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European Journal of Psychotraumatology ; 13(2), 2022.
Article in English | Web of Science | ID: covidwho-2134531


Background: Suicide is a leading cause of death, and rates of attempted suicide have increased during the COVID-19 pandemic. The under-diagnosed psychiatric phenotype of dissociation is associated with elevated suicidal self-injury;however, it has largely been left out of attempts to predict and prevent suicide. Objective: We designed an artificial intelligence approach to identify dissociative patients and predict prior suicide attempts in an unbiased, data-driven manner. Method: Participants were 30 controls and 93 treatment-seeking female patients with posttraumatic stress disorder (PTSD) and various levels of dissociation, including some with the PTSD dissociative subtype and some with dissociative identity disorder (DID). Results: Unsupervised learning models identified patients along a spectrum of dissociation. Moreover, supervised learning models accurately predicted prior suicide attempts with an score up to 0.83. DID had the highest risk of prior suicide attempts, and distinct subtypes of dissociation predicted suicide attempts in PTSD and DID. Conclusions: These findings expand our understanding of the dissociative phenotype and underscore the urgent need to assess for dissociation to identify individuals at high-risk of suicidal self-injury.

Radiotherapy and Oncology ; 163:S50, 2021.
Article in English | EMBASE | ID: covidwho-1747458


Purpose: The six radiation therapy (RT) centres in Atlantic Canada (AC) are equipped with modern technology capable of stereotactic, hypofractionated radiation techniques (SRS, SRT, SABR). However, these techniques remain significantly underutilized. A grant-funded, collaborative, regional quality improvement project was designed to support the implementation of precision RT techniques through inter-professional learning. The objective of this report is to describe the program design and early deliverables. Materials and Methods: A team from the AC Cancer Centres and Princess Margaret Cancer Centre was convened. A needs survey of AC RT centres conducted in 2019 and updated in 2020 guided program development. Adapting to COVID-19 pandemic restrictions, a virtual CME program delivered in four phases over four months was planned. The program includes expertled presentations and discussions, sharing of knowledge and protocols, and the development of centre-specific teams, goals, and implementation plans. A coordinated formative evaluation, using a realist evaluation approach, was designed to monitor implementation and address centre-specific and region-wide challenges to achieve accelerated implementation of precision RT techniques. Quantitative and qualitative methods will utilize the following data to be collected: use of the implementation strategies;timelines and local adoption of stereotactic RT techniques;specialists' knowledge and comfort level;specialists' satisfaction and experiences with the education received;and specialists' and decision-makers' perspectives on implementation processes, barriers, and facilitators. Results: Phase I and II consisted of two half-day virtual meetings. One hundred twenty-six participants including radiation therapists (40), radiation oncologists (27), medical physicists (19), planners (15), trainees (10), administrators (six), nurses (four), and others (five) from all six AC RT centres. Centres with developed protocols for stereotactic RT techniques provided expert content. Virtual break-out rooms grouped centre-specific inter-disciplinary teams who determined customized goals and commenced the development of implementation plans with leadership approval. Follow-up meetings will be conducted at two and four months. Grant funding was used to support meeting organization, RTT participation, online communication platforms, and a project coordinator. The evaluation is ongoing. Conclusions: With a collaborative expert-guided approach, evidence-based advancements in RT delivery can be accomplished in an accelerated manner on an AC regional basis despite variations in centre size and mandates. Evaluation of this process will inform on enablers to accelerate technology and improvements in the care of patients undergoing RT.