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Ashcroft R, Donnelly C, Lam S, Sheffield P, Hamilton B, Kemp C, Adamson K, Brown JB. A qualitative examination of primary care team's participation in the distribution of the COVID-19 vaccination. BMC Prim Care 2024; 25:85. [PMID: 38486138 PMCID: PMC10938813 DOI: 10.1186/s12875-024-02327-2] [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] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 03/05/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Primary health care (PHC) has historically led and implemented successful immunization programs, driven by strong relationships with patients and communities. During the COVID-19 pandemic, Canada began its vaccination strategy with mass immunizations that later included local efforts with PHC providers. This study seeks to understand how PHC contributed to the different phases of the COVID-19 vaccination rollouts in Ontario, Canada's most populous province. METHODS We conducted a descriptive qualitative study with focus groups consisting of PHC providers, administrators, and staff in Ontario. Eight focus groups were held with 39 participants representing geographic diversity across the six Ontario Health regions. Participants reflected a diverse range of clinical, administrative, and leadership roles. Each focus group was audio-recorded and transcribed with transcriptions analyzed using thematic analysis. RESULTS With respect to understanding PHC teams' participation in the different phases of the COVID-19 vaccination rollouts, we identified five themes: (i) supporting long-term care, (ii) providing leadership in mass vaccinations, (iii) integrating vaccinations in PHC practice sites, (iv) reaching those in need through outreach activities; and (v) PHC's contributions being under-recognized. CONCLUSIONS PHC was instrumental in supporting COVID-19 vaccinations in Ontario, Canada across all phases of the rollout. The flexibility and adaptability of PHC allowed teams to participate in both large-scale and small-scale vaccination efforts.
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Affiliation(s)
- Rachelle Ashcroft
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada.
| | | | - Simon Lam
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - Peter Sheffield
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - Bryn Hamilton
- Association of Family Health Teams of Ontario, Toronto, ON, Canada
| | - Connor Kemp
- Frontenac, Lennox, and Addington Ontario Health Team, Kingston, Canada
| | - Keith Adamson
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - Judith Belle Brown
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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Ashcroft R, Mathers A, Gin A, Lam S, Donnelly C, Brown JB, Kourgiantakis T, Mehta K, Rayner J, Sur D, Adamson K, Kirvan A, Dolovich L. Pharmacists' role and experiences with delivering mental health care within team-based primary care settings during the COVID-19 pandemic. Int J Pharm Pract 2024; 32:156-163. [PMID: 38071626 DOI: 10.1093/ijpp/riad086] [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] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 11/16/2023] [Indexed: 03/07/2024]
Abstract
OBJECTIVES Pharmacists have been increasingly integrated into primary care teams, leading to improved health outcomes for patients. The two objectives of this study were (i) to describe how the COVID-19 pandemic impacted pharmacists' role in mental health care within Canadian primary care teams and (ii) to describe Canadian pharmacists' experiences collaborating with other healthcare providers in the delivery of mental health services during the COVID-19 pandemic. METHODS Cross-sectional observational study utilizing an online survey consisting of closed-ended and open-ended questions. Primary care pharmacists in Ontario were eligible to participate. Descriptive statistics were collated, and qualitative data underwent thematic analysis. A total of 51 pharmacists participated in the study. KEY FINDINGS The COVID-19 pandemic has led to the expanding role of pharmacists in attending to the mental health care of patients. Working within a collaborative, interprofessional healthcare environment, pharmacists support patients' mental health in a variety of ways, including medication education and management, non-pharmacologic approaches and supportive conversations, and identification of resources, including referrals, wellness checks, and consulting with physicians. Increasing demand for mental health services has led to higher referrals to pharmacists, which will likely persist and require further education of pharmacists in mental health along with better access to deliver virtual care. CONCLUSION In response to the increasing mental health care needs of patients since the COVID-19 pandemic, primary care pharmacists reported increased attention spent on mental health care. Building capacity and ensuring support for pharmacists to continue to address the increasing mental health care demands is essential.
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Affiliation(s)
- Rachelle Ashcroft
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W., Toronto, ON M5S 1V4, Canada
| | - Annalise Mathers
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St., Toronto, ON M5S 3M2, Canada
| | - Amanda Gin
- Cardiology, Women's College Hospital, 76 Grenville Street, Toronto, ON M5S 1B2, Canada
| | - Simon Lam
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W., Toronto, ON M5S 1V4, Canada
| | - Catherine Donnelly
- Faculty of Health Sciences, Queen's University, Room 815, 18 Stuart Street, Kingston, ON K7L 2V5, Canada
| | - Judith Belle Brown
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St., London, ON N6A 5C1, Canada
| | - Toula Kourgiantakis
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W., Toronto, ON M5S 1V4, Canada
| | - Kavita Mehta
- Association of Family Health Teams of Ontario, 400 University Avenue, Suite 2100, Toronto, ON M5G 1S5, Canada
| | - Jennifer Rayner
- Department of Research and Evaluation, Alliance for Healthier Communities, 970 Lawrence Ave W., Suite 500, North York, ON M6A 3B6, Canada
| | - Deepy Sur
- Ontario Association of Social Workers, 180 Dundas Street W., Suite 2404, Toronto, ON M5G 1Z8, Canada
| | - Keith Adamson
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W., Toronto, ON M5S 1V4, Canada
| | - Anne Kirvan
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W., Toronto, ON M5S 1V4, Canada
| | - Lisa Dolovich
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College St., Toronto, ON M5S 3M2, Canada
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Ochoa R, Brown JB, Fox T. pyPept: a python library to generate atomistic 2D and 3D representations of peptides. J Cheminform 2023; 15:79. [PMID: 37700347 PMCID: PMC10498622 DOI: 10.1186/s13321-023-00748-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 08/23/2023] [Indexed: 09/14/2023] Open
Abstract
We present pyPept, a set of executables and underlying python-language classes to easily create, manipulate, and analyze peptide molecules using the FASTA, HELM, or recently-developed BILN notations. The framework enables the analysis of both pure proteinogenic peptides as well as those with non-natural amino acids, including support to assemble a customizable monomer library, without requiring programming. From line notations, a peptide is transformed into a molecular graph for 2D depiction tasks, the calculation of physicochemical properties, and other systematic analyses or processing pipelines. The package includes a module to rapidly generate approximate peptide conformers by incorporating secondary structure restraints either given by the user or predicted via pyPept, and a wrapper tool is also provided to automate the generation and output of 2D and 3D representations of a peptide directly from the line notation. HELM and BILN notations that include circular, branched, or stapled peptides are fully supported, eliminating errors in structure creation that are prone during manual drawing and connecting. The framework and common workflows followed in pyPept are described together with illustrative examples. pyPept has been released at: https://github.com/Boehringer-Ingelheim/pyPept .
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Affiliation(s)
- Rodrigo Ochoa
- Medicinal Chemistry, Boehringer Ingelheim Pharma GmbH & Co KG, 88397, Biberach/Riss, Germany
| | - J B Brown
- Medicinal Chemistry, Boehringer Ingelheim Pharma GmbH & Co KG, 88397, Biberach/Riss, Germany
| | - Thomas Fox
- Medicinal Chemistry, Boehringer Ingelheim Pharma GmbH & Co KG, 88397, Biberach/Riss, Germany.
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4
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Phillips WR, Gebauer S, Kueper JK, Martinez-Guijosa A, Felzien M, Olde Hartman TC, Westfall JM, DeVoe JE, Stewart M, Herbert CP, Green LA, Brown JB. Primary Care Research: Looking Back and Moving Forward With Reflections on NAPCRG's First 50 Years. Ann Fam Med 2023; 21:456-462. [PMID: 37748895 PMCID: PMC10519759 DOI: 10.1370/afm.3009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 02/20/2023] [Accepted: 04/18/2023] [Indexed: 09/27/2023] Open
Abstract
NAPCRG celebrated 50 years of leadership and service at its 2022 meeting. A varied team of primary care investigators, clinicians, learners, patients, and community members reflected on the organization's past, present, and future. Started in 1972 by a small group of general practice researchers in the United States, Canada, and the United Kingdom, NAPCRG has evolved into an international, interprofessional, interdisciplinary, and intergenerational group devoted to improving health and health care through primary care research. NAPCRG provides a nurturing home to researchers and teams working in partnership with individuals, families, and communities. The organization builds upon enduring values to create partnerships, advance research methods, and nurture a community of contributors. NAPCRG has made foundational contributions, including identifying the need for primary care research to inform primary care practice, practice-based research networks, qualitative and mixed-methods research, community-based participatory research, patient safety, practice transformation, and partnerships with patients and communities. Landmark documents have helped define classification systems for primary care, responsible research with communities, the central role of primary care in health care systems, opportunities to revitalize generalist practice, and shared strategies to build the future of family medicine. The future of health and health care depends upon strengthening primary care and primary care research with stronger support, infrastructure, training, and workforce. New technologies offer opportunities to advance research, enhance care, and improve outcomes. Stronger partnerships can empower primary care research with patients and communities and increase commitments to diversity and quality care for all. NAPCRG offers a home for all partners in this work.
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Affiliation(s)
- William R Phillips
- Department of Family Medicine, University of Washington, Seattle, Washington
| | - Sarah Gebauer
- Saint Louis University-School of Medicine, St Louis, Missouri
| | | | | | | | | | - John M Westfall
- Department of Family Medicine, University of Colorado School of Medicine, Denver, Colorado (Retired)
| | - Jennifer E DeVoe
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
| | | | - Carol P Herbert
- Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, Ontario, Canada
| | - Larry A Green
- University of Colorado School of Medicine, Aurora, Colorado
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Taglione MS, Brown JB. Primary care engagement in health system change: a scoping review of common barriers and effective strategies. BMC Prim Care 2023; 24:157. [PMID: 37550639 PMCID: PMC10408209 DOI: 10.1186/s12875-023-02117-2] [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] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 07/20/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND The complexity of health systems necessitates coordination between a multitude of stakeholders to enact meaningful change. Primary care physicians are a crucial partner to engage, as their investment and participation are critical to the success of any system-level initiative. The aim of this scoping review is to identify common barriers and effective strategies when engaging primary care physicians in designing and implementing health system change. METHODS A scoping review was performed. A literature search was performed in March 2020 using five databases. 668 unique articles were identified and underwent a title and abstract review. 23 articles met criteria for full text review and 10 met final inclusion criteria. A backward citation analysis identified two articles. 12 articles underwent data extraction and thematic analysis. RESULTS Several barriers to engagement were identified including a lack of trust between primary care physicians and decision-makers, strong professional physician identity, clinically irrelevant and complex proposals, and a lack of capacity and supports. Described strategies to overcome these barriers included building trust and relationships, contextual engagement strategies, working with physician leadership, enabling open and intentional communication channels, designing clinically relevant and straightforward initiatives, and considering financial incentives. CONCLUSIONS Barriers to primary care engagement should be addressed with contextually designed strategies and a focus on relationship building, collaborative efforts, and implementing relevant and feasible initiatives. Further research should explore how to best develop relationships with primary care, working with collective voices of primary care physicians, and to better understanding the impact of financial incentives on engagement.
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Affiliation(s)
- Michael Sergio Taglione
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada.
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, ON, M5T 3M6, Canada.
| | - Judith Belle Brown
- Department of Family Medicine, Western University, 1465 Richmond Street, London, ON, N6G 2M1, Canada.
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Menear M, Duhoux A, Bédard M, Paquette JS, Baron M, Breton M, Courtemanche S, Dubé S, Dufour S, Fortin M, Girard A, Larouche-Côté É, L'Espérance A, LeBlanc A, Poitras ME, Rivet S, Sasseville M, Achim A, Archambault P, Bajurny V, Brown JB, Carrier JD, Côté N, Couturier Y, Dogba MJ, Gagnon MP, Ghio SC, Marshall EG, Kothari A, Lussier MT, Mair FS, Smith S, Vachon B, Wong S. Understanding the impacts of the COVID-19 pandemic on the care experiences of people with mental-physical multimorbidity: protocol for a mixed methods study. BMC Prim Care 2023; 24:154. [PMID: 37488515 PMCID: PMC10364355 DOI: 10.1186/s12875-023-02106-5] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 07/06/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Primary care and other health services have been disrupted during the COVID-19 pandemic, yet the consequences of these service disruptions on patients' care experiences remain largely unstudied. People with mental-physical multimorbidity are vulnerable to the effects of the pandemic, and to sudden service disruptions. It is thus essential to better understand how their care experiences have been impacted by the current pandemic. This study aims to improve understanding of the care experiences of people with mental-physical multimorbidity during the pandemic and identify strategies to enhance these experiences. METHODS We will conduct a mixed-methods study with multi-phase approach involving four distinct phases. Phase 1 will be a qualitative descriptive study in which we interview individuals with mental-physical multimorbidity and health professionals in order to explore the impacts of the pandemic on care experiences, as well as their perspectives on how care can be improved. The results of this phase will inform the design of study phases 2 and 3. Phase 2 will involve journey mapping exercises with a sub-group of participants with mental-physical multimorbidity to visually map out their care interactions and experiences over time and the critical moments that shaped their experiences. Phase 3 will involve an online, cross-sectional survey of care experiences administered to a larger group of people with mental disorders and/or chronic physical conditions. In phase 4, deliberative dialogues will be held with key partners to discuss and plan strategies for improving the delivery of care to people with mental-physical multimorbidity. Pre-dialogue workshops will enable us to synthesize an prepare the results from the previous three study phases. DISCUSSION Our study results will generate much needed evidence of the positive and negative impacts of the COVID-19 pandemic on the care experiences of people with mental-physical multimorbidity and shed light on strategies that could improve care quality and experiences.
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Affiliation(s)
- Matthew Menear
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Canada.
- VITAM Centre de recherche en santé durable, Quebec City, Canada.
| | - Arnaud Duhoux
- Faculty of Nursing, Université de Montréal, Montreal, Canada
- Centre de Recherche Charles-Le Moyne, Montreal, Canada
| | - Myreille Bédard
- Person With Lived Experience (Patient Partner), Montreal, Canada
| | - Jean-Sébastien Paquette
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Canada
- VITAM Centre de recherche en santé durable, Quebec City, Canada
| | - Marie Baron
- VITAM Centre de recherche en santé durable, Quebec City, Canada
| | - Mylaine Breton
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | | | - Savannah Dubé
- VITAM Centre de recherche en santé durable, Quebec City, Canada
| | - Stefany Dufour
- VITAM Centre de recherche en santé durable, Quebec City, Canada
| | - Martin Fortin
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Ariane Girard
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | | | | | - Annie LeBlanc
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Canada
- VITAM Centre de recherche en santé durable, Quebec City, Canada
| | - Marie-Eve Poitras
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Sophie Rivet
- VITAM Centre de recherche en santé durable, Quebec City, Canada
| | - Maxime Sasseville
- VITAM Centre de recherche en santé durable, Quebec City, Canada
- Faculty of Nursing, Université Laval, Quebec, Canada
| | - Amélie Achim
- VITAM Centre de recherche en santé durable, Quebec City, Canada
- Department of Psychiatry, Université Laval, Quebec, Canada
| | - Patrick Archambault
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Canada
- VITAM Centre de recherche en santé durable, Quebec City, Canada
| | - Virtue Bajurny
- Person with Lived Experience (Patient Partner), Toronto, Canada
| | | | - Jean-Daniel Carrier
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Nancy Côté
- VITAM Centre de recherche en santé durable, Quebec City, Canada
- Faculty of Social Sciences, Université Laval, Quebec, Canada
| | - Yves Couturier
- School of Social Work, Université de Sherbrooke, Sherbrooke, Canada
| | - Maman Joyce Dogba
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec City, Canada
- VITAM Centre de recherche en santé durable, Quebec City, Canada
| | - Marie-Pierre Gagnon
- VITAM Centre de recherche en santé durable, Quebec City, Canada
- Faculty of Nursing, Université Laval, Quebec, Canada
| | | | | | - Anita Kothari
- Department of Health Studies, Western University, London, Canada
| | - Marie-Thérèse Lussier
- Department of Family Medicine and Emergency Medicine, Université de Montréal, Montreal, Canada
| | - Frances S Mair
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Susan Smith
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, UK
| | - Brigitte Vachon
- School of Rehabilitation, Université de Montréal, Montreal, Canada
| | - Sabrina Wong
- Faculty of Applied Science, University of British Colombia, Vancouver, Canada
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Ashcroft R, Mathers A, Gin A, Lam S, Donnelly C, Brown JB, Kourgiantakis T, Adamson K, Mehta K, Rayner J, Sur D, Kirvan A, Sheffield P, Dolovich L. The Benefits and Challenges of Precepting Pharmacy Students Virtually in Interprofessional Primary Care Teams. Am J Pharm Educ 2023; 87:100098. [PMID: 37380266 DOI: 10.1016/j.ajpe.2023.100098] [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] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 03/01/2023] [Accepted: 03/14/2023] [Indexed: 06/30/2023]
Abstract
OBJECTIVE The objective of this study was to identify pharmacists' perspectives on the benefits and challenges of precepting pharmacy students during circumstances that require using virtual care in team-based primary care practices. METHODS A cross-sectional online survey was disseminated through Qualtrics software from July 5, 2021, to October 13, 2021. We used a convenience sampling technique to recruit a sample of pharmacists working in primary care teams across Ontario, Canada, who were able to complete a web-based survey in English. RESULTS A total of 51 pharmacists participated in the survey and provided complete responses (response rate of 41%). Participants noted benefits at 3 levels of precepting pharmacy students in primary care during the COVID-19 pandemic: (1) benefits to pharmacists, (2) benefits to patients, and (3) benefits to students. Challenges of precepting pharmacy students were: (1) difficulty training students virtually, (2) students not being ideally prepared to begin a practicum training during a pandemic, and (3) reduced availability and new workload demands. CONCLUSION Pharmacists in team-based primary care highlighted substantial benefits and challenges for precepting students during a pandemic. Alternative mechanisms of experiential education delivery can provide new opportunities for pharmacy care yet can also restrict immersion into interprofessional team-based primary care and diminish pharmacist capacity. Additional support and resources to facilitate capacity are critical for pharmacy students to succeed in future practice in team-based primary care.
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Affiliation(s)
- Rachelle Ashcroft
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada.
| | - Annalise Mathers
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - Amanda Gin
- Women's College Hospital, Toronto, Canada
| | - Simon Lam
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | | | - Judith Belle Brown
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Toula Kourgiantakis
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Keith Adamson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Kavita Mehta
- Association of Family Health Teams of Ontario, Toronto, Canada
| | - Jennifer Rayner
- Department of Research and Evaluation, Alliance for Healthier Communities, Toronto, Canada
| | - Deepy Sur
- Ontario Association of Social Workers, Toronto, Canada
| | - Anne Kirvan
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Peter Sheffield
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Canada
| | - Lisa Dolovich
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
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Ranade S, Brown JB, Freeman T, Thind A. Enacting care by being experts and managing relationships: A discourse analysis of chief medical officer of health media briefings during the COVID-19 pandemic. SSM Qual Res Health 2023; 3:100208. [PMID: 36620390 PMCID: PMC9803377 DOI: 10.1016/j.ssmqr.2022.100208] [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] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 10/20/2022] [Accepted: 12/09/2022] [Indexed: 01/01/2023]
Abstract
In Canada, Chief Medical Officers of Health (CMOHs) are responsible for protecting and promoting the health of their respective populations, but few studies have examined this role and its connections with the practice of medicine. In Canada and elsewhere, CMOHs and other public health physicians have articulated their actions as caring for their populations as patients. In order to understand the components of enacted care, this study is a functional discourse analysis of transcribed CMOH media briefings at three time points in five Canadian jurisdictions during the first full year of the COVID-19 pandemic (2020). Transcripts were coded and analysed in an iterative, comparative process to understand the content, actions and purpose of CMOH communication during media briefings. CMOHs used their public communications to enact their care of populations by "being experts" and "managing relationships". "Being experts" involved describing disease characteristics, assessing risk and evidence, framing risk and evidence, and making judgments about intervention and exemption. "Managing relationships" involved self-regulating emotions, acknowledging the emotions of others, seeking adherence and collaboration, and setting expectations and boundaries. The findings suggest that traditional biomedical roles were performed by CMOHs in media briefings, implying the existence of a patient (or multiple patient-like relationships) and supporting further research into the processes by which public health physicians care for populations as patients.
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Affiliation(s)
- Sudit Ranade
- Corresponding author. Centre for Studies in Family Medicine, Schulich Medicine & Dentistry, Western University, The Western Centre for Public Health and Family Medicine, 2nd Floor, 1465 Richmond St., Ontario, Canada N6G 2M1, London
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9
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Hedden L, Spencer S, Mathews M, Marshall EG, Lukewich J, Asghari S, Brown JB, Gill PS, Freeman TR, McCracken RK, Ryan BL, Vaughan C, Wong E, Buote R, Meredith L, Moritz L, Ryan D, McKay M, Schacter G. "There's nothing like a good crisis for innovation": a qualitative study of family physicians' experiences with virtual care during the COVID-19 pandemic. BMC Health Serv Res 2023; 23:338. [PMID: 37016330 PMCID: PMC10072815 DOI: 10.1186/s12913-023-09256-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/07/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND Prior to the pandemic, Canada lagged behind other Organisation for Economic Cooperation and Development countries in the uptake of virtual care. The onset of COVID-19, however, resulted in a near-universal shift to virtual primary care to minimise exposure risks. As jurisdictions enter a pandemic recovery phase, the balance between virtual and in-person visits is reverting, though it is unlikely to return to pre-pandemic levels. Our objective was to explore Canadian family physicians' perspectives on the rapid move to virtual care during the COVID-19 pandemic, to inform both future pandemic planning for primary care and the optimal integration of virtual care into the broader primary care context beyond the pandemic. METHODS We conducted semi-structured interviews with 68 family physicians from four regions in Canada between October 2020 and June 2021. We used a purposeful, maximum variation sampling approach, continuing recruitment in each region until we reached saturation. Interviews with family physicians explored their roles and experiences during the pandemic, and the facilitators and barriers they encountered in continuing to support their patients through the pandemic. Interviews were audio-recorded, transcribed, and thematically analysed for recurrent themes. RESULTS We identified three prominent themes throughout participants' reflections on implementing virtual care: implementation and evolution of virtual modalities during the pandemic; facilitators and barriers to implementing virtual care; and virtual care in the future. While some family physicians had prior experience conducting remote assessments, most had to implement and adapt to virtual care abruptly as provinces limited in-person visits to essential and urgent care. As the pandemic progressed, initial forays into video-based consultations were frequently replaced by phone-based visits, while physicians also rebalanced the ratio of virtual to in-person visits. Medical record systems with integrated capacity for virtual visits, billing codes, supportive clinic teams, and longitudinal relationships with patients were facilitators in this rapid transition for family physicians, while the absence of these factors often posed barriers. CONCLUSION Despite varied experiences and preferences related to virtual primary care, physicians felt that virtual visits should continue to be available beyond the pandemic but require clearer regulation and guidelines for its appropriate future use.
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Affiliation(s)
- Lindsay Hedden
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada.
| | - Sarah Spencer
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada
| | - Maria Mathews
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Emily Gard Marshall
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, NS, Canada
| | - Julia Lukewich
- Faculty of Nursing, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Shabnam Asghari
- Family Medicine, Faculty of Medicine, Memorial University, St John's, Newfoundland and Labrador, Canada
| | - Judith Belle Brown
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Paul S Gill
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Department of Family & Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Thomas R Freeman
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Rita K McCracken
- Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bridget L Ryan
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Crystal Vaughan
- Faculty of Nursing, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Eric Wong
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Richard Buote
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, NS, Canada
| | - Leslie Meredith
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Lauren Moritz
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, NS, Canada
| | - Dana Ryan
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Faculty of Nursing, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | | | - Gordon Schacter
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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10
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Nash DM, Thorpe C, Brown JB, Kueper JK, Rayner J, Lizotte DJ, Terry AL, Zwarenstein M. Perceptions of Artificial Intelligence Use in Primary Care: A Qualitative Study with Providers and Staff of Ontario Community Health Centres. J Am Board Fam Med 2023; 36:221-228. [PMID: 36948536 DOI: 10.3122/jabfm.2022.220177r2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 09/18/2022] [Accepted: 10/20/2022] [Indexed: 03/24/2023] Open
Abstract
PURPOSE To understand staff and health care providers' views on potential use of artificial intelligence (AI)-driven tools to help care for patients within a primary care setting. METHODS We conducted a qualitative descriptive study using individual semistructured interviews. As part of province-wide Learning Health Organization, Community Health Centres (CHCs) are a community-governed, team-based delivery model providing primary care for people who experience marginalization in Ontario, Canada. CHC health care providers and staff were invited to participate. Interviews were audio-recorded and transcribed verbatim. We performed a thematic analysis using a team approach. RESULTS We interviewed 27 participants across 6 CHCs. Participants lacked in-depth knowledge about AI. Trust was essential to acceptance of AI; people need to be receptive to using AI and feel confident that the information is accurate. We identified internal influences of AI acceptance, including ease of use and complementing clinical judgment rather than replacing it. External influences included privacy, liability, and financial considerations. Participants felt AI could improve patient care and help prevent burnout for providers; however, there were concerns about the impact on the patient-provider relationship. CONCLUSIONS The information gained in this study can be used for future research, development, and integration of AI technology.
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Affiliation(s)
- Danielle M Nash
- From the Department of Epidemiology and Biostatistics, the Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada (DMN, DJL, ALT, MZ); ICES, Ontario, Canada (DMN, MZ); Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada (DMN, CT, JBB, JR, ALT, MZ); Department of Computer Science, Faculty of Science, Western University, London, Ontario, Canada (JKK, DJL); Department of Research and Evaluation, Alliance for Healthier Communities, Toronto, Ontario, Canada (JR); Schulich Interfaculty Program in Public Health, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada (ALT).
| | - Cathy Thorpe
- From the Department of Epidemiology and Biostatistics, the Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada (DMN, DJL, ALT, MZ); ICES, Ontario, Canada (DMN, MZ); Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada (DMN, CT, JBB, JR, ALT, MZ); Department of Computer Science, Faculty of Science, Western University, London, Ontario, Canada (JKK, DJL); Department of Research and Evaluation, Alliance for Healthier Communities, Toronto, Ontario, Canada (JR); Schulich Interfaculty Program in Public Health, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada (ALT)
| | - Judith Belle Brown
- From the Department of Epidemiology and Biostatistics, the Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada (DMN, DJL, ALT, MZ); ICES, Ontario, Canada (DMN, MZ); Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada (DMN, CT, JBB, JR, ALT, MZ); Department of Computer Science, Faculty of Science, Western University, London, Ontario, Canada (JKK, DJL); Department of Research and Evaluation, Alliance for Healthier Communities, Toronto, Ontario, Canada (JR); Schulich Interfaculty Program in Public Health, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada (ALT)
| | - Jacqueline K Kueper
- From the Department of Epidemiology and Biostatistics, the Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada (DMN, DJL, ALT, MZ); ICES, Ontario, Canada (DMN, MZ); Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada (DMN, CT, JBB, JR, ALT, MZ); Department of Computer Science, Faculty of Science, Western University, London, Ontario, Canada (JKK, DJL); Department of Research and Evaluation, Alliance for Healthier Communities, Toronto, Ontario, Canada (JR); Schulich Interfaculty Program in Public Health, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada (ALT)
| | - Jennifer Rayner
- From the Department of Epidemiology and Biostatistics, the Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada (DMN, DJL, ALT, MZ); ICES, Ontario, Canada (DMN, MZ); Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada (DMN, CT, JBB, JR, ALT, MZ); Department of Computer Science, Faculty of Science, Western University, London, Ontario, Canada (JKK, DJL); Department of Research and Evaluation, Alliance for Healthier Communities, Toronto, Ontario, Canada (JR); Schulich Interfaculty Program in Public Health, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada (ALT)
| | - Daniel J Lizotte
- From the Department of Epidemiology and Biostatistics, the Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada (DMN, DJL, ALT, MZ); ICES, Ontario, Canada (DMN, MZ); Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada (DMN, CT, JBB, JR, ALT, MZ); Department of Computer Science, Faculty of Science, Western University, London, Ontario, Canada (JKK, DJL); Department of Research and Evaluation, Alliance for Healthier Communities, Toronto, Ontario, Canada (JR); Schulich Interfaculty Program in Public Health, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada (ALT)
| | - Amanda L Terry
- From the Department of Epidemiology and Biostatistics, the Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada (DMN, DJL, ALT, MZ); ICES, Ontario, Canada (DMN, MZ); Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada (DMN, CT, JBB, JR, ALT, MZ); Department of Computer Science, Faculty of Science, Western University, London, Ontario, Canada (JKK, DJL); Department of Research and Evaluation, Alliance for Healthier Communities, Toronto, Ontario, Canada (JR); Schulich Interfaculty Program in Public Health, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada (ALT)
| | - Merrick Zwarenstein
- From the Department of Epidemiology and Biostatistics, the Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada (DMN, DJL, ALT, MZ); ICES, Ontario, Canada (DMN, MZ); Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada (DMN, CT, JBB, JR, ALT, MZ); Department of Computer Science, Faculty of Science, Western University, London, Ontario, Canada (JKK, DJL); Department of Research and Evaluation, Alliance for Healthier Communities, Toronto, Ontario, Canada (JR); Schulich Interfaculty Program in Public Health, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada (ALT)
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Ashcroft R, Donnelly C, Lam S, Kourgiantakis T, Adamson K, Verilli D, Dolovich L, Sheffield P, Kirvan A, Dancey M, Gill S, Mehta K, Sur D, Brown JB. Qualitative examination of collaboration in team-based primary care during the COVID-19 pandemic. BMJ Open 2023; 13:e067208. [PMID: 36731930 PMCID: PMC9895917 DOI: 10.1136/bmjopen-2022-067208] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE The objective of this study was to describe Ontario primary care teams' experiences with collaboration during the COVID-19 pandemic. Descriptive qualitative methods using focus groups conducted virtually for data collection. SETTING Primary care teams located in Ontario, Canada. PARTICIPANTS Our study conducted 11 focus groups with 10 primary care teams, with a total of 48 participants reflecting a diverse range of interprofessional healthcare providers and administrators working in primary care. RESULTS Three themes were identified using thematic analysis: (1) prepandemic team functioning facilitated adaptation, (2) new processes of team interactions and collaboration, and (3) team as a foundation of support. CONCLUSIONS Results revealed the importance of collaboration for provider well-being, and the challenges of providing collaborative team-based primary care in the pandemic context. Caution against converting primary care collaboration to predominantly virtual modalities postpandemic is recommended. Further research on team functioning during the COVID-19 pandemic in other healthcare organisations will offer additional insight regarding how primary care teams can work collaboratively in a postpandemic environment.
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Affiliation(s)
- Rachelle Ashcroft
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Catherine Donnelly
- Rehabilitation Therapy, Queen's University Faculty of Health Sciences, Kingston, Ontario, Canada
| | - Simon Lam
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Toula Kourgiantakis
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Keith Adamson
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - David Verilli
- Village Family Health Team, Toronto, Ontario, Canada
| | - Lisa Dolovich
- University of Toronto Leslie Dan Faculty of Pharmacy, Toronto, Ontario, Canada
| | - Peter Sheffield
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Anne Kirvan
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Maya Dancey
- Telfer School of Management University of Ottawa, Ottawa, Ontario, Canada
| | - Sandeep Gill
- Association of Family Health Teams of Ontario, Toronto, Ontario, Canada
| | - Kavita Mehta
- Association of Family Health Teams of Ontario, Toronto, Ontario, Canada
| | - Deepy Sur
- Ontario Association of Social Workers, Toronto, Ontario, Canada
| | - Judith Belle Brown
- Department of Family Medicine, Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada
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12
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Nash DM, Brown JB, Thorpe C, Rayner J, Zwarenstein M. The Alliance for Healthier Communities as a Learning Health System for primary care: A qualitative analysis in Ontario, Canada. J Eval Clin Pract 2022; 28:1106-1112. [PMID: 35488796 PMCID: PMC9790616 DOI: 10.1111/jep.13692] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 04/08/2022] [Accepted: 04/18/2022] [Indexed: 12/30/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES A learning health system model can be used to efficiently evaluate and incorporate evidence-based care into practice. However, there is a paucity of evidence describing key organizational attributes needed to ensure a successful learning health system within primary care. We interviewed stakeholders for a primary care learning health system in Ontario, Canada (the Alliance for Healthier Communities) to identify strengths and areas for improvement. METHOD We conducted a qualitative descriptive study using individual semistructured interviews with Alliance stakeholders between December 2019 and March 2020. The Alliance delivers community-governed primary healthcare through 109 organizations including Community Health Centres (CHCs). All CHC staff within the Alliance were invited to participate. Interviews were audio-recorded and transcribed verbatim. We performed a thematic analysis using a team approach. RESULTS We interviewed 29 participants across six CHCs, including Executive Directors, managers, healthcare providers and data support staff. We observed three foundational elements necessary for a successful learning health system within primary care: shared organizational goals and culture, data quality and resources. Building on this foundation, people are needed to drive the learning health system, and this is conditional on their level of engagement. The main factors motivating staff member's engagement with the learning health system included their drive to help improve patient care, focusing on initiatives of personal interest and understanding the purpose of different initiatives. Areas for improvement were identified such as the ability to extract and use data to inform changes in real-time, better engagement and protected time for providers to do improvement work, and more staff dedicated to data extraction and analysis. CONCLUSIONS We identified key components needed to establish a learning health system in primary care. Similar primary care organizations in Canada and elsewhere can use these insights to guide their development as learning health systems.
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Affiliation(s)
- Danielle M Nash
- Department of Epidemiology and Biostatistics, The Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Department of Family Medicine, Schulich School of Medicine and Dentistry, Centre for Studies in Family Medicine, Western University, London, Ontario, Canada
| | - Judith Belle Brown
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Centre for Studies in Family Medicine, Western University, London, Ontario, Canada
| | - Cathy Thorpe
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Centre for Studies in Family Medicine, Western University, London, Ontario, Canada
| | - Jennifer Rayner
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Centre for Studies in Family Medicine, Western University, London, Ontario, Canada.,Department of Research and Evaluation, Alliance for Healthier Communities, Toronto, Ontario, Canada
| | - Merrick Zwarenstein
- Department of Epidemiology and Biostatistics, The Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,ICES, Toronto, Ontario, Canada.,Department of Family Medicine, Schulich School of Medicine and Dentistry, Centre for Studies in Family Medicine, Western University, London, Ontario, Canada
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13
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Ryan BL, Brown JB, Freeman TR, Richard L, Stewart M, Meredith L, Choi YH, He JW, Cejic S, Thompson K, Reichert S, Shariff SZ, Booth R, Terry AL, Mathews M. Virtual family physician care during COVID-19: a mixed methods study using health administrative data and qualitative interviews. BMC Prim Care 2022; 23:300. [PMID: 36434524 PMCID: PMC9700898 DOI: 10.1186/s12875-022-01902-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 11/07/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The onset of the COVID-19 pandemic necessitated a rapid shift in primary health care from predominantly in-person to high volumes of virtual care. The pandemic afforded the opportunity to conduct a deep regional examination of virtual care by family physicians in London and Middlesex County, Ontario, Canada that would inform the foundation for virtual care in our region post-pandemic. OBJECTIVES (1) to determine volumes of in-person and virtual family physicians visits and characteristics of the family physicians and patients using them during the early COVID-19 pandemic; (2) to determine how virtual visit volumes changed over the pandemic, compared to in-person; and (3) to explore family physicians' experience in virtual visit adoption and implementation. METHODS We conducted a concurrent mixed-methods study of family physicians from March to October 2020. The quantitative component examined mean weekly number of total, in-person and virtual visits using health administrative data. Differences in outcomes according to physician and practice characteristics for pandemic periods were compared to pre-pandemic. The qualitative study employed Constructivist Grounded Theory, conducting semi-structured family physicians interviews; analyzing data iteratively using constant comparative analysis. We mapped themes from the qualitative analysis to quantitative findings. RESULTS Initial volumes of patients decreased, driven by fewer in-person visits. Virtual visit volumes increased dramatically; family physicians described using telephone almost entirely. Rural family physicians reported video connectivity issues. By early second wave, total family physician visit volume returned to pre-pandemic volumes. In-person visits increased substantially; family physicians reported this happened because previously scarce personal protective equipment became available. Patients seen during the pandemic were older, sicker, and more materially deprived. CONCLUSION These results can inform the future of virtual family physician care including the importance of continued virtual care compensation, the need for equitable family physician payment models, and the need to attend to equity for vulnerable patients. Given the move to virtual care was primarily a move to telephone care, the modality of care delivery that is acceptable to both family physicians and their patients must be considered.
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Affiliation(s)
- Bridget L. Ryan
- grid.39381.300000 0004 1936 8884Western University, London, Canada
| | | | | | | | - Moira Stewart
- grid.39381.300000 0004 1936 8884Western University, London, Canada
| | - Leslie Meredith
- grid.39381.300000 0004 1936 8884Western University, London, Canada
| | - Yun-Hee Choi
- grid.39381.300000 0004 1936 8884Western University, London, Canada
| | - Jennifer Wei He
- grid.39381.300000 0004 1936 8884Western University, London, Canada
| | - Sonny Cejic
- grid.39381.300000 0004 1936 8884Western University, London, Canada
| | - Keith Thompson
- grid.39381.300000 0004 1936 8884Western University, London, Canada
| | - Sonja Reichert
- grid.39381.300000 0004 1936 8884Western University, London, Canada
| | - Salimah Z. Shariff
- grid.39381.300000 0004 1936 8884Western University, London, Canada ,ICES Western, London, Canada
| | - Richard Booth
- grid.39381.300000 0004 1936 8884Western University, London, Canada
| | - Amanda L. Terry
- grid.39381.300000 0004 1936 8884Western University, London, Canada
| | - Maria Mathews
- grid.39381.300000 0004 1936 8884Western University, London, Canada
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14
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Mathews M, Spencer S, Hedden L, Lukewich J, Poitras ME, Marshall EG, Brown JB, Sibbald S, Norful AA. The impact of funding models on the integration of registered nurses in primary health care teams: protocol for a multi-phase mixed-methods study in Canada. BMC Prim Care 2022; 23:290. [PMID: 36402965 PMCID: PMC9675973 DOI: 10.1186/s12875-022-01900-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/03/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Family practice registered nurses co-managing patient care as healthcare professionals in interdisciplinary primary care teams have been shown to improve access, continuity of care, patient satisfaction, and clinical outcomes for patients with chronic diseases while being cost-effective. Currently, however, it is unclear how different funding models support or hinder the integration of family practice nurses into existing primary health care systems and interdisciplinary practices. This has resulted in the underutilisation of family practice nurses in contributing to high-quality patient care. METHODS This mixed-methods project is comprised of three studies: (1) a funding model analysis; (2) case studies; and (3) an online survey with family practice nurses. The funding model analysis will employ policy scans to identify, describe, and compare the various funding models used in Canada to integrate family practice nurses in primary care. Case studies involving qualitative interviews with clinic teams (family practice nurses, physicians, and administrators) and family practice nurse activity logs will explore the variation of nursing professional practice, training, skill set, and team functioning in British Columbia, Nova Scotia, Ontario, and Quebec. Interview transcripts will be analysed thematically and comparisons will be made across funding models. Activity log responses will be analysed to represent nurses' time spent on independent, dependent, interdependent, or non-nursing work in each funding model. Finally, a cross-sectional online survey of family practice nurses in Canada will examine the relationships between funding models, nursing professional practice, training, skill set, team functioning, and patient care co-management in primary care. We will employ bivariate tests and multivariable regression to examine these relationships in the survey results. DISCUSSION This project aims to address a gap in the literature on funding models for family practice nurses. In particular, findings will support provincial and territorial governments in structuring funding models that optimise the roles of family practice nurses while establishing evidence about the benefits of interdisciplinary team-based care. Overall, the findings may contribute to the integration and optimisation of family practice nursing within primary health care, to the benefit of patients, primary healthcare providers, and health care systems nationally.
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Affiliation(s)
- Maria Mathews
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western Centre for Public Health and Family Medicine, 1465 Richmond Street, Second Floor, Rm 2140, London, ON, Canada, N6G 2M1.
| | - Sarah Spencer
- Faculty of Health Sciences, Simon Fraser University, BC, Burnaby, Canada
| | - Lindsay Hedden
- Faculty of Health Sciences, Simon Fraser University, BC, Burnaby, Canada
| | - Julia Lukewich
- Faculty of Nursing, Memorial University, St John's, NL, Canada
| | - Marie-Eve Poitras
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada
| | | | - Judith Belle Brown
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western Centre for Public Health and Family Medicine, 1465 Richmond Street, Second Floor, Rm 2140, London, ON, Canada, N6G 2M1
| | - Shannon Sibbald
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western Centre for Public Health and Family Medicine, 1465 Richmond Street, Second Floor, Rm 2140, London, ON, Canada, N6G 2M1
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15
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Vaughan C, Lukewich J, Mathews M, Marshall EG, Hedden L, Spencer S, Ryan D, McCracken RK, Gill P, Wetmore S, Buote R, Meredith L, Moritz L, Brown JB. Family physicians' perspectives on the impact of COVID-19 on preventative care in primary care: findings from a qualitative study. Fam Pract 2022:cmac113. [PMID: 36269200 PMCID: PMC9620325 DOI: 10.1093/fampra/cmac113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Health system disruptions, caused by unexpected emergencies such as disease outbreaks, natural disasters, and cybercrimes, impact the delivery of routine preventative care. As comprehensive care providers, family physicians (FPs) devote significant time to prevention. However, without emergency and pandemic plans in place in primary care, FPs face added barriers to prioritizing and sustaining preventative care when health systems are strained, which was evident during the COVID-19 pandemic. This study aims to describe FPs' experiences providing preventative care during the COVID-19 pandemic and their perceptions of the impacts of disrupted preventative care in primary care settings. METHODS Using a qualitative descriptive approach, we conducted semistructured interviews with FPs across 4 provinces in Canada (i.e. Newfoundland and Labrador, Nova Scotia, Ontario, British Columbia) between October 2020 and June 2021 as part of a larger multiple case study. These interviews broadly explored the roles and responsibilities of FPs during the COVID-19 pandemic. Interviews were coded thematically and codes from the larger study were analysed further using an iterative, phased process of thematic analysis. RESULTS Interviews averaged 58 min in length (range 17-97 min) and FPs had a mean of 16.9 years of experience. We identified 4 major themes from interviews with FPs (n = 68): (i) lack of capacity and coordination across health systems, (ii) patient fear, (iii) impacts on patient care, and (iv) negative impacts on FPs. Physicians voiced concerns with managing patients' prevention needs when testing availability and coordination of services was limited. Early in the pandemic, patients were also missing or postponing their own primary care appointments. Change in the provision and coordination of routine preventative care had negative impacts on both patients and physicians, affecting disease incidence/progression, physician workload, and psychological wellbeing. CONCLUSION During the COVID-19 pandemic, upstream care efforts were impacted, and FPs were forced to reduce their provision of preventative care. FPs contribute direct insight to primary care delivery that can support pandemic planning to ensure preventative care is sustained during future emergencies.
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Affiliation(s)
- Crystal Vaughan
- Faculty of Nursing, Memorial University of Newfoundland, St John’s, Canada
| | - Julia Lukewich
- Faculty of Nursing, Memorial University of Newfoundland, St John’s, Canada
| | - Maria Mathews
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | | | - Lindsay Hedden
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Sarah Spencer
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Dana Ryan
- Faculty of Nursing, Memorial University of Newfoundland, St John’s, Canada
| | - Rita K McCracken
- Department of Family Medicine, Providence Health Care, Vancouver, Canada
- Department of Family Practice, University of British Columbia Faculty of Medicine, Vancouver, Canada
| | - Paul Gill
- Temerty Faculty of Medicine, Department of Family & Community Medicine, University of Toronto, Toronto, Canada
- Gateway Centre of Excellence in Rural Health, Gateway Rural Health Institute, Goderich, Canada
| | - Stephen Wetmore
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Richard Buote
- Department of Family Medicine, Dalhousie University, Halifax, Canada
| | - Leslie Meredith
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Lauren Moritz
- Department of Family Medicine, Dalhousie University, Halifax, Canada
| | - Judith Belle Brown
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
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Terry AL, Kueper JK, Beleno R, Brown JB, Cejic S, Dang J, Leger D, McKay S, Meredith L, Pinto AD, Ryan BL, Stewart M, Zwarenstein M, Lizotte DJ. Is primary health care ready for artificial intelligence? What do primary health care stakeholders say? BMC Med Inform Decis Mak 2022; 22:237. [PMID: 36085203 PMCID: PMC9461192 DOI: 10.1186/s12911-022-01984-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 09/02/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Effective deployment of AI tools in primary health care requires the engagement of practitioners in the development and testing of these tools, and a match between the resulting AI tools and clinical/system needs in primary health care. To set the stage for these developments, we must gain a more in-depth understanding of the views of practitioners and decision-makers about the use of AI in primary health care. The objective of this study was to identify key issues regarding the use of AI tools in primary health care by exploring the views of primary health care and digital health stakeholders.
Methods
This study utilized a descriptive qualitative approach, including thematic data analysis. Fourteen in-depth interviews were conducted with primary health care and digital health stakeholders in Ontario. NVivo software was utilized in the coding of the interviews.
Results
Five main interconnected themes emerged: (1) Mismatch Between Envisioned Uses and Current Reality—denoting the importance of potential applications of AI in primary health care practice, with a recognition of the current reality characterized by a lack of available tools; (2) Mechanics of AI Don’t Matter: Just Another Tool in the Toolbox– reflecting an interest in what value AI tools could bring to practice, rather than concern with the mechanics of the AI tools themselves; (3) AI in Practice: A Double-Edged Sword—the possible benefits of AI use in primary health care contrasted with fundamental concern about the possible threats posed by AI in terms of clinical skills and capacity, mistakes, and loss of control; (4) The Non-Starters: A Guarded Stance Regarding AI Adoption in Primary Health Care—broader concerns centred on the ethical, legal, and social implications of AI use in primary health care; and (5) Necessary Elements: Facilitators of AI in Primary Health Care—elements required to support the uptake of AI tools, including co-creation, availability and use of high quality data, and the need for evaluation.
Conclusion
The use of AI in primary health care may have a positive impact, but many factors need to be considered regarding its implementation. This study may help to inform the development and deployment of AI tools in primary health care.
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Mathews M, Ryan D, Hedden L, Lukewich J, Marshall EG, Brown JB, Gill PS, McKay M, Wong E, Wetmore SJ, Buote R, Meredith L, Moritz L, Spencer S, Alexiadis M, Freeman TR, Letto A, Ryan BL, Sibbald SL, Terry AL. Family physician leadership during the COVID-19 pandemic: roles, functions and key supports. Leadersh Health Serv (Bradf Engl) 2022; ahead-of-print. [PMID: 35877594 DOI: 10.1108/lhs-03-2022-0030] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Strong leadership in primary care is necessary to coordinate an effective pandemic response; however, descriptions of leadership roles for family physicians are absent from previous pandemic plans. This study aims to describe the leadership roles and functions family physicians played during the COVID-19 pandemic in Canada and identify supports and barriers to formalizing these roles in future pandemic plans. DESIGN/METHODOLOGY/APPROACH This study conducted semi-structured qualitative interviews with family physicians across four regions in Canada as part of a multiple case study. During the interviews, participants were asked about their roles during each pandemic stage and the facilitators and barriers they experienced. Interviews were transcribed and a thematic analysis approach was used to identify recurring themes. FINDINGS Sixty-eight family physicians completed interviews. Three key functions of family physician leadership during the pandemic were identified: conveying knowledge, developing and adapting protocols for primary care practices and advocacy. Each function involved curating and synthesizing information, tailoring communications based on individual needs and building upon established relationships. PRACTICAL IMPLICATIONS Findings demonstrate the need for future pandemic plans to incorporate formal family physician leadership appointments, as well as supports such as training, communication aides and compensation to allow family physicians to enact these key roles. ORIGINALITY/VALUE The COVID-19 pandemic presents a unique opportunity to examine the leadership roles of family physicians, which have been largely overlooked in past pandemic plans. This study's findings highlight the importance of these roles toward delivering an effective and coordinated pandemic response with uninterrupted and safe access to primary care.
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Affiliation(s)
- Maria Mathews
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Dana Ryan
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Lindsay Hedden
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Julia Lukewich
- Faculty of Nursing, Memorial University, St. John's, Canada
| | - Emily Gard Marshall
- Department of Family Medicine Primary Care Research Unit, Dalhousie University, Halifax, Canada
| | - Judith Belle Brown
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Paul S Gill
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | | | - Eric Wong
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Stephen J Wetmore
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Richard Buote
- Department of Family Medicine Primary Care Research Unit, Dalhousie University, Halifax, Canada
| | - Leslie Meredith
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Lauren Moritz
- Department of Family Medicine Primary Care Research Unit, Dalhousie University, Halifax, Canada
| | - Sarah Spencer
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Maria Alexiadis
- Department of Family Practice, Nova Scotia Health Authority, Halifax, Canada
| | - Thomas R Freeman
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Aimee Letto
- Newfoundland and Labrador Medical Association, St. John's, Canada
| | - Bridget L Ryan
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Shannon L Sibbald
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Amanda Lee Terry
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University London, Canada, and Department of Epidemiology and Biostatistics, Schulich School of Western University Medicine and Dentistry, Western University, London, Canada
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18
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Terry AL, Stewart M, Ashcroft R, Brown JB, Burge F, Haggerty J, McWilliam C, Meredith L, Reid GJ, Thomas R, Wong ST. Complex skills are required for new primary health care researchers: a training program responds. BMC Med Educ 2022; 22:565. [PMID: 35869518 PMCID: PMC9306239 DOI: 10.1186/s12909-022-03620-3] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 07/11/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Current dimensions of the primary health care research (PHC) context, including the need for contextualized research methods to address complex questions, and the co-creation of knowledge through partnerships with stakeholders - require PHC researchers to have a comprehensive set of skills for engaging effectively in high impact research. MAIN BODY In 2002 we developed a unique program to respond to these needs - Transdisciplinary Understanding and Training on Research - Primary Health Care (TUTOR-PHC). The program's goals are to train a cadre of PHC researchers, clinicians, and decision makers in interdisciplinary research to aid them in tackling current and future challenges in PHC and in leading collaborative interdisciplinary research teams. Seven essential educational approaches employed by TUTOR-PHC are described, as well as the principles underlying the curriculum. This program is unique because of its pan-Canadian nature, longevity, and the multiplicity of disciplines represented. Program evaluation results indicate: 1) overall program experiences are very positive; 2) TUTOR-PHC increases trainee interdisciplinary research understanding and activity; and 3) this training assists in developing their interdisciplinary research careers. Taken together, the structure of the program, its content, educational approaches, and principles, represent a complex whole. This complexity parallels that of the PHC research context - a context that requires researchers who are able to respond to multiple challenges. CONCLUSION We present this description of ways to teach and learn the advanced complex skills necessary for successful PHC researchers with a view to supporting the potential uptake of program components in other settings.
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Affiliation(s)
- Amanda L. Terry
- Centre for Studies in Family Medicine, Department of Family Medicine, Department of Epidemiology & Biostatistics, Schulich Interfaculty Program in Public Health, Schulich School of Medicine & Dentistry, The University of Western Ontario, Western Centre for Public Health and Family Medicine, 1151 Richmond Street, London, Ontario N6A 3K7 Canada
| | - Moira Stewart
- Centre for Studies in Family Medicine, Department of Family Medicine; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario Canada
| | - Rachelle Ashcroft
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario Canada
| | - Judith Belle Brown
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario Canada
| | - Fred Burge
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia Canada
| | - Jeannie Haggerty
- Department of Family Medicine, McGill University, Montréal, Québec Canada
| | - Carol McWilliam
- Arthur Labatt Family School of Nursing, Faculty of Health Sciences, The University of Western Ontario, London, Ontario Canada
| | - Leslie Meredith
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario Canada
| | - Graham J. Reid
- Centre for Studies in Family Medicine, Department of Family Medicine, Department of Psychology, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Ontario Canada
| | - Roanne Thomas
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario Canada
| | - Sabrina T. Wong
- School of Nursing, Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia Canada
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19
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Takamatsu S, Hamanishi J, Brown JB, Yamaguchi K, Yamanoi K, Murakami K, Gotoh O, Mori S, Mandai M, Matsumura N. Mutation burden-orthogonal tumor genomic subtypes delineate responses to immune checkpoint therapy. J Immunother Cancer 2022; 10:jitc-2022-004831. [PMID: 35868660 PMCID: PMC9289027 DOI: 10.1136/jitc-2022-004831] [Citation(s) in RCA: 1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2022] [Indexed: 12/14/2022] Open
Abstract
Background In cancer therapy, higher-resolution tumor-agnostic biomarkers that predict response to immune checkpoint inhibitor (ICI) therapy are needed. Mutation signatures reflect underlying oncogenic processes that can affect tumor immunogenicity, and thus potentially delineate ICI treatment response among tumor types. Methods Based on mutational signature analysis, we developed a stratification for all solid tumors in The Cancer Genome Atlas (TCGA). Subsequently, we developed a new software (Genomic Subtyping and Predictive Response Analysis for Cancer Tumor ICi Efficacy, GS-PRACTICE) to classify new tumors submitted to whole-exome sequencing. Using existing data from 973 pan-cancer ICI-treated cases with outcomes, we evaluated the subtype-response predictive performance. Results Systematic analysis on TCGA samples identified eight tumor genomic subtypes, which were characterized by features represented by smoking exposure, ultraviolet light exposure, APOBEC enzyme activity, POLE mutation, mismatch repair deficiency, homologous recombination deficiency, genomic stability, and aging. The former five subtypes were presumed to form an immune-responsive group acting as candidates for ICI therapy because of their high expression of immune-related genes and enrichment in cancer types with FDA approval for ICI monotherapy. In the validation cohort, the samples assigned by GS-PRACTICE to the immune-reactive subtypes were significantly associated with ICI response independent of cancer type and TMB high or low status. Conclusions The new tumor subtyping method can serve as a tumor-agnostic biomarker for ICI response prediction and will improve decision making in cancer treatment.
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Affiliation(s)
- Shiro Takamatsu
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Junzo Hamanishi
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - J B Brown
- Life Science Informatics Research Unit, Department of Molecular Biosciences, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Center for Cancer Immunotherapy and Immunobiology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ken Yamaguchi
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Koji Yamanoi
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kosuke Murakami
- Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Osamu Gotoh
- Project for Development of Innovative Research on Cancer Therapeutics, Cancer Precision Medicine Center, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Seiichi Mori
- Project for Development of Innovative Research on Cancer Therapeutics, Cancer Precision Medicine Center, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masaki Mandai
- Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Noriomi Matsumura
- Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, Osaka, Japan
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20
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Takamatsu S, Brown JB, Yamaguchi K, Hamanishi J, Yamanoi K, Takaya H, Kaneyasu T, Mori S, Mandai M, Matsumura N. Utility of Homologous Recombination Deficiency Biomarkers Across Cancer Types. JCO Precis Oncol 2022; 6:e2200085. [PMID: 35613413 PMCID: PMC9200383 DOI: 10.1200/po.22.00085] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Homologous recombination DNA repair deficiency (HRD) is associated with sensitivity to platinum and poly (ADP-ribose) polymerase inhibitors in certain cancer types, including breast, ovarian, pancreatic, and prostate. In these cancers, BRCA1/2 alterations and genomic scar signatures are useful indicators for assessing HRD. However, alterations in other homologous recombination repair (HRR)-related genes and their clinical significance in other cancer types have not been adequately and systematically investigated. A comprehensive pan-cancer analysis on the clinical significance of homologous recombination deficiency![]()
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Affiliation(s)
- Shiro Takamatsu
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - J B Brown
- Life Science Informatics Research Unit, Department of Molecular Biosciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Center for Cancer Immunotherapy and Immunobiology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ken Yamaguchi
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Junzo Hamanishi
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koji Yamanoi
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hisamitsu Takaya
- Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, Osaka, Japan
| | - Tomoko Kaneyasu
- Cancer Precision Medicine Center, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Seiichi Mori
- Cancer Precision Medicine Center, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masaki Mandai
- Department of Gynecology and Obstetrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Noriomi Matsumura
- Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, Osaka, Japan
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21
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Brown JB, Westfall J, Harper D, Green LA. FROM NAPCRG: NAPCRG 50 TH ANNIVERSARY - A YEAR-LONG CELEBRATION. Ann Fam Med 2022; 20:191-192. [PMID: 35346940 PMCID: PMC8959746 DOI: 10.1370/afm.2804] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Judith Belle Brown
- Epperson Zorn Chair for Innovation in Family Medicine and Primary Care, University of Colorado
| | - Jack Westfall
- Epperson Zorn Chair for Innovation in Family Medicine and Primary Care, University of Colorado
| | - Diane Harper
- Epperson Zorn Chair for Innovation in Family Medicine and Primary Care, University of Colorado
| | - Larry A Green
- Epperson Zorn Chair for Innovation in Family Medicine and Primary Care, University of Colorado
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22
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Kueper JK, Terry A, Bahniwal R, Meredith L, Beleno R, Brown JB, Dang J, Leger D, McKay S, Pinto A, Ryan BL, Zwarenstein M, Lizotte DJ. Connecting artificial intelligence and primary care challenges: findings from a multi stakeholder collaborative consultation. BMJ Health Care Inform 2022; 29:bmjhci-2021-100493. [PMID: 35091423 PMCID: PMC8804627 DOI: 10.1136/bmjhci-2021-100493] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/06/2022] [Indexed: 11/15/2022] Open
Abstract
Despite widespread advancements in and envisioned uses for artificial intelligence (AI), few examples of successfully implemented AI innovations exist in primary care (PC) settings.
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Affiliation(s)
- Jacqueline K Kueper
- Department of Epidemiology and Biostatistics, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada .,Department of Computer Science, Western University Faculty of Science, London, Ontario, Canada
| | - Amanda Terry
- Department of Epidemiology and Biostatistics, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada.,Department of Family Medicine, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada.,Schulich Interfaculty Program in Public Health, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Ravninder Bahniwal
- Schulich Interfaculty Program in Public Health, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Leslie Meredith
- Department of Family Medicine, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Ron Beleno
- Age-Well NCE, Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Judith Belle Brown
- Department of Family Medicine, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Janet Dang
- London Middlesex Primary Care Alliance, London, Ontario, Canada.,Thames Valley Family Health Team, London, Ontario, Canada
| | - Daniel Leger
- Department of Family Medicine, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Scott McKay
- Department of Family Medicine, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Andrew Pinto
- Department of Family and Community Medicine, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Department of Family and Community Medicine, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada
| | - Bridget L Ryan
- Department of Epidemiology and Biostatistics, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada.,Department of Family Medicine, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Merrick Zwarenstein
- Department of Epidemiology and Biostatistics, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada.,Department of Family Medicine, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Daniel J Lizotte
- Department of Epidemiology and Biostatistics, Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada.,Department of Computer Science, Western University Faculty of Science, London, Ontario, Canada
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23
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Brown JB, Reichert SM, Valliere Y, McLachlan C, Webster-Bogaert S, Ratzki-Leewing A, Ryan BL, Harris SB. Health Care Providers' Emotional Responses to Their Patients' Hypoglycemic Events: Qualitative Findings From the InHypo-DM Study, Canada. Diabetes Spectr 2021; 34:388-393. [PMID: 34866872 PMCID: PMC8603122 DOI: 10.2337/ds20-0061] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Hypoglycemia can cause psychological distress in people with diabetes; however, less is understood about the emotional impact of hypoglycemia on their health care providers (HCPs). This article focuses on the experiences and emotions of HCPs caring for patients with diabetes. METHODS This was a descriptive qualitative study from the InHypo-DM research program. Purposive sampling was used to recruit 20 HCPs from a variety of professions for 30- to 45-minute semi-structured interviews. An iterative analysis was conducted to identify the overarching themes. RESULTS Three overarching themes encompassed the responses of participants when their patients experienced hypoglycemia. The first was a sense of professional responsibility, as participants felt they must have failed or inadequately fulfilled their professional duties. The second was a more personal range of emotions such as sadness and guilt. The final theme was how these emotions created a "call to action," prompting participants to identify potential strategies to prevent future hypoglycemic events. CONCLUSION This qualitative study highlights the emotional impact of patients' hypoglycemia on HCPs. Although it may have been expected that HCPs have a strong sense of professional responsibility, it was unexpected that these responses often became personal emotions. To ameliorate the negative impact of these responses on patient care, HCPs should engage in activities that enable them to anticipate and manage their own emotional responses. In addition, strategies to optimize hypoglycemia detection and prevention should be promoted.
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Affiliation(s)
- Judith Belle Brown
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Centre for Studies in Family Medicine, Western University, London, Ontario, Canada
- Corresponding author: Judith Belle Brown,
| | - Sonja M. Reichert
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Centre for Studies in Family Medicine, Western University, London, Ontario, Canada
| | - Yashoda Valliere
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Centre for Studies in Family Medicine, Western University, London, Ontario, Canada
| | - Cecelia McLachlan
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Centre for Studies in Family Medicine, Western University, London, Ontario, Canada
| | - Susan Webster-Bogaert
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Centre for Studies in Family Medicine, Western University, London, Ontario, Canada
| | - Alexandria Ratzki-Leewing
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Centre for Studies in Family Medicine, Western University, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Bridget L. Ryan
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Centre for Studies in Family Medicine, Western University, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Stewart B. Harris
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Centre for Studies in Family Medicine, Western University, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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24
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Mansouri K, Karmaus AL, Fitzpatrick J, Patlewicz G, Pradeep P, Alberga D, Alepee N, Allen TEH, Allen D, Alves VM, Andrade CH, Auernhammer TR, Ballabio D, Bell S, Benfenati E, Bhattacharya S, Bastos JV, Boyd S, Brown JB, Capuzzi SJ, Chushak Y, Ciallella H, Clark AM, Consonni V, Daga PR, Ekins S, Farag S, Fedorov M, Fourches D, Gadaleta D, Gao F, Gearhart JM, Goh G, Goodman JM, Grisoni F, Grulke CM, Hartung T, Hirn M, Karpov P, Korotcov A, Lavado GJ, Lawless M, Li X, Luechtefeld T, Lunghini F, Mangiatordi GF, Marcou G, Marsh D, Martin T, Mauri A, Muratov EN, Myatt GJ, Nguyen DT, Nicolotti O, Note R, Pande P, Parks AK, Peryea T, Polash AH, Rallo R, Roncaglioni A, Rowlands C, Ruiz P, Russo DP, Sayed A, Sayre R, Sheils T, Siegel C, Silva AC, Simeonov A, Sosnin S, Southall N, Strickland J, Tang Y, Teppen B, Tetko IV, Thomas D, Tkachenko V, Todeschini R, Toma C, Tripodi I, Trisciuzzi D, Tropsha A, Varnek A, Vukovic K, Wang Z, Wang L, Waters KM, Wedlake AJ, Wijeyesakere SJ, Wilson D, Xiao Z, Yang H, Zahoranszky-Kohalmi G, Zakharov AV, Zhang FF, Zhang Z, Zhao T, Zhu H, Zorn KM, Casey W, Kleinstreuer NC. Erratum: CATMoS: Collaborative Acute Toxicity Modeling Suite. Environ Health Perspect 2021; 129:109001. [PMID: 34647794 PMCID: PMC8516060 DOI: 10.1289/ehp10369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 09/24/2021] [Indexed: 05/21/2023]
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25
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Ngangue P, Brown JB, Forgues C, Ag Ahmed MA, Nguyen TN, Sasseville M, Loignon C, Gallagher F, Stewart M, Fortin M. Evaluating the implementation of interdisciplinary patient-centred care intervention for people with multimorbidity in primary care: a qualitative study. BMJ Open 2021; 11:e046914. [PMID: 34561255 PMCID: PMC8475135 DOI: 10.1136/bmjopen-2020-046914] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE A patient-centred care interdisciplinary pragmatic intervention to support self-management for patients with multimorbidity was implemented in one region of Quebec, Canada. This embedded study aimed to evaluate the process of implementation. DESIGN A descriptive qualitative study was conducted in 2016-2017 using semistructured individual interviews. The Consolidated Framework for Implementation Research (CFIR) was used to guide the data coding, analysis and reporting of the findings. SETTING The study took place in seven Family Medicine Groups in one region (Saguenay-Lac-Saint-Jean) of Quebec, Canada. PARTICIPANTS Ten managers (including two family physicians) and 19 healthcare professionals (HCPs), nurses, kinesiologists, nutritionists and a respiratory therapist, were interviewed. RESULTS Many key elements within the five CFIR domains were identified as impacting the implementation of the intervention : (1) intervention characteristics-evidence strength and quality, design quality and packaging, relative advantage and complexity; (2) outer setting-patients' needs and resources, external policies and incentives; (3) inner setting-structural characteristics, networks and communication, culture, compatibility, readiness for implementation and leadership engagement; (4) characteristics of the managers and HCPs-knowledge and belief about the intervention; (5) process-planning, opinion leaders, formally appointed internal implementation leaders, reflecting and evaluating. CONCLUSION This study revealed the organisational and contextual aspects of the implementation based on different and complementary perspectives. With the growing demand for interdisciplinary teams in primary care, we believe that our insights will be helpful for practices, researchers, and policymakers interested in the implementation of disease prevention and management programmes for people with multiple chronic conditions in primary care. TRIAL REGISTRATION NUMBER NCT02789800.
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Affiliation(s)
- Patrice Ngangue
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Judith Belle Brown
- Department of Family Medicine, Western University, London, Ontario, Canada
| | - Catherine Forgues
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Mohamed Ali Ag Ahmed
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Tu Ngoc Nguyen
- Westmead Apllied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Maxime Sasseville
- Department of Health Sciences, Université du Québec à Chicoutimi, Chicoutimi, Quebec, Canada
| | - Christine Loignon
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Frances Gallagher
- School of Nursing, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Moira Stewart
- Department of Family Medicine, Western University, London, Ontario, Canada
| | - Martin Fortin
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
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26
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Aleksić S, Seeliger D, Brown JB. ADMET Predictability at Boehringer Ingelheim: State-of-the-Art, and Do Bigger Datasets or Algorithms Make a Difference? Mol Inform 2021; 41:e2100113. [PMID: 34473408 DOI: 10.1002/minf.202100113] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 04/27/2021] [Accepted: 08/21/2021] [Indexed: 11/08/2022]
Abstract
Computational methods assisting drug discovery and development are routine in the pharmaceutical industry. Digital recording of ADMET assays has provided a rich source of data for development of predictive models. Despite the accumulation of data and the public availability of advanced modeling algorithms, the utility of prediction in ADMET research is not clear. Here, we present a critical evaluation of the relationships between data volume, modeling algorithm, chemical representation and grouping, and temporal aspect (time sequence of assays) using an in-house ADMET database. We find no large difference in prediction algorithms nor any systemic and substantial gain from increasingly large datasets. Temporal-based data enlargement led to performance improvement in only in a limited number of assays, and with fractional improvement at best. Assays that are well-, intermediately-, or poorly-suited for ADMET predictions and reasons for such behavior are systematically identified, generating realistic expectations for areas in which computational models can be used to guide decision making in molecular design and development.
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Affiliation(s)
- Stevan Aleksić
- Medicinal Chemistry, Boehringer Ingelheim Pharma GmbH & Co. KG, 88397, Biberach, Germany
| | - Daniel Seeliger
- Medicinal Chemistry, Boehringer Ingelheim Pharma GmbH & Co. KG, 88397, Biberach, Germany
| | - J B Brown
- Medicinal Chemistry, Boehringer Ingelheim Pharma GmbH & Co. KG, 88397, Biberach, Germany
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Piccinini-Vallis H, Brown JB, Ryan BL, McDonald SD, Stewart M. Women's Views on Advice About Weight Gain in Pregnancy: A Grounded Theory Study. Matern Child Health J 2021; 25:1717-1724. [PMID: 34406558 DOI: 10.1007/s10995-021-03222-3] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Pregnant women prioritize the health of their pregnancy, and weight gain contributes to the pregnancy's health. Women encounter different messages about gestational weight gain from various sources that can be confusing. This study aimed to increase our understanding of the processes influencing how women experience the gestational weight gain advice they receive. METHODS Grounded theory methodology was chosen. Women receiving prenatal care in a primary care setting were invited to participate in one-on-one interviews. RESULTS All fifteen participants had high educational attainment, fourteen were Caucasian, and five had an elevated pre-pregnancy body mass index. Six interconnected themes emerged from the data: (1) striving to have a healthy pregnancy; (2) experiencing influences; (3) feeling worried; (4) Managing ambiguity; (5) trusting a source of information; and (6) feeling relief. CONCLUSIONS FOR PRACTICE Physicians are perceived by pregnant women to be a source of trusted information about gestational weight gain and are therefore in a strategic position to help women achieve healthy weight gain during pregnancy.
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Affiliation(s)
- Helena Piccinini-Vallis
- Department of Family Medicine, Dalhousie University, 6960 Mumford Road, Halifax, NS, B3L 4P1, Canada.
| | - Judith Belle Brown
- Department of Family Medicine, Western Centre for Public Health and Family Medicine, Western University, 1465 Richmond Street, London, ON, N6G 2M1, Canada
| | - Bridget L Ryan
- Department of Family Medicine, Western Centre for Public Health and Family Medicine, Western University, 1465 Richmond Street, London, ON, N6G 2M1, Canada.,Department of Epidemiology and Biostatistics, Western Centre for Public Health and Family Medicine, Schulich School of Medicine and Dentistry, Western University, 1465 Richmond Street, London, ON, N6G 2M1, Canada
| | - Sarah D McDonald
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Moira Stewart
- Department of Family Medicine, Western Centre for Public Health and Family Medicine, Western University, 1465 Richmond Street, London, ON, N6G 2M1, Canada
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Mathews M, Spencer S, Hedden L, Marshall EG, Lukewich J, Meredith L, Ryan D, Buote R, Liu T, Volpe E, Gill PS, Ryan B, Schacter G, Wickett J, Freeman TR, Sibbald SL, Wong E, McKay M, McCracken R, Brown JB. Development of a primary care pandemic plan informed by in-depth policy analysis and interviews with family physicians across Canada during COVID-19: a qualitative case study protocol. BMJ Open 2021; 11:e048209. [PMID: 34301660 PMCID: PMC8300554 DOI: 10.1136/bmjopen-2020-048209] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 05/05/2021] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Given the recurrent risk of respiratory illness-based pandemics, and the important roles family physicians play during public health emergencies, the development of pandemic plans for primary care is imperative. Existing pandemic plans in Canada, however, do not adequately incorporate family physicians' roles and perspectives. This policy and planning oversight has become increasingly evident with the emergence of the novel coronavirus disease, COVID-19, pandemic. This study is designed to inform the development of pandemic plans for primary care through evidence from four provinces in Canada: British Columbia, Newfoundland and Labrador, Nova Scotia, and Ontario. METHODS AND ANALYSIS We will employ a multiple-case study of regions in four provinces. Each case consists of a mixed methods design which comprises: (1) a chronology of family physician roles in the COVID-19 pandemic response; (2) a provincial policy analysis; and (3) qualitative interviews with family physicians. Relevant policy and guidance documents will be identified through targeted, snowball and general search strategies. Additionally, these policy documents will be analysed to identify gaps and/or emphases in existing policies and policy responses. Interviews will explore family physicians' proposed, actual and potential roles during the pandemic, the facilitators and barriers they have encountered throughout and the influence of gender on their professional roles. Data will be thematically analysed using a content analysis framework, first at the regional level and then through cross-case analyses. ETHICS AND DISSEMINATION Approval for this study has been granted by the Research Ethics of British Columbia, the Health Research Ethics Board of Newfoundland and Labrador, the Nova Scotia Health Authority Research Ethics Board and the Western University Research Ethics Board. Findings will be disseminated via conferences and peer-reviewed publications. Evidence and lessons learnt will be used to develop tools for government ministries, public health units and family physicians for improved pandemic response plans for primary care.
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Affiliation(s)
- Maria Mathews
- Department of Family Medicine, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Sarah Spencer
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Lindsay Hedden
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
- British Columbia Academic Health Science Network, Vancouver, British Columbia, Canada
| | - Emily Gard Marshall
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Julia Lukewich
- Faculty of Nursing, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada
| | - Leslie Meredith
- Department of Family Medicine, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Dana Ryan
- Faculty of Nursing, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada
| | - Richard Buote
- Faculty of Medicine, Memorial University of Newfoundland, St John's, Newfoundland and Labrador, Canada
| | - Tiffany Liu
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Emily Volpe
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Paul S Gill
- University of Toronto, Goderich, Ontario, Canada
- Gateway Rural Health Institute, Goderich, Ontario, Canada
| | - Bridget Ryan
- Department of Family Medicine, Schulich School of Medicine and Dentistry, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Gordon Schacter
- Department of Family Medicine, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Jamie Wickett
- Department of Family Medicine, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Thomas R Freeman
- Department of Family Medicine, Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Shannon L Sibbald
- Department of Family Medicine, Schulich School of Medicine and Dentistry, London, Ontario, Canada
- School of Health Studies, Western University Faculty of Health Sciences, London, Ontario, Canada
| | - Eric Wong
- Department of Family Medicine, Schulich School of Medicine and Dentistry, London, Ontario, Canada
- Thames Valley Family Health Team, London, Ontario, Canada
| | - Maddi McKay
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Doctors Nova Scotia, Dartmouth, Nova Scotia, Canada
| | - Rita McCracken
- Department of Family Medicine, Providence Health Care, Vancouver, British Columbia, Canada
- Department of Family Practice, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Judith Belle Brown
- Department of Family Medicine, Schulich School of Medicine and Dentistry, London, Ontario, Canada
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Ashcroft R, Donnelly C, Dancey M, Gill S, Lam S, Kourgiantakis T, Adamson K, Verrilli D, Dolovich L, Kirvan A, Mehta K, Sur D, Brown JB. Primary care teams' experiences of delivering mental health care during the COVID-19 pandemic: a qualitative study. BMC Fam Pract 2021; 22:143. [PMID: 34210284 PMCID: PMC8248293 DOI: 10.1186/s12875-021-01496-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 06/23/2021] [Indexed: 12/30/2022]
Abstract
Background Integrated primary care teams are ideally positioned to support the mental health care needs arising during the COVID-19 pandemic. Understanding how COVID-19 has affected mental health care delivery within primary care settings will be critical to inform future policy and practice decisions during the later phases of the pandemic and beyond. The objective of our study was to describe the impact of the COVID-19 pandemic on primary care teams’ delivery of mental health care. Methods A qualitative study using focus groups conducted with primary care teams in Ontario, Canada. Focus group data was analysed using thematic analysis. Results We conducted 11 focus groups with 10 primary care teams and a total of 48 participants. With respect to the impact of the COVID-19 pandemic on mental health care in primary care teams, we identified three key themes: i) the high demand for mental health care, ii) the rapid transformation to virtual care, and iii) the impact on providers. Conclusions From the outset of the COVID-19 pandemic, primary care quickly responded to the rising mental health care demands of their patients. Despite the numerous challenges they faced with the rapid transition to virtual care, primary care teams have persevered. It is essential that policy and decision-makers take note of the toll that these demands have placed on providers. There is an immediate need to enhance primary care’s capacity for mental health care for the duration of the pandemic and beyond. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01496-8.
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Affiliation(s)
- Rachelle Ashcroft
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada.
| | | | - Maya Dancey
- Telfer School of Management, University of Ottawa, Ottawa, ON, Canada
| | - Sandeep Gill
- Association of Family Health Teams of Ontario, Toronto, ON, Canada
| | - Simon Lam
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - Toula Kourgiantakis
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - Keith Adamson
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | | | - Lisa Dolovich
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Anne Kirvan
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada
| | - Kavita Mehta
- Association of Family Health Teams of Ontario, Toronto, ON, Canada
| | - Deepy Sur
- Ontario Association of Social Workers, Toronto, ON, Canada
| | - Judith Belle Brown
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
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Takamatsu S, Brown JB, Yamanoi K, Yamaguchi K, Hamanishi J, Kobayashi T, Mandai M, Matsumura N. Abstract 366: Identification of a clinically significant pan-cancer biomarker for homologous recombination deficiency. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-366] [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: 11/16/2022]
Abstract
Abstract
[Background] Genomic alterations in BRCA1/2 and the ‘genomic scar' signatures are associated with homologous recombination DNA repair deficiency (HRD) and serve as therapeutic biomarkers for sensitivity to platinum and PARP inhibitors in breast and ovarian cancers. However, the clinical significance of these biomarkers in other homologous recombination repair (HRR) pathway genes or in other cancer types is not fully understood.
[Method] From the TCGA and the AACR GENIE project databases, we obtained clinical and genomic data of patients with multiple solid cancers, evaluated both locus-specific LOH in HRR pathway gene mutations and two genomic scar signature scores (HRD score and mutational signature 3), identified potential HRD cases, and examined the efficacy of DNA-damaging drugs in these HRD cases.
[Results] Germline and somatic gene mutations in the HRR pathway genes with locus-specific LOH were significantly enriched in cases having high genomic scar scores, whereas those without the LOH were not enriched. Somatic mutations without the LOH were remarkably enriched in hypermutated cases and considered to be passenger mutations. The mutation rate and frequency with LOH in the HRR pathway genes varied widely by cancer type. When stratifying patients by gender and presence of TP53 mutation, the correlation between the two genomic scar scores and the resulting optimal cutoff values for biallelic HRR pathway gene alterations differed greatly. The potential HRD cases that were selected by the two genomic scar cutoffs and biallelic HRR pathway gene alterations showed significantly high gene expression-based HRD scores. In Cox proportional hazard multivariate analyses with covariates of age, stage, gender, HRD, and TP53 mutation, HRD was a good prognostic factor in the group with DNA-damaging agents, but a poor one in the group without the agents.
[Conclusion] Increased attention on locus-specific LOH in HRR pathway gene alterations and the differences in genomic scar signatures stratified by gender and TP53 mutation is newly warranted in order to properly assess HRD in a pan-cancer manner. The results in the present study proved the clinical significance of HRD across cancer types and may contribute to the development of personalized medicine based on HRD.
Citation Format: Shiro Takamatsu, JB Brown, Koji Yamanoi, Ken Yamaguchi, Junzo Hamanishi, Takashi Kobayashi, Masaki Mandai, Noriomi Matsumura. Identification of a clinically significant pan-cancer biomarker for homologous recombination deficiency [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 366.
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Affiliation(s)
- Shiro Takamatsu
- 1Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - JB Brown
- 2Kyoto University Center for Cancer Immunotherapy and Immunobiology, Kyoto, Japan
| | - Koji Yamanoi
- 1Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ken Yamaguchi
- 1Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Junzo Hamanishi
- 1Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takashi Kobayashi
- 3Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Masaki Mandai
- 1Department of Gynecology and Obstetrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Noriomi Matsumura
- 4Department of Obstetrics and Gynecology, Kindai University Faculty of Medicine, Osaka, Japan
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Mansouri K, Karmaus A, Fitzpatrick J, Patlewicz G, Pradeep P, Alberga D, Alepee N, Allen TEH, Allen D, Alves VM, Andrade CH, Auernhammer TR, Ballabio D, Bell S, Benfenati E, Bhattacharya S, Bastos JV, Boyd S, Brown JB, Capuzzi SJ, Chushak Y, Ciallella H, Clark AM, Consonni V, Daga PR, Ekins S, Farag S, Fedorov M, Fourches D, Gadaleta D, Gao F, Gearhart JM, Goh G, Goodman JM, Grisoni F, Grulke CM, Hartung T, Hirn M, Karpov P, Korotcov A, Lavado GJ, Lawless M, Li X, Luechtefeld T, Lunghini F, Mangiatordi GF, Marcou G, Marsh D, Martin T, Mauri A, Muratov EN, Myatt GJ, Nguyen DT, Nicolotti O, Note R, Pande P, Parks AK, Peryea T, Polash A, Rallo R, Roncaglioni A, Rowlands C, Ruiz P, Russo D, Sayed A, Sayre R, Sheils T, Siegel C, Silva AC, Simeonov A, Sosnin S, Southall N, Strickland J, Tang Y, Teppen B, Tetko IV, Thomas D, Tkachenko V, Todeschini R, Toma C, Tripodi I, Trisciuzzi D, Tropsha A, Varnek A, Vukovic K, Wang Z, Wang L, Waters KM, Wedlake AJ, Wijeyesakere SJ, Wilson D, Xiao Z, Yang H, Zahoranszky-Kohalmi G, Zakharov AV, Zhang FF, Zhang Z, Zhao T, Zhu H, Zorn KM, Casey W, Kleinstreuer NC. Erratum: CATMoS: Collaborative Acute Toxicity Modeling Suite. Environ Health Perspect 2021; 129:79001. [PMID: 34242083 PMCID: PMC8270350 DOI: 10.1289/ehp9883] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 06/28/2021] [Indexed: 05/28/2023]
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Fortin M, Stewart M, Ngangue P, Almirall J, Bélanger M, Brown JB, Couture M, Gallagher F, Katz A, Loignon C, Ryan BL, Sampalli T, Wong ST, Zwarenstein M. Scaling Up Patient-Centered Interdisciplinary Care for Multimorbidity: A Pragmatic Mixed-Methods Randomized Controlled Trial. Ann Fam Med 2021; 19:126-134. [PMID: 33685874 PMCID: PMC7939717 DOI: 10.1370/afm.2650] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 07/07/2020] [Accepted: 07/15/2020] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To measure the effectiveness of a 4-month interdisciplinary multifaceted intervention based on a change in care delivery for patients with multimorbidity in primary care practices. METHODS A pragmatic randomized controlled trial with a mixed-methods design in patients aged 18 to 80 years with 3 or more chronic conditions from 7 family medicine groups (FMGs) in Quebec, Canada. Health care professionals (nurses, nutritionists, kinesiologists) from the FMGs were trained to deliver the patient-centered intervention based on a motivational approach and self-management support. Primary outcomes: self-management (Health Education Impact Questionnaire); and self-efficacy. SECONDARY OUTCOMES health status, quality of life, and health behaviors. Quantitative analyses used multi-level mixed effects and generalized linear mixed models controlling for clustering within FMGs. We also conducted in-depth interviews with patients, family members, and health care professionals. RESULTS The trial randomized 284 patients (144 in intervention group, 140 in control group). The groups were comparable. After 4 months, the intervention showed a neutral effect for the primary outcomes. There was significant improvement in 2 health behaviors (healthy eating with odds ratios [OR] 4.36; P = .006, and physical activity with OR 3.43; P = .023). The descriptive qualitative evaluation revealed that the patients reinforced their self-efficacy and improved their self-management which was divergent from the quantitative results. CONCLUSIONS Quantitatively, this intervention showed a neutral effect on the primary outcomes and substantial improvement in 2 health behaviors as secondary outcomes. Qualitatively, the intervention was evaluated as positive. The combination of qualitative and quantitative designs proved to be a good design for evaluating this complex intervention.
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Affiliation(s)
- Martin Fortin
- CORRESPONDING AUTHOR Martin Fortin Department of Family Medicine and Emergency Medicine Université de Sherbrooke 3001 12e Ave N Quebec, Canada, J1H 5N4
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Mf Rahman S, Brown JB, David KV, Valliere Y. Building family medicine into the primary health care system in India through under-graduate and post-graduate education. Educ Prim Care 2020; 32:186-187. [PMID: 33053317 DOI: 10.1080/14739879.2020.1830438] [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: 10/23/2022]
Affiliation(s)
- Sajitha Mf Rahman
- Department of Family Medicine, Christian Medical College, Vellore, India,
| | - Judith Belle Brown
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University London, Ontario, Canada
| | - Kirubah V David
- Department of Family Medicine, Christian Medical College, Vellore, India
| | - Yashoda Valliere
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University London, Ontario, Canada
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Takeuchi A, Takahashi Y, Iida K, Hosokawa M, Irie K, Ito M, Brown JB, Ohno K, Nakashima K, Hagiwara M. Identification of Qk as a Glial Precursor Cell Marker that Governs the Fate Specification of Neural Stem Cells to a Glial Cell Lineage. Stem Cell Reports 2020; 15:883-897. [PMID: 32976762 PMCID: PMC7562946 DOI: 10.1016/j.stemcr.2020.08.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 08/24/2020] [Accepted: 08/24/2020] [Indexed: 02/07/2023] Open
Abstract
During brain development, neural stem cells (NSCs) initially produce neurons and change their fate to generate glias. While the regulation of neurogenesis is well characterized, specific markers for glial precursor cells (GPCs) and the master regulators for gliogenesis remain unidentified. Accumulating evidence suggests that RNA-binding proteins (RBPs) have significant roles in neuronal development and function, as they comprehensively regulate the expression of target genes in a cell-type-specific manner. We systematically investigated the expression profiles of 1,436 murine RBPs in the developing mouse brain and identified quaking (Qk) as a marker of the putative GPC population. Functional analysis of the NSC-specific Qk-null mutant mouse revealed the key role of Qk in astrocyte and oligodendrocyte generation and differentiation from NSCs. Mechanistically, Qk upregulates gliogenic genes via quaking response elements in their 3′ untranslated regions. These results provide crucial directions for identifying GPCs and deciphering the regulatory mechanisms of gliogenesis from NSCs. Differential expression analysis identified Qk as a glial precursor cell marker Loss of Qk ablated both astrocyte and OL production from neural stem cells Qk−/− NSCs failed to become glia and aberrantly expressed neural genes Qk comprehensively upregulates essential genes for gliogenesis as regulons via QREs
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Affiliation(s)
- Akihide Takeuchi
- Department of Anatomy and Developmental Biology, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto 606-8501, Japan.
| | - Yuji Takahashi
- Department of Anatomy and Developmental Biology, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto 606-8501, Japan
| | - Kei Iida
- Department of Anatomy and Developmental Biology, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto 606-8501, Japan; Medical Research Support Center, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto 606-8501, Japan
| | - Motoyasu Hosokawa
- Department of Anatomy and Developmental Biology, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto 606-8501, Japan
| | - Koichiro Irie
- Department of Stem Cell Biology and Medicine, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka 812-8582, Japan
| | - Mikako Ito
- Division of Neurogenetics, Center for Neurological Diseases and Cancer, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - J B Brown
- Laboratory for Molecular Biosciences, Life Science Informatics Research Unit, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto 606-8501, Japan
| | - Kinji Ohno
- Division of Neurogenetics, Center for Neurological Diseases and Cancer, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Kinichi Nakashima
- Department of Stem Cell Biology and Medicine, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka 812-8582, Japan
| | - Masatoshi Hagiwara
- Department of Anatomy and Developmental Biology, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto 606-8501, Japan
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Nakano T, Takeda S, Brown JB. Active learning effectively identifies a minimal set of maximally informative and asymptotically performant cytotoxic structure-activity patterns in NCI-60 cell lines. RSC Med Chem 2020; 11:1075-1087. [PMID: 33479700 PMCID: PMC7513593 DOI: 10.1039/d0md00110d] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/30/2020] [Indexed: 11/21/2022] Open
Abstract
The NCI-60 cancer cell line screening panel has provided insights for development of subtype-specific chemical therapies and repurposing. By extracting chemical structure and cytotoxicity patterns, virtual screening potentially complements the availability of high-throughput assay platforms and improves bioactive compound discovery rates by computational prefiltering of candidate compound libraries. Many groups report high prediction performances in computational models of NCI-60 data when using cross-validation or similar techniques, yet prospective therapy development in novel cancers may have little to no such data and further may not have the resources to perform hit identification using large compound libraries. In contrast to bulk screening and analysis, the active learning methodology has demonstrated how to identify compounds for screening in small batches and update computational models iteratively, leading to predictive models with a minimum number of compounds, and importantly clarifying data volumes at which limits in predictive ability are achieved. Here, in replicate per-cell line experiments using 50% of data (∼20 000 compounds) as the external prediction target, predictive limits are reproducibly demonstrated at the stage of systematic selection of 10-30% of the incorporable half. The pattern was consistent across all 60 cell lines. Limits of predictability are found to be correlated to the doubling times of cell lines and the number of cellular response discontinuities (activity cliffs) present per cell line. Organization into chemical scaffolds delineated degrees of predictive challenge. These results provide key insights for strategies in developing new inhibitors in existing cell lines or for future automated therapy selection in personalized oncotherapy.
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Affiliation(s)
- Takumi Nakano
- Kyoto University Graduate School of Medicine , Department of Molecular Biosciences , Life Science Informatics Research Unit , Konoemachi Yoshida Sakyo , Kyoto 606-8501 , Japan .
| | - Shunichi Takeda
- Kyoto University Graduate School of Medicine , Department of Radiation Genetics , Konoemachi Yoshida Sakyo , Kyoto 606-8501 , Japan
| | - J B Brown
- Kyoto University Graduate School of Medicine , Department of Molecular Biosciences , Life Science Informatics Research Unit , Konoemachi Yoshida Sakyo , Kyoto 606-8501 , Japan .
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Abstract
Background: In Ontario, Canada, social workers are employed in a number of primary healthcare (PHC) settings such as Community Health Centres (CHCs) and Family Health Teams (FHTs). However, many aspects of social work practice within PHC settings are unknown. Objectives: The objectives of our study are to determine the amount of social work services provided in CHCs and FHTs, identify the types of services that social workers provide in CHCs and FHTs and ascertain the methods social workers use to deliver services in CHCs and FHTs. Method: An analysis of a cross-sectional data set obtained from a survey conducted in June 2016 in Ontario was performed. Results: The majority of practices (84.2%) had a social worker, although several practices also hosted other types of mental health workers. In virtually all practices with social workers, they (and individuals designated as mental healthcare providers) were also involved in practice level efforts to support mental healthcare delivery. In several practices, the care they delivered extended beyond that related directly to mental healthcare, ranging from preventive care and health promotion (64.5%) to palliative care (16.8%). In several practices, these workers also offered group appointments related to healthy behaviour (43.6%) and self-management (~33%). Interestingly, the role of social workers in practices where they were the sole designated mental healthcare worker was not meaningfully different from practices where other mental health professionals work. Conclusions: In PHC, social workers deliver or support the delivery of mental healthcare, but their role extends beyond that domain to encompass a broader set of services that contribute to the individual's health and wellbeing.
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Affiliation(s)
- Vela Tadic
- Executive Director, Bruyère Academic Family Health Team, Ottawa, ON
| | - Rachelle Ashcroft
- Assistant Professor, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON
| | - Judith Belle Brown
- Professor, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON
| | - Simone Dahrouge
- Scientist, Bruyère Research Institute, C.T. Lamont Primary Health Care Research Centre, University of Ottawa, Ottawa, ON
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Brown JB, Mulder C, Clark RE, Belsito L, Thorpe C. It starts with a strong foundation: constructing collaborative interprofessional teams in primary health care. J Interprof Care 2020; 35:514-520. [PMID: 32716727 DOI: 10.1080/13561820.2020.1787360] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 10/23/2022]
Abstract
The purpose of this qualitative study was to explore how team members experience and enact interprofessional teamwork in primary health care (PHC). Fifty-three participants (from eight teams), members of the Association of Family Health Teams of Ontario (AFHTO), were interviewed; interviews were audiotaped and transcribed verbatim. The data analyses used an iterative process with individual and team analysis. Findings revealed components that comprise the foundation and pillars of collaborative interprofessional teamwork in PHC. First, participants described a shared philosophsy of teamwork with six elements: values, vision, and mission; collaboration; communication; trust; respect and team members that 'fit.' Second, findings revealed three 'pillars.' The first pillar, leadership, included the elements of specific leadership attributes, such as leaders encouraging teamwork, mitigating conflict, and facilitating change. In the second pillar, participants described three elements of team building: formal and informal team building activities plus how these activities benefited both the team and patient care. The last pillar, optimizing scope of practice, included the elements of recognizing, appreciating, utilizing, and expanding team members' scope of practice. While each component and their concomitant elements can be enacted individually, collectively applying all elements produces collaborative interprofessional teamwork in primary health care.
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Affiliation(s)
- Judith Belle Brown
- Centre for Studies in Family Medicine, Department of Family Medicine, the Western Centre for Public Health and Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Carol Mulder
- Centre for Studies in Primary Care, Department of Family Medicine, Queens University, Kingston, Canada
| | - Rebecca E Clark
- Centre for Studies in Family Medicine, Department of Family Medicine, the Western Centre for Public Health and Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Laura Belsito
- Association of Family Health Teams of Ontario (AFHTO), Toronto, Canada
| | - Cathy Thorpe
- Centre for Studies in Family Medicine, Department of Family Medicine, the Western Centre for Public Health and Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Canada
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Nguyen TN, Ngangue PA, Ryan BL, Stewart M, Brown JB, Bouhali T, Fortin M. The revised Patient Perception of Patient‐Centeredness Questionnaire: Exploring the factor structure in French‐speaking patients with multimorbidity. Health Expect 2020; 23:904-909. [PMID: 32338814 PMCID: PMC7495072 DOI: 10.1111/hex.13068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/13/2020] [Accepted: 04/07/2020] [Indexed: 12/29/2022] Open
Affiliation(s)
- Tu Ngoc Nguyen
- Department of Family Medicine and Emergency Medicine Faculty of Medicine and Health Sciences Université de Sherbrooke Sherbrooke QC Canada
| | - Patrice Alain Ngangue
- Department of Family Medicine and Emergency Medicine Faculty of Medicine and Health Sciences Université de Sherbrooke Sherbrooke QC Canada
| | - Bridget L. Ryan
- Centre for Studies in Family Medicine Department of Family Medicine Schulich School of Medicine & Dentistry Western University London ON Canada
- Department of Epidemiology and Biostatistics Schulich School of Medicine & Dentistry Western University London ON Canada
| | - Moira Stewart
- Centre for Studies in Family Medicine Department of Family Medicine Schulich School of Medicine & Dentistry Western University London ON Canada
- Department of Epidemiology and Biostatistics Schulich School of Medicine & Dentistry Western University London ON Canada
| | - Judith Belle Brown
- Centre for Studies in Family Medicine Department of Family Medicine Schulich School of Medicine & Dentistry Western University London ON Canada
| | - Tarek Bouhali
- Department of Family Medicine and Emergency Medicine Faculty of Medicine and Health Sciences Université de Sherbrooke Sherbrooke QC Canada
| | - Martin Fortin
- Department of Family Medicine and Emergency Medicine Faculty of Medicine and Health Sciences Université de Sherbrooke Sherbrooke QC Canada
- Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac St-Jean QC Canada
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Boeckxstaens P, Brown JB, Reichert SM, Smith CNC, Stewart M, Fortin M. Perspectives of specialists and family physicians in interprofessional teams in caring for patients with multimorbidity: a qualitative study. CMAJ Open 2020; 8:E251-E256. [PMID: 32253205 PMCID: PMC7144580 DOI: 10.9778/cmajo.20190222] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Patients with multimorbidity often require services across different health care settings, yet team processes among settings are rarely implemented. We explored perceptions of specialists and family physicians collaborating in a telemedicine interprofessional consultation for patients with multimorbidity to better understand the value of bringing physicians together across the boundaries of health care settings. METHODS This was a descriptive qualitative, interview-based study. Physicians who had previously participated in the Telemedicine Interprofessional Model of Practice for Aging and Complex Treatments (Telemedicine IMPACT Plus [TIP] Program) were invited to participate and asked to describe their experience of being a member of the program. Interviews were conducted from March to May 2016. We conducted an iterative and interpretive process using both individual and team analysis to identify themes. RESULTS There were 15 participants, 9 specialists and 6 family physicians. Three themes emerged in the analysis: creating new perspectives on care for patients with multimorbidity by sharing knowledge, skills and attitudes; the shift from a consultant model to an interprofessional team model (allowing a window into the community, extending discussions beyond the medical model and focusing on the patient's health in context); and opportunities for learners, including learning about interprofessional collaboration and gaining exposure to a real-world model for caring for people with multimorbidity in outpatient settings. INTERPRETATION Family physicians and specialists participating in a TIP Program believed the program improved their knowledge and skills, while also serving as an effective care delivery strategy. The findings also support that learners require more exposure to nontraditional consultant models in order to care for patients with multimorbidity effectively.
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Affiliation(s)
- Pauline Boeckxstaens
- Department of Family Medicine and Primary Healthcare (Boeckxstaens), Ghent University, Ghent, Belgium; Centre for Studies in Family Medicine (Brown, Reichert, Stewart), Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Medicine (Smith), Toronto East Health Network, Michael Garron Hospital, Toronto, Ont.; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que.
| | - Judith Belle Brown
- Department of Family Medicine and Primary Healthcare (Boeckxstaens), Ghent University, Ghent, Belgium; Centre for Studies in Family Medicine (Brown, Reichert, Stewart), Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Medicine (Smith), Toronto East Health Network, Michael Garron Hospital, Toronto, Ont.; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que
| | - Sonja M Reichert
- Department of Family Medicine and Primary Healthcare (Boeckxstaens), Ghent University, Ghent, Belgium; Centre for Studies in Family Medicine (Brown, Reichert, Stewart), Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Medicine (Smith), Toronto East Health Network, Michael Garron Hospital, Toronto, Ont.; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que
| | - Christopher N C Smith
- Department of Family Medicine and Primary Healthcare (Boeckxstaens), Ghent University, Ghent, Belgium; Centre for Studies in Family Medicine (Brown, Reichert, Stewart), Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Medicine (Smith), Toronto East Health Network, Michael Garron Hospital, Toronto, Ont.; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que
| | - Moira Stewart
- Department of Family Medicine and Primary Healthcare (Boeckxstaens), Ghent University, Ghent, Belgium; Centre for Studies in Family Medicine (Brown, Reichert, Stewart), Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Medicine (Smith), Toronto East Health Network, Michael Garron Hospital, Toronto, Ont.; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que
| | - Martin Fortin
- Department of Family Medicine and Primary Healthcare (Boeckxstaens), Ghent University, Ghent, Belgium; Centre for Studies in Family Medicine (Brown, Reichert, Stewart), Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ont.; Department of Medicine (Smith), Toronto East Health Network, Michael Garron Hospital, Toronto, Ont.; Department of Family Medicine and Emergency Medicine (Fortin), Université de Sherbrooke, Sherbrooke, Que
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Ngangue PA, Forgues C, Nguyen T, Sasseville M, Gallagher F, Loignon C, Stewart M, Belle Brown J, Chouinard MC, Fortin M. Patients, caregivers and health-care professionals' experience with an interdisciplinary intervention for people with multimorbidity in primary care: A qualitative study. Health Expect 2020; 23:318-327. [PMID: 32035012 PMCID: PMC7104629 DOI: 10.1111/hex.13035] [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: 08/21/2019] [Revised: 01/16/2020] [Accepted: 01/23/2020] [Indexed: 12/13/2022] Open
Abstract
Background Multimorbidity challenges the health‐care system and requires innovative approaches. In 2015, a 4‐month patient‐centred interdisciplinary pragmatic intervention was implemented in primary care with the aim of supporting self‐management for patients with multimorbidity. Objective To explore the perceptions and experiences of health‐care professionals, patients and their caregivers with a 4‐month patient‐centred interdisciplinary pragmatic intervention in primary care. Design A descriptive, qualitative study using semi‐structured interviews was conducted. Setting and participants A purposive sample of 30 participants was recruited from seven family medicine groups including patients, caregivers and health‐care professionals (HCPs). Interviews were analysed using Thorne's interpretive description approach. Results Findings were grouped into the benefits and challenges of participating in the intervention. The programme allowed patients to adopt realistic and adapted objectives; to customize interventions to the patient's reality; and to help patients gain confidence, improve their knowledge, skills and motivation to manage their condition. Interprofessional collaboration eased the exchange of information via team meetings and electronic medical records. Challenges were related to collaboration, communication, coordination of work and integration of newly relocated HCPs mainly due to part‐time assignments and staff turnover. HCPs part‐time schedules limited their availability and hindered patients’ follow‐up. Discussion and conclusion This intervention was useful and rewarding from the HCPs, patients and caregivers’ perspective. However, to ensure the success of this complex interdisciplinary intervention, implementers and managers should anticipate organizational barriers such as availability and time management of relocated HCPs.
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Affiliation(s)
- Patrice Alain Ngangue
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Catherine Forgues
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Tu Nguyen
- Westmead Applied Research Centre, The University of Sydney, Camperdown, NSW, Australia
| | - Maxime Sasseville
- Department of health sciences, Université du Québec à Chicoutimi, Chicoutimi, Québec, Canada
| | - Frances Gallagher
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Christine Loignon
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Moira Stewart
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Judith Belle Brown
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | | | - Martin Fortin
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
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Schraeder KE, Reid GJ, Brown JB. An Exploratory Study of Children's Mental Health Providers' Perspectives on the Transition to Adult Care for Young Adolescents in the Canadian Context. J Pediatr Nurs 2019; 49:51-59. [PMID: 31491694 DOI: 10.1016/j.pedn.2019.08.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 01/16/2019] [Revised: 08/16/2019] [Accepted: 08/16/2019] [Indexed: 01/05/2023]
Abstract
PURPOSE Many youth who receive specialized children's mental health treatment might require additional treatment as young adults. Little is known about how to prepare these youth for transitions to adult care. DESIGN AND METHODS This study gained perspectives from children's mental health providers (n = 10) about the process of caring for younger adolescents (aged 12-15) with mental health problems (e.g., depression, anxiety), who might require mental health services after age 18. Providers were asked about their clients' future mental health needs and the possibility of transition to adult care. RESULTS Using Grounded Theory analysis, an over-arching theme was providers' reluctance to consider the transition process for their younger clients (<16 years old). This stemmed from uncertainty among providers about: (1) who [which youth] will need adult mental health services; (2) when this discussion would be appropriate; and (3) what adult services would be available. CONCLUSIONS AND PRACTICE IMPLICATIONS Findings indicate a lack of treatment capacity within children's mental health to routinely monitor youth as they approach the age of transfer (18 years old). In the absence of routine monitoring (post-treatment), it may be difficult to predict who will need adult care. A comprehensive evaluation of existing follow-up practices, in children's mental health and beyond, is needed to identify strategies for ensuring adolescents with recurring conditions receive optimal transition care.
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Affiliation(s)
- Kyleigh E Schraeder
- Department of Psychology, The University of Western Ontario, London, ON, Canada.
| | - Graham J Reid
- Department of Psychology, The University of Western Ontario, London, ON, Canada; Department of Family Medicine, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada; Lawson Health Research Institute, London, ON, Canada.; Department of Paediatrics, The University of Western Ontario, London, ON, Canada; Children's Health Research Institute, London, ON, Canada
| | - Judith Belle Brown
- Department of Family Medicine, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada; School of Social Work, King's University College, London, ON, Canada
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Takeuchi A, Iida K, Tsubota T, Hosokawa M, Denawa M, Brown JB, Ninomiya K, Ito M, Kimura H, Abe T, Kiyonari H, Ohno K, Hagiwara M. Loss of Sfpq Causes Long-Gene Transcriptopathy in the Brain. Cell Rep 2019; 23:1326-1341. [PMID: 29719248 DOI: 10.1016/j.celrep.2018.03.141] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [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: 12/01/2017] [Revised: 01/19/2018] [Accepted: 03/30/2018] [Indexed: 12/13/2022] Open
Abstract
Genes specifically expressed in neurons contain members with extended long introns. Longer genes present a problem with respect to fulfilment of gene length transcription, and evidence suggests that dysregulation of long genes is a mechanism underlying neurodegenerative and psychiatric disorders. Here, we report the discovery that RNA-binding protein Sfpq is a critical factor for maintaining transcriptional elongation of long genes. We demonstrate that Sfpq co-transcriptionally binds to long introns and is required for sustaining long-gene transcription by RNA polymerase II through mediating the interaction of cyclin-dependent kinase 9 with the elongation complex. Phenotypically, Sfpq disruption caused neuronal apoptosis in developing mouse brains. Expression analysis of Sfpq-regulated genes revealed specific downregulation of developmentally essential neuronal genes longer than 100 kb in Sfpq-disrupted brains; those genes are enriched in associations with neurodegenerative and psychiatric diseases. The identified molecular machinery yields directions for targeted investigations of the association between long-gene transcriptopathy and neuronal diseases.
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Affiliation(s)
- Akihide Takeuchi
- Department of Anatomy and Developmental Biology, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto 606-8501, Japan.
| | - Kei Iida
- Department of Anatomy and Developmental Biology, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto 606-8501, Japan; Medical Research Support Center, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto 606-8501, Japan
| | - Toshiaki Tsubota
- Department of Anatomy and Developmental Biology, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto 606-8501, Japan
| | - Motoyasu Hosokawa
- Department of Anatomy and Developmental Biology, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto 606-8501, Japan
| | - Masatsugu Denawa
- Medical Research Support Center, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto 606-8501, Japan
| | - J B Brown
- Laboratory for Molecular Biosciences, Life Science Informatics Research Unit, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto 606-8501, Japan
| | - Kensuke Ninomiya
- Department of Anatomy and Developmental Biology, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto 606-8501, Japan
| | - Mikako Ito
- Division of Neurogenetics, Center for Neurological Diseases and Cancer, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Hiroshi Kimura
- Department of Biological Sciences, Graduate School of Bioscience and Biotechnology, Tokyo Institute of Technology, Yokohama 226-8501, Japan
| | - Takaya Abe
- Genetic Engineering Team, RIKEN Center for Life Science Technologies, Kobe 650-0047, Japan
| | - Hiroshi Kiyonari
- Genetic Engineering Team, RIKEN Center for Life Science Technologies, Kobe 650-0047, Japan; Animal Resource Development Unit, R IKEN Center for Life Science Technologies, Kobe 650-0047, Japan
| | - Kinji Ohno
- Division of Neurogenetics, Center for Neurological Diseases and Cancer, Nagoya University Graduate School of Medicine, Nagoya 466-8550, Japan
| | - Masatoshi Hagiwara
- Department of Anatomy and Developmental Biology, Graduate School of Medicine, Kyoto University, Sakyo-ku, Kyoto 606-8501, Japan.
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Ryan BL, Brown JB, Thorpe C. Moving from space to place: Reimagining the challenges of physical space in primary health care teams in Ontario. Can Fam Physician 2019; 65:e405-e410. [PMID: 31515328 PMCID: PMC6741796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To extend our understanding of how primary health care team members characterize the effects of location on team functioning. DESIGN Qualitative study using grounded theory methodology, with in-depth analysis of data concerning the role of physical space in teamwork. SETTING Family health teams in Ontario. PARTICIPANTS A total of 110 team members from 20 family health teams in Ontario. METHODS Individual semistructured interviews were conducted. Interviews were audiorecorded and transcribed verbatim. Individual and group coding followed grounded theory processes of open, axial, and selective coding. Immersion in interview and field note data facilitated crystallization. MAIN FINDINGS Across sites, regardless of their physical space, team members commented spontaneously about the role of space in team functioning. An overarching theme of a "sense of place" developed from data analysis. A sense of place could be established through co-location (being in the same physical space), the allocation of team members' working spaces, coming together, and having a shared vision. Physical space often operated as a key facilitator or considerable barrier to creating a sense of place; however, some teams with suboptimal physical space functioned as highly integrated teams, creating a sense of place through various means. CONCLUSION Many interprofessional health care teams cannot physically change less-than-optimal spaces. However, teams can thrive and create a sense of place through various means, some of which relate to actual physical space, and some of which relate to promoting common activities and a shared vision-factors that are effective for team building in general. When there are economic limitations, as well as structural constraints, then it is essential that creating a sense of place be a priority. Future research should consider this lens as a means for expanding the discussion and possible solutions around traditional space issues.
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Affiliation(s)
- Bridget L Ryan
- Assistant Professor in the Centre for Studies in Family Medicine, the Department of Family Medicine, and the Department of Epidemiology and Biostatistics at the Schulich School of Medicine and Dentistry at Western University in London, Ont.
| | - Judith Belle Brown
- Professor and Chair of the master of clinical science and doctoral programs in the Centre for Studies in Family Medicine in the Department of Family Medicine at the Schulich School of Medicine and Dentistry at Western University, and, at the time of this study, was Professor in the School of Social Work at King's University College in London
| | - Cathy Thorpe
- Research Associate and Senior Manager in the Centre for Studies in Family Medicine at Western University
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Ryan BL, Brown JB, Tremblay PF, Stewart M. Measuring Patients' Perceptions of Health Care Encounters: Examining the Factor Structure of the Revised Patient Perception of Patient-Centeredness (PPPC-R) Questionnaire. J Patient Cent Res Rev 2019; 6:192-202. [PMID: 31414031 DOI: 10.17294/2330-0698.1696] [Citation(s) in RCA: 9] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Given the ongoing desire to make health care more patient-centered and growing evidence supporting the provision of patient-centered care, it is important to have valid tools for measuring patient-centered care. The patient-centered clinical method (PCCM) is a conceptual framework for providing patient-centered care. A revision to the PCCM framework led to a corresponding need to enhance the Patient Perception of Patient-Centeredness (PPPC) questionnaire. The original PPPC was aligned with the components of the PCCM conceptual framework and developed to measure patient-centeredness from the patient's perspective. The purpose of this study was to examine the factor structure of a revised version of the PPPC (ie, PPPC-R). METHODS Eleven new items were added to the original 14 items. The modified questionnaire was administered to patients in primary health care teams in Ontario, Canada. The confirmatory factor analysis was conducted on a subset of 381 patients who had seen a family physician. RESULTS The initial proposed 4-factor model first tested with a confirmatory factor analysis (CFA) did not fit adequately. Exploratory factor analysis was therefore used as a second step to modify the model and to identify weak items. A 3-factor exploratory model with 18 of the original 25 items was converted into a final hypothetical CFA model that had a good fit (χ2 (132)=176.795, P<0.01; CFI=0.991; RMSEA=0.030). The third factor contained only 2 items and so is interpreted with caution. CONCLUSIONS The validity of the PPPC-R is supported by some congruence between the conceptual framework (the PCCM) and the statistical analysis (CFA), but there is not a 1:1 correspondence. The components of the PCCM represent conceptually what is important when teaching, researching, and providing patient-centered care, whereas the PPPC-R represents patient-centered care as it is experienced by the patient.
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Brown JB, Reichert SM, Valliere Y, Webster-Bogaert S, Ratzki-Leewing A, Ryan BL, Harris SB. Living With Hypoglycemia: An Exploration of Patients' Emotions: Qualitative Findings From the InHypo-DM Study, Canada. Diabetes Spectr 2019; 32:270-276. [PMID: 31462884 PMCID: PMC6695265 DOI: 10.2337/ds18-0074] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Hypoglycemia is one of the most common adverse events for people living with type 1 or type 2 diabetes. To gain a deeper understanding of patients' emotions regarding hypoglycemia, we conducted a descriptive qualitative study. Purposive sampling was used to recruit participants for a 30- to 45-minute semi-structured interview. The 16 participants included both women and men with either type 1 or type 2 diabetes, with a mean age of 53 years and mean time since diagnosis of 21 years. All participants had experienced more than one hypoglycemia event in the past year, ranging from nonsevere to severe. Data collection and analysis occurred in an iterative manner. Individual and team analyses of interviews were conducted to identify overarching themes and sub-themes. Thematic analysis revealed the unique interconnection among the emotions experienced by participants, including fear, anxiety, frustration, confidence, and hope. Time, experience, and reflection helped to build participants' confidence in their ability to manage a hypoglycemia event. Patients' emotions regarding hypoglycemia provide valuable insights into life with diabetes. Although hypoglycemia continues to evoke feelings of fear and anxiety, the role of hope may temper these emotions. Understanding the complex interplay of emotions concerning hypoglycemia can guide health care providers in improving clinical practice and promoting patient-centered interventions. Ultimately, health care providers can build patients' hypoglycemia-related confidence by using a strengths-based approach.
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Affiliation(s)
- Judith Belle Brown
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- School of Social Work, King’s University College, Western University, London, Ontario, Canada
| | - Sonja M. Reichert
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Yashoda Valliere
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Susan Webster-Bogaert
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Alexandria Ratzki-Leewing
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Bridget L. Ryan
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Stewart B. Harris
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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Schraeder KE, Brown JB, Reid GJ. Perspectives on Monitoring Youth with Ongoing Mental Health Problems in Primary Health Care: Family Physicians Are "Out of the Loop". J Behav Health Serv Res 2019; 45:219-236. [PMID: 29260379 DOI: 10.1007/s11414-017-9577-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Children's mental health (CMH) problems often recur. Following specialized mental health treatment, youth may require monitoring and follow-up. For these youth, primary health care is highly relevant, as family physicians (FPs) are the only professionals who follow patients across the lifespan. The current study gained multiple perspectives about (1) the role of FPs in caring for youth with ongoing/recurring CMH problems and (2) incorporating routine mental health monitoring into primary health care. A total of 33 interviews were conducted, including 10 youth (aged 12-15) receiving CMH care, 10 parents, 10 CMH providers, and 3 FPs. Using grounded theory methodology, a theme of FPs being "out of the loop" or not involved in their patient's CMH care emerged. Families perceived a focus on the medical model by their FPs and believed FPs lacked mental health expertise. Findings indicate a need for improved collaboration between CMH providers and FPs in caring for youth with ongoing CMH problems.
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Affiliation(s)
- Kyleigh E Schraeder
- Department of Psychology, The University of Western Ontario, 361 Windermere Rd, Westminister Hall, Room 234E, London, ON, N6A 3K7, Canada.
| | - Judith Belle Brown
- Department of Family Medicine, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
- School of Social Work, King's University College, London, ON, Canada
| | - Graham J Reid
- Department of Psychology, The University of Western Ontario, 361 Windermere Rd, Westminister Hall, Room 234E, London, ON, N6A 3K7, Canada
- Department of Family Medicine, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
- Department of Paediatrics, The University of Western Ontario, London, ON, Canada
- Children's Health Research Institute, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
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Abstract
Physical inactivity, sedentary behavior, and poor diet are contributing to the rise in chronic disease rates throughout the world. HealtheSteps™ is a lifestyle prescription program focused on reducing risk factors for chronic disease through in-person coaching sessions, goal setting and tracking, and technology supports. A process evaluation was conducted alongside a pragmatic randomized controlled trial to: (a) explore the acceptability of HealtheSteps™ program from coach and participant perspectives; and (b) identify where the program can be improved. Participants at risk or diagnosed with a chronic disease were recruited from five primary care/health services organizations into HealtheSteps™. Participants met with a trained coach bi-monthly for 6 months and set goals for physical activity (step counts), exercise (moderate to vigorous activity), and healthy eating. Coaches were interviewed at month 6 and participants at month 12 (6 months postprogram). All coach interviews (n = 12) were analyzed along with a purposeful sample of participant interviews (n = 13). Coaches found that HealtheSteps™ was easy to deliver and recommendations for exercise and healthy eating were helpful. Including discussions on participant readiness to change, along with group sessions, and more in-depth healthy eating resources were suggested by coaches to improve the program. Participants described the multiple avenues of accountability provided in the program as helpful. However, more feedback and interaction during and postprogram from coaches were suggested by participants. HealtheSteps™ is an acceptable program from the perspectives of both coaches and participants with suggested improvements not requiring significant changes to the core program design.
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Affiliation(s)
- Wendy Blunt
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada
| | - Dawn P Gill
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada.,School of Health Studies, Faculty of Health Sciences, Western University, London, Ontario, Canada.,Graduate Program in Health & Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Brendan Riggin
- School of Kinesiology, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Judith Belle Brown
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,School of Social Work, King's University College, Western University, London, Ontario, Canada
| | - Robert J Petrella
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada.,Graduate Program in Health & Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, Ontario, Canada.,School of Kinesiology, Faculty of Health Sciences, Western University, London, Ontario, Canada
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48
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Levy M, Koppula S, Brown JB. Transitioning to academia: Exploring the experience of new family medicine faculty members at the beginning of their academic careers. Can Fam Physician 2018; 64:907-913. [PMID: 30541807 PMCID: PMC6371872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To explore the experience of new family medicine faculty members at the beginning of their academic careers and determine what factors might facilitate their transition to an academic role in family medicine. DESIGN Qualitative, phenomenologic study of new academic family physicians. SETTING Eight Canadian departments of family medicine. PARTICIPANTS English-speaking, full-time academic family physicians who had been in their first faculty position in a Canadian department of family medicine for 1 to 5 years. METHODS Data were collected using semistructured, in-depth interviews that were audiotaped and transcribed verbatim. Data analysis employed an immersion and crystallization technique. The transcriptions were reviewed in an iterative and interpretive manner. Thirteen interviews were performed before saturation was reached. MAIN FINDINGS The following 3 key themes were identified in relation to the experience of being a new academic family medicine faculty member: lack of or inadequate orientation; the challenges associated with transitioning to academia; and balancing the demands of the role. Orientation was often lacking or suboptimal, with participants left to navigate the transition process alone. The challenges associated with the transition to academia included the realities of clinical work and uncertainties about how to incorporate the various aspects of the new role into members' reality (eg, research). Trying to balance the demands of the academic role (eg, committee involvement, manual reviews), as well as finding work-life balance, was overwhelming. CONCLUSION This study highlights the factors that might help recruit and retain academic faculty members in family medicine, as well as help them build successful academic careers. Orientation for these new members is an area that requires more attention. Clear parameters around division of time, support, and expectations for advancement should be explained at the beginning of new faculty members' academic appointments. Effective mentoring might help new faculty members have a more successful transition and reduce the risk of feeling overwhelmed and considering leaving academia.
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Affiliation(s)
- Michelle Levy
- Associate Professor of Family Medicine and Clinical Medical Director in the Faculty of Medicine at Memorial University of Newfoundland in St John's.
| | - Sudha Koppula
- Associate Professor and Director of Faculty Development in the Department of Family Medicine at the University of Alberta in Edmonton
| | - Judith Belle Brown
- Professor and Chair of the master of clinical science and doctoral programs in the Centre for Studies in Family Medicine in the Department of Family Medicine at the Schulich School of Medicine and Dentistry at Western University in London, Ont, and Professor in the School of Social Work at King's University College in London
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Brown JB, Reichert SM, Valliere Y, Webster-Bogaert S, Ratzki-Leewing A, Harris SB. A qualitative enquiry of hypoglycemia and the social determinants of health: The InHypo-DM study, Canada. Fam Syst Health 2018; 36:471-481. [PMID: 29999342 DOI: 10.1037/fsh0000355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION A significant body of research exists on the impact of the social determinants of health (SDoHs) on diabetes care and general health outcomes. However, less is known about health care practitioners' (HCPs') perspectives and experiences regarding the impact of the SDoHs on their patients with Type I and Type 2 diabetes mellitus and how this affects the prevention and treatment of hypoglycemia. METHOD A descriptive qualitative study, derived from the InHypo-DM (Canada) research program. A purposive sampling technique was used to recruit participants residing in southwestern Ontario, Canada, for a 30- to 45-min semistructured interview. Individual and team analysis of interviews was conducted to identify overarching and subthemes. Twenty HCP participants, including endocrinologists, family physicians, and allied health care practitioners, were recruited. Seven were Certified Diabetes Educators. RESULTS Participants articulated 2 overarching components of the SDoHs: patients' socioeconomic issues and psychosocial issues. They highlighted two socioeconomic issues: occupation type and poverty. Participants also emphasized 3 areas pertaining to patients' psychosocial issues: stage in the life cycle (e.g., elderly), social isolation, and mental health. DISCUSSION This study emphasizes the need for conducting detailed and comprehensive social histories during clinical diabetes assessments, as well as the necessity of adequate clinical time and resources for HCPs and patients to address these issues in the context of hypoglycemia management. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
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50
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Abstract
In order to execute more advanced computational chemogenomic workflows, it is essential to understand the basic data formats and options for processing them. In this chapter, de facto standards for compound and protein representation are explained, with procedures for processing them given. A walkthrough demonstrates the step-by-step processes of downloading a ligand-target database, parsing the bioactivity in the database, automatically retrieving its chemical structures and protein sequences from a command line, and finally converting the structures and sequences into representative machine-ready formats. A basic protocol to visualize the parsed database and look for patterns is also given.
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Affiliation(s)
- J B Brown
- Life Science Informatics Research Unit, Laboratory of Molecular Biosciences, Kyoto University Graduate School of Medicine, Kyoto, Japan.
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