West Park Healthcare Centre Research Articles

The Transitions to Long-term In Home Ventilator Engagement Study (Transitions to LIVE): study protocol for a pragmatic randomized controlled trial

Background overview and rationaleWe co-developed a multi-component virtual care solution (TtLIVE) for the home mechanical ventilation (HMV) population using the aTouchAway™ platform (Aetonix). The TtLIVE intervention includes (1) virtual home visits; (2) customizable care plans; (3) clinical workflows that incorporate reminders, completion of symptom profiles, and tele-monitoring; and (4) digitally secure communication via messaging, audio, and video calls; (5) Resource library including print and audiovisual material.Objectives and brief methodsOur primary objective is to evaluate the TtLIVE intervention compared to a usual care control group using an eight-center, pragmatic, parallel-group single-blind (outcome assessors) randomized controlled trial. Eligible patients are children and adults newly transitioning to HMV in Ontario, Canada. Our target sample size is 440 participants (220 each arm). Our co-primary outcomes are a number of emergency department (ED) visits in the 12 months after randomization and change in family caregiver (FC) reported Pearlin Mastery Scale score from baseline to 12 months. Secondary outcomes also measured in the 12 months post randomization include healthcare utilization measured using a hybrid Ambulatory Home Care Record (AHCR-hybrid), FC burden using the Zarit Burden Interview, and health-related quality of life using the EQ-5D. In addition, we will conduct a cost-utility analysis over a 1-year time horizon and measure process outcomes including healthcare provider time using the Care Coordination Measurement Tool. We will use qualitative interviews in a subset of study participants to understand acceptability, barriers, and facilitators to the TtLIVE intervention. We will administer the Family Experiences with Care Coordination (FECC) to interview participants. We will use Poisson regression for a number of ED visits at 12 months. We will use linear regression for the Pearlin Mastery scale score at 12 months. We will adjust for the baseline score to estimate the effect of the intervention on the primary outcomes. Analysis of secondary outcomes will employ regression, causal, and linear mixed modeling. Primary analysis will follow intention-to-treat principles. We have Research Ethics Board approval from SickKids, Children’s Hospital Eastern Ontario, McMaster Children’s Hospital, Children’s Hospital-London Health Sciences, Sunnybrook Hospital, London Health Sciences, West Park Healthcare Centre, and Ottawa Hospital.DiscussionThis pragmatic randomized controlled single-blind trial will determine the effectiveness and cost-effectiveness of the TtLIVE virtual care solution compared to usual care while providing important data on patient and family experience, as well as process measures such as healthcare provider time to deliver the intervention.Trial registrationClinicalTrials.gov NCT04180722. Registered on November 27, 2019.

Maintaining a positive patient experience during COVID-19 in a rehabilitation and complex care setting

West Park Healthcare Centre located in Toronto, Ontario, Canada provides specialized rehabilitative and complex care after a life‐altering illness or injury such as lung disease, amputation, stroke and traumatic musculoskeletal injuries. This narrative showcases the strategies, processes and the lessons learned and subsequently utilized throughout the COVID-19 pandemic to engage patients and their family and peers.

Risk factors for drug-resistant tuberculosis at a referral centre in Toronto, Ontario, Canada: 2010-2016.

Drug-resistant tuberculosis (TB) poses a major public health concern worldwide. However, no studies have addressed risk factors for drug resistance in Ontario, which has its own unique profile of immigrants. We evaluated demographic and clinical risk factors for drug-resistant TB among patients treated at West Park Healthcare Centre, located in Toronto, Ontario (Canada). All patients who were diagnosed with TB and treated at West Park Healthcare Centre between January 2010 and December 2016 were included in this retrospective cohort study. Characteristics of patients with isoniazid mono-resistant (INH-R) TB and multidrug resistant (MDR) TB were compared to patients with drug-susceptible TB with bivariate and multivariable logistic regression. Risk factors for INH-R TB included younger age (younger than 35 years), prior TB treatment, non-diabetic and birth in a non-South-East Asian country, but only the latter two factors were significant in multivariable analysis. On the other hand, we found younger generation (younger than 65 years), birth in European region, recent arrival to Canada (fewer than 120 months), prior treatment and human immunodeficiency virus (HIV) infection were associated with MDR-TB, among which younger age (younger than 35 years), more recent immigration (fewer than 24 months), prior treatment and HIV infection were significant in multivariable analysis. These findings may be of use to TB clinicians in the province by informing the initial empiric antibiotic regimen prescribed while awaiting phenotypic drug susceptibility testing and assisting in decisions regarding whether to request rapid molecular drug susceptibility testing.

A transition program to adult health services for teenagers receiving long-term home mechanical ventilation: A longitudinal qualitative study.

Adolescents receiving long-term home mechanical ventilation (HMV) who survive into adulthood must transition to adult health care services. Lack of transition readiness is reported to result in poor health outcomes. The objective of this study is to explore longitudinally the pediatric-to-adult health care transition experience involving a transition program for adolescents receiving HMV including transition readiness, barriers, facilitators, and modifiable features. A prospective qualitative longitudinal interview study of adolescent and family caregiver dyads recruited through a pediatric-to-adult HMV transition program jointly established by two collaborating health centers: The Hospital for Sick Children and West Park Healthcare Centre in Toronto, Canada. Eligible dyads were interviewed at three time points: pretransition, transition, and 12-months posttransition. Interviews were transcribed verbatim and analyzed using directed content analysis methods. Ventilator-assisted adolescents (VAAs) and caregiver participants perceived a lack of transition readiness in their ability to manage health communication and coordination across multiple adult providers. Transition facilitators included early transition discussion, opportunities for VAAs to speak directly with HMV providers during appointments, receipt of print informational materials regarding adult services, and a joint pediatric-adult team handover meeting. Modifiable transition barriers included lack of other specialist referrals, insufficient information about adult homecare service funding, and limited involvement of family doctors. Unresolved transition barriers resulted in perceptions of service fragmentation. Although the pediatric-to-adult HMV transition program conferred benefits service fragmentation was perceived. Transition barriers may be overcome through early planning and staged transition with all specialists, community providers, and the family and adolescent working in collaboration.

The effect of water-based exercises on balance in persons post-stroke: a randomized controlled trial

Objective: Water-based exercises have been used in the rehabilitation of people with stroke, but little is known about the impact of this treatment on balance. This study examined the effect of water-based exercises compared to land-based exercises on the balance of people with sub-acute stroke. Methods: In this single-blind randomized controlled study, 32 patients with first-time stroke discharged from inpatient rehabilitation at West Park Healthcare Centre were recruited. Participants were randomized into W (water-based + land; n = 17) or L (land only; n = 15) exercise groups. Both groups attended therapy two times per week for six weeks. Initial and progression protocols for the water-based exercises (a combination of balance, stretching, and strengthening and endurance training) and land therapy (balance, strength, transfer, gait, and stair training) were devised. Outcomes included the Berg Balance Score, Community Balance and Mobility Score, Timed Up and Go Test, and 2 Minute Walk Test. Results: Baseline characteristics of groups W and L were similar in age, side of stroke, time since stroke, and wait time between inpatient discharge and outpatient therapy on all four outcomes. Pooled change scores from all outcomes showed that significantly greater number of patients in the W-group showed improvement post-training compared to the L-group (p < 0.05). More patients in W-group showed change scores exceeding the published minimal detectable change scores. Discussion: A combination of water- and land-based exercises has potential for improving balance. The results of this study extend the work showing benefit of water-based exercise in chronic and less-impaired stroke groups to patients with sub-acute stroke.

Multidrug-resistant tuberculosis: Treatment and outcomes of 93 patients.

Tuberculosis (TB) remains a leading cause of death worldwide and the emergence of multidrug-resistant TB (MDR TB) poses a threat to its control. There is scanty evidence regarding optimal management of MDR TB. The majority of Canadian cases of MDR TB are diagnosed in Ontario; most are managed by the Tuberculosis Service at West Park Healthcare Centre in Toronto. The authors reviewed 93 cases of MDR TB admitted from January 1, 2000 to December 31, 2011. Eighty-nine patients were foreign born. Fifty-six percent had a previous diagnosis of TB and most (70%) had only pulmonary involvement. Symptoms included productive cough, weight loss, fever and malaise. The average length of inpatient stay was 126 days. All patients had a peripherally inserted central catheter for the intensive treatment phase because medications were given intravenously. Treatment lasted for 24 months after bacteriologic conversion, and included a mean (± SD) of 5 ± 1 drugs. A successful outcome at the end of treatment was observed in 84% of patients. Bacteriological conversion was achieved in 98% of patients with initial positive sputum cultures; conversion occurred by four months in 91%. MDR TB can be controlled with the available anti-TB drugs.

Poster 365 Evaluation of Health Utility in Patients Receiving OnabotulinumtoxinA (Botox®) for the Treatment of Adult Focal Spasticity: Results from MOBILITY®, a Prospective Observational Cohort Study

PM&RVolume 6, Issue 9S p. S313-S313 Saturday Poster Presentations - Poster Hall Poster 365 Evaluation of Health Utility in Patients Receiving OnabotulinumtoxinA (Botox®) for the Treatment of Adult Focal Spasticity: Results from MOBILITY®, a Prospective Observational Cohort Study Farooq Ismail, Farooq Ismail Westpark Healthcare Centre, Toronto, ON, CanadaSearch for more papers by this authorTheodore Wein MD, Theodore Wein MD Westpark Healthcare Centre, Toronto, ON, CanadaSearch for more papers by this authorMeetu Bhogal M.Sc., Meetu Bhogal M.Sc. Westpark Healthcare Centre, Toronto, ON, CanadaSearch for more papers by this authorGrace Trentin PhD, Grace Trentin PhD Westpark Healthcare Centre, Toronto, ON, CanadaSearch for more papers by this author Farooq Ismail, Farooq Ismail Westpark Healthcare Centre, Toronto, ON, CanadaSearch for more papers by this authorTheodore Wein MD, Theodore Wein MD Westpark Healthcare Centre, Toronto, ON, CanadaSearch for more papers by this authorMeetu Bhogal M.Sc., Meetu Bhogal M.Sc. Westpark Healthcare Centre, Toronto, ON, CanadaSearch for more papers by this authorGrace Trentin PhD, Grace Trentin PhD Westpark Healthcare Centre, Toronto, ON, CanadaSearch for more papers by this author First published: 29 September 2014 https://doi.org/10.1016/j.pmrj.2014.08.744Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume6, Issue9SSeptember 2014Pages S313-S313 RelatedInformation

Long-Term Outcomes and Survival of Patients with Bilateral Transtibial Amputations After Rehabilitation

To examine long-term outcomes and survival of patients after bilateral transtibial amputation (BTTA). A retrospective chart review and a cross-sectional interview was conducted at Amputee Rehabilitation Service, West Park Healthcare Centre, Toronto, Canada, with consecutive diabetic or vascular BTTA patients (n = 82) admitted for rehabilitation from 1998 to 2003. Main outcome measures included the Houghton scale of prosthetic use, SF-12, Frenchay Activities Index, and qualitative measurement of activities of daily living (ADL). Of 82 patients admitted for BTTA rehabilitation, 34 patients were interviewed an average of 3.7 yrs after amputation. Another 32 patients had died. Life expectancy was 4.2 yrs beyond rehabilitation discharge (Kaplan-Meier survival analysis). The mean modified Houghton score at telephone follow-up was 6.3 (maximum score of 9), with a significant improvement from rehabilitation discharge to follow-up (P = 0.001). Eighty-five percent were still wearing prostheses regularly and were walking. Most remained independent in ADLs. Patients undergoing rehabilitation for BTTA continue to do well at long-term follow-up and to survive, on average, for more than 4 yrs after discharge. Therefore, they should be given strong consideration for prosthetic fitting.

Tuberculosis Among Tibetan Refugee Claimants in Toronto: 1998 to 2000

Between 1998 and 2000, approximately 525 Tibetan people previously living in the United States claimed refugee status in Canada, many of whom were referred to our centers for completion of tuberculosis (TB) screening. We reviewed TB-related outcomes in this cohort, to compare our experience with previously published work, and to assess follow-up after a stay in a low-incidence region. We performed a retrospective study of all patients of Tibetan origin assessed at our centers (St. Michael's Hospital and West Park Healthcare Centre, both in Toronto) for completion of TB screening, referred because of abnormal chest radiographic findings or positive tuberculin skin test (TST) result. We compared rates of active and drug-resistant TB in our cohort with local and national rates, as well as those previously published in similar groups. One hundred eighty-nine individuals were referred to us for assessment, and 181 records were available for review. The mean duration of stay in Canada prior to presentation was 2.6 months, after having spent a mean of 11 months in the United States. Thirty-two percent of patients gave a history of previous TB, and 97% were TST positive. Culture-positive TB was diagnosed in 24 patients (13%, 4,571 per 100,000), 12 patients had at least one drug resistance (50% of cases), and 4 patients were resistant to at least isoniazid and rifampin (multidrug resistant, 17% of cases). People from highly TB endemic areas retain a very high risk of active TB and drug resistance, despite an intervening period in a low-prevalence country. It is important to maintain a high degree of suspicion for TB in all people from high-incidence areas. Treatment of all cases of latent TB infection or ongoing medical surveillance is likely justified in this population.

Clinical implications of pulmonary rehabilitation.

Professor of Medicine and Physical Therapy, University of Toronto, Toronto, Ontario; National Sanitarium Chair in Respiratory Rehabilitation Research Correspondence: Dr Roger Goldstein, WestPark Healthcare Centre, 82 Buttonwood Avenue, Toronto, Ontario M6M 2J5. Telephone 416-243-3631, fax 416-243-8947, e-mail rgoldstein@westpark.org The burden of chronic obstructive pulmonary disease (COPD) has grown in recent years, making it the fourth most important cause of morbidity and mortality in Canada. The dramatic rise in COPD prevalence among women reflects increased smoking rates for women over the past 20 years. Many professional societies recommend rehabilitation, as part of COPD management, to increase health-related quality of life and improve functional exercise capacity. Rehabilitation is associated with a reduction in health resource utilization. Unfortunately, its benefits diminish with time. Current challenges include identifying the most effective approaches to rehabilitation in terms of location, essential components and ways to maintain the initial program benefits.

The 360° Feedback® Process: A Tool for Continuous Board Improvement

To remain accountable to stakeholders, healthcare governing boards need meaningful and actionable feedback on their performance. In 1998, the Board of Governors of West Park Hospital (now West Park Healthcare Centre) used the 360° feedback® technique for the first time to gather feedback from a range of stakeholders. Board members found the technology accessible and the process valuable. They are using the individual results to improve individual performance, and have developed work plans to address areas for continued board development.

Stewarding the resources of patients and residents: the funding support assistant role at West Park Healthcare Centre.

Stewarding the resources of patients and residents: the funding support assistant role at West Park Healthcare Centre.

Trace element content in drinking water of nasopharyngeal carcinoma patients

Between 1998 and 2000, approximately 525 Tibetan people previously living in the United States claimed refugee status in Canada, many of whom were referred to our centers for completion of tuberculosis (TB) screening. We reviewed TB-related outcomes in this cohort, to compare our experience with previously published work, and to assess follow-up after a stay in a low-incidence region.We performed a retrospective study of all patients of Tibetan origin assessed at our centers (St. Michael's Hospital and West Park Healthcare Centre, both in Toronto) for completion of TB screening, referred because of abnormal chest radiographic findings or positive tuberculin skin test (TST) result. We compared rates of active and drug-resistant TB in our cohort with local and national rates, as well as those previously published in similar groups.One hundred eighty-nine individuals were referred to us for assessment, and 181 records were available for review. The mean duration of stay in Canada prior to presentation was 2.6 months, after having spent a mean of 11 months in the United States. Thirty-two percent of patients gave a history of previous TB, and 97% were TST positive. Culture-positive TB was diagnosed in 24 patients (13%, 4,571 per 100,000), 12 patients had at least one drug resistance (50% of cases), and 4 patients were resistant to at least isoniazid and rifampin (multidrug resistant, 17% of cases).People from highly TB endemic areas retain a very high risk of active TB and drug resistance, despite an intervening period in a low-prevalence country. It is important to maintain a high degree of suspicion for TB in all people from high-incidence areas. Treatment of all cases of latent TB infection or ongoing medical surveillance is likely justified in this population.