West Park Healthcare Center

Toronto, Canada

West Park Healthcare Center

Toronto, Canada
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Brode S.K.,Sinai University | Brode S.K.,West Park Healthcare Center | Brode S.K.,University of Toronto | Daley C.L.,National Jewish Health | And 3 more authors.
International Journal of Tuberculosis and Lung Disease | Year: 2014

SETTING: Tuberculosis (TB) rates are decreasing in many areas, while non-tuberculous mycobacteria (NTM) infection rates are increasing. The relationship between the epidemiology of TB and NTM infections is not well understood.OBJECTIVE: To understand the epidemiologic relationship between TB and NTM disease worldwide.DESIGN: A systematic review of Medline (1946-2014) was conducted to identify studies that reported temporal trends in NTM disease incidence. TB rates for each geographic area included were then retrieved. Linear regression models were fitted to calculate slopes describing changes over time.RESULTS: There were 22 studies reporting trends in rates of NTM disease, representing 16 geographic areas over four continents: 75% of areas had climbing incidence rates, while 12.5% had stable rates and 12.5% had declining rates. Most studies (81%) showed declining TB incidence rates. The proportion of incident mycobacterial disease caused by NTM was shown to be rising in almost every geographic area (94%).CONCLUSION: We found an increase in the proportion of mycobacterial disease caused by NTM in many parts of the world due to a simultaneous reduction in TB and increase in NTM disease. Research into the interaction between mycobacterial infections may help explain this inverse relationship. © 2014 The Union.


Janaudis-Ferreira T.,West Park Healthcare Center | Janaudis-Ferreira T.,Sunnybrook Research Institute | Beauchamp M.K.,West Park Healthcare Center | Robles P.G.,West Park Healthcare Center | And 3 more authors.
Chest | Year: 2014

Background: The objectives of this systematic review were to synthesize the literature on measures of activities of daily living (ADLs) that have been used in individuals with COPD and to provide an overview of the psychometric properties of the identifi ed measures and describe the relationship of the disease-specifi c instruments with other relevant outcome measures for individuals with COPD and health-care use. Methods: Studies that included a measure of ADLs in individuals with COPD were identifi ed using electronic and hand searches. Two investigators performed the literature search. One investigator reviewed the study title, abstract, and full text of the articles to determine study eligibility and performed the data extraction and tabulation. In cases of uncertainty, a second reviewer was consulted. Results: A total of 679 articles were identifi ed. Of those, 116 met the inclusion criteria. Twentyseven ADLs instruments were identifi ed, of which 11 instruments were respiratory disease-specifi c, whereas 16 were generic. Most instruments combined instrumental ADLs (IADLs) with basic ADLs (BADLs). The majority of the instruments were self-reported; only three instruments were performance based. Twenty-one studies assessed psychometric properties of 16 ADLs instruments in patients with COPD. Conclusions: Although several ADLs instruments were identifi ed, psychometric properties have only been reported in a few. Selection of the most appropriate measure should focus on the target construct (BADLs or IADLs or both), type of test (disease-specifi c vs generic and self-reported vs performance-based), depth of information obtained, and psychometric properties of the instruments. Given the relevance of ADLs to the lives of patients with COPD, its assessment should be more frequently incorporated as a clinical outcome in their management. © 2014 American College of Chest Physicians.


Woo K.Y.,Homes for the Aged Inc | Woo K.Y.,West Park Healthcare Center | Woo K.Y.,University of Toronto
Wounds UK | Year: 2010

Pain is a common problem in patients with chronic wounds.This article discusses a systematised approach to address and manage wound-related pain.The impact of psychological factors on pain is often overlooked. Substantial evidence indicates that the more anxiety patients experience from anticipation, the higher their levels of pain during dressing changes.Anxiety as a psychological stress can trigger a cascade of physiological events that impair wound healing. Strategies to allay anxiety must be part of a comprehensive pain treatment plan.


Salbach N.M.,University of Toronto | Brooks D.,University of Toronto | Brooks D.,West Park Healthcare Center | Romano J.,West Park Healthcare Center | And 2 more authors.
Neurorehabilitation and Neural Repair | Year: 2014

Background and objectives. The 6-minute walk test (6MWT) is used to measure exercise capacity after stroke. We sought to compare cardiorespiratory responses during the 6MWT with responses to a ramp cycle ergometer test (CET) in community-dwelling individuals with stroke. A secondary objective was to determine the relationship between cardiorespiratory responses during each test and daily physical activity. Methods. Participants completed 3 evaluation sessions. The CET and 6MWT were conducted in 2 separate sessions at least 72 hours apart. Participants wore a portable gas analysis unit (Cosmed K4b2), which also measured heart rate (HR) during the 6MWT. A uniaxial accelerometer (activPAL) was used to measure time spent upright (standing and stepping) over 5 days as an estimate of daily physical activity. Results. Complete CET and 6MWT data were obtained for 16 participants (14 men), a mean ± standard deviation of 2.0 ± 1.1 years after stroke and 71.1 ± 9.7 years of age. Compared with the 6MWT, the CET elicited a higher VO2peak (P =.032), VCO2peak (P =.005), respiratory exchange ratio (P =.015), and self-reported perceived breathing (P <.0001) and leg heaviness (P <.0001) at test completion and a lower HRpeak (P =.029). Except for the first minute, VO2 during the 6MWT was, on average, 80% to 85% of VO2peak from the CET. Among 15 participants, average time spent upright per day was not significantly associated with 6MWT distance (r = 0.447, P =.096) or VO2peak from the CET (r = 0.388, P =.153). Conclusions. Exercise intensity achieved during the 6MWT appeared sufficiently high for aerobic training, assuming CET VO2peak accurately reflects aerobic capacity. The 6MWT may be useful for prescribing aerobic exercise poststroke. © The Author(s) 2013.


Hill K.,West Park Healthcare Center | Dolmage T.E.,Diagnostic Healthcare | Woon L.,West Park Healthcare Center | Goldstein R.,West Park Healthcare Center | Brooks D.,University of Toronto
Thorax | Year: 2010

Rationale The SenseWear armband (SAB) is designed to measure energy expenditure (EE). In people with chronic obstructive pulmonary disease (COPD), EE estimated using the SAB (EESAB) is a popular outcome measure. However, a detailed analysis of the measurement properties of the SAB in COPD is lacking. Objective To examine the sensitivity of EESAB, agreement between EESAB and EE measured via indirect calorimetry (EE IC), and its repeatability in COPD. Methods 26 people with COPD (forced expiratory volume in 1 s (FEV1)=496±8% predicted; 15 males) spent 6 min in five standardised tasks that comprised supine, sitting, standing and two walking speeds. A subgroup (n=12) walked using a rollator. Throughout each task, measurements of EESAB and EEIC were collected. The protocol was repeated on a second day. Results EESAB increased between standing and slow walking (2.4, metabolic equivalents (METs) 95% CI 2.2 to 2.7) as well as slow and fast walking (0.5 METs, 95% CI 0.3 to 0.7). Considering all tasks together, the difference between EESAB and EEIC was -0.2 METs (p=0.21) with a limit of agreement of 1.3 METs. The difference between days in EESAB was 0.0 METs with a coefficient of repeatability of 0.4 METs. Rollator use increased the variability in EE SAB, compromising its repeatability and agreement with EE IC. Conclusions EESAB was sensitive to small but important changes. There was fair agreement between EESAB and EEIC, and measurements of EESAB were repeatable. These observations suggest that the SAB is useful for the evaluation of EE in patients with COPD who walk without a rollator.


Beauchamp M.K.,University of Toronto | Nonoyama M.,West Park Healthcare Center | Goldstein R.S.,West Park Healthcare Center | Hill K.,West Park Healthcare Center | And 3 more authors.
Thorax | Year: 2010

Background: In patients with chronic obstructive pulmonary disease (COPD), interval exercise has gained recent attention as a possible means of achieving greater physiological training effects compared with continuous exercise. The primary aim of this systematic review was to compare the effects of interval versus continuous training on peak oxygen uptake, peak power, 6 minute walk test (6MWT) distance and health-related quality of life in individuals with COPD. Methods: Randomised controlled trials comparing the effects of interval versus continuous training in patients with COPD were identified after searches of six databases and reference lists of appropriate studies in May 2009. Two reviewers independently assessed study quality. Weighted mean differences (WMD) with 95% CIs were calculated using a random effects model for measures of exercise capacity and health-related quality of life. Results: Eight randomised controlled trials, with a total of 388 patients with COPD, met the inclusion criteria. No significant differences were found for peak power (WMD 1 W, 95% CI - 1 to 3) or peak oxygen uptake (WMD -0.04 l/min, 95% CI -0.13 to 0.05) between interval and continuous training. The WMD for the Chronic Respiratory Questionnaire dyspnoea score was -0.2 units (95% CI -0.5 to 0.0). There was no difference in 6MWT distance between groups (WMD 4 m, 95% CI -15 to 23). Conclusions: Interval and continuous training modalities did not differ in their effect on measures of exercise capacity or health-related quality of life. Interval training may be considered as an alternative to continuous training in patients with varying degrees of COPD severity.


Woo K.Y.,West Park Healthcare Center
Surgical technology international | Year: 2010

Wound infection is common and delays wound healing. Validated signs included in the mnemonic NERDS and STONEES can be used to identify whether bacterial damage is superficial or deep, respectively. Clinicians must discern when bacterial damage has occurred on a timely basis and what treatment strategies to institute. A variety of topical antimicrobial agents have been developed incorporating iodine, chlorhexidine, silver, honey, topical oxygen, and topical antibiotics. Selection of appropriate strategies should be based on three key factors: healability (healable versus nonhealable), bacterial burden (colonization versus deep infection), and host risk factors. This article reviews and offers succinct recommendations pertaining to the management of wound infection in clinical practice.


Evans R.A.,West Park Healthcare Center | Evans R.A.,University of Leicester
Chronic Respiratory Disease | Year: 2011

Patients with chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) commonly suffer from exertional symptoms of breathlessness and fatigue. The similar systemic manifestations of the conditions, including skeletal muscle dysfunction, are a major contributing factor to the limitation in exercise capacity. A period of exercise training has been shown to improve exercise performance and health-related quality of life for both conditions. Exercise training is a key component of pulmonary rehabilitation (PR) which is now a standard of care for patients with COPD and is symptom based. Although it may be assumed that patients with CHF could be incorporated into cardiac rehabilitation, this is predominantly a secondary prevention programme for patients who are largely asymptomatic. It has been shown that patients with CHF can be successfully trained together with patients with COPD by the same therapists within PR. There are comparable outcome measures that can be used for both COPD and CHF. Many patients with CHF still do not have access to an exercise rehabilitation programme and incorporating them into the PR model of care could be one solution. This article reviews the (1) similar symptoms, mechanisms and consequences between COPD and CHF, (2) rationale and evidence for exercise training in CHF, (3) model of PR, (4) safety of exercise training in CHF, (5) evidence for combined exercise rehabilitation for CHF and COPD, (6) adaptations necessary to include patients with CHF into PR, (7) the chronic care model and (8) summary. © SAGE Publications 2011.


Evans R.,West Park Healthcare Center
Canadian respiratory journal : journal of the Canadian Thoracic Society | Year: 2012

The trend of patients who are invasively ventilated to prefer home care is one that benefits both the patient and the health care system. However, this assumes a role for patients' family members to become informal caregivers. To explore the impact of caring for a ventilator-assisted individual on informal caregivers. A descriptive design with semistructured caregiver interviews and the Caregiver Burden Inventory were used. Participants were informal caregivers of a family member with a progressive neuromuscular disease on invasive ventilation for at least six months. Transcript coding was performed and regularly reviewed, and recruitment continued until data saturation. Qualitative analysis was based on 'thematic analysis'. A total of 21 caregivers were interviewed. Five themes developed: a sense of duty; restriction of day-to-day life; physical and emotional burden; training and education; and the need for more paid support. Caregivers described a sense of duty to take care of loved ones, but suffered a significant restriction of their own time with a negative impact on their physical and mental health. The initial transfer home was highlighted as the most stressful part of the process. The Caregiver Burden Inventory scores supported a high level of burden: median 49 (interquartile range 39.5 to 53.0) of a maximum 96. Homecare for ventilator-assisted individuals with progressive neuromuscular disease causes significant burden to informal caregivers. Approaches to lessen this burden, such as increased paid care, improved professional support and respite care, may enable home ventilation to be a more sustainable modality of care.


Lee A.L.,West Park Healthcare Center | Burge A.T.,West Park Healthcare Center | Holland A.E.,West Park Healthcare Center
The Cochrane database of systematic reviews | Year: 2015

BACKGROUND: People with non-cystic fibrosis bronchiectasis commonly experience chronic cough and sputum production, features that may be associated with progressive decline in clinical and functional status. Airway clearance techniques (ACTs) are often prescribed to facilitate expectoration of sputum from the lungs, but the efficacy of these techniques in a stable clinical state or during an acute exacerbation of bronchiectasis is unclear.OBJECTIVES: Primary: to determine effects of ACTs on rates of acute exacerbation, incidence of hospitalisation and health-related quality of life (HRQoL) in individuals with acute and stable bronchiectasis. Secondary: to determine whether:• ACTs are safe for individuals with acute and stable bronchiectasis; and• ACTs have beneficial effects on physiology and symptoms in individuals with acute and stable bronchiectasis.SEARCH METHODS: We searched the Cochrane Airways Group Specialised Register of trials from inception to November 2015 and PEDro in March 2015, and we handsearched relevant journals.SELECTION CRITERIA: Randomised controlled parallel and cross-over trials that compared an ACT versus no treatment, sham ACT or directed coughing in participants with bronchiectasis.DATA COLLECTION AND ANALYSIS: We used standard methodological procedures as expected by The Cochrane Collaboration.MAIN RESULTS: Seven studies involving 105 participants met the inclusion criteria of this review, six of which were cross-over in design. Six studies included adults with stable bronchiectasis; the other study examined clinically stable children with bronchiectasis. Three studies provided single treatment sessions, two lasted 15 to 21 days and two were longer-term studies. Interventions varied; some control groups received a sham intervention and others were inactive. The methodological quality of these studies was variable, with most studies failing to use concealed allocation for group assignment and with absence of blinding of participants and personnel for outcome measure assessment. Heterogeneity between studies precluded inclusion of these data in the meta-analysis; the review is therefore narrative.One study including 20 adults that compared an airway oscillatory device versus no treatment found no significant difference in the number of exacerbations at 12 weeks (low-quality evidence). Data were not available for assessment of the impact of ACTs on time to exacerbation, duration or incidence of hospitalisation or total number of hospitalised days. The same study reported clinically significant improvements in HRQoL on both disease-specific and cough-related measures. The median difference in the change in total St George's Respiratory Questionnaire (SGRQ) score over three months in this study was 7.5 units (P value = 0.005 (Wilcoxon)). Treatment consisting of high-frequency chest wall oscillation (HFCWO) or a mix of ACTs prescribed for 15 days significantly improved HRQoL when compared with no treatment (low-quality evidence). Two studies reported mean increases in sputum expectoration with airway oscillatory devices in the short term of 8.4 mL (95% confidence interval (CI) 3.4 to 13.4 mL) and in the long term of 3 mL (P value = 0.02). HFCWO improved forced expiratory volume in one second (FEV1) by 156 mL and forced vital capacity (FVC) by 229.1 mL when applied for 15 days, but other types of ACTs showed no effect on dynamic lung volumes. Two studies reported a reduction in pulmonary hyperinflation among adults with non-positive expiratory pressure (PEP) ACTs (difference in functional residual capacity (FRC) of 19%, P value < 0.05; difference in total lung capacity (TLC) of 703 mL, P value = 0.02) and with airway oscillatory devices (difference in FRC of 30%, P value < 0.05) compared with no ACTs. Low-quality evidence suggests that ACTs (HFCWO, airway oscillatory devices or a mix of ACTs) reduce symptoms of breathlessness and cough and improve ease of sputum expectoration compared with no treatment (P value < 0.05). ACTs had no effect on gas exchange, and no studies reported effects of antibiotic usage. Among studies exploring airway oscillating devices, investigators reported no adverse events.AUTHORS' CONCLUSIONS: ACTs appear to be safe for individuals (adults and children) with stable bronchiectasis and may account for improvements in sputum expectoration, selected measures of lung function, symptoms and HRQoL. The role of these techniques in acute exacerbation of bronchiectasis is unknown. In view of the chronic nature of bronchiectasis, additional data are needed to establish the short-term and long-term clinical value of ACTs for patient-important outcomes and for long-term clinical parameters that impact disease progression in individuals with stable bronchiectasis, allowing further guidance on prescription of specific ACTs for people with bronchiectasis.

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