Examining the gaps in perinatal mental health care: A qualitative study of the perceptions of perinatal service providers in Canada.

In Canada, access to perinatal mental health services is disparate across districts, regions, provinces, and territories. Questions remain as to how gaps in service are being experienced by Canadian service providers and clinicians. This paper examines three key questions: 1) What are the experiences of care providers with respect to the screening, identifying, and managing perinatal mental health disorders? 2) What gaps in perinatal mental health care have been identified? and 3) What approaches have been taken by providers, communities, and regions in addressing the needs of their populations? To address these questions, 435 participants from across Canada were surveyed using an online survey constructed by the research members of the CPMHC. A qualitative analysis of the data revealed three key themes: groups marginalized by the current perinatal mental health system, gaps and supports identified by communities; and systemic and policy issues. From these three themes we have identified the key components of changes required in the national approach to perinatal mental health disorders. We identify key resources that could be utilized to create policy change and provide recommendations for change.

Usability and Satisfaction Outcomes from a Pilot Open Trial Examining Remote Patient Monitoring to Treat Pediatric Obesity during the COVID-19 Pandemic.

BACKGROUND: Pediatric obesity is common and a significant burden. Supplementing pediatric obesity treatment with technology is needed. This manuscript examines the usability and satisfaction, as well as explores initial effectiveness, of a remote patient monitoring system (RPMS) designed for youth presenting for pediatric weight management treatment. METHODS: 47 youth, 10 to 17 years old, with obesity and a caregiver participated. For three months, families received treatment via the RPMS. Usability and satisfaction outcomes were examined. Exploratory analyses were conducted to examine initial effectiveness from baseline and post-treatment (month 3) assessments. RESULTS: More than 80% of patients used the RPMS, and overall, patients completed 27 out of 90 daily sessions (30%). Youth and caregivers reported high satisfaction. Non-parametric tests revealed no significant improvements for youth or caregiver weight status after the RPMS treatment. Significant improvements in other outcomes examined were limited. CONCLUSIONS: Families were satisfied with the RPMS, but use of the system was limited. Initial effectiveness was not able to be determined due to the amount of missing data, which was impacted by the COVID-19 pandemic. Modifications of the RPMS and future evaluation of usability and effectiveness are warranted to determine utility in supplementing pediatric obesity clinical treatment.

Design, Implementation, and Examination of a Remote Patient Monitoring System for Pediatric Obesity: Protocol for an Open Trial Pilot Study.

BACKGROUND: Pediatric obesity is a critical public health issue. Augmenting care in multidisciplinary pediatric obesity clinics with innovative evidence-based technology to improve weight status and health outcomes is needed. OBJECTIVE: This study describes the design and methods of an open trial pilot study to examine a remote patient monitoring system (RPMS) for children aged 8-17 years who are receiving treatment in a multidisciplinary pediatric obesity clinic. METHODS: Participants will include 45 youth with obesity and their parents. Families will receive standard care in the clinic and the RPMS for 3 months. The RPMS consists of a tablet, weight scale, and pedometer. The system provides daily educational content and involves the use of the pedometer and weekly weigh-ins. Children and parents will complete baseline, posttreatment (month 3), and follow-up assessments (month 6). The primary aim of the study is to examine feasibility and satisfaction with the RPMS and assess its initial effectiveness. RESULTS: We hypothesize high feasibility and satisfaction, with rates over 75%. Furthermore, after RPMS treatment, children will exhibit improved weight status, health outcomes, dietary intake, physical activity, health-related quality of life, self-efficacy, and home-food environment compared to before treatment. These gains are expected to persist at follow-up. CONCLUSIONS: This study is novel in that it is the first to design, implement, and examine an RPMS in a pediatric obesity clinic. If the RPMS is feasible, effective, and easily accessible, it may prove to be a practical, acceptable, and cost-effective weight management treatment for youth seeking treatment for severe obesity. TRIAL REGISTRATION: ClinicalTrials.gov NCT04029597; https://clinicaltrials.gov/ct2/show/NCT04029597. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/29858.

Substituent effects on Ni-S bond dissociation energies and kinetic stability of nickel arylthiolate complexes supported by a bis(phosphinite)-based pincer ligand.

Pincer complexes of the type [2,6-(R(2)PO)(2)C(6)H(3)]NiSC(6)H(4)Z (R = Ph and i-Pr; Z = p-OCH(3), p-CH(3), H, p-Cl, and p-CF(3)) have been synthesized from [2,6-(R(2)PO)(2)C(6)H(3)]NiCl and sodium arylthiolate. X-ray structure determinations of these thiolate complexes have shown a somewhat constant Ni-S bond length (approx. 2.20 Å) but an almost unpredictable orientation of the thiolate ligand. Equilibrium constants for various thiolate exchange (between a nickel thiolate complex and a free thiol, or between two different nickel thiolate complexes) reactions have been measured. Evidently, the thiolate ligand with an electron-withdrawing substituent prefers to bond with "[2,6-(Ph(2)PO)(2)C(6)H(3)]Ni" rather than "[2,6-(i-Pr(2)PO)(2)C(6)H(3)]Ni", and bonds least favourably with hydrogen. The reactions of the thiolate complexes with halogenated compounds such as PhCH(2)Br, CH(3)I, CCl(4), and Ph(3)CCl have been examined and several mechanistic pathways have been explored.

Accuracy of reporting current medications by cancer patients presenting to an emergency center.

BACKGROUND: Due to high coexistence of comorbidity, cancer patients take many medications and are susceptible to negative consequences of polypharmacy. To avoid adverse events during care transitions, patients need to correctly communicate their medications. The emergency center (EC) presents opportunities to assess patients' knowledge of medications and reconcile medication profiles. OBJECTIVE: The purpose was to evaluate the medication knowledge of cancer patients presenting to the EC and to identify factors associated with higher knowledge. DESIGN AND MEASUREMENTS: For the cross-sectional self-administered survey, 254 patients were enrolled and gave name, dose, frequency, route, and indication for medications. Responses were checked for accuracy against outpatient pharmacy dispensing records within or outside M. D. Anderson Cancer Center. Demographic data was obtained from medical records. For each patient, we calculated a patient medication knowledge (PMK-overall) score indicating percentage of correct responses. RESULTS: Median PMK-overall score was 80%. Patients who used a medication aid to fill out the survey were 6.5 times more likely to have a high level of medication knowledge, or PMK-overall score > or = 80%. Predictors of using a medication aid included lower education level, solid tumor, more than five medications, married, and using a medication list at home. CONCLUSIONS: Though our findings may not be generalizable to settings outside the EC, we found cancer patients to have high levels of medication knowledge. Future studies should validate the use of PMK scores to predict medication adherence and other outcomes. Patients should be encouraged to use a medication aid when presenting information to the health care system.

Recalling taboo and nontaboo words.

People remember emotional and taboo words better than neutral words. It is well known that words that are processed at a deep (i.e., semantic) level are recalled better than words processed at a shallow (i.e., purely visual) level. To determine how depth of processing influences recall of emotional and taboo words, a levels of processing paradigm was used. Whether this effect holds for emotional and taboo words has not been previously investigated. Two experiments demonstrated that taboo and emotional words benefit less from deep processing than do neutral words. This is consistent with the proposal that memories for taboo and emotional words are a function of the arousal level they evoke, even under shallow encoding conditions. Recall was higher for taboo words, even when taboo words were cued to be recalled after neutral and emotional words. The superiority of taboo word recall is consistent with cognitive neuroscience and brain imaging research.

Economic evaluation in critical care: a focus on severe sepsis in oncology.

Hospital care, physician and clinical services, and prescription drugs continue to drive healthcare expenditures across healthcare systems and nations. The critical-care setting, owing to the complexity and intensity of care, is a high user of the resources that drive healthcare spending. Information regarding the cost and effectiveness of critical-care therapies is necessary to properly guide care and policies for this unique population. Many challenges exist for conducting and comparing economic evaluation in critical care. Recently, recommendations on cost and cost-effectiveness analysis in critical care have been developed that will guide future research. A focus area, severe sepsis in oncology, is reviewed to highlight the challenges and opportunities of economic evaluation in this setting.

Pharmacoeconomics in oncology.

Healthcare costs in the USA continue to rise faster than the consumer price index. Nothing demonstrates this more vividly than the double-digit increases posted for the cost of the drug treatment of the oncology patient. A factor that will compound this cost is the expansion in the oncology patient population that will occur as the population ages. Pharmacoeconomics is a discipline that evaluates the relationship between clinical, economic and humanistic outcomes to determine the products and services that maximize the value for each dollar spent. Research in this area is evolving to meet the needs of the individual patient and decision-makers within a payer group, healthcare system, or society. Healthcare interests in countries in Europe, Canada and Australia have already adopted analytical tools and incorporated them into guidelines for drug use. The USA is also moving in this direction now that the Food and Drug Administration is considering requiring studies in pharmacoeconomics in addition to the standard studies of the safety and efficacy of drugs. The importance of this approach to oncology will be seen as policy-makers apply research findings to practice decisions.