Browsing by Author "Lang, Eddy"
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Item Open Access A mapping review of interventions to address patients who frequently seek care in the emergency department(2024-03-27) Memedovich, Ally; Asante, Benedicta; Khan, Maha; Eze, Nkiruka; Holroyd, Brian R.; Lang, Eddy; Kashuba, Sherri; Clement, FionaAbstract Background The high utilization of acute care services, particularly emergency departments (ED), continues to be a significant concern for healthcare providers. Numerous approaches have been studied to meet the care needs of patients who frequently seek care in the ED; however, there is no comprehensive review of the current literature base. As such, a current understanding of the interventions initiated within the ED to address the needs of frequent users is required. This mapping review had three objectives: identify the characteristics associated with the need to frequently seek care in the ED; identify interventions implemented to address the needs of this population; and identify gaps in the current evidence base. Methods A knowledge map was created by scoping the literature to identify characteristics associated with frequent ED use and interventions implemented to address frequent use. Then, a literature search was conducted to determine what has been implemented by EDs to reduce frequent ED use. The literature was searched from 2013 to January 2023. MeSH terms and keywords were used to identify relevant studies. Studies implementing an intervention for those with characteristics associated with frequent ED use and reporting on ED use were included. Results Twenty-three (23) controlled trials and 35 observational studies were included. The most common populations were older adults, those with chronic conditions, and generic “frequent users”. No studies assessed Indigenous Peoples or racial minorities, and few assessed patients with a disability or patients experiencing homelessness. The most common interventions were referrals, care plans, case management, care coordination, and follow-up phone calls. Most studies reported ED revisits, hospitalization, costs, length-of-stay, or outpatient utilization. Few assessed patient or staff perspectives. About one-third of studies (n = 24) reported significant reductions in ED revisits. Conclusions Similar interventions, mainly focused on care coordination and planning, have been implemented to address frequent use of the ED. There are still significant gaps in the populations that have been studied. Efforts now must be undertaken to study more diverse populations whose care needs are not being met elsewhere and thus frequent the ED often.Item Open Access Addictions and Mental Health Patient Boarding in Emergency Departments: Protocol for a Scoping Review(2023-06-08) Ridout, Amelia; Antonio, Anjolaoluwa; Bolton, James; Chan, Eric; Chisholm, Cassandra; Chow, Kristian; Ganshorn, Heather; Grimminck, Rachel; Major, Daniel; Nordstrom, Kimberly; Pearlmutter, Mark; Lang, EddyObjective: The objective of this scoping review is to understand the extent, nature, and quality of evidence relating to the boarding of addictions and mental health (AMH) patients in emergency departments (EDs). Introduction: ‘Boarding’ refers to the time a patient spends in the ED before being transferred to an inpatient bed after an admission decision has been made (1-4). AMH patients are disproportionately likely to experience boarding (1,4,5). Patients can be boarded in the ED for many hours or days, often under suboptimal conditions that harm their health and wellbeing (6). Despite the ongoing issue of AMH patient boarding in EDs across Canada and globally, there is a lack of scoping or systematic reviews that synthesize the literature on this topic. Inclusion criteria: This scoping review will include peer-reviewed literature of all study designs and methodologies that meets the following inclusion criteria: (1) involve a participant population of pediatric and/or adult patients with substance use and/or mental health disorders, (2) focus on the concept of boarding or delayed transfer, and (3) occur within the context of a hospital ED. Methods: We will search the following electronic databases: MEDLINE, Embase, PsycINFO (on the Ovid platform), and CINAHL (on the Ebsco platform). Covidence software will be used to manage the results of the search, select studies that meet the inclusion criteria, remove duplicates, and extract data. Studies will be critically appraised using JBI critical appraisal checklists (7). Results will be reported in accordance with the PRISMA-ScR checklist (8).Item Open Access Analgesia in the emergency department: a GRADE-based evaluation of research evidence and recommendations for practice(BioMed Central, 2013-03-19) Lipp, Chris; Dhaliwal, Raj; Lang, EddyItem 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, EddyBackground: 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.Item Open Access Clinical Appraisal of Needle Thoracostomy in a Canadian Aeromedical System(2022-03) Newton, Graham; Laing, Catherine; Reay, Gudrun; King-Shier, Kathryn; Mageau, Alexis; Lang, EddyBackground: Needle thoracostomy (NT) remains the standard for prehospital treatment of tension pneumothorax, but its effectiveness has been questioned in previous literature. The incidence of NT and clinical characteristics of patients receiving NT for tension pneumothorax in a Canadian helicopter emergency medical service (HEMS) setting have yet to be described. This lack of data leads to difficulty understanding who is at greatest risk for requiring NT, identifying factors that may be important to successful clinical outcomes, and implementing changes to practice. Methods: A retrospective chart review was conducted of adult patients who received NT from a Canadian HEMS service and a case study was conducted to document the novel use of an endotracheal tube to perform an improvised tube thoracostomy in response to NT failure. Results: Only a small proportion (1.3%) of patients attended by the HEMS service received NT during their care. The study sample was predominantly male (77.0%), with an average age of 46.4 years, and a presenting complaint of blunt trauma. Logistic regression analysis revealed initial NT treatment was associated with a low likelihood of clinical improvement in patients presenting with blunt trauma (OR = 0.18; p = .021), receiving CPR prior to NT (OR = 0.14; p = .02), or in those who received bilateral NT treatment (OR = 0.13; p < .01). A pre-treatment BP < 90 mmHg was the sole variable which was predictive of a positive clinical response to initial NT (OR = 3.33; p = .04). The case study provided a descriptive account of the successful use of a simple thoracostomy in combination with endotracheal tube insertion into the thorax to relieve tension pneumothorax following the failure of standard NT treatment in the HEMS setting. Conclusions: Of the patients studied, those most likely to receive NT were males who had suffered blunt trauma. NT may have questionable benefit for patients presenting with blunt trauma, cardiac arrest, or requiring bilateral NT. NT may be insufficient to adequately treat tension pneumothorax, and simple thoracostomy with thoracic endotracheal tube insertion has been successfully used to treat tension pneumothorax refractory to standard prehospital treatment.Item Open Access Development of an In‐Hospital Standardized Mortality Ratio for Emergency Department Sensitive Conditions(2014-05-02) Berthelot, Simon; Stelfox, H. Tomas; Lang, Eddy; Quan, HudeHealthcare systems in developed countries are grappling with emergency department (ED) overcrowding. Although a prominent issue yielding many related metrics, accessibility is only one dimension by which to measure ED performance. To gain a broader understanding of healthcare performance and to adequately measure it in the ED setting, a more comprehensive approach is required. If valuable process and timeline indicators have to be closely linked with patients’ outcomes, the outcomes themselves must also be measured. In direct response to this challenge, this thesis project aimed to develop and validate an in-hospital standardized mortality ratio specific to emergency sensitive conditions as one tool for measuring ED care performance.Item Open Access Effectiveness of stop smoking interventions among adults: protocol for an overview of systematic reviews and an updated systematic review(2019-01-19) Hersi, Mona; Traversy, Gregory; Thombs, Brett D; Beck, Andrew; Skidmore, Becky; Groulx, Stéphane; Lang, Eddy; Reynolds, Donna L; Wilson, Brenda; Bernstein, Steven L; Selby, Peter; Johnson-Obaseki, Stephanie; Manuel, Douglas; Pakhale, Smita; Presseau, Justin; Courage, Susan; Hutton, Brian; Shea, Beverley J; Welch, Vivian; Morrow, Matt; Little, Julian; Stevens, AdrienneAbstract Background Tobacco smoking is the leading cause of cancer, preventable death, and disability. Smoking cessation can increase life expectancy by nearly a decade if achieved in the third or fourth decades of life. Various stop smoking interventions are available including pharmacotherapies, electronic cigarettes, behavioural support, and alternative therapies. This protocol outlines an evidence review which will evaluate the benefits and harms of stop smoking interventions in adults. Methods The evidence review will consist of two stages. First, an overview of systematic reviews evaluating the benefits and harms of various stop smoking interventions delivered in or referred from the primary care setting will be conducted. The second stage will involve updating a systematic review on electronic cigarettes identified in the overview; randomized controlled trials will be considered for outcomes relating to benefits while randomized controlled trials, non-randomized controlled trials, and comparative observational studies will be considered for evaluating harms. Search strategies will be developed and peer-reviewed by medical information specialists. The search strategy for the updated review on e-cigarettes will be developed using that of the candidate systematic review. The MEDLINE®, PsycINFO, Embase, and the Cochrane Library electronic databases will be searched as of 2008 for the overview of reviews and from the last search date of the selected review for the updated review. Organizational websites and trial registries will be searched for unpublished or ongoing reviews/studies. Two reviewers will independently screen the title and abstracts of citations using the liberal accelerated method. Full-text screening will be performed independently by two reviewers. Extracted data will be verified by a second reviewer. Disagreements regarding full-text screening and data extraction will be resolved by consensus or third-party adjudication. The methodological quality of systematic reviews, risk of bias of randomized and non-randomized trials, and methodological quality of cohort studies will be evaluated using AMSTAR 2, the Cochrane risk of bias tool, and a modified version of the Scottish Intercollegiate Guidelines Network critical appraisal tool, respectively. The GRADE framework will be used to assess the quality of the evidence for outcomes. Discussion The evidence review will evaluate the benefits and harms of various stop smoking interventions for adults. Findings will be used to inform a national tobacco cessation guideline by the Canadian Task Force on Preventive Health Care. Systematic review registration PROSPERO (CRD42018099691, CRD42018099692)Item Open Access Efficacy of calcitonin for treating acute pain associated with osteoporotic vertebral compression fracture: An Updated Systematic Review(2018-01) Boucher, Emily; Rosgen, Brianna; Knopp-Sihota, Jennifer; Lang, EddyItem Open Access Evaluating effectiveness of small group literacy instruction for Undergraduate Medical Education students using a pre-post survey study design(Wiley, 2015-06) McClurg, Caitlin; Powelson, Susan; Lang, Eddy; Aghajafari, Fariba; Edworthy, SteveThe purpose of our study was to determine if librarian-led small group information literacy instruction, closely integrated with course content and faculty participation, but without a hands on component, was an effective means to convey evidence based information literacy skills including clinical question formation, resource selection and online searching confidence. Five 15 minute evidence based information literacy sessions were delivered by three librarians to 12 practicing physician-led small groups of 15 students. Students were asked to complete an online survey before and after the lecture and seminar series. Data analysis was through simple descriptive statistics, reporting proportions for question responses. Instruction in a small group environment without a mandatory hands on component had a positive impact on student’s evidence based information literacy skills. Students were more likely to consult a librarian, and had increased confidence in their abilities to search and find relevant information.Item Open Access An Evaluation of Satisfaction with Emergency Department Care in Children and Adolescents with Mental Health Concerns(2022-05-06) Lategan, Conné; Freedman, Stephen; Newton, Amanda S; Arnold, Paul; Lang, EddyThe emergency department (ED) is a vital safety net for children and adolescents with mental health concerns seeking crisis care. Yet, EDs face significant challenges in managing mental health concerns. Evaluating patient and parent/caregiver satisfaction with care delivery is essential to guide improvements in the quality of mental health services provided. This study involved enrolling participants over a 12-month period to evaluate child/adolescent and parent/caregiver satisfaction with mental health care in two pediatric EDs. Patients <18 years of age presenting with a range of mental health concerns (e.g., anxiety, disruptive behaviours, self- harm, depression, situational crisis) were eligible and enrolled. Discharge diagnoses were grouped by ICD-10-CA codes. Data were collected using the Service Satisfaction Scale. I conducted Pearson’s correlation coefficient tests to report associations of general satisfaction with individual aspects of ED care, multivariable regression analysis to report associations of total satisfaction score with patient and clinical care characteristics, and inductive thematic analysis to identify and describe satisfaction and patient experience themes from qualitative feedback. The study included 646 participants, the majority of whom were Caucasian (71.2%; 460/646), female (56.3%; 364/646). The median age of patients was 13 years (IQR, 11-15 years). The most common diagnoses among participants were anxiety or stress-related disorders (39.5%; 245/620), suicidal ideation (26.0%; 161/620), and mood disorders (25.0%; 155/620). The perception of the amount of help a child received during the visit was most strongly associated with general satisfaction (r=0.85). Clinical care characteristics associated with satisfaction were receipt of an evaluation by a mental health team member (p=0.004) and consultation by a psychiatrist (p=0.05) during the ED visit. Themes that emerged from the thematic analysis included satisfaction with the ED health care team’s attitude and interpersonal skills and dissatisfaction with standards of care expectations, wait time for care, and general access to mental health care. Overall, the results point to the need to improve the satisfaction with ED mental health care delivery with a particular focus on enhancing access to care to mental health providers with expertise (e.g., mental health nurses, counsellors, psychiatrists).Item 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, LisaAbstract 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.Item Open Access Health care stakeholder perspectives regarding the role of a patient navigator during transition to adult care(2019-06-17) Dimitropoulos, Gina; Morgan-Maver, Elizabeth; Allemang, Brooke; Schraeder, Kyleigh; Scott, Shannon D; Pinzon, Jorge; Andrew, Gail; Guilcher, Gregory; Hamiwka, Lorraine; Lang, Eddy; McBrien, Kerry; Nettel-Aguirre, Alberto; Pacaud, Daniele; Zwaigenbaum, Lonnie; Mackie, Andrew; Samuel, SusanAbstract Background Transition to adult care represents a vulnerable period for young people with special health care needs as they navigate multiple life transitions and developmental issues. Patient navigators are a promising intervention designed to facilitate the transfer from pediatric to adult care. However, consistent definitions, key tasks, roles and responsibilities are lacking in guiding the scope of practice and the implementation of patient navigators. Methods Fundamental qualitative description was utilized in this study to identify perceptions from health care providers about implementing a patient navigator service for young people with special health care needs in transition to adult care. A purposive sample of health care providers with a variety of backgrounds within pediatric and adult systems in Alberta, Canada were recruited. Semi-structured interviews with participants were analyzed using thematic analysis to inductively identify perceptions regarding the role of patient navigators. Results A total of 43 health care providers highlighted the need for a patient navigator service to encompass 4 key stages for young people with special health care needs transitioning from pediatric to adult services: (1) identification of young people with special health care needs and families requiring support, (2) preparation for transfer, (3) health system navigation and, (4) post-transfer support. Conclusions The results of this qualitative study provide guidance for the development of patient navigator interventions for young people with special health care needs, as well as provide support for current transition services offered across Canada.Item 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, JaynaAbstract 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.Item Open Access Key issues for stakeholder engagement in the development of health and healthcare guidelines(2023-04-28) Petkovic, Jennifer; Magwood, Olivia; Lytvyn, Lyubov; Khabsa, Joanne; Concannon, Thomas W.; Welch, Vivian; Todhunter-Brown, Alex; Palm, Marisha E.; Akl, Elie A.; Mbuagbaw, Lawrence; Arayssi, Thurayya; Avey, Marc T.; Marusic, Ana; Morley, Richard; Saginur, Michael; Slingers, Nevilene; Texeira, Ligia; Ben Brahem, Asma; Bhaumik, Soumyadeep; Bou Akl, Imad; Crowe, Sally; Dormer, Laura; Ekanem, Comfort; Lang, Eddy; Kianzad, Behrang; Kuchenmüller, Tanja; Moja, Lorenzo; Pottie, Kevin; Schünemann, Holger; Tugwell, PeterAbstract Established in 2015, the Multi-Stakeholder Engagement (MuSE) Consortium is an international network of over 120 individuals interested in stakeholder engagement in research and guidelines. The MuSE group is developing guidance for stakeholder engagement in the development of health and healthcare guideline development. The development of this guidance has included multiple meetings with stakeholders, including patients, payers/purchasers of health services, peer review editors, policymakers, program managers, providers, principal investigators, product makers, the public, and purchasers of health services and has identified a number of key issues. These include: (1) Definitions, roles, and settings (2) Stakeholder identification and selection (3) Levels of engagement, (4) Evaluation of engagement, (5) Documentation and transparency, and (6) Conflict of interest management. In this paper, we discuss these issues and our plan to develop guidance to facilitate stakeholder engagement in all stages of the development of health and healthcare guideline development.Item Open Access Limitations of pulmonary embolism ICD-10 codes in emergency department administrative data: let the buyer beware(2017-06-08) Burles, Kristin; Innes, Grant; Senior, Kevin; Lang, Eddy; McRae, AndrewAbstract Background Administrative data is a useful tool for research and quality improvement; however, validity of research findings based on these data depends on their reliability. Diagnoses assigned by physicians are subsequently converted by nosologists to ICD-10 codes (International Statistical Classification of Diseases and Related Health Problems, 10th Revision). Several groups have reported ICD-9 coding errors in inpatient data that have implications for research, quality improvement, and policymaking, but few have assessed ICD-10 code validity in ambulatory care databases. Our objective was to evaluate pulmonary embolism (PE) ICD-10 code accuracy in our large, integrated hospital system, and the validity of using these codes for operational and health services research using ED ambulatory care databases. Methods Ambulatory care data for patients (age ≥ 18 years) with a PE ICD-10 code (I26.0 and I26.9) were obtained from the records of four urban EDs between July 2013 to January 2015. PE diagnoses were confirmed by reviewing medical records and imaging reports. In cases where chart diagnosis and ICD-10 code were discrepant, chart review was considered correct. Physicians’ written discharge diagnoses were also searched using ‘pulmonary embolism’ and ‘PE’, and patients who were diagnosed with PE but not coded as PE were identified. Coding discrepancies were quantified and described. Results One thousand, four hundred and fifty-three ED patients had a PE ICD-10 code. Of these, 257 (17.7%) were false positive, with an incorrectly assigned PE code. Among the 257 false positives, 193 cases had ambiguous ED diagnoses such as ‘rule out PE’ or ‘query PE’, while 64 cases should have had non-PE codes. An additional 117 patients (8.90%) with a PE discharge diagnosis were incorrectly assigned a non-PE ICD-10 code (false negative group). The sensitivity of PE ICD-10 codes in this dataset was 91.1% (95%CI, 89.4–92.6) with a specificity of 99.9% (95%CI, 99.9–99.9). The positive and negative predictive values were 82.3% (95%CI, 80.3–84.2) and 99.9% (95%CI, 99.9–99.9), respectively. Conclusions Ambulatory care data, like inpatient data, are subject to coding errors. This confirms the importance of ICD-10 code validation prior to use. The largest proportion of coding errors arises from ambiguous physician documentation; therefore, physicians and data custodians must ensure that quality improvement processes are in place to promote ICD-10 coding accuracy.Item Open Access Opioid use disorder treatment disruptions during the early COVID-19 pandemic and other emergent disasters: a scoping review addressing dual public health emergencies(2021-07-28) Henderson, Rita; McInnes, Ashley; Mackey, Leslee; Bruised Head, Myles; Crowshoe, Lindsay; Hann, Jessica; Hayward, Jake; Holroyd, Brian R.; Lang, Eddy; Larson, Bonnie; Leonard, Ashley J.; Persaud, Steven; Raghavji, Khalil; Sarin, Chris; Virani, Hakique; Wadsworth, Iskotoahka W.; Whitman, Stacey; McLane, PatrickAbstract Background During public health emergencies, people with opioid use disorder (PWOUD) may be particularly impacted. Emergent disasters such as the COVID-19 pandemic disrupt already-strained harm reduction efforts and treatment availability. This study aims to answer three research questions. How do public health emergencies impact PWOUD? How can health systems respond to novel public health emergencies to serve PWOUD? How can the results of this scoping review be contextualized to the province of Alberta to inform local stakeholder responses to the pandemic? Methods We conducted a scoping review using the 6-stage Arksey and O’Malley framework to analyse early-pandemic and pre-pandemic disaster literature. The results of the scoping review were contextualized to the local pandemic response, through a Nominal Group Technique (NGT) process with frontline providers and stakeholders in Alberta, Canada. Results Sixty one scientific journal articles and 72 grey literature resources were included after full-text screening. Forty sources pertained to early COVID-19 responses, and 21 focused on OUD treatment during other disasters. PWOUD may be more impacted than the general population by common COVID-19 stressors including loss of income, isolation, lack of rewarding activities, housing instability, as well as fear and anxiety. They may also face unique challenges including threats to drug supplies, stigma, difficulty accessing clean substance use supplies, and closure of substance use treatment centres. All of these impacts put PWOUD at risk of negative outcomes including fatal overdose. Two NGT groups were held. One group (n = 7) represented voices from urban services, and the other (n = 4) Indigenous contexts. Stakeholders suggested that simultaneous attention to multiple crises, with adequate resources to allow attention to both social and health systems issues, can prepare a system to serve PWOUD during disasters. Conclusion This scoping review and NGT study uncovers how disasters impact PWOUD and offers suggestions for better serving PWOUD.Item Open Access Painful Memories: Reliability of Pain Intensity Recall at 3 Months in Senior Patients(2017-02-02) Daoust, Raoul; Sirois, Marie-Josée; Lee, Jacques S.; Perry, Jeffrey J.; Griffith, Lauren E.; Worster, Andrew; Lang, Eddy; Paquet, Jean; Chauny, Jean-Marc; Émond, MarcelBackground. Validity of pain recall is questioned in research. Objective. To evaluate the reliability of pain intensity recall for seniors in an emergency department (ED). Methods. This study was part of a prospective multicenter project for seniors (≥65 years old) treated in an ED for minor traumatic injury. Pain intensity (0–10 numerical rating scale) was evaluated at the initial ED visit, at one week (baseline), and 3 months. At three months, patients were asked to recall the pain intensity they had at baseline. Results. 482 patients were interviewed (mean age 76.6 years, SD ± 7.3) and 72.8% were female. Intraclass correlation coefficient between pain at baseline and its recall was 0.24 (95% CI: 0.14–0.33). Senior patients tended to overestimate their pain intensity by a mean of 1.2 (95% CI: 0.9–1.5) units. A stepwise multiple regression analysis showed that the variance of baseline pain recall at 3 months was explained by pain at ED visit (11%), pain at 3 months (7%), and pain at baseline (2%). Conclusion. The accuracy of pain intensity recall after three months is poor in seniors and seems to be influenced by the pain experienced at the time of injury.Item Open Access Screening for depression in children and adolescents: a protocol for a systematic review update(2021-01-12) Beck, Andrew; LeBlanc, John C; Morissette, Kate; Hamel, Candyce; Skidmore, Becky; Colquhoun, Heather; Lang, Eddy; Moore, Ainsley; Riva, John J; Thombs, Brett D; Patten, Scott; Bragg, Heather; Colman, Ian; Goldfield, Gary S; Nicholls, Stuart G; Pajer, Kathleen; Potter, Beth K; Meeder, Robert; Vasa, Priya; Hutton, Brian; Shea, Beverley J; Graham, Eva; Little, Julian; Moher, David; Stevens, AdrienneAbstract Background Major depressive disorder is common, debilitating, and affects feelings, thoughts, mood, and behaviors. Childhood and adolescence are critical periods for the development of depression and adolescence is marked by an increased incidence of mental health disorders. This protocol outlines the planned scope and methods for a systematic review update that will evaluate the benefits and harms of screening for depression in children and adolescents. Methods This review will update a previously published systematic review by Roseman and colleagues. Eligible studies are randomized controlled trials (RCTs) assessing formal screening in primary care to identify children or adolescents not already self-reporting symptoms of, diagnosed with, or treated for depression. If no or only a single RCT is available, we will consider controlled studies without random assignment. Studies of participants with characteristics associated with an elevated risk of depression will be analyzed separately. Outcomes of interest are symptoms of depression, classification of major depressive disorder based on a validated diagnostic interview, suicidality, health-related quality of life, social function, impact on lifestyle behavior (e.g., substance use, school performance, lost time at work, or school), false-positive results, overdiagnosis, overtreatment, labeling, and other harms such as those arising from treatment. We will search MEDLINE, Embase, PsycINFO, CINAHL, the Cochrane Library, and grey literature sources. Two reviewers will independently screen the titles and abstracts using the liberal accelerated method. Full-text screening will be performed independently by two reviewers using pre-specified eligibility criteria. Data extraction and risk of bias assessments will be performed independently by two reviewers. Pre-planned analyses, including subgroup and sensitivity analyses, are detailed within this protocol. Two independent reviewers will assess and finalize through consensus the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, and prepare GRADE evidence profiles and summary of findings tables for each outcome of interest. Discussion The systematic review will provide a current state of the evidence of benefits and harms of depression screening in children and adolescents. These findings will be used by the Canadian Task Force on Preventive Health Care to inform the development of recommendations on depression screening. Systematic review registration PROSPERO CRD42020150373Item Open Access Screening for depression in women during pregnancy or the first year postpartum and in the general adult population: a protocol for two systematic reviews to update a guideline of the Canadian Task Force on Preventive Health Care(2019-01-19) Hamel, Candyce; Lang, Eddy; Morissette, Kate; Beck, Andrew; Stevens, Adrienne; Skidmore, Becky; Colquhoun, Heather; LeBlanc, John; Moore, Ainsley; Riva, John J; Thombs, Brett D; Colman, Ian; Grigoriadis, Sophie; Nicholls, Stuart G; Potter, Beth K; Ritchie, Kerri; Robert, Julie; Vasa, Priya; Lauria-Horner, Bianca; Patten, Scott; Vigod, Simone N; Hutton, Brian; Shea, Beverley J; Shanmugasegaram, Shamila; Little, Julian; Moher, DavidAbstract Background In 2018, the World Health Organization reported that depression is the most common cause of disability worldwide, with over 300 million people currently living with depression. Depression affects an individual’s physical health and well-being, impacts psychosocial functioning, and has specific negative short- and long-term effects on maternal health, child health, developmental trajectories, and family health. The aim of these reviews is to identify evidence on the benefits and harms of screening for depression in the general adult population and in pregnant and postpartum women. Methods Search strategies were developed and tested through an iterative process by an experienced medical information specialist in consultation with the review team. We will search MEDLINE, Embase, PsycINFO, CINAHL, and the Cochrane Library, and a randomized controlled trial filter will be used. The general adult review will be an update of a systematic review previously used by the Canadian Task Force on Preventive Health Care for their 2013 guideline recommendation. The search strategy will be updated and will start from the last search date of the previous review (May 2012). The pregnant and postpartum review will be a de novo review with no date restriction. For both reviews, we will search for unpublished documents following the CADTH Grey Matters checklist and relevant websites. Titles and abstracts will be screened using the liberal accelerated method. Two reviewers will independently screen full-text articles for relevance using pre-specified eligibility criteria and assess the risk of bias of included studies using the Cochrane Risk of Bias tool. Outcomes of interest for the general adult population review include symptoms of depression or diagnosis of major depressive disorder, health-related quality of life, day-to-day functionality, lost time at work/school, impact on lifestyle behaviour, suicidality, false-positive result, labelling/stigma, overdiagnosis or overtreatment, and harms of treatment. Outcomes of interest for the pregnant and postpartum review include mental health outcomes (e.g. diagnosis of major depressive disorder), parenting outcomes (e.g. mother-child interactions), and infant outcomes (e.g. infant health and development). Discussion These two systematic reviews will offer informative evaluations of depression screening. The findings will be used by the Task Force to help develop guideline recommendations on depression screening in the general adult population and in pregnant and postpartum women in Canada. Systematic review registration PROSPERO (CRD42018099690)Item Open Access Strategies for improving ED-related outcomes of older adults who seek care in emergency departments: a systematic review(2024-02-01) Memedovich, Ally; Asante, Benedicta; Khan, Maha; Eze, Nkiruka; Holroyd, Brian R.; Lang, Eddy; Kashuba, Sherri; Clement, FionaAbstract Background Despite constituting 14% of the general population, older adults make up almost a quarter of all emergency department (ED) visits. These visits often do not adequately address patient needs, with nearly 80% of older patients discharged from the ED carrying at least one unattended health concern. Many interventions have been implemented and tested in the ED to care for older adults, which have not been recently synthesized. Methods A systematic review was conducted to identify interventions initiated in the ED to address the needs of older adults. Embase, MEDLINE, CINAHL, Cochrane CENTRAL, the Cochrane Database of Systematic Reviews, and grey literature were searched from January 2013 to January 18, 2023. Comparative studies assessing interventions for older adults in the ED were included. The quality of controlled trials was assessed with the Cochrane risk-of-bias tool for randomized trials, and the quality of observational studies was assessed with the risk of bias in non-randomized studies of interventions tool. Due to heterogeneity, meta-analysis was not possible. Results Sixteen studies were included, assessing 12 different types of interventions. Overall study quality was low to moderate: 10 studies had a high risk of bias, 5 had a moderate risk of bias, and only 1 had a low risk of bias. Follow-up telephone calls, referrals, geriatric assessment, pharmacist-led interventions, physical therapy services, care plans, education, case management, home visits, care transition interventions, a geriatric ED, and care coordination were assessed, many of which were combined to create multi-faceted interventions. Care coordination with additional support and early assessment and intervention were the only two interventions that consistently reported improved outcomes. Most studies did not report significant improvements in ED revisits, hospitalization, time spent in the ED, costs, or outpatient utilization. Two studies reported on patient perspectives. Conclusion Few interventions demonstrate promise in reducing ED revisits for older adults, and this review identified significant gaps in understanding other outcomes, patient perspectives, and the effectiveness in addressing underlying health needs. This could suggest, therefore, that most revisits in this population are unavoidable manifestations of frailty and disease trajectory. Efforts to improve older patients’ needs should focus on interventions initiated outside the ED.