Gail MacKean - Academia.edu (original) (raw)

Papers by Gail MacKean

The primary care companion for CNS disorders, Nov 5, 2015

Between 30% and 60% of individuals with major depressive disorder will have treatment-resistant d... more Between 30% and 60% of individuals with major depressive disorder will have treatment-resistant depression (TRD): depression that does not subside with pharmaceutical treatment. Repetitive transcranial magnetic stimulation (rTMS) is an emerging treatment for TRD. To establish the efficacy and optimal protocol for rTMS among adults and youth with TRD. Two systematic reviews were conducted: one to determine the efficacy of rTMS for adults with TRD and another to determine the effectiveness of rTMS for youth with TRD. For adults, MEDLINE, Cochrane Central Register of Controlled Trials, PubMed, EMBASE, PsycINFO, Cochrane Database of Systematic Reviews, and Health Technology Assessment Database were searched from inception until January 10, 2014 with no language restrictions. Terms aimed at capturing the target diagnosis, such as depression and depressive disorder, were combined with terms describing the technology, such as transcranial magnetic stimulation and rTMS. Results were limited to studies involving human participants and designed as a randomized controlled trial. For youth, the search was altered to include youth only (aged 13-25 years) and all study designs. When possible, meta-analysis of response and remission rates was conducted. Seventy-three articles were included in this review: 70 on adult and 3 on youth populations. Meta-analysis comparing rTMS and sham in adults found statistically significant results favoring rTMS for response (RR: 2.35 [95% CI, 1.70-3.25]) and remission (RR: 2.24 [95% CI, 1.53-3.27]). No statistically significant differences were found when comparing high- and low-frequency, unilateral and bilateral, low- and high-intensity rTMS or rTMS and electroconvulsive therapy (ECT). While meta-analysis of results from the youth literature was not possible, the limited evidence base suggests that rTMS may be effective for treating TRD in youth. The evidence available on the use of rTMS for adults with TRD indicates that rTMS is approximately twice as effective as a sham procedure, although the optimal rTMS protocol remains unclear. Evidence also indicates that rTMS is as effective as ECT and appears promising as a treatment for youth with TRD; however, the evidence base is underdeveloped.

Research Square (Research Square), Sep 29, 2022

During the pandemic many Canadian hospitals made signi cant changes to their 'open family presenc... more During the pandemic many Canadian hospitals made signi cant changes to their 'open family presence' and 'visitor policies' to reduce the spread of COVID-19 by instituting restrictive or 'zero visiting' policies in healthcare facilities. These policies have the potential to create great hardship, anxiety and stress for patients, families, caregivers and frontline healthcare providers (HCPs); along with concerns about the quality and safety of patient care. The presence of family members and other caregivers as essential partners in care is an explicit expression of the philosophy of patient-and family-centred care (PFCC) in action. The purpose of this study is to increase our understanding of how changes to family presence and visiting policies and practices during the COVID-19 pandemic have impacted patients, family caregivers and frontline healthcare providers (HCPs) in acute care hospitals. Methods A total of 38 in-depth semi-structured interviews were conducted with patients, family caregivers and HCPs across Canada who had experience with visiting policies in acute care settings during the pandemic. COVID patients, and the caregivers of COVID patients, were excluded from this study. A maximum variation sampling strategy was used to guide the selection and recruitment of patients, family caregivers and HCPs, based on our interest in gaining a diversity of perspectives and experiences. Results Many patients, family caregivers, and HCPs view family caregiver presence as integral to PFCC, describing the essential roles played by family caregivers prior to the pandemic. There were commonalities across all three groups with respect to their perspectives on the impacts of restrictive visiting policies on patients, family caregivers and HCPs. They fell into four broad integrated categories: (1) emotional and mental health; (2) communication and advocacy; (3) safety and quality of care; and (4) PFCC, trust in the health care system, and future decisions regarding accessing needed healthcare. Recommendations for pandemic visiting policies were also identi ed. Conclusions The ndings from this study highlighted several impacts of restrictive family caregiver presence or visiting policies implemented during COVID-19 on patients, family caregivers and HCPs in acute healthcare settings across Canada. Participants emphasized that there is no "one-size-ts-all" caregiver presence policy that will address all patient needs. To be consistent with the practice of PFCC, patients function(15). Involving families and other partners in care, who tend to be much more keenly aware of any change in cognitive function than hospital staff, are a valuable resource during hospitalization. Furthermore, family members and caregivers are crucial in aiding patients who have problems communicating for a variety of reasons, such as people with complex health issues, disabilities, and for those who have experienced past trauma from the healthcare system. Study Context This study was conducted in collaboration with Healthcare Excellence Canada (HEC) and the IMAGINE Citizens Network (ICN). HEC is a new organization resulting from the merger of the Canadian Patient Safety Institute (CPSI) and the Canadian Foundation for Healthcare Improvement (CFHI), an independent, not-for-pro t charity, funded by Health Canada. The organization works with diverse partners to shape the future of quality and safety and build a better healthcare system with, and for, everyone in Canada. ICN is an Alberta-based, independent citizen-led organization that brings together a network of people-and community-oriented partners who amplify the voice of Albertans in healthcare system reform and envision a healthcare culture where people and their families come rst. Study Objectives and Research Questions The main objective of this study was to increase our understanding of how changes to family presence and visiting policies and practices during the COVID-19 pandemic have impacted patients, caregivers, and frontline HCPs in acute care hospitals across Canada, where initial rapid changes in visiting policies occurred. The following research questions guided the study: (1) what are the impacts of COVID-19 family presence and visiting policies and practices in acute care hospitals, on patients, family caregivers, and frontline HCPs (e.g., physicians, nurses, social workers)?; and (2) what recommendations do patients, family caregivers and HCPs have regarding acute care family presence and visiting policies? Methods An exploratory, descriptive qualitative study was carried out to obtain 'straight descriptions of a phenomena' and provide a 'comprehensive summary of an event in the everyday terms of those events' (16). This design is appropriate to facilitate an exploration of patient, family caregiver, and HCP experiences with restrictive family presence or visiting policies from their own stories. Data Collection Data was collected from key informant interviews who were identi ed through existing networks of HEC and ICN. We conducted 38 semi-structured one-hour interviews via phone or videoconference with patients, family caregivers, and HCPs across Canada, between September 2020 and January 2021. In total, 8 patients, 18 family caregivers, and 12 HCPs participated. Interview participants were recruited from Alberta (n=15), British Columbia (n=7), Ontario (n=7), New Brunswick (n=6), and Saskatchewan (n=1) (see Tables 1-3 for key informant pro les). A maximum variation sampling strategy(17) was used

BMJ Open, May 1, 2022

Introduction When delivered in person, yoga has been shown to be effective in managing irritable ... more Introduction When delivered in person, yoga has been shown to be effective in managing irritable bowel syndrome (IBS) symptoms. Research is needed to test the feasibility and effectiveness of yoga as a therapeutic option when delivered virtually. The primary aim of the mind and yoga for IBS randomised controlled trial is to determine the effects of an 8-week virtual meditation and yoga intervention on IBS symptom severity compared with an advice-only active control group. Methods and analysis Adults diagnosed with IBS will be randomised to receive either a Upa Yoga intervention or an advice-only control group. The intervention will consist of weekly online classes for 8 weeks delivered by a facilitator using Microsoft Office Teams and daily home practice. Feasibility will be evaluated by examining recruitment and attrition rates, adherence, participant satisfaction with the programme and safety. The primary outcome is IBS symptom severity, and key secondary outcomes include (but not limited to) quality of life, anxiety and depression symptoms, COVID-19-related stress and anxiety, and fatigue. Outcomes will be assessed at baseline, 4 weeks and 8 weeks. An embedded design experimental model substudy will be conducted post intervention using qualitative research methods to identify participants' experiences in the yoga programme. Ethics and dissemination This study has been approved by the Conjoint Health Research Ethics Board (REB ID 20-0084). Findings will be disseminated through peerreviewed publication, conference presentation and social media. Trial registration number NCT04302623.

Journal of the Canadian Association of Gastroenterology, May 5, 2022

Both authors serve as senior responsible investigators for this study.

BMC Health Services Research, Mar 31, 2023

Introduction During the pandemic many Canadian hospitals made significant changes to their 'open ... more Introduction During the pandemic many Canadian hospitals made significant changes to their 'open family presence' and 'visitor policies' to reduce the spread of COVID-19 by instituting restrictive or 'zero visiting' policies in healthcare facilities. These policies have the potential to create great hardship, anxiety and stress for patients, families, caregivers and frontline healthcare providers (HCPs); along with concerns about the quality and safety of patient care. The presence of family members and other caregivers as essential partners in care is an explicit expression of the philosophy of patient-and family-centred care (PFCC) in action. The purpose of this study is to increase our understanding of how changes to family presence and visiting policies and practices during the COVID-19 pandemic have impacted patients, family caregivers and frontline healthcare providers (HCPs) in acute care hospitals. Methods A total of 38 in-depth semi-structured interviews were conducted with patients, family caregivers and HCPs in Canadian provinces who had experience with visiting policies in acute care settings during the pandemic. COVID patients, and the caregivers of COVID patients, were excluded from this study. A maximum variation sampling strategy was used to guide the selection and recruitment of patients, family caregivers and HCPs, based on our interest in gaining a diversity of perspectives and experiences. Results Many patients, family caregivers, and HCPs view family caregiver presence as integral to PFCC, describing the essential roles played by family caregivers prior to the pandemic. There were commonalities across all three groups with respect to their perspectives on the impacts of restrictive visiting policies on patients, family caregivers and HCPs. They fell into four broad integrated categories: (1) emotional and mental health; (2) communication and advocacy; (3) safety and quality of care; and (4) PFCC, trust in the healthcare system, and future decisions regarding accessing needed healthcare. Recommendations for pandemic visiting policies were also identified. Conclusions The findings from this study highlighted several impacts of restrictive family caregiver presence or visiting policies implemented during COVID-19 on patients, family caregivers and HCPs in acute healthcare settings across Canada. Participants emphasized that there is no "one-size-fits-all" caregiver presence policy that will address all patient needs. To be consistent with the practice of PFCC, patients and family caregivers are welcomed as part of the healthcare team in ways that work for them, demonstrating that flexibility in family presence and visiting policies is essential.

searchca.net

... Sonja Morrison, RN, MN, AHS,. Saqib Shahab, MBBS, Community Medicine Program, UofA. SEARCH Ad... more ... Sonja Morrison, RN, MN, AHS,. Saqib Shahab, MBBS, Community Medicine Program, UofA. SEARCH Advisors. ... The knowledge gained in these situations is likely only transferred during informal sharing on a local level. (E. Wenger). Thus there are missed opportunities. ...

International Journal of Integrated Care

Background: Health technology reassessment (HTR) is “a structured, evidence-based assessment of t... more Background: Health technology reassessment (HTR) is “a structured, evidence-based assessment of the clinical, social, ethical, and economic effects of a technology currently used in the healthcare system, to inform optimal use of that technology in comparison to its alternatives. ” The purpose of this study is to describe the key themes in the context of current HTR activities and propose a way forward for this newly emerging field.

The Journal of Spinal Cord Medicine, 2021

Context/objective: Spinal cord injury (SCI) is intensely life altering, affecting multiple body s... more Context/objective: Spinal cord injury (SCI) is intensely life altering, affecting multiple body systems and functions, including the ability to walk. Exoskeleton assisted walking (EAW) is a rehabilitation tool that aims to support locomotor training, yet little is known about the patient experience. The purpose of this qualitative study, part of a prospective observational case series, was to increase our understanding of SCI patient experience using a robotic exoskeleton in this acute post-injury period. Design: A qualitative descriptive approach was implemented in this study, with the aim to explore and understand participants' experience with EAW training. Participants/setting: Nine of the 11 participants enrolled in the observational study agreed to participate in an interview. All participants had suffered a SCI, and had received their trauma care and inpatient rehabilitation at a tertiary center in Calgary, Alberta, Canada. Results: The benefits to EAW use described by participants were primarily psychological and included the joy of eye level contact, excitement at being able to walk with assistance, improvement in mood, and hope for the future. Potential physiological benefits include increased strength, decreased spasticity and reduced pain. Challenges to EAW use include weakness and fatigue, and a fear of incontinence. Conclusion: Qualitative research will continue to be an important component in future research on the use of EAW training as part of the rehabilitation process. Increasing understanding of the participants experience with this novel therapeutic modality and technology will be fundamental to improve its implementation in clinical practice.

Introduction: During the pandemic many Canadian hospitals made significant changes to their ‘open... more Introduction: During the pandemic many Canadian hospitals made significant changes to their ‘open family presence’ and ‘visitor policies’ to reduce the spread of COVID-19 by instituting restrictive or ‘zero visiting’ policies in healthcare facilities. These policies have the potential to create great hardship, anxiety and stress for patients, families, caregivers and frontline healthcare providers (HCPs); along with concerns about the quality and safety of patient care. The presence of family members and other caregivers as essential partners in care is an explicit expression of the philosophy of patient- and family-centred care (PFCC) in action. The purpose of this study is to increase our understanding of how changes to family presence and visiting policies and practices during the COVID-19 pandemic have impacted patients, family caregivers and frontline healthcare providers (HCPs) in acute care hospitals. Methods A total of 38 in-depth semi-structured interviews were conducted wi...

Inclusion of patient insights in 30 CADTH CDR assessments. (DOCX 15Â kb)

Pediatrics, 2012

Drawing on several decades of work with families, pediatricians, other health care professionals,... more Drawing on several decades of work with families, pediatricians, other health care professionals, and policy makers, the American Academy of Pediatrics provides a definition of patient- and family-centered care. In pediatrics, patient- and family-centered care is based on the understanding that the family is the child’s primary source of strength and support. Further, this approach to care recognizes that the perspectives and information provided by families, children, and young adults are essential components of high-quality clinical decision-making, and that patients and family are integral partners with the health care team. This policy statement outlines the core principles of patient- and family-centered care, summarizes some of the recent literature linking patient- and family-centered care to improved health outcomes, and lists various other benefits to be expected when engaging in patient- and family-centered pediatric practice. The statement concludes with specific recommen...

Musculoskeletal Care

BACKGROUND Osteoarthritis management aims to reduce pain and improve function. Many factors affec... more BACKGROUND Osteoarthritis management aims to reduce pain and improve function. Many factors affect whether patients follow recommended strategies. Locus of control refers to individual beliefs around who and what influences health. Locus of control is related to the treatment strategies patients prefer. Currently, no studies explore locus of control in non-surgical management of osteoarthritis. OBJECTIVES To explore patients' beliefs about the influences on their osteoarthritis symptoms and disease progression. METHODS Semi-structured interviews were conducted with individuals experiencing self-reported hip and/or knee osteoarthritis who had at least one joint that had not undergone replacement surgery. We used a qualitative description approach and the Braun and Clarke method for thematic analysis. Participants' locus of control classifications-internal, chance, doctors, or other people-were based on the Multidimensional Health Locus of Control (MHLC) Scales Form C score. RESULTS Locus of control was discussed in relation to aetiology, progression, and symptoms. Participants' opinions varied on whether their osteoarthritis progression could be influenced. 46% of participants attributed control to other people. Most participants believed that a previous injury had caused their osteoarthritis and that both themselves and others had some influence over their osteoarthritis symptoms, regardless of their locus of control classification. CONCLUSION This research highlights the need for education about: the aetiology of osteoarthritis, the link between management and progression, and patient management of osteoarthritis. Further research is required to discern why expected patterns were not observed between participants' beliefs and locus of control classifications.