Open Theses and Dissertations
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Browsing Open Theses and Dissertations by Department "Community Health Sciences"
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- ItemOpen AccessA Canadian Population-based Study of the Relationship between Fluoride Exposure and Indicators of Cognitive and Thyroid Functioning; Implications for Community Water Fluoridation(2016) Barberio, Amanda; McLaren, Lindsay; Quiñonez, Carlos; Hosein, ShaunConcerns exist regarding potential harms of community water fluoridation. The study objective was to examine the association between fluoride exposure and indicators of two health outcomes for which concerns have been expressed, cognitive and thyroid functioning, among a population-based sample of Canadians. Data were analyzed from Cycles 2 and 3 of the Canadian Health Measures Survey. Logistic regression and multinomial logistic regression were used to examine associations between fluoride exposure (from urine and tap water) and indicators of cognitive and thyroid functioning, adjusting for covariates. There was no evidence of any relationship between fluoride exposure and thyroid functioning. Higher urinary fluoride was associated with having some cognitive problems (versus none), but this finding disappeared when the sample was constrained to those for whom we could discern fluoride exposure from drinking water. Future research should continue to utilize this high quality data source to explore other potential harms.
- ItemOpen AccessA combined-methods study of the training and practice of Alberta's therapeutic massage bodywork providers(2012-09-05) Porcino, Antony; Verhoef, Marja J.Background Therapeutic massage bodywork (TMB) therapies are commonly used by the public, nevertheless, research validating TMB is nascent. Practitioner variability may be affecting research outcomes. This study therefore describes and explores the relationship between therapist variables (e.g., training, practice focus) and clinical TMB experience, and the consequent implications for TMB research. Methods A combined methods design, consisting of a quantitative, population-based survey and qualitative interviews with practitioners trained in multiple therapies, was used to explore the training and practice of TMB practitioners in Alberta, Canada. Results Of the 5242 distributed surveys, 791 were returned (15.1%). The sample demographics did not significantly differ from other massage therapist study populations. Practitioners were trained in 77 distinct TMB therapies. Most practitioners (94.4%) were trained in two or more therapies, with a median of 8 and range of 40 therapies. Training programs varied widely in number and type of TMB components, training length, or both. Nineteen practitioners trained in multiple TMB therapies were interviewed. Participants reported greatly varying training backgrounds, resulting in practitioners learning and practicing unique combinations of therapy techniques. Moreover, all practitioners described addressing patients’ needs by providing individualized patient treatment based on a responsive feedback process throughout practice. Additionally, practitioners distrust TMB research results because of perceived and actual treatment provision differences between TMB clinical practice and TMB treatments used in research. Conclusions The training received, the number of therapies trained in, and the practice descriptors of TMB practitioners are all highly variable. Clinical experience and continuing education may further alter or enhance treatment techniques. Therefore, treatment provision and individualization are likely practitioner-specific. Practitioners surmise that clinical trials do not accommodate practitioner variability or treatment individualization, resulting in limited clinical application of TMB research. The high variability in training and experience between practitioners necessitates improved research reporting of practitioner qualifications and expertise, and the consequent impact on the results. TMB research designs need to accommodate the inherent individualization of clinical practice and capture relevant contextual outcomes. Knowledge translation of research results must address TMB practitioners’ perceived differences between TMB research treatments and TMB clinical practice.
- ItemOpen AccessA comparative study of dementia-related service provision and configuration in Canada(2013-09-20) Tam-Tham, Helen; Drummond, Neil; Nettel-Aguirre, AlbertoThe purpose of this study was to describe and compare the provision of dementia-related services throughout the disease trajectory. Previously collected interview data from family physicians, geriatric specialists, and case managers in Calgary, Edmonton, and Ottawa (n=34) using a standardized interview schedule were quantified and thematically categorized. The proportions of participants that identified specific services were analyzed at each stage and cumulatively using chi-square tests; proportions of identifiers were also examined through time using time-to-event analysis. Further, relationships between participants and services were described using social network analysis. The following services were analyzed: neuroimaging, depression-related, delirium-related, future planning, informal support, Alzheimer Society and related, in-home support, and day program services. Overall, the findings indicated variation in service delivery among professionals and locations; family physicians and Ottawa clinicians, particularly, may not be providing services at frequencies and times recommended in national guidelines.
- ItemOpen AccessA Comprehensive Case Study of an Orthopaedic Surgery Central Intake Service in the Winnipeg Regional Health Authority: A Single-Entry Model to Manage Waiting Times for Total Joint Replacement Surgery of the Hip and Knee(2018-04-09) Damani, Zaheed; Marshall, Deborah A.; Noseworthy, Thomas Wm.; Quan, Hude; Bohm, Éric Richard; MacKean, Gail; Yelin, Edward H.; Hildebrand, Kevin A.Background: Single-entry is an increasingly prominent waiting time management strategy in healthcare but its impact on quality of care is poorly understood. We evaluated the Winnipeg Central Intake Service (WCIS) for total joint replacement (TJR) surgery of the hip or knee, a single-entry model (SEM) to manage patients referred for TJR surgery of the hip or knee. Methods: A pre/post mixed-methods case study approach was used to measure the WCIS' influence on six dimensions of quality of care: acceptability, accessibility, appropriateness, effectiveness, efficiency, safety. Qualitative interviews were used to assess experiences of patients, family physicians, orthopaedic surgeons, surgical office assistants and WCIS project team members. A pre/post intervention cross-sectional design was used to quantitatively assess changes in the six dimensions by comparing historical and prospective cohorts. Results: Our qualitative inquiry revealed that benefits of the WCIS included streamlined processes, greater patient access, improved measurement and monitoring of outcomes. Challenges included low awareness, change readiness, and initial participation among stakeholders. Unanticipated consequences included workload increases, confusion around stakeholder expectations, and under-reporting of data by surgeons' offices. Stakeholder acceptability was conditional, not universal. Assessment of capacity and readiness to change, and efforts to increase awareness, preparedness and uptake are critical. Factors for successful implementation include clear communication, robust data collection, physician leadership, and patience by all (especially implementation teams) allowing for an effective top-down, and bottom up approach. Our quantitative analysis revealed that the WCIS reduced variability across surgeon waiting times, with modest reductions in overall waits for surgery. There was improvement in some, but not all, dimensions of quality. Waiting time was significantly improved (WT) for consult for TJR of the hip (WT1) and all WTs for TJR of the knee. Total knee replacement surgeries performed within the nationally-recommended 26-week benchmark increased by 5.9% post-WCIS. Post-surgical complication rates (safety) were lower post-WCIS. Accessibility and safety were the only quality dimensions that changed (post-WCIS for TJR of the hip and knee). Conclusion: Overall, WCIS implementation contributed to improvement in some, but not all dimensions of quality of care. This is the first study to comprehensively assess the influence of SEMs on the delivery of TJRs across all dimensions of quality. Findings of this research are generally consistent with existing literature related to SEMs and change management in healthcare. SEMs show an ability to improve accessibility without adversely affecting other dimensions of quality, albeit with conditional, not universal stakeholder acceptability. Limitations of this study include non-longitudinal cohorts, and availability and quality of data. Findings from this research can help strengthen existing SEMs and inform development of new ones for improved patient experience and outcomes and system performance.
- ItemOpen AccessA History of the Social Determinants of Health in Canada through the Lens of the Canadian Public Health Association, 1910-2010: Implications for Present and Future Population Health in Canada(2017) Lucyk, Kelsey; McLaren, Lindsay; Stahnisch, Frank W.The 2008 final report of the WHO’s Commission on Social Determinants of Health (SDOH) marked a watershed in the history of the SDOH for bringing together decades of evidence and theory on the social causes of illness from the diverse health research landscape. Yet, a rich history predates this and other contributions (e.g., 1974 Lalonde Report) that are widely credited as the start of the SDOH approach. This history is revealed through casting the contemporary interpretive lens of the SDOH onto the past. I gained a nuanced understanding of the emergence and evolution of the SDOH in Canada by analyzing the archives of the Canadian Public Health Association (CPHA) from 1910 to 2010. I applied a social history and critical public health perspective while exploring this data using methods of thematic content analysis. To situate my findings with relevance to the contemporary landscape of population and public health (PPH), I complemented my analysis of archival sources with that of published and grey SDOH literature, print news articles, and oral history interviews with PPH leaders. My findings show that as a way of thinking, the SDOH approach is complex and diffuse. This, coupled with the inherently political nature of the SDOH, presents challenges in terms of communicating key messages of the SDOH to decision-makers and the public. Additionally, the history of the SDOH is non-linear and changes alongside social, economic, and political events. Economic recession and growth, for example, at times brought more and less urgency to act on the SDOH within the Canadian PPH community. However, despite that ebb and flow, the foundations of health equity and social justice have remained firm throughout the history of the SDOH. These foundations, combined with the growth and increasing disciplinary coherence of PPH, suggest that action on the SDOH will remain a core commitment of PPH.
- ItemOpen AccessA Mathematical Model For Optimal Admission Screening For Methicillin Resistant Staphylococcus aureus In Acute Care Facilities(2016-01-26) Simmonds, Kimberley Anne; Henderson, Elizabeth; Laupland, Kevin; Joffe, Mark; Svenson, Larry; Dean, Stafford; Li, MichaelMethicillin-resistant Staphylococcus aureus (MRSA) is one of the most common healthcare associated infections (HAIs) worldwide. It has both an economic and personal cost to the healthcare system and infected individuals. Admission screening for MRSA is one method to detect MRSA entering the acute care system. Screening combined with isolation is currently a common method for preventing MRSA transmission in Alberta acute care facilities. There remains uncertainty about the best methods to screening patients for MRSA. Universal screening is the testing of all patients admitted to the hospital, regardless of their risk of MRSA colonization; conversely targeted screening only tests a selected patient population considered at greatest risk for MRSA colonization. Mathematical models for infectious diseases, such as MRSA, are very useful for predicting outcomes with varying scenarios. The purpose of this project was to develop and validate a deterministic differential equations model for MRSA transmission to determine the optimal screening method for the detection of MRSA infected individuals entering acute care facilities. Based on the local epidemiology used to develop this model, the conclusions drawn from the model are that targeted screening of 70-90% of high-risk patients will reduce unidentified-infected MRSA positive individuals. However, this Alberta model that shows a targeted screening program for high-risk individuals with horizontal measures to reduce the hospital transmission rate is the most effective way to reduce MRSA in Alberta acute care facilities.
- ItemOpen AccessA Meta-Analysis of Hydroxyurea Use for β-thalassemia: Implications for Clinical Practice and Medical Education(2015-11-18) Algiraigri, Ali; Kassam, Aliya; Oddone Paolucci, Elizabeth; Wright, NicolaChronic blood transfusion remains the most feasible therapeutic option for the majority of patients with severe β-thalassemia. However, it is associated with serious risks and complications. An alternative option is desirable and may prevent some of the problems associated with current therapy. Hydroxyurea (HU), an oral chemotherapeutic drug, is expected to increase hemoglobin, thereby minimizing the burden of blood transfusion and its complications. The objective of this study was to conduct a systematic review and meta-analysis to evaluate the clinical efficacy and safety of HU in patients with severe β-thalassemia. HU appears to be effective, well tolerated and associated with mild and transient adverse events; however, large randomized clinical trials (RCTs) should be done to confirm such findings. Nonetheless, based on the results of the present meta-analysis, it is recommended that current practice guidelines for severe β-thalassemia be appended to include a trial of HU.
- ItemOpen AccessA Mixed Methods Approach to Identifying Barriers and Supports to Physical Activity in Adults Following Residential Relocation(2018-01-25) Salvo, Grazia; McCormack, Gavin; Lashewicz, Bonnie; Doyle-Baker, TishUsing a systematized review of qualitative studies and a quasi-longitudinal mixed methods analysis of primary data, this thesis explored the built environment’s influence on physical activity among adults. The systematized review provided insight into functional, aesthetic, destination, and safety characteristics’ that are associated with physical activity. Sociodemographic characteristics were also found to affect the built environment-physical activity relationship. In the mixed methods analysis, quantitative data suggested positive associations between self-reported changes in transportation walking and cycling and improvements in objectively measured neighbourhood walkability (Walk Score®) following residential relocation. Findings from the qualitative semi-structure interviews reinforced the quantitative findings and specifically highlighted the importance of having access to safe walking and cycling paths and nearby destinations that support active transportation. The interview data also suggested neighbourhood opportunities that allow adults to connect with community, family and the environment while being active supported enjoyable physical activity. Notably, some participants also reported using time spent on active transportation to compensate for changes in time spent in leisure physical activity. The thesis findings have the potential to inform urban planning and policy for improving physical activity and in turn health in adult populations.
- ItemOpen AccessA Mixed Methods Study of the Continuing Medical Education Needs of Canadian and Calgary Nephrologists(2015-04-30) Bass, Adam; Lockyer, JocelynObjectives: To determine the continuing medical education (CME) needs of Canadian and Calgary nephrologists. Methods: A mixed-methods approach was taken to determine the educational needs of Canadian and Calgary nephrologists. Data collected included a survey of members of the Canadian Society of Nephrology, individual interviews with Calgary nephrologists, individual interviews with editors of nephrology journals, maintenance of certification data from the Royal College of Physicians and Surgeons of Canada, and administrative data on hospital admissions from the Foothills Medical Centre (Calgary, Canada) nephrology inpatient service. Results: In general, nephrologists participate in traditional CME, both locally and at national/international conferences, and perceive CME as serving multiple functions, including identifying learning needs, improving learning, and providing opportunities for networking and socializing with colleagues. Although they rate the quality of their current CME activities highly, there are diverse opinions on the ideal content and format of CME. Most, however, appear to prefer in-person to on-line activities and are interested in content areas that they do not encounter frequently while attending on clinical service. A mixed methods approach helped identify key similarities and differences that spanned two or more data sets in the domains of local CME/CPD planning, content characteristics, content topics, format, collegial interactions and barriers. Conclusions: A mixed methods approach to the determination of educational needs of nephrologists provided data that will enable the development of a local CME/CPD program for nephrologists.
- ItemOpen AccessA Multidisciplinary Clinic for Children with Problematic Severe Asthma: Assessment of Clinical Outcomes, Healthcare Utilization and Costs(2014-12-24) Kam, Karen; Currie, Gillian; Nettel-Aguirre, AlbertoBackground: The Intensive Management of Asthma Clinic (IMAC) at the Alberta Children’s Hospital is a novel multidisciplinary clinic for children with severe problematic asthma. Whether consolidating resources in this clinic is effective, compared to the regular asthma clinic, has not been studied. Methods: This quasi-experimental retrospective study compared the IMAC and regular asthma clinic. Data was collected in three categories: clinical outcomes, healthcare utilization, and costs (healthcare utilization, patient-borne). Primary analyses used linear mixed effects modeling, paired t-tests, and ANOVA. Results: Lung function improved more for IMAC patients. Quality of life scores, measured only in the IMAC, improved. Scheduled clinic visits increased, while ED visits decreased. The increased cost of the IMAC was greater than the total costs saved by subsequent decreased healthcare utilization; overall the IMAC was more expensive. Conclusion: The IMAC is effective in improving clinical outcomes and decreasing healthcare utilization; however, these benefits come at extra cost.
- ItemOpen AccessA Spatial Epidemiological Analysis of Stroke in Alberta, Canada, Using GIS.(2015-01-08) van Rheenen, Susan M.; Hill, Michael D.; Watson, Tim W.J.Stroke is the potentially devastating result of a sudden interruption of blood flow to the brain. It is a leading cause of death and disability world wide and incidence is expected to increase due to an aging population and increased prevalence in risk factors. Epidemiological research can enhance our understanding of stroke as a health problem in the population with respect to the extent of disease incidence and prevalence, the efficacy of health care delivery for stroke prevention and acute care, and to inform public health policy and planning. Geographic Information Systems (GIS) technology and spatial methods provide the means to store and retrieve spatially indexed health data, display the spatial information in maps, and conduct analyses examining health service delivery and utilization. The overall objective of this research is to enrich our current understanding of stroke as a health problem in the province of Alberta, Canada. This thesis is comprised of three studies. The first study utilized GIS-based methods and administrative datasets to identify and locate significant clusters of high and low rates of the major stroke types and in-hospital mortality. Important questions were raised regarding why regional differences exist and how disparities might be mitigated. The second study expanded upon the cluster analysis with an examination of associations between selected predictors and stroke and mortality hot and cold spots, mortality at the individual level, and recurrent stroke, using multivariable logistic regression. Distance from specialized stroke care was a significant predictor of index and recurrent stroke and mortality. EMS transport and Comprehensive Stroke Centre care significantly lowered the odds of stroke mortality. The third study employed spatial methods to evaluate the concordance of GIS predicted versus actual EMS ground transport times and to estimate the proportion of the Alberta population with potential and realized access to stroke care within critical time windows. GIS methods predicted ground transport time with reasonable accuracy and there was expanded access to stroke care over a 5-year time span. This research highlights the benefits of incorporating spatial methods and GIS in epidemiological research to elucidate how and to what extent place matters to health.
- ItemOpen AccessA systematic approach to using regression modelling and ‘big data’ to derive a meaningful clinical decision rule for epilepsy(2018-08-22) Josephson, Colin Bruce; Wiebe, Samuel; Jetté, Nathalie; Sajobi, Tolulope T.; Marshall, Deborah A.Introduction: clinical decision rules (CDRs) have been developed in a number of medical fields resulting in improved patient outcomes, quality of care, and health economics. Aims: to identify all CDRs developed for epilepsy and to derive one that guides the prescription of the antiepileptic drug (AED), levetiracetam, according to its risk of a psychiatric adverse effect. Methods: a systematic review and meta-analysis was first performed to determine the state of the literature with respect to CDRs in epilepsy. The Health Improvement Network (THIN) electronic medical records register was used to identify patients with epilepsy by employing a modified validated case definition with a 5-year washout. Analyses were restricted to patients receiving AED monotherapy and the association between levetiracetam use and psychiatric adverse effects was explored Cox proportional hazards regression with timevarying covariates. Finally, logistic regression with parameter regularisation and k=5 fold cross validation was used to derive the CDR that predicts the development of psychiatric adverse effects following levetiracetam prescription. Results: the systematic review identified four epilepsy-specific CDRs, none of which guided AED prescription. A total of 9595 presumed incident cases of epilepsy (85.7 cases per 100,000 persons) were identified in THIN. Both carbamazepine (hazard ratio [HR]: 0.84, 95% confidence interval [95% CI]: 0.73– 0.97; p = 0.02) and lamotrigine (HR: 0.83, 95% CI: 0.70–0.99; p = 0.03) were associated with reduced hazards of a psychiatric sign, symptom, or disorder iii compared to no AED treatment. Levetiracetam was not associated with psychiatric adverse effects but the analyses were underpowered (n=202; 3%). All patients receiving levetiracetam (1173/7400; 16%) were included for CDR derivation. Prediction variables were incorporated into multiple logistic regression models with parameter regularisation. Odds of reporting a psychiatric complaint were elevated for females and those with a pre-exposure history of depression, anxiety, recreational drug use, or higher social deprivation. The prediction model performed well (area under the curve [AUC] 0.68; 95% confidence interval 0.58- 0.79 after stratified k=5 fold cross-validation). Using a cut-off threshold 0.1, the CDR had a specificity of 83%. Conclusion: If externally validated and properly implemented, this CDR could be used to guide prescription in clinical practice.
- ItemOpen AccessA Targeted Needs Assessment for a Transitional “Boot Camp” Curriculum for Pediatric Surgery Residents(2015-04-30) Blackmore, Christopher; Oddone Paolucci, ElizabethTransition periods in medical education are associated with increased risk for learners and patients. In pediatric surgery, the transition to specialty is especially difficult as learners adjust to new patient populations. In this study we performed a targeted needs assessment to determine the ideal content and format of a pediatric surgery boot camp to aid in the transition to residency. The survey was distributed to pediatric surgery residents and staff across North America. No significant differences were identified between staff and residents in survey responses. The top 5 topics identified for inclusion in a boot camp were: 1) Fluid and electrolyte management, 2) Appendicitis, 3) Pediatric Hernias, 4) Nutrition and 5) Pain Management. The preferred duration for a boot camp was 3-4 days using a variety of educational methods including e-learning, simulation and small group teaching. Based on results of the needs assessment survey, a novel pediatric surgery boot camp curriculum can be developed.
- ItemOpen AccessAdministrative Coding of Type 1 and Type 2 Diabetes: Assessment of Validity and Implications of Coding Practices ob Outcome Evaluation(2013-10-01) Burs, Simona; Rabi, Doreen; Ghali, WilliamRationale: Administrative coding of diabetes mellitus is a difficult task. Objectives: to evaluate misclassification of diabetes status and type, examine contributors to classification uncertainty and explore how difficult cases are perceived by health professionals. Methods: A chart review was performed to validate coding of diabetes type in two data sources. The presence or absence of key clinical information and documentation deficiencies were evaluated. Health professionals were surveyed regarding classification of uncertain cases. Results: 1) Misclassification of diabetes status and type were higher in APPROACH (7.1% and 6.4%) than in ICD-10 (3.6% and 4.3%); 2) treatment with insulin was associated with classification uncertainty (Χ2=36.16; p<0.001); 3) documentation deficiencies were prevalent and were higher in the uncertain classification group (30% vs. 18%). Conclusions: This thesis highlights some elements related to diabetes misclassification. Clear documentation by physicians is required to improve administrative coding of diabetes. Improving administrative data quality may lead to improved outcomes. Keywords: administrative coding, diabetes mellitus, misclassification, insulin
- ItemOpen AccessAdvanced Cancer Patients' Perspectives on a Video Decision Support Aid used to Enhance Goals of Care Discussions(2016) Grendarova, Petra; Hebert, Marilynne; Carr, Eloise; Trotter, Theresa; Kerba, MarcThe purpose of this study was to explore perspectives of advanced cancer patients on the use of a video decision support aid developed to enhance Goals of Care (GOC) discussions and to examine how the video influenced participants' perceptions and knowledge about GOC. A qualitative approach was applied to collect data from participants before and after watching the video. Semi-structured interviews were conducted with 14 participants from an Outpatient Radiation Oncology Bone Metastases Clinic. Extended Elaboration Likelihood Model was the conceptual framework used to guide data analyses. Participants found the video scenarios made the GOC framework more personally relevant. They were able to relate their experiences to the video. Participants found the timing and professional clinic environment appropriate for watching the video. Several participants expressed their intention to initiate discussions with their health care providers and to formalize their GOC plans.
- ItemOpen AccessAn Economic Evaluation of a Novel Electronic Discharge Communication Tool(2017) Sevick, Laura; Clement, Fiona; Ghali, William; Santana, MariaThe transition from acute-care hospitalization to community-based care is a vulnerable period in healthcare delivery due to potential for post-discharge adverse events. This vulnerability has been attributed to the miscommunication between acute and community-based physicians, as current systems do not control for legibility, completeness or timeliness of the discharge summary. One potential approach to bridging this communication gap is the use of electronic discharge communication tools, which can be designed to ensure the consistent and timely transfer of information. Given the limited healthcare budget, the costs and benefits of these tools should be considered prior to large scale implementation. Thus, the goal of this thesis is to establish the cost-effectiveness of electronic discharge communication tools. To achieve this, a systematic review of published literature was conducted (Chapter 2), a prospective economic evaluation of a novel electronic discharge communication tool was completed (Chapter 3), and policy options/considerations were presented (Chapter 4).
- ItemOpen AccessAn Economic Evaluation of the Syncope: Pacing or Recording in the Later Years (SPRITELY) Trial(2018-07-06) Hofmeister, Mark Ronald; Clement, Fiona M.; Spackman, David Eldon; Sheldon, Robert S.The Syncope: Pacing or Recording In ThE Later Years (SPRITELY) trial tests the hypothesis that pacemaker insertion in patients with syncope, bifascicular block, and age greater than 50 years prevents syncope recurrences and major clinical events more effectively than therapy guided by monitoring with an implantable loop recorder. Equipoise or uncertainty reflected in guidelines and recommendations for both strategies may contribute to variation in management and inefficient resource use. Clinical analysis of the SPRITELY trial is complemented with an economic evaluation. The goal of this thesis was to establish the relative cost-effectiveness of the implantable loop recorder and the pacemaker in patients with bifascicular block, unexplained syncope, and age greater than 50 years. An economic evaluation of the SPRITELY trial was conducted to match the prespecified time horizon of two years for the clinical analysis (Chapter 3), and a decision analytic model was built to extend the time horizon to three years to match clinical practice (Chapter 4). In Chapter 5, the effect of taking three different national perspectives for the SPRITELY trial evaluation was explored. This thesis ends with a discussion and conclusions in Chapter 6.
- ItemOpen AccessAn Evaluation of the Primary-to-Specialist Referral System for Elective Hip and Knee Replacements in Alberta(2012-12-04) Fyie, Kenneth Alan; Marshall, DeborahIntroduction: Long waiting times for elective surgical procedures in the Canadian healthcare system are a concern for patients, physicians, and governments. Objective: To measure how changes in elective hip and knee arthroplasty referral processing for primary-to-specialist surgical consultations may impact accessibility, referral appropriateness, and efficiency. Methods: I documented current referral practices by conducting semi-structured interviews with clinical staff at three Alberta hip and knee musculoskeletal clinics, determined accessibility and referral appropriateness outcomes by reviewing 218 patient charts, and efficiency outcomes by conducting time studies at each clinic. Using scenario analyses, I estimated expected system-related improvements from implementing an electronic referral tool. Results: 20-54% of received referrals were incomplete or incorrectly directed, with involuntary waits accounting for 11-15% of waiting times. Implementing electronic referral could reduce inappropriate referrals, waiting time, and reduce staff time to process referrals by 20-25%. Conclusion: An electronic referral tool may reduce waiting times through streamlined referral practices.
- ItemOpen AccessAn Examination of the Impact of Simulation and Multimedia Instruction on Central Venous Catheterization(2017) Lord, Jason; Lockyer, Jocelyn; Palacios Mackay, Maria; Zuege, DannyDependable assessment tools are essential for Competency Based Medical Education (CBME). Competence in central venous catheterization (CVC) is a key objective to be learned by trainees. Tools to assess technical competency include checklists, critical error tools, Objective Structured Assessment for Technical Skills (OSATS) tools and the Ottawa Surgical Competency Operating evaluation (O-SCORE) tool. This study examined the impact of a simulation-based educational intervention on resident knowledge and performance of CVC. It also compared the dependability of the scores derived from the four assessment tools. Junior residents completing their first ICU rotation in Calgary participated in the study. The control group received didactic instruction. The intervention group received simulation-based teaching and an online multimedia educational module. No observed differences between groups were identified in any of the assessment measures. Global rating scales such as the OSATS or O-SCORE tools outperformed checklists or critical error tools when assessing competence for this procedure.
- ItemOpen AccessAn Exploration of Deference Behaviours Exhibited within the Paediatric Resuscitation Environment(2017) Delaloye, Nicole; Gilfoyle, Elaine; Oddone Paolucci, Elizabeth; Ellaway, Rachel; Kassam, AliyaHealthcare professionals’ deference to physician expertise has been observed across a variety of clinical settings. Although such behaviour often results in appropriate and efficient patient care, deference can become detrimental when an inappropriate order or action goes unchallenged. This study aimed to identify the underlying factors influencing deference behaviours exhibited within the paediatric resuscitation environment. Through a three-phase study design and thematic analysis approach informed by principles of grounded theory, six overarching factors were found to influence deference behaviours: factors located outside the resuscitation environment, factors located inside the resuscitation environment, individual characteristics, mental state and experience, cognition, and motivation. Together these six factors were found to influence deference and its associated actions and responses (obedience, conformity, compromise, and rejection). The identification of these factors and this novel understanding of deference could potentially guide healthcare professionals, educators, and researchers in the development of strategies to mitigate instances of compromised patient care.x