Browsing by Author "Patten, Scott Burton"

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    2023 Mathison-Littmann Research Day Abstracts
    (2023-03-03) Patten, Scott Burton
    Abstracts from the 2023 Sebastian K. Littmann Research Day at the University of Calgary.
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    Caring for the Critically Ill
    (2021-09-21) Moss, Stephana Julia; Bobawsky, Kirsten Marie; Stelfox, Henry Thomas; Doig, Christopher James; Patten, Scott Burton
    Family or informal caregivers are key to the delivery of patient-centered care and often act as patient advocates. Visitation from family caregivers in the intensive care unit (ICU) can have long-term impacts on ICU patients post-hospital discharge. A relationship between exposure to critical illness and negative psychological sequalae among family caregivers of critically ill patients is consistently reported. The literature on mental health interventions to improve psychological outcomes in family caregivers of the critically ill has not been appraised. Bereavement interventions in the ICU have not been mapped to core outcomes for evaluating bereavement support among family caregivers. The effect of family visitation on ICU survivors post-discharge psychiatric outcomes is unknown. Perspectives from designated family caregivers during the coronavirus disease 2019 (COVID-19) pandemic have not been well characterized. The work reported in this thesis addresses these knowledge gaps. Based on a systematic review of 102 trials, mental health interventions reduced anxiety (Ratio of Means (RoM), 0.92; 95% confidence interval (CI): 0.87–0.97) and depression (RoM, 0.83; 95%CI: 0.69–0.99), but not post-traumatic stress disorder (RoM, 0.91; 95%CI: 0.80–1.04) or distress (RoM, 1.01; 95%CI: 0.95–1.07) among family caregivers within 3-months post-discharge. Increased burden among family caregivers within 3-months post-discharge (RoM, 1.08; 95%CI: 1.05–1.12) was observed. Three studies of ICU bereavement interventions indicated that available trial evidence is sparse and does not support use of bereavement interventions for family caregivers of patients who die in ICU. Using administrative databases, it was found that ICU family visitation was associated with decreased risk for psychiatric disorders (risk ratio (RR), 0.87; 95%CI: 0.79-0.97), mainly trauma- and stressor-related disorders (RR 0.66; 95%CI: 0.38-0.87), in ICU survivors up to one-year post-discharge. In COVID-19, designated family caregivers of critically ill patients perceived emotional distress related to being the only family member allowed to visit. The results of these studies characterize the impact of a family-centered care approach in the ICU on caring for the critically ill, which is integrated into recommendations for the field.
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    Evaluating the Association Between Delirium in the Intensive Care Unit and Subsequent Neuropsychiatric Disorders Post-Stay
    (2018-08-03) Brown, Kyla Nicole; Stelfox, Henry Thomas; Fiest, Kirsten; Faris, Peter D.; Patten, Scott Burton
    Individuals without pre-existing neuropsychiatric disorders are reported to be at increased risk of developing a neuropsychiatric disorder after admission to an Intensive Care Unit (ICU). This risk may be attributed to the severity of illness and the nature of therapies provided, including intubation, medically induced coma, and numerous medications. Furthermore, approximately half of ICU patients develop delirium during their stay, which may further add to the burden of neuropsychiatric disorders experienced by these patients. If delirium is not identified and treatment initiated early, patients may be at risk for adverse consequences, such as increased mortality, increased length of hospital stay and further cognitive impairment. Therefore, the objectives of this thesis were to (1) examine the overall prevalence and (2) incidence of neuropsychiatric disorders following a stay in a general systems ICU; and (3) determine the association between delirium in the ICU and an onset of a neuropsychiatric disorders subsequent to the ICU stay. The objectives for this study were addressed in two phases. In phase one, a systematic review and meta-analysis was conducted to address the overall pooled prevalence of depression, anxiety, trauma-and-stressor related, and neurocognitive disorders. Based on the analysis, the overall pooled prevalence of the disorders was: 32% (95% Confidence Interval [CI] 25%-39%), 32% (95% CI 24%-40%), 23% (95% CI 18%- 28%), and 42% (95% CI 25%-60%), respectively. The systematic review revealed a significant association between delirium and neuropsychiatric disorders (specifically trauma-and-stressor related and neurocognitive disorders). In phase two, a retrospective cohort study using administrative databases was conducted. The cumulative incidence for depressive, anxiety, trauma-and-stressor related, and neurocognitive disorders were: 10.6%, 8.9%, 2.5%, and 3.7%, respectively. The study results suggested that for patients who ever had delirium in the ICU, there was a 1.23 times the risk of developing any neuropsychiatric disorder compared to those who never had delirium in the ICU. Early treatment of delirium may be necessary to reduce the morbidity of delirium and possibly the subsequent development of neuropsychiatric disorders post-ICU stay.
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    Life in the Shadows: Examining the Role that HIV Status Plays in the Decision Making Processes of HIV Positive Aboriginal Women in Terms of Their Reproductive Health and Their Decisions to Have a Child or Not
    (2016) Nash, Tina Marie Lynn; Thurston, Wilfreda Enid; Crowshoe, Lynden John; Patten, Scott Burton
    This thesis represents a qualitative research study involving three urban dwelling, HIV positive Aboriginal women. It highlights the factors that participants describe as being influential in their decision to have a child or not, given positive HIV status. In depth, semi-structured interviews were conducted with participants and descriptive construction of emerging themes and categories were developed to explain the results. Key factors that were found to influence participant’s decisions to have a child or not were: intention; fertility options; stigma; fear; social support; personal health status; spirituality; and cultural safety. This study also found that an analysis of the role HIV status plays in the decision making processes of HIV positive Aboriginal women with regards to whether or not to have a child must take into account how colonization, systematic discrimination, racism, early childhood and adolescent experiences, poverty, addictions, homelessness, co-morbidity of illness and culture intersect to influence their decisions.
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    Preventive Health Care among Canadian Adults with Schizophrenia and Related Disorders
    (2014-01-07) Beck, Cynthia Anita; Patten, Scott Burton
    Objective: To characterize cardiovascular disease risk factors (CVD-RFs) and preventive health services of people with schizophrenia and related disorders (SCZ) in a Canadian context. Methods: This cross-sectional survey collected laboratory, physical examination, and interview data from 202 randomly selected Calgary outpatients with SCZ. Results: There were high prevalences of several CVD-RFs. Metabolic syndrome was present in 30.0%. Mean 10-year general CVD risk was 8.8%. Many previously known CVD-RFs were inadequately treated, and several previously undetected CVD-RFs were discovered (e.g. 33.3% of diabetes). There was variable receipt of preventive services, and participants explained non-receipt by “Thought it was unnecessary” or “Didn’t get around to it”. Interpretation: This study found substantial physical morbidity coupled with gaps in prevention, detection, and management, as well as patient factors that might be a target of interventions for improved care. Multifaceted strategies will be needed to make a difference in the health of people with schizophrenia.
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    Protocol: Drug-induced Depression, An Updated Systematic Review to Inform Clinical Practice
    (2024-09-18) Patten, Scott Burton; McClurg, Caitlin
    Background: The etiology of depression is biopsychosocial, with therapeutic drugs often listed as potential risk factors. However, the role of drugs and medications in depression etiology remains unclear. The objective of this review is to summarize existing evidence etiologically linking therapeutic drugs to depression. Methods: A systematic review will be conducted in a series of stages. As the goal of the review is to assess etiological evidence, issues of confounding (e.g. by illness or by illness severity) and temporality are of paramount importance. Therefore, the review will focus on randomized controlled trials (RCTs) and high-quality prospective cohort studies. With guidance from an academic librarian (CM), a literature search will be conducted in three stages. The first search will be a screening review of published review articles combined with a grey-literature search. The stage I search will be used to develop a list of drugs commonly implicated in depression etiology. A stage II search will cross-reference these drugs against methodological search terms to identify relevant RCTs. This stage will enable identification of a subset of drugs etiologically linked to depression. Finally, this subset of drugs will be included in the third stage of the literature search, which will cross-reference these specific drugs with search terms for prospective cohort studies, allowing of clinically salient observations on the course of drug-induced depression. Covidence will be used to organize and summarize eligibility assessment initially in screening for relevance, subsequently in selection of studies for full text review and finally in data extraction. The Cochrane RoB-2 and Robins-E tools will be used for quality assessment of included studies. Meta-analysis will be used, as appropriate, in analysis of the stage II studies whereas narrative description will be the main strategy for data synthesis of the stage III studies. The review will be reported using PRISMA standards. Discussion: This systematic review will identify three subsets of drugs that may be linked to depression: (1) a set of drugs frequently implicated in causing depression, (2) a subset of this list consisting of drugs etiologically linked to depression according to reasonable standards of evidence, and (3) a summarization of evidence concerning diagnosis and clinical management of drug-induced depression. Such evidence will inform clinical practice by supporting risk-benefit decisions in treatment selection and by providing a better understanding of the side-effect profiles of medical drugs.
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    Work Injuries and Mental Health Problems
    (2022-06-27) Granger, Steven; Turner, Nicholas; Hershcovis, M Sandy; Weinhardt, Justin; Patten, Scott Burton; Beus, Jeremy M
    Work injuries and mental health problems continue to inflict hardship on workers while imposing severe costs on organizations. Yet no comprehensive attempt to summarize the relationship between work injuries and mental health problems exists despite evidence of their association. Further, theoretical development of the relationship between work injuries and mental health problems has stalled in recent years. I address these issues by conducting three studies to explain the association between work injuries and mental health problems, conditions shaping and mechanisms underlying this association, and the expected trajectory of mental health problems prior to and following a work injury. Study 1 is the first comprehensive meta-analysis to look at the relationship between work injuries and mental health problems, ordering effects (i.e., work injuriesmental health problems, mental health problemswork injuries), and key conditions. Study 1 indicates the association between work injuries and mental health problems is small but robust, with larger effect sizes emerging when mental health problems are measured following a work injury as opposed to preceding a work injury. Study 2 examines cognitive mechanisms linking work injuries and mental health, as well as a key social condition distinguishing the work injury-mental health problems relationship using data from the Canadian Longitudinal Study of Aging (Raina et al., 2009). Study 2 results suggest maladaptive cognitions link prior work injury with later mental health problems, and memory-related issues link prior mental health problems with later work injury. Further, some evidence emerged for the role of social support mitigating the relationship between prior work injury and later mental health problems, but not vice versa. Finally, Study 3 examines the relationship between work injuries and mental health over time through an intensive longitudinal survey of young workers. Results from this study indicate that young workers tend to be resilient when confronting a work injury, with minor initial differences in mental health. Altogether, the results from these studies have important implications for occupational health and safety initiatives surrounding the prevention, recovery, and reporting of work injuries and mental health problems.