Publications by authors named "Ted Scott"

8 Publications

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Post Discharge after Surgery Virtual Care with Remote Automated Monitoring Technology (PVC-RAM): protocol for a randomized controlled trial.

CMAJ Open 2021 Jan-Mar;9(1):E142-E148. Epub 2021 Mar 2.

School of Nursing (McGillion, Levesque, Lounsbury, Bird, Ouellette), McMaster University, Hamilton, Ont.; Population Health Research Institute (McGillion, Whitlock, Devereaux, Belley-Cote, Borges, Vincent, Lamy, Bangdiwala, Le Manach, Harvey, Conen), Hamilton, Ont.; Department of Anesthesiology and Perioperative Medicine (Parlow, Arellano), Queen's University, Kingston, Ont.; Department of Anesthesiology and Perioperative Medicine (Parlow, Shelley, DuMerton, Arellano), Kingston Health Sciences Centre, Kingston, Ont.; Department of Medicine (Belley-Cote, Yousef, Borges, Marcucci, Chaudhry, Haider, Guyatt, Patel, Conen, Tandon), McMaster University, Hamilton, Ont.; Department of Health Research Methods, Evidence, and Impact (Whitlock, Devereaux, Marcucci, Bangdiwala, Guyatt), McMaster University, Hamilton, Ont.; Departments of Critical Care and Anesthesiology (Jacka), University of Alberta, Edmonton, Alta.; Department of Surgery (Adili, Harlock, Simunovic, Nenshi), McMaster University, Hamilton, Ont.; St. Joseph's Healthcare Hamilton (Adili, LeBlanc, Nenshi, Tandon), Hamilton, Ont.; Department of Anesthesiology and Pain Medicine (Lalu, McCartney, Hamilton), University of Ottawa and The Ottawa Hospital, Ottawa, Ont.; Ottawa Hospital Research Institute (Moloo, Lalu, Halman, Forster, Hamilton), Ottawa, Ont.; Department of Anesthesia and Perioperative Medicine (Sehmbi, Nagappa, Yang), Schulich School of Medicine, University of Western Ontario, London, Ont.; Department of Anesthesia and Perioperative Medicine (Sehmbi, Nagappa, Yang), London Health Sciences Centre, London, Ont.; Hamilton Health Sciences (Meyer, Paulin, Pettit, Lamy, Lounsbury, Scott, Patel, Ouellette, O'Leary), Hamilton, Ont.; Department of Anesthesia (Shanthanna, Paul, Le Manach, O'Leary), McMaster University, Hamilton, Ont.; Department of Medicine (Roshanov, Mrkobrada), Schulich School of Medicine, University of Western Ontario, London, Ont.; Department of Internal Medicine (Ofori), University of Port Harcourt, Port Harcourt, Nigeria, West Africa; Department of Medicine (Graham, Taylor), University of Alberta, Edmonton, Alta.; Department of Medicine (Halman, Forster), University of Ottawa and The Ottawa Hospital, Ottawa, Ont.; Lawrence S. Bloomberg Faculty of Nursing (Peter), University of Toronto, Toronto, Ont.; Department of Medicine (Marosi), Queen's University, Kingston, Ont.; Alberta Health Services (Deuchar), Alberta, Canada; Department of Surgery (Parry, Schlachta, Schemitsch), University of Western Ontario and London Health Sciences Centre, London, Ont.; Department of Surgery (Williams), University of Alberta, Edmonton, Alta.; Department of Oncology (Meyer), McMaster University, Hamilton, Ont.; Department of Surgery (Pichora), Queen's University and Kingston Health Sciences Centre, Kingston, Ont.; Department of Surgery (Moloo), University of Ottawa and The Ottawa Hospital, Ottawa, Ont.; The Ottawa Hospital (Waggott), Ottawa, Ont.

Background: After nonelective (i.e., semiurgent, urgent and emergent) surgeries, patients discharged from hospitals are at risk of readmissions, emergency department visits or death. During the coronavirus disease 2019 (COVID-19) pandemic, we are undertaking the Post Discharge after Surgery Virtual Care with Remote Automated Monitoring Technology (PVC-RAM) trial to determine if virtual care with remote automated monitoring (RAM) compared with standard care will increase the number of days adult patients remain alive at home after being discharged following nonelective surgery.

Methods: We are conducting a randomized controlled trial in which 900 adults who are being discharged after nonelective surgery from 8 Canadian hospitals are randomly assigned to receive virtual care with RAM or standard care. Outcome adjudicators are masked to group allocations. Patients in the experimental group learn how to use the study's tablet computer and RAM technology, which will measure their vital signs. For 30 days, patients take daily biophysical measurements and complete a recovery survey. Patients interact with nurses via the cellular modem-enabled tablet, who escalate care to preassigned and available physicians if RAM measurements exceed predetermined thresholds, patients report symptoms, a medication error is identified or the nurses have concerns they cannot resolve. The primary outcome is number of days alive at home during the 30 days after randomization.

Interpretation: This trial will inform management of patients after discharge following surgery in the COVID-19 pandemic and offer insights for management of patients who undergo nonelective surgery in a nonpandemic setting. Knowledge dissemination will be supported through an online multimedia resource centre, policy briefs, presentations, peer-reviewed journal publications and media engagement.

Trial Registration: ClinicalTrials.gov, no. NCT04344665.
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http://dx.doi.org/10.9778/cmajo.20200176DOI Listing
March 2021

Identifying optimal frameworks to implement or evaluate digital health interventions: a scoping review protocol.

BMJ Open 2020 08 13;10(8):e037643. Epub 2020 Aug 13.

Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada

Introduction: Digital health interventions (DHIs) are defined as health services delivered electronically through formal or informal care. DHIs can range from electronic medical records used by providers to mobile health apps used by consumers. DHIs involve complex interactions between user, technology and the healthcare team, posing challenges for implementation and evaluation. Theoretical or interpretive frameworks are crucial in providing researchers guidance and clarity on implementation or evaluation approaches; however, there is a lack of standardisation on which frameworks to use in which contexts. Our goal is to conduct a scoping review to identify frameworks to guide the implementation or evaluation of DHIs.

Methods And Analysis: A scoping review will be conducted using methods outlined by the Joanna Briggs Institute reviewers' manual and will conform to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Studies will be included if they report on frameworks (ie, theoretical, interpretive, developmental) that are used to guide either implementation or evaluation of DHIs. Electronic databases, including MEDLINE, EMBASE, CINAHL and PsychINFO will be searched in addition to grey literature and reference lists of included studies. Citations and full text articles will be screened independently in Covidence after a reliability check among reviewers. We will use qualitative description to summarise findings and focus on how research objectives and type of DHIs are aligned with the frameworks used.

Ethics And Dissemination: We engaged an advisory panel of digital health knowledge users to provide input at strategic stages of the scoping review to enhance the relevance of findings and inform dissemination activities. Specifically, they will provide feedback on the eligibility criteria, data abstraction elements, interpretation of findings and assist in developing key messages for dissemination. This study does not require ethical review. Findings from review will support decision making when selecting appropriate frameworks to guide the implementation or evaluation of DHIs.
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http://dx.doi.org/10.1136/bmjopen-2020-037643DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7430416PMC
August 2020

Postoperative Remote Automated Monitoring and Virtual Hospital-to-Home Care System Following Cardiac and Major Vascular Surgery: User Testing Study.

J Med Internet Res 2020 03 18;22(3):e15548. Epub 2020 Mar 18.

Population Health Research Institute, Hamilton, ON, Canada.

Background: Cardiac and major vascular surgeries are common surgical procedures associated with high rates of postsurgical complications and related hospital readmission. In-hospital remote automated monitoring (RAM) and virtual hospital-to-home patient care systems have major potential to improve patient outcomes following cardiac and major vascular surgery. However, the science of deploying and evaluating these systems is complex and subject to risk of implementation failure.

Objective: As a precursor to a randomized controlled trial (RCT), this user testing study aimed to examine user performance and acceptance of a RAM and virtual hospital-to-home care intervention, using Philip's Guardian and Electronic Transition to Ambulatory Care (eTrAC) technologies, respectively.

Methods: Nurses and patients participated in systems training and individual case-based user testing at two participating sites in Canada and the United Kingdom. Participants were video recorded and asked to think aloud while completing required user tasks and while being rated on user performance. Feedback was also solicited about the user experience, including user satisfaction and acceptance, through use of the Net Promoter Scale (NPS) survey and debrief interviews.

Results: A total of 37 participants (26 nurses and 11 patients) completed user testing. The majority of nurse and patient participants were able to complete most required tasks independently, demonstrating comprehension and retention of required Guardian and eTrAC system workflows. Tasks which required additional prompting by the facilitator, for some, were related to the use of system features that enable continuous transmission of patient vital signs (eg, pairing wireless sensors to the patient) and assigning remote patient monitoring protocols. NPS scores by user group (nurses using Guardian: mean 8.8, SD 0.89; nurses using eTrAC: mean 7.7, SD 1.4; patients using eTrAC: mean 9.2, SD 0.75), overall NPS scores, and participant debrief interviews indicated nurse and patient satisfaction and acceptance of the Guardian and eTrAC systems. Both user groups stressed the need for additional opportunities to practice in order to become comfortable and proficient in the use of these systems.

Conclusions: User testing indicated a high degree of user acceptance of Philips' Guardian and eTrAC systems among nurses and patients. Key insights were provided that informed refinement of clinical workflow training and systems implementation. These results were used to optimize workflows before the launch of an international RCT of in-hospital RAM and virtual hospital-to-home care for patients undergoing cardiac and major vascular surgery.
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http://dx.doi.org/10.2196/15548DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7113803PMC
March 2020

Postoperative Remote Automated Monitoring: Need for and State of the Science.

Can J Cardiol 2018 07 25;34(7):850-862. Epub 2018 Apr 25.

McMaster University, Faculty of Health Sciences, Hamilton, Ontario, Canada; Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada.

Worldwide, more than 230 million adults have major noncardiac surgery each year. Although surgery can improve quality and duration of life, it can also precipitate major complications. Moreover, a substantial proportion of deaths occur after discharge. Current systems for monitoring patients postoperatively, on surgical wards and after transition to home, are inadequate. On the surgical ward, vital signs evaluation usually occurs only every 4-8 hours. Reduced in-hospital ward monitoring, followed by no vital signs monitoring at home, leads to thousands of cases of undetected/delayed detection of hemodynamic compromise. In this article we review work to date on postoperative remote automated monitoring on surgical wards and strategy for advancing this field. Key considerations for overcoming current barriers to implementing remote automated monitoring in Canada are also presented.
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http://dx.doi.org/10.1016/j.cjca.2018.04.021DOI Listing
July 2018

Technology-Enabled Remote Monitoring and Self-Management - Vision for Patient Empowerment Following Cardiac and Vascular Surgery: User Testing and Randomized Controlled Trial Protocol.

JMIR Res Protoc 2016 Aug 1;5(3):e149. Epub 2016 Aug 1.

McMaster University, Hamiltion, ON, Canada.

Background: Tens of thousands of cardiac and vascular surgeries (CaVS) are performed on seniors in Canada and the United Kingdom each year to improve survival, relieve disease symptoms, and improve health-related quality of life (HRQL). However, chronic postsurgical pain (CPSP), undetected or delayed detection of hemodynamic compromise, complications, and related poor functional status are major problems for substantial numbers of patients during the recovery process. To tackle this problem, we aim to refine and test the effectiveness of an eHealth-enabled service delivery intervention, TecHnology-Enabled remote monitoring and Self-MAnagemenT-VIsion for patient EmpoWerment following Cardiac and VasculaR surgery (THE SMArTVIEW, CoVeRed), which combines remote monitoring, education, and self-management training to optimize recovery outcomes and experience of seniors undergoing CaVS in Canada and the United Kingdom.

Objective: Our objectives are to (1) refine SMArTVIEW via high-fidelity user testing and (2) examine the effectiveness of SMArTVIEW via a randomized controlled trial (RCT).

Methods: CaVS patients and clinicians will engage in two cycles of focus groups and usability testing at each site; feedback will be elicited about expectations and experience of SMArTVIEW, in context. The data will be used to refine the SMArTVIEW eHealth delivery program. Upon transfer to the surgical ward (ie, post-intensive care unit [ICU]), 256 CaVS patients will be reassessed postoperatively and randomly allocated via an interactive Web randomization system to the intervention group or usual care. The SMArTVIEW intervention will run from surgical ward day 2 until 8 weeks following surgery. Outcome assessments will occur on postoperative day 30; at week 8; and at 3, 6, 9, and 12 months. The primary outcome is worst postop pain intensity upon movement in the previous 24 hours (Brief Pain Inventory-Short Form), averaged across the previous 14 days. Secondary outcomes include a composite of postoperative complications related to hemodynamic compromise-death, myocardial infarction, and nonfatal stroke- all-cause mortality and surgical site infections, functional status (Medical Outcomes Study Short Form-12), depressive symptoms (Geriatric Depression Scale), health service utilization-related costs (health service utilization data from the Institute for Clinical Evaluative Sciences data repository), and patient-level cost of recovery (Ambulatory Home Care Record). A linear mixed model will be used to assess the effects of the intervention on the primary outcome, with an a priori contrast of weekly average worst pain intensity upon movement to evaluate the primary endpoint of pain at 8 weeks postoperation. We will also examine the incremental cost of the intervention compared to usual care using a regression model to estimate the difference in expected health care costs between groups.

Results: Study start-up is underway and usability testing is scheduled to begin in the fall of 2016.

Conclusions: Given our experience, dedicated industry partners, and related RCT infrastructure, we are confident we can make a lasting contribution to improving the care of seniors who undergo CaVS.
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http://dx.doi.org/10.2196/resprot.5763DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4999307PMC
August 2016

Increasing the detection rate of congenital heart disease during routine obstetric screening using cine loop sweeps.

J Ultrasound Med 2013 Jun;32(6):973-9

Department of Medical Radiation Sciences, Mohawk College, Hamilton, Ontario, Canada.

Objectives: The purpose of this study was to demonstrate an increase in the detection rate of fetal cardiac defects using 2 cine loop sweeps.

Methods: Image reviewers examined a series of 93 cases randomly sorted, including 79 studies with normal findings and 14 studies with abnormal findings. All of the images were assessed by 5 standard criteria. Cases were classified as normal, abnormal, or indeterminate. Reviewers using the conventional approach reviewed 3 still images: the 4-chamber, left ventricular outflow tract, and right ventricular outflow tract views. Reviewers using the cine loop sweeps viewed 2 grayscale sweeps through the fetal heart in real time. The image sequences were reviewed independently by 2 experts, 3 nonexperts, and 2 sonographers blinded to each others' results.

Results: The cine loop sweeps had an increased detection rate of 38% for the nonexperts and 36% for the experts compared with the conventional approach. The cine loop sweeps allowed identification of all cardiac defects by at least 2 of the 7 reviewers; the percentage of cases with false-positive findings was 3.9%. With the conventional approach, 2 defects went undetected by all reviewers, and 4 defects were found by only 1 reviewer; the percentage of cases with false-positive findings was 5.4%.

Conclusions: The use of cine loop sweeps has the potential to increase the detection of fetal cardiac defects without increasing the rate of false-positive findings or increasing the interpretation and decision-making times.
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http://dx.doi.org/10.7863/ultra.32.6.973DOI Listing
June 2013

Tendon and nerve excursion in the carpal tunnel in healthy and CTD wrists.

Clin Biomech (Bristol, Avon) 2011 Nov 8;26(9):930-6. Epub 2011 May 8.

School of Kinesiology & Health Science, York University, Toronto, ON, Canada.

Background: During hand and finger motions, friction between flexor digitorum superficialis tendon and the median nerve is thought to play a role in the development of cumulative trauma disorders. This study investigated three methods to determine excursions of the flexor digitorum superficialis tendon and median nerve using several motions.

Methods: Twenty-five participants (mean age 37.2 years SD 13.4) were classified as healthy (n=16), self-reported distal upper extremity cumulative trauma disorders (6), or wheelchair users (3). Static carpal tunnel measurements were taken and displacements of the index flexor digitorum superficialis tendon and median nerve were determined via the velocity time integral and post hoc integration of the Doppler ultrasound waveform using a 12-5 MHz linear array transducer, as well as using predictive equations.

Findings: Median nerves in symptomatic wrists were larger than healthy wrists by 4.2 mm(2) (left) and 4.1 mm(2) (right) proximally to less than 1.4 mm(2) distally. In healthy wrists, left-right tendon excursion differences ranged from 0.7 mm to 4.3 mm depending on the motion while left to right differences in symptomatic wrists ranged over 22.2 mm. Ultrasound measures of tendon excursion overestimated those determined using predictive equations and were poorly correlated. The ratio of median nerve excursion to tendon excursion was lower in finger only motions compared to wrist motions with or without finger motion.

Interpretation: Spectral Doppler ultrasound imaging provided insights into tendon excursion that was not apparent with mathematical modeling. The difference in excursion between finger motions and wrist motions could be beneficial in therapeutic techniques.
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http://dx.doi.org/10.1016/j.clinbiomech.2011.03.014DOI Listing
November 2011

Treating a chronic skin condition.

Adv Nurse Pract 2003 Mar;11(3):21

Department of Dermatology, Kaiser Permanente, San Diego, Calif., USA.

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March 2003