Nova Scotia Health Authority

Dartmouth, Canada

Nova Scotia Health Authority

Dartmouth, Canada
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News Article | May 19, 2017
Site: www.marketwired.com

Beds sit empty at Digby hospital, while neighboring hospitals unable to meet needs of all patients DIGBY, NOVA SCOTIA--(Marketwired - May 19, 2017) - "The Nova Scotia Health Authority (NSHA) is not doing enough to ensure the Digby General Hospital is being used to full capacity," says Carl Crouse, CUPE national representative. "Right now, there are approximately half of the 33 beds sitting empty, while hospitals nearby are reportedly in need of more beds on a regular basis." "Digby has had empty in-patient beds and empty restorative care beds for months now," adds Crouse. "In a provincial health care system where there is overcrowding and bed shortages, it's a real failure of the health authority to have any facility operating below capacity." "Our members are joining the call by the community, including the Digby Health Coalition, to improve public health care in the area," says the Nan McFadgen, president of CUPE Nova Scotia. "We agree with the coalition. The health authority and elected officials are not listening to the workers who provide health care services or the residents who depend on them," says McFadgen. "We want to see a comprehensive plan that will deliver better quality, full-service health care and allow the Digby community to be a part of the decision-making process." CUPE 8920 represents 4,700 members working in acute care facilities across the province, including the Digby General Hospital.


News Article | June 19, 2017
Site: www.rdmag.com

A phase 1 randomized controlled trial has found an Ebola virus disease (EVD) vaccine, developed in Canada, was well-tolerated with no safety concerns, and high antibodies were present in participants 6 months after immunization. The study, led by Canadian researchers, is published in CMAJ (Canadian Medical Association Journal). The research team conducted the clinical trial "as part of a coordinated, international effort to expeditiously evaluate candidate EVD vaccines and make them available to control the epidemic," writes lead author Dr. May ElSherif, Canadian Center for Vaccinology, IWK Health Centre, Halifax, Nova Scotia, with coauthors. There have been some recent clusters of Ebola cases in Africa and more expected as survivors may still spread the virus to uninfected people. The trial involved 40 healthy people aged 18 to 65 years and looked at safety of the vaccine and the lowest dose required for an immune response after injection with one of 3 doses. At a ratio of 3:1, thirty participants received the vaccine and 10 received placebo injections. The researchers found that adverse events were mild to moderate, with only 3 severe reactions, including headache, diarrhea and fatigue, which completely resolved. "The results of this trial were positive and very promising; all 3 dose levels of the VSV [vesicular stomatitis virus] Ebola vaccine were well-tolerated by participants, and no safety concerns were identified," says Dr. May ElSherif. Several Ebola vaccine candidates are being assessed in ongoing or recently completed phase 1, 2, and 3 trials in various parts of the world. This VSV-Ebola vaccine (formal name: rVSVΔG-ZEBOV-GP) was developed at the Canadian National Microbiology Laboratory of the Public Health Agency of Canada. A similar parallel trial was conducted at the Walter Reed Army Institute of Research (WRAIR) in the United States. Data from this trial and others indicated an optimum dose of 20 million pfu that will be assessed among people with compromised immune systems in areas where Ebola is endemic. An upcoming study at 2 sites in Africa, as well as in Montréal and Ottawa in Canada, will test the safety and protection levels of the VSV-Ebola vaccine in HIV-infected adults and adolescents. A completed phase 3 trial showed that the vaccine is effective in preventing EVD in contacts of recently confirmed cases. Given the ongoing presence of Ebola, "these facts underscore the importance of continuing efforts and collaborations that may ultimately lead to licensed Ebola vaccines that would protect humans and prevent or control outbreaks in the future," conclude the authors. The study was conducted by researchers from the Canadian Immunization Research Network (CIRN) at the Canadian Center for Vaccinology at the IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia; National Microbiology Laboratory, Winnipeg, Manitoba; Battelle Biomedical Research Center, Columbus, Ohio; United States Army Medical Research Institute of Infectious Diseases and the Joint Program Executive Office for Chemical and Biological Defense Medical Countermeasure Systems' Joint Vaccine Acquisition Program, Fort Detrick, Maryland; BioProtection Systems/NewLink Genetics Corporation, Ames, Iowa; and Veristat LLC, Southborough, Massachusetts.


News Article | June 19, 2017
Site: www.eurekalert.org

A phase 1 randomized controlled trial has found an Ebola virus disease (EVD) vaccine, developed in Canada, was well-tolerated with no safety concerns, and high antibodies were present in participants 6 months after immunization. The study, led by Canadian researchers, is published in CMAJ (Canadian Medical Association Journal). The research team conducted the clinical trial "as part of a coordinated, international effort to expeditiously evaluate candidate EVD vaccines and make them available to control the epidemic," writes lead author Dr. May ElSherif, Canadian Center for Vaccinology, IWK Health Centre, Halifax, Nova Scotia, with coauthors. There have been some recent clusters of Ebola cases in Africa and more expected as survivors may still spread the virus to uninfected people. The trial involved 40 healthy people aged 18 to 65 years and looked at safety of the vaccine and the lowest dose required for an immune response after injection with one of 3 doses. At a ratio of 3:1, thirty participants received the vaccine and 10 received placebo injections. The researchers found that adverse events were mild to moderate, with only 3 severe reactions, including headache, diarrhea and fatigue, which completely resolved. "The results of this trial were positive and very promising; all 3 dose levels of the VSV [vesicular stomatitis virus] Ebola vaccine were well-tolerated by participants, and no safety concerns were identified," says Dr. May ElSherif. Several Ebola vaccine candidates are being assessed in ongoing or recently completed phase 1, 2, and 3 trials in various parts of the world. This VSV-Ebola vaccine (formal name: rVSVΔG-ZEBOV-GP) was developed at the Canadian National Microbiology Laboratory of the Public Health Agency of Canada. A similar parallel trial was conducted at the Walter Reed Army Institute of Research (WRAIR) in the United States. Data from this trial and others indicated an optimum dose of 20 million pfu that will be assessed among people with compromised immune systems in areas where Ebola is endemic. An upcoming study at 2 sites in Africa, as well as in Montréal and Ottawa in Canada, will test the safety and protection levels of the VSV-Ebola vaccine in HIV-infected adults and adolescents. A completed phase 3 trial showed that the vaccine is effective in preventing EVD in contacts of recently confirmed cases. Given the ongoing presence of Ebola, "these facts underscore the importance of continuing efforts and collaborations that may ultimately lead to licensed Ebola vaccines that would protect humans and prevent or control outbreaks in the future," conclude the authors. The study was conducted by researchers from the Canadian Immunization Research Network (CIRN) at the Canadian Center for Vaccinology at the IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia; National Microbiology Laboratory, Winnipeg, Manitoba; Battelle Biomedical Research Center, Columbus, Ohio; United States Army Medical Research Institute of Infectious Diseases and the Joint Program Executive Office for Chemical and Biological Defense Medical Countermeasure Systems' Joint Vaccine Acquisition Program, Fort Detrick, Maryland; BioProtection Systems/NewLink Genetics Corporation, Ames, Iowa; and Veristat LLC, Southborough, Massachusetts.


Marshall E.G.,Dalhousie University | Gibson R.J.,Nova Scotia Health Authority | Lawson B.,Dalhousie University | Burge F.,Dalhousie University
BMJ Open | Year: 2017

Introduction: There is little evidence on how primary care providers (PCPs) model their practices in Nova Scotia (NS), Canada, what services they offer or what accessibility is like for the average patient. This study will create a database of all family physicians and primary healthcare nurse practitioners in NS, including information about accessibility and the model of care in which they practice, and will link the survey data to administrative health databases. Methods and analysis: 3 census surveys of all family physicians, primary care nurse practitioners (ie, PCPs) and their practices in NS will be conducted. The first will be a telephone survey conducted during typical daytime business hours. At each practice, the person answering the telephone will be asked questions about the practice's accessibility and model of care. The second will be a telephone survey conducted after typical daytime business hours to determine what out-of-office services PCP practices offer their patients. The final will be a tailored fax survey that will collect information that could not be obtained in the first 2 surveys plus new information on scope of practice, practice model and willingness to participate in research. Survey data will be linked with billing data from administrative health databases. Multivariate regression analysis will be employed to assess whether access and availability outcome variables are associated with PCP and model of practice characteristics. Negative binomial regression analysis will be employed to assess the association between independent variables from the survey data and health system use outcomes from administrative data. Ethics and dissemination: This study has received ethical approval from the Nova Scotia Health Authority and the Health Data Nova Scotia Data Access Committee. Dissemination approached will include stakeholder engagement at local and national levels, conference presentations, peer-reviewed publications and a public website.


Jolemore S.,Nova Scotia Health Authority | Soroka S.D.,Dalhousie University
Healthcare Management Forum | Year: 2017

This article describes key considerations for creation of evidence-informed in-house physician leadership development. Ten elements extracted from a scan of the peer-reviewed and grey literature are presented, and key learnings at the Queen Elizabeth II Health Sciences Centre, a quaternary academic health sciences centre in Halifax, Nova Scotia, are highlighted. Each element is briefly described with practical considerations and challenges to implementation outlined in the context of the former Capital District Health Authority, where the authors collaborated to create in-house physician leadership development prior to the consolidation of health districts in that province. The purpose of this article is to share how the authors used evidence to plan physician leadership development and to explore the additional situational and contextual factors and considerations needed for implementation. © The Canadian College of Health Leaders.


Crocker C.E.,Dalhousie University | Crocker C.E.,Nova Scotia Health Authority | Tibbo P.G.,Dalhousie University
Schizophrenia Research | Year: 2016

Cannabis is the third most common recreational drug used world-wide after tobacco and alcohol. Globally, cannabis legalization is becoming more common. In light of its known link to psychosis development, it is imperative that we are well-informed regarding the impact of cannabis on the course of psychosis, in both males and females. However, the majority of the work to date on the role of cannabis in psychosis outcomes has not had a gender focus, important when considering patient specific treatments. This review examines what is currently known, from gender focused studies, about the interaction of gender, cannabis use and psychotic disorders. © 2017 Elsevier B.V.


Perl J.,University of Toronto | Perl J.,Li Ka Shing Knowledge Institute | Na Y.,University of Toronto | Tennankore K.K.,Dalhousie University | And 2 more authors.
Clinical Journal of the American Society of Nephrology | Year: 2017

Background and objectives The last 15 years has seen growth in home hemodialysis (HD) utilization in Canada owing to reports of improved outcomes relative to patients on conventional in-center HD. What effect growth has had on home HD technique and patient survival during this period is not known. Design, settings, participants, & measurements We compared the risk of home HD technique failure, mortality, and the composite outcome among three incident cohorts of patients on home HD in Canada: 1996–2002, 2003–2007, and 2008–2012. A multivariable piece-wise exponential model was used to evaluate all outcomes using inverse probability of treatment and censoring weights. Results A total of 1869 incident patients on home HD were identified from the Canadian Organ Replacement Register. Relative to those treated between 2003 and 2007 (n=568), the risk of home HD technique failure was similar between patients treated between 1996 and 2002 (n=233; adjusted hazard ratio [AHR], 1.39; 95% confidence interval [95% CI], 0.78 to 2.46) but higher among incident patients on home HD treated between 2008 and 2012 (n=1068; AHR, 1.51; 95% CI, 1.06 to 2.15). Relative to patients treated between 2003 and 2007, adjusted mortality was similar among those treated between 2008 and 2012 (AHR, 0.83; 95% CI, 0.58 to 1.19) and those treated between 1996 and 2002 (AHR, 0.67; 95% CI, 0.38 to 1.21). The risk of the composite outcome of death and technique failure was similar across cohorts, as was the risk of receiving a kidney transplant. Increasing age, diabetes as a comorbidity, and smoking status were associated with an increased risk of death as well as the composite outcome. Medium-sized facilities had a lower risk of death, technique failure, and the composite outcome compared with larger facilities. Conclusions A higher risk of technique failure was seen in the most contemporary era. Further characterization of the risk factors for, and causes of technique failure is needed to develop strategies to improve patient retention on home HD. © 2017 by the American Society of Nephrology.


Stevenson C.,Nova Scotia Health Authority | Burstall D.,Nova Scotia Health Authority
Healthcare Management Forum | Year: 2016

The District Health Authority Consolidation (Transition and Design) project in Nova Scotia was initiated to consolidate the existing nine district health authorities into one provincial health authority. This article provides an overview of the internal change management approach and activities that were developed to support the various phases of the design and transition process. Three phases of work are outlined, and specific change management activities are described as are lessons learned from the overall approach. © 2016 The Canadian College of Health Leaders. All rights reserved.


Legge A.,Nova Scotia Health Authority | Doucette S.,Dalhousie University | Hanly J.G.,Nova Scotia Health Authority
Journal of Rheumatology | Year: 2016

Objective. To describe organ damage accrual, predictors of damage progression, and effect on health-related quality of life (HRQOL) in patients with systemic lupus erythematosus (SLE). Methods.A longitudinal database of patients who met the American College of Rheumatology (ACR) classification criteria for SLE was used. Annual assessments included the Systemic Lupus International Collaborating Clinics/ACR Damage Index (SDI) and the Medical Outcomes Study Short Form-36 (SF-36). The prognostic significance of demographic, disease-related, and treatment-related factors on damage progression was examined using multivariable Cox regression. The effect of changes in SDI scores on HRQOL, measured using the SF-36 summary and subscale scores, was assessed using linear mixed-effects modeling. Results. There were 273 patients with SLE studied over a mean (SD) duration of followup of 7.3 (4.3) years. During followup, 126 (46.2%) had an increase in SDI scores. Patients with preexisting damage at baseline were more likely to have earlier damage progression (HR 2.09, 95% CI 1.44-3.01). Older age, ≥ 8 ACR classification criteria, immunosuppressive drugs, cigarette smoking, and higher mean serum C-reactive protein levels were associated with an earlier increase in SDI scores in multivariable analysis. In general, changes in SDI scores were associated with initial declines in SF-36 scores at the time that damage occurred, with subsequent change comparable to that seen in patients without damage progression. Conclusion. This study identified multiple risk factors, some modifiable, associated with damage progression in patients with SLE. The negative effect on HRQOL emphasizes the need for treatment strategies to reduce the risk of organ damage over time. Copyright © 2016. All rights reserved.


Pavlova B.,Nova Scotia Health Authority | Pavlova B.,Dalhousie University | Perlis R.H.,Massachusetts General Hospital | Alda M.,Nova Scotia Health Authority | And 3 more authors.
The Lancet Psychiatry | Year: 2015

Background: Anxiety disorders are increasingly recognised as an important determinant of outcomes in patients with bipolar disorder. However, a reliable estimate of their prevalence is still missing, because the published prevalence of anxiety disorders in individuals with bipolar disorder varies widely. In this study, we aimed to quantify the lifetime prevalence of anxiety disorders in individuals with bipolar disorder and compare it with rates in people without the disorder. Methods: We searched the Web of Knowledge and Medline (through the PubMed interface) for articles published in any language from the database inception dates up until June 1, 2014, using a combination of the word "bipolar" and search terms for anxiety disorders. We included studies that reported original data about the lifetime prevalence of DSM-III and DSM-IV anxiety disorders in adults with bipolar disorder that recruited participants irrespective of comorbidities and that used a validated diagnostic interview to establish the diagnoses of bipolar disorder and at least one anxiety disorder. We excluded studies that reported only the current prevalence or if we were unable to establish whether they described current or lifetime prevalence, and those with discrepancies in the data that could not be resolved by contacting the authors. We did a random-effects meta-analysis of lifetime prevalence of DSM-III and DSM-IV anxiety disorders in adults with bipolar disorder, in which we quantified the lifetime prevalence of any anxiety disorder in people with bipolar disorder. We compared this prevalence in people with bipolar I disorder versus those with bipolar II disorder, and in people with bipolar disorder versus population controls. Findings: Data from 40 studies, including 14 914 individuals from North America, Europe, Australia, South America, and Asia, indicate that the lifetime prevalence of anxiety disorders in individuals with bipolar disorder is 45% (95% CI 40-51). Direct comparison in five samples with a total of 1378 individuals with bipolar disorder and 56 812 population controls without bipolar disorder indicates a three-fold increase (risk ratio [RR] 3·22 [95% CI 2·41-4·29]; p<0·0001) in the prevalence of anxiety disorders in those with bipolar disorder. 13 studies that included both individuals with bipolar I disorder (n=4270) and those with bipolar II disorder (n=1939) showed no difference in the lifetime prevalence of anxiety disorders between these subtypes (RR 1·07 [95% CI 0·96-1·20]; p=0·223). We noted significant heterogeneity among included studies that was not accounted for by reported differences in study characteristics. Interpretation: People with bipolar disorder are at increased risk of anxiety disorders compared with those without bipolar disorder; nearly one in two has an anxiety disorder in their lifetime. Anxiety disorders should therefore be assessed alongside the mood symptoms in patients with bipolar disorder. Funding: Capital Health Research Fund. © 2015 Elsevier Ltd.

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