Browsing by Author "Mitchell, Ian"

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    A Decade of Respiratory Syncytial Virus Epidemiology and Prophylaxis: Translating Evidence into Everyday Clinical Practice
    (2011-01-01) Paes, Bosco A; Mitchell, Ian; Banerji, Anna; Lanctôt, Krista L; Langley, Joanne M
    Respiratory syncytial virus (RSV) is a common infection in infancy, with nearly all children affected by two years of age. Approximately 0.5% to 2.0% of all children are hospitalized with lower respiratory tract disease, of which 50% to 90% have bronchiolitis and 5% to 40% have pneumonia. Morbidity and mortality are highest in children with nosocomial infection and in those with underlying medical illnesses such as cardiac and chronic lung disease. Aboriginal children residing in remote northern regions are specifically considered to be at high risk for hospitalization due to RSV infection. Thorough hand washing and health education are the principal strategies in primary prevention. In the absence of a vaccine, palivizumab prophylaxis is currently the best intervention to reduce the burden of illness and RSV-related hospitalization in high-risk children. Health care professionals should provide palivizumab prophylaxis cost effectively in accordance with recommendations issued by pediatric societies and national advisory bodies.The present article reviews the epidemiology of RSV infection and the short- and long-term impact of disease in high-risk infants and special populations. Prevention strategies and treatment are discussed based on the existing scientific evidence, and future challenges in the management of RSV infection are addressed.
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    Asthma in Adolescents: A Randomized, Controlled Trial of an Asthma Program for Adolescents and Young Adults with Severe Asthma
    (2002-01-01) Cowie, Robert L; Underwood, Margot F; Little, Cinde B; Mitchell, Ian; Spier, Sheldon; Ford, Gordon T
    BACKGROUND: Asthma is common and is often poorly controlled in adolescent subjects.OBJECTIVE: To determine the impact of an age-specific asthma program on asthma control, particularly on exacerbations of asthma requiring emergency department treatment, and on the quality of life of adolescents with asthma.METHODS: The present randomized, controlled trial included patients who were 15 to 20 years of age and had visited emergency departments for management of their asthma. The interventional group attended an age-specific asthma program that included assessment, education and management by a team of asthma educators, respiratory therapists and respiratory physicians. In the control group, spirometry was performed, and the patients continued to receive usual care from their regular physicians. The outcomes were assessed by a questionnaire six months after entry into the study.RESULTS: Ninety-three subjects entered the study and were randomly assigned to the intervention or control group. Of these, only 62 patients were available for review after six months. Subjects in both the control and the intervention groups showed a marked improvement in their level of asthma control, reflected primarily by a 73% reduction in the rate of emergency department attendance for asthma. Other indexes of disease control, including disease-specific quality of life, as assessed by questionnaires, were improved. There was, however, no discernible difference between the subjects in the two groups, with the exception of an improvement in favour of the intervention group in the symptom (actual difference 0.7, P=0.048) and emotional (actual difference 0.8, P=0.028) domains of the asthma quality of life questionnaire. The overall quality of life score favoured the intervention group by a clinically relevant difference of 0.6, but this difference did not reach statistical significance (P=0.06).CONCLUSIONS: Although all subjects demonstrated a significant improvement in asthma control and quality of life, the improvement attributable to this intervention was limited to two domains in disease-specific quality of life.
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    Delayed diagnosis of high proximal tracheoesophageal fistula in esophageal atresia and a novel approach to the treatment of tracheomalacia by submanubrial tracheopexy
    (Springer Plus, 2014-02-27) Bjornson, Candice; Brindle, Mary E.; Bailey, Michelle J.A.; Mitchell, Ian; Soles, Melissa
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    Do Pediatric Medical Subspecialty Residents Experience Moral Distress?
    (2014-10-02) Adesugba, Adeolu; Mitchell, Ian
    Moral distress is a human experience arising when an individual knows what is ethically appropriate but is unable to carry out that action due to institutional constraints. It affects healthcare professions when there is a psychological disequilibrium and can lead to burnout. In this research, descriptive phenomenology was used to investigate whether pediatric subspecialty residents experience moral distress. The results indicate that they do experience moral distress for reasons including issues regarding futile treatment, barriers that prevent effective communication, inadequate resources and strenuous relationships with parents of patients. Residents in this study cope with moral distress by talking with colleagues or senior staff members about the difficult situations they encountered. Recommendations from this research include the introduction of regular rounds sessions to deal with difficult cases and regular orientations on support services available to medical subspecialty residents.
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    Ethical Issues in Residency Education Related to the First Wave of the COVID-19 Pandemic: A Narrative Inquiry Study
    (2022-09) Kassam, Aliya; Mitchell, Ian; Page, Stacey; Lauzon, Julie
    Background: Around the world, the unprecedented COVID-19 pandemic has increased the demand for, and on, healthcare workers as it also continues to strain healthcare systems. Ethical issues that arise during pandemic health emergencies understandably impact such individuals as healthcare providers who have responsibilities to the public. Residency programs were faced with new challenges to provide care and educate junior doctors (resident physicians) while ensuring learner and patient safety and resource allocation amidst the suspension of standard in-person learning opportunities. We sought to understand both the positive and negative experiences of first-year residents during the first wave of COVID-19, as well as to describe potential ethical issues from their stories. Method: We used narrative inquiry (NI) methodology to explore resident physicians’ experiences. A semi-structured interview guide was utilized and included questions pertaining to ethical principles as well as both positive and negative aspects of the pandemic. Sampling was purposive. Interviews were audio-recorded and transcribed. Three members of the research team coded transcripts in duplicate to determine themes surrounding experiences as well as observations of ethical principles and arguments. To describe resident experiences of both the positive and negative aspects of the pandemic, a composite story with threads was constructed. Discrepancies were resolved through discussion to attain consensus. Results: Eleven residents participated from Internal Medicine (n=2), Family Medicine (n=2), Ophthalmology (n=1), General Surgery (n=1), Pediatrics (n=1), Diagnostic Radiology (n=1), Public Health (n=1), Psychiatry (n=1), Emergency Medicine (n=1). Resident stories had three common themes in which ethical issues were described: 1) Intersecting healthcare and medical education systems, 2) Public health and the public good, 3) Health systems planning/healthcare delivery. Junior’s journal entry became the composite story of the eleven participants. Three key narrative threads of the story were: 1) Engage us, 2) Because we see the need for the duty to treat, 3) And we are all in this together. Discussion: While residents identified lack of autonomy as they straddled roles as both novice employees and learners across intersecting systems, this was not unique to the pandemic. The pandemic, however may have exacerbated the lack of autonomy experienced by resident physicians. The notion of public health and the public good at times eclipsed individual wellbeing for residents and patients alike, leading to consequences in health systems’ planning/healthcare delivery. Despite these challenges, there were positive aspects to the pandemic such as teamwork and collaboration as well as the feeling of altruism to help achieve what was best for the public good. Conclusion: Efforts to understand how resident physicians can be engaged in their own education as well as how they can navigate public health crises with respect to ethical principles could benefit both residency education and healthcare delivery.
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    Psychological Distress in Emergency Medical Services Practitioners: Identifying and Measuring the Issues
    (2017) Lefevre, Nicola Louise; Doig, Christopher; Mitchell, Ian; Page, Stacy; Guichon, Juliet; McLaughlin, Kevin
    This thesis investigates psychological distress in Emergency Medical Services practitioners through three pieces of inter-related research. The first examines the prevalence of compassion fatigue in all health care practitioners by systematic review of literature. The second conceptualizes three manifestations of distress (compassion fatigue, burnout, and post-traumatic stress disorder), places them in the context of EMS work by describing practitioners’ experience, and broadly strategizes ways to address them. The third measures the presence of compassion fatigue, burnout, and post-traumatic stress disorder in a sample of EMS practitioners through a survey based study. Overall, the research showed that EMS practitioners are experiencing psychological distress as compassion fatigue, burnout and PTSD, and that compassion fatigue has been identified across diverse practitioner groups in health care. Recommendations are consistently made that further research needs to be conducted to investigate root causes, and that education and support programs would be of benefit to practitioners.
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    Respiratory-Related Hospitalizations following Prophylaxis in the Canadian Registry for Palivizumab (2005–2012) Compared to Other International Registries
    (2013-06-19) Paes, Bosco; Mitchell, Ian; Li, Abby; Harimoto, Tetsuhiro; Lanctôt, Krista L.
    Respiratory syncytial virus (RSV) infection occurs commonly in infants aged ≤2 years, and severe infection results in hospitalization with accompanying morbidity and mortality. Palivizumab has been available for prophylaxis for the past 15 years. Prospective data on patients who received palivizumab from 2005 to 2012 has been assembled in the Canadian registry (CARESS) to document utilization, compliance, and health outcomes in both hospital and community settings. Long-term data is necessary to evaluate the impact of palivizumab on the incidence of RSV infections, minimize healthcare resources, and identify which infant subpopulations are receiving prophylaxis. A database search was also conducted for similar information from published registries, and hospitalization rates were compared to results from randomized clinical trials (RCTs).Overall hospitalization rates (percent; range) for respiratory-related illnesses and RSV-specific infection in infants who meet standard indications for prophylaxis were 6.6 (3.3–7.7) and 1.55 (0.3–2.06), respectively, in CARESS, which closely aligns with registry data from 4 other countries, despite the former comprising the largest cohort of complex patients internationally. Overall RSV-related hospitalization rates were lower across registries compared to equivalent patients in RCTs. Registry data provides valuable information regarding real-world experience with palivizumab, while facilitating the genesis of new research themes.
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    Social Workers' Experience of Moral Distress
    (2016) Jaskela, Shannon; Mitchell, Ian; Page, Stacey; Guichon, Juliet
    According to Jameton (1985), “moral distress arises when one knows the right thing to do, but institutional constraints make it nearly impossible to pursue the right course of action” (as cited in Pendry, 2007, p.1). The issue of nurses and moral distress has been studied extensively; however, little attention has been paid to social workers’ experience of moral distress. The main objectives of this qualitative descriptive research were to explore whether ten health care social workers experienced moral distress and, if so, what were the causes and effects of such moral distress. The supports they use to deal with such distress were also explored. The participants voiced that they experience moral distress from a variety of sources and that the effects of such distress can result in exhaustion, apathy towards patients, and social workers leaving their positions. The results of this research are discussed and suggestions for further research and practice are presented.
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    Surgical Versus Nonsurgical Interventions to Relieve upper Airway Obstruction in Children with Pierre Robin Sequence
    (2015-01-01) Kam, Karen; McKay, Meghan; MacLean, Joanna; Witmans, Manisha B; Spier, Sheldon; Mitchell, Ian
    BACKGROUND: Newborns with Pierre Robin sequence (PRS) often experience chronic intermittent hypoxemia/hypoventilation associated with airway obstruction. The heterogeneity of the severity of upper airway obstruction makes management a challenge; the optimal intervention in individual cases is not clear.OBJECTIVE: To investigate the prevalence of surgical/nonsurgical interventions for PRS at two children’s hospitals. Patient characteristics and outcomes were examined.METHODS: The present retrospective chart review identified 139 patients with PRS born between 2000 and 2010. Demographic information, mode of airway management, associated anomalies and syndromes, polysomnography results, length of intensive care unit and hospital stay, complications and deaths were extracted.RESULTS: Interventions included prone positioning (alone [61%]), tongue-lip adhesion (45%), nasopharyngeal intubation (28%), continuous positive airway pressure (20%), tracheostomy (19%) and mandibular distraction osteogenesis (5%). Tracheostomies were more prevalent in syndromic patients (P=0.03). Patients who underwent tracheostomy had a lower birth weight (P=0.03) compared with newborns with other interventions. Patients who underwent surgical interventions had longer intensive care unit stays (Pud_less_than0.001). No intervention was associated with a statistically significant likelihood of requiring a subsequent intervention. Thirty percent of patients underwent polysomnography, with a higher proportion of these using continuous positive airway pressure (n=15) (Pud_less_than0.01).CONCLUSIONS: In the present descriptive study, patients with syndromic PRS or low birth weight underwent early intervention, which included a tracheostomy. Objective measures of airway obstruction were underutilized. Decision making regarding evaluation and management of upper airway obstruction in this population remains clinician and resource dependent. Reporting data obtained from a large cohort of PRS patients is important to compare experiences and motivate future studies investigating this complex condition.
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    “The Third Sex” – A study of distress in physicians
    (2017) Kenny, Kathryn May; Mitchell, Ian; Brain, Philippa; Guichon, Juliet; Raffin Bouchal, Donna Shelley
    The purpose of this inquiry was to gain a rich and deep understanding of the lived experiences of physicians who engage in Disorders of Sexual Development (DSD) diagnosis, disclosure and management. The primary aim of this inquiry was to achieve an in-depth understanding of ethical and/or moral dilemmas, emotions, feelings, and challenges that may arise in DSD counselling, and to begin to understand the meaning behind these experiences, and how physicians shape their practices based on these experiences. Hermeneutic phenomenology was selected as the most appropriate method of qualitative research as outlined by Max Van Manen. Open ended unstructured interviews were conducted with seven physicians of various specialties in the Calgary Zone of Alberta Health Services who work with patients under the age of eighteen. DSD diagnosis and counselling was revealed to be a distressing clinical encounter for physicians in my study; however, the origin as well as depth to which physicians perceive an impact on their clinical practice is quite variable. Physicians are faced with varying degrees of uncertainty in DSD counselling and all specialties acknowledge its presence. Physicians have uniquely adapted practice styles to minimize the effect of this uncertainty. Physicians involved in the surgical dimension of the DSD counselling experience describe the possible violation of the ethical principle non-maleficence as a source of personal distress. Poor communication, as embodied in the form of mixed diagnostic and management messages between various multidisciplinary health care team members and the parents of DSD infants/children, contributes to physician anxiety. Lastly DSD counselling is made more difficult by the societal and sometimes cultural expectations placed on families. The interpretive description of this inquiry has the promise to help readers gain a greater understanding of the essence of DSD counselling from the perspective of the physician. I hope the rich descriptions provided in the analysis section of this paper will compel each reader of this paper to advocate for DSD patients whether or not they are directly involved in healthcare. Increased exposure and education, framed within a positive perception, is critical to the improvement of the lives of DSD patients throughout the world.