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Hawke LD, Bastidas-Bilbao H, Cappe V, van Kesteren MR, Stewart DE, Gupta M, Simpson AIF, Campbell BH, Castle D, Stergiopoulos V. Medical Assistance in Dying for Mental Illness as a Sole Underlying Medical Condition and Its Relationship to Suicide: A Qualitative Lived Experience-Engaged Study: Aide Médicale à Mourir Pour Maladie Mentale Comme Seule Condition Médicale Sous-Jacente et Son Lien Avec le Suicide: Une Etude Qualitative Engagée Dans l'Expérience Vécue. Can J Psychiatry 2024; 69:314-325. [PMID: 37885204 PMCID: PMC11032095 DOI: 10.1177/07067437231209658] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
OBJECTIVE This lived experience-engaged study aims to understand patient and family perspectives on the relationship between suicidality and medical assistance in dying when the sole underlying medical condition is mental illness (MAiD MI-SUMC). METHOD Thirty individuals with mental illness (age M = 41.8 years, SD = 14.2) and 25 family members (age M = 47.5 years, SD = 16.0) participated in qualitative interviews examining perspectives on MAiD MI-SUMC and its relationship with suicide. Audio recordings were transcribed and analysed using reflexive thematic analysis. People with lived experience were engaged in the research process as team members. RESULTS Four main themes were developed, which were consistent across individuals with mental illness and family members: (a) deciding to die is an individual choice to end the ongoing intolerable suffering of people with mental illness; (b) MAiD MI-SUMC is the same as suicide because the end result is death, although suicide can be more impulsive; (c) MAiD MI-SUMC is a humane, dignified, safe, nonstigmatized alternative to suicide; and (4) suicidality should be considered when MAiD MI-SUMC is requested, but suicidality's role is multifaceted given its diverse manifestations. CONCLUSION For patient-oriented mental health policy and treatment, it is critical that the voices of people with lived experience be heard on the issue of MAiD MI-SUMC. Given the important intersections between MAiD MI-SUMC and suicidality and the context of suicide prevention, the role that suicidality should play in MAiD MI-SUMC is multifaceted. Future research and policy development are required to ensure that patient and family perspectives guide the development and implementation of MAiD MI-SUMC policy and practice.
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Affiliation(s)
- Lisa D. Hawke
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | | | - Vivien Cappe
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | | | - Donna E. Stewart
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Mental Health, University Health Network, Toronto, Ontario, Canada
| | - Mona Gupta
- Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Alexander I. F. Simpson
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | | | - David Castle
- Department of Psychiatry, University of Tasmania, Hobart, Tasmania, Australia
- Statewide Mental Health Service, Hobart, Tasmania, Australia
| | - Vicky Stergiopoulos
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Carter ED, Stewart DE, Rees EE, Bezuidenhoudt JE, Ng V, Lynes S, Desenclos JC, Pyone T, Lee ACK. Surveillance system integration: reporting the results of a global multicountry survey. Public Health 2024; 231:31-38. [PMID: 38603977 DOI: 10.1016/j.puhe.2024.03.004] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 02/28/2024] [Accepted: 03/04/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVES Currently, there is no comprehensive picture of the global surveillance landscape. This survey examines the current state of surveillance systems, levels of integration, barriers and opportunities for the integration of surveillance systems at the country level, and the role of national public health institutes (NPHIs). STUDY DESIGN This was a cross-sectional survey of NPHIs. METHODS A web-based survey questionnaire was disseminated to 110 NPHIs in 95 countries between July and August 2022. Data were descriptively analysed, stratified by World Health Organization region, World Bank Income Group, and self-reported Integrated Disease Surveillance (IDS) maturity status. RESULTS Sixty-five NPHIs responded. Systems exist to monitor notifiable diseases and vaccination coverage, but less so for private, pharmaceutical, and food safety sectors. While Ministries of Health usually lead surveillance, in many countries, NPHIs are also involved. Most countries report having partially developed IDS. Surveillance data are frequently inaccessible to the lead public health agency and seldomly integrated into a national public health surveillance system. Common challenges to establishing IDS include information technology system issues, financial constraints, data sharing and ownership limitations, workforce capacity gaps, and data availability. CONCLUSIONS Public health surveillance systems across the globe, although built on similar principles, are at different levels of maturity but face similar developmental challenges. Leadership, ownership and governance, supporting legal mandates and regulations, as well as adherence to mandates, and enforcement of regulations are critical components of effective surveillance. In many countries, NPHIs play a significant role in integrated disease surveillance.
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Affiliation(s)
- E D Carter
- US Centers for Disease Control and Prevention, USA
| | | | - E E Rees
- Public Health Agency of Canada, Canada
| | | | - V Ng
- Public Health Agency of Canada, Canada
| | - S Lynes
- International Association of National Public Health Institutes, Belgium
| | - J C Desenclos
- International Association of National Public Health Institutes & Santé publique France, France
| | - T Pyone
- World Health Organization, Geneva, Switzerland
| | - A C K Lee
- UK Health Security Agency & The University of Sheffield, UK
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Kimber M, Baker-Sullivan E, Stewart DE, Vanstone M. Improving Health Professional Recognition and Response to Child Maltreatment and Intimate Partner Violence: Protocol for Two Mixed Methods Pilot Randomized Controlled Trials. JMIR Res Protoc 2024; 13:e50864. [PMID: 38512307 PMCID: PMC10995786 DOI: 10.2196/50864] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 01/24/2024] [Accepted: 02/05/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND The optimal educational approach for preparing health professionals with the knowledge and skills to effectively recognize and respond to family violence, including child maltreatment and intimate partner violence, remains unclear. The Violence, Evidence, Guidance, and Action (VEGA) Family Violence Education Resources is a novel intervention that can be completed via self-directed learning or in a workshop format; both approaches focus on improving health professional preparedness to address family violence. OBJECTIVE Our studies aim to determine the acceptability and feasibility of conducting a randomized controlled trial to evaluate the effectiveness of the self-directed (experimental intervention) and workshop (active control) modalities of VEGA, as an adjunct to standard education, to improve learner (Researching the Impact of Service provider Education [RISE] with Residents) and independent practice (RISE with Veterans) health professional preparedness, knowledge, and skills related to recognizing family violence in their health care encounters. METHODS The RISE with Residents and RISE with Veterans research studies use embedded experimental mixed methods research designs. The quantitative strand for each study follows the principles of a pilot randomized controlled trial. For RISE with Residents, we aimed to recruit 80 postgraduate medical trainees; for RISE with Veterans, we intended to recruit 80 health professionals who work or have worked with Veterans (or their family members) of the Canadian military or the Royal Canadian Mounted Police in a direct service capacity. Participants complete quantitative assessments at baseline, after intervention, and at 3-month follow-up. A subset of participants from each arm also undergoes a qualitative semistructured interview with the aim of describing participants' perceptions of the value and impact of each VEGA modality, as well as research burden. Scores on potential outcome measures will be mapped to excerpts of qualitative data via a mixed methods joint display to aid in the interpretation of findings. RESULTS We consented 71 individuals to participate in the RISE with Residents study. Data collection was completed on August 31, 2023, and data are currently being cleaned and prepared for analysis. As of January 15, 2024, we consented 34 individuals in the RISE with Veterans study; data collection will be completed in March 2024. For both studies, no data analysis had taken place at the time of manuscript submission. Results will be disseminated through peer-reviewed publications; academic conferences; and posting and sharing of study summaries and infographics on social media, the project website, and via professional network listserves. CONCLUSIONS Reducing the impacts of family violence remains a pressing public health challenge. Both research studies will provide a valuable methodological contribution about the feasibility of trial methods in health professions education focused on family violence. They will also contribute to education science about the differences in the effectiveness of self-directed versus facilitator-led learning strategies. TRIAL REGISTRATION ClinicalTrials.gov NCT05490121, https://clinicaltrials.gov/study/NCT05490121; ClinicalTrials.gov NCT05490004, https://clinicaltrials.gov/study/NCT05490004. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/50864.
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Affiliation(s)
- Melissa Kimber
- Offord Centre for Child Studies, Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Elizabeth Baker-Sullivan
- Offord Centre for Child Studies, Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Donna E Stewart
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Centre for Mental Health, University Health Network, Toronto, ON, Canada
| | - Meredith Vanstone
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
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Littell JH, Abel KM, Biggs MA, Blum RW, Foster DG, Haddad LB, Major B, Munk-Olsen T, Polis CB, Robinson GE, Rocca CH, Russo NF, Steinberg JR, Stewart DE, Stotland NL, Upadhyay UD, van Ditzhuijzen J. Correcting the scientific record on abortion and mental health outcomes. BMJ 2024; 384:e076518. [PMID: 38413135 DOI: 10.1136/bmj-2023-076518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Affiliation(s)
- Julia H Littell
- Graduate School of Social Work and Social Research, Bryn Mawr College, Bryn Mawr, PA, USA
| | - Kathryn M Abel
- Centre for Women's Mental Health, Faculty of Biology, Medicine and Health Sciences, University of Manchester, Manchester, UK
| | - M Antonia Biggs
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of California San Francisco, Oakland, CA, USA
| | - Robert W Blum
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Diana Greene Foster
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of California San Francisco, Oakland, CA, USA
| | - Lisa B Haddad
- Center for Biomedical Research, Population Council, New York, NY, USA
| | - Brenda Major
- Department of Psychological and Brain Sciences, University of California Santa Barbara, USA
| | - Trine Munk-Olsen
- Department of Clinical Research (Research Unit for Child and Adolescent Psychiatry), University of Southern Denmark, Odense, Denmark
- The National Center for Register-based Research, Aarhus University, Aarhus, Denmark
| | - Chelsea B Polis
- Center for Biomedical Research, Population Council, New York, NY, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Corinne H Rocca
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of California San Francisco, Oakland, CA, USA
| | | | - Julia R Steinberg
- Department of Family Science, School of Public Health, University of Maryland, College Park, MD, USA
| | - Donna E Stewart
- Departments of Psychiatry, Obstetrics and Gynecology, Medicine, Surgery, Anesthesiology, Family and Community Medicine, University of Toronto, Toronto, Canada
- Toronto General Hospital Research Institute, Toronto, Canada
| | - Nada Logan Stotland
- Department of Psychiatry and Behavioral Sciences, Rush Medical Center, Rush University, Chicago, IL, USA
| | - Ushma D Upadhyay
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of California San Francisco, Oakland, CA, USA
| | - Jenneke van Ditzhuijzen
- Interdisciplinary Social Science: Social Policy and Public Health, Utrecht University, Utrecht, Netherlands
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Center, Amsterdam, Netherlands
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Stergiopoulos V, Bastidas-Bilbao H, Gupta M, Buchman DZ, Stewart DE, Rajji T, Simpson AIF, van Kesteren MR, Cappe V, Castle D, Shields R, Hawke LD. Care considerations in medical assistance in dying for persons with mental illness as the sole underlying medical condition: a qualitative study of patient and family perspectives. BMC Psychiatry 2024; 24:120. [PMID: 38355467 PMCID: PMC10865571 DOI: 10.1186/s12888-024-05541-5] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 01/19/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Persons with mental illness as their sole underlying medical condition are eligible to access medical assistance in dying (MAiD) in a small number of countries, including Belgium, the Netherlands, Luxemburg and Switzerland. In Canada, it is anticipated that people experiencing mental illness as their sole underlying medical condition (MI-SUMC) will be eligible to request MAiD as of March 17th 2024. To date, few studies have addressed patient and family perspectives on MAiD MI-SUMC care processes. This study aimed to address this gap and qualitatively explore the perspectives of persons with lived experience of mental illness and family members on care considerations during MI-SUMC implementation. METHODS Thirty adults with lived experience of mental illness and 25 adult family members residing in Ontario participated in this study. To facilitate participant engagement, the semi-structured interview used a persona-scenario exercise to discuss perspectives on MAiD MI-SUMC acceptability and care considerations. Framework analysis was used to inductively analyze data using NVivo 12 Pro. Steps, processes, or other care considerations suggested by the participants were charted in a framework matrix after familiarization with the narratives. Key themes were further identified. A lived-experience advisory group participated in every aspect of this study. RESULTS Six themes were developed from the patient and family narratives: (1) Raising MAiD MI-SUMC awareness; (2) Sensitive Introduction of MAiD MI-SUMC in goals of care discussions; (3) Asking for MAiD MI-SUMC: a person-focused response; (4) A comprehensive circle of MAiD MI-SUMC care; (5) A holistic, person-centered assessment process; and (6) Need for support in the aftermath of the decision. These themes highlighted a congruence of views between patient and family members and described key desired process ingredients, including a person-centred non-judgmental stance by care providers, inter-professional holistic care, shared decision making, and the primacy of patient autonomy in healthcare decision making. CONCLUSIONS Family and patient perspectives on the implementation of MAiD MI-SUMC offer important considerations for service planning that could complement existing and emerging professional practice standards. These stakeholders' perspectives will continue to be essential in MAiD MI-SUMC implementation efforts, to better address the needs of diverse communities and inform improvement efforts.
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Affiliation(s)
- Vicky Stergiopoulos
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
- University of Toronto, Toronto, Ontario, Canada.
| | | | - Mona Gupta
- Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Daniel Z Buchman
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Donna E Stewart
- University of Toronto, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
| | - Tarek Rajji
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Alexander I F Simpson
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | | | - Vivien Cappe
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - David Castle
- University of Tasmania, Hobart, Tasmania, Australia
- Statewide Mental Health Service, Hobart, Tasmania, Australia
| | - Roslyn Shields
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Lisa D Hawke
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
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6
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Rybkina J, Jacob N, Colella B, Gold D, Stewart DE, Ruttan LA, Meusel LAC, McAndrews MP, Abbey S, Green R. Self-managing symptoms of Long COVID: an education and strategies research protocol. Front Public Health 2024; 12:1106578. [PMID: 38384879 PMCID: PMC10879441 DOI: 10.3389/fpubh.2024.1106578] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 01/04/2024] [Indexed: 02/23/2024] Open
Abstract
Post-acute sequelae of SARS-COV-2 (PASC) is growing in prevalence, and involves symptoms originating from the central neurological, cardiovascular, respiratory, gastrointestinal, autonomic nervous, or immune systems. There are non-specific symptoms such as fatigue, headaches, and brain fog, which cannot be ascribed to a single system. PASC places a notable strain on our healthcare system, which is already laden with a large number of acute-COVID-19 patients. Furthermore, it impedes social, academic and vocational functioning, and impacts family life, relationships, and work/financial life. The treatment for PASC needs to target this non-specific etiology and wide-ranging sequelae. In conditions similar to PASC, such as "chemo brain," and prolonged symptoms of concussion, the non-specific symptoms have shown to be effectively managed through education and strategies for self-management and Mindfulness interventions. However, such interventions have yet to be empirically evaluated in PASC to our knowledge. In response to this gap, we have developed a virtual education intervention synthesized by psychiatrists and clinical psychologists for the current study. We will undertake a two-phase randomized controlled trial to determine the feasibility (Phase 1; N = 90) and efficacy (Phase 2; sample sized based on phase 1 results) of the novel 8 week Education and Self-Management Strategies group compared to a mindfulness skills program, both delivered virtually. Main outcomes include confidence/ability to self-manage symptoms, quality of life, and healthcare utilization. This study stands to mitigate the deleterious intrusiveness of symptoms on everyday life in patients with PASC, and may also help to reduce the impact of PASC on the healthcare system. Clinical trial registration:https://classic.clinicaltrials.gov/ct2/show/NCT05268523; identifier NCT05268523.
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Affiliation(s)
- Julia Rybkina
- KITE Research Institute, Toronto Rehabilitation Institute—University Health Network, Toronto, ON, Canada
| | - Nithin Jacob
- KITE Research Institute, Toronto Rehabilitation Institute—University Health Network, Toronto, ON, Canada
| | - Brenda Colella
- Telerehab Centre for Acquired Brain Injury, Toronto Rehabilitation Institute—University Centre, University Health Network, Toronto, ON, Canada
| | - David Gold
- Krembil Brain Institute, University of Toronto, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Donna E. Stewart
- University of Toronto, Centre for Mental Health and Senior Scientist, University Health Network, Toronto, ON, Canada
| | - Lesley A. Ruttan
- University of Toronto Scarborough, Neuro-Rehab Program, Toronto Rehabilitation Institute—University Centre, University Health Network, Toronto, ON, Canada
| | - Liesel-Ann C. Meusel
- Telerehab Centre for Acquired Brain Injury, Toronto Rehabilitation Institute—University Centre, University Health Network, Toronto, ON, Canada
| | - Mary P. McAndrews
- Krembil Research Institute, University of Toronto, University Health Network, Toronto, ON, Canada
| | - Susan Abbey
- Medical Psychiatry and Psychiatry and Psychosocial Oncology, University Health Network, Toronto, ON, Canada
| | - Robin Green
- KITE Research Institute, Toronto Rehabilitation Institute—University Health Network, Toronto, ON, Canada
- Department of Psychiatry, Division of Neurosciences and Clinical Translation, University of Toronto, Toronto, ON, Canada
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White P, Abbey S, Angus B, Ball HA, Buchwald DS, Burness C, Carson AJ, Chalder T, Clauw DJ, Coebergh J, David AS, Dworetzky BA, Edwards MJ, Espay AJ, Etherington J, Fink P, Flottorp S, Garcin B, Garner P, Glasziou P, Hamilton W, Henningsen P, Hoeritzauer I, Husain M, Huys ACML, Knoop H, Kroenke K, Lehn A, Levenson JL, Little P, Lloyd A, Madan I, van der Meer JWM, Miller A, Murphy M, Nazareth I, Perez DL, Phillips W, Reuber M, Rief W, Santhouse A, Serranova T, Sharpe M, Stanton B, Stewart DE, Stone J, Tinazzi M, Wade DT, Wessely SC, Wyller V, Zeman A. Anomalies in the review process and interpretation of the evidence in the NICE guideline for chronic fatigue syndrome and myalgic encephalomyelitis. J Neurol Neurosurg Psychiatry 2023; 94:1056-1063. [PMID: 37434321 DOI: 10.1136/jnnp-2022-330463] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 05/03/2023] [Indexed: 07/13/2023]
Abstract
Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is a disabling long-term condition of unknown cause. The National Institute for Health and Care Excellence (NICE) published a guideline in 2021 that highlighted the seriousness of the condition, but also recommended that graded exercise therapy (GET) should not be used and cognitive-behavioural therapy should only be used to manage symptoms and reduce distress, not to aid recovery. This U-turn in recommendations from the previous 2007 guideline is controversial.We suggest that the controversy stems from anomalies in both processing and interpretation of the evidence by the NICE committee. The committee: (1) created a new definition of CFS/ME, which 'downgraded' the certainty of trial evidence; (2) omitted data from standard trial end points used to assess efficacy; (3) discounted trial data when assessing treatment harm in favour of lower quality surveys and qualitative studies; (4) minimised the importance of fatigue as an outcome; (5) did not use accepted practices to synthesise trial evidence adequately using GRADE (Grading of Recommendations, Assessment, Development and Evaluations trial evidence); (6) interpreted GET as mandating fixed increments of change when trials defined it as collaborative, negotiated and symptom dependent; (7) deviated from NICE recommendations of rehabilitation for related conditions, such as chronic primary pain and (8) recommended an energy management approach in the absence of supportive research evidence.We conclude that the dissonance between this and the previous guideline was the result of deviating from usual scientific standards of the NICE process. The consequences of this are that patients may be denied helpful treatments and therefore risk persistent ill health and disability.
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Affiliation(s)
- Peter White
- Wolfson Institute for Population Health, Queen Mary University Barts and The London School of Medicine and Dentistry, London, UK
| | - Susan Abbey
- Toronto General Hospital Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Brian Angus
- Nuffield Department of Medicine, Oxford University, Oxford, UK
| | - Harriet A Ball
- Bristol Medical School, University of Bristol Faculty of Health Sciences, Bristol, UK
| | - Dedra S Buchwald
- Institute for Research and Education to Advance Community Health, Washington State University, Seattle, Washington, USA
| | | | - Alan J Carson
- Centre for Clinical Brain Sciences, Royal Infirmary, Edinburgh, UK
| | - Trudie Chalder
- Department of Psychological Medicine, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Daniel J Clauw
- Departments of Anesthesiology, Medicine and Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Jan Coebergh
- Ashford St Peter's NHS Foundation Trust, Chertsey, St George's University Hospitals, London, UK
| | - Anthony S David
- Institute of Mental Health, University College London, London, UK
| | - Barbara A Dworetzky
- Department of Neurology, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Mark J Edwards
- Neuroscience Research Centre, St George's University, London, UK
| | - Alberto J Espay
- James J. and Joan A. Gardner Family Center for Parkinson's disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, Ohio, USA
| | | | - Per Fink
- Research Clinic for Functional Disorders, Aarhus University, Aarhus, Denmark
| | - Signe Flottorp
- Centre for Epidemic Interventions Research, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Béatrice Garcin
- Hopital Avicenne, Universite Sorbonne Paris Nord - Campus de Bobigny, Bobigny, France
| | - Paul Garner
- Centre for Evidence Synthesis in Global Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Paul Glasziou
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences & Medicine, Bond University, Robina, Queensland, Australia
| | - Willie Hamilton
- Institute of Health Research, University of Exeter, Exeter, UK
| | - Peter Henningsen
- Psychosomatic Medicine, University Hospital, Technical University Munich, Munich, Germany
| | - Ingrid Hoeritzauer
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Mujtaba Husain
- Persistent Physical Symptom Service, South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Hans Knoop
- Department of Medical Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Kurt Kroenke
- Regenstrief Institute, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Alexander Lehn
- Brisbane Clinical Neuroscience Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - James L Levenson
- Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Paul Little
- Primary Care Research Centre, Primary Care Population Sciences and Medical Education Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Andrew Lloyd
- Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Ira Madan
- Faculty of Occupational Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jos W M van der Meer
- Department of Internal Medicine, Radboud University Medical College, Nijmegen, Netherlands
| | - Alastair Miller
- Department of Medicine, Cumberland Infirmary Carlisle, Carlisle, UK
| | - Maurice Murphy
- Department of Infection and Immunity, Barts Health NHS Trust, London, UK
| | - Irwin Nazareth
- Primary Care & Population Science, University College London, London, UK
| | - David L Perez
- Neurology and Psychiatry, Massachusetts General Hospital, Charlestown, Massachusetts, USA
| | - Wendy Phillips
- Department of Neurology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Markus Reuber
- Department of Neuroscience, The Medical School, University of Sheffield, Sheffield, UK
| | - Winfried Rief
- Division of Clinical Psychology and Psychotherapy Clinic, University of Marburg, Marburg, Germany
| | - Alastair Santhouse
- Persistent Physical Symptom Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Tereza Serranova
- Dept. of Neurology and Center of Clinical Neuroscience, Charles University in Prague, Prague, Czech Republic
| | - Michael Sharpe
- Psychological Medicine Research, University of Oxford, Oxford, UK
| | - Biba Stanton
- Department of Neurology, King's College Hospital, London, UK
| | - Donna E Stewart
- Centre for Mental Health, University of Toronto, University Health Network, Toronto, Ontario, Canada
| | - Jon Stone
- Centre for Clinical Brain Sciences, Royal Infirmary, University of Edinburgh, Edinburgh, UK
| | - Michele Tinazzi
- Department of Neurosciences, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Derick T Wade
- Centre for Movement, Occupational and Rehabilitation Sciences, Oxford Brookes University, Oxford, UK
| | - Simon C Wessely
- Psychological Medicine, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Vegard Wyller
- Division of Medicine and Laboratory Sciences, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Adam Zeman
- Cognitve Neurology Research Group, University of Exeter Medical School, Exeter, UK
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8
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Bastidas-Bilbao H, Stergiopoulos V, Cappe V, van Kesteren MR, Stewart DE, Gupta M, Simpson AIF, Dawthorne M, Rajji TK, Castle D, Hawke LD. Walking Alongside: Views of Family Members on Medical Assistance in Dying for Mental Illness as the Sole Underlying Medical Condition. Qual Health Res 2023; 33:1140-1153. [PMID: 37773095 PMCID: PMC10626980 DOI: 10.1177/10497323231197365] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
Medical assistance in dying (MAiD) was introduced into Canadian federal legislation in 2016. Mental illness as the sole underlying medical condition (MI-SUMC) is currently excluded from eligibility; such exclusion is scheduled to expire on March 17, 2024. Irremediability, capacity, quality of life, autonomy, family involvement, and healthcare system constraints have been debated intensively. Recent studies have not explored the views of family members of persons with mental illness on MAiD MI-SUMC. This study aimed to fill this knowledge gap. Twenty-five Ontario residents who had a loved one with mental illness participated. A persona-scenario exercise was designed to explore participants' views on MAiD MI-SUMC in hypothetical situations. Reflexive thematic analysis was used to analyze the data. A lived experience-advisory panel was engaged throughout the study. Seven themes were developed: Witnessing suffering; A road with barriers and limitations; Societal barriers; The unknowns of mental illness; Individual choices: the life or death that a person wants; MAiD MI-SUMC as an acceptable choice when suffering cannot be relieved with available treatments and supports; and The emotional outcome. Participants constructed their views based on their experience of supporting a loved one with mental illness. MAiD MI-SUMC was perceived as a multifaceted issue, whose acceptability and potential introduction required a concurrent exploration and discussion of the challenges arising due to limitations of the healthcare system, the opportunities and limits to family involvement, and the value of patient autonomy.
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Affiliation(s)
| | - Vicky Stergiopoulos
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Vivien Cappe
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | - Donna E. Stewart
- University of Toronto, Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada
| | - Mona Gupta
- Centre Hospitalier de L'Université de Montréal, Montréal, QC, Canada
| | - Alexander I. F. Simpson
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | | | - Tarek K. Rajji
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - David Castle
- University of Tasmania, Hobart, TAS, Australia
- Statewide Mental Health Service, Hobart, TAS, Australia
| | - Lisa D. Hawke
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
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9
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Affiliation(s)
- Donna E Stewart
- Centre for Mental Health, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health, Karolinska Institutet, Stockholm, Sweden
| | - Paul S Appelbaum
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, NY, USA
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10
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Lee P, Kurscheid JM, Laksono B, Park MJ, Clements ACA, Lowe C, Stewart DE, Gray DJ. Model validation for a knowledge and practices survey towards prevention of soil-transmitted helminth infections in rural villages in Indonesia. Sci Rep 2023; 13:1444. [PMID: 36697451 PMCID: PMC9876981 DOI: 10.1038/s41598-023-27781-3] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 01/09/2023] [Indexed: 01/26/2023] Open
Abstract
The rate of soil-transmitted helminth (STH) infection is estimated to be around 20% in Indonesia. Health promotion and health education are cost-effective strategies to supplement STH prevention and control programs. Existing studies suggest that quantitative tools for knowledge, attitudes and practices (KAP) are important to monitor effective community-based STH interventions. However, evidence is limited regarding the applicability of such tools. This study aims to identify the socio-demographic predictors for STH-related knowledge and practices and validate the quantitative tools in population use. A cross-sectional study design was conducted among residents of 16 villages in Central Java, Indonesia. Adult and child respondents were interviewed to assess general knowledge and practices in relation to STH. Two mixed effects models identified the significant factors in predicting knowledge and practice scores. The model predicted knowledge and practice scores were compared with the observed scores to validate the quantitative measurements developed in this study. Participants' socio-demographic variables were significant in predicting an individual's STH-related knowledge level and their hand washing and hygiene practices, taking into account household-level variability. Model validation results confirmed that the quantitative measurement tools were suitable for assessing STH associated knowledge and behaviour. The questionnaire developed in this study can be used to support school- and community-based health education interventions to maximize the effect of STH prevention and control programs.
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Affiliation(s)
- P Lee
- School of Medicine & Dentistry, Griffith University, Gold Coast, QLD, Australia.,Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - J M Kurscheid
- Department of Global Health, Research School of Population Health, Australian National University, Acton, ACT, Australia.,Health Systems Support Unit, Swiss Centre for International Health, Swiss Tropical and Public Health Institute, 4051, Basel, Switzerland
| | - B Laksono
- Faculty of Medicine, Universitas Diponegoro, Semarang, 50275, Indonesia
| | - M J Park
- Department of Nursing, College of Nursing, Konyang University, Daejeon, South Korea
| | - A C A Clements
- Department of Global Health, Research School of Population Health, Australian National University, Acton, ACT, Australia.,Faculty of Health Sciences, Curtin University, Perth, Australia
| | - C Lowe
- Department of Global Health, Research School of Population Health, Australian National University, Acton, ACT, Australia.
| | - D E Stewart
- School of Medicine & Dentistry, Griffith University, Gold Coast, QLD, Australia.,Department of Global Health, Research School of Population Health, Australian National University, Acton, ACT, Australia
| | - D J Gray
- Department of Global Health, Research School of Population Health, Australian National University, Acton, ACT, Australia
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11
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Sheehan KA, Schulz-Quach C, Ruttan LA, MacGillivray L, McKay MS, Seto A, Li A, Stewart DE, Abbey SE, Berkhout SG. "Don't Just Study our Distress, Do Something": Implementing and Evaluating a Modified Stepped-Care Model for Health Care Worker Mental Health During the COVID-19 Pandemic. Can J Psychiatry 2023; 68:43-53. [PMID: 35854421 PMCID: PMC9301355 DOI: 10.1177/07067437221111372] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Throughout the COVID-19 pandemic, there have been concerns about the mental health of health care workers (HCW). Although numerous studies have investigated the level of distress among HCW, few studies have explored programs to improve their mental well-being. In this paper, we describe the implementation and evaluation of a program to support the mental health of HCW at University Health Network (UHN), Canada's largest healthcare network. METHODS Using a quality improvement approach, we conducted a needs assessment and then created and evaluated a modified stepped-care model to address HCW mental health during the pandemic. This included: online resources focused on psychoeducation and self-management, access to online support and psychotherapeutic groups, and self-referral for individual care from a psychologist or psychiatrist. We used ongoing mixed-methods evaluation, combining quantitative and qualitative analysis, to improve program quality. RESULTS The program is ongoing, running continuously throughout the pandemic. We present data up to November 30, 2021. There were over 12,000 hits to the UHN's COVID mental health intranet web page, which included self-management resources and information on group support. One hundred and sixty-six people self-referred for individual psychological or psychiatric care. The mean wait time from referral to initial appointment was 5.4 days, with an average of seven appointments for each service user. The majority had moderate to severe symptoms of depression and anxiety at referral, with over 20% expressing thoughts of self-harm or suicide. Post-care user feedback, collected through self-report surveys and semistructured interviews, indicated that the program is effective and valued. CONCLUSIONS Development of a high-quality internal mental health support for HCW program is feasible, effective, and highly valued. By using early and frequent feedback from multiple perspectives and stakeholders to address demand and implement changes responsively, the program was adjusted to meet HCW mental health needs as the pandemic evolved.
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Affiliation(s)
- Kathleen A Sheehan
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Centre for Mental Health, 7989University Health Network, Toronto, Ontario, Canada
| | - Christian Schulz-Quach
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Centre for Mental Health, 7989University Health Network, Toronto, Ontario, Canada.,Princess Margaret Cancer Centre, 7989University Health Network, Toronto, Ontario, Canada
| | - Lesley A Ruttan
- 7961Toronto Rehabilitation Institute, 7989University Health Network, Toronto, Ontario, Canada.,Graduate Department of Psychological Clinical Science, 33530University of Toronto, Scarborough, Ontario, Canada
| | - Lindsey MacGillivray
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Centre for Mental Health, 7989University Health Network, Toronto, Ontario, Canada
| | - Martha S McKay
- 7961Toronto Rehabilitation Institute, 7989University Health Network, Toronto, Ontario, Canada
| | - Alison Seto
- Centre for Mental Health, 7989University Health Network, Toronto, Ontario, Canada
| | - Adrienne Li
- 7961Toronto Rehabilitation Institute, 7989University Health Network, Toronto, Ontario, Canada.,7991York University, Toronto, Ontario, Canada
| | - Donna E Stewart
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Centre for Mental Health, 7989University Health Network, Toronto, Ontario, Canada
| | - Susan E Abbey
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Centre for Mental Health, 7989University Health Network, Toronto, Ontario, Canada
| | - Suze G Berkhout
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Centre for Mental Health, 7989University Health Network, Toronto, Ontario, Canada
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12
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McTavish JR, Chandra PS, Stewart DE, Herrman H, MacMillan HL. Child Maltreatment and Intimate Partner Violence in Mental Health Settings. Int J Environ Res Public Health 2022; 19:ijerph192315672. [PMID: 36497747 PMCID: PMC9735990 DOI: 10.3390/ijerph192315672] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 06/01/2023]
Abstract
Intimate partner violence (IPV) and child maltreatment (physical, emotional, sexual abuse, neglect, and children's exposure to IPV) are two of the most common types of family violence; they are associated with a broad range of health consequences. We summarize evidence addressing the need for safe and culturally-informed clinical responses to child maltreatment and IPV, focusing on mental health settings. This considers clinical features of child maltreatment and IPV; applications of rights-based and trauma- and violence-informed care; how to ask about potential experiences of violence; safe responses to disclosures; assessment and interventions that include referral networks and resources developed in partnership with multidisciplinary and community actors; and the need for policy and practice frameworks, appropriate training and continuing professional development provisions and resources for mental health providers. Principles for a common approach to recognizing and safely responding to child maltreatment and IPV are discussed, recognizing the needs in well-resourced and scarce resource settings, and for marginalized groups in any setting.
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Affiliation(s)
- Jill R. McTavish
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, 293 Wellington St. North, Hamilton, ON L8L 8E7, Canada
| | - Prabha S. Chandra
- NIMHANS Hospital, Hosur Rd, near Bangalore Milk Dairy, Hombegowda Nagar, Bengaluru 560029, Karnataka, India
| | - Donna E. Stewart
- Centre for Mental Health, University Health Network, 200 Elizabeth St, 7EN229, Toronto, ON M5G 2C4, Canada
| | - Helen Herrman
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC 3052, Australia
- Orygen, Parkville, VIC 3052, Australia
| | - Harriet L. MacMillan
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, 293 Wellington St. North, Hamilton, ON L8L 8E7, Canada
- Department of Pediatrics, McMaster University, Health Sciences Centre 3A, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada
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13
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Tweed S, Stewart DE, Hornsey E, Graham W. Increasing role of Public Health Rapid Response Teams in infectious disease outbreaks. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac130.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Following the Ebola crisis (2013-2016), the WHO, Global Health Security Agenda and other international actors advocated for the development of Public Health Rapid Response Teams (RRTs) to strengthen outbreak response. Despite significant investment, evidence on the uptake, composition and effectiveness of such teams remains lacking.
Methods
Qualitative review of published and grey literature including from governmental and multilateral agencies, with semi-structured interviews of key informants. Thematic content analysis was completed and evidence synthesised to inform future policy recommendations.
Results
RRTs have been adopted globally providing surge capacity in outbreak settings. RRTs typically include microbiologists and field epidemiologists but can be more efficacious when broadly multidisciplinary with the inclusion of social scientists, risk communicators and infection prevention and control professionals. The organisation of RRTs must be responsive to district and national contexts so existing systems are not undermined, with regional collaboration beneficial where skill gaps exist. Literature and interviewees agreed that RRTs should not be uniformly defined by narrow technical capabilities, but rather regional standards and evaluation of deployments used to assess operational readiness.
Conclusions
Public Health RRTs should be multiprofessional in nature and evaluated against regional standards to be effective. Future research should seek to assess the experience of countries before and after RRT implementation including detailed economic assessment.
Key messages
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Affiliation(s)
- S Tweed
- Institute of Global Health, University College London , London, UK
| | - DE Stewart
- Public Health Rapid Support Team, UK Health Security Agency , London, UK
| | - E Hornsey
- Public Health Rapid Support Team, UK Health Security Agency , London, UK
- Department of Infectious Disease Epidemiology, LSHTM , London, UK
| | - W Graham
- Department of Infectious Disease Epidemiology, LSHTM , London, UK
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14
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Hussain-Shamsy N, Somerton S, Stewart DE, Grigoriadis S, Metcalfe K, Oberlander TF, Schram C, Taylor VH, Dennis CL, Vigod SN. The development of a patient decision aid to reduce decisional conflict about antidepressant use in pregnancy. BMC Med Inform Decis Mak 2022; 22:130. [PMID: 35562801 PMCID: PMC9099318 DOI: 10.1186/s12911-022-01870-1] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 05/09/2022] [Indexed: 11/30/2022] Open
Abstract
Background People with moderate to severe depression in pregnancy must weigh potential risks of untreated or incompletely treated depression against the small, but uncertain risks of fetal antidepressant drug exposure. Clinical support alone appears insufficient for helping individuals with this complex decision. A patient decision aid (PDA) has the potential to be a useful tool for this population. The objective of our work was to use internationally recognized guidelines from the International Patient Decision Aids Standards Collaboration to develop an evidence-based PDA for antidepressant use in pregnancy. Methods A three-phased development process was used whereby, informed by patient and physician perspectives and evidence synthesis, a steering committee commissioned a web-based PDA for those deciding whether or not to start or continue antidepressant treatment for depression in pregnancy (Phase 1). A prototype was developed (Phase 2) and iteratively revised based on feedback during field testing based on a user-centred process (Phase 3). Results We developed a web-based PDA for people deciding whether to start or continue antidepressant use for depression in pregnancy. It has five interactive sections: (1) information on depression and treatment; (2) reasons to start/continue an antidepressant and to start/stop antidepressant medication; (3) user assessment of values regarding each issue; (4) opportunity to reflect on factors that contribute to decision making; and (5) a printable PDF that summarizes the user’s journey through the PDA. Conclusions This tool, which exclusively focuses on depression treatment with Selective Serotonin Reuptake Inhibitors and Serotonin–Norepinephrine Reuptake Inhibitors, can be used by individuals making decisions about antidepressant use to treat depression during pregnancy. Limitations of the PDA are that it is not for other conditions, nor other medications that can be used for depression, and in its pilot form cannot be used by women who do not speak English or who have a visual impairment. Pending further study, it has the potential to enhance quality of care and patient experience. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-022-01870-1.
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Affiliation(s)
- Neesha Hussain-Shamsy
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, ON, Canada
| | - Sarah Somerton
- Garry Hurvitz Centre for Brain and Mental Health, Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada
| | - Donna E Stewart
- Centre for Mental Health, University Health Network, Toronto General Hospital Research Institute, 200 Elizabeth Street, Toronto, ON, Canada.,Temerty Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, Canada
| | - Sophie Grigoriadis
- Temerty Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, Canada.,Sunnybrook Health Sciences Centre and Research Institute, 2075 Bayview Avenue, Toronto, ON, Canada.,Women's College Hospital and Research Institute, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada
| | - Kelly Metcalfe
- Women's College Hospital and Research Institute, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON, Canada
| | - Tim F Oberlander
- BC Children's Hospital, 4500 Oak Street, Vancouver, BC, Canada.,Department of Pediatrics, Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, Canada
| | - Carrie Schram
- Women's College Hospital and Research Institute, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada
| | - Valerie H Taylor
- Department of Psychiatry, University of Calgary, 2500 University Dr NW, Calgary, AB, Canada
| | - Cindy-Lee Dennis
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON, Canada
| | - Simone N Vigod
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, 4th Floor, Toronto, ON, Canada. .,Temerty Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, Canada. .,Women's College Hospital and Research Institute, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada.
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15
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Freeland A, Godkin D, Dembo J, Chan P, Knoops F, Lachmann M, Morissette L, Smith DH, Stewart DE, Trew M, Wong MR, Charbonneau M. Medical Assistance in Dying (MAiD) for Persons Whose Sole Underlying Medical Condition is a Mental Disorder: Challenges and Considerations. Can J Psychiatry 2022; 67:71-87. [PMID: 34465248 PMCID: PMC8811251 DOI: 10.1177/07067437211043315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Alison Freeland
- Associate Dean, Education (Regional), Temerty School of Faculty of Medicine, University of Toronto, Toronto, Ontario; Vice-President, Education, Academic Affairs and Patient Experience, Trillium Health Partners, Mississauga, Ontario; Associate Professor, Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Dianne Godkin
- Senior Ethicist, Trillium Health Partners, Mississauga, Ontario; Adjunct Lecturer, Faculty of Nursing, University of Toronto, Toronto, Ontario
| | - Justine Dembo
- Assistant Professor, Department of Psychiatry, University of Toronto, Toronto, Ontario; Staff Psychiatrist, Sunnybrook Health Sciences Centre, Toronto, Ontario
| | - Peter Chan
- Clinical Professor, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia; Geriatric and Consultation-Liaison Psychiatrist, Department of Psychiatry, Vancouver General Hospital, Vancouver, British Columbia
| | | | - Mark Lachmann
- Assistant Professor, Division of Geriatric Psychiatry, University of Toronto; Medical Lead, Bridgepoint Active Health Care, Sinai Health, Toronto, Ontario
| | - Louis Morissette
- Assistant Professor, Department of Psychiatry and Addictions, University of Montreal, Montreal, Quebec; Forensic Psychiatrist, Institut national de psychiatrie légale Philippe-Pinel, Montreal, Quebec
| | - Derryck H Smith
- Clinical Professor Emeritus, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
| | - Donna E Stewart
- University Professor, University of Toronto; Head of Research, University Health Network Centre for Mental Health; Senior Scientist, Toronto General Hospital Research Institute, Toronto, Ontario
| | - Michael Trew
- Medical Lead, Addiction and Mental Health Special Projects; Knowledge Lead, Addiction and Mental Health, Clinical Knowledge and Content Management, Calgary, Alberta
| | - Melanie R Wong
- Resident, Division of Geriatric Psychiatry, Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Manon Charbonneau
- Assistant Clinical Professor, Department of Psychiatry and Addictions, University of Montreal, Montreal, Quebec; Chief of Service, Child and Adolescent Psychiatry, CISSS de la Côte-Nord, Quebec
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16
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Keng A, Stewart DE, Sheehan KA. Neuropsychiatric Symptoms After Brain Tumor Resection in Children and Adolescents: A Scoping Review. J Acad Consult Liaison Psychiatry 2021; 63:110-118. [PMID: 34229094 DOI: 10.1016/j.jaclp.2021.06.007] [Citation(s) in RCA: 1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/23/2021] [Accepted: 06/26/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Brain tumors are one of the most common solid tumors in pediatric populations, with their treatments having significant neuropsychiatric impact. OBJECTIVE The objective of this study was to review the literature on neuropsychiatric sequelae after surgical resection of brain tumors in children and adolescents. METHODS Using a scoping method, we reviewed empirical articles describing pediatric patients with brain tumors who underwent partial or total resection and examined major neuropsychiatric domains postoperatively over time. RESULTS The initial search yielded 15,543 articles. After duplicate removal, abstract screening, and review, 44 articles were included. Cognitive deficits were the most widely studied outcomes and found to be associated with tumor location, operative variables, perioperative complications, treatment types, and psychosocial factors. Cerebellar mutism, or posterior fossa syndrome, commonly co-occurred with emotional and behavioral dysregulation after posterior fossa resections. Depression, anxiety, and somatization were frequently grouped together as "distress," with higher rates among pediatric patients with brain tumor than among healthy peers. Problematic school behaviors, antisocial, and attention-deficit traits were increased; however, several other behaviors (e.g., risky sexual behaviors, substance use) were equal or lower when compared to peers. Posttraumatic stress disorder was highly prevalent and often interfered with social functioning. Delirium, eating disorders, and longer-term outcomes received inadequate attention. CONCLUSION Identifying risk factors of neuropsychiatric sequelae and their impact after pediatric brain tumor resection is important for prognostication and the development of tailored management strategies for these children and adolescents.
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Affiliation(s)
- Alvin Keng
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
| | - Donna E Stewart
- Centre for Mental Health, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Kathleen Ann Sheehan
- Centre for Mental Health, University Health Network, University of Toronto, Toronto, ON, Canada
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17
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Gagliardi AR, Yip CYY, Irish J, Wright FC, Rubin B, Ross H, Green R, Abbey S, McAndrews MP, Stewart DE. The psychological burden of waiting for procedures and patient-centred strategies that could support the mental health of wait-listed patients and caregivers during the COVID-19 pandemic: A scoping review. Health Expect 2021; 24:978-990. [PMID: 33769657 PMCID: PMC8235883 DOI: 10.1111/hex.13241] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 02/01/2021] [Accepted: 02/09/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Waiting for procedures delayed by COVID-19 may cause anxiety and related adverse consequences. OBJECTIVE To synthesize research on the mental health impact of waiting and patient-centred mitigation strategies that could be applied in the COVID-19 context. METHODS Using a scoping review approach, we searched 9 databases for studies on waiting lists and mental health and reported study characteristics, impacts and intervention attributes and outcomes. RESULTS We included 51 studies that focussed on organ transplant (60.8%), surgery (21.6%) or cancer management (13.7%). Most patients and caregivers reported anxiety, depression and poor quality of life, which deteriorated with increasing wait time. The impact of waiting on mental health was greater among women and new immigrants, and those of younger age, lower socio-economic status, or with less-positive coping ability. Six studies evaluated educational strategies to develop coping skills: 2 reduced depression (2 did not), 1 reduced anxiety (2 did not) and 2 improved quality of life (2 did not). In contrast, patients desired acknowledgement of concerns, peer support, and periodic communication about wait-list position, prioritization criteria and anticipated procedure date. CONCLUSIONS Findings revealed patient-centred strategies to alleviate the mental health impact of waiting for procedures. Ongoing research should explore how to optimize the impact of those strategies for diverse patients and caregivers, particularly in the COVID-19 context. PATIENT OR PUBLIC CONTRIBUTION Six patients and four caregivers waiting for COVID-19-delayed procedures helped to establish eligibility criteria, plan data extraction and review a draft and final report.
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Affiliation(s)
- Anna R. Gagliardi
- Toronto General Hospital Research InstituteUniversity Health NetworkTorontoCanada
| | | | - Jonathan Irish
- Surgical Oncology Program/Access to Care‐SurgeryOntario Health‐Cancer Care OntarioTorontoCanada
| | | | - Barry Rubin
- Peter Munk Cardiac CentreUniversity Health NetworkTorontoCanada
| | - Heather Ross
- Ted Rogers Centre of Excellence in Heart FunctionUniversity Health NetworkTorontoCanada
| | - Robin Green
- Toronto Rehabilitation InstituteUniversity Health NetworkTorontoCanada
| | - Susan Abbey
- Medical Psychiatry & Psychosocial OncologyUniversity Health NetworkTorontoCanada
| | | | - Donna E. Stewart
- University Health Network Centre for Mental HealthUniversity of TorontoTorontoCanada
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18
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Kimber M, McTavish JR, Vanstone M, Stewart DE, MacMillan HL. Child maltreatment online education for healthcare and social service providers: Implications for the COVID-19 context and beyond. Child Abuse Negl 2021; 116:104743. [PMID: 32980151 PMCID: PMC7513691 DOI: 10.1016/j.chiabu.2020.104743] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/10/2020] [Accepted: 09/13/2020] [Indexed: 05/12/2023]
Abstract
Evidence indicates that healthcare and social service providers (HSSPs) receive inadequate education related to recognizing and responding to child maltreatment. This is despite the fact HSSPs are identified as an important factor in the primary, secondary, and tertiary prevention of this childhood exposure. The need for online education for HSSPs' is highlighted during the COVID-19 pandemic restrictions and will continue to be relevant afterward. The objective of this commentary is to provide an overview of: (a) educational interventions for HSSPs' related to recognizing and responding to child maltreatment; (b) the development of VEGA (Violence, Evidence, Guidance, Action), which is an online platform of educational resources to support HSSPs to recognize and respond to child maltreatment; and (c) the RISE (Researching the Impact of Service provider Education) project, which is an ongoing multi-province evaluation of VEGA in Canada. It is important to consider ongoing ways that HSSPs can receive education related to recognizing and responding to child maltreatment. The virtual implementation of VEGA and the RISE Project provide a necessary opportunity to continue to increase the capacity of Canada's HSSPs to adequately and safely recognize and respond to child maltreatment, while simultaneously advancing education scholarship for the field of child maltreatment and which will have relevance for the COVID-19 context and beyond.
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Affiliation(s)
- Melissa Kimber
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, MIP Suite 201A, Hamilton, ON, L8S 4K1, Canada.
| | - Jill R McTavish
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, McMaster University, 1280 Main Street West, MIP Suite 201A, Hamilton, ON, L8S 4K1, Canada
| | - Meredith Vanstone
- Department of Family Medicine, Faculty of Health Sciences, McMaster University, 1280 Main Street West, DBHSC 5003E, Hamilton, ON, L8S 4K1, Canada
| | - Donna E Stewart
- Centre for Mental Health, University of Toronto and University Health Network, 200 Elizabeth Street, EN-7-229, Toronto, ON, M5G 2C4, Canada
| | - Harriet L MacMillan
- Offord Centre for Child Studies, Department of Psychiatry and Behavioural Neurosciences, and Department of Pediatrics, McMaster University, 1280 Main Street West, MIP 201A, Hamilton, ON, L8S 4K1, Canada
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Stewart DE, Viens P, Muralidharan O, Kastanias P, Dembo J, Riazantseva E. E-Survey of Stressors and Protective Factors in Practicing Medical Assistance in Dying. J Palliat Med 2021; 24:1489-1496. [PMID: 33601999 DOI: 10.1089/jpm.2020.0664] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: To better identify, quantify, and understand the current stressors and protective factors reported by Canadian medical assistance in dying (MAiD) assessors and providers to inform policy, education, and supports. Methods: E-survey of MAiD stressors (n = 33) and protective factors (n = 27); resilience measurement and comments relating to practice involving physicians and nurse practitioners who provide MAiD services and belong to the Canadian Association of MAiD Assessors and Providers or a francophone equivalent. The survey was conducted, while Parliament was considering changes to MAiD eligibility criteria, which occurred during COVID-19 pandemic restrictions. Results: In total, there were 131 respondents (response rate 35.8%). Two possible changes to future eligibility (mental disorders as the sole reason for MAiD and mature minors) were highly scored as were extra clinical load and patients' family conflict over MAiD. Twenty percent of respondents considered stopping MAiD work. The CD Resilience Scale-2 mean score was 6.90. Highly scored protective factors included compassionate care, relief of suffering, patient autonomy, patient gratitude, feelings of honor, privilege, and professionally satisfying work. Discussion: The identified stressors and reasons for considering stopping MAiD work indicate needs for policy, education, and supports to be optimized or developed. Respondents showed high resilience and highly scored protective factors, which should be optimized. This survey should be repeated in countries where MAiD is legal to determine stressors and protective factors in MAiD practice, stressors addressed, and protective factors enhanced where feasible in the local context for optimal care.
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Affiliation(s)
- Donna E Stewart
- Psychiatry, Family and Community Medicine, Centre for Mental Health and the Toronto General Hospital Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Pierre Viens
- Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Québec, Canada
| | | | - Patti Kastanias
- University Health Network, Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Justine Dembo
- Department of Psychiatry, Sunnybrook Health Science Centre, University of Toronto, Toronto, Ontario, Canada
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Affiliation(s)
- Donna E Stewart
- University Professor, Department of Psychiatry, 7938University of Toronto, Toronto, Ontario, Canada; Head of Research and Academic Development, Centre for Mental Health, Senior Scientist, University Health Network, Toronto, Ontario, Canada; Ethics and Review Committee, World Psychiatric Association, Geneva, Switzerland
| | - Harriet MacMillan
- Distinguished University Professor, Departments of Psychiatry and Behavioural Neurosciences, and Pediatrics, and Chedoke Health Chair in Child Psychiatry, Offord Centre for Child Studies, 3710McMaster University, Hamilton, Ontario, Canada
| | - Melissa Kimber
- Assistant Professor, Department of Psychiatry and Behavioural Neurosciences and Core Member of the Offord Centre for Child Studies, 3710McMaster University, Hamilton, Ontario, Canada
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Affiliation(s)
- Donna E. Stewart
- University Health Network Centre for Mental HealthUniversity of TorontoTorontoONCanada
| | - Paul S. Appelbaum
- Department of PsychiatryColumbia University College of Physicians and SurgeonsNew YorkNYUSA
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Affiliation(s)
- Harriet L MacMillan
- Department of Psychiatry and Behavioural Neurosciences, Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Melissa Kimber
- Department of Psychiatry and Behavioural Neurosciences, Offord Centre for Child Studies, McMaster University, Hamilton, Ontario, Canada
| | - Donna E Stewart
- University Health Network Centre for Mental Health, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Filler T, Foster AM, Grace SL, Stewart DE, Straus SE, Gagliardi AR. Patient-Centered Care for Women: Delphi Consensus on Evidence-Derived Recommendations. Value Health 2020; 23:1012-1019. [PMID: 32828212 DOI: 10.1016/j.jval.2020.03.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 03/06/2020] [Accepted: 03/21/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Patient-centered care (PCC) could reduce gender inequities in quality of care. Little is known about how to implement patient-centered care for women (PCCW). We aimed to generate consensus recommendations for achieving PCCW. METHODS We used a 2-round Delphi technique. Panelists included 21 women of varied age, ethnicity, education, and urban/rural residence; and 21 health professionals with PCC or women's health expertise. Panelists rated recommendations, derived from prior research and organized by a 6-domain PCC framework, on a 7-point Likert scale in an online survey. We used summary statistics to report response frequencies and defined consensus as when ≥85% panelists chose 5 to 7. RESULTS The response rate was 100%. In round 1, women and professionals retained 46 (97.9%) and 42 (89.4%) of 47 initial recommendations, respectively. The round 2 survey included 6 recommendations for women and 5 recommendations for professionals (did not achieve consensus in round 1 or were newly suggested). In round 2, women retained 2 of 6 recommendations and professionals retained 3 of 5 recommendations. Overall, 49 recommendations were generated. Both groups agreed on 44 (94.0%) recommendations (13 retained by 100% of both women and clinicians): fostering patient-physician relationship (n = 11), exchanging information (n = 10), responding to emotions (n = 4), managing uncertainty (n = 5), making decisions (n = 8), and enabling patient self-management (n = 6). CONCLUSION The recommendations represent the range of PCC domains, are based on evidence from primary research, and reflect high concordance between women and professional panelists. They can inform the development of policies, guidelines, programs, and performance measures that foster PCCW.
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Affiliation(s)
- Tali Filler
- Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
| | - Angel M Foster
- Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | | | - Donna E Stewart
- Centre for Mental Health, University Health Network, Toronto, Canada
| | - Sharon E Straus
- Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, Toronto, Canada.
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Nyhof BB, Jameel B, Dunn S, Grace SL, Khanlou N, Stewart DE, Gagliardi AR. Identifying strategies to implement patient-centred care for women: Qualitative interviews with women. Patient Educ Couns 2020; 103:1422-1427. [PMID: 32063437 DOI: 10.1016/j.pec.2020.02.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 01/02/2020] [Accepted: 02/07/2020] [Indexed: 05/26/2023]
Abstract
OBJECTIVE Patient-centred care (PCC) is one approach for mitigating gendered inequities in health care quality. Little is known about how to implement PCC for women (PCCW). This study explored women's views about PCCW implementation. METHODS Descriptive analysis of semi-structured qualitative telephone interviews with diverse women about PCC using an established 6-domain PCC framework. RESULTS Participants were 33 women who varied in health care experience, age, education and setting. Themes were consistent across these characteristics. Women said that clinicians often dismissed their healthcare concerns. We transformed desired PCC elements into strategies to implement PCCW, 27 at the point-of-care (i.e. assume a non-judgmental disposition, demonstrate active listening, elicit questions, acknowledge emotions, explore preferences for treatment, and offer self-care information) and 3 at the system level (education for women/girls and clinicians about PCCW, widespread access to women's-only services or women clinicians). CONCLUSION Many women experienced suboptimal PCC. By sharing their PCC experiences, women identified PCC elements of importance to them, and insight on actionable point-of-care and system-level strategies to implement PCCW. PRACTICE IMPLICATIONS This study revealed numerous ways that clinicians can foster PCCW, and insight on how healthcare managers and policy-makers can support PCCW implementation.
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Affiliation(s)
- Bryanna B Nyhof
- Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
| | - Bismah Jameel
- Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
| | - Sheila Dunn
- Women's College Hospital Research Institute, Women's College Hospital, Toronto, Canada
| | - Sherry L Grace
- Toronto General Hospital Research Institute, University Health Network, Toronto, Canada; Faculty of Health, York University, Toronto, Canada
| | | | - Donna E Stewart
- Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
| | - Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, Toronto, Canada.
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Keng A, Stewart DE, Sheehan KA. Examining the Neuropsychiatric Sequelae Postsurgical Resection of Adult Brain Tumors Through a Scoping Review. Psychosomatics 2020; 61:209-219. [DOI: 10.1016/j.psym.2019.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 12/19/2019] [Accepted: 12/20/2019] [Indexed: 10/25/2022]
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Filler T, Dunn S, Grace SL, Straus SE, Stewart DE, Gagliardi AR. Multi-level strategies to tailor patient-centred care for women: qualitative interviews with clinicians. BMC Health Serv Res 2020; 20:212. [PMID: 32169069 PMCID: PMC7071699 DOI: 10.1186/s12913-020-05082-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 03/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient-centered care (PCC) is one approach for ameliorating persistent gendered disparities in health care quality, yet no prior research has studied how to achieve patient-centred care for women (PCCW). The purpose of this study was to explore how clinicians deliver PCCW, challenges they face, and the strategies they suggest are needed to support PCCW. METHODS We conducted semi-structured qualitative interviews (25-60 min) with clinicians. Thirty-seven clinicians representing 7 specialties (family physicians, cardiologists, cardiac surgeons, obstetricians/gynecologist, psychiatrists, nurses, social workers) who manage depression (n = 16), cardiovascular disease (n = 11) and contraceptive counseling (n = 10), conditions that affect women across the lifespan. We used constant comparative analysis to inductively analyze transcripts, mapped themes to a 6-domain PCC conceptual framework to interpret findings, and complied with qualitative research reporting standards. RESULTS Clinicians said that women don't always communicate their health concerns and physicians sometimes disregard women's health concerns, warranting unique PCC approaches.. Clinicians described 39 approaches they used to tailor PCC for women across 6 PCC domains: foster a healing relationship, exchange information, address emotions/concerns, manage uncertainty, make decisions, and enable self-management. Additional conditions that facilitated PCCW were: privacy, access to female clinicians, accommodating children through onsite facilities, and flexible appointment formats and schedules. Clinicians suggested 7 strategies needed to address barriers of PCCW they identified at the: patient-level (online appointments, transport to health services, use of patient partners to plan and/or deliver services), clinician-level (medical training and continuing professional development in PCC and women's health), and system-level (funding models for longer appointment times, multidisciplinary teamwork to address all PCC domains). CONCLUSIONS Our research revealed numerous strategies that clinicians can use to optimize PCCW, and health care managers and policy-makers can use to support PCCW through programs and policies. Identified strategies addressed all domains of an established PCC conceptual framework. Future research should evaluate the implementation and impact of these strategies on relevant outcomes such as perceived PCC among women and associated clinical outcomes to prepare for broad scale-up.
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Affiliation(s)
- Tali Filler
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, Toronto, Ontario, M5G2C4, Canada
| | | | - Sherry L Grace
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, Toronto, Ontario, M5G2C4, Canada.,York University, Toronto, Canada
| | | | - Donna E Stewart
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, Toronto, Ontario, M5G2C4, Canada
| | - Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, Toronto, Ontario, M5G2C4, Canada.
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Gagliardi AR, Dunn S, Foster AM, Grace SL, Khanlou N, Stewart DE, Straus SE. Is patient-centred care for women a priority for policy-makers? Content analysis of government policies. Health Res Policy Syst 2020; 18:23. [PMID: 32070365 PMCID: PMC7029558 DOI: 10.1186/s12961-020-0533-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 02/04/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Considerable research shows that women experience gendered disparities in healthcare access and quality. Patient-centred care (PCC) could reduce inequities by addressing the patient's clinical and personal needs. Healthcare policies can influence service delivery to optimise patient outcomes. This study assessed whether and how government policies recognise and promote PCC for women (PCCW). METHODS We analysed the content of English-language policies published in Canada from 2010 to 2018 on depression and cardiac rehabilitation - conditions featuring known gendered inequities - that were identified on government websites. We extracted data and used summary statistics to enumerate mentions of PCC and women's health. RESULTS We included 30 policies (20 depression, 10 cardiac rehabilitation). Of those, 20 (66.7%) included any content related to PCC (median 1.0, range 0.0 to 5.0), most often exchanging information (14, 46.7%) and making decisions (13, 43.3%). Less frequent domains were enabling self-management (8, 26.7%), addressing emotions (6, 20.0%) and fostering the relationship (4, 13.3%). No policies included content for the domain of managing uncertainty. A higher proportion of cardiac rehabilitation guidelines included PCC content. Among the 30 policies, 7 (23.3%) included content related to at least one women's health domain (median 0.0, range 0.0 to 3.0). Most frequently included were social determinants of health (4, 13.3%). Fewer policies mentioned any issues to consider for women (2, 28.6%), issues specific to subgroups of women (2, 28.6%) or distinguished care for women from men (2, 28.6%). No policies included mention of abuse or violence, or discrimination or stigma. The policies largely pertained to depression. Despite mention of PCC or women's health, policies offered brief, vague guidance on how to achieve PCCW; for example, "Patients value being involved in decision-making" and "Women want care that is collaborative, woman- and family-centered, and culturally sensitive." CONCLUSIONS Despite considerable evidence of need and international recommendations, most policies failed to recognise gendered disparities or promote PCC as a mitigating strategy. These identified gaps represent opportunities by which government policies could be developed or strengthened to support PCCW. Future research should investigate complementary strategies such as equipping policy-makers with the evidence and tools required to develop PCCW-informed policies.
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Affiliation(s)
- Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, Toronto, M5G2C4, Canada.
| | - Sheila Dunn
- Department of Family and Community Medicine, University of Toronto and Women's College Research Institute, Toronto, M5S1B2, Canada
| | - Angel M Foster
- Faculty of Health Sciences, University of Ottawa, Ottawa, K1N6N5, Canada
| | - Sherry L Grace
- York University and University Health Network, Toronto, M3J1P3, Canada
| | | | - Donna E Stewart
- University of Toronto, Toronto General Hospital Research Institute, Toronto, M5G2C4, Canada
| | - Sharon E Straus
- Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, M5B1W8, Canada
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Gagliardi AR, Nyhof BB, Dunn S, Grace SL, Green C, Stewart DE, Wright FC. How is patient-centred care conceptualized in women's health: a scoping review. BMC Womens Health 2019; 19:156. [PMID: 31822284 PMCID: PMC6902460 DOI: 10.1186/s12905-019-0852-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 11/15/2019] [Indexed: 12/25/2022]
Abstract
Background Gendered disparities in health care delivery and outcomes are an international problem. Patient-centred care (PCC) improves patient and health system outcomes, and is widely advocated to reduce inequities. The purpose of this study was to review published research for frameworks of patient-centred care for women (PCCW) that could serve as the basis for quality improvement. Methods A scoping review was conducted by searching MEDLINE, EMBASE, CINAHL, SCOPUS, Cochrane Library, and Joanna Briggs index for English-language quantitative or qualitative studies published from 2008 to 2018 that included at least 50% women aged 18 years or greater and employed or generated a PCCW framework. Findings were analyzed using a 6-domain PCC framework, and reported using summary statistics and narrative descriptions. Results A total of 9267 studies were identified, 6670 were unique, 6610 titles were excluded upon title/abstract screening, and 11 were deemed eligible from among 60 full-text articles reviewed. None were based on or generated a PCCW framework, included solely women, or analyzed or reported findings by gender. All studies explored or described PCC components through qualitative research or surveys. None of the studies addressed all 6 domains of an established PCC framework; however, additional PCC elements emerged in 9 of 11 studies including timely responses, flexible scheduling, and humanized management, meaning tailoring communication and treatment to individual needs and preferences. There were no differences in PCC domains between studies comprised primarily of women and other studies. Conclusions Given the paucity of research on PCCW, primary research is needed to generate knowledge about PCCW processes, facilitators, challenges, interventions and impacts, which may give rise to a PCCW framework that could be used to plan, deliver, evaluate and improve PCCW.
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Affiliation(s)
- Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, 13 EN-228, Toronto, ON, M5G2C4, Canada.
| | - Bryanna B Nyhof
- Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
| | | | - Sherry L Grace
- York University and University Health Network, Toronto, Canada
| | - Courtney Green
- Society of Obstetricians and Gynaecologists of Canada, Ottawa, Canada
| | - Donna E Stewart
- Toronto General Hospital Research Institute, University Health Network, Toronto, Canada
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Ramlakhan JU, Foster AM, Grace SL, Green CR, Stewart DE, Gagliardi AR. What constitutes patient-centred care for women: a theoretical rapid review. Int J Equity Health 2019; 18:182. [PMID: 31771588 PMCID: PMC6880419 DOI: 10.1186/s12939-019-1048-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 09/05/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Women experience disparities in health care delivery and outcomes. Patient-centred care for women (PCCW) is needed. This study examined how PCC has been conceptualized and operationalized in women's health research. METHODS We conducted a theoretical rapid review of PCCW in MEDLINE, EMBASE, CINAHL and SCOPUS from 2008 to 2018 for studies involving women aged 18 years or greater with any condition, and analyzed data using an established 6-domain framework of patient-centred communication. RESULTS We included 39 studies, which covered the following clinical areas: maternal care, cancer, diabetes, HIV, endometriosis, dementia, distal radius fracture, overactive bladder, and lupus erythematosus. The 34 (87.2%) studies that defined or described PCC varied in the PCC elements they addressed, and none addressed all 6 PCC domains. Common domains were exchanging information (25, 73.5%) and fostering the patient-clinician relationship (22, 64.7%). Fewer studies addressed making decisions (16, 47.1%), enabling patient self-management (15, 44.1%), responding to emotions (12, 35.3%), or managing uncertainty (1, 2.9%). Compared with mixed-gender studies, those comprised largely of women more frequently prioritized exchanging information above other domains. Few studies tested strategies to support PCCW or evaluated the impact of PCCW; those that did demonstrated beneficial impact on patient knowledge, satisfaction, well-being, self-care and clinical outcomes. CONCLUSIONS Studies varied in how they conceptualized PCCW, and in many it was defined narrowly. Few studies examined how to implement or measure PCCW; thus, we lack insight on how to operationlize PCCW. Thus, further research is needed to confirm this, and whether PCCW differs across conditions, knowledge needed to inform policies, guidelines and measures aimed at improving health care and associated outcomes for women.
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Affiliation(s)
- Jessica U Ramlakhan
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada
| | - Angel M Foster
- Faculty of Health Sciences, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
| | - Sherry L Grace
- School of Kinesiology and Health Science, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada.,University Health Network, 550 University Ave, Toronto, ON, M5G 2A2, Canada
| | - Courtney R Green
- Society of Obstetricians & Gynecologists of Canada, 2781 Lancaster Road, Suite 200, Ottawa, ON, K1B 1A7, Canada
| | - Donna E Stewart
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, 13EN-228, Toronto, ON, M5G 2C4, Canada
| | - Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, 200 Elizabeth Street, 13EN-228, Toronto, ON, M5G 2C4, Canada.
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Gagliardi AR, Green C, Dunn S, Grace SL, Khanlou N, Stewart DE. How do and could clinical guidelines support patient-centred care for women: Content analysis of guidelines. PLoS One 2019; 14:e0224507. [PMID: 31703076 PMCID: PMC6839851 DOI: 10.1371/journal.pone.0224507] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 10/14/2019] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES Patient-centred care (PCC) improves multiple patient and health system outcomes. However, many patients do not experience PCC, particularly women, who are faced with disparities in care and outcomes globally. The purpose of this study was to identify if and how guidelines address PCC for women (PCCW). METHODS We searched MEDLINE, EMBASE, National Guideline Clearing House, and guideline developer websites for publicly-available, English-language guidelines on depression and cardiac rehabilitation, conditions with known gendered inequities. We used summary statistics to report guideline characteristics, clinical topic, mention of PCC according to McCormack's framework, and mention of women's health considerations. We appraised guideline quality with the AGREE II instrument. RESULTS A total of 27 guidelines (18 depression, 9 cardiac rehabilitation) were included. All 27 guidelines mentioned at least one PCC domain (median 3, range 1 to 6), most frequently exchanging information (20, 74.1%), making decisions (20, 74.1%), and enabling patient self-management (21, 77.8%). No guidelines fully addressed PCC: 9 (50.0%) of 18 depression guidelines and 3 (33.3%) of 9 cardiac rehabilitation guidelines addressed 4 or more PCC domains. Even when addressed, guidance was minimal and vague. Among 14 (51.9%) guidelines that mentioned women's health, most referred to social determinants of health; none offered guidance on how to support women impacted by these factors, engage women, or tailor care for women. These findings pertained even to women-specific guidelines. Reported use or type of guideline development process/system did not appear to be linked with PCCW content. Based on quality appraisal with AGREE II, guidelines were either not recommended or recommended with modifications. In particular, the stakeholder involvement AGREE II domain was least addressed, but guidelines that scored higher for stakeholder involvement also appeared to better address PCCW. IMPLICATIONS This research identified opportunities to generate guidelines that achieve PCCW. Strategies include employing a PCC framework, considering gender issues, engaging women on guideline-writing panels, and including patient-oriented tools in guidelines. Primary research is needed to establish what constitutes PCCW.
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Affiliation(s)
- Anna R. Gagliardi
- University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Courtney Green
- Society of Obstetricians and Gynaecologists of Canada, Ottawa, Ontario, Canada
| | - Sheila Dunn
- Women’s College Hospital, Toronto, Ontario, Canada
| | - Sherry L. Grace
- York University and University Health Network, Toronto, Ontario, Canada
| | - Nazilla Khanlou
- York University and University Health Network, Toronto, Ontario, Canada
| | - Donna E. Stewart
- University Health Network and University of Toronto, Toronto, Ontario, Canada
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Vigod SN, Hussain-Shamsy N, Stewart DE, Grigoriadis S, Metcalfe K, Oberlander TF, Schram C, Taylor VH, Dennis CL. A patient decision aid for antidepressant use in pregnancy: Pilot randomized controlled trial. J Affect Disord 2019; 251:91-99. [PMID: 30913472 DOI: 10.1016/j.jad.2019.01.051] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 12/29/2018] [Accepted: 01/22/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Decisions about antidepressant use in pregnancy are complex. We performed a pilot randomized controlled trial assessing the feasibility of a trial protocol for an online patient decision aid (PDA) for women deciding about antidepressant use in pregnancy. METHODS 96 preconception and pregnant Canadian women recruited from specialist (n = 51) and non-specialist (n = 45) settings with Decisional Conflict Scale (DCS, range 0-100) score of ≥25 signifying moderate-to-high decisional conflict were randomly allocated to either the PDA or a control condition that guided participants to publicly available resources for advice around antidepressants and pregnancy. Follow-up data were collected at 4 weeks post-randomization. RESULTS About 88.9% of eligible participants consented to participate. Women's views of the tool were positive; 88.7% of participants provided follow-up data. At follow-up, mean DCS score had decreased by 19.9 points in the PDA group vs. 13.3 in controls (adjusted mean difference, MD, 7.01, 95% CI -14.3 to 0.30). In the non-specialist setting, DCS scores decreased more for PDA users (25.5 points) than controls (10.5 points; adjusted MD -15.1, 95% CI -25.6 to -4.55); the MD was negligible in the specialist setting. LIMITATIONS The main limitation is the highly educated, high-income nature of our sample. CONCLUSIONS Evaluation of an online PDA for antidepressant use in pregnancy with national recruitment is feasible. Pilot results suggest that the tool is acceptable and reduces decisional conflict more than clinical care alone in a non-specialist setting. Evaluation of the PDA's impact on longer-term maternal and child clinical outcomes is a key next step.
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Affiliation(s)
- Simone N Vigod
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Women's College Hospital and Research Institute, Toronto, ON, Canada.
| | | | - Donna E Stewart
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; University Health Network, Toronto, ON, Canada
| | - Sophie Grigoriadis
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Kelly Metcalfe
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Tim F Oberlander
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Carrie Schram
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Valerie H Taylor
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Cindy-Lee Dennis
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
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Gagliardi AR, Dunn S, Foster A, Grace SL, Green CR, Khanlou N, Miller FA, Stewart DE, Vigod S, Wright FC. How is patient-centred care addressed in women's health? A theoretical rapid review. BMJ Open 2019; 9:e026121. [PMID: 30765411 PMCID: PMC6398665 DOI: 10.1136/bmjopen-2018-026121] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Efforts are needed to reduce gendered inequities and improve health and well-being for women. Patient-centred care (PCC), an approach that informs and engages patients in their own health, is positively associated with improved care delivery, experiences and outcomes. This study aimed to describe how PCC for women (PCCW) has been conceptualised in research. METHODS We conducted a theoretical rapid review of PCCW in four health conditions. We searched MEDLINE, EMBASE, CINAHL, SCOPUS, Cochrane Library and Joanna Briggs index for English-language articles published from January 2008 to February 2018 inclusive that investigated PCC and involved at least 50% women aged 18 or older. We analysed findings using a six-domain PCC framework, and reported findings with summary statistics and narrative descriptions. RESULTS After screening 2872 unique search results, we reviewed 51 full-text articles, and included 14 (five family planning, three preventive care, four depression, one cardiovascular disease and one rehabilitation). Studies varied in how they assessed PCC. None examined all six PCC framework domains; least evaluated domains were addressing emotions, managing uncertainty and enabling self-management. Seven studies that investigated PCC outcomes found a positive association with appropriate health service use, disease remission, health self-efficacy and satisfaction with care. Differing views about PCC between patients and physicians, physician PCC attitudes and geographic affluence influenced PCC. No studies evaluated the influence of patient characteristics or tested interventions to support PCCW. CONCLUSION There is a paucity of research that has explored or evaluated PCCW in the conditions of interest. We excluded many studies because they arbitrarily labelled many topics as PCC, or simply concluded that PCC was needed. More research is needed to fully conceptualise and describe PCCW across different characteristics and conditions, and to test interventions that improve PCCW. Policies and incentives may also be needed to stimulate greater awareness and delivery of PCCW.
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Affiliation(s)
- Anna R Gagliardi
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Sheila Dunn
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Angel Foster
- Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Sherry L Grace
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
- School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Courtney R Green
- Society of Obstetricians and Gynecologists of Canada, Ottawa, Ontario, Canada
| | - Nazilla Khanlou
- Society of Obstetricians and Gynecologists of Canada, Ottawa, Ontario, Canada
- Faculty of Health/School of Nursing, York University, Toronto, Ontario, Canada
| | - Fiona A Miller
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Donna E Stewart
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Simone Vigod
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Frances C Wright
- Louise Temerty Breast Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Abstract
Postpartum depression (PPD) is common, disabling, and treatable. The strongest risk factor is a history of mood or anxiety disorder, especially having active symptoms during pregnancy. As PPD is one of the most common complications of childbirth, it is vital to identify best treatments for optimal maternal, infant, and family outcomes. New understanding of PPD pathophysiology and emerging therapeutics offer the potential for new ways to add to current medications, somatic treatments, and evidence-based psychotherapy. The benefits and potential harms of treatment, including during breastfeeding, are presented.
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Affiliation(s)
- Donna E Stewart
- Department of Psychiatry, University of Toronto, Toronto, Ontario M5G 2C4, Canada; .,Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario M5G 2C4, Canada.,Toronto General Hospital Research Institute, Toronto, Ontario M5G 2C4, Canada.,University Health Network Centre for Mental Health, Toronto, Ontario M5G 2C4, Canada
| | - Simone N Vigod
- Department of Psychiatry, University of Toronto, Toronto, Ontario M5G 2C4, Canada; .,Women's College Research Institute, Women's College Hospital, Toronto, Ontario M5G 2C4, Canada;
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Abstract
OBJECTIVE Consultation-liaison (C-L) psychiatrists are involved in physician-assisted death (PAD) teams in many permitting jurisdictions. This paper will describe our Canadian PAD experience over 2 years, highlighting the role of C-L psychiatrists, at a large hospital network that provides medical assistance in dying (MAID, as this is called in Canada). METHODS We will describe the Canadian criteria for MAID, our multispecialty MAID team experience and the roles, issues and concerns experienced by C-L psychiatrists. Some brief patient examples will be provided. RESULTS Our MAID team has managed 186 MAID inquiries, assessed 95 MAID requests and provided 49 MAID interventions over a 24 month period. The 2 co-leaders of the MAID team, 8 assessors and 1 intervention physician are C-L psychiatrists. Each of the MAID criteria: grievous medical condition, advanced state of irreversible decline, intolerable suffering, natural death reasonably foreseeable, voluntary request, capacity and informed consent pose specific challenges to be resolved in the assessment. Several unique MAID issues, including the role of education and mandatory psychiatric assessment and protocols will also be discussed. CONCLUSIONS Our experience shows that C-L psychiatrists are well-situated to provide vital expertise and leadership to multispecialty PAD teams.
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Affiliation(s)
- Donna E Stewart
- University Health Network Centre for Mental Health, University of Toronto, Faculty of Medicine, 200 Elizabeth Street, EN7-229, Toronto, ON M52C4, Canada.
| | - Gary Rodin
- University Health Network Centre for Mental Health, Department of Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Faculty of Medicine, Canada
| | - Madeline Li
- University Health Network Centre for Mental Health, Department of Supportive Care, Princess Margaret Cancer Centre, University of Toronto, Faculty of Medicine, Canada
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Abstract
BACKGROUND Intimate partner sexual violence (IPSV) is a common but often overlooked form of intimate partner violence (IPV) that may have unique consequences for those who experience it. We aimed to explore how outcomes associated with IPSV differ from outcomes associated with other forms of intimate partner and sexual violence. METHODS We conducted a narrative review of the English-language literature, including original research studies and reports that focused on outcomes associated with IPSV. We aimed to quantify the risk for health outcomes associated with exposure to IPSV in comparison with exposure to other forms of interpersonal violence or nonexposure to interpersonal violence. RESULTS Twenty-eight publications were reviewed, most were small observational studies focused on women exposed to IPSV. Reported outcomes were related to mental health (n = 20 studies), physical and sexual health (n = 19 studies), and health of children with a parent exposed to IPSV (n = 1 study). Compared with other forms of interpersonal violence, exposure to IPSV was associated with greater risk for posttraumatic stress disorder and depressive symptoms, problematic substance use, suicidality, pain and other somatic symptoms, adverse sexual health problems, specific physical injuries including strangulation, and death by homicide. Children with an exposed parent were at higher risk for internalizing symptoms such as depression, anxiety, and somatization. CONCLUSIONS Sexual violence in intimate partner relationships is common and has distinct consequences compared with other forms of interpersonal violence including elevated risks for suicidality and death by homicide. It should be given special consideration within the assessment and management of interpersonal violence.
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Affiliation(s)
| | - Donna E Stewart
- 1 Department of Psychiatry, University of Toronto , Toronto, Canada .,2 Toronto General Research Institute, University Health Network , Toronto, Canada
| | - Simone N Vigod
- 1 Department of Psychiatry, University of Toronto , Toronto, Canada .,3 Department of Psychiatry, Women's College Hospital and Research Institute , Toronto, Canada
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Stewart DE, Wilk AR, Toll AE, Harper AM, Lehman RR, Robinson AM, Noreen SA, Edwards EB, Klassen DK. Measuring and monitoring equity in access to deceased donor kidney transplantation. Am J Transplant 2018; 18:1924-1935. [PMID: 29734498 DOI: 10.1111/ajt.14922] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [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: 10/19/2017] [Revised: 04/01/2018] [Accepted: 04/29/2018] [Indexed: 01/25/2023]
Abstract
The Organ Procurement and Transplantation Network monitors progress toward strategic goals such as increasing the number of transplants and improving waitlisted patient, living donor, and transplant recipient outcomes. However, a methodology for assessing system performance in providing equity in access to transplants was lacking. We present a novel approach for quantifying the degree of disparity in access to deceased donor kidney transplants among waitlisted patients and determine which factors are most associated with disparities. A Poisson rate regression model was built for each of 29 quarterly, period-prevalent cohorts (January 1, 2010-March 31, 2017; 5 years pre-kidney allocation system [KAS], 2 years post-KAS) of active kidney waiting list registrations. Inequity was quantified as the outlier-robust standard deviation (SDw ) of predicted transplant rates (log scale) among registrations, after "discounting" for intentional, policy-induced disparities (eg, pediatric priority) by holding such factors constant. The overall SDw declined by 40% after KAS implementation, suggesting substantially increased equity. Risk-adjusted, factor-specific disparities were measured with the SDw after holding all other factors constant. Disparities associated with calculated panel-reactive antibodies decreased sharply. Donor service area was the factor most associated with access disparities post-KAS. This methodology will help the transplant community evaluate tradeoffs between equity and utility-centric goals when considering new policies and help monitor equity in access as policies change.
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Affiliation(s)
- D E Stewart
- Research Department, United Network for Organ Sharing, Richmond, VA, USA
| | - A R Wilk
- Research Department, United Network for Organ Sharing, Richmond, VA, USA
| | - A E Toll
- Research Department, United Network for Organ Sharing, Richmond, VA, USA
| | - A M Harper
- Research Department, United Network for Organ Sharing, Richmond, VA, USA
| | - R R Lehman
- Research Department, United Network for Organ Sharing, Richmond, VA, USA
| | - A M Robinson
- Research Department, United Network for Organ Sharing, Richmond, VA, USA
| | - S A Noreen
- Research Department, United Network for Organ Sharing, Richmond, VA, USA
| | - E B Edwards
- Research Department, United Network for Organ Sharing, Richmond, VA, USA
| | - D K Klassen
- Chief Medical Officer, United Network for Organ Sharing, Richmond, VA, USA
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Martinez-Cengotitabengoa M, Diaz-Gutierrez MJ, Besga A, Bermúdez-Ampudia C, López P, Rondon MB, Stewart DE, Perez P, Gutierrez M, Gonzalez-Pinto A. Prescripción de benzodiacepinas y caídas en mujeres y hombres ancianos. Revista de Psiquiatría y Salud Mental 2018; 11:12-18. [DOI: 10.1016/j.rpsm.2017.01.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 11/15/2016] [Accepted: 01/09/2017] [Indexed: 11/15/2022]
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Stewart DE, Garcia VC, Aeder MI, Klassen DK. New Insights Into the Alleged Kidney Donor Profile Index Labeling Effect on Kidney Utilization. Am J Transplant 2017; 17:2696-2704. [PMID: 28556492 DOI: 10.1111/ajt.14379] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [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: 01/29/2017] [Revised: 04/25/2017] [Accepted: 05/11/2017] [Indexed: 01/25/2023]
Abstract
The Kidney Donor Profile Index (KDPI) became a driving factor in deceased donor kidney allocation on December 4, 2014, with the implementation of the kidney allocation system (KAS). On April 20, 2016, the annual recalibration of the Kidney Donor Risk Index into KDPI was incorrectly programmed in DonorNet, resulting in erroneously high KDPI values, by between 1 and 21 percentage points (e.g. actual KDPI of 70% was displayed as 86%). The error was corrected on May 19, 2016, <24 h after being recognized. During this 30-day period, the distribution of recipients largely resembled pre-KAS patterns. The observed discard rate of 22.9% was higher than the post-KAS average of 19.6% (odds ratio [OR]: 1.22) but far lower than the projected rate of 31.4% (OR: 1.96) based on the usual discard rate by KDPI relationship, suggesting clinicians and patients did not rely heavily on this single number (KDPI) in kidney-utilization decisions. Still, risk-adjusted analyses suggest the elevated discard rate was most likely attributable to the erroneously high KDPIs, not a shift in donor characteristics or random chance. The rise in discard rate was sharply higher for kidneys with inflated KDPI that crossed the 85% policy threshold (OR: 1.46; p = 0.049) versus those that did not (OR: 1.06; p = 0.631).
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Affiliation(s)
- D E Stewart
- Research Department, United Network for Organ Sharing, Richmond, VA
| | - V C Garcia
- Research Department, United Network for Organ Sharing, Richmond, VA
| | - M I Aeder
- Department of Surgery, University Hospitals Case Medical Center, Cleveland, OH
| | - D K Klassen
- Chief Medical Officer, United Network for Organ Sharing, Richmond, VA
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Stewart DE, Chandra PS. WPA International Competency-Based Curriculum for Mental Health Providers on Intimate Partner Violence and Sexual Violence Against Women. World Psychiatry 2017; 16:223-224. [PMID: 28498592 PMCID: PMC5428184 DOI: 10.1002/wps.20432] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Donna E Stewart
- University Health Network Centre for Mental Health, University of Toronto, Toronto, Canada
| | - Prabha S Chandra
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
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Abstract
PURPOSE OF REVIEW The purpose of this study was to review the literature on perinatal intimate partner violence, focusing on recent knowledge to guide mental health professionals on the best approaches to identify and treat women exposed to perinatal intimate partner violence. RECENT FINDINGS Risk factors have been broadened from individual victim and perpetrator factors to include relationship, community, and societal factors which interact together. Better information is now available on how to identify, document, and treat women exposed to violence around the time of conception, pregnancy, and the postpartum period. Recent information helps psychiatrists and other mental health professionals assist women exposed to violence related to the perinatal period; however, further research is needed to provide improved evidence for optimal interventions for better patient outcomes.
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Affiliation(s)
- Donna E Stewart
- University Health Network Centre for Mental Health, University of Toronto, 200 Elizabeth Street, EN-7-229, Toronto, ON, M5G2C4, Canada.
| | - Simone N Vigod
- Women's College Hospital and Research Institute and University of Toronto, Toronto, Canada
| | - Harriet L MacMillan
- Departments of Psychiatry and Behavioural Sciences, and of Pediatrics, McMaster University, Hamilton, Canada
| | - Prabha S Chandra
- National Institute of Mental Health and Neuroscience, Bengaluru, India
| | - Alice Han
- Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Marta B Rondon
- Psychiatry and Mental Health Unit, Universidad Peruana Cayetano Heredia, Lima, Peru
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Wainright JL, Kucheryavaya AY, Klassen DK, Stewart DE. The Impact of the New Kidney Allocation System on Prior Living Kidney Donors' Access to Deceased Donor Kidney Transplants: An Early Look. Am J Transplant 2017; 17:1103-1111. [PMID: 27805305 DOI: 10.1111/ajt.14102] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 04/28/2016] [Revised: 10/16/2016] [Accepted: 10/25/2016] [Indexed: 01/25/2023]
Abstract
This study investigated the early effects of the new kidney allocation system (KAS) on the access of prior living kidney donors (PLDs) to deceased donor kidney transplants. Using data from the Organ Procurement and Transplantation Network, we compared prevalent and incident cohorts of PLDs in the 1-year periods before and after KAS implementation (pre-KAS group: December 4, 2013, to December 3, 2014, n = 50 [newly listed PLDs]; post-KAS group: December 4, 2014, to December 3, 2015, n = 39). We assessed transplant rates per active patient-year, waiting times, and Kidney Donor Profile Index (KDPI) of transplanted kidneys. Transplant rates were not statistically different before and after KAS implementation for either prevalent (2.37 vs. 2.29, relative risk [RR] 0.96; 95% confidence interval [CI] 0.62-1.49) or incident (4.76 vs. 4.36, RR 0.92; 95% CI 0.53-1.60) candidates. Median waiting time (MWT) to deceased donor kidney transplant for prevalent PLDs in the post-KAS cohort was 102.6 days compared with 82.3 days in the pre-KAS cohort (p = 0.98). The median KDPI for PLD recipients was 31% with KAS versus 23% before KAS (p = 0.02). Despite a sharp decrease in the MWT for highly prioritized candidates with calculated panel reactive antibodies of 98-100% (from >7000 to 1164 days), PLDs still had much shorter waiting times (MWT 102.6 days). The new system continues to provide quick access to high-quality organs for PLDs.
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Affiliation(s)
- J L Wainright
- Research Department, United Network for Organ Sharing, Richmond, VA
| | - A Y Kucheryavaya
- Research Department, United Network for Organ Sharing, Richmond, VA
| | - D K Klassen
- Office of the Chief Medical Officer, United Network for Organ Sharing, Richmond, VA
| | - D E Stewart
- Research Department, United Network for Organ Sharing, Richmond, VA
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Crann SE, Barata PC, Mitchell R, Mawhinney L, Thistle P, Chirenje ZM, Stewart DE. Healthcare providers' perspectives on the acceptability and uptake of HPV vaccines in Zimbabwe. J Psychosom Obstet Gynaecol 2016; 37:147-155. [PMID: 27400371 DOI: 10.1080/0167482x.2016.1199544] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Human papillomavirus (HPV) vaccines are a critical strategy in the prevention of cervical cancer, especially in countries like Zimbabwe where cervical cancer screening rates are low. In Zimbabwe, cervical cancer is the leading cause of cancer-related deaths in women but the HPV vaccine is not yet widely available. This study examined healthcare providers': (1) perceptions of current hospital practices and issues in cervical cancer prevention and treatment in Zimbabwe; (2) knowledge of HPV and HPV vaccines; and (3) perspectives on introducing HPV vaccination programs in Zimbabwe, including potential facilitators and barriers to successful implementation. METHOD In-depth semi-structured interviews were conducted at a rural hospital with 15 healthcare providers in Zimbabwe. Interviews included eight main questions and a number of additional probes that reflected the study's purpose. Data were analyzed using thematic analysis. RESULTS Participants reported that women are not consistently being screened for cervical cancer. There were generally low levels of knowledge about HPV and HPV vaccines, but participants asked many questions indicating a desire to learn more. Although they were highly supportive of implementing HPV vaccination programs in Zimbabwe, they also identified a number of likely psychosocial, cultural, and logistical barriers to successful implementation, including cost, vaccine schedule, and hospital infrastructure. However, participants also provided a number of culturally relevant solutions, including education and community engagement. CONCLUSION This study provides insight from healthcare providers about barriers to implementation and possible solutions that can be used by policy makers, practitioners, and other stakeholders to facilitate the successful implementation of forthcoming HPV immunization programs in Zimbabwe.
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Affiliation(s)
- Sara E Crann
- a Department of Psychology , University of Guelph , Guelph , Ontario , Canada
| | - Paula C Barata
- a Department of Psychology , University of Guelph , Guelph , Ontario , Canada
| | - Rachel Mitchell
- b Department of Psychiatry , University of Toronto , Toronto , Ontario , Canada
| | - Leah Mawhinney
- c Faculty of Medicine , University of Toronto , Toronto , ON , Canada
| | - Paul Thistle
- d Department of Obstetrics and Gynecology , University of Toronto , Toronto , Canada.,e Karanda Mission Hospital, Mt Darwin , Zimbabwe.,f Department of Obstetrics and Gynecology , College of Health Sciences, University of Zimbabwe , Avondale , Harare , Zimbabwe
| | - Zvavahera Mike Chirenje
- f Department of Obstetrics and Gynecology , College of Health Sciences, University of Zimbabwe , Avondale , Harare , Zimbabwe
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Affiliation(s)
- Donna E Stewart
- From the University Health Network Centre for Mental Health (D.E.S.), the Toronto General Hospital Research Institute (D.E.S.), the Reproductive Life Stages Program, Women's Mental Health Program, and Women's College Hospital and Research Institute (S.V.), and the University of Toronto (D.E.S., S.V.) - all in Toronto
| | - Simone Vigod
- From the University Health Network Centre for Mental Health (D.E.S.), the Toronto General Hospital Research Institute (D.E.S.), the Reproductive Life Stages Program, Women's Mental Health Program, and Women's College Hospital and Research Institute (S.V.), and the University of Toronto (D.E.S., S.V.) - all in Toronto
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Stewart DE. Perinatal mental health in low- and middle-income country migrants. BJOG 2016; 124:753. [PMID: 27493003 DOI: 10.1111/1471-0528.14225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- D E Stewart
- University Health Network and Departments of Psychiatry and Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada
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Midence L, Arthur HM, Oh P, Stewart DE, Grace SL. Women's Health Behaviours and Psychosocial Well-Being by Cardiac Rehabilitation Program Model: A Randomized Controlled Trial. Can J Cardiol 2016; 32:956-62. [DOI: 10.1016/j.cjca.2015.10.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 09/29/2015] [Accepted: 10/09/2015] [Indexed: 01/01/2023] Open
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Park MJ, Clements ACA, Gray DJ, Sadler R, Laksono B, Stewart DE. Quantifying accessibility and use of improved sanitation: towards a comprehensive indicator of the need for sanitation interventions. Sci Rep 2016; 6:30299. [PMID: 27452598 PMCID: PMC4958982 DOI: 10.1038/srep30299] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 06/30/2016] [Indexed: 12/03/2022] Open
Abstract
To prevent diseases associated with inadequate sanitation and poor hygiene, people needing latrines and behavioural interventions must be identified. We compared two indicators that could be used to identify those people. Indicator 1 of household latrine coverage was a simple Yes/No response to the question “Does your household have a latrine?” Indicator 2 was more comprehensive, combining questions about defecation behaviour with observations of latrine conditions. Using a standardized procedure and questionnaire, trained research assistants collected data from 6,599 residents of 16 rural villages in Indonesia. Indicator 1 identified 30.3% as not having a household latrine, while Indicator 2 identified 56.0% as using unimproved sanitation. Indicator 2 thus identified an additional 1,710 people who were missed by Indicator 1. Those 1,710 people were of lower socioeconomic status (p < 0.001), and a smaller percentage practiced appropriate hand-washing (p < 0.02). These results show how a good indicator of need for sanitation and hygiene interventions can combine evidences of both access and use, from self-reports and objective observation. Such an indicator can inform decisions about sanitation-related interventions and about scaling deworming programmes up or down. Further, a comprehensive and locally relevant indicator allows improved targeting to those most in need of a hygiene-behaviour intervention.
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Affiliation(s)
- M J Park
- Department of Nursing, College of Nursing, Konyang University, Daejeon, South Korea.,Menzies Health Institute of Queensland and School of Medicine, Griffith University, Brisbane, Australia
| | - A C A Clements
- Research School of Population Health, the Australian National University, Canberra, Australia
| | - D J Gray
- Research School of Population Health, the Australian National University, Canberra, Australia
| | - R Sadler
- Menzies Health Institute of Queensland and School of Medicine, Griffith University, Brisbane, Australia
| | - B Laksono
- Yayasan Wahanna Bakti Sehatera (YWBS) Foundation, Semarang, Indonesia
| | - D E Stewart
- Menzies Health Institute of Queensland and School of Medicine, Griffith University, Brisbane, Australia
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Abstract
This study investigates the relationship between South Asian immigrantwomen’s patriarchal beliefs and their perceptions of spousal abuse. Twenty-minute telephone surveys were conducted with 47 women. The survey collected information about demographic characteristics, patriarchal beliefs, ethnic identity, and abuse status. Participants were read a vignette that depicted an abusive situation and were asked whether they felt that the woman in the vignette was a victim of spousal abuse. As hypothesized, higher agreement with patriarchal social norms predicted a decreased likelihood of identifying the woman in the vignette as a victim of spousal abuse. This finding is discussed in terms of its application to violence against women educational programs in the South Asian immigrant community.
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Affiliation(s)
- Farah Ahmad
- University Health Network, Women’s Health Program
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Klassen DK, Edwards LB, Stewart DE, Glazier AK, Orlowski JP, Berg CL. The OPTN Deceased Donor Potential Study: Implications for Policy and Practice. Am J Transplant 2016; 16:1707-14. [PMID: 26813036 DOI: 10.1111/ajt.13731] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 01/06/2016] [Accepted: 01/17/2016] [Indexed: 01/25/2023]
Abstract
The Organ Procurement and Transplantation Network (OPTN) Deceased Donor Potential Study, funded by the Health Resources and Services Administration, characterized the current pool of potential deceased donors and estimated changes through 2020. The goal was to inform policy development and suggest practice changes designed to increase the number of donors and organ transplants. Donor estimates used filtering methodologies applied to datasets from the OPTN, the National Center for Health Statistics, and the Agency for Healthcare Research and Quality and used these estimates with the number of actual donors to estimate the potential donor pool through 2020. Projected growth of the donor pool was 0.5% per year through 2020. Potential donor estimates suggested unrealized donor potential across all demographic groups, with the most significant unrealized potential (70%) in the 50-75-year-old age group and potential Donation after Circulatory Death (DCD) donors. Actual transplants that may be realized from potential donors in these categories are constrained by confounding medical comorbidities not identified in administrative databases and by limiting utilization practices for organs from DCD donors. Policy, regulatory, and practice changes encouraging organ procurement and transplantation of a broader population of potential donors may be required to increase transplant numbers in the United States.
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Affiliation(s)
- D K Klassen
- United Network for Organ Sharing, Richmond, VA
| | - L B Edwards
- Research Department, United Network for Organ Sharing, Richmond, VA
| | - D E Stewart
- Research Department, United Network for Organ Sharing, Richmond, VA
| | | | - J P Orlowski
- LifeShare Transplant Donor Services of Oklahoma, Oklahoma City, OK
| | - C L Berg
- Department of Medicine, Duke University School of Medicine, Durham, NC
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Stewart DE, Kucheryavaya AY, Klassen DK, Turgeon NA, Formica RN, Aeder MI. Changes in Deceased Donor Kidney Transplantation One Year After KAS Implementation. Am J Transplant 2016; 16:1834-47. [PMID: 26932731 DOI: 10.1111/ajt.13770] [Citation(s) in RCA: 195] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 02/21/2016] [Accepted: 02/24/2016] [Indexed: 01/25/2023]
Abstract
After over a decade of discussion, analysis, and consensus-building, a new kidney allocation system (KAS) was implemented on December 4, 2014. Key goals included improving longevity matching between donor kidneys and recipients and broadening access for historically disadvantaged subpopulations, in particular highly sensitized patients and those with an extended duration on dialysis but delayed referral for transplantation. To evaluate the early impact of KAS, we compared Organ Procurement and Transplantation Network data 1 year before versus after implementation. The distribution of transplants across many recipient characteristics has changed markedly and suggests that in many ways the new policy is achieving its goals. Transplants in which the donor and recipient age differed by more than 30 years declined by 23%. Initial, sharp increases in transplants were observed for Calculated Panel-Reactive Antibody 99-100% recipients and recipients with at least 10 years on dialysis, with a subsequent tapering of transplants to these groups suggesting bolus effects. Although KAS has arguably increased fairness in allocation, the potential costs of broadening access must be considered. Kidneys are more often being shipped over long distances, leading to increased cold ischemic times. Delayed graft function rates have increased, but 6-month graft survival rates have not changed significantly.
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Affiliation(s)
- D E Stewart
- Research Department, United Network for Organ Sharing, Richmond, VA
| | - A Y Kucheryavaya
- Research Department, United Network for Organ Sharing, Richmond, VA
| | - D K Klassen
- Office of the Chief Medical Officer, United Network for Organ Sharing, Richmond, VA
| | - N A Turgeon
- Department of Surgery, Emory University, Atlanta, GA
| | - R N Formica
- Department of Medicine and Surgery, Yale School of Medicine, New Haven, CT
| | - M I Aeder
- Department of Surgery, University Hospitals Case Medical Center, Cleveland, OH
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