Publications by authors named "Noori Akhtar-Danesh"

119 Publications

Wait times in the management of non-small cell lung carcinoma before, during and after regionalization of lung cancer care: a high-resolution analysis.

Can J Surg 2021 Mar 26;64(2):E218-E227. Epub 2021 Mar 26.

From the School of Medicine, University of Toronto, Toronto, Ont. (Shakeel, Dhanoa, Khan, Dibajnia, Behzadi); the Department of Oncology, Trillium Health Partners, Mississauga, Ont. (Dibajnia, Behzadi); the Department of Medicine, Health Sciences North, Sudbury, Ont. (Dibajnia); the Northern Ontario School of Medicine, Laurentian University, Sudbury, Ont. (Dibajnia); the School of Nursing, McMaster University, Hamilton, Ont. (Akhtar-Danesh); and the Department of Surgery, University of Toronto, Toronto, Ont. (Behzadi).

Background: Timeliness can have a substantial effect on treatment outcomes, prognosis and quality of life for patients with lung cancer. We sought to evaluate changes in wait times for patients with non-small cell lung carcinoma (NSCLC) and to identify bottlenecks in cancer care.

Methods: We included patients who received treatment with curative intent or palliative treatment for NSCLC, diagnosed through mediastinal staging by a thoracic surgeon. Data were collected from 3 cohorts over 3 time periods: before the regionalization of lung cancer care (2005-2007, C1), immediately postregionalization (2011-2013, C2) and 5 years after regionalization (2016-2017, C3). Total wait time and delays along treatment pathways were compared across cohorts using multivariate Cox proportionality models.

Results: Our total sample size was 299 patients. Overall, there was no significant difference in total wait time among the 3 cohorts. However, wait time from symptom onset to first physician visit significantly increased in C3 compared with C2 (hazard ratio [HR] 0.41, p < 0.01) and C1 (HR 0.43, p < 0.01). Time from first physician visit to computed tomography (CT) scan significantly decreased in C3 compared with C2 (HR 1.54, p < 0.01). Time from abnormal CT scan to first surgeon visit also significantly decreased in C2 (HR 1.43, p < 0.01) and C3 (HR 4.47, p < 0.01) compared with C1, and between C3 and C2 (HR 2.67, p < 0.01). In contrast, time from first surgeon visit to completion of staging significantly increased in C2 (HR 0.36, p < 0.01) and C3 (HR 0.24, p < 0.01) compared with C1, as well as between C3 and C2 (HR 0.60, p < 0.01). Time to first treatment after completion of staging was significantly shorter for C3 than C1 (HR 1.58, p < 0.01).

Conclusion: Trends toward a reduction in wait time are evident 5 years after the regionalization of lung cancer care, primarily led by shorter wait times for CT scans and thoracic surgeon consults. However, wait times can further be reduced by addressing delays in staging completion and patient and provider education to identify the early signs of NSCLC.
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http://dx.doi.org/10.1503/cjs.013319DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8064257PMC
March 2021

Efficacy of Early (≤ 24 Hours), Late (25-72 Hours), and Delayed (>72 Hours) Surgery with Magnetic Resonance Imaging-Confirmed Decompression in American Spinal Injury Association Impairment Scale Grades C and D Acute Traumatic Central Cord Syndrome Caused by Spinal Stenosis.

J Neurotrauma 2021 Apr 6. Epub 2021 Apr 6.

Department of Neurosurgery and University of Maryland School of Medicine, Baltimore, Maryland, USA.

The therapeutic significance of timing of decompression in acute traumatic central cord syndrome (ATCCS) caused by spinal stenosis remains unsettled. We retrospectively examined a homogenous cohort of patients with ATCCS and magnetic resonance imaging (MRI) evidence of post-treatment spinal cord decompression to determine whether timing of decompression played a significant role in American Spinal Injury Association (ASIA) motor score (AMS) 6 months following trauma. We used the test, analysis of variance, Pearson correlation coefficient, and multiple regression for statistical analysis. During a 19-year period, 101 patients with ATCCS, admission ASIA Impairment Scale (AIS) grades C and D, and an admission AMS of ≤95 were surgically decompressed. Twenty-four of 101 patients had an AIS grade C injury. Eighty-two patients were males, the mean age of patients was 57.9 years, and 69 patients had had a fall. AMS at admission was 68.3 (standard deviation [SD] 23.4); upper extremities (UE) 28.6 (SD 14.7), and lower extremities (LE) 41.0 (SD 12.7). AMS at the latest follow-up was 93.1 (SD 12.8), UE 45.4 (SD 7.6), and LE 47.9 (SD 6.6). Mean number of stenotic segments was 2.8, mean canal compromise was 38.6% (SD 8.7%), and mean intramedullary lesion length (IMLL) was 23 mm (SD 11). Thirty-six of 101 patients had decompression within 24 h, 38 patients had decompression between 25 and 72 h, and 27 patients had decompression >72 h after injury. Demographics, etiology, AMS, AIS grade, morphometry, lesion length, surgical technique, steroid protocol, and follow-up AMS were not statistically different between groups treated at different times. We analyzed the effect size of timing of decompression categorically and in a continuous fashion. There was no significant effect of the timing of decompression on follow-up AMS. Only AMS at admission determined AMS at follow-up (coefficient = 0.31; 95% confidence interval [CI]:0.21;  = 0.001). We conclude that timing of decompression in ATCCS caused by spinal stenosis has little bearing on ultimate AMS at follow-up.
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http://dx.doi.org/10.1089/neu.2021.0040DOI Listing
April 2021

Caring ahead: Mixed methods development of a questionnaire to measure caregiver preparedness for end-of-life with dementia.

Palliat Med 2021 Apr 23;35(4):768-784. Epub 2021 Feb 23.

Faculty of Health Sciences, School of Nursing, McMaster University, Hamilton, ON, Canada.

Background: Family caregivers of persons with dementia often feel unprepared for end-of-life and preparedness predicts caregiver outcomes in bereavement. Existing questionnaires assessing preparedness have limitations. A multi-dimensional questionnaire assessing family caregiver preparedness for the end-of-life of persons with dementia is needed to identify caregivers at risk for negative outcomes in bereavement and evaluate the quality of strategies within a palliative approach.

Aim: To develop a multi-dimensional questionnaire titled 'Caring Ahead' to assess feelings of preparedness for end-of-life in family caregivers of persons with dementia.

Design: A mixed methods, sequential design employed semi-structured interviews, a Delphi-survey and pilot-testing of the questionnaire, June 2018 to July 2019.

Setting/population: Participants included five current and 16 bereaved family caregivers of persons with symptoms advanced dementia from long-term care homes in Ontario, Canada; and 12 professional experts from clinical and academic settings in Canada, Europe, United States.

Results: Interviews generated three core concepts and 114 indicators of preparedness sampling cognitive, affective and behavioural traits in four domains (i.e., medical, psychosocial, spiritual, practical). Indicators were translated and reduced to a pool of 73 potential questionnaire items. 30-items were selected to create the 'Caring Ahead' preparedness questionnaire through a Delphi-survey. Items were revised through a pilot-test with cognitive interviewing.

Conclusions: Family caregivers' feelings of preparedness for end-of-life need to be assessed and the quality of strategies within a palliative approach evaluated. Future psychometric testing of the Caring Ahead questionnaire will evaluate evidence for validity and reliability.
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http://dx.doi.org/10.1177/0269216321994732DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8022086PMC
April 2021

Uptake and survival effects of minimally invasive surgery for lung cancer: A population-based study.

Eur J Surg Oncol 2021 Jan 13. Epub 2021 Jan 13.

Division of Thoracic Surgery, Department of Surgery, McMaster University, Canada.

Introduction: Despite growing evidence supporting the safety of minimally invasive surgery (MIS) in the treatment of lung cancer, its uptake is still variable and its outcomes debated. This study examines the factors associated with MIS uptake and its effects on survival in patients with non-small cell lung cancer (NSCLC).

Methods: All patients in the Canadian province of Ontario with early stage NSCLC (stage I/II) from 2007 to 2017 were included. A logistic regression identified the predictors of MIS uptake, and a flexible parametric model was used to estimate survival rates based on MIS versus open resection.

Results: In total, 8,988 patients underwent surgical resection; 53.6% had MIS. Year of diagnosis was associated with MIS uptake (OR = 1.33, p < 0.001); patients in later years were more likely to receive MIS. Rurality was a significant predictor of MIS, though distance from nearest regional cancer center did not predict MIS utilization. Patients with stage II disease were less likely to receive MIS compared to those with stage I disease (OR = 0.44, p < 0.001). MIS had a significantly higher 5-year survival compared to open resection for stage I and II disease. Patients >70 years had the greatest 5-year survival benefit from MIS.

Conclusions: We observed a substantial long-term survival benefit in patients undergoing MIS for early stage NSCLC. This difference was most pronounced in the oldest age group. These findings support the use of MIS in the treatment of lung cancer and challenge the notion that MIS compromises oncologic outcomes.
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http://dx.doi.org/10.1016/j.ejso.2021.01.002DOI Listing
January 2021

"A Crazy Roller Coaster at the End": A Qualitative Study of Death Preparedness With Caregivers of Persons With Dementia.

SAGE Open Nurs 2020 Jan-Dec;6:2377960820949111. Epub 2020 Aug 25.

School of Nursing, Faculty of Health Sciences, McMaster University.

Introduction: Caregivers of persons with dementia experience challenges that can make preparing for end-of-life particularly difficult. Feeling prepared for death is associated with caregiver well-being in bereavement and is promoted by strategies supporting a palliative approach. Further conceptualization of caregiver preparedness for death of persons with dementia is needed to guide the practice of healthcare providers and to inform development of a preparedness questionnaire.

Objectives: We aimed to: 1) explore the end-of-life experiences of caregivers of persons with dementia to understand factors perceived as influencing preparedness; and 2) identify the core concepts (i.e., components), barriers and facilitators of preparedness for death.

Methods: This study used an interpretive descriptive design. Semi-structured interviews were conducted with sixteen bereaved caregivers of persons with dementia, recruited from long-term care homes in Ontario. Data was analyzed through reflexive thematic analysis.

Findings: Four themes were interpreted including: 'A crazy rollercoaster at the end' which described the journey of caregivers at end-of-life. The journey provided context for the development of core concepts (i.e., components) of preparedness represented by three themes: 'A sense of control, 'Doing right' and 'Coming to terms'.

Conclusion: The study findings serve to expand the conceptualization of preparedness and can guide improvements to practice in long-term care. Core concepts, facilitators and influential factors of preparedness will provide the conceptual basis and content to develop the Caring Ahead: Preparing for End-of-Life with Dementia questionnaire.
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http://dx.doi.org/10.1177/2377960820949111DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7774442PMC
August 2020

Uptake of minimally invasive surgery for early stage colorectal cancer and its effect on survival: A population-based study.

Surg Oncol 2020 Dec 4;35:540-546. Epub 2020 Nov 4.

Division of Thoracic Surgery, Department of Surgery, McMaster University, Canada.

Purpose: The uptake of minimally invasive surgery (MIS) for colorectal cancer (CRC) varies between jurisdictions. We aimed to identify the factors associated with the uptake of MIS for early-stage CRC and its oncologic outcomes in the Canadian province of Ontario.

Methods: This study includes all patients with CRC in Ontario from 2007 to 2017. A logistic regression analysis was used to identify the predictors of MIS and a flexible parametric survival model to estimate survival rates based on MIS versus open surgery.

Results: In total, 14,675 patients with CRC were identified of which 29.5% had MIS resections. The likelihood of undergoing MIS decreased with age, disease stage, and distance to the regional cancer center, and increased with year of diagnosis. The likelihood of mortality for MIS was significantly lower compared to open surgery (p < 0.001). In terms of survival, MIS was most beneficial to older patients with stage II disease, despite their lower likelihood of receiving MIS.

Conclusions: Despite the lower uptake of MIS among older patients and patients with stage II disease, these patients had the greatest long-term survival benefit from MIS. This suggests further use of laparoscopy to patient populations that are often excluded.
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http://dx.doi.org/10.1016/j.suronc.2020.10.017DOI Listing
December 2020

Change in treatment modality and trends in survival among stage I non-small cell lung cancer patients: a population-based study.

J Thorac Dis 2020 Sep;12(9):4670-4679

Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.

Background: A number of treatment modalities are available to patients with early non-small cell lung cancer (NSCLC) but there is inconsistency regarding their effects on survival. The associated survival of each treatment modality is crucial for patients in making informed treatment decisions. We aimed to examine the change in treatment modality and trends in survival for patients with stage I NSCLC and assess the association between treatment modality and survival.

Methods: All patients diagnosed with stage I NSCLC in the Canadian province of Ontario between 2007 and 2015 were included in this population-based study. We used a flexible parametric model to estimate the trends in survival rate.

Results: Overall, 11,910 patients were identified of which 7,478 patients (62.8%) received surgical resection and 2,652 (22.3%) radiation only. The proportion of patients who received radiation only increased from 13.2% in 2007 to 28.0% in 2015 (P-for-trend <0.001). Survival increased for all treatment modalities from 2007 to 2015. The increase in 5-year survival was more than 20% for all surgical groups and more than 35% for radiation-only group.

Conclusions: The survival of patients with stage I NSCLC increased for all treatment modalities over the study period, most distinctly in elderly patients, which coincided with a rise in the use of radiation therapy. While surgical resection was associated with the best chance of 5-year survival, radiation therapy is a safe and effective treatment for medically inoperable patients with early disease.
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http://dx.doi.org/10.21037/jtd-20-1387DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7578458PMC
September 2020

Attitudes, beliefs, and practices among Swiss chiropractors regarding medication prescribing for musculoskeletal conditions: a national Q-methodology study.

Chiropr Man Therap 2020 10 20;28(1):54. Epub 2020 Oct 20.

Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.

Background: Swiss chiropractors have been licensed since 1995 to prescribe from a limited formulary of medications for treating musculoskeletal (MSK) conditions. In January 2018, this formulary was expanded to include additional muscle relaxant, analgesic, and anti-inflammatory medications. Internationally, controversy remains over whether or not medication prescribing should be pursued within the chiropractic profession.

Objective: The purpose of this study was to assess Swiss chiropractors' attitudes, beliefs, and practices regarding their existing medication prescription privileges. This information will provide new insights on the topic and help inform research and policy discussions about expanding chiropractic prescription rights in other jurisdictions.

Methods: A 13-item questionnaire and Q-methodology approach were used to conduct the assessment. Recruitment was conducted by e-mail between December 2019 and February 2020, and all members of the Swiss Chiropractic Association were eligible to participate. Data were analyzed using by-person factor analysis and descriptive statistics.

Results: In total, 187 Swiss chiropractors participated in this study (65.4% response rate). Respondents reported prescribing analgesics, anti-inflammatories, and muscle relaxants to a median of 5, 5, and 0% of patients, respectively. Forty-two percent of respondents expressed interest in further expanding the range of current medications available to Swiss chiropractors for treating MSK conditions. Only 15% expressed interest in expanding this range to include medications for treating non-MSK conditions. In the Q-methodology analysis, four salient viewpoints/groups regarding medication prescribing emerged: prescribers, non-prescribers, collaborators, and integrators. All except non-prescribers thought medication prescription privileges were advantageous for the chiropractic profession in Switzerland. There was also strong consensus among all four groups that medication prescribing should not replace manual therapy in chiropractic practice.

Conclusion: This was the first national survey on attitudes toward prescribing medications among Swiss chiropractors since the year 2000, and the first using Q-methodology. With this approach, four unique groups of chiropractic prescribers were identified. Even with diversity among clinicians, the findings of this study showed general support for, along with conservative use of, prescribing privileges within the Swiss chiropractic profession. Studies in jurisdictions outside of Switzerland are needed to assess whether chiropractors are interested in expanding their scopes of practice to include similar prescribing privileges.
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http://dx.doi.org/10.1186/s12998-020-00341-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7574492PMC
October 2020

Attitudes, beliefs, and practices regarding medication prescribing for musculoskeletal conditions: a protocol for a national Q-methodology study of Swiss chiropractors.

J Can Chiropr Assoc 2020 Aug;64(2):119-130

School of Nursing, McMaster University.

Background: Since 1995, chiropractors in Switzerland have been licensed to prescribe medications for treating musculoskeletal conditions. However, controversy remains over whether or not medication prescribing should be pursued within the chiropractic profession internationally.

Objective: To assess Swiss chiropractors' attitudes, beliefs, and practices regarding their existing medication prescription privileges.

Methods: A Q-methodology approach will be used to collect data for the assessment. In addition, scope expansion and frequency of prescribing by Swiss chiropractors will be queried using a 13-item questionnaire. Recruitment will be conducted by e-mail and all members of the Swiss Chiropractic Association will be eligible to participate. Data will be analyzed using by-person factor analysis and descriptive statistics.

Discussion: This will be the first national update on attitudes toward prescribing medications among Swiss chiropractors since 2003, and the first using Q-methodology. The results of this study are important as they will inform future directions and research regarding chiropractic prescription rights.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7500235PMC
August 2020

Screening and Intervention Practices for Alcohol Use by Pregnant Women and Women of Childbearing Age: Results of a Canadian Survey.

J Obstet Gynaecol Can 2020 Sep 19;42(9):1121-1128. Epub 2020 Jul 19.

The Society of Obstetricians and Gynaecologists of Canada, Ottawa, ON. Electronic address:

Objective: To determine health care providers' familiarity with and use of the Society of Obstetricians and Gynaecologists of Canada's (SOGC's) 2010 Alcohol Use and Pregnancy Consensus Clinical Guidelines and to identify barriers and enablers that affected guideline uptake.

Methods: We conducted an online pan-Canadian survey of midwives, obstetricians, family physicians, and nurses. The survey was divided into five sections: knowledge, SOGC guidelines, screening and intervention practices, attitudes and beliefs, and demographic information.

Results: Just over half of the 588 respondents who provided care to pregnant women or to women of childbearing age were familiar with and used the guidelines. Most respondents screened for alcohol use by asking women about alcohol consumption, but relatively few used a screening questionnaire. Approximately two-thirds of respondents provided brief intervention and referral to harm reduction or treatment services. Enablers of guideline adherence included knowledge about the risks of alcohol in pregnancy, perceived responsibility to identify and address at-risk drinking, and a belief that women are motivated to reduce their alcohol consumption if pregnant or planning to become pregnant. Lack of confidence in ability to use screening questionnaires and to provide brief intervention, as well as a lack of belief in the effectiveness of both practices, were barriers to use.

Conclusion: Strategies are needed to improve familiarity with and uptake of the Alcohol Use and Pregnancy Consensus Clinical Guidelines. Particular attention should be given to education and training regarding the use of validated screening questionnaires and brief intervention practices.
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http://dx.doi.org/10.1016/j.jogc.2020.02.114DOI Listing
September 2020

Treatment Modality and Trends in Survival for Gallbladder Cancer: a Population-Based Study.

J Gastrointest Cancer 2021 Mar;52(1):256-262

Division of Thoracic Surgery, Department of Surgery, McMaster University, Hamilton, Canada.

Purpose: There are only a few reports on the treatment-based survival of gallbladder cancer (GBC). The primary objective of this study was to examine the change in treatment modality and the related trends in the survival of GBC.

Methods: This study includes all cases of primary GBC diagnosed in the province of Ontario, Canada, from January 2007 to December 2015 with known disease stage. Treatment modalities were classified as no treatment, radiation or chemotherapy, and surgical resection. We examined the association between surgical resection and demographics and tumor characteristics and estimated the trends in survival based on treatment modality.

Results: In total, 564 patients with GBC were identified, of which 374 (66.3%) were female. Although there were no significant trends in treatment modalities over the study period (p = 0.276), survival rates improved for all treatment modalities over time. There was a 35% increase in 5-year survival for the surgical resection group from 2007 to 2015. For patients with stage I-II disease, the 5-year survival rate increased 40% over time. The highest 5-year survival was observed for the surgical resection group in patients with stage I-II disease (0.533 (95% CI, 0.514-0.552)) while the average 5-year survival rate for all patients over the study period was 0.247 (95% CI, 0.228-0.266).

Conclusions: Most cases of GBC continue to be diagnosed in the late stage. Five-year survival for the surgical resection group has markedly improved over time, specifically for patients with stage I-II disease which increased from 30% in 2007 to 70% in 2015.
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http://dx.doi.org/10.1007/s12029-020-00397-wDOI Listing
March 2021

Methods of competing risks flexible parametric modeling for estimation of the risk of the first disease among HIV infected men.

BMC Med Res Methodol 2020 01 29;20(1):17. Epub 2020 Jan 29.

School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Canada.

Background: Patients infected with the Human Immunodeficiency Virus (HIV) are susceptible to many diseases. In these patients, the occurrence of one disease alters the chance of contracting another. Under such circumstances, methods for competing risks are required. Recently, competing risks analyses in the scope of flexible parametric models have risen to address this requirement. These lesser-known analyses have considerable advantages over conventional methods.

Methods: Using data from Multi Centre AIDS Cohort Study (MACS), this paper reviews and applies methods of competing risks flexible parametric models to analyze the risk of the first disease (AIDS or non-AIDS) among HIV-infected patients. We compared two alternative subdistribution hazard flexible parametric models (SDH1 and SDH2) with the Fine & Gray model. To make a complete inference, we performed cause-specific hazard flexible parametric models for each event separately as well.

Results: Both SDH1 and SDH2 provided consistent results regarding the magnitude of coefficients and risk estimations compared with estimations obtained from the Fine & Gray model, However, competing risks flexible parametric models provided more efficient and smoother estimations for the baseline risks of the first disease. We found that age at HIV diagnosis indirectly affected the risk of AIDS as the first event by increasing the number of patients who experience a non-AIDS disease prior to AIDS among > 40 years. Other significant covariates had direct effects on the risks of AIDS and non-AIDS.

Discussion: The choice of an appropriate model depends on the research goals and computational challenges. The SDH1 models each event separately and requires calculating censoring weights which is time-consuming. In contrast, SDH2 models all events simultaneously and is more appropriate for large datasets, however, when the focus is on one particular event SDH1 is more preferable.
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http://dx.doi.org/10.1186/s12874-020-0900-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6990537PMC
January 2020

Usefulness of Abductive Reasoning in Nursing Education: A Pilot Study.

Nurse Educ 2020 Jul/Aug;45(4):220-224

Author Affiliations: Assistant Professor (Dr Mirza), School of Nursing, Thompson Rivers University, Kamloops, British Columbia; and Associate Professors (Dr Danesh and Ms Noesgaard), Assistant Professor (Dr Martin), and Professor (Dr Byrne), School of Nursing, McMaster University, Hamilton, Ontario, Canada.

Background: Hypothetico-deductive reasoning used by novice nurses could limit their ability to explain a presenting care situation in its entirety. Hence, scholars recommend the use of abductive reasoning as an alternative approach.

Purpose: This study explored the effects of abductive reasoning training on baccalaureate nursing students' hypothesis generation abilities.

Method: Through a pretest-posttest study, we delivered educational training on abductive reasoning and examined hypothesis accuracy, expertise, and breadth. Participants generated scenario-specific hypotheses before and after the training. Academic content experts validated the scenarios, and 2 independent raters scored participants' hypotheses.

Results: Twenty first- and second-year nursing students participated in this pilot study. Posttest scores showed a significant improvement in participants' hypothesis generation abilities: accuracy (P < .001), expertise (P < .001), and breadth (P = .006).

Conclusion: Abductive reasoning training in nursing education may improve students' hypothesis generation abilities.
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http://dx.doi.org/10.1097/NNE.0000000000000755DOI Listing
November 2019

Trends in survival based on treatment modality for esophageal cancer: a population-based study.

Eur J Gastroenterol Hepatol 2019 Oct;31(10):1192-1199

Division of Thoracic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.

Objectives: The primary objective was to examine the trends in treatment modalities and the respective survival rates for esophageal cancer in the province of Ontario, Canada.

Methods: This is a population-based study of all esophageal cancer cases diagnosed in Ontario between 2007 and 2015, including squamous cell carcinoma and adenocarcinoma, with known disease stage. Other characteristics include sex, age, date of diagnosis, and treatment modalities. Treatment modalities were classified as no-treatment, radiation only or chemotherapy only, chemoradiation, and surgical resection.

Results: In total, 2572 patients were identified with esophageal cancer from 2007 to 2015, of which 2014 (78.3%) were male. The mean age at diagnosis was 66.6 (SD = 11.7) years. Survival rate increased over time in patients who underwent chemoradiation or surgical resection but remained unchanged for the radiation-only or chemotherapy-only group and decreased for the no-treatment group. Survival considerably improved (15-20%) for patients with stages I-III disease.

Conclusions: The positive trends in the survival rate for esophageal patients could be due to adoption of multimodal therapy. Despite a lower proportion of advanced disease among patients over 80, they received less curative treatments compared with other age groups. Further studies are required to identify strategies to maximize survival for patients with stage IV disease, and patients 80 years and older.
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http://dx.doi.org/10.1097/MEG.0000000000001498DOI Listing
October 2019

Trends in Survival Based on Treatment Modality in Non-Small Cell Lung Cancer Patients: A Population-Based Study.

Cancer Invest 2019 22;37(8):355-366. Epub 2019 Aug 22.

Department of Surgery, Division of Thoracic Surgery, McMaster University , Hamilton , Canada.

We examined the trends in survival based on treatment modality among non-small cell lung cancer (NSCLC) patients in the province of Ontario, Canada, from 2007 to 2015. We investigated the trends in survival based on treatment modality. Among 56,417 identified patients, the mean age at diagnosis was 70.1 years (SD = 10.7). Treatment modalities varied significantly over time (<.001). Overall, 23.0% of patients received surgical treatments. We observed more than 20% increase in five-year survival rates for all surgical groups over time. Patients undergoing sublobar/lobar resections had higher survival rate.
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http://dx.doi.org/10.1080/07357907.2019.1653465DOI Listing
October 2019

Efficacy of Ultra-Early (< 12 h), Early (12-24 h), and Late (>24-138.5 h) Surgery with Magnetic Resonance Imaging-Confirmed Decompression in American Spinal Injury Association Impairment Scale Grades A, B, and C Cervical Spinal Cord Injury.

J Neurotrauma 2020 02 1;37(3):448-457. Epub 2019 Aug 1.

Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, Maryland.

In cervical traumatic spinal cord injury (TSCI), the therapeutic effect of timing of surgery on neurological recovery remains uncertain. Additionally, the relationship between extent of decompression, imaging biomarker evidence of injury severity, and outcome is incompletely understood. We investigated the effect of timing of decompression on long-term neurological outcome in patients with complete spinal cord decompression confirmed on postoperative magnetic resonance imaging (MRI). American Spinal Injury Association (ASIA) Impairment Scale (AIS) grade conversion was determined in 72 AIS grades A, B, and C patients 6 months after confirmed decompression. Thirty-two patients underwent decompressive surgery ultra-early (< 12 h), 25 underwent decompressive surgery early (12-24 h), and 15 underwent decompressive surgery late (> 24-138.5 h) after injury. Age, gender, injury mechanism, intramedullary lesion length (IMLL) on MRI, admission ASIA motor score, and surgical technique were not statistically different among groups. Motor complete patients ( = 0.009) and those with fracture dislocations ( = 0.01) tended to be operated on earlier. Improvement of one grade or more was present in 55.6% of AIS grade A, 60.9% of AIS grade B, and 86.4% of AIS grade C patients. Admission AIS motor score ( = 0.0004) and pre-operative IMLL ( = 0.00001) were the strongest predictors of neurological outcome. AIS grade improvement occurred in 65.6%, 60%, and 80% of patients who underwent decompression ultra-early, early, and late, respectively ( = 0.424). Multiple regression analysis revealed that IMLL was the only significant variable predictive of AIS grade conversion to a better grade (odds ratio, 0.908; confidence interval [CI], 0.862-0.957;  < 0.001). We conclude that in patients with post-operative MRI confirmation of complete decompression following cervical TSCI, pre-operative IMLL, not the timing of surgery, determines long-term neurological outcome.
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http://dx.doi.org/10.1089/neu.2019.6606DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978784PMC
February 2020

Caregiver preparedness for death in dementia: an evaluation of existing tools.

Aging Ment Health 2020 10 30;24(10):1671-1680. Epub 2019 May 30.

McMaster University, Faculty of Health Sciences, School of Nursing, Hamilton, Ontario, Canada.

Death preparedness amongst family caregivers (CG) is a valuable and measurable concept. Preparedness predicts CG outcomes in bereavement and is modifiable through a palliative approach which includes advance care planning (ACP) interventions. Improving death preparedness is important for CGs of persons with dementia (PwD) whom are more likely to develop negative outcomes in bereavement, and experience less than adequate palliative care. However, the adequacy of existing tools to measure death preparedness in CGs of PwD is unknown, which limits intervention design and prospective evaluation of ACP effectiveness. We conducted a review and evaluation of existing tools measuring the attribute domains and traits of CG death preparedness. Literature was searched for articles describing caregiving at end of life (EOL). Measurement tools were extracted, screened for inclusion criteria, and data extracted regarding: conceptual basis, population of development, and psychometrics. Tool content was compared to preparedness domains/traits to assess congruency and evaluate the adequacy of tools as measures of death preparedness for CGs of PwD. Authors extracted 569 tools from articles, retaining seven tools for evaluation. The majority of tools, n = 5 (70%) did not sample all preparedness domains/traits. Few tools had items specific to EOL; only one tool had a specific item questioning CG preparedness for death, and only one tool had items specific to dementia. Limitations in existing tools suggest they are not adequate measures of death preparedness for CGs of PwD. Consequently, the authors are currently developing a questionnaire to be titled, 'Caring Ahead' for this purpose.
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http://dx.doi.org/10.1080/13607863.2019.1622074DOI Listing
October 2020

Beyond Average Information: How Q-Methodology Enhances Course Evaluations in Anatomy.

Anat Sci Educ 2020 Mar 20;13(2):137-148. Epub 2019 May 20.

Education Program in Anatomy, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada.

Course evaluations can be used for curriculum improvement and have the potential to better the student learning experience. However, because most are based on Likert scales and open-ended feedback, understanding diversity in student opinion and uncovering optimal options for course change and improvement are often difficult. Alternatively, Q-methodology can be used to investigate patterns of thought within a group and may offer greater potential for course reform. This manuscript offers a tutorial-based explanation of the three components of Q-methodology studies (1) survey instrument development, (2) data collection, and (3) analysis and interpretation, then demonstrates, via case study, the use of Q-methodology to evaluate a fourth-year undergraduate pathoanatomy course. The goal of this article is to enable the reader to broadly apply Q-methodology in other courses to gain insight and feedback beyond that offered by traditional Likert scale methods. As demonstrated through the pathoanatomy case study, Q-methodology highlights groups (denoted by factors) of like-minded students that share opinions, preferences, and values. Overall, Q-methodology analyses support course instructors in identifying areas of course strength and improvement in an evidence-based way. This alternative to traditional Likert scales represents a promising solution to ongoing course evaluation limitations.
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http://dx.doi.org/10.1002/ase.1885DOI Listing
March 2020

Potential Dangers of Nursing Overtime in Critical Care.

Nurs Leadersh (Tor Ont) 2018 Sep;31(3):48-60

Retired Professor, School of Nursing, McMaster University, Hamilton, ON.

Around the world, registered nurses are working increasing amounts of overtime. This is particularly true in critical care environments, which experience unpredictable fluctuations in patient volume and acuity combined with a need for greater numbers of specialized nurses. Although it is commonplace, little consensus exists surrounding the effects of overtime on nursing sick time and patient outcomes. Using data from 11 different critical care units nestled within three major academic health science centres in Southern Ontario, a multilevel-model Poisson regression analysis was used to evaluate the association between nursing overtime and nursing sick time, patient mortality and patient infection incidents. Most significantly, for every 10 hours of nursing overtime worked, study findings revealed an associated 3.3-hour increase in nursing sick time. Because of the potential cost and patient care ramifications, hospitals and nurse managers are encouraged to track collective and individual paid and unpaid hours to impose appropriate limits and ensure accountability. Further qualitative research should be commissioned to explore the underlying reasons for these findings and diversify the settings and, in turn, wider application.
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http://dx.doi.org/10.12927/cjnl.2018.25677DOI Listing
September 2018

Condition-Specific Pamphlets to Improve End-of-life Communication in Long-term Care: Staff Perceptions on Usability and Use.

J Am Med Dir Assoc 2019 03 21;20(3):262-267. Epub 2018 Dec 21.

Creative Arts Therapies Department, Concordia University, Canada.

Objectives: This article reports findings on the usability and staff use of 5 condition- specific pamphlets of high prevalence in long-term care (LTC): dementia, heart failure, chronic obstructive pulmonary disease, renal failure, and frailty. The pamphlets were created in response to residents', families', and staff's recommendations for activating early reflections and communication about end-of-life care.

Design: A mixed-method (qualitative and quantitative) survey design was used. Step 1 collected survey data on the usability of the pamphlets. Step 2 collected survey data on pamphlet use.

Settings And Participants: Two nurses with specialized palliative care training, 2 resident/family representatives, 10 condition-specific specialists, and 33 LTC palliative leads reviewed the pamphlets for usability prior to distribution. A total of 178 LTC home staff in 4 participating LTC homes reported on pamphlet use.

Measures: Specialists and resident/family representatives were asked to provide open comments and LTC home palliative leads were asked to complete a survey on the accuracy, readability, and relevance of the pamphlets. After 6 months of distribution, all staff in participating LTC homes were asked to complete a survey on pamphlet use, usefulness, and comfort with distribution.

Results: The pamphlets were reportedly accurate, relevant, and easy to understand. Following 6 months of availability, most staff in LTC had read the pamphlets, found the information useful, and planned to share them. However, half of the staff questioned their role in pamphlet distribution and most had not distributed them. Regulated staff (ie, staff affiliated with a regulated profession) expressed more comfort sharing the pamphlets than care aides and support staff.

Conclusions/implications: Condition-specific pamphlets appear to hold promise in providing residents and families with relevant information that may activate early reflections and conversations about end-of-life care. However, structured implementation strategies, training, and discussions are required to improve staff comfort with distribution and explore roles in distribution and follow-up.
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http://dx.doi.org/10.1016/j.jamda.2018.11.009DOI Listing
March 2019

What Does Death Preparedness Mean for Family Caregivers of Persons With Dementia?

Am J Hosp Palliat Care 2019 May 5;36(5):436-446. Epub 2018 Dec 5.

1 Faculty of Health Sciences, School of Nursing, McMaster University, Hamilton, Ontario, Canada.

Purpose:: The purpose of this study was to clarify the concept of death preparedness for family caregivers in dementia. Conceptualization was required to support the assessment, promotion, and operationalization (ie, measurement) of death preparedness through palliative care interventions such as advance care planning.

Methods:: Rodgers evolutionary method of concept analysis was selected to guide this study because of the dynamic nature of death preparedness influenced by context, setting, and time. A comprehensive literature search was conducted. Authors performed constant comparative analysis to identify and interpret surrogate/related concepts, attributes, antecedents, and consequences of death preparedness.

Results:: Most importantly attributes included (1) knowing and recognizing the symptoms of decline in dementia and what dying looks like; (2) understanding emotions and grief responses; (3) accessing and appraising supports needed to manage and care for dying; (4) organizing affairs and completing tasks in advance; (5) accepting that losses are inevitable and imminent; (6) reflecting on caregiving and finding meaning, "a silver-lining"; and (7) closing, reconciling, and renewing relationship bonds and completing the family member's life.

Discussion:: This study contributed a full definition of death preparedness in dementia. Findings aligned with/expanded upon Hebert et al Theoretical Framework of Preparedness for End-of-Life. The use of problem- and emotion-based coping strategies by caregivers with support from health-care providers to promote feelings of death preparedness (including self-efficacy and control) and minimize uncertainty was the implication of this study. Development of a holistic preparedness instrument is underway.
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http://dx.doi.org/10.1177/1049909118814240DOI Listing
May 2019

Critical Care Nurses' Reasons for Working or Not Working Overtime.

Crit Care Nurse 2018 Dec;38(6):47-57

Vanessa M. Lobo develops workshops for clinicians and teaches in Health Organization Management at the Canadian University Dubai, Dubai, United Arab Emirates. Jenny Ploeg is a professor in the School of Nursing and associate member, Department of Health, Aging and Society, McMaster University, Hamilton, Ontario. She is scientific director of the Aging, Community and Health Research Unit, School of Nursing, McMaster University. Anita Fisher is an associate professor in the School of Nursing, Faculty of Health Science at McMaster University. Gladys Peachey is retired from the faculty of Nursing at McMaster University. Noori Akhtar-Danesh is an associate professor of biostatistics, School of Nursing, McMaster University.

Background: Around the world, registered nurses are working increasing amounts of overtime. This is particularly true in critical care environments, which experience unpredictable fluctuations in patient volume and acuity, combined with a need for more specialized nurses.

Objective: To explore critical care nurses' reasons for working or not working overtime.

Methods: A semistructured interview guide was used to interview 28 frontline nurses from 11 critical care units in Ontario, Canada. Analysis was guided by Thorne's interpretive description methodology.

Results: Participants' reasons for working overtime included (1) financial gain (96% of participants); (2) helping and being with colleagues (68%); (3) continuity for nurses and patients (39%); and (4) accelerated career development (39%). Their reasons for not working overtime were (1) feeling tired and tired of being at work (50%); (2) having established plans (71%); and (3) not receiving enough notice (61%).

Conclusions: Findings from this study provide important variations and extension of existing literature on the topic, and appear to be the first reported in Canadian critical care units. Additional research is required to understand administrative decision-making processes that lead to the use of overtime.
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http://dx.doi.org/10.4037/ccn2018616DOI Listing
December 2018

Social capital and self-rated health: A cross-sectional study of the general social survey data comparing rural and urban adults in Ontario.

Health Soc Care Community 2019 03 30;27(2):424-436. Epub 2018 Sep 30.

McMaster University, Hamilton, Ontario, Canada.

The concept of social capital shows great promise for its potential to influence individual and population health. Yet challenges persist in defining and measuring social capital, and little is known about the mechanisms that link social capital and health. This paper reports on the quantitative phase of a sequential explanatory mixed methods study using data from Canada's 2013 General Social Survey (data collected 2013-14). An exploratory factor analysis revealed six underlying dimensions of social capital for 7,187 adults living in Ontario, Canada. These factors included trust in people, neighbourhood social capital, trust in institutions, sense of belonging, civic engagement, and social network size. A logistic regression indicated that having high Trust in People and Trust in Institutions were associated with better mental health while high Trust in Institutions, Sense of Belonging, and Civic Engagement were associated with better physical health. When comparing rural and urban residents, there were no differences in their self-reported health, nor did social capital influence their health any differently, despite rural residents having higher social capital scores. The study findings are important for understanding the nature of social capital and how it influences health, and provide direction for targeted health promotion strategies.
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http://dx.doi.org/10.1111/hsc.12662DOI Listing
March 2019

Policy to practice: Investment in transitioning new graduate nurses to the workplace.

J Nurs Manag 2018 May 23;26(4):373-381. Epub 2018 Mar 23.

School of Nursing, Faculty of Health Sciences, Health Sciences Centre, McMaster University, Hamilton, ON, Canada.

Aim: To analyse nurses' perceptions of the impact of an extended transition programme on key dimensions of care delivery 1-6 years after graduation. The dimensions included decision-making, communication, care management, system integration and commitment.

Background: Health care employers in Ontario, Canada, can apply for government funding to support an extended transition programme for new graduate nurses that includes orientation and mentorship.

Methods: A cross-sectional study design was used. Nurses who participated in the transition programme were compared with nurses who did not. A survey was administered to a convenience sample of 2369 nurses.

Results: There were statistically significant differences between the two groups. Nurses in the transition programme had higher mean scores on the key dimensions of care delivery. Results were confirmed when controlling for length of time since graduation.

Conclusion: Extended transition benefits new graduate nurses. It has a lasting effect over time and impacts key dimensions of care delivery. It can also enhance workforce integration and reduce turnover.

Implications For Nursing Management: Responding to the needs of new graduate nurses has potential long-term advantages for health care organisations and can influence both quality and delivery of care.
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http://dx.doi.org/10.1111/jonm.12540DOI Listing
May 2018

"Now I Don't Have to Guess": Using Pamphlets to Encourage Residents and Families/Friends to Engage in Advance Care Planning in Long-Term Care.

Gerontol Geriatr Med 2017 Jan-Dec;3:2333721417747323. Epub 2017 Dec 20.

McMaster University, Hamilton, Ontario, Canada.

This article explores whether access to illness trajectory pamphlets for five conditions with high prevalence in long-term care (LTC) can encourage residents and families/friends to openly engage in advance care planning (ACP) discussions with one another and with health providers. In all, 57 residents and families/friends in LTC completed surveys and 56 participated in seven focus groups that explored whether the pamphlets supported ACP engagement. Survey results suggested that access to pamphlets encouraged residents and families/friends to reflect on future care (48/57, 84%), clarified what questions to ask (40/57, 70%), and increased comfort in talking about end of life (EOL) care (36/57, 63%). Discussions between relatives and friends/families (32/57, 56%) or with health providers (21/57, 37%) were less common. Focus group deliberations illuminated that while reading illness-specific information was validating, a tendency to protect one another from an emotional topic, prevented residents and families/friends from conversing with one another about EOL issues. Having access to pamphlets with information about EOL care provides important and welcome opportunities for reflection for both residents in LTC and their families/friends. Moving residents and families/friends from reflecting on issues to discussing them together could require staff support through planned care conferences or staff initiated conversations at the bedside.
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http://dx.doi.org/10.1177/2333721417747323DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5751914PMC
December 2017

A government policy on full-time nursing employment in Ontario, Canada: An evaluation.

Health Policy 2018 02 22;122(2):109-114. Epub 2017 Sep 22.

Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Van Dyck - Room 136-A, PO Box 11-0236, Riad El-Solh, Beirut 1107 2020, Lebanon. Electronic address:

Purpose: To evaluate the impact of a government full-time employment policy targeting new graduate nurses in the province of Ontario, Canada, by comparing participants with non-participants.

Methods: The Policy Impact on Nurse Employment (PINEP) survey was administered in 2014 to nurses who graduated between 2007 and 2012. Backward multiple logistic regression analysis was conducted to determine the effect of participation in the policy on key outcomes: full-time employment, retention and perceptions of clinical proficiency.

Results: A total of 2369 nurses responded to the survey. Policy participants were 1.5 times more likely to be employed full-time and 2.3 times more likely to be retained in their initial position at the time of survey compared to non-participants. Participants also perceived their clinical proficiency to be higher.

Conclusions: The evidence is converging around the importance of providing full-time employment to nurses to sustain the workforce, increase clinical proficiency and improve patient outcomes. In Ontario, the government created a policy to stimulate full-time employment for nurses. Results demonstrate that nursing employment has become more stable. Yet more needs to be done particularly in relation to the precarious employment trend.
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http://dx.doi.org/10.1016/j.healthpol.2017.07.001DOI Listing
February 2018

Strategic Workforce Planning for Health Human Resources: A Nursing Case Analysis.

Can J Nurs Res 2016 Sep-Dec;48(3-4):93-99. Epub 2016 Dec 2.

4 Institute of Health Policy Management and Evaluation, University of Toronto, Canada.

Background Health-care organizations provide services in a challenging environment, making the introduction of health human resources initiatives especially critical for safe patient care. Purpose To demonstrate how one specialty hospital in Ontario, Canada, leveraged an employment policy to stabilize its nursing workforce over a six-year period (2007 to 2012). Methods An observational cross-sectional study was conducted in which administrative data were analyzed to compare full-time status and retention of new nurses prepolicy and during the policy. The Professionalism and Environmental Factors in the Workplace Questionnaire® was used to compare new nurses hired into the study hospital with new nurses hired in other health-care settings. Results There was a significant increase in full-time employment and a decrease in part-time employment in the study hospital nursing workforce. On average, 26% of prepolicy new hires left the study hospital within one year of employment compared to 5% of new hires during policy implementation. The hospital nurses scored significantly higher than nurses employed in other health-care settings on 5 out of 13 subscales of professionalism. Conclusions Decision makers can use these findings to develop comprehensive health human resources guidelines and mechanisms that support strategic workforce planning to sustain and strengthen the health-care system.
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http://dx.doi.org/10.1177/0844562116680715DOI Listing
July 2018

Application of AOSpine Subaxial Cervical Spine Injury Classification in Simple and Complex Cases.

J Orthop Trauma 2017 Sep;31 Suppl 4:S24-S32

*Department of Neurosurgery, University of Maryland, Maryland, MD, USA; †Department of Orthopaedics, University Medical Center Utrecht, Utrecht, the Netherlands; ‡Department of Orthopaedic Surgery, The Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA; and §School of Nursing, McMaster University, Hamilton, ON, Canada.

Introduction: Cervical spine injury classification systems should be simple, easy to relate and remember, reliable guide for surgical planning, and predictor of outcome in clinical settings. We investigated whether the AOSpine subaxial cervical spine classification system predicted injury severity and neurologic outcome.

Material And Methods: We analyzed the relevant clinical, imaging, management, and American Spinal Injury Association (ASIA) impairment scale (AIS) grade conversion of 92 AIS grades A-C patients with cervical spine injury. We correlated morphology class with age, injury severity score (ISS), follow-up ASIA motor score (AMS), intramedullary lesion length (IMLL), and AIS grade conversion at 6 months after injury.

Results: The mean age of patients was 39.3 years, 83 were men, and 69 were injured during an automobile accident or after a fall. The AOSpine class was A4 in 8, B2 in 5, B2A4 in 16, B3 in 19, and C in 44 patients. The mean ISS was 29.7 and AMS was 17.1. AIS grade was A in 48, B in 25, and C in 19 patients. Mean IMLL on postoperative magnetic resonance imaging was 72 mm: A4 = 68.1; B2A4 = 86.5; B2 = 59.3; B3 = 46.8; and C = 79.9. At a mean follow-up of 6 months, the mean AMS was 39.6. Compared to patients with class B3 injuries, those with class C injuries were significantly younger (P < 0.0001), had longer IMLL (P < 0.002), and were less likely to have AIS grade conversion to a better grade (P < 0.02).

Conclusions: The AOSpine subaxial cervical spine injury classification system successfully predicted injury severity (longer IMLL) and chances of neurologic recovery (AIS grade conversion) across different class subtypes.
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http://dx.doi.org/10.1097/BOT.0000000000000944DOI Listing
September 2017

Critical care nurses' perceptions of the outcomes of working overtime in Canada.

Nurs Outlook 2017 Jul - Aug;65(4):400-410. Epub 2017 Jan 7.

School of Nursing, McMaster University, Hamilton, Ontario, Canada.

Background: Nursing overtime is being integrated into the normal landscape of practice to ensure optimal staffing levels and addresses variations in patient volume and acuity. This is particularly true in critical care where fluctuations in either are difficult to predict.

Purpose: The goal of this study was to explore critical care nurses' perceptions of the outcomes of working overtime.

Methods: Sally Thorne's interpretive description guided the collection and analysis of data. Participants were recruited from 11 different critical care units within three large teaching hospitals in Southern Ontario, Canada. A total of 28 full- and part-time registered nurses who had worked in an intensive care unit for at least one year took part in this study. Data were collected through semistructured, audio-recorded, individual interviews that took place in rooms adjacent to participants' critical care units. Template analysis facilitated the determination and abstraction of themes using NVivo for Mac 10.1.1.

Findings: Major themes highlighting the perceived outcomes of overtime included (a) physical effects, (b) impact on patient-centered care, (c) balancing family and work, (d) financial gain, and € safety is jeopardized.

Conclusions: Nursing managers and institutions need to be accountable for staffing practices they institute, and nurses themselves may require further education regarding healthy work-life balance. There are both negative and positive consequences of nursing overtime for nurses and patients, but nurses at large valued the option to work it.
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http://dx.doi.org/10.1016/j.outlook.2016.12.009DOI Listing
September 2017

Intramedullary Lesion Length on Postoperative Magnetic Resonance Imaging is a Strong Predictor of ASIA Impairment Scale Grade Conversion Following Decompressive Surgery in Cervical Spinal Cord Injury.

Neurosurgery 2017 04;80(4):610-620

School of Nursing and Depart-ment of Clinical Epidemiology and Bio-statistics, McMaster University, Hamilton, Ontario, Canada.

Background: Evidence indicates that, over time, patients with spinal cord injury (SCI) improve neurologically in various degrees. We sought to further investigate indicators of grade conversion in cervical SCI.

Objective: To detect predictors of ASIA impairment scale (AIS) grade conversion in SCI following surgical decompression.

Methods: In a retrospective study, demographics, clinical, imaging, and surgical data from 100 consecutive patients were assessed for predictors of AIS grade conversion.

Results: American Spinal Injury Association motor score was 17.1. AIS grade was A in 52%, B in 29%, and C in 19% of patients. Surgical decompression took place on an average of 17.6 h following trauma (≤12 h in 51 and >12 h in 49). Complete decompression was verified by magnetic resonance imaging (MRI) in 73 patients. Intramedullary lesion length (IMLL) on postoperative MRI measured 72.8 mm, and hemorrhage at the injury epicenter was noted in 71 patients. Grade conversion took place in 26.9% of AIS grade A patients, 65.5% of AIS grade B, and 78.9% of AIS grade C. AIS grade conversion had statistical relationship with injury severity score, admission AIS grade, extent of decompression, presence of intramedullary hemorrhage, American Spinal Injury Association motor score, and IMLL. A stepwise multiple logistic regression analysis indicated IMLL was the sole and strongest indicator of AIS grade conversion (odds ratio 0.950, 95% CI 0.931-0.969). For 1- and 10-mm increases in IMLL, the model indicates 4% and 40% decreases, respectively, in the odds of AIS grade conversion.

Conclusion: Compared with other surrogates, IMLL remained as the only predictor of AIS grade conversion.
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http://dx.doi.org/10.1093/neuros/nyw053DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5748932PMC
April 2017