Bloomberg Researchers Advancing Science & Delivering Solutions with support of CIHR

19 June 2017

Bloomberg Nursing researchers help inform policy, improve quality of life, prevent disease and shape the landscape of the health care system on a local and global scale. Some of our outstanding researchers were recently awarded funding by the Canadian Institute of Health Research (CIHR) to support their important research.

Dr. Kristin Cleverley

Ranked number 1 by the Canadian Institutes of Health Research (CIHR) SPOR (Supporting Patient Oriented Research – Collaboration Grants) review panel, Bloomberg Nursing Assistant Professor Dr. Kristin Cleverley will engage youth and caregivers as experts in a Delphi study to come to consensus on process and outcomes indicators that can be used to improve the quality of transitions between child and adult mental health services. Dr. Cleverley is a Clinician-Scientist in the Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health and Professional Practice at the Centre for Addiction and Mental Health (CAMH) and the CAMH Chair in Mental Health Nursing Research at the University of Toronto.

Although the transition between health services is widely recognized as a problematic health systems hurdle, the factors necessary for successful transition from child to adult mental health services are poorly understood. Understanding the process and outcome indicators of child to adult mental health care transitions can be used to guide the development and evaluation of interventions to improve these difficult transitions.

This patient-oriented research project is a response to the call for system improvement. Given their experiences in navigating the mental health care system, youth and their caregivers are in the best position to identify key processes that facilitate continuity in care between child and adult mental health services. Study findings will be implemented into child mental health services to facilitate the transition from CAMHS-AMHS, improve patients’ experience of the mental health care system, and inform future intervention development and implementation research.

Prioritizing Youth and Caregivers as Experts of Mental Health Care Transitions: A National Delphi Study is in partnership with The Centre for Addition and Mental Health, The Hospital for Sick Children, East Metro Youth Services, the National Youth Advisory Council (NYAC) and the Sashbear Foundation.

In addition, Dr. Cleverley has been awarded a project grant from the Canadian Institute of Health Research for her Longitudinal Youth in Transition Study. This significant grant aims to improve the outcomes of transitional aged youth with mental health concerns by providing front-line clinicians and decision-makers with evidence of factors that facilitate or impede mental health care transitions and on the effect of transitioning on youth and their families.

This will be accomplished by completing a 3-year longitudinal cohort study to examine continuity of care, psychiatric symptoms, functioning, and service-use of youth aged 16-18 with mental illness as they transition out of child mental health services at age 18. Participants will be recruited from child and youth mental health programs at the Centre for Addiction and Mental Health, The Hospital for Sick Children and 2 community mental health sites. Youth and their caregivers will inform the study design and knowledge translation methods.

The results of this research study will have important implications for youth, families and clinicians regarding identifying enablers and barriers to optimal transitions and supporting the development and evaluation of clinical interventions to enhance continuity of care.

Dr. Cleverley is a Clinician-Scientist in the Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health at the Centre for Addiction and Mental Health (CAMH) and the CAMH Chair in Mental Health Nursing Research at the Lawrence Bloomberg Faculty of Nursing at the University of Toronto.

Dr. Louise Rose

Dr. Louise Rose has been awarded funding by CIHR for the study Core Outcome Set Development for Effectiveness Trials of Interventions to Prevent or Treat Delirium. Dr. Rose and co-investigators will conduct a Delphi study to seek opinion from patients/family with experience of delirium, clinicians, and researchers and aims to inform future studies on the prevention and treatment of delirium.

Delirium is a condition also known as acute confusional state. Patients have altered consciousness level, sleep disturbance, memory problems, and are unable to focus attention or concentrate. Delirium is common, serious, and potentially preventable. Delirium impacts nearly all patients from the critically ill to elderly living at home. Delirium can result in death, complications, prolonged hospital stay, and loss of independence resulting in long-term care placement.

At present, there is no consistency in outcomes studied by researchers for methods to prevent or treat delirium. This research aims to develop a core outcome set (COS) for studies of methods to prevent or treat delirium for critically ill and hospitalized patients, those requiring palliative care, and older adults at risk of delirium.

Dr. Louise Rose & Dr. Craig Dale

Led by Sunnybrook Hospital’s Dr. Brian Cuthbertson, the SuDDICU study – A study of the impact of preventative antibiotics (SDD) on patient outcome and antibiotic resistance in the critically ill in intensive care has been awarded funding by the Canadian Institute of Health Research’s “Strategy for Patient-Orienated Research (SPOR). Bloomberg Nursing Assistant Professor Craig Dale and Associate Professor Louise Rose are part of this multi-site, multi-year study, with Dr. Rose as one of 4 principal co-investigators and Dr. Dale as a co-investigator.

Approximately 20%-50% of Intensive Care Unit (ICU) patients experience infection(s) during their stay in the unit, with pneumonia being the most common. When ICU patients experience infection, they have longer stays in the hospital. With infection in hospital becoming increasingly difficult to treat, patients can often experience poor outcomes, including death. New methods to prevent infection are urgently needed.

Selective Decontamination of the Digestive (SDD) tract involves the prophylactic (or pre-emptive) application of topical antibiotics to the mouth and stomach coupled with a short course of intravenous antibiotics. Although not widely adopted into ICUs around the world (including Canada) due to concerns about antibiotic resistance, SDD has been demonstrated to reduce rates of infection and increase patient survival.

The SuDDICU study aims to assess whether adding SDD to a patient’s usual care in the ICU does more good than harm in reducing death and other poor outcomes among ICU patients. The study is patient-orientated research, which sees patients as partners, focusing on patient-identified priorities and improving patient outcomes.

Dr. Dale will be involved as an expert in oral care delivery during critical illness. Working with Dr. Rose, he will develop new knowledge about the optimal application of this novel therapy.

Dr. Rose will be responsible for the patient engagement and knowledge translation components of the study.

Dr. Kimberley Widger

Bloomberg Nursing Assistant Professor Dr. Kimberley Widger has been awarded a grant for a national population-based study, End-of-life health care use for children with life-threatening conditions by CIHR’s Institute of Human Development, Child and Youth Health (IHDCYH). Dr. Widger’s study was one of 25 projects selected by CIHR’s Analysis of Existing Cohorts & Databases competition.

A child’s death has a life-long and potentially traumatic impact on families, communities and even the health professionals who provide care. Thus, for children with life-threatening conditions it is important to provide the highest quality of care, maximize quality of life, ensure a good death in the preferred location, and establish the foundation for well-supported bereavement for surviving family members.

Along with co-investigators, Dr. Widger will partner with Statistics Canada to create and examine a national cohort of children who died from a life-threatening condition over a 5-year period. The study aims to characterize the intensity of end-of-life care in children with life-threatening conditions and identify patient, disease, and healthcare factors associated with variations in this intensity and in location of death.

End-of-life health care use for children with life-threatening conditions will be the first national effort to characterize end-of-life care in children with life-threatening illness and explore predictors of higher intensity care and location of death, providing important information about potential areas where care could be further optimized to reduce burden and improve quality. Additionally, the study will identify gaps in administrative data and that could be addressed by expanding data abstraction and/or creating a national pediatric palliative care registry. Improved understanding of current health care usage patterns for children at the end-of-life may reveal particular patient characteristics, needs, and opportunities to optimize service use and enhance care quality.