Admission and discharge profiles of people with MS accessing in-patient rehabilitation in Canada.

Background: Rehabilitation is the mainstay of management for people with disabilities of neurological origin to maximize function and reduce disability. Access to in-patient rehabilitation is usually reserved for people after crises or those who are discharged from acute care such as in stroke or trauma. Access to people with Multiple Sclerosis (MS) differs across countries and unknown for Canada.

Simulating Realistic Continuous Glucose Monitor Time Series By Data Augmentation.

Background: Simulated data are a powerful tool for research, enabling benchmarking of blood glucose (BG) forecasting and control algorithms. However, expert created models provide an unrealistic view of real-world performance, as they lack the features that make real data challenging, while black-box approaches such as generative adversarial networks do not enable systematic tests to diagnose model performance.

Methods: To address this, we propose a method that learns missingness and error properties of continuous glucose monitor (CGM) data collected from people with type 1 diabetes (OpenAPS, OhioT1DM, RCT, and Racial-Disparity), and then augments simulated BG data with these properties.

Reducing research wastage by starting off on the right foot: optimally framing the research question.

Purpose: Strongly framed research questions are clear as to the population (P), the exposures or interventions (E/I), comparison groups (C), outcomes (O), time when relevant (T), and what the investigator wants to know. A solid framework sets up the measurement model, analysis, and anticipated results. The purpose of this study was to estimate the extent to which research questions in journals that focused on patient-reported outcome measures (PROM) and quality of life (QOL) are clear.

Are the Items of the Starkstein Apathy Scale Fit for the Purpose of Measuring Apathy Post-stroke?

Given the importance of apathy for stroke, we felt it was time to scrutinize the psychometric properties of the commonly used Starkstein Apathy Scale (SAS) for this purpose. The objectives were to: (i) estimate the extent to which the SAS items fit a hierarchical continuum of the Rasch Model; and (ii) estimate the strength of the relationships between the Rasch analyzed SAS and converging constructs related to stroke outcomes. Data was from a clinical trial of a community-based intervention targeting participation.

Properties of common anxiety scales among patients with bipolar disorder.

Objectives: Almost half of the patients with a bipolar disorder (BD) have anxiety disorder(s) (AD) during their lifetime, but feasible measures for all AD are few. Furthermore, cognitive impairments can compromise reliability of existing scales, since many are needed for full coverage. Thus, we investigated how reliably patients responded to anxiety scales and any symptom overlap to propose future improvements to anxiety assessments.

Functioning Profiles of Young People with MS in Inpatient Rehabilitation: Data from the National Rehabilitation Reporting System in Canada.

Background: Recent evidence has suggested an existence of a MS prodome, indicating that symptoms of neurodegeneration were present before the first clinical event. These early signs of MS are usually not recognized as a symptom of MS and some young adults with MS are very likely to have had these symptoms in their childhood or adolescence. It is thus of interest to examine the differences in disability profiles of young people with MS.

Online Learning and Residents' Acquisition of Mechanical Ventilation Knowledge: Sequencing Matters.

Objective: Rapid advancements in medicine and changing standards in medical education require new, efficient educational strategies. We investigated whether an online intervention could increase residents' knowledge and improve knowledge retention in mechanical ventilation when compared with a clinical rotation and whether the timing of intervention had an impact on overall knowledge gains.

Design: A prospective, interventional crossover study conducted from October 2015 to December 2017.

Replicability, Reproducibility, and Agent-based Simulation of Interventions.

Secondary use of medical data and use of observational data for causal inference has been growing. Yet these data bring many challenges such as confounding due to unobserved variables and variation in medical processes across settings. Further, while methods exist to handle some of these problems, researchers lack ground truth to evaluate these methods.

Computer-Assisted Motivational Interviewing Intervention to Facilitate Teen Pregnancy Prevention and Fitness Behavior Changes: A Randomized Trial for Young Men.

Purpose: Despite recent declines, teen unintended pregnancy and sexually transmitted infections in the United States remain at levels higher than comparable nations. Initiatives to prevent teen pregnancy have focused primarily on female adolescents; how to effectively engage young men to reduce their risk of fathering a teen pregnancy has not been well studied. We proposed to adapt an innovative computer-assisted motivational interviewing (CAMI) intervention, originally designed and tested with young women, for use with young men, aged 15-24 years, to reduce their risk of fathering a teen pregnancy.

Impact of an electronic handoff documentation tool on team shared mental models in pediatric critical care.

Objective: To examine the impact of the implementation of an electronic handoff tool (the Handoff Tool) on shared mental models (SMM) within patient care teams as measured by content overlap and discrepancies in verbal handoff presentations given by different clinicians caring for the same patient.

Materials And Methods: Researchers observed, recorded, and transcribed verbal handoffs given by different members of patient care teams in a pediatric intensive care unit. The transcripts were qualitatively coded and analyzed for content overlap scores and the number of discrepancies in handoffs of different team members before and after the implementation of the tool.

Driven to distraction: The nature and apparent purpose of interruptions in critical care and implications for HIT.

Objectives: To examine the apparent purpose of interruptions in a Pediatric Intensive Care Unit and opportunities to reduce their burden with informatics solutions.

Materials And Methods: In this prospective observational study, researchers shadowed clinicians in the unit for one hour at a time, recording all interruptions participating clinicians experienced or initiated, their starting time, duration, and a short description that could help to infer their apparent purpose. All captured interruptions were classified inductively on their source and apparent purpose and on the optimal representational media for fulfilling their apparent purpose.

How have research questions and methods used in clinical trials published in Clinical Rehabilitation changed over the last 30 years?

Research in rehabilitation has grown from a rare phenomenon to a mature science and clinical trials are now common. The purpose of this study is to estimate the extent to which questions posed and methods applied in clinical trials published in Clinical Rehabilitation have evolved over three decades with respect to accepted standards of scientific rigour. Studies were identified by journal, database, and hand searching for the years 1986 to 2016.

Trajectory of MS disease course for men and women over three eras.

Background: Heterogeneity in disease course exists within multiple sclerosis (MS) subtypes.

Objective: The objective was to estimate disease course heterogeneity over three distinct onset periods (pre-1995, 1995-2004, and 2005-present) for men and women.

Methods: Group-based trajectory model (GBTM) was used to estimate clusters of patients following stable or unstable disease progression trajectories based on the Expanded Disability Status Scale (EDSS).

Revealing structures in narratives: A mixed-methods approach to studying interdisciplinary handoff in critical care.

Objective: To examine a novel mixed-methods approach for studying patterns of clinical communication that could inform future informatics solutions, with a specific focus on handoff within interdisciplinary teams.

Materials And Methods: Researchers observed, recorded, and transcribed verbal handoff discussions of different members of critical care teams. The transcripts were coded qualitatively, and then analyzed quantitatively for emerging structural patterns using categorical cluster analysis, and for degree of shared mental models (SMM) using the modified Pyramid method.

In Search of Social Translucence: An Audit Log Analysis of Handoff Documentation Views and Updates.

Communication and information sharing are critical parts of teamwork in the hospital; however, achieving open and fluid communication can be challenging. Finding specific patient information within documentation can be difficult. Recent studies on handoff documentation tools show that resident handoff notes are increasingly used as an alternative information source by non-physician clinicians.

Characterization of a handoff documentation tool through usage log data.

Handoffs are a critical component of coordinated patient care; however, poor handoffs have been associated with near misses and adverse events. To address this, national agencies have recommended standardizing handoffs, for example through the use of handoff documentation tools. Recent research suggests that handoff tools, typically designed for physicians, are often used by non-physician providers as information sources.

Methods and measures: what's new for MS?

At no other time in the history of multiple sclerosis (MS) has the accurate measurement of health outcomes been so important. There are now many kinds of interventions of proven or potential efficacy available for people with MS and many other methods are under investigation. Not all outcomes that matter can be measured with a biological parameter.

Pharmacotherapy in pediatric critical illness: a prospective observational study.

Background And Objectives: Pharmacotherapy is an under-evaluated element of critical care medicine. In order to better understand pharmacotherapy in pediatric critical illness, we evaluated a cohort of emergency admissions to a university-affiliated pediatric intensive care unit (PICU).

Methods: A prospective, observational study was performed.

OpenMDC: an open-source framework for medical device communication.

We have developed an extensible, open source framework for collecting data from bedside medical devices which support RS-232 serial output. The system uses inexpensive hardware to convert RS-232 signals to Universal Serial Bus (USB) format, enabling "plug-and-play" device communication at low cost. A prototype of the system has been created and tested with Puritan-Bennett 840 ventilators.