Saskatchewan Hospital Research Articles

A300 ADVANCED HEPATIC ECHINOCOCCOSIS: A CASE REPORT

Abstract Background Alveolar echinococcosis (AE) is a rare and potentially fatal disease caused by the parasite echinococcus multilocularis (EM). Humans are intermediate hosts who become infected through contact with definitive hosts (foxes, wolves, coyotes, dogs and cats) and ingestion of contaminated food and water. AE primarily affects the liver but has the potential for local or metastatic spread. It has a clinical latency time of 5-15 years and resembles a malignancy in appearance and growth, posing a challenge in diagnosis and management. Treatment includes benzimidazole therapy and surgical resection, however, removal of the entire parasitic mass is not always possible. Aims Present a case of hepatic AE involving the gallbladder, biliary tree, and spleen. Methods Case report. Results A 49-year-old farmer was admitted to a Saskatchewan hospital for a 2-week history of abdominal pain, jaundice, and progressive weight loss. Computed tomography (CT) of the abdomen and pelvis showed a necrotic mass in the gallbladder compromising the liver, splenic lesions and involvement of the biliary tree. The patient was given a preliminary diagnosis of metastatic cholangiocarcinoma and underwent a gallbladder biopsy which returned as echinococcus, confirmed with two liver biopsies and a positive EM nucleic acid test. He was then diagnosed with advanced hepatic AE with metastasis to the gallbladder, biliary tree, and spleen. The patient required a long-term hepatic drain and developed a hepatocutaneous fistula. While surgery is curative, his disease was too extensive for resection. He was started on Albendazole and received into our care for a liver transplant assessment 10 months later. Currently, there is limited literature on liver transplantation in advanced AE as it may not be curative. Additionally, subsequent immunosuppression may expedite residual parasite growth leading to aggressive disease recurrence. In this case, liver transplant would also require a splenectomy and excision of the hepatocutaneous fistula for complete parasite removal. Repeat CT of the abdomen and pelvis at thirteen months after the patient's initial hospitalization did not show disease progression. Given his stability on Albendazole, the added surgical complexity, and possibility of aggressive disease recurrence post liver-transplant, the multidisciplinary committee decided against liver transplant at this time. He continues to do well on Albendazole 15 months after initial presentation. Conclusions The reported mortality rate of AE is ampersand:003E 90% within 10-15 years of diagnosis if untreated or inadequately treated. This case highlights the complexities in management of advanced hepatic AE and the importance of early diagnosis and treatment with radical surgery. Although not curative, benzimidazole therapy is effective in slowing disease progression in unresectable cases. Further studies are needed to assess the role of liver transplantation in advanced hepatic AE. Funding Agencies None

Heart Failure after Laboratory Confirmed Influenza Infection (FLU-HF).

Background:Influenza has been shown to exacerbate heart failure (HF). Importantly, no study to date has examined the relationship between HF hospitalizations (HFH) with laboratory confirmed influenza infections. This study evaluated the association between laboratory confirmed influenza infection and HFH in the two largest hospitals in Saskatchewan, Canada.Methods:We used a retrospective self-controlled case series design to evaluate the association between laboratory-confirmed influenza infection and HFH. We compared the incidence ratio for HFH during the influenza risk interval with the control interval. We defined the influenza risk interval as the seven days after a laboratory confirmed influenza result and the control interval as one year before and after the risk interval.Results:We identified 114 HFH that occurred within one year before and after a positive test result for influenza between April 1, 2010, and April 30, 2018. Of these, 28 (28 admissions per week) occurred during the risk interval and 86 (0.853 admissions per week) occurred during the control interval. The incidence ratio of a HFH during the risk interval as compared with the control interval was 33.53 (95% confidence interval [CI], 21.89 to 51.36). A decline in incidence was observed after day seven; between days 8 to 14 and 14 to 28 incidence ratios was 0.91 (95% CI, 0.13 to 6.52) and 0.91 (95% CI, 0.22 to 3.68) respectively.Conclusion:We have observed a significant association between acute influenza infection and HFH. However, further research with a larger sample size and involving a multicenter setting is warranted.HighlightsInfluenza may contribute and exacerbate heart failure events especially during annual influenza season.Early identification of influenza among patients with heart failure, could lead to earlier treatment with antiviral medication, reduce unnecessary antibiotic use, and tail off the morbidity and mortality.In this study, despite our efficient study design, our sample size was limited to only the two largest hospitals in the province, possibly excluding a significant population in remote areas.

Health, charity, and citizenship: Protestant hospitals in rural Saskatchewan, Canada 1906-1942

ABSTRACT In this study, the authors explore the history of two rural Presbyterian mission hospitals in Saskatchewan, Canada, during the early twentieth century. At this time, medical missionaries were encouraged to offer hospital care to support the early homesteaders of the Canadian prairies, linked to the construction of the ‘frontier’ British-Anglo empire. Small religious hospitals were initially seen as fundamental to the expansion of the nation-state, but many faced closure or financial ruin during the economic bust of the 1930s. Utilizing hospital, missionary and church records, they analyse how missionaries provided hospital care to a diverse community of primarily Eastern European immigrants. They argue that the nature of this hospital work varied greatly depending on the local context and hospital type. They demonstrate that the benefits of modernity were unevenly distributed among hospitals during this time. Presbyterian mission hospitals were holistic religious, medical and social institutions. In addition to providing medical and nursing care, missionaries in Presbyterian hospitals offered various forms of charity work. They were as concerned with the soul as they were with the body and as interested in improving community mores as they were with healing individual sickness. The course of history followed by these hospitals supported the narrative expressed by leftist Co-operative Commonwealth Federation (CCF) premier Tommy Douglas that radical change was required to prevent the financial demise of Saskatchewan hospitals after the Great Depression. The proliferation of union and community hospitals also reduced the former significance of these early Presbyterian hospitals. The study of small rural missionary hospitals in Canada reveals that hospitals were far from uniform during the early twentieth century, and provides a useful comparison for other missionary hospitals in diverse colonial contexts, prior to the development of state hospital insurance.

Pharmacy Distribution, Clinical, and Management Services: A Survey of Small Hospitals in Canada Supported by Telepharmacy Services.

The Canadian Society of Hospital Pharmacists' Hospital Pharmacy in Canada Report presents data from pharmacy departments that service hospitals with at least 50 acute care beds. This report provides valuable data on pharmacy distribution, clinical, and management services in relation to hospital size, type, and geographic region. Pharmacy and hospital leadership use these extensive data in identifying baseline, benchmarking current, and planning enhanced pharmacy services. However, for most of Canada's small hospitals, such data remain unknown, and leadership remains uninformed. To gather and analyze data about current pharmacy distribution, clinical, and management services in hospitals with fewer than 50 acute care beds receiving third-party remote pharmacy (telepharmacy) services. In April 2019, pharmacy administrators of hospitals in Ontario, Quebec, and Saskatchewan that had fewer than 50 acute care beds and were using third-party telepharmacy services were invited to complete a comprehensive survey addressing concepts similar to those in the Hospital Pharmacy in Canada Survey. The following data on clinical pharmacy practice were collected: models of care, assignments to patient care programs, pharmacists' activities, performance indicators, and professional evaluation. The description of pharmacy distribution services comprised type of system, technology, location, hours of operation, method of medication order entry and verification, and medication administration records. Details on facilities' parenteral admixture infrastructure, policy for and provision of sterile compounding, and pharmacy department human resources, including composition and staffing ratios, were also collected. Of the 27 hospitals in Ontario, Quebec, and Saskatchewan that were invited to participate, 24 (89%) completed the survey. The median facility size was 19 acute care beds. Previously unavailable in Canada, these quantitative data from small hospitals supported by telepharmacy services provide facts about pharmacy distribution, clinical, and management services to inform hospital and pharmacy leaders. Creation of a survey unique to small hospitals, whether or not they use telepharmacy services, could provide a valuable resource to assist in the benchmarking, planning, and enhancement of pharmacy services in remote and rural communities.

Mobile medical simulation for rural anesthesia providers: A feasibility study.

IntroductionFamily practice anesthesia (FPA) providers are family physicians trained to deliver anesthesia care; they often practice in rural hospitals to facilitate surgical care. FPA providers in rural hospitals face challenges including professional isolation and limited opportunities for formal continuing education. To address needs identified by FPA providers, we piloted mobile medical simulation in rural Saskatchewan.MethodsUsing a logic model framework, we evaluated feasibility of a one-day interdisciplinary mobile simulation workshop for healthcare providers in a rural Saskatchewan hospital. As part of this mixed methods pilot study, we interviewed stakeholders to explore their perceptions of human and financial resources associated with delivering medical simulations in rural locations. Multiple simulation scenarios were utilized to train participants in clinical and professional skills. Participants completed pre- and post-workshop surveys to evaluate their experience.ResultsFinancial and human resources included cost of renting, transportation of mannequins, and the time required to create the scenarios. Participants (n = 10) reported improved knowledge and found the experience valuable. The session prompted participants to reflect on their deficiencies in certain clinical procedures/skills and highlight learning strategies to address the gap.DiscussionMobile medical simulation brought continuing medical education (CME) to health professionals in a rural location, but the program was expensive. Our logic model may inform educators and administrators considering mobile medical simulation for physicians in rural areas when balancing resource allocation and the organization’s commitment to CME for rural physicians.

Anticoagulant therapies for acute venous thromboembolism among a cohort of patients discharged from Canadian urban and rural hospitals

ObjectiveTo determine anticoagulant therapy at hospital discharge for patients with acute venous thromboembolism (VTE) and secondarily, to describe factors affecting choice of therapy.DesignA retrospective chart review.SettingCanadian hospitals in Edmonton, Alberta...

Regionalization and the Closure of 52 Hospitals in Rural Saskatchewan

In the early 1990s Canada was in a recession and the government of Saskatchewan felt the pressure of a growing deficit. In 1992, the provincial government decided to reduce the health care budget by 3.3%. The following year, the government undertook regionalization of health care services through the Health Districts Act, with a focus on promoting preventative health care rather than solely treatment-based care. The budget cuts resulted in the closure of 52 rural hospitals, leading to a public outcry. Evaluations of the reform were not able to show a definite detrimental effect on health outcomes in the corresponding communities. Community members expressed increased caregiver burden, travel costs and travel time to the next nearest hospital, and potential inequalities in access to care. When undertaking reform, it is important that government consider the voices of local communities in the decision-making process. Au debut des annees 90, le Canada etait en recession et, en Saskatchewan, le deficit budgetaire posait un probleme pressant au gouvernement provincial. Celui-ci decida de reduire le budget de la sante de 3,3% en 1992. L’annee suivante, le gouvernement mit en place une regionalisation des services de sante fondee sur la Loi sur les Districts de Sante, avec comme objectif de favoriser la prevention par rapport aux soins purement curatifs. 52 hopitaux ruraux durent fermer a cause des coupes budgetaires, entrainant une reaction de rejet de la part du public. Les evaluations de la reforme n’ont pas pu etablir avec certitude une deterioration de la sante dans les communautes concernees. Les habitants des communautes concernees ont exprime une charge accrue pour les aidants, des couts et temps de transports plus eleves pour se rendre a l’hopital le plus proche, et d’eventuelles inegalites d’acces aux soins. Les voix des populations concernees devraient etre ecoutees lors de la prise de decision sur de telles reformes.

Characteristics and residence of First Nations patients and their use of health care services in Saskatchewan, Canada: informing First Nations and Métis health services.

In Canada, Aboriginal people, particularly First Nations experience significant health disparities and a lower health status compared with the non-Aboriginal population. The purpose of this study was to examine the demographic and clinical characteristics of First Nations patients admitted to hospitals in Saskatchewan, and the acute care services used by First Nations compared with non-First Nations, specifically hospital length of stay. Primary residence of patients was also mapped to determine geographic patterns that would inform health service provision. A retrospective medical chart audit was carried out to collect data on patient demographics and clinical characteristics of 203 First Nations and 200 non-First Nations patients admitted to two urban hospitals in Saskatchewan from 2012 to 2014. The most common reason for admission of First Nations and non-First Nations patients was infection (24.6%) and cardiology conditions (19.5%), respectively. There was no significant difference in mean length of stay for First Nations (10.44 days) compared with non-First Nations (10.57 days). After adjusting for age, mean length of stay for First Nations was nearly 3 days longer than non-First Nations. First Nations patients' residence was from across the broad geography of Saskatchewan, with 45% living in rural communities or on reserve. The outcomes of this study are clinically meaningful and support the need for research, in collaboration with Aboriginal patients and families, to further examine and improve the care experience in order to decrease health disparities for Aboriginal patients in Canada.

Psychotropic Drug Prescription Practice in Psychiatric In-Patients in Saskatchewan, Canada

Background: Psychotropic drugs play a huge role in providing care in psychiatric and mental health. The judicious and appropriate use of these medications goes a long way in providing improved quality of health among psychiatric inpatients in Canada. Objective: To appraise the prevalence, pattern, and rational for psychotropic drugs prescription in different psychiatric inpatient settings in Saskatchewan, Canada. Material and methods: We conducted a one-day cross-sectional study at three psychiatric treatment facilities in Saskatchewan, Canada. They were: a) Regional Psychiatric Centre in Saskatoon (RPC); b) Saskatchewan Hospital in North Battleford (SH); and c) Dube Centre for Mental Health in Saskatoon (DC). Data were collected blindly from selected patients’ records in these centres and analyzed using the Statistical Package for Social Science (SPSS) version 21. Results: A total of 381 patients’ records were retrieved and distributed in the three sites; RPC (47.5%), SH (36.5%) and DC (16%). The majority of in-patients were males (76.6%) and between the ages of 25 to 65 years. Schizophrenia was the most Axis 1 DSM-IV psychiatric diagnosis (46.2% counts for all patients) with Saskatchewan Hospital having the highest percentage (61.8%) of patients diagnosed. We calculated a total of 2275 regular prescriptions and 1322 pro re nata (PRN) prescriptions. The mean number of regular and PRN psychotropic medications per patient were 2.83 and 1.38 respectively. The most commonly prescribed drugs were benzodiazepines with Lorazepam being the most prescribed PRN psychotropic drug. Conclusions: To ensure more judicious use of psychotropic medications, assessment, and management of patients’ short and long-term outcomes, including clinical evaluation of the benefits and side effects of these drugs are vital.

Trends in using beta-blockers and methyldopa for hypertensive disorders during pregnancy in a Canadian population

ObjectiveTo describe trends in and patterns of antihypertensive drug use in a general obstetric population. Study designHistorical cohort study. A total of 18,117 women who gave birth in a Saskatchewan hospital between January 1, 1980 and December 31, 2005 with a diagnosis of hypertensive disorders in pregnancy were identified and included in the analysis. ResultsThe rate of treatment with antihypertensive drugs for pregnant women with chronic hypertension rose from 19.94% in 1980–1984 to 37.63% in 2000–2005. There were similar increases in antihypertensive drug use from 1.51% to 14.47% for gestational hypertension/non-severe preeclampsia, and from 1.56% to 20.86% for severe preeclampsia/eclampsia. Methyldopa was the most frequently used drug, followed by beta-blockers, with other antihypertensive drugs accounting for about 18.43% of total uses. The use of both methyldopa and labetalol has increased in recent years while the use of other antihypertensive drugs has decreased. Other antihypertensive drugs were more commonly prescribed in earlier gestation, while methyldopa and labetalol were generally prescribed in later gestation. ConclusionThe use of antihypertensive drugs in pregnancy is relatively common and is increasing, with the liberal use of methyldopa and (especially) labetalol contributing appreciably to this increase.

Visiting the Mentally Ill: Volunteer Visitors at Saskatchewan Hospital, Weyburn 1950-1965

This article offers a glimpse into the lives and activities of some of the patients, volunteers and staff in the Saskatchewan mental health system during the period of deinstitutionalization. Drawing on her own experience as a patient in psychiatric wards as well as ongoing research in the history of mental health, it features the role of Regina Volunteer Visitors in Saskatchewan Hospital, Weyburn and examines the importance of occupational and recreational therapies and activities in improving the lives of the patients in that institution. It emphasizes the perspectives of patients and volunteers who actively worked to develop recreational activities, with the intention of helping individuals connect with the surrounding communities. The views and perspectives presented here are drawn from a variety of historical and oral interview sources, including views from visitors to the asylum and patients who lived within its walls. The author has also been a consumer of mental health services, and spent time in the Provincial Mental Hospital in North Battleford. The article therefore makes an important contribution to enhancing our understanding of the social history of deinstitutionalization, not only for its unique source base, but also because those sources have been examined and explained to readers through the perspectives of a former patient herself. This article draws significant attention to the changing opportunities for patients as they interacted with the women's volunteer groups, as well as to how the changes brought about by the encroaching deinstitutionalization, care in the community, and decisions from "above" affected the individuals on the ground.

The End of the Asylum (Town): Community responses to the depopulation and closure of the Saskatchewan Hospital, Weyburn

Never is the fraught relationship between the state-run custodial mental hospital and its host community clearer than during the period of rapid deinstitutionalization, when communities, facing the closure of their mental health facilities, inserted themselves into debates about the proper configuration of the mental health care system. Using the case of Weyburn, Saskatchewan, site in the 1960s of one of Canada's earliest and most radical experiments in rapid institutional depopulation, this article explores the government of Saskatchewan's management of the conflict between the latent functions of the old-line mental hospital as a community institution, an employer, and a generator of economic activity with its manifest function as a site of care made obsolete by the shift to community models of care.

Evaluating repeated patient handling injuries following the implementation of a multi-factor ergonomic intervention program among health care workers

Objective The objective of this study was to evaluate repeated patient handling injuries following a multi-factor ergonomic intervention program among health care workers. Methods This was a quasi-experimental study which had an intervention group and a non-randomized control group. Data were collected from six hospitals in Saskatchewan, Canada from September 1, 2001 to December 1, 2006. Results A total of 1,480 individuals who had a previous injury were eligible for the study. Medium and small size hospitals in the intervention group had significantly fewer repeated injuries than in the control group. Multivariate analysis showed that the intervention group had 38.1% lower odds of having repeated injury compared to the control group, after adjusting for hospital size. Conclusions The work-related repeated injury after a multi-factor intervention program was reduced. The synergistic relationships between components of multi-factor intervention and applicability of injury prevention programs to different settings need to be further explored. Impact on Industry Implementing a multi-factor program with the right equipment and training can lower the risk of injury among health care workers.

Prairies, psychedelics and place: The dynamics of region in psychiatric research

In 1957, the word ‘psychedelic’ entered the English lexicon from a rather unexpected location: an asylum superintendent working on the Canadian prairies in one of the provincial mental hospitals in Saskatchewan. During the 1950s Saskatchewan-based researchers engaged in political and psychiatric reforms that brought international attention to their work in a relatively isolated geographic location. This article considers the influence of location on the development of a medical theory that challenged prevailing ideas about the causation and treatment of mental illness and addiction. Drawing on perspectives from historians, political scientists, sociologists and geographers, this case study explores the historical meanings of region and place and combines older historiographical traditions, which define region in political terms, with concepts borrowed from other disciplines, which offer a more nuanced view of cultural geography, to examine the development of psychedelic research in the post-World War II period.

Fault/no fault part 2: uneasy bedfellows

Vance Davis was just 19 when he died in a Saskatchewan hospital 6 years ago. He had been admitted for a head injury. Vance had a high level of consciousness in the intensive care unit, but that level dropped dramatically in the few minutes it took to transfer him to a ward. The change was recorded,

Positive predictive value of ICD‐9 codes 410 and 411 in the identification of cases of acute coronary syndromes in the Saskatchewan Hospital automated database

Case definitions are essential to epidemiological research. To evaluate ICD-9 codes 410 and 411 to identify cases of acute coronary syndromes (ACS), and the clinical information availability in the administrative and hospital discharge records of Saskatchewan, Canada. In the context of a safety cohort study, we identified hospitalisations with primary discharge codes 410 (2260) and 411 (799). We selected all records with code 411, and a random sample (200) with code 410. Based on information obtained by trained abstractors from hospital records, events were classified by two cardiologists as definite or possible according to adapted AHA/ESC criteria. The validity of 410 and 411 codes was assessed by calculating the positive predictive value (PPV). Completeness of the recorded information on risk factors and use of aspirin was explored. The PPVs of the codes 410 and 411 for ACS were 0.96 (95%CI: 0. 92-0.98) and 0.86 (95%CI: 0.83-0.88), respectively. The PPV of 410 for acute myocardial infarction (AMI) was 0.95 (95%CI: 0.91-0.98). The PPV of 411 was 0.73 (95%CI: 0.70-0.77) for primary unstable angina (UA) and 0.09 (95%CI: 0.07-0.11) for AMI. Hospital charts review revealed key information for clinical variables, smoking, obesity and use of aspirin at admission. ICD-9 410 code has high PPV for AMI cases, likewise 411 for UA cases. Case validation remains important in epidemiological studies with administrative health databases. Given the pathophysiology of ACS, both AMI and UA might be used as study end points. In addition to code 410, we recommend the use of 411 plus validation.

A Review of 2975 Consecutive Operations By One Surgeon in An Accredited Outpatient Plastic Surgicentre: A Canadian Experience

The present paper constitutes a retrospective review of 2975 consecutive operations performed by the author, one of the three owners of the Saskatoon Plastic Surgicentre. The unit opened in 1987; therefore, the study spans 17 years. Patients are not kept overnight, and the Surgicentre is approved and equipped as a level C facility for general anesthesia. Only patients who score 1 or 2 according to the American Association of Anesthesiologists are treated. Only certified anesthesiologists are used. Of the patients with postoperative complications, only two required transfer to a hospital. One developed a pneumothorax, which was treated on arrival at the intensive care unit with no sequelae. The other collapsed following facelift surgery. She was transferred to University of Saskatchewan hospital and died later that evening with a massive pulmonary embolus. In a properly established outpatient centre, a large number of patients can be safely treated with very few complications. However, despite placing patient safety as the first consideration and adhering strictly to the highest standards, death can occur.

The closure of rural hospitals in Saskatchewan: method or madness?

On April 14, 1993 the Minister of Health of the Province of Saskatchewan announced the closure of 52 of the 112 small hospitals using the criteria of: size, utilization for two consecutive years and distance to the nearest-neighbouring hospital. Amazingly, that government was re-elected. This study compared two models of reasons for hospital closure: the government criteria; and historical population, resource, and utilization factors, gathered for the year prior to closure and a decade earlier. Of the 112 small hospitals in Saskatchewan, the 10 hospitals in the frontier area were not included. Hospitals in the settled part of the province were divided into two distinct zones. The Northern zone, with 53 hospitals is characterized by rich dark soil and prosperous trade centres and the Southern zone, with 49 hospitals is characterized by light brown sandy soil and oil and gas exploration centres. Two discriminant models were developed. The government model consisted of size, two years of utilization and distance. The historical model consisted of population, resource, and utilization factors for the years 1981/1982 and 1991/1992. The dependent variable for both models was hospital status (open=1 and closed =0). The government model accurately predicted 91.18% of the closure decisions. The historical model had a classification accuracy of 95.10% for the whole of settled Saskatchewan, 96.23% for the Northern zone, and 95.92% for the Southern zone. The historical model was more accurate than the government model. Closing a hospital is a sad event. The manner in which the government closed nearly half of the small hospitals in Saskatchewan and gained re-election is an important account of responsible public policy. The historical model developed to examine this story takes public policy one step further in that it is possible for governments to recognize signals that indicate when communities should undertake orderly transitions in the operation of their health services facilities.

Closing rural hospitals in Saskatchewan: on the road to wellness?

Rising health care costs at a time of economic stagnation, federal cutbacks to Medicare, and an obsession with budget deficits at all levels of government have contributed to a sense of urgency to reform the Canadian health care system. Accompanying these economic and political motivations for reform, has been a shift in our understanding of health and well-being that lays less emphasis on the institutionalization and medicalization of health care. As part of its wellness approach to health, the Saskatchewan government in 1992 announced the closure and conversion of 52 small rural hospitals to wellness centres as part of a shift from institutional care to community based care. While the health costs and benefits of this shift are contested, the paradox is that closing rural hospitals may have unrealized health and social costs because of the psychological and community importance of hospitals to the meaning of place. This paper begins with a review of the meaning and importance of local institutions for communities. It is clear from this starting point that the debate about the economic and health benefits and costs of rural hospital closures is a limited basis for understanding hospital closures. Finally, the history of Saskatchewan hospitals and a narrative of the recent closures of rural hospitals drawn from a sampling of provincial newspapers and oral discussions highlights the need to understand the hospital closure in terms of its impact on health irrespective of the medical impacts.

Action Research: From mental hospital reform in Saskatchewan to community building in California.

Abstract. Action Research was used at the Saskatchewan Hospital, Weyburn in the 1950s. The research influenced the hospital and the field of psychology. At the heart of the approach was intense collaboration between the researcher and hospital staff who were the end users of the information. Action Research is contrasted with two other models, the Academic and the Applied. Two applications of action research at Weyburn are described, followed by subsequent usage in California with consumer cooperatives and an organization for families of mental health clients. Collaboration with lay individuals changes the research process and requires trade-offs between rigour and relevance.The Saskatchewan Hospital, Weyburn provided my first opportunity to engage in action research (AR), an approach also known as action science (Argyris, Putnam, & Smith, 1985), participatory action research (Whyte, 1991) and praxis research (Honadle, 1996). There are similarities between AR and Schon's (1983) model of reflective practice, in which a person simultaneously engages in research and practice using theory as a framework while fully respecting the discrete nature of each case. AR emphasizes the practical use and dissemination of research products and builds utilization strategies into the overall research design (Ketterer, Price, & Politser, 1980). My usage can be traced back to Lewin's (1946) conception of AR as requiring the active involvement of the potential users of the information throughout the research. This is not business as usual for the researcher but a different kind of business. According to Parlee (1983), Psychological knowledge would be dramatically changed if it were consistently developed through interaction with its 'subjects' and its intended audiences instead of being developed with professional colleagues in mind and 'given away' (p. 1). AR tends to be value-driven rather than value-neutral and has several related objectives: to improve the lives of the participants (a good test of the success of AR is whether the participants are better off after the research than they were before); to advance knowledge; and to improve the practice of AR through a critical examination of the collaborative process (Sanford, 1970).Prior to coming to the Saskatchewan Hospital, I followed the conventional academic model of research. It took many years before I realized the epistemological breakthroughs made at Weyburn, not so much in content but in approach. I became aware of the assumptions underlying the academic model and how these differed from a collaborative approach. Table 1 shows three research models, the Academic, the Applied, and Action Research, as ideal types. There are hybrids and variants of each model, omitted here in the interests of parsimony.Let us travel back in time over 40 years to Saskatchewan Hospital, Weyburn. In 1957 this was one of the most intellectually exciting places in the mental health landscape. The provincial CCF (now NDP) government encouraged experimentation with new social programs. Cutting edge work was undertaken in community mental health, architectural psychology, psychedelic drugs, operant conditioning, and hospital administration. Psychologists were part of the intellectual ferment and the research done at Weyburn influenced both the hospital and the field of psychology. Ayllon's behaviour modification ward sparked interest in applied behavioural analysis in institutional settings (Ayllon & Michael, 1959) which stimulated the creation of new journals and organizations. The focus on the behavioural effects of architecture gave impetus to a new specialty of environmental psychology.With a vigorous commitment to the value of research-based knowledge, this large Kirkbride-style mental hospital, probably the largest single building between Winnipeg and Vancouver, came very close to being what Campbell (1969) called an experimenting society and Hutchins (1968) described as a questioning community. …