New Grant-Winners Seek to Improve Care and Services

September 28, 2017

Congratulations to Island Health's latest research grant-winners and their teams!

Each has been awarded $20-$40,000 dollars to pursue their projects. Island Health's research grant program aims to encourage new researchers, support local research collaborations, and raise awareness about research and knowledge translation to improve care and outcomes in the communities we serve.

Dr. Rosanne Beuthin (Consultant, Medical Assistance in Dying, Island Health) with Anne Bruce (UVic Nursing), “Physicians’ Experience with Medical Assistance in Dying”

Summary: In Island Health, MAiD is carried out approximately twice a week. While physicians can decline to participate in MAiD, they do have an obligation to provide patients with all available information and options, and the decision is complex. This study aims to examine how physicians are participating in assisted dying (or not), how they are affected, how they perceive their role, and what gaps in knowledge or skill exist. The results will provide direction for physicians and ensure a smooth transition for everyone engaging with MAiD in the midst of this unprecedented change.

Dr. Jonathan Down (Developmental Pediatrician, Island Health) with Lenora Marcellus (UVic Nursing), “Does receiving a diagnosis of FASD improve quality of life for women who are pregnant or new parents?”

Summary: Fetal Alcohol Spectrum Disorder (FASD) is a range of disabilities that result from alcohol exposure during pregnancy. Usually FASD is diagnosed during childhood and additional supports and services are provided. However, many adults have not been diagnosed, and adults with FASD can have challenges with work, friendships and independence. Adults with other cognitive conditions such as autism or ADHD say that receiving a later diagnosis has helped them, but little is known about whether it would be helpful or harmful for pregnant women or new mothers to be diagnosed with FASD. This study team will talk to 10 women before and after they have received a diagnosis of FASD to see if it had a positive or negative impact on them and their children. They will also study whether there are any changes in their quality of life, their feelings about themselves or their relationships with their children, and if they were able to access more services. The results will improve support programs and quality of life for women with FASD.

Dr. Nichole Fairbrother (Psychiatry; Island Medical Program), “New mothers' thoughts of harm: Prevalence and relation to OCD and child harm”

Summary: Almost half of new mothers experience unwanted, intrusive thoughts of intentionally harming their infant, which can be upsetting and frightening to both mothers and maternity care providers. On the one hand, these thoughts may mean that the mother is at risk of harming her infant; on the other hand, they are very similar to thoughts seen in obsessive compulsive disorder (OCD; a mental health condition), which is not associated with any increased risk of violence. In order to protect both women and their infants, it is important to respond accurately to these thoughts. The research team has recently completed data collection for a large study of new mothers’ thoughts of infant-related harm. The team will use the current funding to increase the number of participants in the study to assess the relationship between aggressive parenting and new mothers’ unwanted, intrusive thoughts of intentional harm towards the newborn. The results will form the basis for prenatal education about postpartum thoughts of infant-related harm.

Dr. Nichole Fairbrother with Dr. Patricia Janssen (UBC) “Online cognitive behaviour therapy for postpartum obsessive compulsive disorder”

Summary: Women are at higher risk of developing obsessive compulsive disorder (OCD) following the birth of a child. Postpartum OCD can be very distressing, and can make it difficult for new mothers to live their life normally. Cognitive behaviour therapy (CBT)--a type of talk therapy--is very effective for OCD and for postpartum OCD, but its effectiveness has only been confirmed for face-to-face therapy. However, face-to-face therapy is very expensive, and often not available. Another option is internet-delivered CBT, where therapists interact with patients through email. This is much less expensive and can be provided to people living in rural and remote settings. It has been found to be effective for some conditions, but internet-delivered CBT has not yet been tested for postpartum OCD. The research team will use this funding to prepare an application to the Canadian Institutes of Health Research so they can test the effectiveness of internet-delivered CBT, with email support from therapists. This will be the first time that this type of CBT has been tested as a treatment for postpartum OCD. If successful, internet-based CBT for postpartum OCD will be made available across British Columbia.

Dr. Dee Hoyano (Medical Health Officer, Island Health) with Nathan Lachowsky (UVic School of Public Health and Social Policy), “Improving HIV and STI Prevention and Health Services for Gay and Bisexual Men within Island Health”

Summary: In 2014, the BC Provincial Health Officer released a report recommending a renewal of HIV prevention efforts for gay, bisexual and other men who have sex with men, given the persistence of the epidemic. In response, Island Health commissioned a review of services that revealed a lack of data in this area. Using a community-based participatory approach, this research team will collect preliminary data for a grant application to the Canadian Institutes of Health Research and/or the Canadian Foundation for AIDS Research. The team's objectives are: to evaluate the awareness, acceptability and uptake of existing health promotion (e.g. recent HIV testing campaign), prevention options (e.g. antiretroviral-based prevention), and health services (e.g. GetCheckedOnline); and to explore reasons for poor engagement in prevention and health services.

Sue Kurucz (Manager, Integrated Community Services, Island Health) with Andre Smith (UVic Sociology), “Optimizing antipsychotic use in residential care: The role of organizational readiness for change”

Summary: In residential care, older adults who exhibit challenging symptoms of dementia can threaten the safety of other residents and increase rates of staff injury and burden. Antipsychotic drugs are often used to manage these symptoms despite evidence of adverse events and higher morbidity and mortality. Some residential care facilities have achieved remarkable lowering of use whereas others continue to rely on these drugs. This study will compare two facilities in Victoria that implemented interventions to reduce drug-use with different levels of success. Through interviews with nurses, licensed practical nurses, residential care aides and family caregivers, the research team will identify ways for participants to question or reduce antipsychotic drug prescriptions, and for alternate approaches to be considered; and for the input of family members to be included in care-planning. The results will enable health care providers to improve the management of challenging symptoms in residents with dementia, and to reduce antipsychotic drug use.

Dr. Christine Lee (Medical Microbiologist and Researcher, Island Health) with Caylee Raber (Emily Carr Health Design Lab), “Optimizing microbiology test utilization and development of microbiology laboratory stewardship program"

Summary: Laboratory tests are essential components of patient care, and test results have a direct impact on patient management and outcomes; an estimated 60–70% of all medical decisions are based on lab test results. However, studies have shown that 25–50% of laboratory tests ordered are inappropriate. In addition to being wasteful, the costs of laboratory results are significant, because abnormal results (whether truly positive or falsely abnormal) lead to further investigations and prolonged hospital admission. For example, urine cultures are often ordered when an elderly patient arrives in the hospital or has non-specific symptoms. However, many older adults harbor bacteria in their urine without causing any symptoms of underlying urinary tract infections. A lab result that identified these bacteria might prompt physicians to start antibiotic therapy, but there is no benefit to treating people without urinary tract infections, and in fact it can be harmful. The goal of this study is to identify problems and collaborate with direct healthcare staff to find workable and sustainable solutions to improve the ordering, collection, and use of lab samples.

Dr. Alison Walzak (Physician, Internal Medicine, Island Health) with Olav Krigolson (UVic School of Exercise Science, Physical & Health Education) and Bruce Wright, “Electroencephalographic Assessment of Clinician Fatigue”

Summary: Clinician fatigue has been called the “Achilles Heel” of the medical profession. Currently, the only way to assess fatigue is through self-reporting, which relies on doctors to admit when they are fatigued and relieve themselves of duty. This research team aims to extend a pilot project, which demonstrated that portable electroencephalography (EEG or “brain-wave”) technology could successfully predict fatigue in medical students during a simulated night shift. The team intends to use the same portable EEG technology to detect when doctors and nurses are fatigued, and therefore more prone to making clinical errors. The results could ultimately improve patient safety and efficiency by finding a more accurate way to diagnose clinician fatigue.