2021 MASH/MJM Interprofessional Health Research Symposium | May 6, 2021
McGill Association of Students in Healthcare & McGill Journal of Medicine
Published online: 8 May 2021Panel Presentations
Early Mobilization in People with Cardiovascular Disease Reduces Discharge to a Rehabilitation Facility
Koorosh Semsar-Kazerooni11. Department of Medicine and Health Sciences, McGill University, Montréal, QC, Canada
Abstract
Introduction: Early mobilization (EM) in the intensive care unit is the first stage of the rehabilitation process and is recommended by critical care societies. However, there is little known about outcomes of people with acute cardiovascular disease undergoing EM.
Methods: Consecutive admissions to a tertiary-care Cardiovascular Intensive Care Unit (CICU) prior to and following implementation of a structured nurse-driven EM program were reviewed. The Level of Function (LOF) Mobility Scale, which ranges from 0 to 5 was used to measure and guide mobility. The primary outcome was discharge to a healthcare facility (rehabilitation or long-term care facility).
Results: 1,489 patients were included in the analysis (pre-intervention, N=637; intervention, N=852). There were no differences in age and sex (overall mean age 68.1 ± 16.1 years; 39.3% female). The most common admission diagnoses were acute coronary syndrome (36%, N=536), heart failure (13.3%, N=198) and atrial fibrillation (10.0%, N=149). In the intervention cohort, more than one-quarter (N=222; 26.1%) had at least mildly impaired pre-hospital functional status. The LOF was 4.6±0.7 pre-hospital, 3.2±1.4 on admission, and 4.2±0.9 on CICU discharge. Half of patients (51.6%; 440/852) increased their LOF by ≥1 during CICU admission. The adverse event rate was 0.3% with no life-threatening events, patient falls, tube/line dislodgements, or injuries to personnel. The intervention group, compared to the pre-intervention group, was less likely to be discharged to a healthcare facility (9.6% vs. 12.2%, P<0.007). The intervention group compared to the pre-intervention group had a lower rate of in-hospital death (4.2% vs. 6.8%; P=0.04) and 30-day post-hospital discharge ER visit (P=0.003), although there was no difference in CICU or hospital length of stay (P=0.63 and P=0.54, respectively) or 30-day readmission rates (P=0.14).
Conclusion: A nurse-driven EM program in people with acute cardiovascular disease resulted in decreased likelihood of discharge to rehabilitation centre and reduced in-hospital mortality.
Understanding chronic pain mechanisms and designing novel treatment approaches
Haoyi Qui11. Department of Physiology and Information Cell Mechanisms, McGill University, Montréal, QC, Canada
Abstract
Chronic pain is a debilitating disease with unmet medical needs. Lack of proper pain management in patients is due to our incomplete understanding of changes in pain processing pathways under health and disease conditions. The dorsal horn of the spinal cord contains a complex network of interneurons that processes touch and pain inputs from the periphery. However, the function and connectivity of these interneurons remain poorly understood.
Here, we introduce an innovative tool that allows for the precise control of the activity of a specific interneuron population. To evaluate the efficacy of this tool, we used knock-in mice expressing Cre recombinase under the control of the parvalbumin (PV; PV:Cre mice) gene, a marker of inhibitory spinal cord interneurons. The tool consisted of an inhibitory pharmacogenetic tool (hM4D) and an excitatory opsin (oChIEF) inserted in a Cre-dependent manner in an AAV2/9 viral vector. The virus was injected unilaterally in the spinal cord of PV:Cre mice. Injections were followed by surgical implantation of a cannula through which a software-controlled blue laser modulated oChIEF activity.
Upon intraperitoneal injection of CNO, virus-injected mice displayed mechanical hypersensitivity for a period of 60-90 minutes. During that time, photostimulation with blue light caused an alleviation of this hypersensitivity. We present functional evidence that this vector can be used to inhibit or activate PV neurons in vivo. We demonstrate that upon inhibition of these neurons, gentle touch stimuli provoke an intense pain response called mechanical allodynia, a common symptom of chronic pain. Our results elucidate the physiological role of PV neurons in vivo and point to these interneurons as potential therapeutic targets for the treatment of mechanical allodynia due to chronic pain.
Investigating the Relationship between Alzheimer’s Disease and the Default Mode Network-Hippocampus Dialogue: A Population Neuroscience Approach
Chloé Savignac11. Department of Neuroscience, McGill University, Montréal, QC, Canada
Abstract
Introduction/Aim: The inability of some patients to verbally expressed their pain creates the need for a tool that could objectively assess pain in intellectually disabled adolescents. Neuroimaging techniques combined with machine learning are seen as possible candidates for the identification of a pain biomarker. This preliminary study aimed to investigate the use of network characteristics to assess acute pain perception in healthy and chronic musculoskeletal pain adolescents.
Methods: Brain activity was recorded in 14 healthy participants and 54 chronic pain patients aged 10-18 years old using a dry EEG headset (DSI-24). Recordings were performed at resting-state with eyes opened and during tonic noxious heat stimulations. The heat test lasted 2min at constant temperature. The thermode’s temperature was set at the subject’s pain threshold as previously measured, prior to the recording session, by a 5/10 pain intensity on a computerized pain scale. Preprocessing was performed on MATlab using the EEGLAB toolbox and EEGapp plug-in. Spectral Power, Weighted Phase Lag Index (PLI) and Directed Phase Lag Index (dPLI) were analyzed.
Results: Healthy participants demonstrated a marked alpha power suppression during tonic noxious stimulation. While there is no major difference in functional connectivity measured by the wPLI, chronic pain patients showed less fronto-temporal connectivity during noxious stimulation as measured by the dPLI.
Discussion/Conclusion: Spectral power analysis is limited in the assessment of pain as it does not capture the dynamics behind feed-forward and feedback projections. Brain network characteristics such as directed functional connectivity may provide insight into the cerebral mechanisms behind pain perception.
Telemedicine scheduling optimization in surgical outpatient clinics
Amy Lorincz11. Department of Experimental Surgery, McGill University, Montréal, Quebec, Canada
Abstract
The COVID-19 pandemic has introduced a new paradigm in Canadian healthcare presenting challenges for patients and clinicians that must be addressed in order to achieve accessible and safe healthcare. Additionally, it has imposed restrictions on in-person interactions creating a need for exploring alternative methods of healthcare delivery while maintaining high-quality treatment.
In an initial study with Orthopaedic and Ear, Nose, and Throat (ENT) surgeons, it was found that 66% of consultations could be completed virtually. This presents the opportunity to save patients a trip to the hospital and minimize their risk of contracting the COVID-19 virus. Building on past scheduling optimization research, the application of modelling techniques has proven to reduce patient wait time by 65%.
To determine if optimized patient flow will lead to an improvement in the utilization of telemedicine in surgical outpatient clinics, two objectives will be of focus.
(1) Establishing the optimal mix of telemedicine and in-person consultation. Patients will be classified as suitable or not suitable using a machine learning algorithm. Socio-economic factors, medical history, outcome of telemedicine consultations, next steps for a patient will all be used as inputs to the algorithm. It is hypothesized that by identifying significant factors in a classification model that drive the need for in-person appointments, unnecessary hospital visits can be reduced.
(2) Developing optimal scheduling templates for telemedicine consultations. Personalized scheduling templates will be developed using a discrete event simulation model to test the templates. The model will use the consultation durations as inputs into the model. It is hypothesized that satisfaction will increase for patients and clinicians with the optimization of telemedicine scheduling templates.
With greater insight into forecasting which patients can be seen virtually vs. in-person, schedules can be optimized, and high-quality healthcare can continue to be delivered in a safe and accessible way for both patients and clinicians.
A mixed methods intervention adaptation and pilot randomized controlled trial of a dyadic depression intervention for adults with chronic physical diseases and concomitant depression and their caregivers: A study proposal
Lydia Ould Brahim11. Ingram School of Nursing, McGill University, Montréal, QC, Canada
Abstract
Background: Caregivers provide over 70% of care for adults with chronic diseases. Approximately 20% of adults with chronic diseases experience concomitant depression, which raises their risk of mortality and negatively affects their caregivers’ health. Including caregivers in interventions may positively impact use of the intervention and decrease attrition, optimizing intervention efficacy. Given healthcare resource constraints, providing a dyadic intervention (care recipient and caregiver participate) using acceptable and cost-effective modes of delivery, such as self-management, is a priority.
Objectives: In phase 1, the DIRECT-sc toolkit, an existing depression self-management intervention for adults with chronic conditions, will be adapted to include a prescribed caregiver role. In phase 2, a pilot RCT of the adapted dyadic intervention, DIRECT-support, will be conducted.
Methods: Overseen by a steering committee of experts, the phase 1 adaptation process will include consolidation of evidence from systematic reviews, relevant theory, and results of interviews with care recipient-caregiver dyads (n = 24) and healthcare professionals (HCPs) (n = 12). The preliminary version of DIRECT-support will be tested with 5 dyads and 5 HCPs (n=15) and its acceptability assessed using validated questionnaires and semi-structured interviews or focus groups with all participants.
Phase 2, a parallel-group pilot RCT, will be conducted with 26 dyads (n = 52), randomized to (a) DIRECT-support for 6-weeks or (b) a usual care control group. Data on feasibility (e.g., attrition rates), acceptability (e.g., satisfaction), and participant outcomes (primary outcome depressive symptoms) will be collected using study logs and validated questionnaires. Semi-structured interviews will be conducted with a subset of participants to further explore acceptability.
Significance: An innovative dyadic approach holds promise as a source of support for individuals with chronic disease and their caregivers. This study will provide feasibility and acceptability data needed to elucidate the challenges and potential benefits of dyadic interventions in chronic disease care.
Poster Presentations
Healthcare Professionals’ Disclosure of Mental Illness in the Workplace
Emilie Hudson11. Department of Nursing, McGill University, Montréal, QC, Canada
Abstract
Introduction: Although the prevalence of mental health problems and illnesses among healthcare professionals (HCP) is similar to that of the general population, there is a dearth of research on how these illness experiences shape HCP practice and work environments. This rapid scoping review aims to explore the disclosure of mental illness by HCP in the workplace.
Method: This review follows the JBI methodological framework for scoping reviews, with modifications to fit its ‘rapid’ nature. Searches were conducted in CINAHL and MEDLINE. All levels of screening and extraction were conducted by one person (EH) and were validated by the co-authors (MLT, AA). A thematic synthesis approach was used to analyze the quantitative and qualitative data.
Results: The search yielded 3772 record. Seventeen were included. Disclosure was found to be a process that started with weighing the pros and cons of disclosing. Facilitators for disclosure were professional responsibilities and personal benefits, while risk for stigmatization, personal experiences with mental illness, and fears related to professional identity and employment were found to hinder disclosure. Once a HCP chose to disclose, several considerations were found to influence the decision-making process, including who, what, when, and how disclosure should occur. Non-controlled disclosure, where a HCP’s mental illness was made known by another person in the workplace, was also described. After disclosure occurred, few positive outcomes were reported; negative responses from others and adverse consequences were common.
Discussion: Disclosure of mental illness in the workplace is a complex, oftentimes stigmatizing process with few benefits and many potential repercussions on career and professional identity. Though HCP may reflect values of openness, compassion and caring towards their patients, it does not always manifest towards their colleagues. Increased awareness and education are needed so that work environments become safer for those who need to disclose their mental illness.
iPSC Secretome in the Rescue of Cardiac Function After Hypoxia-Induced Injury
Jeremy Zwaig11. Department of Experimental Surgery, McGill University, Montréal, QC, Canada
Abstract
Myocardial infarction (MI) often leads to heart failure or death due to the cardiac tissue’s inability to regenerate after injury. Unlike other organs in the human body that have innate reparative capabilities after an injury like the liver, the human heart only worsens after it is damaged. There have been many attempts to implant stem cells and immature cardiac cells into infarct hearts to try to induce recovery, yielding insignificant results and a lack of cardiac function improvement. Now, the focus has shifted towards cell-free therapies to induce cardiac repair after MI. This study aims to compare induced pluripotent stem cell (iPSC)-derived secretomes from diseased and healthy patients and evaluate secretome’s potential as a treatment for hypoxia-injured iPSC-derived cardiomyocytes (iPSC-CMs).
CD34+ cells were isolated from diseased (n=3) and control (n=1) patient’s blood and reprogrammed into iPSCs using episomal vectors. Stem cells proliferated for 5-10 passages and their secretome was collected. iPSCs were differentiated into iPSC-CMs and incubated in a hypoxia chamber to mimic a MI phenotype. Damaged iPSC-CMs were treated with the secretome derived from patient-specific iPSCs, healthy control iPSCs, or commercially available mesenchymal stem cells (MSCs). Crystal violet, TUNEL, AlamarBlue assays were used to assess changes in iPSC-CM viability, apoptosis, and metabolic activity after treatment with stem cell secretome. We hypothesize that the patient-specific iPSC and healthy control iPSC-derived secretomes will both significantly improve cardiac function more than the secretome derived from MSCs. We hope to elucidate whether iPSCs generated from patient blood make an effective source of secretome to treat cardiac tissue after injury. Determining the effectiveness of stem cell secretomes from different sources in treating damaged cardiomyocytes will be a step towards the usage of secretome as a cardiac repair therapy. After this preliminary experiment, secretomes will be characterized and tested in a mouse model.
The role of sex hormones in plaque instability in men and women with severe carotid atherosclerosis
Diana Di Iorio11. Department of Physiology, McGill University, Montréal, QC, Canada
Abstract
Background: Carotid atherosclerotic plaques can be stable or unstable, the latter being more likely to rupture resulting in strokes. The causes of plaque instability are unknown; however, men tend to have more unstable plaques than women, yet women have increased mortality rates post-stroke. Sex hormones affect the vasculature differently in men and women; until menopause estrogen offers women protection against cardiovascular disease. We hypothesize that sex hormones and their receptors regulate plaque instability, where unstable plaques show higher levels of receptor expression.
Methods: Using liquid chromatography mass spectrometry, we measured circulating levels of testosterone, estradiol, androstenedione, and dehydroepiandrosterone (DHEA) in the blood of patients undergoing carotid endarterectomies. We classified plaques into 4 groups: women stable/unstable and men stable/unstable. We performed immunohistochemistry on plaques to quantify the mean percent area stained for estrogen receptor (ER-), estrogen receptor (ER-), G protein-coupled estrogen receptor (GPER), and androgen receptor (AR). We qualitatively assessed plaques to characterize receptor expression. We used PCR to quantify receptor gene expression in plaques.
Results: No significant differences in testosterone, androstenedione, and DHEA levels were noted between patient groups. Men had significantly greater staining for ER- and ER- in unstable vs stable plaques (p<0.05). Men and women with unstable plaques showed significantly higher staining for AR than stable plaques (p<0.05).
Discussion: Our preliminary findings indicate a possible association between sex hormone receptor expression levels and plaque instability. Identifying effects of sex hormones may lead to hormone-specific therapies aimed at reverting unstable to stable plaques.
Exploring key stakeholders preferences for family involvement in early psychosis intervention services - A novel survey design process
Helen Martin11. Department of Psychiatry, McGill University, Montréal, QC, Canada
Abstract
Introduction: Clinical decision making is a dynamic and complex process in mental healthcare. Increasingly, this has led to challenges with the advent of patient-oriented care advocating for incorporating preferences of patients and their family members in clinical decision making. Family involvement is strongly advocated in several clinical practice guidelines in early psychosis intervention services.
Yet, little is known about how these key stakeholders (service users, families and service providers) prioritize family involvement in routine care. A discrete choice experiment (DCE) is a method used to elicit the preferences and the relative importance of different service features (attributes) and its levels within a decision-making process. DCEs have become popular in healthcare; however, approaches to identify the attributes/levels influencing a decision of interest and to selection methods for their inclusion in a DCE are under-reported. Our objectives were: to explore the development process used to select the attributes/levels and to describe a systematic and rigorous development process for design of a DCE in the context of Early Intervention (EI) psychosis services.
Methods: An accelerated experience based co-design method was undertaken to form a working group committee comprising of key stakeholders. Methods employed included literature review, an adapted four-stage Nominal Group Technique (NGT) and qualitative analysis of group discussion data.
Results & Discussion: A working group committee comprised of nine members with experience of receiving and\or providing early psychosis intervention services was formed. Preliminary results identified through the four-stage NGT were seven key attribute themes – participation in treatment planning, acceptance and understanding, physical and practical support, relationships and communication, being informed, being there during hospitalization\crisis, and respecting service users agency and privacy. As the analysis is ongoing, results will be updated prior to the presentation. This detailed, rigorous and systematic approach to DCE development will be useful to researchers seeking to establish methods for reducing and prioritizing attributes for inclusion in future healthcare DCEs. Additionally, this co-design method will reflect real-life preferences of key stakeholders’ for involving family caregivers in routine EI services.
Sex-Specific Effects of Anti-Fatigue Lens Wear on Musculoskeletal Discomfort and Performance during a Seated Computer Task in University Students
Samuel Lamanuzzi11. Department of Kinesiology and Physical Education, McGill University, Montréal, QC, Canada
Abstract
Introduction/Rationale: Computer users, especially females and university students, are likely to develop musculoskeletal discomfort. Studies suggest links between vision, neck/shoulder discomfort and computer performance, and that these links could be sex-specific. Anti-fatigue lenses (AFL) claim to reduce eye strain and neck/shoulder musculoskeletal discomfort. However, no studies have objectively quantified their impact on the above-mentioned parameters and on computer performance, and how these effects might differ between females and males.
Objective/Hypotheses: Examine the effectiveness of AFL wear on eye strain, neck/shoulder discomfort and computer performance during a seated computer-based text editing task. We hypothesized that AFL would reduce visual and musculoskeletal discomfort and improve performance in both sexes.
Methods: 24 asymptomatic participants (mean age: 23 +/- 2.3 years, n = 12 males) with 20/20 vision were recruited. Participants underwent two separate data collection sessions in a single-blind experiment in either an AFL condition or a placebo lens condition. Each participant performed two 90-minute seated computer editing tasks. At 10-minute intervals, 10cm visual analogue scales (VAS) for eye strain, neck/shoulder discomfort and other discomfort were recorded, along with the performance criteria of edited lines/min. Data was statistically analyzed using ANOVA tests for effects of condition (AFL, placebo), time, sex and their interactions.
Results/Conclusions: Eye strain, neck/shoulder discomfort, and whole body discomfort increased over time (for all three: p < 0.0001), and more so in females (time x sex interaction, for eye strain and neck/shoulder discomfort: p < 0.0001; for whole-body discomfort: p = 0.013). There was no statistical significance when comparing the eyewear conditions or performance criteria of the participants. For the same task and similar performance, women’s symptoms are more affected by computer task time. Further studies of more complex and/or longer tasks and symptomatic individuals may be required to see effects of AFL.
Developing Training for Medical Students to Serve as Medical Interpreters
Darya Naumova11. Department of Medicine and Health Sciences, McGill University, Montréal, QC, Canada.
Abstract
Language barriers pose serious obstacles to patients and healthcare providers in the healthcare system in Montreal. The gold standard for medical interpretation is the use of professional interpreters. However, this service is scarce and not widely available throughout the McGill University Healthcare Centre (MUHC) network. Consequently, ad hoc interpreters, such as family members, friends, and laymen recruited via the hospital intercom system are commonly used. However, evidence shows that the use of untrained, ad hoc interpreters can significantly compromise healthcare interactions, leading to errors in medical decisions.
MedComm is a student-run initiative at the McGill University that aims to address the need of medical interpretation at MUHC. The project has two goals: (1) provide medical interpreter training to multilingual medical student volunteers; (2) develop an online interface and mobile application that facilitates healthcare professionals’ request for a medical student interpreter. Here, we provide evidence on the development of the interpretation training.
Medical interpretation certification includes a training on basic principles of interpretation, the specifics of the medical environment, as well as common medical terms. Since medical students are already trained in medical terminology, a supplemental training on the basics of interpretation would provide them with necessary qualifications. A number of medical schools in North America have introduced a variation of interpretation training for medical students, including: Brown University (Providence, RI), Loyola University (Chicago, IL), Mount Sinai (New York, NY), and Penn State College of Medicine (Hershey, PA).
MedComm has developed a pilot 2-hour training on medical interpretation with theoretical and practical components. First, students are introduced to the basic definitions of medical interpretation, rules and guiding principles, interpreter’s code of conduct, as well as potential issues with the use of medical students as interpreters. Then, trainees watch two videos of best and worst scenarios, followed by group discussions.
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