Saskatchewan Health Research Articles

Microbiological analysis of tunneled hemodialysis catheters isolated from patients receiving hemodialysis in Saskatchewan.

Aim: To compare the microbial communities inside hemodialysis catheters from symptomatic and asymptomatic patients to determine their differences.Materials & methods: Catheters (n=41) were removed from patients in the Saskatchewan Health Authority over an 18-month period. The catheter section inside the body was flushed and the contents were evaluated using culture-dependent and culture-independent analysis.Results: All catheters were colonized by bacteria, with considerable overlap between groups based on microbial communities and the individual species detected. More Gram-negative species were detected by sequencing, whereas predominantly Gram-positive strains were cultured. Antibiotic resistance and biofilm formation was widespread and not correlated with either catheter group.Conclusion: Common pathogens were detected in each set of catheters, therefore predicting infections based on the microbiology is difficult.

Saskatchewan Health Authority Library's service innovation during the COVID-19 pandemic and receipt of the 2022 CHLA/ABSC Flower Award.

Saskatchewan Health Authority Library's service innovation during the COVID-19 pandemic and receipt of the 2022 CHLA/ABSC Flower Award.

Toward Equity in Access to Midwifery in Saskatchewan: Key Informants’ Perspectives

In this article, we report on the second phase of our exploratory research into issues related to equity in access to midwifery in Saskatchewan. This phase of the research project aimed to explore equity in access to midwifery as understood and experienced by key stakeholders involved in the early stages of midwifery implementation in Saskatchewan. A total of 19 interviews were conducted with participants from Saskatchewan Health, the Midwifery Transitional Council, and Saskatoon’s Regional Midwifery Operations Committee, as well as practitioners, primary health care managers, directors from select regional health authorities, and Saskatchewan midwives. Additionally, all available midwifery policy documents and relevant Primary Health Care and Health Human Resource documents complemented the qualitative analysis. Initial thematic analysis led to five policy recommendations: (1) develop a provincial definition of “priority population” for midwifery clients, (2) establish a midwifery health human resource plan, (3) identify provincial midwifery research priorities, (4) facilitate growth in interprofessional relationships, and (5) develop a provincial “road map” for implementation. A secondary analysis of participants’ responses revealed concern over the poor public education about midwifery services and lack of provincial government prioritization, as well as varied perceptions of the concept of “equity.” We conclude that although general commitments to equity in midwifery service and access are enshrined in Saskatchewan’s health care policies and midwifery regulations, insider perspectives suggest that significant yet modifiable barriers to equity in access to care currently exist. This article has been peer reviewed

Effect of Acute Isometric Handgrip Exercise on Vascular Function in Children and Emerging Adults with Congenital Heart Disease

Endothelial dysfunction is common in congenital heart disease (CHD). Isometric handgrip (IHG) exercise may improve endothelial function; however, whether this applies to patients with CHD is unknown. We investigated brachial artery flow-mediated dilation (FMD) pre- and post- acute IHG exercise using duplex ultrasound in CHD and healthy controls (CTL; n=19 (7 F) vs. 21 (9 F), age: 13±4 vs. 13±4 y). Whereas IHG improved mean FMD in controls, it had no effect on the mean FMD response in patients with CHD. Subsequently, participants within each group were categorized based on ΔFMD response (post-pre IHG FMD), in which those that experienced a decrease were classified as non-responders (NRESP) and those that experienced an increase were classified as responders (RESP). Among NRESP, ΔFMD was lower in CHD vs. controls ( p=0.0224). Among RESP, ΔFMD was lower in CHD vs. controls ( p=0.0543). Data during pre-occlusion in NRESP from pre- to post-IHG exercise showed improved antegrade shear rate (condition effect, p=0.0078), retrograde shear rate (interaction effect, p=0.0410), and oscillatory shear index (interaction effect, p=0.049) in CHD compared to controls. Potentially, IHG exercise enhanced vascular sensitivity to shear, resulting in an increase in baseline diameter and reduced FMD in CHD NRESP. Thus, reduced FMD after acute IHG exercise is influenced by improvements in resting shear rate parameters in patients with CHD. Saskatchewan Health Research Foundation, Heart and Stroke Foundation of Canada. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Characterization of Antithrombotic Regimens for Patients with Nonvalvular Atrial Fibrillation and Obesity Discharged from Cardiology Wards.

Despite data derived from observational studies, optimal anticoagulation strategies have yet to be established for patients with nonvalvular atrial fibrillation and obesity. To describe direct oral anticoagulant (DOAC) regimens prescribed for adult patients with nonvalvular atrial fibrillation who weighed more than 120 kg. This single-centre, retrospective cohort study, conducted in the Saskatchewan Health Authority - Regina Area, involved adult patients with body weight greater than 120 kg who had an indication for oral anticoagulation to treat nonvalvular atrial fibrillation and were discharged by a cardiologist between June 2019 and July 2021. A total of 62 patients were included (median weight 135 kg). At discharge, DOACs were prescribed for 57 (92%) of the patients and warfarin for 5 (8%). In numeric terms, patients receiving warfarin were at higher risk of thromboembolism or thrombosis; however, the small sample size limited the ability to draw conclusions. Practice patterns in the Saskatchewan Health Authority - Regina Area indicated substantial use of DOACs for patients with body weight greater than 120 kg; however, for those with the highest weights, warfarin was still in use.

Antipsychotic Prescribing in Older Adults after In-Hospital Initiation.

In older adults, the use of antipsychotics to treat delirium or the behavioural and psychological symptoms of dementia is potentially inappropriate and may be associated with adverse effects. Antipsychotics newly initiated in hospital may be inadvertently continued after discharge. In the Saskatchewan Health Authority (SHA) - Regina area, the frequency and duration of antipsychotic continuation for older adults after initiation during a hospital stay is unknown. To describe potentially inappropriate antipsychotic use in older adults after discharge from hospital, specifically rates of postdischarge antipsychotic therapy after initiation in hospital and continuation up to 180 days after discharge; prescribing regimens used; risk factors associated with continuation; pharmacist involvement; and plans for antipsychotic discontinuation, tapering, and/or follow-up. This retrospective chart review included inpatients 65 years of age or older who were discharged from medicine units at SHA - Regina area hospitals between September 30, 2021, and June 28, 2022. Outpatient dispensing histories were also gathered. Of the 189 patients included in the analysis, 60 (31.7%) had continuation of antipsychotic therapy at discharge. Of these, 48 (80.0%), 33 (55.0%), and 24 (40.0%) had continuation of antipsychotic therapy at 30, 90, and 180 days after discharge, respectively. Of the patients with continuing antipsychotic therapy, 53 (88.3%) were 75 years of age or older, and 9 (15.0%) had documentation of an outpatient antipsychotic follow-up plan. Postdischarge continuation of antipsychotics was similar to that reported in the literature. Patients continued on antipsychotics after discharge were at a greater than 50% risk of continuation at 90 days and were unlikely to have a follow-up plan. Future quality improvement efforts should include standardized prioritization of medication reviews, documentation of indications, and regular reassessment of therapy.

A83 ADAPTATION AND VALIDATION OF QUESTIONNAIRES TO MEASURE SATISFACTION WITH TELEPHONE CARE AMONG IBD PATIENTS AND GASTROENTEROLOGY CARE PROVIDERS

Abstract Background People living with inflammatory bowel disease (IBD) require regular medical follow-up, which could be challenging for individuals living in rural areas and those who have limited access to specialized care. Telephone care (TC) could improve health care by increasing access to specialized care. The Covid-19 pandemic resulted in increased use of virtual care, which was predominantly TC in Saskatchewan (SK) , Canada. There are no validated questionnaires to measure satisfaction with TC among IBD patients and gastrointestinal care providers (GCPs). Purpose This study aimed to adapt and validate a questionnaire to evaluate the satisfaction of IBD individuals and GCPs with TC in SK, Canada. Method The Telehealth Usability Questionnaire was adapted to the IBD TC context by a committee of experts, comprised of three IBD GCPs, two IBD-patient partners, and two health care researchers. Two questionnaires were generated -: the Telephone Care Satisfaction Questionnaire (TCSQ) for patients (IBD-TCSQ-patient) and GCPs (IBD-TCSQ-provider). The committee evaluated the content validity of the adapted questionnaires. A pilot assessed the readability and usability of the questionnaire items. Subsequently, individuals living with IBD in SK and GCPs completed an online survey with the TCSQ-patient and IBD-TCSQ-provider questionnaires in the winter of 2022. Data were analysed using descriptive and correlational techniques. Psychometric analyses were conducted to examine the reliability and validity of the TCSQ-patient, but not for the TCSQ-provider due to small sample size. Result(s) The IBD-TCSQ-patient and IBD-TCSQ-provider questionnaires were developed, each with 16 individual items and one question on global TC satisfaction. The pilot demonstrated good readability and usability of the questionnaires. Then, 87 IBD individuals completed the IBD-TCSQ-patient and six GCPs the IBD-TCSQ-provider. The standardized level of TC satisfaction for the 16-item IBD-TCSQ-patient was 5.70 (SD=0.94) on a scale from 1.00-7.00. All items of the IBD-TCSQ-patient were significantly correlated (p<0.001). A strong correlation was observed between the 16-item standardized TC satisfaction and its overall item r=0.85 (p<0.001). The IBD-TCSQ-patient had optimal internal reliability (α=0.96). Two factors were identified in the exploratory factor analysis. Factor 1 focused on TC convenience while factor 2 addressed TC usability. Regarding the IBD-TCSQ-provider questionnaire, the standardized level of TC satisfaction was 5.76 (SD=0.68) on a scale from 1.00 to 7.00. Conclusion(s) We generated questionnaires to measure satisfaction with TC among individuals living with IBD and GCPs. The study results confirmed good validity and reliability of the IBD-TCSQ-patient questionnaire. The IBD-TCSQ-provider questionnaire was adapted; subsequent studies could assess its validity and reliability among GCPs nationally. These questionnaires could help identify opportunities for improvement and utilization of TC among IBD patients and GCPs. Please acknowledge all funding agencies by checking the applicable boxes below Other, None Please indicate your source of funding; Saskatchewan Health Research Foundation (SHRF) Disclosure of Interest None Declared

A84 FACTORS ASSOCIATED WITH HIGH LEVELS OF TELEPHONE CARE SATISFACTION AMONG INDIVIDUALS WITH INFLAMMATORY BOWEL DISEASE

Abstract Background Individuals with inflammatory bowel disease (IBD) require regular medical follow-up with gastroenterology care providers. Individuals in rural areas face barriers in assessing specialized IBD care. Virtual care (VC) may act as a solution. The coronavirus disease 2019 pandemic increased the use of VC, particularly telephone care (TC) appointments in Saskatchewan, Canada. There is limited evidence around the levels and factors associated with satisfaction with TC among individuals with IBD. Purpose This study aims to measure satisfaction with TC in individuals with IBD who live in Saskatchewan, Canada, and evaluate the factors associated with TC satisfaction. Method A cross-sectional study was conducted among individuals with IBD through an online survey between December 2021 and April 2022 in Saskatchewan. The Telephone Care Satisfaction Questionnaire for individuals with IBD (TCSQ-patient) was a 16-item questionnaire used to measure TC satisfaction on a scale from 1 (very dissatisfied) to 7 (very satisfied). The online survey also included the Quality of Care Through the Patient’s Eyes-IBD (QUOTE-IBD) questionnaire, Short Inflammatory bowel disease questionnaire (SIBDQ), and demographic questions. Factors associated with TC satisfaction were explored using linear regression models. A backward model building strategy was used, and 95% confidence intervals (95%CI) were reported. Result(s) In total, 87 individuals with IBD participated in the study. Among the study participants, 54 (64.3%) had Crohn's disease, 53 (61.6%) were female, 60 (69.8%) lived in urban centres, and 37 (43.5%) were between 41-59 years old. The mean satisfaction with TC was 5.70 (SD=0.94). In addition, the means of the QUOTE-IBD and SIBDQ were, respectively, 8.96 (SD=1.70) and 48.14 (SD=13.02). In the bivariate analysis, area of residence (rural vs. urban) and health related quality of life quality (SIBDQ>50 vs SIBDQ<50) were associated with satisfaction with TC, respectively, 0.47 (95%CI 0.02-0.91) and 0.48 (95%CI 0.08-0.88). Adjusting by gender, age group, type of disease, and health care provider managing IBD, we identified that the satisfaction with TC was 0.48 (95%CI 0.02-0.94) higher among individuals with IBD living in rural Saskatchewan in comparison to their urban counterparts. Conclusion(s) Individuals living with IBD in Saskatchewan reported high levels of satisfaction with TC. Rural residence is associated with higher levels of TC satisfaction. These results could help in the promotion of TC utilization and improve access to specialized IBD care, especially among those living in rural areas. Please acknowledge all funding agencies by checking the applicable boxes below Other Please indicate your source of funding; Saskatchewan Health Research Foundation (SHRF) Disclosure of Interest None Declared

Process and Outcome of Community Engagement Event on Substance Use and Addiction Risks Facing Their Immigrant Communities in Regina, Saskatchewan.

Canada is a significant destination for immigrants who are drawn from different ethnic and cultural backgrounds some of whom have a hidden risk for substance use disorders due to acculturation stress and are not screened for risks of substance use or addiction when considering medical admissibility. Not surprisingly, healthcare providers in Regina are reporting a noticeable increase in substance use among immigrants. These immigrants experience barriers in seeking substance use prevention and treatment services due to diverse challenges: stigma, shame, and lack of knowledge of existing services. Considering the discussed challenges and risks of substance use disorders in immigrant communities, creating a safe space for discussing these topics is urgent. To understand and address these challenges, a connection grant from the Saskatchewan Health Research Foundation (SHRF) to mobilize immigrant communities in Regina to explore substance use issues and their impact on the community was sought and received. Subsequently, a Zoom knowledge-sharing event brought settlement agency stakeholders together to deliberate issues on substance use and addiction faced by immigrants in Regina, Saskatchewan. The Zoom session included presentations on immigrants and substance use from the clinical, community, and lived experience perspectives of immigrants. Because of the challenges and risks, this community consultation process revealed that acculturation stress and the ease of obtaining socially acceptable substances fuel substance use and addiction among immigrants in Regina; this is further exacerbated by the lack of programming available to prevent and reduce the risks of substance use in this population. A team of knowledge keepers with lived experiences, service providers, and researchers was assembled to explore substance use and addiction among immigrants. This manuscript reports the process of community engagement to identify solutions to this budding issue. The strengths, challenges, and lessons learned are identified.

Anticoagulation Interventions by Pharmacists in Acute Care.

Clinical pharmacy key performance indicators (cpKPIs) relate to activities performed by pharmacists that have been shown to improve patient outcomes. Within Saskatchewan Health Authority (SHA) Regina, most cpKPIs are incorporated into the organization's clinical practice standards, which provide guidance in prioritizing care, especially for high-risk medications, including anticoagulants. To track pharmacists' interventions associated with clinical practice standards, a locally developed electronic data-capture system (known as AIM High) was implemented. To quantify and describe pharmacists' anticoagulation interventions on 16 wards with dedicated ward-based clinical pharmacists and to compare intervention rates between the cardiology and internal medicine wards to further evolve the organization's practice model. Data from the electronic data-capture system were retrospectively analyzed for a 5-year period (January 2016 to December 2020). A total of 94 201 interventions were recorded in the AIM High system (average 362 interventions per week or 26 interventions per pharmacist per week). Of these, 15 661 (16.6%) cited the anticoagulation standard (average 60 anticoagulation interventions per week or 4 anticoagulant interventions per pharmacist per week). For the cardiology and internal medicine wards, 4183 of 11 888 (35.2%) and 9034 of 54 843 (16.5%) interventions cited the anticoagulation standard, respectively. The top 4 types of anticoagulation interventions were dose changed (n = 4372 or 27.9%), drug started or restarted (n = 3867 or 24.7%), patient education (n = 3094 or 19.8%), and drug discontinued (n = 2944 or 18.8%). Dedicated ward-based clinical pharmacists were following clinical practice standards incorporating the majority of cpKPIs to complete anticoagulation interventions. The types of anticoagulation interventions evolved over time and were influenced by the patient population.

Unruly Hair with Irregular Cross Sections: Answer.

*University of Arkansas for Medical Sciences, College of Medicine, Little Rock, AR; †Department of Pathology and Laboratory Medicine, Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada; and ‡Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock, AR. Correspondence: Nikhil Nair, BA, University of Arkansas for Medical Sciences, College of Medicine, 4301 W. Markham Street, Little Rock, AR 72205 (e-mail: [email protected]). The authors declare no conflicts of interest. I confirm that each author acknowledges their participation in conducting the research leading to this manuscript and agrees to its submission to be considered for publication.

Unruly Hair With Irregular Cross Sections: Challenge.

*University of Arkansas for Medical Sciences, College of Medicine, Little Rock, AR; †Department of Pathology and Laboratory Medicine, Saskatchewan Health Authority, Saskatoon, Saskatchewan, Canada; and ‡Department of Dermatology, University of Arkansas for Medical Sciences, Little Rock, AR. Correspondence: Nikhil Nair, BA, 4301 W. Markham St., Little Rock, AR 72205 (e-mail: [email protected]). The authors declare no conflicts of interest. I confirm that each author acknowledges their participation in conducting the research leading to this manuscript and agrees to its submission to be considered for publication.

Effect of the COVID-19 pandemic on elective cataract surgery wait times

ObjectifLa prolongation du temps d'attente avant une chirurgie de la cataracte risque d'avoir des effets négatifs sur la qualité de vie des patients et d'accroître l'incidence de chutes et de dépression. La pandémie de COVID-19 a posé de sérieux défis quant à la réalisation des chirurgies de la cataracte sans caractère d'urgence. On a donc examiné, grâce aux données du ministère de la santé de l'Alberta, les effets de la pandémie sur le temps d'attente avant une chirurgie de la cataracte dans la région d'Edmonton en comparant les temps d'attente avant et pendant la pandémie. MéthodesIl s'agissait d'une étude fondée sur une population rétrospective. Les données provenaient d'une base de données centralisée portant sur les chirurgies de la cataracte réalisées en milieu hospitalier (Hôpital Royal Alexandra, Hôpital communautaire de Fort Saskatchewan et Centre de santé WestView) entre avril 2019 et mars 2022 (soit 3 années financières). RésultatsL'attente moyenne avant une chirurgie de la cataracte est passée de 14,4 ± 1,4 semaines en 2019–2020 à 18,2 ± 2,7 semaines en 2020–2021 (p = 0,005) pour redescendre à 11,5 ± 1,3 semaines en 2021–2022 (p < 0,001). Le nombre de chirurgies réalisées est passé de 13 103 en 2019–2020 à 9308 (p = 0,09) et à 10 365 (p = 0,1) au cours des 2 années suivantes, respectivement. Le nombre d'heures de bloc opératoire réservées aux cas prévus chaque année a chuté à 4463 heures (p = 0,42) et à 4552 heures (p = 0,15) pendant la pandémie, comparativement à 5541 heures avant la pandémie. Cela dit, le nombre moyen de patients en attente d'une chirurgie est passé de 6629 à la fin de 2019–2020 à 6122 (p = 0,029) et à 4011 (p < 0,001) au cours des 2 années suivantes, respectivement. ConclusionLe temps d'attente moyen précédant une chirurgie de la cataracte sans caractère d'urgence a significativement augmenté pendant la première année de la pandémie de COVID-19. Or, le temps d'attente a diminué pendant la deuxième année de la pandémie, vu la réduction du nombre de patients en attente d'une chirurgie.

North American COVID-19 Myocardial Infarction (NACMI) Risk Score for Prediction of In-Hospital Mortality.

BackgroundIn-hospital mortality in patients with ST-segment elevation myocardial infarction (STEMI) is higher in those with COVID-19 than in those without COVID-19. The factors that predispose to this mortality rate and their relative contribution are poorly understood. This study developed a risk score inclusive of clinical variables to predict in-hospital mortality in patients with COVID-19 and STEMI.MethodsBaseline demographic, clinical, and procedural data from patients in the North American COVID-19 Myocardial Infarction registry were extracted. Univariable logistic regression was performed using candidate predictor variables, and multivariable logistic regression was performed using backward stepwise selection to identify independent predictors of in-hospital mortality. Independent predictors were assigned a weighted integer, with the sum of the integers yielding the total risk score for each patient.ResultsIn-hospital mortality occurred in 118 of 425 (28%) patients. Eight variables present at the time of STEMI diagnosis (respiratory rate of >35 breaths/min, cardiogenic shock, oxygen saturation of <93%, age of >55 ​years, infiltrates on chest x-ray, kidney disease, diabetes, and dyspnea) were assigned a weighted integer. In-hospital mortality increased exponentially with increasing integer risk score (Cochran-Armitage χ2, P ​< ​.001), and the model demonstrated good discriminative power (c-statistic ​= ​0.81) and calibration (Hosmer-Lemeshow, P ​= ​.40). The increasing risk score was strongly associated with in-hospital mortality (3.6%-60% mortality for low-risk and very high–risk score categories, respectively).ConclusionsThe risk of in-hospital mortality in patients with COVID-19 and STEMI can be accurately predicted and discriminated using readily available clinical information.

A critical role of energy sensor AMPKα1 in rapamycin dependent memory CD8+ T cell survival

Abstract Energy sensors mTORC1 and AMPKα1 regulate T-cell metabolism and differentiation, while rapamycin (Rapa), an inhibitor of mTORC1, supports T-cell memory. However, the underlying pathway, the exact mechanisms, and the role of AMPKα1 in Rapa-induced T-cell memory is not well understood. Using the Listeria monocytogenes (rLmOVA) infection model and genetic and pharmaceutical tools, we demonstrate that Rapa promotes T-cell memory in mice post-rLmOVA infection. When T-cells stimulated in vitro in the presence of IL-2 without rapamycin (IL-2/T) or with rapamycin (IL-2+Rapa /T) and transferred into mice, it differentiated into short-term effector T (TE) [IL-7R−CD62L−KLRG1+] and long-lived memory T (TM) [IL-7R+CD62L+KLRG1−] cells, respectively. We determined that rapamycin-treated T cells activated transcriptional factors, FOXO1, TCF1 and Eomes and metabolic pAMPKα1(T172), pULK1(S555), and ATG7 molecules and promoted mitochondrial biogenesis and oxidative phosphorylation (OXPHOS). Using Seahorse-real time metabolic analyzer, we found that rapamycin-treated AMPKα-deficient TM cells up-regulated transcription factor HIF-1α and induced a metabolic switch from OXPHOS to glycolysis. Interestingly, despite the rapamycin treatment, AMPKα-deficient TM cells lost their cell survival capacity. Altogether, our data provide a mechanistic explanation for enhanced T-cell survival after rapamycin treatment and suggest that rapamycin promotes T-cell memory via transcriptional FOXO1-TCF1-Eomes programs and AMPKα1-ULK1-ATG7 metabolic axis. And AMPKα1 plays a critical role in rapamycin-induced increased survival and metabolic switching of CTLs during the transition of effector to memory T cells. Supported by Canadian Institutes of Health Research grant (409228). Saskatchewan Health Research Foundation (SHRF) postdoctoral fellowship.

Economic Burden of Chronic Obstructive Pulmonary Disease and Lung Cancer Between 2000 and 2015 in Saskatchewan: Study Protocol.

BackgroundChronic obstructive pulmonary disease (COPD) and lung cancer are both detrimental diseases that present great burdens on society. Years of life lost (YLL), premature years of life lost (PYLL), working years lost (WYL), and productivity loss are all effective measures in identifying economic burden of disease.ObjectiveWe propose a population-based study to analyze comprehensive provincial cohorts of Saskatchewan residents with COPD, lung cancer, and combined COPD and lung cancer in order to identify the burden these diseases present.MethodsSaskatchewan residents over the age of 35 years who had COPD, lung cancer, or both, between January 1, 2000, and December 31, 2015, will be identified and used in this study. Data for analysis including age, gender, and date of death, alongside Statistics Canada income estimates, will be used to estimate productivity loss and WYL. Statistics Canada life tables will be used to calculate YLL and PYLL by subtracting the patients’ ages at death by their life expectancies, adjusted using sex and age at death. We will link the Saskatchewan cancer registry with Saskatchewan health administrative databases to create three cohorts: (1) COPD; (2) lung cancer; and (3) COPD and lung cancer. Individuals with lung cancer will be identified using ICDO-T (International Classification of Diseases for Oncology-Topography) codes, and those with COPD will be defined and identified as individuals who had at least 1 visit to a physician with a diagnosis of COPD or 1 hospital separation with a diagnosis of COPD. Those without a valid health care coverage for a consecutive 12 months prior to the first diagnostic code will be excluded from the study. Those with a combined diagnosis of COPD and lung cancer will be identified as individuals who were diagnosed with COPD in the 12 months following their lung cancer diagnosis or anytime preceding their lung cancer diagnosis.ResultsAs of April 2021, we have had access to all relevant data for this study, have received funding (January 2020), and have begun the preliminary analysis of our data set.ConclusionsIt is well documented that COPD and lung cancer are both destructive diseases in terms of YLL, PYLL, WYL, and productivity loss; however, no studies have been conducted to analyze a cohort with combined COPD and lung cancer. Understanding the economic burden associated with each of our 3 cohorts is necessary in understanding and thus reducing the societal impact of COPD and lung cancer.International Registered Report Identifier (IRRID)RR1-10.2196/31350

Engaging Community Partners to Understand and Respond to Substance Use and Addiction Crisis Facing Families in Prince Albert, Saskatchewan.

Substance use is a persisting health care crisis that has led to residents’ addiction to diverse substances in Prince Albert, Saskatchewan. This public health issue affects not only those with a substance use disorder but also those within their circle of family and friends. This paper aims to outline the community engagement processes that we undertook to identify community priorities for addressing the substance use and addiction issues facing them. We began the community engagement using a patient-oriented research process, which led to the development of a grant application. Following the awarding of this grant application by the Saskatchewan Health Research Foundation and Saskatchewan Centre for Patient-Oriented Research, we conducted interviews with family members affected by addiction in the city. The study provided us with significant insight into the impacts of substance use disorders on family members. The importance of collaboration among people with lived experience, health care providers, and community partners helped us to identify our research questions. Community members also actively participated in the data collection, analysis, and presentation of the findings where priorities for the interventions were identified. The conversations we had because of the community’s engagement and participation in the research process enhanced our understanding of the realities of caring for people with substance use disorders and the importance of family involvement throughout the process. We also learned lessons regarding community engagement and participation in research on a stigmatizing and complex topic.

Sâkipakâwin: Assessing Indigenous Cancer Supports in Saskatchewan Using a Strength-Based Approach.

Given that the health care system for Indigenous people tends to be complex, fragmented, and multi-jurisdictional, their cancer experiences may be especially difficult. This needs assessment study examined system-level barriers and community strengths regarding cancer care experiences of Indigenous people in Saskatchewan. Guided by an advisory committee including Indigenous patient and family partners, we conducted key informant interviews with senior Saskatchewan health care administrators and Indigenous leaders to identify supports and barriers. A sharing circle with patients, survivors, and family members was used to gather cancer journey experiences from Indigenous communities from northern Saskatchewan. Analyses were presented to the committee for recommendations. Key informants identified cancer support barriers including access to care, coordination of care, a lack of culturally relevant health care provision, and education. Sharing circle participants discussed strengths and protective factors such as kinship, connection to culture, and spirituality. Indigenous patient navigation, inter-organization collaboration, and community relationship building were recommended to ameliorate barriers and bolster strengths. Recognizing barriers to access, coordination, culturally relevant health care provision, and education can further champion community strengths and protective factors and frame effective cancer care strategies and equitable cancer care for Indigenous people in Saskatchewan.

P.093 Implementation of virtual interdisciplinary bedside rounds on an acute stroke unit

Background: The novel corona virus pandemic presented the Saskatoon Stroke Program with challenges related to patient- and caregiver-centered communication. Keeping all parties informed of a patient’s health status and plan of care in the setting of extreme visitation restrictions was difficult. Virtual interdisciplinary bedside rounds (VIDR) were introduced to enhance communication for stroke patients. Methods: A video conferencing application was adopted by the Saskatchewan Health Authority. Consent to participate was obtained by a social worker. Bedside nurses facilitated patient participation in VIDR on either a tablet or workstation on wheels, while caregivers were able to attend virtually. Each team member accessed the VIDR from an individual device to maintain social distancing. A structured questionnaire has been initiated to capture participant reported experiences and satisfaction with VIDR (data collection ongoing). Results: Most patients and caregivers were amiable to participate in VIDR. Challenges included: accessing appropriate technology for both family and staff members; rural and remote internet reliability; and maintaining a reasonable duration of rounds. There was overwhelming anecdotal positive feedback from participants. Conclusions: We implemented VIDR to enhance communication during the pandemic. Caregivers felt connected to the care team and up-to-date in the plan of care.

Developing a patient-oriented realist evaluation for COVID-19 vaccine implementation in Saskatchewan: a methodologic framework.

Background:There is an urgent need to inform decision-making and safe delivery of vaccines in a timely manner. Our objective is to describe the methods we used to perform a patient-oriented realist evaluation of COVID-19 vaccination implementation in Saskatchewan, Canada, in order to understand the underlying mechanisms and contexts of vaccination implementation and vaccine uptake.Methods:This methodology paper describes a patient-oriented, realist, mixed-method evaluation to assess COVID-19 vaccination implementation in Regina, Saskatoon and Prince Albert, Saskatchewan. The study comprised 3 iterative phases guided by Realist And Meta-narrative Evidence Synthesis: Evolving Standards II (RAMESES II). In phase 1 (January–February 2021), we developed the initial program theory, in phase 2 (March–May 2021), we tested and refined the initial program theory, and in phase 3 (June–July 2021), we established the final program theory. Three patient and family partners with different backgrounds and experiences were selected purposively from various locations (urban and rural) in Saskatchewan to engage collaboratively in the evaluation. Data analysis and synthesis occurred at all 3 phases of the project. We analysed qualitative data from phases 2 and 3 using a “retroductive” approach. We used quantitative data to compare outcomes from the 3 sites.Interpretation:This protocol describes how we developed a final program theory for COVID-19 vaccination implementation with patient and family partners to show for whom, under what circumstances, how and why Saskatchewan’s COVID-19 vaccination program has led to vaccine uptake. With patient and family partners’ engagement, the evaluation findings will be shared with the Saskatchewan Health Authority and provincial government policy-makers and communications departments, published in peer-reviewed journals, presented at provincial or national conferences, and disseminated through any additional media identified by the patient and family partners.