Browsing by Author "Rabi, Doreen M."
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Item Open Access Can Virtual Care Support the Outpatient Management of Patients Treated with Chronic Hemodialysis? Lessons from Designing and Testing a Virtual Visit Program in Alberta(2020-05-25) Lunney, Meaghan; Tonelli, Marcello; Bello, Aminu K.; Rabi, Doreen M.; Thomas, Chandra M.Many people have difficulty accessing healthcare. Virtual care allows patients and providers to interact using information and communication technologies, which may mitigate inconvenience associated with in-person appointments and potentially barriers to accessing care. Virtual appointments using videoconferencing technology (herein named virtual visits) have become a widely used form of virtual care due to its convenience and accessibility for patients. People with kidney failure receiving dialysis require frequent and ongoing care from multiple healthcare providers and there is a significant potential for virtual visits in this setting. However, the current interest among relevant stakeholders and the optimal delivery processes for outpatient virtual kidney failure management, to our knowledge, are unknown. Our program of study involved: a systematic review of studies exploring the use of virtual care in kidney failure management; interviews with patients and healthcare providers about virtual visit design; and a pilot test of the virtual visit intervention at a kidney clinic to learn about the user experience and identify workflow and resource requirements needed for delivering virtual visits. We hope this research will help inform future decision-making around virtual visit services in our kidney program. Our review found a gap in evidence related to virtual visits for outpatient kidney failure management. Interviews with patients, nurses, and nephrologists confirmed an interest in virtual visits, mainly as they are more convenient for patients and may increase access to care. Further, these stakeholders provided virtual visit recommendations that helped inform the intervention design. Our pilot study found that patients and nephrologists were highly satisfied with the virtual visit intervention. Both groups stated they would use virtual visits again and recommend them to their peers. Most patients used their own devices (computers, tablets, smartphones), but the clinic did not have sufficient hardware for virtual visits. Workflow considerations identified through our study included: using electronic medical records and coordinating with dialysis nurses to collect health information needed for the virtual visit; providing training and technical support to patients; and using a combination of in-person visits and virtual visits as appropriate. Further, clarity around medical-legal matters, platform governance, and future remuneration policies is needed. Overall, our research suggests virtual visits are appropriate for outpatient kidney failure care and warranted by patients, nurses, and nephrologists, given the right circumstances. We identified process and workflow considerations for facilitating virtual visit in outpatient kidney clinics. Lastly, we identified barriers, mainly related to information technology infrastructure and governance, that will need to be addressed to fully capitalize on the benefits of virtual care.Item Open Access Clinical, sociodemographic, and environmental factors associated with hospitalizations for acute complications in adults with type 1 diabetes mellitus(2012) Butalia, Sonia; Rabi, Doreen M.Objective: To identify factors associated with hospitalizations for acute complications in adults with type 1 diabetes. Within this thesis, three discrete studies were conducted which assessed 1) clinical and sociodemographic factors; 2) driving distance to diabetes care sites; and, 3) seasonality. Methods: This thesis used clinical, administrative, and geographic data. Analysis included descriptive statistics, logistic regression models, and Geographic Information Systems (GIS) methodology. Results: The results showed: 1) Diabetic ketoacidosis (DKA) hospitalization was associated with shorter duration of diabetes, higher hemoglobin Ale, gastroparesis, and psychiatric disorders. Hypoglycemia hospitalization was associated with longer duration of diabetes and neuropathy; 2) Driving distance to diabetes care sites overall was not associated with hospitalizations; and, 3) DKA and hypoglycemia hospitalizations had seasonal variation. Conclusions: This thesis identified unique factors associated with hospitalizations for acute complications. This information could inform specific initiatives to improve the health and well being of adults with type 1 diabetes.Item Open Access Expanding the evidence of endovascular treatment for acute ischemic stroke: patient–centered outcomes, population–level impact, and patients presenting with mild stroke symptoms(2020-10-06) Zerna, Anna Charlotte; Hill, Michael D.; Demchuck, Andrew M.; Rabi, Doreen M.Endovascular treatment (EVT) for anterior circulation acute ischemic stroke due to large‐vessel occlusion is the new standard of care resulting in reduced disability compared to medical treatment. Practice guidelines recommend the use of EVT but can only speak to the evidence provided by clinical trials and might not be appropriate when complex medical decisions need to consider the heterogeneity of patients in routine clinical care. Brought about by the limitations of the clinical trials, the work described in this doctoral thesis aimed to assess the long–term sustainability of efficacy of EVT, the utilization of post–stroke outcomes that are patient–centered and more meaningful to affected individuals, and the effectiveness of EVT in patient populations that have not been part of clinical trial cohorts. These are commonly older patients with comorbidities and patients presenting with mild stroke symptoms. The miFUNCTION scale was shown to display greater granularity in the mild to moderately–severe disability range post–stroke compared to the modified Rankin Scale and thus provide more insight into the patient's ability and capacity to engage in meaningful life roles after EVT. In a population–based analysis, adult patients undergoing EVT spent on average more than one week longer at home within the first 90 days compared with patients receiving medical treatment. Home‐time was used as a novel, health‐economic, and patient‐centered outcome. For patients presenting with mild symptoms, EVT resulted in similar 90–day outcomes compared to medical management despite an increased risk of neurological deterioration at 24 hours. Due to uncertainty regarding the risk–benefit–ratio, a well–designed clinical trial will need to establish how best to treat these patients. Overall, the work described here provides greater understanding of how the benefits and risks of EVT might vary across the population and differ from the rather homogenous patient cohort that has been assessed in the clinical trials. The results of this research will be meaningful to patients who experience acute ischemic strokes caused by large vessel occlusion and also aid with economic and regulatory decisions to more broadly offer and organize EVT across Alberta and beyond.Item Open Access Exploring the Relationship Between Diabetes and Physical Activity Behaviours: Results from the Canadian Health Measures Survey (2007-2017)(2020-05-12) Booth, Jane; Sigal, Ronald J.; Rabi, Doreen M.; Goldfield, Gary S.; Sajobi, Tolulope T.Background: Diabetes Canada clinical practice guidelines recommend that individuals with type 2 diabetes accumulate a minimum of 150 minutes per week of moderate-to vigorous-intensity physical activity (MVPA) and reduce the amount of time spent sedentary. To our knowledge, there are no nationally-representative studies in Canada that have used objectively-measured physical activity data to assess the associations between physical activity and sociodemographic characteristics or cardiometabolic measures in people with type 2 diabetes. Thus, the objectives of this thesis were to (1) evaluate the associations between physical activity, sedentary time and cardiometabolic health and (2) evaluate the associations between physical activity, sedentary time and sociodemographic characteristics in adults with type 2 diabetes in a representative sample of the Canadian population. Methods: Cycles 1 to 5 of the Canadian Health Measures Survey (CHMS) were used. Participants with type 2 diabetes between 20 and 79 years of age who had at least four days of valid activity monitor wear were included. Means, medians and interquartile ranges were used to present estimates of physical activity and sedentary time. Physical activity was stratified by MVPA tertile and cardiometabolic mean values and/or proportions with 95% confidence intervals were compared. Median regression was used to evaluate the associations between 60-minute per week increment in total MVPA with hemoglobin A1c (A1C) and body mass index (BMI). Ordinal logistic regression was used to estimate the odds of achieving lower amounts of MVPA based on sociodemographic factors. Results: Only 21.5% of adults with type 2 diabetes met clinical practice guideline recommendations for physical activity. Higher amounts of MVPA and daily steps were associated with lower BMI, waist circumference and cardiometabolic risk composite score. Female sex, lower income, BMI ≥ 25 kg/m2, and being a current or former smoker were associated with lower levels of physical activity. Conclusions: Less than one quarter of adults with type 2 diabetes met physical activity recommendations. We identified important sociodemographic characteristics that were determinants of low levels of physical activity which should be considered by healthcare providers and policy-makers in order to inform and deliver effective physical activity interventions.Item Open Access Malignancy risk of hyperfunctioning thyroid nodules compared with non-toxic nodules: systematic review and a meta-analysis(2021-02-25) Lau, Lorraine W.; Ghaznavi, Sana; Frolkis, Alexandra D.; Stephenson, Alexandra; Robertson, Helen L.; Rabi, Doreen M.; Paschke, RalfAbstract Background Hyperfunctioning or hot nodules are thought to be rarely malignant. As such, current guidelines recommend that hot nodules be excluded from further malignancy risk stratification. The objective of this systematic review and meta-analysis is to compare the malignancy risk in hot nodules and non-toxic nodules in observational studies. Methods Ovid MEDLINE Daily and Ovid MEDLINE, EMBASE, Scopus, and Web of Science databases were searched. Observational studies which met all of the following were included: (1) use thyroid scintigraphy for nodule assessment, (2) inclusion of both hyperfunctioning and non-functioning nodules based on scintigraphy, (3) available postoperative histopathologic nodule results, (4) published up to November 12, 2020 in either English or French. The following data was extracted: malignancy outcomes include malignancy rate, mapping of the carcinoma within the hot nodule, inclusion of microcarcinomas, and presence of gene mutations. Results Among the seven included studies, overall incidence of malignancy in all hot thyroid nodules ranged from 5 to 100% in comparison with non-toxic nodules, 3.8–46%. Odds of malignancy were also compared between hot and non-toxic thyroid nodules, separated into solitary nodules, multiple nodules and combination of the two. Pooled odds ratio (OR) of solitary thyroid nodules revealed a single hot nodule OR of 0.38 (95% confidence interval (CI) 0.25, 0.59), toxic multinodular goiter OR of 0.51 (95% CI 0.34, 0.75), and a combined hot nodule OR of 0.45 (95% CI 0.31, 0.65). The odds of malignancy are reduced by 55% in hot nodules; however, the incidence was not zero. Conclusions Odds of malignancy of hot nodules is reduced compared with non-toxic nodules; however, the incidence of malignancy reported in hot nodules was higher than expected. These findings highlight the need for further studies into the malignancy risk of hot nodules.Item Open Access Polycystic Ovarian Syndrome: An Investigation of Non-Pharmacologic Management Strategies and Cardiometabolic Consequences(2021-05-12) Benham, Jamie L.; Sigal, Ronald J.; Corenblum, Bernard; Rabi, Doreen M.; Friedenreich, Christine M.Background: Preliminary evidence suggests exercise training may result in improved reproductive, anthropometric, cardiometabolic and psychosocial health in women with polycystic ovary syndrome (PCOS).Objective: To evaluate the effects of exercise training on reproductive, anthropometric, cardiometabolic, and sleep quality health measures in reproductive-aged women with PCOS.Methods: First, we performed a systematic review and meta-analysis of studies assessing the effects of exercise training on reproductive outcomes. Second, we performed a pilot randomized controlled trial evaluating the feasibility of conducting a larger trial evaluating reproductive, anthropometric, cardiometabolic, and sleep quality health measures. Feasibility outcomes included: participant recruitment, attrition, adherence to prescribed exercise and daily ovulation assessment.Results: The systematic review included 14 studies involving 617 women. Semi-quantitative analysis suggested exercise training may increase ovulation rates, menstrual regularity and pregnancy. In the trial, all recruitment methods were important as each recruited participant was not reached by the other methods. 47 participants were randomized: no-exercise control (n=17), high-intensity interval training (HIIT) (n=16), continuous aerobic exercise training (CAET) (n=14). Across all groups, attrition was 15%. Median exercise adherence was 68% (IQR 53%, 86%). Ovulation assessment adherence dropped from 87% (IQR 61%, 97%) in the first 3-months of the intervention to 65% (IQR 0%, 96%) in the final 3-months. 22/33 (66.7%) women ovulated during the intervention period with no between-group differences. Body mass index decreased for CAET compared with HIIT (-0.9 kg/m2, p=0.04) and control (-1.0 kg/m2, p=0.01). Mean waist circumference decreased significantly (-7.3 cm, -6.9 cm, -4.5 cm in HIIT, CAET and control) with no significant between-group differences. In HIIT compared with CAET, LDL-C decreased significantly (-0.33 mmol/L, p=0.03). In HIIT compared with control, HDL-C increased (0.18 mmol/L, p=0.04). 79% of participants reported poor sleep quality.Conclusions: While exercise training may improve anthropometric, reproductive and sleep quality health markers in women with PCOS, the effects of exercise training on reproductive health measures remain unclear. Feasibility challenges with exercise training and daily ovulation assessment adherence limited the ability to analyze the effect of exercise on ovulation. Further studies are needed to determine optimal exercise prescriptions for this population.Item Open Access The relationship between urban environment and the inflammatory bowel diseases: a systematic review and meta-analysis(BioMed Central, 2012) Kaplan, Gilaad G.; Soon, Ing Shian; Molodecky, Natalie A.; Rabi, Doreen M.; Ghali, William A.; Barkema, Herman W.Item Open Access A Study to Understand and Improve Sexual Activity after Acute Coronary Syndrome(2018-12-13) Boothby, Célina A.; Rabi, Doreen M.; Campbell, Tavis S.; Santana, Maria Jose; Norris, ColleenA major cardiovascular event, like acute coronary syndrome (ACS), can have an extensive and long-term impact on many aspects of a patient-partner relationship, including aspects of sexual activity (SA). Current clinical recommendations suggest that both patients and partners should receive SA support after an ACS episode. To this date, there has been little qualitative inquiry that engages both patient and partner perspectives on their opinions of by whom, where, and how, SA support should be provided post-ACS. The objectives of this thesis were to 1) characterize the experiences of re-engaging in SA post-ACS by patients and partners and to 2) determine if cardiac rehabilitation (CR) could be an acceptable and effective point of intervention for SA support post-ACS by patients and partners. A multi-methods study design was used to address both objectives through qualitative inquiry and a systematic review. The qualitative study provided supportive evidence of the importance of SA by patients and partners post-ACS, revealed that couples thought SA support was insufficient and articulated ways that education could be improved, and identified CR as a potential point of SA support. The systematic review revealed seven studies that reported a significant benefit in SA outcomes in the CR group, one study that reported significant harm, and eleven studies that reported a non-significant difference. This thesis suggests that there is room for improvement in terms of content and delivery of SA support to both patients and partners post-ACS, and that CR may be an appropriate place for such support.