Engaging Women With Lived Experience: A Novel Cross-Canada Approach.

Women with heart disease, stroke, and vascular cognitive impairment (VCI) experience gender inequities across the health care continuum. The Heart and Stroke Foundation of Canada conducted needs assessment to inform its approach in addressing health inequities experienced by women with heart disease, stroke, and VCI across the continuum of care. Although specific input is confidential, this article outlines the engagement methods used and the evaluation results. The 3-stage engagement process consisted of an internal content review, 18 in-person discussion groups via a cross-Canada tour, 14 expert interviews, and a collaboration session. In total, 204 and 57 participants were recruited for the cross-Canada tour and collaboration session, respectively. Using the Public and Patient Engagement Evaluation Tool, participants scored the engagement processes positively and found participation to be a valuable use of their time. This undertaking highlighted aspects to consider when engaging people with lived experience and how engagement can support the recovery journey. Insights presented throughout this article can help inform future research that seeks to engage stakeholders at a national level.

People With Lived Experience at the Centre of Canadian Stroke Best Practice Recommendations: A Model for Guideline Developers.

Actively engaging people with lived experience (PWLE) in stroke-related clinical practice guideline development has not been effectively implemented. This pilot project evaluated the feasibility, perceived value, and effectiveness of the Community Consultation and Review Panel (CCRP), a new model to engage PWLE in the writing and review of Canadian Stroke Best Practice Recommendations. Responses to a standardized evaluation tool indicated that participants perceived the CCRP as valued, impactful, effective, and beneficial to stroke care. This project successfully demonstrated that values, experiences, and recommendations of PWLE can be effectively incorporated into guideline content and is applicable to all guideline development processes.

Using Mobile-Health to Connect Women with Cardiovascular Disease and Improve Self-Management.

Background/Introduction: Self-management approaches are regarded as appropriate methods to support patients with cardiovascular disease (CVD) and to prevent secondary complications and hospitalizations. Key to successful self-management is the ability of individuals to enlist peer supports to help sustain motivation and efforts to manage their condition. The purpose of this study was to investigate the proof of concept of a peer-support mobile-health (m-health) program, called Healing Circles, and explore the program's effect on self-management, social support, and health-related quality of life in women with CVD. MATERIALS AND METHODS: Healing Circles is a consumer m-health solution developed to facilitate peer support and self-management by connecting people with CVD in groups of five to nine people. Women with CVD (obstructive coronary artery disease) were included in this single group, pre/post study if they owned an iPhone/iPad with at least iOS 7.0. Participants (n = 21) used the Healing Circles program for a 10-week period. Self-management, social support, and health-related quality-of-life outcomes were assessed before and after the use of the program. User experiences and satisfaction were obtained during an exit interview. RESULTS: After 10 weeks of using the Healing Circles program, statistically significant improvements were observed in the participants' health behaviors (p = 0.04), self-monitoring (p = 0.04), social support (p = 0.01), and social integration (p = 0.002). As well, many women had a level of high satisfaction with the concept of using m-health for the delivery of peer support. CONCLUSION: The delivery of peer and self-management support using m-health technologies is well received and may improve self-management and social support. More research is needed to test hypotheses of the effect of the Healing Circles program on clinical outcomes.

A unique carrier for delivery of therapeutic compounds beyond the blood-brain barrier.

BACKGROUND: Therapeutic intervention in many neurological diseases is thwarted by the physical obstacle formed by the blood-brain barrier (BBB) that excludes most drugs from entering the brain from the blood. Thus, identifying efficacious modes of drug delivery to the brain remains a "holy grail" in molecular medicine and nanobiotechnology. Brain capillaries, that comprise the BBB, possess an endogenous receptor that ferries an iron-transport protein, termed p97 (melanotransferrin), across the BBB. Here, we explored the hypothesis that therapeutic drugs "piggybacked" as conjugates of p97 can be shuttled across the BBB for treatment of otherwise inoperable brain tumors. APPROACH: Human p97 was covalently linked with the chemotherapeutic agents paclitaxel (PTAX) or adriamycin (ADR) and following intravenous injection, measured their penetration into brain tissue and other organs using radiolabeled and fluorescent derivatives of the drugs. In order to establish efficacy of the conjugates, we used nude mouse models to assess p97-drug conjugate activity towards glioma and mammary tumors growing subcutaneously compared to those growing intracranially. PRINCIPAL FINDINGS: Bolus-injected p97-drug conjugates and unconjugated p97 traversed brain capillary endothelium within a few minutes and accumulated to 1-2% of the injected by 24 hours. Brain delivery with p97-drug conjugates was quantitatively 10 fold higher than with free drug controls. Furthermore, both free-ADR and p97-ADR conjugates equally inhibited the subcutaneous growth of gliomas growing outside the brain. Evocatively, only p97-ADR conjugates significantly prolonged the survival of animals bearing intracranial gliomas or mammary tumors when compared to similar cumulated doses of free-ADR. SIGNIFICANCE: This study provides the initial proof of concept for p97 as a carrier capable of shuttling therapeutic levels of drugs from the blood to the brain for the treatment of neurological disorders, including classes of resident and metastatic brain tumors. It may be prudent, therefore, to consider implementation of this novel delivery platform in various clinical settings for therapeutic intervention in acute and chronic neurological diseases.