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Halifax, Canada

Stacey D.,University of Ottawa | Bakker D.,Laurentian University | Ballantyne B.,Northeast Cancer Center | Chapman K.,A+ Network | And 10 more authors.
Implementation Science | Year: 2012

Background: Management of cancer treatment-related symptoms is an important safety issue given that symptoms can become life-threatening and often occur when patients are at home. With funding from the Canadian Partnership Against Cancer, a pan-Canadian steering committee was established with representation from eight provinces to develop symptom protocols using a rigorous methodology (CAN-IMPLEMENT©). Each protocol is based on a systematic review of the literature to identify relevant clinical practice guidelines. Protocols were validated by cancer nurses from across Canada. The aim of this study is to build an effective and sustainable approach for implementing evidence-informed protocols for nurses to use when providing remote symptom assessment, triage, and guidance in self-management for patients experiencing symptoms while undergoing cancer treatments.Methods: A prospective mixed-methods study design will be used. Guided by the Knowledge to Action Framework, the study will involve (a) establishing an advisory knowledge user team in each of three targeted settings; (b) assessing factors influencing nurses' use of protocols using interviews/focus groups and a standardized survey instrument; (c) adapting protocols for local use, ensuring fidelity of the content; (d) selecting intervention strategies to overcome known barriers and implementing the protocols; (e) conducting think-aloud usability testing; (f) evaluating protocol use and outcomes by conducting an audit of 100 randomly selected charts at each of the three settings; and (g) assessing satisfaction with remote support using symptom protocols and change in nurses' barriers to use using survey instruments. The primary outcome is sustained use of the protocols, defined as use in 75% of the calls. Descriptive analysis will be conducted for the barriers, use of protocols, and chart audit outcomes. Content analysis will be conducted on interviews/focus groups and usability testing with comparisons across settings.Discussion: Given the importance of patient safety, patient-centered care, and delivery of quality services, learning how to effectively implement evidence-informed symptom protocols in oncology healthcare services is essential for ensuring safe, consistent, and effective care for individuals with cancer. This study is likely to have a significant contribution to the delivery of remote oncology services, as well as influence symptom management by patients at home. © 2012 Stacey et al.; licensee BioMed Central Ltd.

Wood S.,Capital Health | Tirone S.,Dalhousie University
Journal of Leisure Research | Year: 2013

The health of family and friends affected by another person's substance use and/or gambling is an undervalued health issue. These relationships are rarely explored as caregiving. Research on caregivers suggests leisure is important for improving, maintaining, and protecting their health. Guided by feminist social constructionism, this article explores how women caring for people harmfully involved with alcohol, drugs and/or gambling experience leisure in Nova Scotia, Canada. Data were collected from ten women though semistructured interviews. Examples of caregiving are provided. Three themes demonstrate the results: loss of leisure, negotiation of leisure, and leisure as escape. Understanding the women's experience of leisure in this caregiving relationship has important implications for their health.

Carson V.,University of Alberta | Spence J.C.,University of Alberta | Cutumisu N.,University of Alberta | Boule N.,University of Alberta | Edwards J.,Capital Health
Research Quarterly for Exercise and Sport | Year: 2010

Little research has examined seasonal, differences in physical activity (PA) levels among children. Proxy reports of PA were completed by 1,715parents on their children in Edmonton, Alberta, Canada. Total PA (TPA) minutes were calculated, and each participant was classified as active, somewhat active, or inactive. Logistic regression models were conducted to examine associations between PA status and seasons. Significant seasonal differences were observed for TPA, weekday PA, weekend PA, and active play. Children were significantly more likely to be physically active in the summer and, spring and somewhat physically active in the summer and fall, relative to winter. Children living in cold climates are less likely to be physically active in the winter. © 2010 by the American Alliance for Health, Physical Education, Recreation and Dance.

Chevalier B.A.,Capital Health
Nephrology nursing journal : journal of the American Nephrology Nurses' Association | Year: 2011

Heparin is commonly administered during hemodialysis to prevent clotting in the extracorporeal circuit. The authors' unit instituted a change in heparin type and preparation procedure based on patient safety and potential cost savings. Fifty patient charts were reviewed to determine whether the change affected specific patient outcomes. Economic impact measures included drug, supply, and labor costs. No changes in hemodialysis efficacy or rates of adverse events were observed. Annual cost savings were estimated to be $81,627 USD.

Hanly J.G.,Dalhousie University | Thompson K.,Dalhousie University | Skedgel C.,Capital Health | Skedgel C.,University of East Anglia
Arthritis Care and Research | Year: 2016

Objective: To determine total physician encounters, emergency room (ER) visits, and hospitalizations in an incident cohort of systemic lupus erythematosus (SLE) cases and matched control patients over 13 years. Methods: A retrospective cohort study was performed utilizing administrative health care data from approximately 1 million people with access to universal health care. Using International Classification of Diseases, Ninth and Tenth Revisions diagnostic codes, 7 SLE case definitions were used. Each case was matched by age and sex to 4 randomly selected controls. Data included physician billings, ER visits, and hospital discharges over 13 years. Results: The number of incident SLE cases varied from 564 to 4,494 depending on the case definition used. The mean age varied from 47.7 to 50.6 years and the proportion of females from 78.0% to 85.1%. SLE utilization of physicians was highest in the index year, and declined significantly thereafter for all case definitions. By the fourth year, encounters with subspecialty physicians fell by 60% (rheumatologists), 50% (internists), and 31% (other physicians). In contrast, visits to family physicians fell by only 9%. Visits to the ER and hospital admissions for SLE cases were also more frequent early in the disease course and fell significantly over the study for both ER visits (all case definitions) and hospitalizations (2 of 7 case definitions). Conclusion: In SLE patients, health care utilization is highest in the first few years following the diagnosis, which is also the time of maximal involvement by rheumatologists. Utilization declines over time, and encounters with patients’ family physicians predominate over those of other physician groups. © 2016, American College of Rheumatology

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