Browsing by Author "McNeil, Deborah"
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Item Open Access A protocol for the formative evaluation of the implementation of patient-reported outcome measures in child and adolescent mental health services as part of a learning health system(2024-07-15) McCabe, Erin; Dyson, Michele; McNeil, Deborah; Hindmarch, Whitney; Ortega, Iliana; Arnold, Paul D.; Dimitropoulos, Gina; Clements, Ryan; Santana, Maria J.; Zwicker, Jennifer D.Abstract Background Mental health conditions affect one in seven young people and research suggests that current mental health services are not meeting the needs of most children and youth. Learning health systems are an approach to enhancing services through rapid, routinized cycles of continuous learning and improvement. Patient-reported outcome measures provide a key data source for learning health systems. They have also been shown to improve outcomes for patients when integrated into routine clinical care. However, implementing these measures into health systems is a challenging process. This paper describes a protocol for a formative evaluation of the implementation of patient-reported measures in a newly operational child and adolescent mental health centre in Calgary, Canada. The purpose is to optimize the collection and use of patient-reported outcome measures. Our specific objectives are to assess the implementation progress, identify barriers and facilitators to implementation, and explore patient, caregivers and clinician experiences of using these measures in routine clinical care. Methods This study is a mixed-methods, formative evaluation using the Consolidated Framework for Implementation Research. Participants include patients and caregivers who have used the centre’s services, as well as leadership, clinical and support staff at the centre. Focus groups and semi-structured interviews will be conducted to assess barriers and facilitators to the implementation and sustainability of the use of patient-reported outcome measures, as well as individuals’ experiences with using these measures within clinical care. The data generated by the patient-reported measures over the first five months of the centre’s operation will be analyzed to understand implementation progress, as well as validity of the chosen measures for the centres’ population. Discussion The findings of this evaluation will help to identify and address the factors that are affecting the successful implementation of patient-reported measures at the centre. They will inform the co-design of strategies to improve implementation with key stakeholders, which include patients, clinical staff, and leadership at the centre. To our knowledge, this is the first study of the implementation of patient-reported outcome measures in child and adolescent mental health services and our findings can be used to enhance future implementation efforts in similar settings.Item Open Access Alberta Family Integrated Care (FICare) and Breastfeeding for Moderate to Late Preterm Infants: Cluster Randomized Controlled Trial 2 Month Follow-up(2023-01-02) Moe, Amanda; Benzies, Karen; McNeil, Deborah; Brockway, MeredithIntroduction: Human milk, specifically mothers’ own milk, is the optimal nutrition for infants and has significant protective effects, which are even greater for infants born prematurely. Compared to full-term infants, fewer preterm infants achieve exclusive breastfeeding to age 6 months. Aim: The purpose of this study was to examine the risks and protective factors associated with breastfeeding at age 2 months in moderate and late preterm infants who received Alberta Family Integrated Care (FICare) versus Standard Care while in the Neonatal Intensive Care Unit (NICU). Alberta FICare is a novel care model that empowers parents to build their knowledge, skill, and confidence in caring for their preterm infant. Methods: A longitudinal follow-up to the Alberta FICare cluster randomized controlled trial was conducted. Alberta FICare data for 455 infants (n = 204 Alberta FICare; n = 251 Standard Care) and their mothers were linked to feeding type data (exclusive human milk, non-exclusive human milk, or no human milk) collected at the infant’s 2-month public health immunization visit. Multinomial logistic regression was used to examine the factors associated with proportions of breastfeeding at age 2 months. Results: After controlling for covariates, there was a significant group difference favoring Standard Care versus Alberta FICare for non-exclusive breastfeeding compared to no breastfeeding at age 2 months. There were no significant group differences in model sub-analyses comparing exclusive breastfeeding versus non-exclusive breastfeeding and exclusive breastfeeding versus no breastfeeding. Mothers with singletons, higher education, higher parental NICU stress, higher breastfeeding self-efficacy, and feeding exclusively human milk at discharge were more likely to provide exclusive breastfeeding at age 2 months. Conclusion: Infants in the Standard Care group were more likely to receive non-exclusive breastfeeding at age 2 months compared to no breastfeeding. Group (Alberta FICare versus Standard Care) was not significant when comparing exclusive breastfeeding outcomes. Of the factors associated with exclusive breastfeeding in preterm infants, breastfeeding self-efficacy is a potentially modifiable one that could be targeted for interventions. Further research is required to examine the association between higher parental NICU stress and exclusive breastfeeding.Item Open Access Development and evaluation of virtual simulation games to increase the confidence and self-efficacy of healthcare learners in vaccine communication, advocacy, and promotion(2024-02-25) Doucette, Emily J.; Fullerton, Madison M.; Pateman, Margaret; Lip, Alyssa; Houle, Sherilyn K.; Kellner, James D.; Leal, Jenine; MacDonald, Shannon E.; McNeil, Deborah; Tyerman, Jane; Luctkar-Flude, Marian; Davidson, Sandra; Constantinescu, CoraAbstract Background Although healthcare providers (HCPs) are the most trusted source of vaccine information, there is a paucity of easily accessible, multidisciplinary educational tools on vaccine communication for them. Virtual simulation games (VSGs) are innovative yet accessible and effective tools in healthcare education. The objectives of our study were to develop VSGs to increase HCP confidence and self-efficacy in vaccine communication, advocacy, and promotion, and evaluate the VSGs’ effectiveness using a pre-post self-assessment pilot study. Methods A multidisciplinary team of experts in medicine, nursing, pharmacy, and simulation development created three VSGs for HCP learners focused on addressing conversations with vaccine hesitant individuals. We evaluated the VSGs with 24 nursing students, 30 pharmacy students, and 18 medical residents who completed surveys and 6-point Likert scale pre-post self-assessments to measure changes in their confidence and self-efficacy. Results There were no significant differences in baseline confidence and self-efficacy across the three HCP disciplines, despite varied levels of education. Post-VSG confidence and self-efficacy (median: 5) were significantly higher than pre-VSG (median: 4–5) for all three HCP disciplines (P ≤ 0.0005), highlighting the effectiveness of the VSGs. Medical residents reported significantly lower post-VSG confidence and self-efficacy than nursing and pharmacy learners despite completing the most significant amount of education. Conclusions Following the completion of the VSGs, learners in medicine, nursing, and pharmacy showed significant improvement in their self-assessed confidence and self-efficacy in holding vaccine conversations. The VSGs as an educational tool, in combination with existing clinical immunization training, can be used to increase HCP confidence and engagement in vaccine discussions with patients, which may ultimately lead to increased vaccine confidence among patients.Item Open Access Development and validation of the Cannabis Exposure in Pregnancy Tool (CEPT): a mixed methods study(2024-04-16) Chaput, Kathleen H.; McMorris, Carly A.; Metcalfe, Amy; Ringham, Catherine; McNeil, Deborah; Konschuh, Shaelen; Sycuro, Laura J.; McDonald, Sheila W.Abstract Background Evidence of associations between prenatal cannabis use (PCU) and maternal and infant health outcomes remains conflicting amid broad legalization of cannabis across Canada and 40 American states. A critical limitation of existing evidence lies in the non-standardized and crude measurement of prenatal cannabis use (PCU), resulting in high risk of misclassification bias. We developed a standardized tool to comprehensively measure prenatal cannabis use in pregnant populations for research purposes. Methods We conducted a mixed-methods, patient-oriented tool development and validation study, using a bias-minimizing process. Following an environmental scan and critical appraisal of existing prenatal substance use tools, we recruited pregnant participants via targeted social media advertising and obstetric clinics in Alberta, Canada. We conducted individual in-depth interviews and cognitive interviewing in separate sub-samples, to develop and refine our tool. We assessed convergent and discriminant validity internal consistency and 3-month test–retest reliability, and validated the tool externally against urine-THC bioassays. Results Two hundred fifty four pregnant women participated. The 9-item Cannabis Exposure in Pregnancy Tool (CEPT) had excellent discriminant (Cohen’s kappa = -0.27–0.15) and convergent (Cohen’s kappa = 0.72–1.0) validity; as well as high internal consistency (Chronbach’s alpha = 0.92), and very good test–retest reliability (weighted Kappa = 0.92, 95% C.I. [0.86–0.97]). The CEPT is valid against urine THC bioassay (sensitivity = 100%, specificity = 82%). Conclusion The CEPT is a novel, valid and reliable measure of frequency, timing, dose, and mode of PCU, in a contemporary sample of pregnant women. Using CEPT (compared to non-standardized tools) can improve measurement accuracy, and thus the quality of research examining PCU and maternal and child health outcomes.Item Open Access Effect of maternal mental health improvement programs on obesity in pediatric populations: a protocol for a systematic review and meta-analysis(2018-08-29) Wajid, Abdul; Mughal, Muhammad K; McNeil, Deborah; Robertson, Helen L; Kingston, DawnAbstract Background Childhood obesity has become a global epidemic irrespective of the socioeconomic status of a country or nation. Obesity increases the risk of various diseases in children, for example asthma, sleep apnea, bone and joint problems, type-2 diabetes, and heart problems. The existing literature informs us of the many factors associated with childhood obesity. Among these factors, maternal mental health has been found to be a strong predictor. Maternal mental health programs were implemented to address the issue of childhood obesity but with little or no improvement. It suggests systematically reviewing the literature to assess the contents of these programs and carrying out meta-analysis for the overall effect of these interventions. Methods The studies included in this review will be experimental designs such as randomized controlled trials (RCTs) which provide information on interventions to improve maternal mental health and its effects on childhood obesity. We plan to search MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, PsycINFO, ERIC, CINAHL, ProQuest Dissertations and Theses Global, Scopus, and Web of Science with no restrictions as to language. Reference lists of the selected articles will also be searched for additional articles. The Cochrane EPOC Risk of Bias Tool will be used to assess the quality of studies. If the studies lend themselves to a statistical analysis, we will also carry out a meta-analysis. Discussion This review will help determine the effect of maternal health improvement programs on childhood obesity. These findings, in turn, will guide the research community on the development of related programs in the future. Systematic review registration PROSPERO: CRD42017072737 .Item Open Access Feeding and Readiness: The Transition from Hospital-to-Home with a Late-Preterm Infant(2020-01) Shillington, Jessica; McNeil, Deborah; Bouchal, Shelley Raffin; Scotland, Jeanne; Premji, Shahirose Sadrudin J.E.In comparison to full-term infants, late-preterm infants (34 0/7 and 36 6/7 weeks’ gestation) have a greater likelihood of morbidity and a three-fold increased risk for mortality. Parents of late-preterm infants have identified inadequate preparation to manage their newborn’s unique needs at home, yet little is known about their hospital discharge experience. This study aims to describe the perspectives of parents surrounding their transition from hospital-to-home with their late-preterm infant. Twelve parents, nine mothers and three fathers, were recruited from Calgary, Alberta, and shared their experiences through in-person interviews and one focus group. Interpretative description was used to guide the study, and data were analyzed through interpretive thematic analysis and description. Key themes from the parents’ experiences were revealed to be "Fed is best" and "Feeling ready". These two themes support parents’ “Transition from hospital-to-home with their late-preterm infant” and are influenced by contextual attributes, including "Previous parenting experience" and the "Discharge care setting". Parents described verbal approval from healthcare professionals, early community follow-up, and discharge teaching specific to the unique characteristics of a late-preterm infant to increase their feelings of readiness to transition home. Parents found the care of their late-preterm infant to be normalized, particularly on the postpartum unit. Feeding was found to be the most significant challenge parents’ experienced, and the parent participants expressed a “fed is best” stance indicating that breastmilk is nutritionally superior, yet they feel the most important thing for their newborn is to feed and grow. Mothers and fathers of late-preterm infants need support from healthcare providers to take care of themselves and to choose a feeding method that works best for them and their infant. In hopes of reducing feeding challenges, parents need education on the characteristics of their late-preterm infant before leaving hospital and to have teaching reinforced in the community.Item Open Access Impact of maternal depression and anxiety on immunization status of children: a prospective cohort study(2024-06-17) MacDonald, Shannon E.; Dhungana, Manisha; Stagg, Victoria; McDonald, Sheila; McNeil, Deborah; Kellner, James D.; Tough, Suzanne; Saini, VineetAbstract Background Maternal depression and anxiety can have a detrimental impact on birth outcomes and healthy child development; there is limited knowledge on its influence on immunization schedule adherence. Therefore, the objectives of this study were to determine the impact of maternal depression and anxiety in the perinatal period on prolonged vaccine delay of childhood vaccines. Methods In this prospective cohort study, we analyzed linked survey and administrative data of 2,762 pregnant women in Calgary, Alberta, Canada. Data were collected at two time-points: prenatal (< 25 weeks of gestation) and postpartum (4 months postpartum). We used multivariable logistic regression to examine the association between depression and anxiety with prolonged immunization delay, adjusting for covariates. Results In multivariable analysis, maternal depression at either time point was not associated with prolonged delay for DTaP-IPV-Hib (OR 1.16, 95% CI 0.74–1.82), MMR/MMRV (OR 1.03, 95% CI 0.72–1.48), or all routine childhood vaccines combined (OR 1.32, 95% CI 0.86–2.04). Maternal anxiety at either time point was also not associated with prolonged delayed for DTaP-IPV-Hib (OR 1.08, 95% CI 0.77–1.53), MMR/MMRV (OR 1.07, 95% CI 0.82–1.40), or all vaccines combined (OR 1.00, 95% CI 0.80–1.26). In both the depression and anxiety models, children of Canadian-born mothers had higher odds of prolonged delay, as did those with low-income mothers. Conclusion Health care providers can be reassured that maternal depression and anxiety do not appear to influence maternal commitment to routine immunization. Findings suggested that low income and household moves may influence adherence to vaccine schedules and health care providers may want to provide anticipatory guidance to these families.Item Open Access Interpersonal psychotherapy for perinatal women: a systematic review and meta-analysis protocol(2019-10-29) Bright, Katherine S; Charrois, Elyse M; Mughal, Muhammad K; Wajid, Abdul; McNeil, Deborah; Stuart, Scott; Hayden, K. A; Kingston, DawnAbstract Background Interpersonal psychotherapy (IPT) is an intervention that has established efficacy in the prevention and treatment of depressive disorders. Previous systematic reviews have not evaluated the effectiveness of IPT on symptoms of stress, anxiety, depression, quality of life, relationship satisfaction/quality, social supports, and an improved psychological sense of well-being. There is limited data regarding factors that moderate and mediate the effectiveness of IPT including the timing of the intervention or the mode of delivery of IPT intervention. The objective of this systematic review and meta-analysis is to evaluate the effectiveness, feasibility, and acceptability of IPT interventions to treat perinatal psychological distress and to summarize the evidence on predictors, mediators, and moderators of IPT. Methods We will include peer-reviewed studies that recruited perinatal women. The search strategy will involve the following databases: MEDLINE (Ovid), EMBASE (Ovid), PsycINFO (Ovid), Cochrane Central Register of Controlled Trials (Ovid), CINAHL with Full Text (EBSCO), Social Work Abstracts (EBSCO), SocINDEX with Full Text (EBSCO), Academic Search Complete (EBSCO), Family & Society Studies Worldwide (EBSCO), Family Studies Abstracts (EBSCO), and Scopus. Study inclusion criteria include (1) randomized controlled trials, quasi-experimental studies, and pre-post studies that evaluated the effectiveness of IPT; (2) qualitative studies that evaluated feasibility and acceptability of IPT; (3) study sample included and analyzed perinatal women; and (4) publication language was English. Using pilot-tested screening and data extraction forms, two reviewers will independently review studies in three steps: (1) abstract/title screening, (2) full-text screening of potentially accepted studies, and (3) data extraction of accepted studies. Disagreements will be resolved by a third reviewer. Studies will be aggregated for meta-synthesis and meta-analysis should the data allow for this. Two independent reviewers will grade methodological quality. Discussion Findings from this review will inform future development and implementation of IPT intervention research for perinatal women. Identifying key factors of successful IPT interventions will inform intervention design and adaptation of IPT interventions to increase the likelihood that perinatal women will engage in and benefit from IPT interventions. This review will also identify key considerations for increasing the effectiveness of IPT interventions during the perinatal period. Systematic review registration PROSPERO CRD42019114292Item Open Access Knowledge translation strategies used for sustainability of an evidence-based intervention in child health: a multimethod qualitative study(2024-02-17) Cassidy, Christine E.; Flynn, Rachel; Campbell, Alyson; Dobson, Lauren; Langley, Jodi; McNeil, Deborah; Milne, Ella; Zanoni, Pilar; Churchill, Megan; Benzies, Karen M.Abstract Background Sustainability of evidence-based interventions (EBIs) is suboptimal in healthcare. Evidence on how knowledge translation (KT) strategies are used for the sustainability of EBIs in practice is lacking. This study examined what and how KT strategies were used to facilitate the sustainability of Alberta Family Integrated Care (FICare)™, a psychoeducational model of care scaled and spread across 14 neonatal intensive care units, in Alberta, Canada. Methods First, we conducted an environmental scan of relevant documents to determine the use of KT strategies to support the sustainability of Alberta FICare™. Second, we conducted semi-structured interviews with decision makers and operational leaders to explore what and how KT strategies were used for the sustainability of Alberta FICare™, as well as barriers and facilitators to using the KT strategies for sustainability. We used the Expert Recommendations for Implementation Change (ERIC) taxonomy to code the strategies. Lastly, we facilitated consultation meetings with the Alberta FICare™ leads to share and gain insights and clarification on our findings. Results We identified nine KT strategies to facilitate the sustainability of Alberta FICare™: Conduct ongoing training; Identify and prepare local champions; Research co-production; Remind clinicians; Audit and provide feedback; Change record systems; Promote adaptability; Access new funding; and Involve patients/consumers and family members. A significant barrier to the sustainability of Alberta FICare™ was a lack of clarity on who was responsible for the ongoing maintenance of the intervention. A key facilitator to sustainability of Alberta FICare was its alignment with the Maternal, Newborn, Child & Youth Strategic Clinical Network (MNCY SCN) priorities. Co-production between researchers and health system partners in the design, implementation, and scale and spread of Alberta FICare™ was critical to sustainability. Conclusion This research highlights the importance of clearly articulating who is responsible for continued championing for the sustainability of EBIs. Additionally, our research demonstrates that the adaptation of interventions must be considered from the onset of implementation so interventions can be tailored to align with contextual barriers for sustainability. Clear guidance is needed to continually support researchers and health system leaders in co-producing strategies that facilitate the long-term sustainability of effective EBIs in practice.Item Open Access Knowledge translation strategies used for sustainability of an evidence-based intervention in child health: a multimethod qualitative study(2024-02-17) Cassidy, Christine E.; Flynn, Rachel; Campbell, Alyson; Dobson, Lauren; Langley, Jodi; McNeil, Deborah; Milne, Ella; Zanoni, Pilar; Churchill, Megan; Benzies, Karen M.Abstract Background Sustainability of evidence-based interventions (EBIs) is suboptimal in healthcare. Evidence on how knowledge translation (KT) strategies are used for the sustainability of EBIs in practice is lacking. This study examined what and how KT strategies were used to facilitate the sustainability of Alberta Family Integrated Care (FICare)™, a psychoeducational model of care scaled and spread across 14 neonatal intensive care units, in Alberta, Canada. Methods First, we conducted an environmental scan of relevant documents to determine the use of KT strategies to support the sustainability of Alberta FICare™. Second, we conducted semi-structured interviews with decision makers and operational leaders to explore what and how KT strategies were used for the sustainability of Alberta FICare™, as well as barriers and facilitators to using the KT strategies for sustainability. We used the Expert Recommendations for Implementation Change (ERIC) taxonomy to code the strategies. Lastly, we facilitated consultation meetings with the Alberta FICare™ leads to share and gain insights and clarification on our findings. Results We identified nine KT strategies to facilitate the sustainability of Alberta FICare™: Conduct ongoing training; Identify and prepare local champions; Research co-production; Remind clinicians; Audit and provide feedback; Change record systems; Promote adaptability; Access new funding; and Involve patients/consumers and family members. A significant barrier to the sustainability of Alberta FICare™ was a lack of clarity on who was responsible for the ongoing maintenance of the intervention. A key facilitator to sustainability of Alberta FICare was its alignment with the Maternal, Newborn, Child & Youth Strategic Clinical Network (MNCY SCN) priorities. Co-production between researchers and health system partners in the design, implementation, and scale and spread of Alberta FICare™ was critical to sustainability. Conclusion This research highlights the importance of clearly articulating who is responsible for continued championing for the sustainability of EBIs. Additionally, our research demonstrates that the adaptation of interventions must be considered from the onset of implementation so interventions can be tailored to align with contextual barriers for sustainability. Clear guidance is needed to continually support researchers and health system leaders in co-producing strategies that facilitate the long-term sustainability of effective EBIs in practice.Item Open Access NICU Staff Use of Taste For Preterm Infants(2014-05-05) Mahabeer, Rikhye; McNeil, Deborah; Chow, JeanBackground: Food taste experience for tube fed preterm infants is sporadic and provided with milk feeds or glucose solutions. It is unknown how often taste experience is provided with tube feeding. Objectives: The research examined the knowledge, beliefs, and practices of NICU staff regarding preterm infant taste and whether these factors differ among staff by NICU site, experience, or profession. Methods: A cross sectional survey method was used and a 14 item questionnaire was developed. Results: The majority of staff lacked knowledge regarding fetal and preterm sense of taste development. Conversely, staff believed strongly in, and routinely provided taste during tube feeding. Practice varied across professions and by months of experience. Practice did not vary to the same degree by NICU sites. Conclusions: Opportunities exist to address gaps in NICU staff knowledge of preterm infant taste. Standardization of taste practices and updating of guiding documents are needed.Item Open Access Quality improvement interventions to prevent unplanned extubations in pediatric critical care: a systematic review(2022-12-02) Wollny, Krista; Cui, Sara; McNeil, Deborah; Benzies, Karen; Parsons, Simon J.; Sajobi, Tolulope; Metcalfe, AmyAbstract Background An unplanned extubation is the uncontrolled and accidental removal of a breathing tube and is an important quality indicator in pediatric critical care. The objective of this review was to comprehensively synthesize literature published on quality improvement (QI) practices implemented to reduce the rate of unplanned extubations in critically ill children. Methods We included original, primary research on quality improvement interventions to reduce the rate of unplanned extubations in pediatric critical care. A search was conducted in MEDLINE (Ovid), Embase, and CINAHL from inception through April 29, 2021. Two reviewers independently screened citations in duplicate using pre-determined eligibility criteria. Data from included studies were abstracted using a tool created by the authors, and QI interventions were categorized using the Behavior Change Wheel. Vote counting based on the direct of effect was used to describe the effectiveness of quality improvement interventions. Study quality was assessed using the Quality Improvement Minimum Quality Criteria Set (QI-MQCS). Results were presented as descriptive statistics and narrative syntheses. Results Thirteen studies were included in the final review. Eleven described primary QI projects; two were sustainability studies that followed up on previously described QI interventions. Under half of the included studies were rated as high-quality. The median number of QI interventions described by each study was 5 [IQR 4–5], with a focus on guidelines, environmental restructuring, education, training, and communication. Ten studies reported decreased unplanned extubation rates after the QI intervention; of these, seven had statistically significant reductions. Both sustainability studies observed increased rates that were not statistically significant. Conclusions This review provides a comprehensive synthesis of QI interventions to reduce unplanned extubation. With only half the studies achieving a high-quality rating, there is room for improvement when conducting and reporting research in this area. Findings from this review can be used to support clinical recommendations to prevent unplanned extubations, and support patient safety in pediatric critical care. Systematic review registration This review was registered on PROSPERO (CRD42021252233) prior to data extraction.Item Open Access Suffragettes for Caesareans: "Every woman should have a choice"(2016) Imanoff, Julia; Mannion, Cynthia; McCaffrey, Graham; White, Deborah; McNeil, DeborahPatient choice for caesarean delivery (CD) is complex. This choice poses a challenge to maternity Health Care Providers (HCPs) in terms of resource allocation, economics, and surgical risks. Yet, women’s understanding of choice is poorly understood. This study answers the question: how HCPs might understand women’s choice for CD? Four primiparous women who chose a CD were recruited. Semi-structured interviews were used to generate data. The interpretation followed a hermeneutic approach. The interpretations emphasized the complexities of choice, HCPs’ role in birth experiences, and how the woman in this study understood vaginal deliveries as risky and unpredictable and caesarean deliveries as safe and controlled. These findings question how HCP’s understandings of choice can shape patient care. HCPs have the opportunity to recognize the meaning of the choice for each woman and how it is situated in a broader historical context, and how they can promote positive birth experiences in their practice.Item Open Access The Alberta Neonatal Abstinence Syndrome Mother-Baby Care ImprovEmeNT (NASCENT) program: protocol for a stepped wedge cluster randomized trial of a hospital-level Neonatal Abstinence Syndrome rooming-in intervention(2023-05-06) Wine, Osnat; McNeil, Deborah; Kromm, Seija K.; Foss, Karen; Caine, Vera; Clarke, Denise; Day, Nathaniel; Johnson, David W.; Rittenbach, Katherine; Wood, Stephen; Hicks, MattAbstract Background Neonatal Abstinence Syndrome (NAS), a problem common in newborns exposed to substances in-utero, is an emerging health concern. In traditional models of care, infants with NAS are routinely separated from their mothers and admitted to the Neonatal Intensive Care Unit (NICU) with long, expensive length of stay (LOS). Research shows a rooming-in approach (keeping mothers and infants together in hospital) with referral support is a safe and effective model of care in managing NAS. The model’s key components are facilitating 24-h care by mothers on post-partum or pediatric units with support for breastfeeding, transition home, and access to Opioid Dependency Programs (ODP). This study will implement the rooming-in approach at eight hospitals across one Canadian Province; support practice and culture shift; identify and test the essential elements for effective implementation; and assess the implementation’s impact/outcomes. Methods A stepped wedge cluster randomized trial will be used to evaluate the implementation of an evidence-based rooming-in approach in the postpartum period for infants born to mothers who report opioid use during pregnancy. Baseline data will be collected and compared to post-implementation data. Six-month assessment of maternal and child health and an economic evaluation of cost savings will be conducted. Additionally, barriers and facilitators of the rooming-in model of care within the unique context of each site and across sites will be explored pre-, during, and post-implementation using theory-informed surveys, interviews, and focus groups with care teams and parents. A formative evaluation will examine the complex contextual factors and conditions that influence readiness and sustainability and inform the design of tailored interventions to facilitate capacity building for effective implementation. Discussion The primary expected outcome is reduced NICU LOS. Secondary expected outcomes include decreased rates of pharmacological management of NAS and child apprehension, increased maternal ODP participation, and improved 6-month outcomes for mothers and infants. Moreover, the NASCENT program will generate the detailed, multi-site evidence needed to accelerate the uptake, scale, and spread of this evidence-based intervention throughout Alberta, leading to more appropriate and effective care and use of healthcare resources. Trial registration ClinicalTrials.gov, NCT0522662. Registered February 4th, 2022.Item Open Access Unplanned Extubations: Adverse Events in Pediatric Critical Care(2022-04-19) Wollny, Krista; Metcalfe, Amy; McNeil, Deborah; Sajobi, Tolulope; Benzies, Karen; Parsons, Simon JUnplanned extubations are the uncontrolled and accidental removal of an endotracheal tube and are an adverse event and quality indicator in pediatric intensive care units (PICUs). The literature on quality improvement (QI) interventions to prevent unplanned intubations in PICUs has not been comprehensively synthesized. Furthermore, large-scale studies of practices related to intubation and preventing unplanned extubations have not been conducted across multiple PICUs. Unplanned extubations are infrequent events, with recent studies reporting rates between 0.74-1.5 events/100 intubation days. This has contributed to small sample sizes in previous studies. Small sample sizes and single-centre studies limit the generalizability of findings and the ability to detect associations. These gaps are addressed in this dissertation. The overarching aim of this dissertation was to explore unplanned extubations in PICUs, applying theories and methodology from quality improvement, implementation science, knowledge translation, and epidemiology. In the first manuscript, we conducted a systematic review on quality improvement interventions to prevent unplanned extubations in PICUs. The median number of QI interventions described by the ten included studies was 4.5 [IQR 4-5], with a focus on guidelines, environmental restructuring, education, training, and communication. The second manuscript is an observational, cross-sectional study exploring care practices related to intubation and preventing unplanned extubations across PICUs. Data were gathered via a survey distributed to PICUs in the Virtual Pediatric Systems (VPS) database, and the analyses demonstrated substantial variability in clinical practice, including staffing, frequency of procedures, and treatment-related goals. The third manuscript is a retrospective observational study and prediction model that explored unplanned extubations requiring reintubation in PICUs using data from the VPS database. Of the 5,703 patients that experienced an unplanned extubation, 1,661 (29.1%) required reintubation. Variables associated with increased risk of reintubation were younger age and respiratory diagnosis. The multilevel least absolute shrinkage selection operator (LASSO) logistic regression model predicting reintubation resulted in an AUROC of 0.59 (95% CI: 0.57–0.61) with variables age, weight, diagnosis, and scheduled admission. The results of these three manuscripts contribute to the field of patient safety in PICUs, which is integrated into clinical recommendations and directions for future research.Item Open Access Women’s Perceptions, Beliefs, and Decision-making Process of Consuming Cannabis During Pregnancy and Lactation: An Interpretive Description(2021-06) Weisbeck, Sarah; Ginn, Carla; Chaput, Katie; Benzies, Karen; McNeil, DeborahBackground: In Canada, cannabis is the most frequently used substance after tobacco during pregnancy and lactation, and rates are increasing. Accumulating evidence suggests that cannabis exposure has a detrimental impact on neonatal and childhood development, underscoring the urgency of understanding pregnant women’s perspectives, knowledge, and beliefs regarding cannabis use during the perinatal period. Aim: To gain a deeper understanding of cannabis consumption during pregnancy and lactation and insight into how health care professionals can effectively address the increasing prevalence of cannabis use in pregnancy. Methods: 10 Albertan female-identifying women who self-reported cannabis consumption during pregnancy and lactation were interviewed, and data were analyzed using qualitative interpretive description methodology. Findings: Participants viewed cannabis as “natural” and “safe” and defined their consumption during pregnancy and lactation as medicinal. Information-seeking behaviors included developing social groups of trusted individuals and reliance on anecdotal stories. Discussion: The decision to consume cannabis during pregnancy and lactation is complex and influenced by multiple factors, including views that cannabis is a safe and effective medicinal option and mistrust of health care professionals. This decision remains highly stigmatized and viewed by society as problematic, which contrasts women’s belief that cannabis contributes to their overall health. Keywords: cannabis, pregnancy, lactation.