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Couturier JL, Kimber M, Ford C, Coelho JS, Dimitropoulos G, Kurji A, Boman J, Isserlin L, Bond J, Soroka C, Dominic A, Boachie A, McVey G, Norris M, Obeid N, Pilon D, Spettigue W, Findlay S, Geller J, Grewal S, Gusella J, Jericho M, Johnson N, Katzman D, Chan N, Grande C, Nicula M, Clause-Walford D, Leclerc A, Loewen R, Loewen T, Steinegger C, Waite E, Webb C, Brouwers M. A study protocol for implementing Canadian Practice Guidelines for Treating Children and Adolescents with Eating Disorders. Implement Sci Commun 2024; 5:5. [PMID: 38183084 PMCID: PMC10768347 DOI: 10.1186/s43058-023-00538-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/11/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND Eating disorders have one of the highest mortality rates among psychiatric illnesses. Timely intervention is crucial for effective treatment, as eating disorders tend to be chronic and difficult to manage if left untreated. Clinical practice guidelines play a vital role in improving healthcare delivery, aiming to minimize variations in care and bridge the gap between research and practice. However, research indicates an active guideline implementation approach is crucial to effective uptake. METHODS Mixed methods will be used to inform and evaluate our guideline implementation approach. Semi-structured focus groups will be conducted in each of the eight provinces in Canada. Each focus group will comprise 8-10 key stakeholders, including clinicians, program administrators, and individuals with lived experience or caregivers. Qualitative data will be analyzed using conventional content analysis and the constant comparison technique and the results will be used to inform our implementation strategy. The study will then evaluate the effectiveness of our implementation approach through pre- and post-surveys, comparing changes in awareness, use, and impact of the guidelines in various stakeholder groups. DISCUSSION Through a multifaceted implementation strategy, involving the co-creation of educational materials, tailored training, and context-specific strategies, this study intends to enhance guideline uptake and promote adherence to evidence-based practices. Our study will also contribute valuable information on the impact of our implementation strategies.
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Affiliation(s)
- Jennifer L Couturier
- McMaster Children's Hospital, McMaster University, 1200 Main St W, Hamilton, ON, L8N 3Z5, Canada.
| | - Melissa Kimber
- McMaster Children's Hospital, McMaster University, 1200 Main St W, Hamilton, ON, L8N 3Z5, Canada
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Sheri Findlay
- McMaster Children's Hospital, McMaster University, 1200 Main St W, Hamilton, ON, L8N 3Z5, Canada
| | - Josie Geller
- University of British Columbia, Vancouver, Canada
| | - Seena Grewal
- University of British Columbia, Vancouver, Canada
| | | | | | - Natasha Johnson
- McMaster Children's Hospital, McMaster University, 1200 Main St W, Hamilton, ON, L8N 3Z5, Canada
| | | | | | | | - Maria Nicula
- McMaster Children's Hospital, McMaster University, 1200 Main St W, Hamilton, ON, L8N 3Z5, Canada
| | - Drew Clause-Walford
- McMaster Children's Hospital, McMaster University, 1200 Main St W, Hamilton, ON, L8N 3Z5, Canada
| | | | | | | | | | | | - Cheryl Webb
- McMaster Children's Hospital, McMaster University, 1200 Main St W, Hamilton, ON, L8N 3Z5, Canada
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Mooney J, Dominic A, Lewis A, Chafe R. Young adults with eating disorders perspectives on educational resources to support the transition into adult medicine: a thematic analysis. J Eat Disord 2023; 11:46. [PMID: 36959660 PMCID: PMC10034871 DOI: 10.1186/s40337-023-00771-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 03/13/2023] [Indexed: 03/25/2023] Open
Abstract
Background Eating disorders (EDs) commonly develop in adolescence and can be a chronic condition. Once patients reach the age when it is no longer permitted or appropriate for them to be seen in a children’s healthcare setting, they will need to transition into adult-focused care. This transition period can be challenging, with increased risks of negative health outcomes and disruptions in care. Appropriate educational resources could be an effective support for patients during this transition. Our objectives were to engage patients about the value of developing educational supports and determine how these supports should be structured to be most useful to young adults with EDs. Methods Patients who had transitioned out of a hospital-based ED program between 2017 and 2020 were invited to participate in a semi-structured interview. Data were analyzed using thematic analysis and qualitative description. Results Six young adults (5 females and 1 male) with EDs were interviewed. All participants thought it would be helpful to have an educational resource. Three main themes and seven subthemes were identified. Themes identified related to the unique challenges of transition for ED patients given the age of onset and cycle of symptoms; issues in adult care related to comorbidities and new level of autonomy; and the value of educational resources as both a connection tool and a benchmark. Participants also thought it would be useful to include in any educational resource a summary of their previous treatments, information regarding the transition process, a list of main healthcare providers they saw for their ED, a description of the differences and expectations of the adult system, a list of their follow up appointments, and a list of community and emergency mental health resources. Conclusions Participants said that educational supports can play a useful role for young adults with EDs during their transition into adult care. They also provided valuable insights into the desired contents of such supports and expanded on the roles that educational resources could serve for ED patients. Most adolescents who have an eating disorder will reach an age when it is no longer appropriate for them to receive care in a children’s health program. They will then need to transition to an adult-focused program. This transition period can be challenging, with increased risks of negative health outcomes and disruptions in care. One approach for better supporting patients during transition is through the development of appropriate educational resources. Before developing these resources, it is important to hear from patients about how they should be structured to be as useful as possible. We interviewed six patients who had recently transitioned out of a pediatric eating disorder program about the value of an educational transition resource and what should be included in it. Patients identified several unique transition issues for young adults with eating disorders. We identified valuable insights and seven key themes from these interviews. While all patients recognized the value of educational resources, rather than being just a static source of information, they envisioned a resource that could also be a dynamic record of their previous care and a tool for engaging with their new adult-focused health care providers.
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Affiliation(s)
- Jennifer Mooney
- grid.17091.3e0000 0001 2288 9830Division of Adolescent Health and Medicine, Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Anna Dominic
- grid.25055.370000 0000 9130 6822Discipline of Pediatrics, Faculty of Medicine, Memorial University of Newfoundland, Room 409, Janeway Hostel, 300 Prince Phillip Drive, St. John’s, NL A1B 3V6 Canada
| | - Alyona Lewis
- grid.25055.370000 0000 9130 6822Canadian Longitudinal Study On Aging (CLSA), Memorial University of Newfoundland, St. John’s, Canada
| | - Roger Chafe
- grid.25055.370000 0000 9130 6822Discipline of Pediatrics, Faculty of Medicine, Memorial University of Newfoundland, Room 409, Janeway Hostel, 300 Prince Phillip Drive, St. John’s, NL A1B 3V6 Canada
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Katzman DK, Spettigue W, Agostino H, Couturier J, Dominic A, Findlay SM, Lam PY, Lane M, Maguire B, Mawjee K, Parikh S, Steinegger C, Vyver E, Norris ML. Incidence and Age- and Sex-Specific Differences in the Clinical Presentation of Children and Adolescents With Avoidant Restrictive Food Intake Disorder. JAMA Pediatr 2021; 175:e213861. [PMID: 34633419 PMCID: PMC8506291 DOI: 10.1001/jamapediatrics.2021.3861] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE To our knowledge, this is the first pediatric surveillance study of children and adolescents with avoidant restrictive food intake disorder (ARFID). OBJECTIVES To examine the incidence and age- and sex-specific differences in the clinical presentation of ARFID in children and adolescents in Canada. DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional study, patients with ARFID were identified through the Canadian Paediatric Surveillance Program by surveying 2700 Canadian pediatricians monthly from January 1, 2016, to December 31, 2017. MAIN OUTCOMES AND MEASURES The incidence of ARFID in Canadian children (5-18 years of age) and age- and sex-specific clinical characteristics at presentation. RESULTS In total, 207 children and adolescents (mean [SD] age, 13.1 [3.2] years; 127 [61.4%] female) were included in this study. The incidence of ARFID in children 5 to 18 years of age was 2.02 (95% CI, 1.76-2.31) per 100 000 patients. Older children and adolescents were more likely to endorse eating too little (5-9 years of age: 76.7%; 95% CI, 58%-88.6; 10-14 years of age: 90.9%; 95% CI, 84.6%-94.8%; 15-18 years of age: 95.6%; 95% CI, 83.6%-98.9%; P = .02), have a loss of appetite (5-9 years of age: 53.3%; 95% CI, 35.4%-70.4%; 10-14 years of age: 74.2%; 95% CI, 66.0%-81.0%; 15-18 years of age: 80.0%; 95% CI, 65.5%-89.4%; P = .03), be medically compromised (mean body mass index z score: 10-14 vs 5-9 years of age: -1.31; 95% CI, -2.0 to -0.6; 15-18 vs 5-9 years of age: -1.35; 95% CI, -2.2 to -0.5; 15-18 vs 10-14 years of age: -0.04; 95% CI, -0.6 to 0.5; P < .001; mean percentage of treatment goal weight: 10-14 vs 5-9 years of age: -8.6; 95% CI, -14.3 to -2.9; 15-18 vs 5-9 years of age: -9.8; 95% CI, -16.3 to -3.3; 15-18 vs 10-14 years of age: -1.2; 95% CI, -5.8 to 3.4; P < .001; mean heart rate (beats per min): 10-14 vs 5-9 years of age: -10; 95% CI, -21.9 to 1.9; 15-18 vs 5-9 years of age: -19.7; 95% CI, -33.1 to -6.2; 15-18 vs 10-14 years of age: -9.7; 95% CI, -18.7 to -0.7; P = .002), have higher rates of anxiety (5-9 years of age: 26.7%; 95% CI, 13.7-45.4; 10-14 years of age: 52.3%; 95% CI, 43.7%-60.7%; 15-18 years of age: 53.3%; 95% CI, 38.6%-67.5%; P = .03) and depression (5-9 years of age: 0%; 10-14 years of age: 6.8%; 95% CI, 3.6%-12.7%; 15-18 years of age: 26.7%; 95% CI, 15.7%-41.6%; P < .001), and be more likely to be hospitalized (5-9 years of age: 13.3%; 95% CI, 5.0%-31.1%; 10-14 years of age: 41.7%; 95% CI, 33.5%-50.3%; 15-18 years of age: 55.6%; 95% CI, 40.7%-69.5%; P = .001). Younger children were more likely to endorse lack of interest in food (5-9 years of age: 56.7%; 95% CI, 38.4%-73.2%; 10-14 years of age: 75.0%; 95% CI, 66.8%-81.7%; 15-18 years of age: 57.8%; 95% CI, 42.8%-71.4%; P = .03), avoidance of certain foods (5-9 years of age: 90.0%; 95% CI, 72.6%-96.8%; 10-14 years of age: 69.7%; 95% CI, 61.3%-77.0%; 15-18 years of age: 62.2%; 95% CI, 47.2%-75.3%; P = .03), and refusal based on sensory characteristics (5-9 years of age: 66.7%; 95% CI, 47.9%-81.3%; 10-14 years of age: 38.6%; 95% CI, 30.7%-47.3%; 15-18 years of age: 22.2%; 95% CI, 12.3%-36.9%; P < .001). Eating but not enough was more common in girls (75.0%; 95% CI, 64.1%-83.4%) vs boys (68.5%; 95% CI, 59.8%-76.1; P = .04), and boys had a higher rate of refusal based on sensory characteristics (51.2%; 95% CI, 40.2%-62.2%) compared with girls (31.5%; 95% CI, 23.9%-40.2%; P = .007). CONCLUSIONS AND RELEVANCE This study suggests that ARFID is a relatively common eating disorder and is associated with important age- and sex- specific clinical characteristics that may help in early recognition and timely treatment of the presenting symptoms.
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Affiliation(s)
- Debra K. Katzman
- Division of Adolescent Medicine, Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Wendy Spettigue
- Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Holly Agostino
- Montreal Children’s Hospital and McGill University Health Center, Montreal, Quebec, Canada
| | - Jennifer Couturier
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Anna Dominic
- Janeway Children’s Health & Rehabilitation Centre, Eastern Health, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| | - Sheri M. Findlay
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Pei-Yoong Lam
- BC Children’s Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Margo Lane
- Winnipeg Health Sciences Centre and University of Manitoba, Winnipeg, Manitoba, Canada
| | - Bryan Maguire
- Biostatistics, Design and Analysis, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Karizma Mawjee
- Division of Adolescent Medicine, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada,Now with KPMG LLP (Canada), Toronto, Ontario, Canada
| | - Supriya Parikh
- Biostatistics, Design and Analysis, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Cathleen Steinegger
- Division of Adolescent Medicine, Department of Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Ellie Vyver
- Alberta Children’s Hospital and University of Calgary, Calgary, Alberta, Canada
| | - Mark L. Norris
- Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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Agostino H, Burstein B, Moubayed D, Taddeo D, Grady R, Vyver E, Dimitropoulos G, Dominic A, Coelho JS. Trends in the Incidence of New-Onset Anorexia Nervosa and Atypical Anorexia Nervosa Among Youth During the COVID-19 Pandemic in Canada. JAMA Netw Open 2021; 4:e2137395. [PMID: 34874405 PMCID: PMC8652595 DOI: 10.1001/jamanetworkopen.2021.37395] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
IMPORTANCE The COVID-19 pandemic has had considerable mental health consequences for children and adolescents, including the exacerbation of previously diagnosed eating disorders. Whether the pandemic is a factor associated with the concomitant increase in new-onset anorexia nervosa or atypical anorexia nervosa remains unknown. OBJECTIVE To assess the incidence and severity of newly diagnosed anorexia nervosa or atypical anorexia nervosa in a national sample of youth before and during the first wave of the COVID-19 pandemic. DESIGN, SETTING, AND PARTICIPANTS This repeated cross-sectional study analyzed new eating disorder assessments that were conducted at 6 pediatric tertiary-care hospitals in Canada between January 1, 2015, and November 30, 2020. Patients aged 9 to 18 years with a new anorexia nervosa or atypical anorexia nervosa diagnosis at the index assessment were included. EXPOSURES COVID-19-associated public health confinement measures during the first wave of the pandemic (March 1 to November 30, 2020). MAIN OUTCOMES AND MEASURES Primary outcomes were the incidence and hospitalization rates within 7 days of de novo anorexia nervosa or atypical anorexia nervosa diagnosis. Event rate trends during the first wave were compared with trends in the 5-year prepandemic period (January 1, 2015, to February 28, 2020) using an interrupted time series with linear regression models. Demographic and clinical variables were compared using a χ2 test for categorical data and t tests for continuous data. RESULTS Overall, 1883 children and adolescents with newly diagnosed anorexia nervosa or atypical anorexia nervosa (median [IQR] age, 15.9 [13.8-16.9] years; 1713 female patients [91.0%]) were included. Prepandemic anorexia nervosa or atypical anorexia nervosa diagnoses were stable over time (mean [SD], 24.5 [1.6] cases per month; β coefficient, 0.043; P = .33). New diagnoses increased during the first wave of the pandemic to a mean (SD) of 40.6 (20.1) cases per month with a steep upward trend (β coefficient, 5.97; P < .001). Similarly, hospitalizations for newly diagnosed patients increased from a mean (SD) of 7.5 (2.8) to 20.0 (9.8) cases per month, with a significant increase in linear trend (β coefficient, -0.008 vs 3.23; P < .001). These trends were more pronounced in Canadian provinces with higher rates of COVID-19 infections. Markers of disease severity were worse among patients who were diagnosed during the first wave rather than before the pandemic, including more rapid progression (mean [SD], 7.0 [4.2] months vs 9.8 [7.4] months; P < .001), greater mean (SD) weight loss (19.2% [9.4%] vs 17.5% [9.6%]; P = .01), and more profound bradycardia (mean [SD] heart rate, 57 [15.8] beats per minute vs 63 [15.9] beats per minute; P < .001). CONCLUSIONS AND RELEVANCE This cross-sectional study found a higher number of new diagnoses of and hospitalizations for anorexia nervosa or atypical anorexia nervosa in children and adolescents during the first wave of the COVID-19 pandemic in Canada. Research is needed to better understand the drivers and prognosis for these patients and to prepare for their mental health needs in the event of future pandemics or prolonged social isolation.
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Affiliation(s)
- Holly Agostino
- Division of Adolescent Medicine, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Brett Burstein
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Dina Moubayed
- Section of Adolescent Medicine, Department of Pediatrics, Sainte Justine Hospital, Université de Montréal, Montreal, Quebec, Canada
| | - Danielle Taddeo
- Section of Adolescent Medicine, Department of Pediatrics, Sainte Justine Hospital, Université de Montréal, Montreal, Quebec, Canada
| | - Rosheen Grady
- Division of Adolescent Medicine, Department of Pediatrics, McMaster’s Children’s Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Ellie Vyver
- Section of Adolescent Medicine, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Gina Dimitropoulos
- Faculty of Social Work, Departments of Pediatrics and Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Anna Dominic
- Division of Adolescent Medicine, Department of Pediatrics, Janeway Children’s Hospital, Memorial University, St John’s, Newfoundland, Canada
| | - Jennifer S. Coelho
- Department of Psychiatry, University of British Columbia, and Provincial Specialized Eating Disorders Program for Children and Adolescents, British Columbia Children’s Hospital, Vancouver, British Columbia, Canada
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Thoduparambil PP, Dominic A, Varghese SM. EEG-based deep learning model for the automatic detection of clinical depression. Phys Eng Sci Med 2020; 43:1349-1360. [PMID: 33090373 DOI: 10.1007/s13246-020-00938-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 10/10/2020] [Indexed: 11/28/2022]
Abstract
Clinical depression is a neurological disorder that can be identified by analyzing the Electroencephalography (EEG) signals. However, the major drawback in using EEG to accurately identify depression is the complexity and variation that exist in the EEG of a depressed individual. There are several strategies for automated depression diagnosis, but they all have flaws, which make the diagnostic task inaccurate. In this paper, a deep model is designed in which an integration of Convolution Neural Network (CNN) and Long Short Term Memory (LSTM) is implemented for the detection of depression. CNN and LSTM are used to learn the local characteristics and the EEG signal sequence, respectively. In the deep learning model, filters in the convolution layer are convolved with the input signal to generate feature maps. All the extracted features are given to the LSTM for it to learn the different patterns in the signal, after which the classification is performed using fully connected layers. LSTM has memory cells to remember the essential features for a long time. It also has different functions to update the weights during training. Testing of the model was done by random splitting technique and obtained 99.07% and 98.84% accuracies for the right and left hemispheres EEG signals, respectively.
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Affiliation(s)
- Pristy Paul Thoduparambil
- Department of Computer Science and Engineering, Mar Athanasius College of Engineering, Kothamangalam, Kerala, India.
| | - Anna Dominic
- Department of Computer Science and Engineering, Mar Athanasius College of Engineering, Kothamangalam, Kerala, India
| | - Surekha Mariam Varghese
- Department of Computer Science and Engineering, Mar Athanasius College of Engineering, Kothamangalam, Kerala, India
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Dominic A, Sarangan J, Suresh S, Sai M. Heat transfer performance of Al2O3/water nanofluids in a mini channel heat sink. J Nanosci Nanotechnol 2014; 14:2368-2376. [PMID: 24745233 DOI: 10.1166/jnn.2014.8543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The high density heat removal in electronic packaging is a challenging task of modern days. Finding compact, energy efficient and cost effective methods of heat removal is being the interest of researchers. In the present work, mini channel with forced convective heat transfer in simultaneously developing regime is investigated as the heat transfer coefficient is inversely proportional to hydraulic diameter. Mini channel heat sink is made from the aluminium plate of 30 mm square with 8 mm thickness. It has 15 mini channel of 0.9 mm width, 1.3 mm height and 0.9 mm of pitch. DI water and water based 0.1% and 0.2% volume fractions of Al2O3/water nanofluids are used as coolant. The flow rates of the coolants are maintained in such a way that it is simultaneously developing. Reynolds number is varied from 400 to 1600 and heat input is varied from 40 W to 70 W. The results showed that heat transfer coefficient is more than the heat transfer coefficient of fully developed flow. Also the heat transfer is more for nanofluids compared to DI water.
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Heath O, English D, Simms J, Ward P, Hollett A, Dominic A. Improving collaborative care in managing eating disorders: a pilot study. J Contin Educ Health Prof 2013; 33:235-243. [PMID: 24347102 DOI: 10.1002/chp.21187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
INTRODUCTION The purpose of this pilot study was to evaluate the impact of a continuing interprofessional educational workshop focused on eating disorders in a rural area in Newfoundland and Labrador (NL), Canada. The pilot study helped determine if the eating disorder workshop was feasible for implementation to a broader audience. A conceptual model developed by our eating disorder team and described in the article guided this innovative program. METHODS The intensive 2-day workshop was piloted in one community with 41 health and education professionals in attendance. A key element was the focus on creating and sustaining collaborative care for eating disorders. Participants completed pre-post workshop measures of interprofessional attitudes and skills, self-reported knowledge, confidence, and intention to change practice (post questionnaire only). A 6-month follow-up survey measured self-reported practice change. RESULTS There were significant positive changes in interprofessional attitudes and skills as well as knowledge and confidence in collaborative management of eating disorders. Post-workshop, 69% (n = 24/35) of participants indicated intention to change practice, and on follow-up, 7 of 10 respondents reported implementing changes in practice as a result of the workshop. Low response rate at follow-up was a limitation. DISCUSSION Results support the impact of the workshop in improving knowledge, confidence, and attitudes toward collaboration and changing practice and the value of implementing the program province-wide.
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Affiliation(s)
- Olga Heath
- Faculty of Medicine, Memorial University, St. John's, NL, Canada.
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Yang RC, Young A, Nevis IFP, Lee D, Jain AK, Dominic A, Pullenayegum E, Klarenbach S, Garg AX. Life insurance for living kidney donors: a Canadian undercover investigation. Am J Transplant 2009; 9:1585-90. [PMID: 19519823 DOI: 10.1111/j.1600-6143.2009.02679.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Some living kidney donors encounter difficulties obtaining life insurance, despite previous surveys of insurance companies reporting otherwise. To better understand the effect of donation on insurability, we contacted offices of life insurance companies in five major cities in Canada to obtain $100 000 of life insurance (20-year term) for 40 fictitious living kidney donors and 40 paired controls. These profiles were matched on age, gender, family history of kidney disease and presence of hypertension. The companies were blinded to data collection. The study protocol was reviewed by the Office of Research Ethics. The main study outcomes were the annual premium quoted and total time spent on the phone with the insurance agent. All donor and control profiles received a quote, with no significant difference in the premium quoted (medians $190 vs. $209, p = 0.89). More time was spent on the phone for donor compared to control profiles, but the absolute difference was small (medians 9.5 vs. 7.0 min, p = 0.046). Age, gender, family history of kidney disease and new-onset hypertension had no further effect on donor insurability in regression analysis. We found no evidence that kidney donors were disadvantaged in the first step of applying for life insurance. The effect donation has on subsequent phases of insurance underwriting remains to be studied.
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Affiliation(s)
- R C Yang
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
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Ramnarayan R, Dominic A, Alapatt J, Buxton N. Congenital spinal dermal sinuses: poor awareness leads to delayed treatment. Childs Nerv Syst 2006; 22:1220-4. [PMID: 16555076 DOI: 10.1007/s00381-006-0073-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2005] [Revised: 09/30/2005] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Congenital spinal dermal sinuses are relatively uncommon congenital abnormalities that result from abnormal neurulation. Lack of awareness about this problem, especially at the primary care level, results in these patients not being managed appropriately. This issue is highlighted in this case series of nine patients. MATERIALS AND METHODS The nine patients--six males and three females--were treated over a 3-year period in two centres in the UK and India. The age varied from 212 months to 19 years. Clinical presentations included meningitis or neurological deficits. One was asymptomatic. MRI was done in all cases and showed the sinus tracts in all cases. In five cases, there were intramedullary dermoids and in the others the sinus tract ended either on the dura or blindly. All cases were treated surgically by excision of the sinus and tumour if any. In terms of the neurological status, one became normal, four improved and four remained the same. Of the four who remained the same, two had had normal neurological examination preoperatively. The mean duration from first assessment by a medical practitioner to correct diagnosis and referral to a neurosurgeon was 5 years (range 2 months to 18 years). Proper diagnosis and appropriate management was delayed in these cases because professionals were not aware of this condition. CONCLUSIONS Primary care physicians should be made more aware about congenital spinal dermal sinuses. This will facilitate early diagnosis and referral to specialist services.
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Affiliation(s)
- R Ramnarayan
- Department of Neurosurgery, Medical College, Kozhikode, India.
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Rosales TO, Crosbie V, Dominic A, Garland J. Medical Evaluation of Young Mushua Innu with History of Solvent Abuse. Paediatr Child Health 2002. [DOI: 10.1093/pch/7.suppl_a.17ab] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Bastug DE, Dominic A, Ortiz O, DiBartolomeo AG, Kotzan JM, Abraham FM. Popliteal artery thrombosis in a patient with Cogan syndrome: treatment with thrombolysis and percutaneous transluminal angioplasty. Cardiovasc Intervent Radiol 1997; 20:57-9. [PMID: 8994726 DOI: 10.1007/s002709900110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A 31-year-old woman with Cogan syndrome (a rare form of systemic vasculitis) was evaluated for a cold, painful left foot with diminished pulses. Arteriography demonstrated thrombosis of the left popliteal artery with evidence of vasculitis. Thrombolytic therapy was begun with initial success but eventual rethrombosis. After reinitiating thrombolytic therapy combined with intraarterial vasodilator therapy, successful angioplasty was performed with sustained results at 6-month follow-up.
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Affiliation(s)
- D E Bastug
- Department of Radiology, West Virginia University, Robert C. Byrd Health Sciences Center, Morgantown 26506-9235, USA
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