McGill University Health Centre Research Articles

A Medical Student's Perspective on "Fighting for a Hand to Hold"

Fighting for a Hand to Hold by Dr. Samir Shaheen-Hussain is a heartbreaking and compelling read depicting the history of injustices, terror and trauma inflicted upon Indigenous children by the Canadian medical system. As an emergency pediatrician at the McGill University Health Centre and associate professor at McGill University, Dr. Shaheen-Hussain weaves his clinical experiences and long-standing advocacy efforts alongside archival research to shed insight on medical colonialism. This piece is structured in two parts: a book review followed by a personal reflection. It is accompanied by a podcast interview with Dr. Shaheen-Hussain in which he discusses his social justice work, his book, and advocacy advice for students in healthcare. This book review highlights the importance of Fighting for a Hand to Hold as a seminal piece of literature for all healthcare professionals and trainees across Canada. In the personal reflection, the author considers their own experiences with race and racism as a person of colour, settler Canadian, and medical student. This reflection concludes by advocating for more emphasis on Indigenous health in Canadian medical education and practice.

Using the Theoretical Domains Framework to Identify Barriers and Facilitators to Elder-Friendly Care Implementation Within a Multi-Site Academic Health Centre.

Societal demographic shifts are occurring globally. Within Quebec, Canada, the percentage of adults over 65 (older adults) is predicted to increase from 19.3% to >25.9% by the year 2036. Older adults (OAs) experience hospitalizations more frequently than persons aged 15-64years old, and hospitalizations for OAs can be detrimental due to naturally occurring physiological changes. To address the needs of this population, the Quebec government mandated that all acute care hospitals implement OA-friendly care standards called AAPA ("l'Approche Adaptée à la Personne Âgée"). To describe an approach for identifying barriers and facilitators (BFs) to AAPA implementation at the McGill University Health Centre, an academic healthcare centre in Montreal that provides tertiary and quaternary care. Our approach included an organizational quality improvement (QI) model based on the Institute for Healthcare Improvement QI approach and the use of the Theoretical Domains Framework (TDF) to guide the assessment of BFs to AAPA implementation. To identify the BFs of AAPA implementation, themes were generated from the raw data. In total, 32 barriers and 88 facilitators were identified. Each BF was linked to one or more corresponding domain from the TDF. Seven of the most frequently occurring domains were: (1) knowledge, (2) beliefs about consequences, (3) social/professional role and identity, (4) social influences, (5) environmental context and resources, (6) intentions, and (7) goals. A theory-informed approach, such as the TDF, can be used to facilitate the implementation of evidence-based guidelines.

Neoadjuvant prehabilitation therapy for locally advanced non-small-cell lung cancer: Optimizing outcomes throughout the trajectory of care.

e20545 Background: Prehabilitation is well established for improving outcomes in cancer surgery. Combining prehabilitation with neoadjuvant treatments may provide an opportunity to rapidly initiate cancer-directed therapy while improving functional status in preparation for local consolidation. In this proof-of-concept study, we analyzed non-small-cell lung cancer patients who underwent simultaneous prehabilitation and neoadjuvant therapy. Methods: We retrospectively analyzed all patients who underwent neoadjuvant treatment for non-small-cell lung cancer followed by curative intent surgery at the McGill University Health Center between 2015-2020. Patients who were screened for the prehabilitation program were identified. Screening included assessment of physical performance, nutritional status and signs for anxiety and depression. 6-minute-walk test was used as a functional outcome parameter of prehabilitation. Results: We identified a total of 93 patients who underwent neoadjuvant therapy. Of these, 12 patients were screened to undergo a prehabilitation program. For 1 patient surgical intervention was too soon to complete the program, 1 patient dropped out after the first and another patient was deemed fit to undergo surgery without intervention. Thus, 9 patients completed full neoadjuvant prehabilitation therapy. Postoperative median length of stay was 2 days (IQR 1-5) and there were no mortalities. We found major complications in 1 patient and minor complications (prolonged air leak) in 2 cases. Patients improved their 6-minute-walk test despite undergoing neoadjuvant treatment by a mean of 35 meters (SD 39). Conclusions: Neoadjuvant prehabilitation therapy is feasible and associated with encouraging results. The performance of all measures remains a logistic challenge. With multimodal strategies for lung cancer treatment becoming key to optimal outcomes, neoadjuvant prehabilitation therapy is a concept worthy of prospective multi-center evaluation.

Association of Opioid Consumption Profiles After Hospitalization With Risk of Adverse Health Care Events

Although better pain management has guided policies for opioid use over the past few decades, evidence is limited regarding how patterns of use are associated with the risk of potentially avoidable opioid-related adverse events. To estimate the risk of harms associated with opioid dose and duration of use, and to ascertain whether the risk is modified by treatment indication and age. This ad hoc cohort study followed up patients who were enrolled in a cluster randomized trial of medication reconciliation between October 1, 2014, and November 30, 2016, 12 months after they were discharged from the McGill University Health Centre in Montreal, Quebec, Canada. To be eligible for this study, patients needed to have filled at least 1 opioid prescription 3 months after discharge. Patients with a history of using methadone or buprenorphine were excluded. Data analyses were performed between February 1, 2019, and February 28, 2020. Time-varying measures of opioid use included current use, daily morphine milligram equivalent (MME) dose, cumulative and continuous use duration, and type of ingredients in prescription opioids used. Hospitalization records, dispensed prescriptions records, and postdischarge interviews were used to evaluate adherence to the opioid prescriptions after discharge. Opioid-related emergency department visits, hospital readmissions, or all-cause death. Outcomes were ascertained using provincial medical services claims and hospitalization databases. Of 3486 participants in the cluster randomized trial (mean [SD] age of 69.6 [14.9] years; 2010 men [57.7%]), 1511 patients were included in this ad hoc cohort study. Among those with at least 1 opioid dispensation, 241 patients (15.9%) experienced an opioid-related emergency department visit, hospital readmission, or death. Results from marginal structural Cox proportional hazards regression models showed more than a 2-fold increase in the risk of opioid-related adverse events associated with a cumulative use duration of more than 90 days (adjusted hazard ratio, 2.56; 95% CI, 1.25-5.27) compared with 1 to 30 days. A 3-fold risk increase was found with a mean daily dose higher than 90 MME (adjusted hazard ratio, 3.51; 95% CI, 1.58-7.82) compared with 90 MME or lower. This study found an association between risk of adverse health care events and higher opioid doses and longer treatment duration. This finding can inform policies for limiting opioid duration and dose to attenuate the risk of avoidable morbidity.

Reliability of Postsurgical Soft Tissue Reaction Grading Scales for Bone-anchored Hearing Implants.

This study aims to assess and compare the reliability of the Holgers, the IPS, and the Tullamore scales for skin tolerability assessment of postoperative bone-anchored hearing implant images. A survey study and retrospective review of percutaneous osseointegrated auditory implant images for scoring using three skin classification scales. McGill University Health Center, Montreal, Quebec, Canada. Healthcare workers experienced and inexperienced with osseointegrated auditory implant skin classification scales. Participation involved completing: 1) survey questionnaires assessing experience with osseointegrated auditory implants and related skin reactions and 2) scoring postoperative osseointegrated auditory implant with surrounding skin images using the Holgers Classification, the IS (of the IPS) scale, and the Tullamore Classification. Participants were asked to rate 12 images of postoperative osseointegrated auditory implant and surrounding soft tissue. This process was repeated until participants scored all images using the three scales; each rater graded 36 images in total. The order in which scales were presented occurred at random. Intraclass correlation coefficients were calculated to assess reliability. Thirty-one participants were recruited to the study. Fourteen (45.2%) had experience with at least 1 osseointegrated auditory implant skin classification scale, while 17 (54.8%) did not have experience. The wide and overlapping 95% confidence intervals of the intraclass correlation coefficients results do not provide us with enough evidence to define a well-established degree and hierarchy of reliability when comparing the scales. Among experienced raters, all scales presented moderate to good reliability. The Holgers Classification, the IPS scale, and the Tullamore Classification all present moderate to good reliability when used by experienced raters to assess skin reactions following surgical implantation of an osseointegrated hearing device. As a result, clinicians should use these scales with a degree of caution. The findings of this study do not provide us with enough evidence to single out one of the scales as a standard to follow, but more extensive studies are required to assess the reliability of the scales.

The Use of Genetic Testing Panels for Dyslipidemia: A Quality Improvement Project at the McGill University Health Centre

Background: Genetic testing panels are used to identify the most common genetic causes of dyslipidemia, and the results of these panels can guide treatment and management. The objective of this quality improvement project was to assess the appropriateness of genetic testing panels requested by the McGill University Health Centre (MUHC). Methods: Genetic testing panels sent for analysis from January 2018 to December 2019 were identified. Ordering physician specialty, patient personal and family medical history, lipid panel results, and genetic testing results were collected. Then, validated Familial Hyperlipidemia (FH) scores (Simon-Broome Registry Criteria, Dutch Lipid Clinic Network Criteria, FH Canada criteria) were calculated for patients who underwent genetic testing for suspected FH. Results: There were 36 genetic test panels sent out for analysis during the study period, of which 24 were accessible for data analysis. Pathogenic mutations were identified in 7/24 (29%) of the analyzed panels. The 19/24 (79%) of the panels were requested by lipid specialists, and all of the panels positive for pathogenic mutations were requested by lipid specialists. Interestingly, 23/24 (94%) of the patients met the Canadian criteria for at least considering genetic testing, suggesting that most panels were appropriately requested. Only 3/24 (12%) of patients had insufficient criteria for FH by the Simon-Broome criteria, but all of these carried pathogenic mutations. Conclusion: These results suggest that at the MUHC, using the Canadian criteria identifies a greater number of patients for genetic testing and for appropriate diagnosis and treatment.

PO23: Safety and Efficacy of 2D Brachytherapy vs 3D Image-Guided Adaptive Brachytherapy for Locally Advanced Cervical Cancer - A Single Institution Retrospective Study

Introduction: Treatment paradigms for locally advanced cervical cancer have shifted from the use of 2D-brachytherapy (2D-BT) to that of 3D-image-guided adaptive BT (3D-IGABT), with the goal of delivering doses more precisely to clinical targets while sparing organs-at-risk. In this retrospective study, we aimed to report our institution's experience, the McGill University Health Centre, with 3D-IGABT for the treatment of cervical cancer.

Fit Testing Retrofitted Full-Face Snorkel Masks as a Form of Novel Personal Protective Equipment During the COVID-19 Pandemic.

Objective: Bottlenecks in the personal protective equipment (PPE) supply chain have contributed to shortages of PPE during the COVID-19 pandemic, resulting in fractures in the functionality of healthcare systems. This study was conducted with the aim of determining the effectiveness of retrofitted commercial snorkel masks as an alternative respirator for healthcare workers during infectious disease outbreaks.Methods: A retrospective analysis was performed, analyzing qualitative and quantitative fit test results of the retrofitted Aria Ocean Reef® full-face snorkeling mask on healthcare workers at the McGill University Health Centre between April-June 2020. Historical fit test results, using medical-grade respirators, for healthcare workers were also analyzed.Results: During the study period, 71 participants volunteered for fit testing, 60.6% of which were nurses. The overall fit test passing rate using the snorkel mask was 83.1%. Of the participants who did not previously pass fit testing with medical-grade respirators, 80% achieved a passing fit test with the snorkel respirator.Conclusions: The results suggest that this novel respirator may be an effective and feasible alternative solution to address PPE shortages, while still providing healthcare workers with ample protection. Additional robust testing will be required to ensure that respirator fit is maintained, after numerous rounds of disinfection.

Phylogenetic Clustering among Asylum Seekers with New HIV-1 Diagnoses in Montreal, QC, Canada.

Migrants are at an increased risk of HIV acquisition. We aimed to use phylogenetics to characterize transmission clusters among newly-diagnosed asylum seekers and to understand the role of networks in local HIV transmission. Retrospective chart reviews of asylum seekers linked to HIV care between 1 June 2017 and 31 December 2018 at the McGill University Health Centre and the Jewish General Hospital in Montreal were performed. HIV-1 partial pol sequences were analyzed among study participants and individuals in the provincial genotyping database. Trees were reconstructed using MEGA10 neighbor-joining analysis. Clustering of linked viral sequences was based on a strong bootstrap support (>97%) and a short genetic distance (<0.01). Overall, 10,645 provincial sequences and 105 asylum seekers were included. A total of 13/105 participant sequences (12%; n = 7 males) formed part of eight clusters. Four clusters (two to three people) included only study participants (n = 9) and four clusters (two to three people) included four study participants clustered with six individuals from the provincial genotyping database. Six (75%) clusters were HIV subtype B. We identified the presence of HIV-1 phylogenetic clusters among asylum seekers and at a population-level. Our findings highlight the complementary role of cohort data and population-level genotypic surveillance to better characterize transmission clusters in Quebec.

Autologous Free Dermal-Fat-Fascial Graft for Parotidectomy Defects: A Case Series.

Background:Frey’s syndrome and facial asymmetry from loss of parotid tissue are long-term sequelae of parotid surgeries causing significant morbidity. Various techniques have been used to fill the parotidectomy defect, preserve facial contour symmetry, and prevent Frey’s syndrome. Free dermal-fat-fascial graft (DFFG) is one such technique; however, its use is largely undocumented in the literature. In this case series, we investigate the efficacy of free DFFG in reconstructing parotidectomy defects at 2 tertiary care centers.Materials and methods:Medical records of 54 patients who underwent primary parotidectomy and immediate reconstruction with autologous abdominal free DFFG by 2 surgeons in George Washington University Hospital and McGill University Health Centre between 2007 and 2019 were collected prospectively. Patients responded to 2 questionnaires addressing postoperative outcomes.Results:Fifty-four patients were included; 32 superficial parotidectomies and 22 total parotidectomies were performed for 39 benign and 15 malignant tumors. Thirty-seven patients could be reached. Out of 37 patients who responded to the first questionnaire, 59% (22) reported complete facial symmetry, 27% (10) reported mild hollowness, and 14% (5) reported mild fullness. None declared noticeable hollowness or fullness. While 81% (30) did not experience Frey’s syndrome, 5.4% (2) experienced mild symptoms without disability, and 13.5% (5) experienced debilitating symptoms. Out of 37 patients, 8 patients responded to a second questionnaire addressing the outcome of the abdominal graft donor site. In regard to the donor site, 87.5% (7) were satisfied or very satisfied from its cosmetic appearance, 75% (6) were not bothered by its cosmetic appearance, and 87.5% (7) had no discomfort at the graft donor site. Patients did not report any other symptom at the graft donor site.Conclusion:In this large series of total parotidectomies including malignant pathologies, autologous abdominal free DFFG effectively prevented Frey’s syndrome and preserved facial cosmesis in most patients.

A157 REAL-WORLD TIGHT OBJECTIVE MONITORING WITH ADALIMUMAB LEADS TO EARLIER DOSE OPTIMIZATION AND HIGHER CLINICAL REMISSION RATES AT 12 MONTHS.

Abstract Background Data suggests that tight objective monitoring of inflammatory bowel diseases (IBD) may improve one-year clinical outcomes. Aims The goal of this study is to assess the adherence to serial tight objective monitoring, via clinical symptoms and biomarkers, and the effect of such tight monitoring on one year outcome in IBD patients at an academic and an university-affiliated center. Methods We retrospectively reviewed the chart of 428 consecutive IBD patients who started adalimumaby at the McGill University Health Center and Jewish General Hospital (Montreal, Canada) between January 1, 2015 and January 1, 2019 [338 Crohn’s disease(CD), 90 ulcerative colitis(UC)]. Clinical symptoms (assessed by Harvey-Bradshaw-Index and partial Mayo), C-Reactive Protein(CRP), and fecal calprotectin(FCAL) were captured at treatment initiation and at 3, 6, 9, and 12 months. Combined adherence was defined as the evaluation of ≥2 of 3 parameters(clinical, CRP, FCAL). Dose optimization and drug sustainability curves were plotted by Kaplan-Meier method. Results Clinical symptoms were assessed in nearly all patients at 3 (CD-UC:95-94%), 6 (90-83%), 9 (86-85%) and 12 (96-89%) months. CRP was also available for most patients but the frequency of assessment decreased in CD patients over the study period. In comparison, compliance to serial FCAL testing was low throughout the follow-up period. Clinical remission at one-year was significantly higher in patients who were adherent to early assessment visit at 3 months (p=0.001 both for CD and UC). Adherence to early follow-up also resulted in earlier dose optimisation in both CD and UC patients(pLogrank=0.026 for UC and p=0.09 for CD). However, the overall drug sustainability did not differ. Conclusions Clinical assessment and CRP, but not FCAL, were frequently assessed in patients starting adalimumab. Adherence to early objective combined follow-up visits resulted in earlier dose optimization and improved one-year clinical outcomes but did not change drug sustainability rates. Funding Agencies None

Reasons for delay in timely administration of adjuvant chemotherapy for patients with stage III colon cancer: a multicentre cohort study from the McGill University Department of Oncology

PurposeAdjuvant chemotherapy within 56 or 84 days following curative resection is globally accepted as the standard of care for stage III colon cancer as it has been associated with improved...

Clinical and psychosocial factors affecting work productivity among patients with hidradenitis suppurativa: A cluster analytical investigation

To the Editor: The presence of hidradenitis suppurativa (HS) affects patients' psychosocial work functionality.1Shlyankevich J. Chen A.J. Kim G.E. Kimball A.B. Hidradenitis suppurativa is a systemic disease with substantial comorbidity burden: a chart-verified case-control analysis.J Am Acad Dermatol. 2014; 71: 1144-1150Google Scholar This cross-sectional study, conducted from October 2018 to December 2019, aimed to correlate work presenteeism and absenteeism with psychosocial and disease severity parameters. Adult patients ≥ 18 years, literate in English or French, and attending the HS clinic at the McGill University Health Centre participated in the study. Participants completed validated questionnaires on clinical characteristics, quality of life and psychiatric morbidity, HS severity, and work productivity. Psychiatric health was assessed using the Dermatology Life Quality Index (DLQI) and the Beck Depression Inventory. HS severity was assessed using Hurley staging, HS Physician Global Assessment (PGA), Severity Assessment of Hidradenitis Suppurativa (SAHS), and the International Hidradenitis Suppurativa Severity Score System (IHS4) (Supplemental Tables I and II, available at https://doi.org/10.1016/j.jaad.2021.02.066). Absenteeism was measured by the number of workdays missed in the previous 4 weeks due to HS. Presenteeism was gauged by the number of days in the preceding 4 weeks that a patient worked but was disturbed by HS during work. Patients graded the impact of HS on their work performance on a scale of 0-10. This rating was self-reported and liable to subjective reporting and recall bias. Most of the 131 participants were female (n = 76; 58.02%) and Caucasian (n = 82; 62.6%), with a mean age of 38.11 ± 14.32 years. Of 102 employed patients, 81 (79.41%) worked in office settings and 21 (20.59%) worked in field jobs. Absenteeism was reported in 44 (43.14%) with mean missed workdays of 1.76 (standard deviation [SD], 2.11). Presenteeism was more prevalent, reported by 79 (77.45%) with mean bothered days at work of 5.13 (SD, 5.11). A 2-step clustering algorithm (Fig 1) revealed a fair quality clustering solution with a poor productivity cluster comprising 55 (53.9%) participants and a high productivity cluster comprising 47 (46.1%) participants. Over the previous 4 weeks, poor productivity patients reported disturbance by HS on a mean of 6.51 (SD, 5.55) days compared with 3.23 (SD, 3.78) for high productivity patients. Poor productivity patients missed a mean of 2.13 (SD, 2.34) workdays, compared with 1.23 (SD, 1.55) days by high productivity patients. Poor productivity patients reported significantly worse scores on the DLQI and higher scores on the Beck Depression Inventory, body mass index, visual analog score for pain, Hurley staging, HS-PGA, IHS4, and SAHS scores. (Table I). HS impact on productivity correlated closest with Hurley staging and DLQI scores (Table I).Table IComparison of clinical and psychosocial characteristics of poor productivity and high productivity among hidradenitis suppurativa patientsVariablesPoor productivity clusterHigh productivity clusterP valueMeanSDMeanSDClinical profile Age35.9311.90539.0414.059.23 Delay in diagnosis (years)9.057.22511.5512.961.22 Hurley staging2.700.451.400.53<.001 DLQI18.207.5246.705.676<.001 Beck depression inventory15.8410.8327.776.789<.001 BMI30.9537.786928.5236.0472.09 VAS5.872.4572.812.410<.001 PGA3.641.1921.790.999<.001 IHS411.357.1392.532.244<.001 SAHS8.403.2294.001.732<.001Work productivity profile Missed days2.132.3561.231.547.07 Bothered days6.515.5543.233.779.002 Productivity on bothered days∗Productivity on bothered days 0-10 (self-reported).6.961.3097.041.835.83BMI, Body mass index; DLQI, Dermatology Life Quality Index; IHS4, International Hidradenitis Suppurativa Severity Score System; PGA, Physician Global Assessment; SAHS, Severity Assessment of Hidradenitis Suppurativa; SD, Standard deviation; VAS, visual analog score.∗ Productivity on bothered days 0-10 (self-reported). Open table in a new tab BMI, Body mass index; DLQI, Dermatology Life Quality Index; IHS4, International Hidradenitis Suppurativa Severity Score System; PGA, Physician Global Assessment; SAHS, Severity Assessment of Hidradenitis Suppurativa; SD, Standard deviation; VAS, visual analog score. Although presenteeism was more prevalent, only absenteeism was a significant predictor of perceived loss of productivity. In bivariate correlations, Hurley staging was significantly associated with bothered workdays (r = 0.28, P < .001) but not with missed days (r = 0.19, P = .09) or subjectively measured productivity (r = -0.13, P = .25). Chi-squared analysis revealed that patients in office-based settings most often reported bothered work (χ2 = 19.7, P < .001). In a multivariable regression analysis (Table I) adjusted for age and gender and controlling for both presenteeism and absenteeism, only absenteeism was a significant predictor of perceived productivity loss (B = -0.26, P = .01). This model revealed 21% variance in perceived productivity loss (F = 4.84, P < .01). Our data illustrate that the HS impact on work productivity correlates with the standard indicators of clinical severity, quality of life, and depression. None disclosed.

The effect of a topical combination of clonidine and pentoxifylline on post-traumatic neuropathic pain patients: study protocol for a randomized, double-blind placebo-controlled trial

BackgroundFirst-line pharmacotherapy for neuropathic pain entails the use of systemic antidepressants and anticonvulsants. These drugs are not optimally effective and poorly tolerated, especially for older patients with comorbid conditions. Given the high number of such patients, there is a need for a greater repertoire of safer and more effective analgesics. Clonidine and pentoxifylline are vasodilator agents that work synergistically to enhance tissue perfusion and oxygenation. The topical administration of these drugs, individually and in combination, has shown anti-nociceptive properties in rodent models of neuropathic pain. A topically-administered combination of clonidine and pentoxifylline also effectively reduced the intensity of both spontaneous and evoked pain in healthy volunteers with experimentally-induced neuropathic pain. The next step in advancing this formulation to clinical use is the undertaking of a phase II clinical study to assess its efficacy and safety in neuropathic pain patients.Methods/designThis is a study protocol for a randomized, double-blind, placebo-controlled, phase II clinical trial with a cross-over design. It is a single-centered, 5-week study that will enroll a total of 32 patients with post-traumatic peripheral neuropathic pain. Patients will be treated topically with either a combination of clonidine and pentoxifylline or placebo for a period of 2 weeks each, in randomly assigned order across patients, with an intervening washout period of 1 week. The primary outcome measures of the study are the intensity of spontaneous pain recorded daily in a pain diary with a visual analog scale, and the degree of mechanical allodynia evoked by a brush stimulus. The secondary outcome measures of the study include scores of pain relief and change in the area of punctate hyperalgesia. This trial has been prospectively registered with ClinicalTrials.gov on November 1, 2017. ClinicalTrials.gov Identifier: NCT03342950.DiscussionThe analgesic use of topical treatment with clonidine and pentoxifylline in combination has not been investigated in post-traumatic neuropathic pain. This study could generate the first evidence for the efficacy and safety of the formulation in alleviating pain in patients with neuropathic pain. Furthermore, this trial will provide objective grounds for the investigation of other agents that enhance tissue oxygenation in the topical treatment of peripheral neuropathic pain.Trial registrationThis trial has been registered with ClinicalTrials.gov owned by NIH’s US National Library of Medicine.ClinicalTrials.gov NCT03342950. Registered on November 1, 2017 (trial was prospectively registered).Protocol version and identifiersThis is protocol version 5, dated June 2018. McGill University Health Center (MUHC) Reaseach Ethics Board (REB) identification number: TTNP 2018-3906.

Acceptability of a Patient Portal (Opal) in HIV Clinical Care: A Feasibility Study.

Opal (opalmedapps.com), a patient portal in use at the Cedars Cancer Centre of the McGill University Health Centre (MUHC) (Montreal, Canada), gives cancer patients access to their medical records, collects information on patient-reported outcome measures (PROMs), and has demonstrated patient satisfaction with care. This feasibility study aims to evaluate Opal’s potential acceptability in the context of HIV care. People living with HIV (PLWH) and their healthcare providers (HCPs) completed cross-sectional surveys from August 2019 to February 2020 at large HIV centers, including the Chronic Viral Illness Service of the MUHC, and other HIV clinical sites in Montreal and Paris, France. This study comprised 114 PLWH (mean age 48 years old, SD = 12.4), including 74% men, 24% women, and 2% transgender or other; and 31 HCPs (mean age 46.5 years old, SD = 11.4), including 32% men, 65% women, and 3% other. Ownership of smartphones and tablets was high (93% PLWH, 96% HCPs), and participants were willing to use Opal (74% PLWH, 68% HCPs). Participants were interested in most Opal functions and PROMs, particularly PROMs capturing quality of life (89% PLWH, 77% HCPs), experience of healthcare (86% PLWH, 97% HCPs), and HIV self-management (92% PLWH, 97% HCPs). This study suggests Opal has high acceptability and potential usefulness as perceived by PLWH and HCPs.

Management of Renin-Angiotensin-Aldosterone System blockade in patients admitted to hospital with confirmed coronavirus disease (COVID-19) infection (The McGill RAAS-COVID- 19): A structured summary of a study protocol for a randomized controlled trial

Management of Renin-Angiotensin-Aldosterone System blockade in patients admitted to hospital with confirmed coronavirus disease (COVID-19) infection (The McGill RAAS-COVID- 19): A structured summary of a study protocol for a randomized controlled trial

A Longitudinal View of Successful Aging With HIV: Role of Resilience and Environmental Factors

Background: Much attention is paid to the negative aspects of aging with HIV. Less is known about those doing well, yet much could be learned from those aging successfully. Objective: The purpose of this study is to estimate the extent to which people aging with HIV met criteria for successful aging and maintained this status over time. A second objective was to identify factors that placed people at promise for successful aging. Methods: Participants were members of the Positive Brain Health Now (BHN) cohort which recruited from five Canadian sites (2014-2016) with prospective follow-up over 27 months. People ≥50 were classified as aging successfully if they were at or above norms on 7 or 8 of 8 health-related quality of life domains from the RAND-36. Promise factors covered socio-demographic, HIV, co-morbidity, lifestyle, resilience, and environmental domains. Group-based Trajectory Analysis, logistic regression and regression tree analysis, a form of machine learning, were applied. Results: Of the 513 people age ≥50 at study entry, 73 (14·2%) met criteria for successful aging at entry and over time. The most influential factor was loneliness: splitting the sample into two groups with the prevalence of successful aging 28·4% in the not-lonely compared to 4·6% in the lonely. Other influential factors were feeling safe, social network, motivation, stigma, and socioeconomic status. These factors identified 17 sub-groups with at least 30 members with the proportions classified as aging successfully ranging from 0% to 79·4%. Conclusion: The results indicate the important role of social determinants of health in successful aging in people with HIV. Funding Statement: This project was supported by grants from the Canadian Institutes of Health Research (LKF,MJB, NM, TCO-125272), the CIHR Canadian HIV Trials Network (CTN 273), and salary support from the Fonds de Recherche Sante du Quebec (LKF) and the Research Institute of the McGill University Health Centre (MJB). Declaration of Interests: Authors declare that they have no conflicts of interest. Ethics Approval Statement: All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The project was approved by the Research Ethics Board of each of the participating institutions. All participants provided informed consent.

The Predictive Value of Inflammatory Biomarkers in Esophageal Anastomotic Leaks

This study investigated the role of the neutrophil-to-lymphocyte ratio (NLR) in predicting anastomotic leak (AL) after esophagectomy for esophageal adenocarcinoma. This is a retrospective analysis of a prospectively collected database from the McGill University Health Center. Included were all patients with esophageal adenocarcinoma who underwent esophagectomy between 2005 and 2016. Patients with chronic infections, concurrent active malignancies, and autoimmune conditions were excluded. NLR values were obtained on postoperative days (POD) 0, 1, 2, and 3. Receiver operating characteristic curve study and multivariable logistic analysis were conducted to evaluate the diagnostic value of NLR. The study included 330 patients, and AL developed in 16%. Mean NLR values on POD1, 2, and 3 were higher in patients with leaks (20 vs 14 on POD1, P < .001; 20 vs 12 on POD2, P < .001; and 19 vs 10 on POD3, P < .001). The NLR value on POD3 was associated with an area under the curve of 70% and a negative predictive value of 92.4%. Multivariable analyses identified higher American Society of Anesthesiologists Physical Status Classification, increasing NLR trend (between POD1 and POD3), POD1 NLR, POD2 NLR, and POD3 NLR as independent factors associated with AL. Patients who developed AL demonstrate higher mean NLR values in the early postoperative period with rising trends. Conversely a low NLR is associated with a high negative predictive value for AL. This simple metric allows risk stratification that may guide treatment decisions in esophagectomy patients.

Anxiety Linked to Hypertensive Disorders in Pregnancy

Back to table of contents Previous article Next article Clinical & ResearchFull AccessAnxiety Linked to Hypertensive Disorders in PregnancyTerri D'ArrigoTerri D'ArrigoSearch for more papers by this authorPublished Online:12 Jan 2021https://doi.org/10.1176/appi.pn.2021.12a11AbstractRates of comorbid anxiety and preeclampsia increased nearly sixfold over 10 years.Pregnant women who have anxiety may be at increased risk for hypertensive disorders of pregnancy such as gestational hypertension, preeclampsia, and eclampsia, suggests a study in the Journal of Affective Disorders.Women should be screened for mental disorders in the first trimester of pregnancy, says Tuong-Vi Nguyen, M.D., M.Sc.McGill University“Mental health screening should be considered in the first trimester of the pregnancy if it is to be used prospectively to prevent hypertensive disorders of pregnancy and mental health disorders in the postpartum period,” study researcher Tuong-Vi Nguyen, M.D., M.Sc., told Psychiatric News. She is an assistant professor and a reproductive psychiatrist at McGill University in Montreal.The researchers analyzed data from a population-based retrospective study involving nearly 9.1 million pregnant women using Healthcare Cost and Utilization Project Nationwide Inpatient Sample (HCUP-NIS) data from 2004 through 2014. This database samples 20% of all discharges from community hospitals in the United States except for long-term care and rehabilitation facilities. For their analysis, the researchers used ICD-9 codes for gestational hypertension, preeclampsia, and eclampsia and categorized mental disorders as bipolar disorder, depression, mood disorder, and anxiety disorder as well as mental disorders of mother, antepartum condition, or complication.The rapid increase in rates of comorbid mental health disorders and hypertensive disorders in pregnancy are a call to action for health care professionals, says Eva Suarthana, M.D., Ph.D.McGill UniversityPregnant women who had anxiety had a 32% greater risk of gestational hypertension, a 52% greater risk of preeclampsia, and an 81% greater risk of eclampsia compared with pregnant women who did not have anxiety. The rate of pregnant women with anxiety disorder and gestational hypertension increased from 1.75 per 10,000 women in 2004 to 12.99 per 10,000 women by 2014. At the same time, the rate of pregnant women with anxiety and preeclampsia increased from 2.21 to 12.85 per 10,000 women.“In the past decade people have become more aware of and open about mental health problems, so I personally expected to see an increasing trend,” said senior author Eva Suarthana, M.D., Ph.D., an adjunct professor in the Obstetrics and Gynecology Department at McGill University and a researcher at McGill University Health Center in Montreal. “Nevertheless, I was still surprised to see such a remarkable increase and thought that health care professionals need to do something about this concerning trend.”The researchers found that having depression did not consistently increase the risk of hypertensive disorders in pregnancy. Pregnant women with depression had a 15.6% greater risk of gestational hypertension and a 25.5% greater risk of preeclampsia than those who did not have depression, but they did not appear to have an increased risk of eclampsia.The medical literature supports actively treating pregnant women with psychiatric disorders to wellness, says Jennifer Payne, M.D.Rouse Photography Group LLCJennifer Payne, M.D., an associate professor of psychiatry and behavioral sciences and the director of the Women’s Mood Disorders Center at Johns Hopkins Medicine, said there is no harm in psychiatrists screening their pregnant patients who have anxiety for hypertension.“Technically, the patients’ OB-GYNs are screening them regularly, [but] it never hurts to have more screening, particularly if a psychiatrist is prescribing a medication that can raise blood pressure,” said Payne, who was not involved in the research.Payne emphasized the importance of psychiatric treatment in this population.“In general the literature currently supports actively treating pregnant women with psychiatric disorders, including anxiety, to wellness. Untreated psychiatric disorders are not benign in pregnancy,” Payne said.This study was supported in part by the Academic Enrichment Fund of the Department of Obstetrics and Gynecology at McGill University. ■“Pregnancy Hypertension and Its Association With Maternal Anxiety and Mood Disorders: A Population-Based Study of 9 Million Pregnancies”. ISSUES NewArchived

Seroprevalence and Risk Factors for SARS-CoV-2 Among Incarcerated Adult Men in Quebec, Canada (2021): A Cross-Sectional Study

Background: People in prison are at increased risk of SARS-CoV-2 infection due to overcrowding and challenges in implementing infection prevention and control measures. We examined the seroprevalence of SARS-CoV-2 and associated risk factors among incarcerated adult men in Quebec, Canada.Methods: We conducted a cross-sectional seroprevalence study in 2021 in three provincial prisons, representing 45% of Quebec’s incarcerated male provincial population. The primary outcome was SARS-CoV-2 antibody seropositivity (Roche Elecsys® serology test). Participants completed self-administered questionnaires on sociodemographic, clinical, and carceral characteristics. The association of carceral variables with SARS-CoV-2 seropositivity was examined using Poisson regression models with robust standard errors. Crude and adjusted prevalence ratios (aPR) with 95% confidence intervals (95%CI) were calculated.Findings: Between January 19 and September 15, 2021, 246 of 1,100 (22%) recruited individuals tested positive across three prisons (range 15–27%). Seropositivity increased with time spent in prison since March 2020 (aPR 2·17, 95%CI 1·53–3·07 for “all” vs. “little time”), employment during incarceration (aPR 1·64, 95%CI 1·28–2·11 vs. not), shared meal consumption during incarceration (“with cellmates”: aPR 1·46, 95%CI 1·08–1.97 vs. “alone”; “with sector”: aPR 1·34, 95%CI 1·03–1·74 vs. “alone”), and incarceration post-prison outbreak (aPR 2·32, 95% CI 1·69–3·18 vs. “pre-outbreak”).Interpretation: The seroprevalence of SARS-CoV-2 among incarcerated individuals was high and varied between prisons. Several carceral factors were associated with seropositivity, underscoring the importance of decarceration and occupational safety measures, individual meal consumption, and enhanced infection prevention and control measures including vaccination during incarceration. Funding Information: The Public Health Agency of Canada funded this study (# 2021-HQ-000103). Declaration of Interests: CD, AH, SC, JS, HP, LDB, and SP declare no competing interests. NK reports research funding from Gilead Sciences, advisory fees from Gilead Sciences, ViiV Healthcare, Merck and Abbvie, and speaker fees from Gilead Sciences and Merck, all outside of the submitted work. MMG reports an investigator-sponsored research grant from Gilead Sciences Inc. MMG reports contractual arrangements with the World Health Organization, the Institut national de santé publique du Québec, and the Institut d’excellence en santé et services sociaux du Québec, all outside of the submitted work. MPC reports grants from the McGill Interdisciplinary Initiative in Infection and Immunity and from the Canadian Institutes of Health Research. MPC reports personal fees from GEn1E Lifesciences and form nplex biosciences, both outside the submitted work. MPC is the co-founder of Kanvas Biosciences, Inc. and owns equity in the company. MPC has a pending patent for Methods for detecting tissue damage, graft versus host disease, and infections using cell-free DNA profiling pending, and a pending patent for Methods for assessing the severity and progression of SARS-CoV-2 infections using cell-free DNA. JC has research funding from ViiV Healthcare and Gilead Sciences, and reports remuneration for advisory work (ViiV Healthcare, Gilead Sciences and Merck Canada), outside the submitted work.Ethics Approval Statement: Participants provided written informed consent and received an honorarium of $10 CAD for their study participation. This study was approved by the McGill University Health Centre Research Ethics Board (MUHC REB #2021–6888) and the Direction régionale des services correctionnels du Québec (#2020–12493).