University Health Center Research Articles

Improving Effective Weight Management in a University Health Center

The prevalence of obesity has nearly tripled since 1975, making weight management essential yet inadequately addressed in health care. This quality improvement project successfully improved weight management in a university health center with the 5 As (assess, advise, agree, assist, and arrange) Framework and four 2-week plan-do-study-act cycles. Each cycle incorporated data evaluation and tests of change related to project interventions, including a screening trigger tool, shared decision-making tool, case management log, and team engagement plan. Effective care, as measured by a point system based on current evidence-based weight management guidelines, reached a 78% mean score, exceeding the 75% aim of the project.

The McGill World Restart a Heart 2020 Campaign: a student-led, patient-engaged, large-scale online simulation program

Abstract Background Cardiac arrest is a leading cause of death, with the majority of cases occurring in homes or public places. Up to 55% are witnessed by family members, colleagues or friends, yet most victims don't receive cardiopulmonary resuscitation (CPR), which can triple the odds of survival. Mortality therefore remains high at over 90%. Enhancing bystander CPR skills is a crucial public health investment. Objective Engage the Canadian and global community in a thought-provoking and immersive experience to explore cardiac arrests, destigmatize bystander CPR, and enhance resuscitation knowledge and skills. Partner with patients, leverage innovative technologies, and social media, to develop a digital scalable simulation/educational exercise. Methods Interprofessional healthcare students from the Faculty coordinated a University World Restart a Heart (WRAH) 2020 Campaign as part of a global initiative. Amplified by social media influencers, the Campaign team produced a bilingual digital Campaign with succinct and high-impact videos including survivor and non-survivor family perspectives, digital live events, a patient education guide for families of cardiac arrest patients, and an open access eModule. Our Steering Committee comprised University leadership, intensive and emergency care physicians, a cardiac arrest survivor, and the communications team from the Faculty, Centre for Simulation and Interactive Learning, and University Health Centre. Results The Campaign garnered an international audience with over 74,636 impressions across social media platforms (Facebook, Instagram, and Twitter), 42,600 views of Campaign videos, and 1,500 views of hour-long webinars. Campaign ambassadors had a combined viewership of over 500,000 followers, and included astronaut physicians, Olympic athletes, adult and pediatric cardiac arrest survivors, and social media influencers. The Campaign launched an innovative bystander resuscitation eModule that delivers scalable screen-based simulation. The patient education guide, in collaboration with the University Health Centre's Patient Education Office, focuses on the chain of survival and expectations for acute management, hospitalization and recovery. Conclusion Tens of thousands of individuals reached through the University WRAH 2020 Campaign are now empowered to initiate CPR, which may help reduce the morbidity and mortality of cardiac arrests. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): The McGill Fund.

Self-contamination following removal of two personal protective equipment suits: a randomized, controlled, crossover simulation trial

Healthcare personnel are often at high risk of contamination when participating in airway management and other aerosol-generating procedures. To explore the differences in self-contamination after removal of gown and coverall personal protective equipment (PPE) using an ultraviolet-fluorescent solution. This prospective, randomized, controlled crossover trial was set in a third-level university health centre in Buenos Aires, Argentina between August and October 2020. The study included 60 anaesthesia personnel volunteers, and no participants were excluded from the study. A two-period/two-intervention design was chosen; each intervention comprised audio-guided placement of PPE, full-body spraying of fluorescent solution, audio-guided removal of PPE, and self-contamination assessment through ultraviolet light scanning. The primary outcome was the mean within-participant difference (any traces) between PPE suits. Statistical significance was tested using t-tests for paired data. The allocation ratio was 25/35 (gown followed by coverall/coverall followed by gown). Self-contamination after removal of coveralls was greater than that after removal of gowns, with a mean within-participant difference of 11.45 traces (95% confidence interval 8.26-14.635; P<0.001). Significant differences were found for the number of self-contaminated body zones, small fluorescent traces and large fluorescent traces. Removal of a gown was associated with a markedly lower risk of self-contamination. Quick one-step removal of a gown and gloves may reduce self-contamination in the arm/hand area. Fluorescent solutions can help to identify self-contamination and compare outcomes between available PPE suits. Repeated training sessions and enhanced knowledge on self-contamination following removal of PPE are paramount. NCT04763304 (on ClinicalTrials.gov).

A fully artificial pancreas versus a hybrid artificial pancreas for type 1 diabetes: a single-centre, open-label, randomised controlled, crossover, non-inferiority trial

For people with type 1 diabetes, there is currently no automated insulin delivery system that does not require meal input. We aimed to assess the efficacy of a novel faster-acting insulin aspart (Fiasp) plus pramlintide fully closed-loop system that does not require meal input. In this open-label, randomised controlled, crossover, non-inferiority trial we compared the Fiasp (Novo Nordisk, Bagsværd, Denmark) plus pramlintide closed-loop system with no meal input (fully artificial pancreas) and the Fiasp-alone closed-loop system with precise carbohydrate counting (hybrid artificial pancreas). Adults (≥18 years) who had a clinical diagnosis of type 1 diabetes for at least 12 months, had glycated haemoglobin 12% or lower, and had been on insulin pump therapy for at least 6 months were enrolled at McGill University Health Centre, Montreal, QC, Canada. The Fiasp plus pramlintide fully closed-loop system delivered pramlintide in a basal-bolus manner with a fixed ratio of 10 μg:U relative to insulin. A research staff member counted the carbohydrate content of meals to input in the hybrid closed-loop system. Participants completed the two full-day crossover interventions in a random order allocated by a computer-generated code implementing a blocked randomisation (block size of four). The primary outcome was the percentage of time spent within the glucose target range (3·9-10·0 mmol/L), with a 6% non-inferiority margin, assessed in all participants who completed both interventions. This trial is registered with ClinicalTrials.gov, NCT03800875. Between Feb 8, 2019, and Sept 19, 2020, we enrolled 28 adults, of whom 24 completed both interventions and were included in analyses. The percentage of time spent in the target range was 74·3% (IQR 61·5-82·8) with the fully closed-loop system versus 78·1% (66·3-87·5) with the hybrid Fiasp-alone closed-loop system (paired difference 2·6%, 95% CI -2·4 to 12·2; non-inferiority p=0·28). Eight (33%) participants had at least one hypoglycaemia event (<3·3 mmol/L) with the fully closed-loop system compared with 14 (58%) participants with the hybrid closed-loop system (2200-2200 h). Non-mild nausea was reported by three (13%) participants and non-mild bloating by one (4%) participant with the fully closed-loop system compared with zero participants with the hybrid closed-loop system. The Fiasp plus pramlintide fully closed-loop system was not non-inferior to the Fiasp-alone hybrid closed-loop system for the overall percentage of time in the glucose target range. However, participants still spent a high percentage of time within the target range with the fully-closed loop system. Outpatient studies comparing the fully closed-loop hybrid systems with patient-estimated, rather than precise, carbohydrate counting are warranted. Diabetes Canada.

Real-World Serologic Responses to Extended-Interval and Heterologous COVID-19 mRNA Vaccination in Frail Elderly - Interim Report from a Prospective Observational Cohort Study

Background: The Coronavirus disease 2019 (Covid-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has prompted accelerated vaccines development. Their use was prioritized to protect the most vulnerable, notably, the elderly. Because of fluctuations in vaccine availability, strategies such as delayed second dose and heterologous prime-boost have been employed. The effectiveness of these strategies in the frail elderly are unknown. Methods: In this real-world vaccination study, under a government-decreed rationing strategy, elderly adults residing in long-term care facilities, with or without previously-documented SARS-CoV-2 infection, were administered homologous or heterologous mRNA vaccines, with an extended 16-week interval between doses. Clinical data and blood were serially collected during and after this interval period. Sera were tested for SARS-CoV-2-specific IgG antibodies (to trimeric S; RBD; nucleocapsid) by automated chemiluminescent ELISA. Findings: After a significant increase 4 weeks post-prime dose, there was a significant decline in anti-RBD and anti-S IgG levels until the boost dose, followed by an increase 4 weeks later. Previously uninfected individuals exhibited lower antibody responses up to 16 weeks post-prime dose, but achieved comparable levels to previously infected counterparts by 4 weeks post-second dose. Individuals primed with BNT162b2 exhibited larger decrease in anti-RBD and anti-S IgG levels with 16-week interval between doses, compared to those who received mRNA-1273. No differences in antibody levels 4 weeks after the second dose were noted between the two vaccines, in either homologous or heterologous combinations. Interpretations: These interim results of this ongoing longitudinal study show that, among frail elderly, neither age, sex, nor comorbidity affect antigenicity of mRNA-based COVID vaccines, but previous SARS-CoV-2 infection and type of mRNA vaccine influenced antibody responses when used with a 16-week interval between doses. Homologous/heterologous use of mRNA vaccines was not associated with significant differences in antibody responses 4 weeks following second dose, supporting their interchangeability.Funding: This project was supported by funding from the Public Health Agency of Canada, through the Vaccine Surveillance Reference group and the COVID-19 Immunity Task Force (CITF).Declaration of Interest: None to declare.Ethical Approval: This study was conducted in 12 LTC facilities of the Montréal Centre-Sud – Integrated University Health and Social Services Centre (CIUSSS du Centre-Sud-de-l'Île-de-Montréal) and was approved by its research ethics board (Comité d'éthique de la rechercheVieillissement-Neuroimagerie, protocol number 20-21-36 MP).

Use of seven types of medical jargon by male and female primary care providers at a university health center

ObjectivesThe purposes of this study were to investigate extent and type of jargon use among primary care providers at a university health center, to evaluate the association of jargon use with patient outcomes, and to identify differences in jargon use between male and female providers. MethodThe study employed a causal comparative design. Audio recordings of 87 primary care interviews were transcribed and coded using Pitt and Hendrickson's seven-category medical jargon classification framework. ResultsNearly 80% of appointments included at least one instance of unexplained jargon, with an average of more than four uses of jargon per visit. The most frequently used types of jargon were technical terminology and medical vernacular. Acronyms and abbreviations, medicalized English, and unnecessary synonyms were also regularly used. Just under half of distinct jargon terms were explained. Male providers used nearly 50% more jargon per minute than female providers, and they used more technical jargon than did their female colleagues. However, they explained that jargon just as frequently as female providers. ConclusionsWhereas previous studies have frequently limited the operational definition of jargon to two or three types, the comprehensive typology proposed by Pitt and Hendrickson provides a useful tool for identifying a wide range of jargon usage. Future research should examine the outcomes of this range of jargon types in more varied, less educated patient populations, and across different types of healthcare providers. Practice implicationsWith jargon used on average more than once every four minutes in our sample, and only half of jargon terms explained, medical jargon may be more of a problem even in primary care contexts than providers themselves realize. Male providers especially may want to make efforts to become more conscious of their jargon use and take care to explain terms, in an effort to facilitate more effective patient-provider communication and improved patient outcomes.

An Application of Social Marketing Theory to develop a social marketing campaign to address mental health literacy and help-seeking behavior among male college students

Male college students have been observed to have low mental health literacy and help-seeking behaviors. The purpose of this study was to apply social marketing theory to address mental health literacy among male undergraduate students in order to improve both mental health literacy and help-seeking behaviors. The current study employed qualitative methods involving key informant interviews among male undergraduate university students (n = 26). Participants were provided three vignettes representing a male college student presenting with anxiety, depression, or stress during the key informant interviews. The concepts from the key informant interviews were mapped onto the social marketing theory marketing mix (product, price, place, promotion). The social marketing mix identified methods to improve professional help-seeking behaviors (product) among male undergraduate students by reducing stigma, both perceived social stigma and self-stigma, as well as addressing masculine norms (price) in locations where students are comfortable, such as the university health center or the Internet (place), by connecting the physical signs and symptoms (promotion) to mental health concerns. Findings were translated into a targeted and tailored social marketing campaign implemented in male restrooms in the campus recreation center. Social marketing theory is a valuable tool for developing targeted and tailored social marketing programs for mental well-being among college students.

The Practice and Opinions of the Applicants of a University Health Center on Multivitamin/Mineral Use, Ankara-Turkey

Aim: The aim of this study was to determine the nutritional status, knowledge on multivitamin/mineral supplements and their use among individuals who applied to an outpatient clinic and to evaluate the factors related to multivitamin/mineral preparations (MVM) use.&#x0D; Subjects and Method: This descriptive study was conducted at outpatient clinics (serving for hospital staff and health sciences faculty students) between May-June 2019 with 1650 (≥18 years of age) applicants and one out of four individuals (n=415) were asked to participate in the study. A total of 289 people accepted to participate. The data were collected via face-to-face questionnaire.&#x0D; Results: Of the participants, 66.8% were women; 58.9% were between the ages of 20-34 years; and MVM use was 36.3%. Participants stated their economic status as “good” (p&lt;0.001); physically inactive subjects (p&lt;0.001); and current smokers (p=0.008) were using MVMs more than the others. Almost half of them (46.0%) thought that they had adequate and balanced diet and were using MVMs less (p&lt;0.001). While purchasing MVMs, 61.9% of the users pay attention to price, 47.6% to the brand, 39.0% to the naturality and 32.4% to content.&#x0D; Conclusion: In line with these results, in order to increase the level of awareness of people education should be provided to raise awareness on healthy nutrition and use of food supplements, at an early age, and public awareness should be ensured through mass media and social media projects.

Characteristics of teach-back as practiced in a university health center, and its association with patient understanding, self-efficacy, and satisfaction

ObjectivesThe purpose of this research was to investigate the extent to which recommended characteristics of teach-back were employed by providers in a university Student Health Services department, and to evaluate its association with patient understanding, self-efficacy, and satisfaction. MethodThe study employed a causal comparative design. Audio recordings of 87 primary care interviews were transcribed and coded for presence and characteristics of teach-back. Patients and providers filled out post-encounter questionnaires. ResultsWhen teach-back was used, most recommended characteristics of teach-back were regularly employed. However, providers rarely placed the onus for understanding on themselves, and almost never “closed the loop” by asking patients to repeat back information until they got it correct. Teach-back was associated with higher patient self-efficacy, and high fidelity of implementation with better patient understanding of the reason for the treatment plan. ConclusionsFindings add to existing evidence regarding effectiveness of teach-back. Additional benefits may be realized when implementation is true to recommended characteristics. More research is needed into the necessity of closing the loop and placing onus on the provider. Practice implicationsGiven that neither patients nor providers accurately gauged the level of patient understanding in the medical encounter, teach-back may offer a simple, quick means of reinforcing provider health information and raising patient self-efficacy.

Next-generation gene panel testing in adolescents and adults in a medical neuropsychiatric genetics clinic.

Intellectual disability (ID) encompasses a clinically and genetically heterogeneous group of neurodevelopmental disorders that may present with psychiatric illness in up to 40% of cases. Despite the evidence for clinical utility of genetic panels in pediatrics, there are no published studies in adolescents/adults with ID or autism spectrum disorder (ASD). This study was approved by our institutional research ethics board. We retrospectively reviewed the medical charts of all patients evaluated between January 2017 and December 2019 in our adult neuropsychiatric genetics clinic at the McGill University Health Centre (MUHC), who had undergone a comprehensive ID/ASD gene panel. Thirty-four patients aged > 16years, affected by ID/ASD and/or other neuropsychiatric/behavioral disorders, were identified. Pathogenic or likely pathogenic variants were identified in one-third of our cohort (32%): 8 single-nucleotide variants in 8 genes (CASK, SHANK3, IQSEC2, CHD2, ZBTB20, TREX1, SON, and TUBB2A) and 3 copy number variants (17p13.3, 16p13.12p13.11, and 9p24.3p24.1). The presence of psychiatric/behavioral disorders, regardless of the co-occurrence of ID, and, at a borderline level, the presence of ID alone were associated with positive genetic findings (p = 0.024 and p = 0.054, respectively). Moreover, seizures were associated with positive genetic results (p = 0.024). One-third of individuals presenting with psychiatric illness who met our red flags for Mendelian diseases have pathogenic or likely pathogenic variants which can be identified using a comprehensive ID/ASD gene panel (~ 2500 genes) performed on an exome backbone.

Strategies to improve human papillomavirus (HPV) vaccination rates among college students

Objective Improve (HPV) vaccination rates in a college-aged population using a strategic toolkit for student health services. Participants Eighteen to twenty-six year-olds enrolled at Johns Hopkins University who utilized the Student Health & Wellness Center (JHU SHWC) during the study period. Methods The toolkit comprised of a) continuing medical education (CME) presentation on strategies to improve HPV vaccination, b) campus-wide visual messaging regarding HPV prevalence, genital warts, cancer, and vaccine availability, and c) an electronic medical record (EMR) form prompting discussion about the HPV vaccine during visits. Results HPV vaccination rates at JHU SHWC improved from historical baseline 290/2,372 students/year (12.2%) to 515/2,479 students/year (20.8%), [risk ratio (RR) 1.70 (95% CI, 1.47–1.96), p < 0.001]. Additional changes included significant increases in vaccination rate per visit and vaccination rate by gender, especially among male students. Conclusions Methods and resources from this toolkit could be successfully adapted and deployed by college health centers.

Will telemedicine survive after COVID-19?

During the last 20 years, telemedicine has evolved in Quebec despite several barriers. We studied how a university health centre in Montreal implemented a strategy to enhance the use of telemedicine with the deployment of appropriate infrastructures, continuous training, and the use of advanced technologies, before and during the pandemic. COVID-19 accelerated the use of telemedicine by overcoming some pre-existing barriers. However, telemedicine was mainly limited to a distance consultation during the pandemic using telephone calls or videoconference. The future of telemedicine depends on lifting these obstacles. We need to better define telemedicine and in-person medicine to guarantee the quality of medical and professional acts. We propose some strategies to achieve these goals, combining cultural change, continuous training, new technologies to improve quality of care, and a vision of healthcare with telemedicine oriented on value creation.

Opioid analgesics following surgery for gynecologic cancer patients at a university health center: have we altered our prescribing patterns in this patient population?

Objectives: Our objective was to analyze the effect of increased opioid prescribing regulations, implemented as an updated state law in July 2016, on the number of opioid tablets prescribed to postoperative gynecologic oncology patients at a state-funded university health center. Methods: This Institutional Review Board (IRB)-approved, retrospective review utilized several electronic health records systems and our referral list to identify patients who qualified. Patients were included in the study if they received surgery performed by a gynecologic oncologist for suspicious masses, premalignant or malignant conditions of the uterus, tubes, ovaries or cervix. The charts were divided into Before July 2016 and After July 2016. The number of opioids prescribed to patients at time of discharge was recorded when available. Qualitative data was collected including the prescription or recommendation for non-opioid analgesics within the discharge summary, and type of procedure conducted (open versus minimally invasive). Demographic information including age, ethnicity and insurance coverage was also recorded. The study was designed to detect a 25% decrease in opioid tablets prescribed after the regulation was implemented (alpha = 0.05, power 0.8). Comparisons were made between groups after a Kolmogorov-Smirnov and Shapiro-Wilk test determined that the data was not normally distributed. Therefore, we utilized Mann-Whitney U tests to compare number of opioid tabs prescribed and to compare median age between the Before and After July 2016 groups. We used Chi-Square and Fischer Exact tests to compare differences in ethnicity and non-opioid analgesic (NSAID) use between the Before and After July 2016 groups. Finally, we utilized a multivariate linear regression model to determine if ethnicity and NSAID use significantly impacted the number of opioid tablets prescribed. Statistical analyses were performed utilizing SPSS software version 25. Results: We identified a statistically significant, 50% decrease in the number of opioid tablets prescribed after gynecologic oncology surgeries after July 2016. As anticipated, we also saw fewer opioid tablets prescribed following minimally invasive procedures compared to open cases (p=0.007). When examining non-opioid analgesic data, we identified significantly more patients received a prescription for non-opioid analgesics in the After July 2016 group compared to the Before July 2016 group (p Conclusions: This study confirms there was a significant decrease in the number of opioid tablets prescribed to postoperative gynecologic oncology patients at discharge since July 2016 in our state-funded university hospital. The difference cannot be attributed to the change in the regulatory guidelines alone, but is temporally related to the updated provider requirements. These results reemphasize that minimally invasive surgery has a reduced number of prescribed opioids, inferring a decreased amount of postoperative analgesic requirements. Multi-institutional study is required with more patients to detail the factors involved in further decreasing opioid prescribing and use. It appears from these results that increasing regulatory oversight is an important variable in harnessing the opioid epidemic.

Experiences of emergency triage nurses in the police handover of mentally ill patients: A qualitative descriptive study

BackgroundDue to the high prevalence of mental health illnesses, police officers are often the community resource to emergency calls for someone experiencing a mental health crisis. Despite the successful efforts of crisis intervention teams, the police frequently escort and transfer the individual in crisis to the emergency department (ED). To our knowledge, one study has explored the interactions of first responders and ED staff; however, we lack an understanding of ED triage nurse experiences. AimTo explore the experiences of ED triage nurses regarding the handover of a mental health patient by police in a Quebec University Health Center. MethodSemi-structured interviews with seven nurses were thematically analyzed. The COREQ checklist for reporting qualitative research was used. ResultsNurses and police officers are both concern about patient's well-being; yet, their approach, as discussed in the theme “Medical versus Legal Responsibility”, varied based on their differing responsibilities and views of caring versus protecting. Despite a need for ED-triage protocols, as described in the theme “Ambiguities of Existing ED-Triage Protocols”, all nurses saw police officers as fellow colleagues and expressed that a change had taken place in police culture towards mental health. The latter issues are explained in the themes “Interagency Collaboration and Team-Based Approach”, and “Changing Police Culture on Mental Health.” ConclusionThere is a need for inter-professional collaboration and education to better understand the roles and scope of practice of both professions, and ED triage nurses should receive more training in the domain of mental health.

How collective interactions and institutional logics influence permanency planning in child protection in Quebec

BackgroundIn the Canadian province of Quebec, placing children in foster care is an exceptional measure whose ultimate goal is family reunification. When child-protection workers decide that reunification is unlikely, they must design permanency plans that ensure continuity of care and stable relationships for the child. Most studies of this important decision-making process have focused on individual practitioners as if they acted alone. This process is collective, interactive, and influenced by various contextual elements. ObjectiveThe objective of this exploratory study was to examine the collective, interactive aspects of the decision-making process involved in permanency planning. Participants and settingThe participants were key players involved in child-protection decisions at an Integrated University Health and Social Services Centre (CIUSSS). MethodsThe theoretical approach of this study combines Giddens's structuration theory with ethnomethodology. Data were collected through interviews with 16 key players and nine months of observing advisory-committee meetings. ResultsIn making permanent placement decisions, the participants must engage in extensive interactions with one another. They must also apply various institutional (clinical, legal, and managerial) logics with differing goals and differing operational frameworks, the tensions among which make the process more complex and challenging. ConclusionsOur findings highlight the complexity of making permanent placement decisions and the importance of interaction and collaboration in this process. These findings suggest that management of this process should focus not on holding practitioners accountable and penalizing them for mistakes, but rather on providing adequate conditions for practice to facilitate thoughtful collective deliberation and learning and ethical decision-making.

Vascular aging phenotypes based on VaSerа-screening results in young people with hypertension: Place of connective tissue dysplasia

Objective. To assess the occurrence of various vascular aging phenotypes among young people, depending on the level of blood pressure (BP) and in relation to risk factors (RF) and the presence of connective tissue dysplasia (CTD).Design and methods. In total, 250 young people (88 boys and 162 girls) aged from 18 to 25 years old were examined at the University Health Center. All the subjects were divided into tercile groups based on cardio-ankle vascular index (CAVI), determined by the VaSera-1500 (Fucuda Denshia, Japan). According to the latest expert recommendations the third tercile group corresponds to early vascular aging or EVA syndrome. The first tercile group corresponds to favorable vascular aging. We have analyzed the representation of various vascular phenotypes in individuals with elevated and normal BP, as well as the main RF and external signs of CTD in each of CAVI-tercile group. Data processing was performed using the software package “Statistica 10.0” (StatSoft Inc., USA).Results. Among young people with office hypertension and high normal BP, the EVA phenotype and phenotypes of normal and favorable vascular aging are equally distributed. In persons with office normal and elevated BP, vascular stiffness correlates with weight, body mass index and waist circumference (with the increase in arterial rigidity these indicators decrease). CTD is registered among subjects with severe vascular remodeling both in boys and girls.Conclusions. Our data indicate the feasibility of angiology screening for identification of vascular aging phenotypes as a part of preventive measures among young people, regardless of the level of initial office BP. This strategy strategy will contribute to a more differentiated identification of risk groups and more individualized preventive interventions based on vascular aging phenotypes.

Effects of Surgical Delay Due to COVID-19 on Women Requiring Emergency Gynaecological Surgery.

In response to the coronavirus-19 (COVID-19) pandemic, the McGill University Health Centre introduced protocols to protect health care workers during emergency surgeries. These included waiting for a COVID-19 test result or waiting 20 minutes after aerosol-inducing procedures before proceeding with surgery. The following brief communication describes the impact of surgical delay on the outcomes of 3 emergency gynaecologic procedures: dilatation and curettage, laparoscopic salpingectomy, and laparoscopic cystectomy and detorsion. Our results show that delays associated with COVID-19 protocols did not negatively impact patients undergoing these surgeries.

Voice-based screening for SARS-CoV-2 exposure in cardiovascular clinics.

AimsArtificial intelligence (A.I) driven voice-based assistants may facilitate data capture in clinical care and trials; however, the feasibility and accuracy of using such devices in a healthcare environment are unknown. We explored the feasibility of using the Amazon Alexa (‘Alexa’) A.I. voice-assistant to screen for risk-factors or symptoms relating to SARS-CoV-2 exposure in quaternary care cardiovascular clinics.MethodsWe enrolled participants to be screened for signs and symptoms of SARS-CoV-2 exposure by a healthcare provider and then subsequently by the Alexa. Our primary outcome was interrater reliability of Alexa to healthcare provider screening using Cohen’s Kappa statistic. Participants rated the Alexa in a post-study survey (scale of 1 to 5 with 5 reflecting strongly agree). This study was approved by the McGill University Health Centre ethics board.ResultsWe prospectively enrolled 215 participants. The mean age was 46 years (17.7 years standard deviation [SD]), 55% were female, and 31% were French speakers (others were English). In total, 645 screening questions were delivered by Alexa. The Alexa mis-identified one response. The simple and weighted Cohen’s kappa statistic between Alexa and healthcare provider screening was 0.989 (95% CI: 0.982, 0.997) and 0.992 (955 CI 0.985, 0.999) respectively. The participants gave an overall mean rating of 4.4 (out of 5, 0.9 SD).ConclusionOur study demonstrates the feasibility of an A.I. driven multilingual voice-based assistant to collect data in the context of SARS-CoV-2 exposure screening. Future studies integrating such devices in cardiovascular healthcare delivery and clinical trials are warranted.Registration https://clinicaltrials.gov/ct2/show/NCT04508972

Influence of Maternal Age and Ovarian Reserve on the Decision to Continue or to Cancel IVF Cycles in Patients with One or Two Large Follicles: a Dual Effect.

This study aimed to study whether IVF stimulation that results in one or two mature follicles should proceed to oocyte retrieval. This is a retrospective cohort study conducted at McGill University Health Center on 459 patients who underwent IVF treatment between 2011 and 2014, undergoing hormonal stimulation and monitoring of their ovarian response. The primary outcomes were pregnancy and live birth rates. Statistical modeling was used to determine individual roles of patient age and ovarian reserve on outcomes, while controlling for the other factors. Of the 459 cycles included in the study, 360 cycles (78.4%) ended in embryo transfer. Live birth rates per cycle were 15.6%, for the ≤ 34-year-olds; 6.5%, for the 35-39-year-olds; and 2.7%, for the ≥ 40-year-olds (p < 0.01). Twenty-five percent of the cycles in the ≥ 40-year-old group were canceled versus 17% and 15% in the 35-39-year-old and ≤ 34-year-old groups, respectively (p < 0.05). Testing likelihood of live birth as a function of age and antral follicular count (AFC) revealed that a 1-year increase in age reduces the likelihood of live birth by 11% (p < 0.05) and one-unit increase in AFC count leads to a 9% increase in the odds of a live birth (p < 0.05). For the youngest age group, the AFC had a most significant effect, and those with AFC > 11 had 56% live birth rate, while those with AFC ≤ 11 had only 6% of live birth rate. This study supports a shift in reasoning from age being the predictor of outcomes in women with a low response at IVF to both age and ovarian reserve needing to be taken into consideration.

Does the timing of cabergoline administration impact rates of ovarian hyperstimulation syndrome?

ObjectiveDoes the timing of cabergoline administration impact the rate of mild/moderate ovarian hyperstimulation syndrome in women with a GnRH agonist trigger?MethodsWe conducted a retrospective cohort analysis of 285 in-vitro fertilization patients at risk of OHSS who received a GnRH agonist trigger from 2011 to 2019 at McGill University Health Centre. Group 1 (Trig, n=101) began taking cabergoline 0.5 mg orally for 7 days at the time of GnRH agonist trigger, while Group 2 (Retriev, n=184) started taking cabergoline on the day of oocyte retrieval. The rates of OHSS were then compared between the groups using analysis of variance and chi-square analysis, where appropriate.ResultsThe baseline demographic characteristics of the two groups were similar. Trig appeared to be at a slightly higher risk of OHSS based on a significantly higher antral follicle count (20.2±4.2 vs. 19.0±4.3; P=0.02), higher number of stimulated follicles >10 mm at trigger (25.7±7.0 vs. 22.8±8.3, P=0.003), and higher peak serum E2 level (17,325±2,542 vs. 14,822±3,098; P=0.0001). The Trig group had lower rates of mild and moderate OHSS (24% vs. 36%; P=0.045). Neither group had any patients who developed severe OHSS. Trig had fewer patients presenting with pelvic free fluid (13% vs. 23%; P=0.03), lower hematocrit (37.8±4.8% vs. 40.5±4.2%; P=0.0001), higher albumin concentrations (30.4±2.7 vs. 29.5±2.0; P=0.01), and lower potassium concentrations (3.9±0.5 vs. 4.2±0.7; P=0.0002).ConclusionCabergoline at the time of trigger as compared to the time of collection should be investigated to assess its role in reducing the rates of mild/moderate OHSS.