The Nova Scotia Health Authority is a provincial health authority serving Nova Scotia, Canada. It is the largest employer in the province, with more than 23,000 employees, 2,500 physicians and 7,000 volunteers working from 45 different facilities. Its largest hospital is the QEII Health Sciences Centre in Halifax.On September 1st, 2021, the newly elected provincial government undertook wholesale changes in the NS Health Authority. The CEO and volunteer board members were released from their duties. An interim CEO was appointed. Karen Oldfield, newly appointed interim CEO, previously was the senior executive at the Halifax Ports Corporation.
To determine the effect of integrating a web-based tool (The Drug Burden Index (DBI) Calculator©) into hospital pharmacist medication optimization activities on high-risk medication use and explore implementation successes and challenges. The intervention was effective in reducing DBI score and no adverse drug withdrawal events were seen in the intervention group. The DBI Calculator© supported deprescribing efforts although several barriers to implementation remained. This trial shows that a pharmacist-led deprescribing intervention can support deprescribing of high-risk medication in hospital; however, further research is required to support widespread implementation. To determine the effectiveness of integrating a web-based tool into hospital pharmacist medication optimization activities on high-risk medication use and explore implementation. An implementation study with retrospective control group. The intervention consisted of multi-step pharmacist-led medication review using The Drug Burden Index (DBI) Calculator© implemented on four wards. Patients aged ≥ 70 years admitted on one or more medications with anticholinergic or sedative properties were eligible to participate. Primary outcome was change in DBI score and secondary outcomes included safety (adverse drug withdrawal events), feasibility (pharmacist time) and fidelity (whether intervention elements were conducted). Implementation was explored through mixed methods: post-intervention interviews with participants/caregivers, pharmacists and prescribers, and subgroup analyses. Data were analyzed from 148 retrospective control and 40 intervention participants. Participants were median 79 (interquartile range = 12) years old and 61
Purpose To determine the diagnostic performance of the combined use of radiographs and physical exam findings, compared with magnetic resonance arthrography (MRA) alone, for the primary diagnosis of labral tears in individuals with femoroacetabular impingement syndrome.Methods A retrospective comparative case series was performed with data collected between 2012 and 2016. Patients were included if their chart indicated: (1) hip arthroscopy for femoroacetabular impingement syndrome was performed with intra-articular video recording; (2) diagnostic MRA was completed within 18 months prior to surgery and a detailed description of the acetabular labrum status was available in the radiological report; (3) diagnostic radiographs to detect the presence of femoroacetabular impingement syndrome; and (4) physical exam findings were documented for flexion, abduction, external rotation; flexion, adduction, internal rotation; and resisted straight leg raise tests. Exam findings were positive when all three clinical tests initiated a pain response. Intra-articular video recordings were used to confirm the presence of labral tears. The diagnostic performance for each tool (MRA, radiographs, physical exams) was determined by calculating the sensitivity, specificity, positive and negative predictive values, and accuracy. Diagnostic validity was evaluated using receiver operating characteristic curves.Results A total of 224 records (108 males/116 females) were included. The sensitivity and specificity and diagnostic validity for MRA in detecting labral tears were 67%, 83%, and 0.751, respectively, while radiographs combined with physical exams and exam findings alone were 76%, 100%, and 0.879 and 94%, 100%, and 0.879, respectively.Conclusions Physical exams such as the flexion, abduction, external rotation; flexion, adduction, internal rotation; and resisted straight leg raise, when concurrently positive, may be relied upon for labral tear diagnosis due to their higher sensitivity and better diagnostic validity compared with MRA, in patients who are candidates for hip arthroscopy. MRA can be considered a secondary tool when further evaluation for intra- or extra-articular hip pathologies is needed, particularly when surgical intervention may be required.Level of Evidence Level III, retrospective comparative case series.
Caffeine, the most used global stimulant, can impact neurocognition. Hormonal fluctuations occurring across the human menstrual cycle affect similar cognitive domains. Research is needed to identify whether the purported cognitive-enhancing effects of caffeine vary across menstrual cycle phase. The objective of this study was to examine the impact of caffeine on EEG-derived markers of auditory change detection and novelty processing (MMN, P3a, P3b and RON) across phases of the menstrual cycle in naturally cycling females. Participants were randomly assigned to complete the experiment while in their menstrual (n = 31), follicular (n = 26) or luteal (n = 29) phase, completing two sessions wherein they were administered either a caffeine pill (200 mg, oral) or a placebo in a counterbalanced order using a randomized, double-blinded procedure. Auditory tone detection was assessed via a novelty oddball task while EEG data were collected. Caffeine significantly enhanced target detection at both the neural (P3b, MMN and RON) and behavioural levels, with effects most prominent in the menstrual phase. Additionally, P3a and P3b amplitudes differed significantly between phase groups under placebo conditions but not under caffeine conditions. Caffeine significantly enhanced target detection at both the electrophysiological and behavioural levels, with these effects mostly limited to the menstrual phase. Additionally, there were significant differences in ERP activity between all menstrual phases under both placebo and caffeine conditions. Our results suggest that caffeine enhances auditory novelty processing, particularly during the menstrual phase, though future research is needed to further explore the intersection of caffeine and the HMC.
Background: The increasing global prevalence of multimorbidity poses major challenges for primary healthcare systems because its treatment and prevention require coordinated, patient-centered, and interprofessional models of care. In Nova Scotia, Canada, one response has been the implementation of interprofessional team-based primary healthcare. This study evaluated the implementation of multimorbidity care program components in three interprofessional primary healthcare teams. The aim was to describe programs and identify enablers, barriers, and lessons learned to guide future implementation of similar programs in primary healthcare settings. Methods: A qualitative case study design was used, involving in-depth semi-structured interviews and focus groups with 12 team members across two rural and one urban primary healthcare practices in Nova Scotia, Canada. Data were analyzed using the Consolidated Framework for Implementation Research (CFIR) to explore contextual and organizational factors influencing implementation. Thematic analysis identified common enablers, barriers, and recommendations across the CFIR framework’s domains: Innovation, Outer and Inner Settings, Characteristics of Individuals, and Implementation Processes. Results: Implementation was supported by several enablers, including strong leadership engagement, interprofessional collaboration, and effective use of Information Technology systems that enhanced workflow and communication. Providers reported that team-based care improved job satisfaction and enabled patients to receive more coordinated, accessible care. Community partnerships and blended models of virtual and in-person care also facilitated implementation. However, programs faced multiple barriers, including staffing shortages, limited funding for key roles, high costs and complexity of Electronic Medical Records (EMR), and patient discomfort with virtual care. Additional challenges included limited training, competing provider priorities, and difficulties coordinating across multiple sites. Participants recommended expanding training on EMR systems, increasing funding for navigator roles and infrastructure, streamlining technology, and fostering leadership and team engagement. Conclusions: The implementation of multimorbidity care programs in primary healthcare settings is influenced by both systemic and contextual factors. While interprofessional teamwork, leadership support, and community partnerships are essential enablers, sustainable funding, structured training, and user-friendly technology are critical for program scalability and success. These findings offer actionable guidance for policymakers, healthcare leaders, and researchers seeking to strengthen integrated multimorbidity care, enhance provider satisfaction, and improve patient outcomes in primary healthcare.
ABSTRACT:Chronic pain and post-traumatic stress symptoms (PTSS) frequently co-occur. However, how they interact in the brain to influence cognition and emotion is not well understood. In this study, we examined how PTSS affects working memory-related networks during an N-back task. In addition, we examined how these networks interact with subcortical threat regions and influence working memory and pain symptoms. Fifty-three chronic low back pain participants completed the N-back task during fMRI. Brain activation was analyzed in relation to PTSS as both a continuous measure and a high-versus-low group, using whole-brain parcellation across task loads (FDR corrected). We also examined whether abnormally activated regions were functionally connected to periaqueductal gray subregions, the amygdala, or hippocampus, and how these connections related to PTSS. Although higher PTSS did not affect task performance, it was associated with reduced activation in dorsal and inferior lateral frontal regions during the 3-back condition. Post-traumatic stress symptoms were also associated with increased functional connectivity between the dorsolateral prefrontal cortex and periaqueductal gray, but not with the amygdala or hippocampus. Reduced prefrontal activations and high connectivity with periaqueductal gray predicted higher depression and catastrophizing symptoms. Thus, in chronic pain, PTSS selectively disrupts prefrontal circuits, suggesting that higher trauma symptoms interact with prefrontal circuits when cognitive demand is high. Post-traumatic stress symptoms strengthen coupling between prefrontal regions and brainstem threat/pain circuits, suggesting cognitive-affective coupling. These neural alterations occur even when working memory performance is intact and are linked to higher depression and pain catastrophizing. Larger studies are needed to confirm and clarify these mechanisms.
