Publications by authors named "Kendall Ho"

76 Publications

Telehealth and the COVID-19 Pandemic: International Perspectives and a Health Systems Framework for Telehealth Implementation to Support Critical Response.

Yearb Med Inform 2021 Apr 21. Epub 2021 Apr 21.

Sri Sathya Sai Central Trust, Puttaparthi, India.

Objectives: Telehealth implementation is a complex systems-based endeavour. This paper compares telehealth responses to (COrona VIrus Disease 2019) COVID-19 across ten countries to identify lessons learned about the complexity of telehealth during critical response such as in response to a global pandemic. Our overall objective is to develop a health systems-based framework for telehealth implementation to support critical response.

Methods: We sought responses from the members of the International Medical Informatics Association (IMIA) Telehealth Working Group (WG) on their practices and perception of telehealth practices during the times of COVID-19 pandemic in their respective countries. We then analysed their responses to identify six emerging themes that we mapped to the World Health Organization (WHO) model of health systems.

Results: Our analysis identified six emergent themes. (1) Government, legal or regulatory aspects of telehealth; (2) Increase in telehealth capacity and delivery; (3) Regulated and unregulated telehealth; (4) Changes in the uptake and perception of telemedicine; (5) Public engagement in telehealth responses to COVID-19; and (6) Implications for training and education. We discuss these themes and then use them to develop a systems framework for telehealth support in critical response.

Conclusion: COVID-19 has introduced new challenges for telehealth support in times of critical response. Our themes and systems framework extend the WHO systems model and highlight that telemedicine usage in response to the COVID-19 pandemic is complex and multidimensional. Our systems-based framework provides guidance for telehealth implementation as part of health systems response to a global pandemic such as COVID-19.
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http://dx.doi.org/10.1055/s-0041-1726484DOI Listing
April 2021

Virtual care in the ED: a game changer for the future of our specialty?

Authors:
Kendall Ho

CJEM 2021 Jan 25;23(1):1-2. Epub 2021 Jan 25.

Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada.

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http://dx.doi.org/10.1007/s43678-020-00058-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7829647PMC
January 2021

Autonomic Alterations After Pulmonary Vein Isolation in the CIRCA-DOSE (Cryoballoon vs Irrigated Radiofrequency Catheter Ablation) Study.

J Am Heart Assoc 2021 Feb 26;10(5):e018610. Epub 2021 Feb 26.

Center for Cardiovascular Innovation Vancouver Canada.

Background The natural history of autonomic alterations following catheter ablation of drug-refractory paroxysmal atrial fibrillation is poorly defined, largely because of the historical reliance on non-invasive intermittent rhythm monitoring for outcome ascertainment. Methods and Results The study included 346 patients with drug-refractory paroxysmal atrial fibrillation undergoing pulmonary vein isolation using contemporary advanced-generation ablation technologies. All patients underwent insertion of a Reveal LINQ (Medtronic) implantable cardiac monitor before ablation. The implantable cardiac monitor continuously recorded physical activity, heart rate variability (measured as the SD of the average normal-to-normal), daytime heart rate, and nighttime heart rate. Longitudinal autonomic data in the 2-month period leading up to the date of ablation were compared with the period from 91 to 365 days following ablation. Following ablation there was a significant decrease in SD of the average normal-to-normal (mean difference versus baseline of 19.3 ms; range, 12.9-25.7; <0.0001), and significant increases in daytime and nighttime heart rates (mean difference versus baseline of 9.6 bpm; range, 7.4-11.8; <0.0001, and 7.4 bpm; range, 5.4-9.3; <0.0001, respectively). Patients free of arrhythmia recurrence had significantly faster daytime (11±11 versus 8±12 bpm, =0.001) and nighttime heart rates (8±9 versus 6±8 bpm, =0.049), but no difference in SD of the average normal-to-normal (=0.09) compared with those with atrial fibrillation recurrence. Ablation technology and cryoablation duration did not influence these autonomic nervous system effects. Conclusions Pulmonary vein isolation results in significant sustained changes in the heart rate parameters related to autonomic function. These changes are correlated with procedural outcome and are independent of the ablation technology used. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01913522.
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http://dx.doi.org/10.1161/JAHA.120.018610DOI Listing
February 2021

Organizing a Mass Gathering Amidst a Rising COVID-19 Public Health Crisis: Lessons Learned From a Chinese Public Health Forum in Vancouver, BC.

Cureus 2020 Dec 29;12(12):e12365. Epub 2020 Dec 29.

Department of Emergency Medicine, University of British Columbia, Vancouver, CAN.

Introduction The coronavirus disease 2019 (COVID-19) evolved from a rising public health concern to a pandemic over mere weeks. Before March 11, 2020, the Public Health Agency of Canada had not advised against any mass gatherings. Herein, we highlight practical precautions taken by event organizers to adapt to the rising public health threat from COVID-19 and maintain public safety when conducting a health forum for the Chinese community of Vancouver, British Columbia on February 22, 2020. Materials and Methods In the pre-forum phase, we advertised the availability of virtual conferencing for remote participation in the forum and also had an official communication from the Ministry of Health available regarding COVID-19 on our website. At the forum, we ensured that attendees sanitized their hands at registration and had access to sanitizers throughout the forum. Additionally, we provided translated health literature on COVID-19 to participants and had our health professional speakers address COVID-19-related questions. Results This year, 231 older Chinese adults attended the forum in-person, while 150 participated remotely. The total number of 381 participants compares well to previous iterations of the forum, with twice the amount of participants on average attending online than before. Of the participants who attended the forum, 89% suggested that the forum would be effective in improving their overall health and 87% cited the forum's utility in directing them to access community resources. None of the attendees had COVID-19 or are suspected to have contracted it at the forum. Conclusion Conducting a mass gathering during a crisis required closely following guidance from local public health authorities, constant and clear communication with attendees, and employing practical risk mitigation strategies.
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http://dx.doi.org/10.7759/cureus.12365DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7842969PMC
December 2020

Evaluation of Patient Engagement in a Clinical Emergency Care Network: Findings From the BC Emergency Medicine Network.

J Patient Exp 2020 Dec 19;7(6):937-940. Epub 2020 May 19.

Department of Emergency Medicine, University of British Columbia, BC Emergency Medicine Network, Vancouver, British Columbia, Canada.

The British Columbia Emergency Medicine Network (EM Network) has collaborated with patient partners to utilize their experiential knowledge to inform planning and implementation. Patient partners participated in several EM Network committees and initiatives. This study evaluated how patient partners and other leaders in the EM Network perceived patient engagement efforts 1 year after launch. The Public and Patient Engagement Evaluation Tool V2.0 found that there was an appropriate level of patient engagement at this early stage, an opportunity to attract more patient partners as the EM Network grows, and a need to ensure adequate resources to support more activities.
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http://dx.doi.org/10.1177/2374373520925721DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7786762PMC
December 2020

Perceived Effectiveness and Motivations for the Use of Web-Based Mental Health Programs: Qualitative Study.

J Med Internet Res 2020 07 31;22(7):e16961. Epub 2020 Jul 31.

Work & Mental Health Research Unit, The Institute of Mental Health Research, University of Ottawa, Ottawa, ON, Canada.

Background: The prevalence of depression is high and has been stable despite increased treatment, research, and dissemination. People encounter barriers to seeking traditional mental health services, which could be mitigated by using web-based prevention methods.

Objective: This study aims to understand what people at high risk for depression perceive as effective aspects of web-based mental health programs and what motivates people at high risk for depression to use web-based mental health programs.

Methods: We conducted an inductive content analysis using telephone interview data from 77 participants at high risk for depression who were recruited from 2 randomized controlled trials (RCTs). Participants from the first RCT were working men who had been randomly assigned to 1 of the following 3 groups: control group, who had access to general depression information from a website called BroMatters; intervention group 1, who had access to the BroMatters website along with the associated BroHealth web-based mental health program; and intervention group 2, who had access to the BroMatters website, the BroHealth web-based mental health program, and telephone sessions with a life coach. Participants from the second RCT were men and women who had been assigned to the intervention group, who received access to the HardHat web-based mental health program, or the control group, who only received access to the HardHat web-based mental health program following completion of the RCT. Participants for this inductive content analysis study were recruited from the intervention groups in both RCTs. Two groups of participants (n=41 and n=20) were recruited from the BroHealth RCT, and a third group comprised 16 participants that were recruited from the HardHat RCT.

Results: We generated four categories regarding the perceived effectiveness of web-based programs and five categories related to what motivates the use of web-based programs. Participants identified awareness, program medium and functionality, program content, and coaches as categories related to the effectiveness of the programs. Categories of motivators to use web-based programs included providing reminders or incentives, promotion of the programs, providing appropriate medium and functionality, appropriate content, and perceived need. The final category related to motivators reflects perceptions of participants who were either unsure about what motivates them or believed that there is no way to motivate use.

Conclusions: Conflicting evidence was obtained regarding the perceived effectiveness of aspects of the content and functionality of web-based programs. In general, web-based mental health programs were perceived to help increase mental health awareness, especially when it includes live access to a coach. However, the results also revealed that it is difficult to motivate people to begin using web-based mental health programs. Strategies that may motivate the use of such programs include perceived personal need, effective promotion, providing incentives and reminders, and improving functionality.
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http://dx.doi.org/10.2196/16961DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7428897PMC
July 2020

Testing a school-based program to promote digital health literacy and healthy lifestyle behaviours in intermediate elementary students: The Learning for Life program.

Prev Med Rep 2020 Sep 18;19:101149. Epub 2020 Jun 18.

Digital Emergency Medicine, Department of Emergency Medicine, Faculty of Medicine, The University of British Columbia, 818 West 10th Avenue, Vancouver, BC V5Z 1M9, Canada.

Promoting digital health literacy and healthy lifestyle behaviours in children can lead to positive long-term health outcomes and prevent chronic diseases. However, there are few school-based interventions promoting this education to intermediate elementary students. The objective of this study was to test the effectiveness of a novel intervention to increase students' digital health literacy and health knowledge. Learning for Life is a classroom-based education program, developed for grade 4-7 students and delivered by teachers over six weeks. Three Canadian schools were recruited to deliver the intervention in 2018. This study had a pre-post design and no control group. Students' self-reported digital health literacy and healthy lifestyle behaviours were measured at pre-intervention (n = 126), post-intervention (n = 119), and two-month follow-up (n = 104). Students at pre-intervention had a mean (SD) age of 10.98 (0.56) years (57.1% females). Almost all (97%) students had unsupervised access to the Internet through a computer or smartphone. From pre- to post-intervention, students' digital health literacy increased (p = 0.009), but decreased from post-intervention to follow-up (p < 0.001). Post-intervention, the majority of students could identify at least one healthy behaviour (e.g., exercising one hour/day) and reported making at least one healthy change in their lives (e.g., eating more fruits/vegetables). This study demonstrated that the Learning for Life intervention can improve intermediate elementary students' digital health literacy over the short-term and help them learn and retain healthy lifestyle knowledge and behaviours. These findings affirm the need for interventions promoting digital healthy literacy and healthy lifestyle behaviours for this age group.
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http://dx.doi.org/10.1016/j.pmedr.2020.101149DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7347644PMC
September 2020

Machine Learning Clustering for Blood Pressure Variability Applied to Systolic Blood Pressure Intervention Trial (SPRINT) and the Hong Kong Community Cohort.

Hypertension 2020 08 29;76(2):569-576. Epub 2020 Jun 29.

The University of British Columbia, Canada (K.H.).

Visit-to-visit blood pressure variability (BPV) has been shown to be a predictor of cardiovascular disease. We aimed to classify the BPV levels using different machine learning algorithms. Visit-to-visit blood pressure readings were extracted from the SPRINT study in the United States and eHealth cohort in Hong Kong (HK cohort). Patients were clustered into low, medium, and high BPV levels with the traditional quantile clustering and 5 machine learning algorithms including K-means. Clustering methods were assessed by Stability Index. Similarities were assessed by Davies-Bouldin Index and Silhouette Index. Cox proportional hazard regression models were fitted to compare the risk of myocardial infarction, stroke, and heart failure. A total of 8133 participants had average blood pressure measurement 14.7 times in 3.28 years in SPRINT and 1094 participants who had average blood pressure measurement 165.4 times in 1.37 years in HK cohort. Quantile clustering assigned one-third participants as high BPV level, but machine learning methods only assigned 10% to 27%. Quantile clustering is the most stable method (stability index: 0.982 in the SPRINT and 0.948 in the HK cohort) with some levels of clustering similarities (Davies-Bouldin Index: 0.752 and 0.764, respectively). K-means clustering is the most stable across the machine learning algorithms (stability index: 0.975 and 0.911, respectively) with the lowest clustering similarities (Davies-Bouldin Index: 0.653 and 0.680, respectively). One out of 7 in the population was classified with high BPV level, who showed to have higher risk of stroke and heart failure. Machine learning methods can improve BPV classification for better prediction of cardiovascular diseases.
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http://dx.doi.org/10.1161/HYPERTENSIONAHA.119.14213DOI Listing
August 2020

Remote assessment via video evaluation (RAVVE): a pilot study to trial video-enabled peer feedback on clinical performance.

BMC Med Educ 2019 Dec 18;19(1):466. Epub 2019 Dec 18.

Centre for Health Education Scholarship, Department of Medicine, Faculty of Medicine, University of British Columbia, P.A. Woodward Instructional Resources Centre, 429 - 2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada.

Background: Video review processes for evaluation and coaching are often incorporated into medical education as a means to accurately capture physician-patient interactions. Compared to direct observation they offer the advantage of overcoming many logistical challenges. However, the suitability and viability of using video-based peer consultations for professional development requires further investigation. This study aims to explore the acceptability and feasibility of video-based peer feedback to support professional development and quality improvement in patient care.

Methods: Five rheumatologists each provided four videos of patient consultations. Peers evaluated the videos using five-point scales, providing annotations in the video recordings, and offering recommendations. The rheumatologists reviewed the videos of their own four patient interactions along with the feedback. They were asked to document if they would make practice changes based on the feedback. Focus groups were conducted and analysed to explore the effectiveness of video-based peer feedback in assisting physicians to improve clinical practice.

Results: Participants felt the video-based feedback provided accurate and detailed information in a more convenient, less intrusive manner than direct observation. Observations made through video review enabled participants to evaluate more detailed information than a chart review alone. Participants believed that reviewing recorded consultations allowed them to reflect on their practice and gain insight into alternative communication methods.

Conclusions: Video-based peer feedback and self-review of clinical performance is an acceptable and pragmatic approach to support professional development and improve clinical care among peer clinicians. Further investigation into the effectiveness of this approach is needed.
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http://dx.doi.org/10.1186/s12909-019-1905-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6921528PMC
December 2019

The Use of eHealth Applications in Hong Kong: Results of a Random-Digit Dialing Survey.

J Med Syst 2019 Jul 23;43(9):293. Epub 2019 Jul 23.

School of Nursing, Hong Kong Sanatorium & Hospital, Happy Valley, Hong Kong.

eHealth has become popular worldwide, and it is transforming health care. However, studies examining  the use of eHealth applications in the Chinese population are scarce. The study reports on the characteristics of eHealth applications in Hong Kong information and communication technology (ICT) users, their attitudes towards eHealth, and their reasons for not using eHealth applications. A cross-sectional random-digit dialing survey targeting adults using ICT was conducted in Hong Kong to elicit information on respondents' use of and attitudes towards eHealth. A total of 495 ICT users completed the survey, of whom 353 (71.3%) were eHealth users. A smartphone was the most frequent way of performing eHealth activities (71.7%). The most prevalent eHealth activity was reading about health/illness (86.4%), with 93.5% indicating that eHealth applications improved their understanding of health care issues. People with less education were less likely to use eHealth applications. Non-eHealth users indicated that the main reasons for not using eHealth applications were lack of interest in health information (49.3%) and lack of confidence in the reliability of online information (45.1%). Quality monitoring of health information available on ICTs and tailoring the design and readability are recommended to meet the needs of those seeking health resources and to promote eHealth. Evidence from the study demonstrates the potential of eHealth to improve the dissemination of health information in Hong Kong, and it provides a basis for improving eHealth integration.
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http://dx.doi.org/10.1007/s10916-019-1422-2DOI Listing
July 2019

Knowledge to action framework for home health monitoring.

Healthc Manage Forum 2019 Jul;32(4):183-187

2 Department of Emergency Medicine, UBC Faculty of Medicine.

Chronic disease management is a grand challenge, both to the patients for optimal management and to the overall health system with cost utilization. Emerging research evidence suggests that Home Health Monitoring (HHM) using home-based, remoting monitoring technologies can improve the patients' quality of life, self-management, and achieve cost-effectiveness for the health system. How should HHM be introduced and integrated appropriately into the current healthcare delivery pathways to improve patient care and collect evidence of benefits simultaneously? The Knowledge to Action (KTA) framework is an effective approach in the implementation science literature to methodically guide the translation of evidence-based research findings into practice, putting knowledge into practical use. This article examines the use of the seven-step KTA model to address implementation facilitators and barriers of applying HHM in chronic disease management and then focus on its applicability on chronic obstructive pulmonary disease as an example.
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http://dx.doi.org/10.1177/0840470419855364DOI Listing
July 2019

Process and findings informing the development of a provincial emergency medicine network.

Healthc Manage Forum 2019 Sep 9;32(5):253-258. Epub 2019 Jun 9.

1 Department of Emergency Medicine, University of British Columbia, BC Emergency Medicine Network, Vancouver, British Columbia, Canada.

We describe the process undertaken to inform the development of the recently launched British Columbia (BC) Emergency Medicine Network (EM Network). Five methods were undertaken: (1) a scoping literature review, (2) a survey of BC emergency practitioners and EM residents, (3) key informant interviews, (4) focus groups in sites across BC, and (5) establishment of a brand identity. There were 208 survey respondents: 84% reported consulting Internet resources once or more per emergency department shift; however, 26% reported feeling neutral, somewhat unsatisfied, or very unsatisfied with searching for information on the Internet to support their practice. Enthusiasm was expressed for envisioned EM Network resources, and the key informant interviews and focus group results helped identify and refine key desired components of the EM Network. In describing this, we provide guidance and lessons learned for health leaders and others who aspire to establish similar clinical networks, whether in EM or other medical disciplines.
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http://dx.doi.org/10.1177/0840470419844276DOI Listing
September 2019

Canadian Validation of German Medical Emergency Datasets.

Stud Health Technol Inform 2019 ;257:212-217

University Hospital Muenster, Germany.

Medical Emergency Datasets (MEDs) are brief summarizations of an individual's medical history, providing vital patient information to emergency medical providers. A recent German study [1] evaluated whether MEDs are useful to local emergency physicians and paramedics, and which health data were relevant to their medical management. To validate of the German study internationally, Canadian physicians and paramedics were recruited to provide feedback on the utility of the German MEDs as well as their specific content. Original documents and surveys were translated to English directly, with a goal of collecting quantitative and qualitative feedback. Overall, physicians and paramedics found the MEDs to be useful in their evaluation of hypothetical medical scenarios. Most of the MED content was very useful, with some items appearing extraneous. The findings of this study will be used to inform future development of MEDs as well as to drive future research.
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August 2019

Let's Talk About B: Barriers to Hepatitis B Screening and Vaccination Among Asian and South Asian Immigrants in British Columbia.

J Racial Ethn Health Disparities 2018 12 19;5(6):1337-1345. Epub 2018 Mar 19.

Digital Emergency Medicine, Department of Emergency Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.

Introduction: Chronic hepatitis B (HBV) is prevalent among Asian immigrants in Canada with high morbidity and mortality rates. While some studies have identified barriers to health care and information access, few have studied the impact of culturally relevant information and addressed challenges with recommendations for effective public education and outreach programs.

Methods: Culturally tailored HBV education workshops were delivered over a 12-month period to Chinese, Filipino, Korean and Punjabi immigrants in Lower Mainland, British Columbia (BC). Data from pre- and post-workshop surveys and 2-week and 1-month follow-up interviews were collected and analyzed to evaluate knowledge gaps and challenges around HBV prevention and screening. Barriers, health care service gaps and facilitators identified in the interviews were coded and analyzed.

Results: Data were collected from 827 workshop participants. Our results show that targeted immigrants in Lower Mainland, BC face many barriers to accessing HBV screening and vaccination. Limited knowledge and awareness of HBV vaccination/prevention/treatment, limited English proficiency and eLiteracy skills, system and provider level barriers to accessing HBV care, and immigration related barriers are among the reported challenges. More than half of participants who took part in the HBV education workshops engaged in actions related to HBV prevention or management.

Conclusion: Study findings support the need for culturally tailored HBV public education and outreach programs to further advance HBV immunization and awareness in BC. Addressing barriers and developing targeted programmatic strategies identified in this study will promote more effective HBV education programming and improve uptake of HBV screening and vaccination in BC's immigrant populations.
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http://dx.doi.org/10.1007/s40615-018-0483-0DOI Listing
December 2018

The British Columbia Emergency Medicine Network: A Paradigm Shift in a Provincial System of Emergency Care.

Cureus 2018 Jan 4;10(1):e2022. Epub 2018 Jan 4.

Department of Emergency Medicine, University of British Columbia.

As generalists, emergency practitioners face challenges in providing state-of-the-art care owing to the broad spectrum of practice and the rapid rate of new knowledge generation. Networks have become increasingly prevalent in health care, and it was in this backdrop, and the resulting opportunity to advance evidence-informed emergency care in the Canadian province of British Columbia (BC), that a new "Emergency Medicine Network" (EM Network) was launched in 2017. The EM Network consists of four programs, each led by a physician with expertise and a track record in the domain: (1) Clinical Resources; (2) Innovation; (3) Continuing Professional Development; and (4) Real-time Support. This paper provides an overview of the EM Network, including its background, purpose, programs, anticipated evolution, and impact on the BC health care system.
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http://dx.doi.org/10.7759/cureus.2022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5837260PMC
January 2018

Clinical Texting Among Medical Trainees of the University of British Columbia [Formula: see text].

J Cutan Med Surg 2018 Jul/Aug;22(4):384-389. Epub 2018 Feb 7.

5 Department of Dermatology and Skin Science, University of British Columbia, Vancouver, BC, Canada.

We believe cellphone text messages are commonly used in medical practice whether in rural or urban settings and that clinical photos are often attached to them. Our interest is the use of this technology to provide dermatology service to rural and remote British Columbia. Concern has been expressed about the security of confidential information and adequacy of privacy protection in such an application. We have found little published information about the extent of texting in rural and remote settings (and none in our jurisdiction) or the number and nature of privacy breaches that have actually occurred as a result. To obtain such information, we first set out to survey medical practitioners about their actual use. The results reported here are from medical trainees enrolled with the University of British Columbia who are in both rural and urban settings.
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http://dx.doi.org/10.1177/1203475418758292DOI Listing
December 2018

Engaging patients as partners in health research: Lessons from BC, Canada.

Healthc Manage Forum 2018 Mar 1;31(2):41-44. Epub 2018 Feb 1.

2 BC SUPPORT Unit, Vancouver, British Columbia, Canada.

Canada is seeing increased interest in engaging patients in health research, recognizing the potential to improve its relevance and quality. The momentum is promising, but there may be a tendency to ignore the challenges inherent when lay people and professionals collaborate. We address some of these challenges as they relate to recruitment, training, and support for patients at the British Columbia (BC) Support for People and Patient-Oriented Research Unit, part of Canada's Strategy for Patient-Oriented Research. A retrospective review of a telehealth project demonstrates that, as well as the practical elements of recruitment, training, and support, attention must be paid to issues of credibility, legitimacy, and power when engaging patients. We propose that all patient-oriented research projects would benefit from using a similar framework to guide patient engagement planning and implementation, helping to anticipate and mitigate challenges from the outset. Projects would ideally also include the study of patient engagement methods, to add to this important body of knowledge.
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http://dx.doi.org/10.1177/0840470417741712DOI Listing
March 2018

Preferred Features of E-Mental Health Programs for Prevention of Major Depression in Male Workers: Results from a Canadian National Survey.

Stud Health Technol Inform 2017 ;245:249-252

Digital Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada.

The purpose of this study was to estimate and compare the proportions of preferred design features and likely use of e-mental health programs and understand potential barriers to the use of e-mental health programs in working men who were at high risk of a major depressive episode. A cross-sectional survey in 10 provinces in Canada was conducted between March and December 2015 (n = 511). Of the 17 different features assessed, the top three features that were most likely to be used by high-risk men were: "information about improving sleep hygiene" (61.3%), "practice and exercise to help reduce symptoms of stress and depression" (59.5%) and "having access to quality information and resources about work stress issues" (57.8%). E-mental health programs may be a promising strategy for prevention of depression in working men. Development of e-mental health programs should consider men's preferences and perceived barriers to enhance the acceptability of this approach.
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June 2018

Attitudes of Health Professional Educators Toward the Use of Social Media as a Teaching Tool: Global Cross-Sectional Study.

JMIR Med Educ 2017 Aug 4;3(2):e13. Epub 2017 Aug 4.

Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.

Background: The use of social media in health education has witnessed a revolution within the past decade. Students have already adopted social media informally to share information and supplement their lecture-based learning. Although studies show comparable efficacy and improved engagement when social media is used as a teaching tool, broad-based adoption has been slow and the data on barriers to uptake have not been well documented.

Objective: The objective of this study was to assess attitudes of health educators toward social media use in education, examine differences between faculty members who do and do not use social media in teaching practice, and determine contributing factors for an increase in the uptake of social media.

Methods: A cross-sectional Web-based survey was disseminated to the faculty of health professional education departments at 8 global institutions. Respondents were categorized based on the frequency of social media use in teaching as "users" and "nonusers." Users sometimes, often, or always used social media, whereas nonusers never or rarely used social media.

Results: A total of 270 health educators (52.9%, n=143 users and 47.0%, n=127 nonusers) were included in the survey. Users and nonusers demonstrated significant differences on perceived barriers and potential benefits to the use of social media. Users were more motivated by learner satisfaction and deterred by lack of technology compatibility, whereas nonusers reported the need for departmental and skill development support. Both shared concerns of professionalism and lack of evidence showing enhanced learning.

Conclusions: The majority of educators are open-minded to incorporating social media into their teaching practice. However, both users and nonusers have unique perceived challenges and needs, and engaging them to adapt social media into their educational practice will require previously unreported approaches. Identification of these differences and areas of overlap presents opportunities to determine a strategy to increase adoption.
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http://dx.doi.org/10.2196/mededu.6429DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5562930PMC
August 2017

Designing a Surveillance System in Canada to Detect Adverse Interactions Between Traditional Chinese Medicine and Western Medicine: Issues and Considerations.

Stud Health Technol Inform 2017 ;234:412-417

Digital Emergency Medicine, Department of Emergency Medicine, Faculty of Medicine, University of British Columbia.

The use of Chinese medicinal materials (CMM) in the context of Traditional Chinese Medicine (TCM) is increasingly prevalent in Canada and worldwide. Self-medication with CMM and concurrent usage with Western medicine are also common. While taking CMM carries recognized risk of adverse effects on their own, their interactions with Western medicine can further generate additional adverse effects but are largely underestimated and undetected due to under-reporting. This is especially true in Canada and other Western countries where CMM is regulated as natural products. Currently worldwide, surveillance of CMM is variable and primarily through spontaneous and voluntary reporting systems. Current approaches in the Western world, including Canada, are by-and-large ineffective in detecting CMM-Western medicine adverse interactions. We propose the development of a Canadian surveillance system for CMM usage that involves both health professionals and patients so as to increase detection of potential adverse reactions and improve safety. As a first step, we will carry out surveys and focus groups with the stakeholder groups to identify desirable features of such a surveillance system as important ground work.
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June 2018

Social Media in Health Science Education: An International Survey.

JMIR Med Educ 2017 Jan 4;3(1):e1. Epub 2017 Jan 4.

School of Medicine, University College Dublin, Dublin, Ireland.

Background: Social media is an asset that higher education students can use for an array of purposes. Studies have shown the merits of social media use in educational settings; however, its adoption in health science education has been slow, and the contributing reasons remain unclear.

Objective: This multidisciplinary study aimed to examine health science students' opinions on the use of social media in health science education and identify factors that may discourage its use.

Methods: Data were collected from the Universitas 21 "Use of social media in health education" survey, distributed electronically among the health science staff and students from 8 universities in 7 countries. The 1640 student respondents were grouped as users or nonusers based on their reported frequency of social media use in their education.

Results: Of the 1640 respondents, 1343 (81.89%) use social media in their education. Only 462 of the 1320 (35.00%) respondents have received specific social media training, and of those who have not, the majority (64.9%, 608/936) would like the opportunity. Users and nonusers reported the same 3 factors as the top barriers to their use of social media: uncertainty on policies, concerns about professionalism, and lack of support from the department. Nonusers reported all the barriers more frequently and almost half of nonusers reported not knowing how to incorporate social media into their learning. Among users, more than one fifth (20.5%, 50/243) of students who use social media "almost always" reported sharing clinical images without explicit permission.

Conclusions: Our global, interdisciplinary study demonstrates that a significant number of students across all health science disciplines self-reported sharing clinical images inappropriately, and thus request the need for policies and training specific to social media use in health science education.
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http://dx.doi.org/10.2196/mededu.6304DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5244031PMC
January 2017

Facilitators of and barriers to accessing clinical prevention services for the South Asian population in Surrey, British Columbia: a qualitative study.

CMAJ Open 2016 Jul-Sep;4(3):E390-E397. Epub 2016 Aug 18.

MPH practicum student, Fraser Health Authority, Surrey, BC, and MPH candidate, University of Waterloo (Majid), Waterloo, Ont.; Population Health Observatory (Douglas), Fraser Health Authority, Surrey, BC; Fraser Health Authority (Lee), Surrey, BC; Digital Emergency Medicine (Stacy, Ho) and Department of Emergency Medicine (Ho), Faculty of Medicine, University of British Columbia, and the University of British Columbia P.A. Woodward Instructional Resources Centre (Stacy, Ho), Vancouver, BC; South Asian Health Institute, Fraser Health Authority and Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia (Garg), New Westminster, BC.

Background: British Columbia falls short in uptake of recommended clinical prevention services, with even lower rates among immigrant populations. This study explored facilitators of and barriers to uptake of clinical prevention services among people from South Asia, who represent 31% of the population in Surrey, British Columbia.

Methods: We used a qualitative descriptive approach and employed vignettes in a focus group setting to elicit perspectives of South Asian people on accessing clinical prevention services. Participants aged 40 years or more were recruited between October 2014 and February 2015 from health care and community settings such as older-adult housing, day programs and health education events. Letters of introduction to the study were provided in English or Punjabi or both to all potential participants. We conducted qualitative content analysis of the results.

Results: Sixty-two South Asian adults (36 women and 26 men) aged 40-87 years participated in 1 of 8 focus groups in health care or community settings. Facilitators of and barriers to accessing clinical prevention services were noted at the patient, primary care provider and health care system levels. Facilitators at the patient level included taking ownership over one's health, health literacy and respecting the provider's advice; barriers included fear of the diagnosis, death and/or procedures, perceived low risk of disease or utility of the intervention, and side effects of procedures. Provider factors centred on a trust-based patient-provider relationship, strong communication and adequate time during visits. Health care system factors included such facilitators as processes to routinely offer prevention services as part of other health care or social services, systems that encourage prevention-oriented family practice and services at low or no cost to the patient.

Interpretation: Our findings validate previously identified facilitators of and barriers to accessing preventive care for immigrant populations. However, the results suggest that system-level factors influencing the duration of primary care visits may have a more salient impact on uptake of clinical prevention services in this population.
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http://dx.doi.org/10.9778/cmajo.20150142DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5143023PMC
August 2016

The Effects of an E-Mental Health Program and Job Coaching on the Risk of Major Depression and Productivity in Canadian Male Workers: Protocol for a Randomized Controlled Trial.

JMIR Res Protoc 2016 Nov 15;5(4):e218. Epub 2016 Nov 15.

Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.

Background: Major depression (MDE) is prevalent in men and affects men's health and productivity. Because of the stigma against depression and social/gender norms, men are less likely to seek help for emotion and stress-related issues. Therefore, innovative solutions tailored for men are needed. With rapid development of the Internet and information technologies, one promising solution that has drawn considerable attentions is electronic mental (e-mental) health programs and services.

Objective: The objective of our study is to evaluate the effectiveness of the e-mental health program BroHealth on reducing the risk of having MDE and improving productivity and return to investment.

Methods: The target population is Canadian working men who are at high risk of having MDE (N=1200). Participants will be recruited using the method of random digit dialing across the country and workplace advertisement. Eligible participants will be randomly allocated into the following groups: (1) a control group, (2) a group receiving BroHealth only, and (3) a group receiving BroHealth and telephone-based job coaching service. The groups will be assessed at 6 and 12 months after randomization. The primary outcome is the risk proportion of MDE over 12 months, which will be assessed by the World Health Organization's (WHO's) Composite International Diagnostic Interview-Short Form for Major Depression. Intention-to-treat principle will be used in the analysis. The 12-month proportions of MDE in the groups will be estimated and compared. Logistic regression modeling will be used to examine the effect of the intervention on the outcome, controlling for the effects of baseline confounders.

Results: It is anticipated that the randomized controlled trial (RCT) will be completed by 2018. This study has been approved by the Conjoint Health Research Ethics Review Board of the University of Calgary. The trial is funded by a team grant from the Movember Foundation, a global charity for men's health. BroHealth was developed at the Digital Emergency Medicine, University of British Columbia, and the usability testing has been completed.

Conclusions: BroHealth was developed based on men's needs. We hypothesized that BroHealth will be an effective, acceptable, and sustainable product for early prevention of MDE in workplaces.

Clinicaltrial: Clinicaltrials.gov NCT02777112; https://clinicaltrials.gov/ct2/show/NCT02777112 (Archived by WebCite at http://www.webcitation.org/6lbOQpiCG).
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http://dx.doi.org/10.2196/resprot.6350DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5128721PMC
November 2016

Applying the Resilient Health System Framework for Universal Health Coverage.

Stud Health Technol Inform 2016 ;231:54-62

Department of Electrical and Computer Engineering, McMaster University, Canada.

Since the 1978 Declaration of Alma-Ata affirming health as a fundamental human right, policy-makers and stakeholders have proposed many different strategies to achieve the goal of 'health for all'. However, globally there still remains a lack of access to health information and quality health care, especially in low- and middle-income countries (LMIC). Digital health holds great promise to improve access and quality of care. We propose using the "resilient health system framework" as a guide to scale-up digital health as a means to achieve universal health care (UHC) and health for all. This article serves as a call to action for all governments to include population-based digital health tools as a foundational element in on-going health system priorities and service delivery.
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March 2018

Emergency Data Management - Overcoming (Information) Borders.

Stud Health Technol Inform 2016 ;231:18-22

University Hospital Muenster, Germany.

Background: In order to improve access to critical patient data in case of emergency, many countries have begun or intend to implement emergency datasets. In Germany, the German Medical Association developed a medical emergency dataset (MED), which provides the possibility to store information on prior diagnoses, medications, allergies and other emergency-relevant information on the German Electronic Health Card.

Objectives: The aim of the study is to evaluate how the MED can be used internationally.

Methods: A total of 64 paper-based emergency data sets were completed by primary care physicians in Germany, and were then evaluated by German clinicians, emergency physicians, and paramedics on the basis of fictitious emergency scenarios. Thirty randomly selected MEDs were then translated into English and will be evaluated by international emergency physicians and paramedics.

Results: In Germany, clinicians, emergency physicians and paramedics rated the emergency data set as very useful or useful in more than 70% of the reviewed cases. The international evaluation will start in September 2016, so these results are pending at this time.

Conclusion: The first study results from Germany indicate high potential benefits of the emergency data set in real patient care situations. The subsequent tests will show whether the MED is also suitable for international use.
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March 2018

Preferred Features of E-Mental Health Programs for Prevention of Major Depression in Male Workers: Results From a Canadian National Survey.

J Med Internet Res 2016 06 6;18(6):e132. Epub 2016 Jun 6.

Department of Psychiatry, University of Calgary, Calgary, AB, Canada.

Background: Major depression is a prevalent mental disorder and imposes considerable burden on health and productivity. Men are not immune to major depression, yet they often delay seeking help because of perceived stigma and gender norms. E-mental health programs hold potential for early prevention of major depression. However, we have little knowledge about men's preferences for design features of e-mental health programs.

Objectives: The objective of this study was to (1) estimate and compare the proportions of Internet use for medical information, preferred design features, and likely use of e-mental health programs; (2) examine factors associated with the likely use of e-mental health programs; and (3) understand potential barriers to the use of e-mental health programs among Canadian working men, who were at high risk of a major depressive episode (MDE).

Methods: A cross-sectional survey in 10 Canadian provinces was conducted between March and December 2015. Random digit dialing method was used through household landlines and cell phones to collect data from 511 working men who were at high risk of having an MDE and 330 working men who were at low risk of having an MDE.

Results: High-risk men were more likely to endorse the importance of accessing health resources on the Internet than low-risk men (83.4% vs 75.0%, respectively; P=.01). Of the 17 different features assessed, the top three features most likely to be used by high-risk men were: "information about improving sleep hygiene" (61.3%), "practice and exercise to help reduce symptoms of stress and depression" (59.5%), and "having access to quality information and resources about work stress issues" (57.8%). Compared with men at low risk for MDE, men at high risk for MDE were much more likely to consider using almost every one of the different design features. Differences in preferences for the design features by age among men at high risk of MDE were found only for 3 of 17 features. Differences in preferences for design features between English- and French-speaking participants were found only for 4 out of the 17 features. Analysis of qualitative data revealed that privacy issues, perceived stigma, ease of navigation, personal relevance, and lack of personal interaction, time, and knowledge were identified as barriers to the use of e-mental health programs in working men who were at high risk of MDE.

Conclusion: E-mental health programs may be a promising strategy for prevention of depression in working men. Development of e-mental health programs should consider men's preferences and perceived barriers to enhance the acceptability of this approach.
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http://dx.doi.org/10.2196/jmir.5685DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4914776PMC
June 2016

Speed and accuracy of mobile BlackBerry Messenger to transmit chest radiography images from a small community emergency department to a geographically remote referral center.

J Telemed Telecare 2016 Jun 21;22(4):244-51. Epub 2015 Jul 21.

University of British Columbia, Vancouver, BC, Canada Department of Emergency Medicine, Vancouver General Hospital, Canada.

Background: Small emergency departments (EDs) may rely on radiologists at remote centers for interpretations of chest radiographs (CXRs). We investigated systematic transmission of CXR images from a small ED to a geographically remote referral center using the mobile BlackBerry Messenger (BBM) application.

Methods: Investigators obtained de-identified CXR images of consecutive ED patients via mobile phone camera. Each CXR image, along with a brief clinical history, was sent via BBM to an emergency physician located at a remote referral site, and the receiving physician replied via BBM to confirm reception. All communications, image generation, and image analysis was conducted on mobile phones. The primary outcome was the proportion of BBMs received within two minutes of sending; the secondary outcome was the proportion of BBM replies to the sending physician within five minutes. Image accuracy-comparing the radiologist's interpretation with the receiving emergency physician's interpretation-was estimated using predefined criteria.

Results: Of 1281 consecutive ED patients, 231 (18.0 %) had CXRs obtained, 320 CXRs were analyzed and 611 BBMs sent. All BBMs (100.0%, 95% confidence interval (CI) 99.4-00.0) arrived within two minutes; 595 BBMs (97.4%, 95% CI 95.8-98.4) were replied to within five minutes. Of the 58 CXRs with abnormalities requiring intervention, there were 55 concordances (overall agreement 94.2%, 95% CI 85.9-98.3; kappa 0.95, 95% CI 0.89-1.0) CONCLUSION: Systematic transmission of CXR images from a small ED to a remote large center using mobile phones may be a safe and effective strategy to rapidly communicate important patient information.
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http://dx.doi.org/10.1177/1357633X15595734DOI Listing
June 2016

Speed and accuracy of text-messaging emergency department electrocardiograms from a small community hospital to a provincial referral center.

J Telemed Telecare 2016 Mar 29;22(2):105-13. Epub 2015 May 29.

Department of Emergency Medicine, Vancouver General Hospital, Canada.

Background: Currently, transmission of electrocardiograms (EKGs) from a small emergency department (ED) to specialists at referral hospitals can be a time-consuming and laborious process. We investigate whether text messaging by use of short message service (SMS) of EKGs from a small hospital to consultants at a large hospital is rapid and accurate.

Methods: This study involved a one-month prospective evaluation of consecutive EKGs recorded in a small community ED. Investigators obtained de-identified photographs of each EKG via a mobile phone camera. Each EKG picture, along with a brief patient clinical history, was sent via SMS to on-call emergency physicians located at a large referral care site. All images were evaluated solely on a mobile phone. The primary outcome was the proportion of SMS that were received within two minutes of being sent. As a secondary outcome, the intra-rater evaluation of the initial EKG and the SMS EKG image were compared on 13 standardized features. The tertiary outcome was cost of text messaging.

Results: A total of 298 patients (14.6%) had 409 EKGs performed and a total of 926 SMS were sent. 921 SMS (99.5%, 95% confidence interval (CI) 98.7-99.8%) arrived within two minutes with a median transmission time of nine seconds (interquartile range (IQR) 3-32 s). Between the gold standard original EKG, and the interpretation of the texted image, six out of 409 (1.5%, 95% CI 0.6-3.3%) had any differences recorded, across all 13 categories. Overall, the study cost 4.1 cents per texted image.

Conclusions: Systematic text messaging of ED EKGs from a small community hospital to a referral center is a rapid, accurate, portable, and inexpensive method of data transfer. This may be a safe and effective strategy to communicate vital patient information.
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http://dx.doi.org/10.1177/1357633X15587626DOI Listing
March 2016

Advancing social media in medical education.

CMAJ 2015 May 7;187(8):549-550. Epub 2015 Apr 7.

Faculty of Medicine (Davis), University of British Columbia; Department of Emergency Medicine, and eHealth Strategy Office (Ho), Faculty of Medicine, University of British Columbia; Vancouver, BC; UCD School of Medicine and Medical Science (Last), University College Dublin, Dublin, Ireland.

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http://dx.doi.org/10.1503/cmaj.141417DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4435861PMC
May 2015