdisciplinary teams and communication with family to facilitate diagnosis and treatment, and the use of education and increased awareness of apathy to facilitate management. Themes surrounding barriers included lack of initiative and motivation to maintain treatment plans, and a lack of evidence for apathy specific interventions. While a key barrier identified was the lack of information HCPs have access to, persons with PD and caregivers would prefer to receive a diagnosis of apathy even with limited management methods. Thus, education and awareness were noted as two of the most important facilitators, overall. Conclusion These findings suggest that diagnosing, treating, and managing apathy in PD requires interdisciplinary teams, that include family and caregivers. We identified that where HCPs perceive lack of knowledge as a barrier to diagnosis, persons with PD and caregivers find being given a diagnosis facilitates understanding. These findings highlight the importance of qualitative research involving persons with PD and apathy, caregivers, and HCPs who aid in management of this symptom. Barriers reported suggest future research must aim to identify apathy specific treatments, both pharmacologic and non-pharmacologic.
Open Access
Building a new life: a qualitative study of how family carers deal with significant changes
(2022-07-01) Duggleby, Wendy; O’Rourke, Hannah M.; Baxter, Pamela; Nekolaichuk, Cheryl; Thompson, Genevieve; Peacock, Shelley; Ghosh, Sunita; Holroyd-Leduc, Jayna; McAiney, Carrie; Dubé, Véronique; Swindle, Jennifer; Pagnucco-Renaud, Madeleine; Sana, Samina
Abstract Background Family carers of persons living with dementia who are residing in long term care (LTC), often experience significant changes in their roles and relationships which affects mental and physical health. Research has focused on describing the carers’ experience, but not on how they deal with these changes or their perceptions of support needs. The purpose of this study was to explore how family carers of persons living with dementia residing in LTC deal with significant changes and to understand how best to support these carers. Methods Eight face-to-face audio-recorded focus group interviews were conducted with 45 participants from September 2019 to January 2020, as part of a larger study aimed at guiding the adaptation of an online toolkit to support family carers of persons living with dementia residing in LTC. Applied thematic analysis was used to analyze the focus group data. Findings/results Carers dealt with the significant changes they experienced through the process of “building a new life” consisting of two sub-processes: a) building new relationships (with their family member, LTC staff and others outside of LTC), and b) finding space for themselves (sharing of care and finding balance). Understanding dementia, support from others (staff, family and friends), connecting with resources, and being included in care decisions helped carers build a new life. Conclusion The process of building a new life describes the ways that family carers deal with the life-altering changes they experienced when a family member is admitted to LTC. Carers may be supported in building their new life, by providing them with information about dementia and how to relate to staff and their family member living with dementia. The quality of care being provided and the LTC environment may also play an important role in how carers deal with the significant changes they experience.
Embargo
Care for Older Adults Living with Dementia in the Emergency Department: Informing the Development of a Clinical Care Pathway
(2024-06-11) Jelinski, Dana Christine; Goodarzi, Zahra; Holroyd-Leduc, Jayna; Reich, Krista; Lang, Eddy
Background: People living with dementia (PLWD) are frequent users of the emergency department (ED). PLWD experience adverse outcomes in the ED at higher rates than older adults without dementia, and care partners play a vital role in supporting them. While there is some evidence that exists regarding best practices in caring for PLWD in the ED, there are gaps in evidence on the experiences of caring for PLWD in ED and implementing best practices from the view of healthcare providers (HCPs). Objectives: The objectives of this thesis were to (1) synthesize barriers and facilitators to care for PLWD in the ED through the perspective of care partners as well as HCP perceptions of care partner roles within the ED, and (2) explore barriers and facilitators to care through the perspective of HCPs. Methods: A systematic review and meta-synthesis were conducted following the Joanna Briggs Institute Manual for Evidence Synthesis to synthesize care partner perspectives and roles regarding care for PLWD in the ED. Semi-structured interviews with HCPs were used to directly understand experiences in caring for PLWD in the ED. Results: Care partners and HCPs reported similar barriers and facilitators to care for PLWD in the ED. Key barriers to care included gaps in primary care, the ED environment, and lack of dementia specific guidance and training. Key facilitators included the importance of care partner and patient involvement, and communication and collaboration among care teams. Conclusion: The findings of this study inform the development of interventions that target behavior change and promote dementia friendly EDs. Key implications highlighted in this study include education and training, staffing and environmental changes, and care guidance and policy implementation.
Open Access
Characteristics of knowledge translation theories, models and frameworks for health technology reassessment: expert perspectives through a qualitative exploration
(2021-04-29) Esmail, Rosmin; Clement, Fiona M; Holroyd-Leduc, Jayna; Niven, Daniel J; Hanson, Heather M
Abstract Background Health Technology Reassessment (HTR) is a process that systematically assesses technologies that are currently used in the health care system. The process results in four outputs: increase use or decrease use, no change, or de-adoption of a technology. Implementation of these outputs remains a challenge. The Knowledge Translation (KT) field enables to transfer/translate knowledge into practice. KT could help with implementation of HTR outputs. This study sought to identify which characteristics of KT theories, models, and frameworks could be useful, specifically for decreased use or de-adoption of a technology. Methods A qualitative descriptive approach was used to ascertain the perspectives of international KT and HTR experts on the characteristics of KT theories, models, and frameworks for decreased use or de-adoption of a technology. One-to-one semi-structured interviews were conducted from September to December 2019. Interviews were audio recorded and transcribed verbatim. Themes and sub-themes were deduced from the data through framework analysis using five distinctive steps: familiarization, identifying an analytic framework, indexing, charting, mapping and interpretation. Themes and sub-themes were also mapped to existing KT theories, models, and frameworks. Results Thirteen experts from Canada, United States, United Kingdom, Australia, Germany, Spain, and Sweden participated in the study. Three themes emerged that illustrated the ideal traits: principles that were foundational for HTR, levers of change, and steps for knowledge to action. Principles included evidence-based, high usability, patient-centered, and ability to apply to the micro, meso, macro levels. Levers of change were characterized as positive, neutral, or negative influences for changing behaviour for HTR. Steps for knowledge to action included: build the case for HTR, adapt research knowledge, assess context, select interventions, and assess impact. Of the KT theories, models, and frameworks that were mapped, the Consolidated Framework for Implementation Research had most of the characteristics, except ability to apply to micro, meso, macro levels. Conclusions Characteristics that need to be considered within a KT theory, model, and framework for implementing HTR outputs have been identified. Consideration of these characteristics may guide users to select relevant KT theories, models, and frameworks to apply to HTR projects.
Open Access
Depressive symptoms in long term care facilities in Western Canada: a cross sectional study
(2019-12-02) Hoben, Matthias; Heninger, Abigail; Holroyd-Leduc, Jayna; Knopp-Sihota, Jennifer; Estabrooks, Carole; Goodarzi, Zahra
Abstract Background The main objective is to better understand the prevalence of depressive symptoms, in long-term care (LTC) residents with or without cognitive impairment across Western Canada. Secondary objectives are to examine comorbidities and other factors associated with of depressive symptoms, and treatments used in LTC. Methods 11,445 residents across a random sample of 91 LTC facilities, from 09/2014 to 05/2015, were stratified by owner-operator model (private for-profit, public or voluntary not-for-profit), size (small: < 80 beds, medium: 80–120 beds, large > 120 beds), location (Calgary and Edmonton Health Zones, Alberta; Fraser and Interior Health Regions, British Columbia; Winnipeg Health Region, Manitoba). Random intercept generalized linear mixed models with depressive symptoms as the dependent variable, cognitive impairment as primary independent variable, and resident, care unit and facility characteristics as covariates were used. Resident variables came from the Resident Assessment Instrument – Minimum Data Set (RAI-MDS) 2.0 records (the RAI-MDS version routinely collected in Western Canadian LTC). Care unit and facility variables came from surveys completed with care unit or facility managers. Results Depressive symptoms affects 27.1% of all LTC residents and 23.3% of LTC resident have both, depressive symptoms and cognitive impairment. Hypertension, urinary and fecal incontinence were the most common comorbidities. Cognitive impairment increases the risk for depressive symptoms (adjusted odds ratio 1.65 [95% confidence interval 1.43; 1.90]). Pain, anxiety and pulmonary disorders were also significantly associated with depressive symptoms. Pharmacologic therapies were commonly used in those with depressive symptoms, however there was minimal use of non-pharmacologic management. Conclusions Depressive symptoms are common in LTC residents –particularly in those with cognitive impairment. Depressive symptoms are an important target for clinical intervention and further research to reduce the burden of these illnesses.
Embargo
Developing a Novel Care Pathway for Symptoms of Agitation or Aggression in Persons Living with Dementia in Long-Term Care: A Multi-Methods Implementation Research Study
(2023-06) Wong, Britney; Goodarzi, Zahra; Holroyd-Leduc, Jayna; Ismail, Zahinoor; Watt, Jennifer
Background: Agitation and/or aggression are common among persons living with dementia (PLWD) in LTC, and together pose a significant burden to residents and their caregivers. Current treatment practices for agitation and/or aggression are highly variable among PLWD in LTC. There is a need to develop a more effective approach to treatment and to explore the barriers and facilitators to providing care for agitation and/or aggression among PLWD in LTC. Objectives: The first objective was to develop an evidence-informed clinical care pathway co-designed with stakeholders, to improve care for agitation and/or aggression among PLWD in LTC. The second objective was to identify barriers and facilitators to agitation and/or aggression care across the spectrum of care. Methods: Objective 1 used a modified Delphi panel to develop the clinical care pathway. Objective 2 used semi-structured interviews with key stakeholders to identify the barriers and facilitators to care. Framework Analysis was used to map identified barriers and facilitators to key behavioral domains of the Theoretical Domains Framework. Results: Crucial pathway features included using an interdisciplinary care team approach across the spectrum of care and featuring a broad range of non-pharmacological interventions. Several statements in our pathway did not reach agreement and require a third round of the Delphi. Perceived barriers for agitation and/or aggression care included a lack of validated tools to detect agitation and/or aggression, inconsistent training practices, and a limited number of available non-pharmacological interventions. Key facilitators were using an interdisciplinary care team and having trained healthcare providers to administer non-pharmacological interventions. Conclusions: Our study advances the state of evidence for agitation and/or aggression care among PLWD in LTC. Our efforts will inform future implementation research strategies working to improve the delivery and management of care. With more effective care approaches, the quality of life of PLWD in LTC will also improve.
Open Access
Enhancing the uptake of systematic reviews of effects: what is the best format for health care managers and policy-makers? A mixed-methods study
(2018-06-22) Marquez, Christine; Johnson, Alekhya M; Jassemi, Sabrina; Park, Jamie; Moore, Julia E; Blaine, Caroline; Bourdon, Gertrude; Chignell, Mark; Ellen, Moriah E; Fortin, Jacques; Graham, Ian D; Hayes, Anne; Hamid, Jemila; Hemmelgarn, Brenda; Hillmer, Michael; Holmes, Bev; Holroyd-Leduc, Jayna; Hubert, Linda; Hutton, Brian; Kastner, Monika; Lavis, John N; Michell, Karen; Moher, David; Ouimet, Mathieu; Perrier, Laure; Proctor, Andrea; Noseworthy, Thomas; Schuckel, Victoria; Stayberg, Sharlene; Tonelli, Marcello; Tricco, Andrea C; Straus, Sharon E
Abstract Background Systematic reviews are infrequently used by health care managers (HCMs) and policy-makers (PMs) in decision-making. HCMs and PMs co-developed and tested novel systematic review of effects formats to increase their use. Methods A three-phased approach was used to evaluate the determinants to uptake of systematic reviews of effects and the usability of an innovative and a traditional systematic review of effects format. In phase 1, survey and interviews were conducted with HCMs and PMs in four Canadian provinces to determine perceptions of a traditional systematic review format. In phase 2, systematic review format prototypes were created by HCMs and PMs via Conceptboard©. In phase 3, prototypes underwent usability testing by HCMs and PMs. Results Two hundred two participants (80 HCMs, 122 PMs) completed the phase 1 survey. Respondents reported that inadequate format (Mdn = 4; IQR = 4; range = 1–7) and content (Mdn = 4; IQR = 3; range = 1–7) influenced their use of systematic reviews. Most respondents (76%; n = 136/180) reported they would be more likely to use systematic reviews if the format was modified. Findings from 11 interviews (5 HCMs, 6 PMs) revealed that participants preferred systematic reviews of effects that were easy to access and read and provided more information on intervention effectiveness and less information on review methodology. The mean System Usability Scale (SUS) score was 55.7 (standard deviation [SD] 17.2) for the traditional format; a SUS score < 68 is below average usability. In phase 2, 14 HCMs and 20 PMs co-created prototypes, one for HCMs and one for PMs. HCMs preferred a traditional information order (i.e., methods, study flow diagram, forest plots) whereas PMs preferred an alternative order (i.e., background and key messages on one page; methods and limitations on another). In phase 3, the prototypes underwent usability testing with 5 HCMs and 7 PMs, 11 out of 12 participants co-created the prototypes (mean SUS score 86 [SD 9.3]). Conclusions HCMs and PMs co-created prototypes for systematic review of effects formats based on their needs. The prototypes will be compared to a traditional format in a randomized trial.
Open Access
Evaluating the Association between Estradiol and Quality of Life and Cardiovascular Risk and Mortality in Healthy Women and Women with Chronic Kidney Disease
(2016) Ramesh, Sharanya; Ahmed, Sofia; Wilton, Stephen; James, Matthew; Holroyd-Leduc, Jayna
Chronic kidney disease (CKD) is associated with a poor quality of life and high risk of cardiovascular (CV) mortality, specifically sudden cardiac death (SCD), and an upregulated renin angiotensin system. Women with end stage kidney disease (ESKD) experience premature menopause, and in healthy women menopause is correlated with a poor quality of life and higher CV mortality. A series of studies was conducted in healthy women and women with CKD to determine the associations between menopause status, serum estradiol and 1) cardiac autonomic tone (CAT), a surrogate marker for SCD, in a high Angiotensin II (AngII) state 2) mortality in women with ESKD and 3) quality of life(QoL) in women with CKD. We also summarized the impressions of healthcare workers and patients on the discussion of symptoms of low sex hormones in a clinical setting. In healthy men and women, sex hormones did not correlate with baseline CAT; however, men with lower testosterone levels were unable to maintain CAT in response to AngII. At baseline, postmenopausal women had a lower CAT in comparison to premenopausal women. In response to AngII postmenopausal women and premenopausal women in the luteal phase were unable to maintain their CAT. Through a survey of nephrologists we found that nephrologists recognize the impact of CKD on sex hormones in women but report infrequently discussing sex hormone related issues with patients. In a systematic review of studies examining the effect of postmenopausal hormone therapy on CV outcomes in women with ESKD, hormone therapy was associated with a favourable lipid profile. However, we found that peri- and premenopausal women with ESKD on hemodialysis had a higher risk of all-cause, cardiovascular and non-cardiovascular mortality compared to postmenopausal women. Furthermore menopause specific QoL scores did not correlate with kidney function in CKD women. We found that associations between menopause status and CV risk and QoL in the CKD population are complex. This body of work can be used for hypothesis generation for future studies and trials aimed to determine the mediators of cardiovascular risk and poor quality of life in this population.
Open Access
Fall prevention interventions for older community-dwelling adults: systematic reviews on benefits, harms, and patient values and preferences
(2021-01-09) Pillay, Jennifer; Riva, John J; Tessier, Laure A; Colquhoun, Heather; Lang, Eddy; Moore, Ainsley E; Thombs, Brett D; Wilson, Brenda J; Tzenov, Amanda; Donnelly, Catherine; Émond, Marcel; Holroyd-Leduc, Jayna; Milligan, Jamie; Keto-Lambert, Diana; Rahman, Sholeh; Vandermeer, Ben; Tricco, Andrea C; Straus, Sharon E; Thomas, Sonia M; Mitchelmore, Bradley R; Rolland-Harris, Elizabeth; Hartling, Lisa
Abstract Background An estimated 20–30% of community-dwelling Canadian adults aged 65 years or older experience one or more falls each year. Fall-related injuries are a leading cause of hospitalization and can lead to functional independence. Many fall prevention interventions, often based on modifiable risk factors, have been studied. Apart from the magnitude of the benefits and harms from different interventions, the preferences of older adults for different interventions as well as the relative importance they place on the different potential outcomes may influence recommendations by guideline panels. These reviews on benefits and harms of interventions, and on patient values and preferences, will inform the Canadian Task Force on Preventive Health Care to develop recommendations on fall prevention for primary care providers. Methods To review the benefits and harms of fall prevention interventions, we will update a previous systematic review of randomized controlled trials with adaptations to modify the classification of interventions and narrow the scope to community-dwelling older adults and primary-care relevant interventions. Four databases (MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Ageline), reference lists, trial registries, and relevant websites will be searched, using limits for randomized trials and date (2016 onwards). We will classify interventions according to the Prevention of Falls Network Europe (ProFANE) Group’s taxonomy. Outcomes include fallers, falls, injurious falls, fractures, hip fractures, institutionalization, health-related quality of life, functional status, and intervention-related adverse effects. For studies not included in the previous review, screening, study selection, data extraction on outcomes, and risk of bias assessments will be independently undertaken by two reviewers with consensus used for final decisions. Where quantitative analysis is suitable, network or pairwise meta-analysis will be conducted using a frequentist approach in Stata. Assessment of the transitivity and coherence of the network meta-analyses will be undertaken. For the reviews on patient preferences and outcome valuation (relative importance of outcomes), we will perform de novo reviews with searches in three databases (MEDLINE, PsycInfo, and CINAHL) and reference lists for cross-sectional, longitudinal quantitative, or qualitative studies published from 2000. Selection, data extraction, and risk of bias assessments suitable for each study design will be performed in duplicate. The analysis will be guided by a narrative synthesis approach, which may include meta-analysis for health-state utilities. We will use the CINeMa approach to a rate the certainty of the evidence for outcomes on intervention effects analyzed using network meta-analysis and the GRADE approach for all other outcomes. Discussion We will describe the flow of literature and characteristics of all studies and present results of all analyses and summary of finding tables. We will compare our findings to others and discuss the limitations of the reviews and the available literature. Systematic review registration This protocol has not been registered.
Open Access
Guidelines for Epilepsy Care – Gaps, Knowledge and Implementation
(2016) Sauro, Khara; Wiebe, Samuel; Jetté, Nathalie; Quan, Hude; Holroyd-Leduc, Jayna; DeCoster, Carolyn
Epilepsy is the second most common neurological condition and can be associated with significant morbidity, premature mortality, and high resource use. Epilepsy is a spectrum disorder due its diverse presentation, making it challenging to manage. As a result, treatment gaps exist. Clinical practice guidelines should facilitate the care of people with epilepsy. While evidence exists that guidelines are effective in improving the quality of care in some clinical settings, this has not been demonstrated for epilepsy. The objectives of this thesis are to: 1) Identify gaps in epilepsy guidelines, 2) Determine barriers and facilitators to implementation of epilepsy guidelines, and 3) Develop a knowledge translation (KT) strategy to optimize dissemination and implementation of epilepsy guidelines. Several methods were used to achieve the study objectives. A systematic review of epilepsy guidelines was conducted to identify gaps. A mixed-methods approach (quantitative survey and focus groups) was used to identify the determinants of guideline use among neurologists. Based on the results of the study examining determinants of guideline use, a theory-based KT strategy was proposed to facilitate future implementation of epilepsy guidelines in clinical practice. The systematic review identified 63 guidelines for the care of epilepsy covering 19 populations/conditions. Gaps in the availability of guidelines for high priority areas (i.e. elderly) and significant heterogeneity in quality were identified. Despite the number of guidelines available for the care of people with epilepsy, use of these guidelines clinically is poor. Reasons for the poor implementation of these guidelines among neurologists (end-users of epilepsy guidelines) were identified here, and include: lack of knowledge, poor credibility, applicability and motivation, insufficient resources, and lack of clarity regarding the target users. A three-pillared KT strategy to overcome the barriers of guideline use, and leverage facilitators is proposed to improve implementation in clinical practice. This body of work provides novel evidence into the current state of epilepsy guidelines, and the factors that determine their use clinically. This novel insight helps bridge a knowledge gap while the KT strategy outlined here provides the tools required to move towards improving implementation of guidelines for the care of people with epilepsy internationally.
Open Access
Implementation strategies for hospital-based probiotic administration in a stepped-wedge cluster randomized trial design for preventing hospital-acquired Clostridioides difficile infection
(2023-12-11) Bresee, Lauren C.; Lamont, Nicole; Ocampo, Wrechelle; Holroyd-Leduc, Jayna; Sabuda, Deana; Leal, Jenine; Dalton, Bruce; Kaufman, Jaime; Missaghi, Bayan; Kim, Joseph; Larios, Oscar E.; Henderson, Elizabeth; Raman, Maitreyi; Fletcher, Jared R.; Faris, Peter; Kraft, Scott; Shen, Ye; Louie, Thomas; Conly, John M.
Abstract Background Clostridioides difficile infection (CDI) is associated with considerable morbidity and mortality in hospitalized patients, especially among older adults. Probiotics have been evaluated to prevent hospital-acquired (HA) CDI in patients who are receiving systemic antibiotics, but the implementation of timely probiotic administration remains a challenge. We evaluated methods for effective probiotic implementation across a large health region as part of a study to assess the real-world effectiveness of a probiotic to prevent HA-CDI (Prevent CDI-55 +). Methods We used a stepped-wedge cluster-randomized controlled trial across four acute-care adult hospitals (n = 2,490 beds) to implement the use of the probiotic Bio-K + ® (Lactobacillus acidophilus CL1285®, L. casei LBC80R® and L. rhamnosus CLR2®; Laval, Quebec, Canada) in patients 55 years and older receiving systemic antimicrobials. The multifaceted probiotic implementation strategy included electronic clinical decision support, local site champions, and both health care provider and patient educational interventions. Focus groups were conducted during study implementation to identify ongoing barriers and facilitators to probiotic implementation, guiding needed adaptations of the implementation strategy. Focus groups were thematically analyzed using the Theoretical Domains Framework and the Consolidated Framework of Implementation Research. Results A total of 340 education sessions with over 1,800 key partners and participants occurred before and during implementation in each of the four hospitals. Site champions were identified for each included hospital, and both electronic clinical decision support and printed educational resources were available to health care providers and patients. A total of 15 individuals participated in 2 focus group and 7 interviews. Key barriers identified from the focus groups resulted in adaptation of the electronic clinical decision support and the addition of nursing education related to probiotic administration. As a result of modifying implementation strategies for identified behaviour change barriers, probiotic adherence rates were from 66.7 to 75.8% at 72 h of starting antibiotic therapy across the four participating acute care hospitals. Conclusions Use of a barrier-targeted multifaceted approach, including electronic clinical decision support, education, focus groups to guide the adaptation of the implementation plan, and local site champions, resulted in a high probiotic adherence rate in the Prevent CDI-55 + study.
Open Access
Improving care for residents in long term care facilities experiencing an acute change in health status
(2020-11-25) Munene, Abraham; Lang, Eddy; Ewa, Vivian; Hair, Heather; Cummings, Greta; McLane, Patrick; Spackman, Eldon; Faris, Peter; Zuzic, Nancy; Quail, Patrick B; George, Marian; Heinemeyer, Anne; Grigat, Daniel; McMillen, Mark; Reid, Shawna; Holroyd-Leduc, Jayna
Abstract Background Long term care (LTC) facilities provide health services and assist residents with daily care. At times residents may require transfer to emergency departments (ED), depending on the severity of their change in health status, their goals of care, and the ability of the facility to care for medically unstable residents. However, many transfers from LTC to ED are unnecessary, and expose residents to discontinuity in care and iatrogenic harms. This knowledge translation project aims to implement a standardized LTC-ED care and referral pathway for LTC facilities seeking transfer to ED, which optimizes the use of resources both within the LTC facility and surrounding community. Methods/design We will use a quasi-experimental randomized stepped-wedge design in the implementation and evaluation of the pathway within the Calgary zone of Alberta Health Services (AHS), Canada. Specifically, the intervention will be implemented in 38 LTC facilities. The intervention will involve a standardized LTC-ED care and referral pathway, along with targeted INTERACT® tools. The implementation strategies will be adapted to the local context of each facility and to address potential implementation barriers identified through a staff completed barriers assessment tool. The evaluation will use a mixed-methods approach. The primary outcome will be any change in the rate of transfers to ED from LTC facilities adjusted by resident-days. Secondary outcomes will include a post-implementation qualitative assessment of the pathway. Comparative cost-analysis will be undertaken from the perspective of publicly funded health care. Discussion This study will integrate current resources in the LTC-ED pathway in a manner that will better coordinate and optimize the care for LTC residents experiencing an acute change in health status.
Open Access
Improving KT tools and products: development and evaluation of a framework for creating optimized, Knowledge-activated Tools (KaT)
(2020-05-08) Kastner, Monika; Makarski, Julie; Hayden, Leigh; Lai, Yonda; Chan, Joyce; Treister, Victoria; Harris, Kegan; Munce, Sarah; Holroyd-Leduc, Jayna; Graham, Ian D; Straus, Sharon E
Abstract Background Positive impacts of quality improvement initiatives on health care and services have not been substantial. Knowledge translation (KT) strategies (tools, products and interventions) strive to facilitate the uptake of knowledge thereby the potential to improve care, but there is little guidance on how to develop them. Existing KT guidance or planning tools fall short in operationalizing all aspects of KT practice activities conducted by knowledge users (researchers, clinicians, patients, decision-makers), and most do not consider their variable needs or to deliver recommendations that are most relevant and useful for them. Methods We conducted a 3-phase study. In phase 1, we used several sources to develop a conceptual framework for creating optimized Knowledge-activated Tools (KaT) (consultation with our integrated KT team, the use of existing KT models and frameworks, findings of a systematic review of multimorbidity interventions and a literature review and document analysis on existing KT guidance tools). In phase 2, we invited KT experts to participate in a Delphi study to refine and evaluate the conceptual KaT framework. In phase 3, we administered an online survey to knowledge users (researchers, clinicians, decision-makers, trainees) to evaluate the potential usefulness of an online mock-up version of the KaT framework. Results We developed the conceptual KaT framework, and iteratively refined it with 35 KT experts in a 3-round Delphi study. The final framework represents the blueprint for what is needed to create KT strategies. Feedback from 201 researcher, clinician, decision-maker and trainee knowledge users on the potential need and usefulness of an online, interactive version of KaT indicated that they liked the idea of it (mean score 4.36 on a 5-point Likert scale) and its proposed features (mean score range 4.30–4.79). Conclusions Our findings suggest that mostly Canadian KT experts and knowledge users perceived the KaT framework and the future development of an online, interactive version to be important and needed. We anticipate that the KaT framework will provide clarity for knowledge users about how to identify their KT needs and what activities can address these needs, and to help streamline the process of these activities to facilitate efficient uptake of knowledge.
Open Access
Interventions that have potential to help older adults living with social frailty: a systematic scoping review
(2024-06-15) Kastner, Monika; Herrington, Isabella; Makarski, Julie; Amog, Krystle; Bain, Tejia; Evangelista, Vianca; Hayden, Leigh; Gruber, Alexa; Sutherland, Justin; Sirkin, Amy; Perrier, Laure; Graham, Ian D.; Greiver, Michelle; Honsberger, Joan; Hynes, Mary; Macfarlane, Charlie; Prasaud, Leela; Sklar, Barbara; Twohig, Margo; Liu, Barbara; Munce, Sarah; Marr, Sharon; O’Neill, Braden; Papaioannou, Alexandra; Seaton, Bianca; Straus, Sharon E.; Dainty, Katie; Holroyd-Leduc, Jayna
Abstract Background The impact of social frailty on older adults is profound including mortality risk, functional decline, falls, and disability. However, effective strategies that respond to the needs of socially frail older adults are lacking and few studies have unpacked how social determinants operate or how interventions can be adapted during periods requiring social distancing and isolation such as the COVID-19 pandemic. To address these gaps, we conducted a scoping review using JBI methodology to identify interventions that have the best potential to help socially frail older adults (age ≥65 years). Methods We searched MEDLINE, CINAHL (EPSCO), EMBASE and COVID-19 databases and the grey literature. Eligibility criteria were developed using the PICOS framework. Our results were summarized descriptively according to study, patient, intervention and outcome characteristics. Data synthesis involved charting and categorizing identified interventions using a social frailty framework. Results Of 263 included studies, we identified 495 interventions involving ~124,498 older adults who were mostly female. The largest proportion of older adults (40.5%) had a mean age range of 70-79 years. The 495 interventions were spread across four social frailty domains: social resource (40%), self-management (32%), social behavioural activity (28%), and general resource (0.4%). Of these, 189 interventions were effective for improving loneliness, social and health and wellbeing outcomes across psychological self-management, self-management education, leisure activity, physical activity, Information Communication Technology and socially assistive robot interventions. Sixty-three interventions were identified as feasible to be adapted during infectious disease outbreaks (e.g., COVID-19, flu) to help socially frail older adults. Conclusions Our scoping review identified promising interventions with the best potential to help older adults living with social frailty.
Open Access
Knowledge translation and health technology reassessment: identifying synergy
(2018-08-30) Esmail, Rosmin; Hanson, Heather; Holroyd-Leduc, Jayna; Niven, Daniel J; Clement, Fiona
Abstract Background Health Technology Reassessment (HTR) is an emerging field that shifts the focus from traditional methods of technology adoption to managing technology throughout its lifecycle. HTR is a mechanism to improve patient care and system efficiency through a reallocation of resources away from low-value care towards interventions and technologies that are high value. To achieve this, the outputs of HTR and its recommendations must be translated into practice. The evolving field of knowledge translation (KT) can provide guidance to improve the uptake of evidence-informed policies and recommendations resulting from the process of HTR. This paper argues how the theories, models and frameworks from KT could advance the HTR process. Discussion First, common KT theories, models and frameworks are presented. Second, facilitators and barriers to KT within the context of HTR are summarized from the literature. Facilitators and barriers to KT include ensuring a solid research evidence-base for the technology under reassessment, assessing the climate and context, understanding the social an political context, initiating linkage and exchange, having a structured HTR Process, adequate resources, and understanding the roles of researchers, knowledge users, and stakeholders can enhance knowledge translation of HTR outputs. Third, three case examples at the individual (micro), organizational (meso), and policy (macro) levels are used to illustrate to describe how a KT theory, model or framework could be applied to a HTR project. These case studies show how selecting and applying KT theories, models and frameworks can facilitate the implementation of HTR recommendations. Conclusion HTR and KT are synergistic processes that can be used to optimize technology use throughout its lifecycle. We argue that the application of KT theories, models and frameworks, and the assessment of barriers and facilitators to KT can facilitate translation of HTR recommendations into practice.