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Article ; Online: Efficacy of Risk Prediction Models and Thresholds to Select Patients for Lung Cancer Screening.

Smith, Richard J / Vijayaharan, Thurairajah / Linehan, Victoria / Sun, Zhuolu / Ein Yong, Jean Hai / Harris, Scott / Mariathas, Hensley H / Bhatia, Rick

Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes

2022 Volume 73, Issue 4, Page(s) 672–679

Abstract: ... ...

Abstract	Purpose
MeSH term(s)	Canada ; Early Detection of Cancer ; Humans ; Lung Neoplasms/diagnostic imaging ; Mass Screening ; Retrospective Studies ; Risk Assessment
Language	English
Publishing date	2022-04-26
Publishing country	United States
Document type	Journal Article
ZDB-ID	418190-6
ISSN	1488-2361 ; 0846-5371 ; 0008-2902
ISSN (online)	1488-2361
ISSN	0846-5371 ; 0008-2902
DOI	10.1177/08465371221089899
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Article ; Online: Implementation of an ED surge management platform: a study protocol.

Anaraki, Nahid Rahimipour / Jewer, Jennifer / Hurley, Oliver / Mariathas, Hensley H / Young, Christina / Norman, Paul / Patey, Christopher / Wilson, Brenda / Etchegary, Holly / Senior, Dorothy / Asghari, Shabnam

Implementation science communications

2022 Volume 3, Issue 1, Page(s) 21

Abstract: Background: Emergency departments (EDs) around the world are struggling with long wait times and overcrowding. To address these issues, a quality improvement program called SurgeCon was created to improve ED efficiency and patient satisfaction. This ... ...

Abstract	Background: Emergency departments (EDs) around the world are struggling with long wait times and overcrowding. To address these issues, a quality improvement program called SurgeCon was created to improve ED efficiency and patient satisfaction. This paper presents a framework for managing and evaluating the implementation of an ED surge management platform. Our framework builds on the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to structure our approach and the Consolidated Framework for Implementation Research (CFIR) to guide our choice of outcome variables and scalability. Methods: Four hospital EDs will receive the SurgeCon quality improvement intervention. Using a stepped wedge cluster design, each ED will be randomized to one of four start dates. Data will be collected before, during, and after the implementation of the intervention. RE-AIM will be used to guide the assessment of SurgeCon, and guided by CFIR, we will measure ED key performance indicators (KPI), patient-reported outcomes, and implementation outcomes related to SurgeCon's scalability, adaptability, sustainability, and overall costs. Participants in this study consist of patients who visit any of the four selected EDs during the study period, providers/staff, and health system managers. A mixed-methods approach will be utilized to evaluate implementation outcomes. Discussion: This study will provide important insight into the implementation and evaluation techniques to enhance uptake and benefits associated with an ED surge-management platform. The proposed framework bridges research and practice by involving researchers, practitioners, and patients in the implementation and evaluation process, to produce an actionable framework that others can follow. We anticipate that the implementation approach would be generalizable to program implementations in other EDs. Trial registration: • Name of the registry: ClinicalTrials.gov • Trial registration number: NCT04789902 • Date of registration: 03/10/2021.
Language	English
Publishing date	2022-03-02
Publishing country	England
Document type	Journal Article
ISSN	2662-2211
ISSN (online)	2662-2211
DOI	10.1186/s43058-021-00247-1
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Article: An Examination of Three Spatial Event Cluster Detection Methods

Mariathas, Hensley H / Rosychuk, Rhonda J

ISPRS international journal of geo-information. 2015 Mar. 06, v. 4, no. 1

2015

Abstract: In spatial disease surveillance, geographic areas with large numbers of disease cases are to be identified, so that targeted investigations can be pursued. Geographic areas with high disease rates are called disease clusters and statistical cluster ... ...

Abstract	In spatial disease surveillance, geographic areas with large numbers of disease cases are to be identified, so that targeted investigations can be pursued. Geographic areas with high disease rates are called disease clusters and statistical cluster detection tests are used to identify geographic areas with higher disease rates than expected by chance alone. In some situations, disease-related events rather than individuals are of interest for geographical surveillance, and methods to detect clusters of disease-related events are called event cluster detection methods. In this paper, we examine three distributional assumptions for the events in cluster detection: compound Poisson, approximate normal and multiple hypergeometric (exact). The methods differ on the choice of distributional assumption for the potentially multiple correlated events per individual. The methods are illustrated on emergency department (ED) presentations by children and youth (age < 18 years) because of substance use in the province of Alberta, Canada, during 1 April 2007, to 31 March 2008. Simulation studies are conducted to investigate Type I error and the power of the clustering methods.
Keywords	children ; disease surveillance ; monitoring ; youth ; Alberta
Language	English
Dates of publication	2015-0306
Size	p. 367-384.
Publishing place	Multidisciplinary Digital Publishing Institute
Document type	Article
Note	Journal Article
ZDB-ID	2655790-3
ISSN	2220-9964
ISSN	2220-9964
DOI	10.3390/ijgi4010367
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Article ; Online: The effect of laboratory requisition modification, audit and feedback with academic detailing or both on utilization of blood urea testing in family practice in Newfoundland, Canada.

Barrett, Brendan J / Randell, Edward W / Mariathas, Hensley H / Mohammadi, Asghar / Darcy, Stephen / Wilson, Robert / Brian Johnston, K / Parfrey, Patrick S

Clinical biochemistry

2020 Volume 83, Page(s) 21–27

Abstract: Objectives: Measuring blood urea at the same time as serum creatinine in stable ambulatory patients in family practice is largely unnecessary. The objective was to assess the relative impact of changing the laboratory requisition versus audit and ... ...

Abstract	Objectives: Measuring blood urea at the same time as serum creatinine in stable ambulatory patients in family practice is largely unnecessary. The objective was to assess the relative impact of changing the laboratory requisition versus audit and feedback and academic detailing on the volume of orders for blood urea. Design and methods: A natural experiment was observed over the period April 2015 to March 2018 in the Canadian province of Newfoundland where three health regions had different approaches to trying to reduce such urea testing. The Eastern and Western regions removed urea from the standard laboratory requisition but the test could still be ordered by writing it on the requisition. Central region requisitions continued to list urea. Audit and feedback was undertaken with family doctors in Eastern region after the requisition change and that was followed by academic detailing. A nephrologist gave presentations to groups of family doctors on one occasion in Central region. Results: The volume of serum creatinine testing was largely unchanged over time in each region. The volume of urea testing reduced by 73%, 48% and 28% in Eastern, Western and central regions. Interrupted time series analysis showed significant changes in test volume after requisition change in Eastern and Western regions as well as after audit and feedback in Eastern and the presentations in Central region. The incremental impact of academic detailing was not statistically significant. Conclusion: We conclude that removing urea from standard test order menus was the most effective in reducing test volumes, but combination with audit and feedback augmented the impact.
MeSH term(s)	Blood Chemical Analysis/statistics & numerical data ; Creatinine/blood ; Education, Medical, Continuing ; Family Practice ; Feedback ; Health Services Research ; Humans ; Medical Audit ; Newfoundland and Labrador ; Outcome and Process Assessment, Health Care ; Practice Patterns, Physicians'/statistics & numerical data ; Unnecessary Procedures/statistics & numerical data ; Urea/blood
Chemical Substances	Urea (8W8T17847W) ; Creatinine (AYI8EX34EU)
Language	English
Publishing date	2020-05-22
Publishing country	United States
Document type	Journal Article
ZDB-ID	390372-2
ISSN	1873-2933 ; 0009-9120
ISSN (online)	1873-2933
ISSN	0009-9120
DOI	10.1016/j.clinbiochem.2020.05.008
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Article: A Quality Improvement Emergency Department Surge Management Platform (SurgeCon): Protocol for a Stepped Wedge Cluster Randomized Trial.

Mariathas, Hensley H / Hurley, Oliver / Anaraki, Nahid Rahimipour / Young, Christina / Patey, Christopher / Norman, Paul / Aubrey-Bassler, Kris / Wang, Peizhong Peter / Gadag, Veeresh / Nguyen, Hai V / Etchegary, Holly / McCrate, Farah / Knight, John C / Asghari, Shabnam

JMIR research protocols

2022 Volume 11, Issue 3, Page(s) e30454

Abstract: Background: Despite many efforts, long wait times and overcrowding in emergency departments (EDs) have remained a significant health service issue in Canada. For several years, Canada has had one of the longest wait times among the Organisation for ... ...

Abstract	Background: Despite many efforts, long wait times and overcrowding in emergency departments (EDs) have remained a significant health service issue in Canada. For several years, Canada has had one of the longest wait times among the Organisation for Economic Co-operation and Development countries. From a patient's perspective, this challenge has been described as "patients wait in pain or discomfort for hours before being seen at EDs." To overcome the challenge of increased wait times, we developed an innovative ED management platform called SurgeCon that was designed based on continuous quality improvement principles to maintain patient flow and mitigate the impact of patient surge on ED efficiency. The SurgeCon quality improvement intervention includes a protocol-driven software platform, restructures ED organization and workflow, and aims to establish a more patient-centric environment. We piloted SurgeCon at an ED in Carbonear, Newfoundland and Labrador, and found that there was a 32% reduction in ED wait times. Objective: The primary objective of this trial is to determine the effects of SurgeCon on ED performance by assessing its impact on length of stay, the time to a physician's initial assessment, and the number of patients leaving the ED without being seen by a physician. The secondary objectives of this study are to evaluate SurgeCon's effects on patient satisfaction and patient-reported experiences with ED wait times and its ability to create better-value care by reducing the per-patient cost of delivering ED services. Methods: The implementation of the intervention will be assessed using a comparative effectiveness-implementation hybrid design. This type of hybrid design is known to shorten the amount of time associated with transitioning interventions from being the focus of research to being used for practice and health care services. All EDs with 24/7 on-site physician support (category A hospitals) will be enrolled in a 31-month, pragmatic, stepped wedge cluster randomized trial. All clusters (hospitals) will start with a baseline period of usual care and will be randomized to determine the order and timing of transitioning to intervention care until all hospitals are using the intervention to manage and operationalize their EDs. Results: Data collection for this study is continuing. As of February 2022, a total of 570 randomly selected patients have participated in telephone interviews concerning patient-reported experiences and patient satisfaction with ED wait times. The first of the 4 EDs was randomly selected, and it is currently using SurgeCon's eHealth platform and applying efficiency principles that have been learned through training since September 2021. The second randomly selected site will begin intervention implementation in winter 2022. Conclusions: By assessing the impact of SurgeCon on ED services, we hope to be able to improve wait times and create better-value ED care in this health care context. Trial registration: ClinicalTrials.gov NCT04789902; https://clinicaltrials.gov/ct2/show/NCT04789902. International registered report identifier (irrid): DERR1-10.2196/30454.
Language	English
Publishing date	2022-03-24
Publishing country	Canada
Document type	Journal Article
ZDB-ID	2719222-2
ISSN	1929-0748
ISSN	1929-0748
DOI	10.2196/30454
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Article ; Online: Psychological Distress and Quality of Life in Participants Undergoing Genetic Testing for Arrhythmogenic Right Ventricular Cardiomyopathy Caused by TMEM43 p.S358L: Is It Time to Offer Population-Based Genetic Screening?

Brothers, Cassidy / Etchegary, Holly / Curtis, Fiona / Simmonds, Charlene / Houston, Jim / Young, Terry-Lynn / Pullman, Daryl / Mariathas, Hensley H / Connors, Sean / Hodgkinson, Kathleen

Public health genomics

2021 Volume 24, Issue 5-6, Page(s) 253–260

Abstract: Purpose: We have identified 27 families in Newfoundland and Labrador (NL) with the founder variant TMEM43 p.S358L responsible for 1 form of arrhythmogenic right ventricular cardiomyopathy. Current screening guidelines rely solely on cascade genetic ... ...

Abstract	Purpose: We have identified 27 families in Newfoundland and Labrador (NL) with the founder variant TMEM43 p.S358L responsible for 1 form of arrhythmogenic right ventricular cardiomyopathy. Current screening guidelines rely solely on cascade genetic screening, which may result in unrecognized, high-risk carriers who would benefit from preemptive implantable cardioverter-defibrillator therapy. This pilot study explored the acceptability among subjects to TMEM43 p.S358L population-based genetic screening (PBGS) in this Canadian province. Methods: A prospective cohort study assessed attitudes, psychological distress, and health-related quality of life (QOL) in unselected individuals who underwent genetic screening for the TMEM43 p.S358L variant. Participants (n = 73) were recruited via advertisements and completed 2 surveys at baseline, 6 months, and 1 year which measured health-related QOL (SF-36v2) and psychological distress (Impact of Events Scale). Results: No variant-positive carriers were identified. Of those screened through a telephone questionnaire, >95% felt positive about population-genetic screening for TMEM43 p.S358L, though 68% reported some degree of anxiety after seeing the advertisement. There were no significant changes in health-related QOL or psychological distress scores over the study period. Conclusion: Despite some initial anxiety, we show support for PBGS among research subjects who screened negative for the TMEM43 p.S358L variant in NL. These findings have implications for future PBGS programs in the province.
MeSH term(s)	Arrhythmogenic Right Ventricular Dysplasia/diagnosis ; Arrhythmogenic Right Ventricular Dysplasia/genetics ; Canada ; Genetic Testing ; Humans ; Membrane Proteins/genetics ; Pilot Projects ; Prospective Studies ; Psychological Distress ; Quality of Life
Chemical Substances	Membrane Proteins ; TMEM43 protein, human
Language	English
Publishing date	2021-09-09
Publishing country	Switzerland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2457023-0
ISSN	1662-8063 ; 1662-4246
ISSN (online)	1662-8063
ISSN	1662-4246
DOI	10.1159/000517265
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Article ; Online: Reducing Wait Time for Lung Cancer Diagnosis and Treatment: Impact of a Multidisciplinary, Centralized Referral Program.

Common, Jessica L / Mariathas, Hensley H / Parsons, Kaylah / Greenland, Jonathan D / Harris, Scott / Bhatia, Rick / Byrne, Suzanne C

Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes

2018 Volume 69, Issue 3, Page(s) 322–327

Abstract: Background: A multidisciplinary, centralized referral program was established at our institution in 2014 to reduce delays in lung cancer diagnosis and treatment following diagnostic imaging observed with the traditional, primary care provider-led ... ...

Abstract	Background: A multidisciplinary, centralized referral program was established at our institution in 2014 to reduce delays in lung cancer diagnosis and treatment following diagnostic imaging observed with the traditional, primary care provider-led referral process. The main objectives of this retrospective cohort study were to determine if referral to a Thoracic Triage Panel (TTP): 1) expedites lung cancer diagnosis and treatment initiation; and 2) leads to more appropriate specialist consultation. Methods: Patients with a diagnosis of lung cancer and initial diagnostic imaging between March 1, 2015, and February 29, 2016, at a Memorial University-affiliated tertiary care centre in St John's, Newfoundland, were identified and grouped according to whether they were referred to the TTP or managed through a traditional referral process. Wait times (in days) from first abnormal imaging to biopsy and treatment initiation were recorded. Statistical analysis was performed using the Wilcoxon rank-sum test. Results: A total of 133 patients who met inclusion criteria were identified. Seventy-nine patients were referred to the TTP and 54 were managed by traditional means. There was a statistically significant reduction in median wait times for patients referred to the TTP. Wait time from first abnormal imaging to biopsy decreased from 61.5 to 36.0 days (P < .0001). Wait time from first abnormal imaging to treatment initiation decreased from 118.0 to 80.0 days (P < .001). The percentage of specialist consultations that led to treatment was also greater for patients referred to the TTP. Conclusions: A collaborative, centralized intake and referral program helps to reduce wait time for diagnosis and treatment of lung cancer.
MeSH term(s)	Aged ; Cohort Studies ; Female ; Humans ; Lung Neoplasms/diagnosis ; Lung Neoplasms/therapy ; Male ; Referral and Consultation ; Retrospective Studies ; Time-to-Treatment/statistics & numerical data
Language	English
Publishing date	2018-06-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	2068691-2
ISSN	1488-2361 ; 0846-5371
ISSN (online)	1488-2361
ISSN	0846-5371
DOI	10.1016/j.carj.2018.02.001
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Article ; Online: Six-year time-trend analysis of dyslipidemia among adults in Newfoundland and Labrador: findings from the laboratory information system between 2009 and 2014.

Pedram, Pardis / Aref-Eshghi, Erfan / Mariathas, Hensley H / Hurley, Oliver / Godwin, Marshall / Duke, Pauline / Mahdavian, Masoud / Asghari, Shabnam

Lipids in health and disease

2018 Volume 17, Issue 1, Page(s) 99

Abstract: Background: Dyslipidemia, an increased level of total cholesterol (TC), triglycerides (TG), low-density-lipoprotein cholesterol (LDL-C) and decreased level of high-density-lipoprotein cholesterol (HDL-C), is one of the most important risk factors for ... ...

Abstract	Background: Dyslipidemia, an increased level of total cholesterol (TC), triglycerides (TG), low-density-lipoprotein cholesterol (LDL-C) and decreased level of high-density-lipoprotein cholesterol (HDL-C), is one of the most important risk factors for cardiovascular disease. We examined the six-year trend of dyslipidemia in Newfoundland and Labrador (NL), a Canadian province with a historically high prevalence of dyslipidemia. Methods: A serial cross-sectional study on all of the laboratory lipid tests available from 2009 to 2014 was performed. Dyslipidemia for every lipid component was defined using the Canadian Guidelines for the Diagnosis and Treatment of Dyslipidemia. The annual dyslipidemia rates for each component of serum lipid was examined. A fixed and random effect model was applied to adjust for confounding variables (sex and age) and random effects (residual variation in dyslipidemia over the years and redundancies caused by individuals being tested multiple times during the study period). Results: Between 2009 and 2014, a total of 875,208 records (mean age: 56.9 ± 14.1, 47.6% males) containing a lipid profile were identified. The prevalence of HDL-C and LDL-C dyslipidemia significantly decreased during this period (HDL-C: 35.8% in 2009 [95% CI 35.5-36.1], to 29.0% in 2014 [95% CI: 28.8-29.2], P = 0.03, and LDL-C: 35.2% in 2009 [95% CI: 34.9-35.4] to 32.1% in 2014 [95% CI: 31.9-32.3], P = 0.02). A stratification by sex, revealed no significant trend for any lipid element in females; however, in men, the previously observed trends were intensified and a new decreasing trend in dyslipidemia of TC was appeared (TC: 34.1% [95% CI 33.7-34.5] to 32.3% [95%CI: 32.0-32.6], p < 0.02, HDL-C: 33.8% (95%CI: 33.3-34.2) to 24.0% (95% CI: 23.7-24.3)], P < 0.01, LDL-C: 32.9% (95%CI:32.5-33.3) to 28.6 (95%CI: 28.3-28.9), P < 0.001). Adjustment for confounding factors and removing the residual noise by modeling the random effects did not change the significance. Conclusion: This study demonstrates a significant downward trend in the prevalence of LDL-C, HDL-C, and TC dyslipidemia, exclusively in men. These trends could be the result of males being the primary target for cardiovascular risk management.
MeSH term(s)	Canada/epidemiology ; Cardiovascular Diseases/blood ; Cardiovascular Diseases/epidemiology ; Cardiovascular Diseases/pathology ; Cholesterol/blood ; Cholesterol, HDL/blood ; Cholesterol, LDL/blood ; Dyslipidemias/blood ; Dyslipidemias/epidemiology ; Dyslipidemias/pathology ; Female ; Humans ; Male ; Middle Aged ; Newfoundland and Labrador/epidemiology ; Risk Factors ; Triglycerides/blood
Chemical Substances	Cholesterol, HDL ; Cholesterol, LDL ; Triglycerides ; Cholesterol (97C5T2UQ7J)
Language	English
Publishing date	2018-05-02
Publishing country	England
Document type	Journal Article
ISSN	1476-511X
ISSN (online)	1476-511X
DOI	10.1186/s12944-018-0752-2
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Article ; Online: Geographic clustering of emergency department presentations for atrial fibrillation and flutter in Alberta, Canada.

Rosychuk, Rhonda J / Mariathas, Hensley H / Graham, Michelle M / Holroyd, Brian R / Rowe, Brian H

Academic emergency medicine : official journal of the Society for Academic Emergency Medicine

2015 Volume 22, Issue 8, Page(s) 965–975

Abstract: Objectives: Atrial fibrillation and flutter (AFF) are the most common arrhythmias seen in the outpatient setting, and they affect more than 300,000 adult Canadians. The aims of this study were to examine temporal and geographic trends in emergency ... ...

Abstract	Objectives: Atrial fibrillation and flutter (AFF) are the most common arrhythmias seen in the outpatient setting, and they affect more than 300,000 adult Canadians. The aims of this study were to examine temporal and geographic trends in emergency department (ED) presentations made by adults (age ≥ 35 years) for AFF in Alberta, Canada, from 1999 to 2011. Statistical disease cluster detection techniques were used to identify geographic areas with higher numbers of individuals presenting with AFF and higher numbers of ED presentations for AFF than expected by chance alone. Geographic clusters of individuals with stroke or heart failure follow-up within 365 days of ED presentations for AFF were also identified. Methods: All ED presentations for AFF made by individuals aged ≥35 years were extracted from Alberta's Ambulatory Care Classification System. The Alberta Health Care Insurance Plan provided population counts and demographics for the patients presenting (age, sex, year, geographic unit). The Physician Claims File provided non-ED physician claims data after a patient's ED presentation. Statistical analyses included numerical and graphical summaries, directly standardized rates, and statistical disease cluster detection tests. Results: During 12 years, there were 63,395 ED presentations for AFF made by 32,101 individuals. Standardized rates remained relatively stable over time, at about two per 1,000 for individuals presenting to the ED for AFF and about three per 1,000 for ED presentations for AFF. The northern and southeastern parts of the province were identified as clusters of individuals presenting for AFF, and ED presentations for AFF, and several of the areas demonstrated clusters in multiple years. Further, several of the geographic clusters were also identified as potential clusters for stroke or heart failure within 365 days after the ED presentations for AFF. Conclusions: This population-based study spanned 12 fiscal years and showed variations in the number of people presenting to EDs for AFF and the number of ED presentations for AFF over geography. The potential clusters identified may represent geographic areas with higher disease severity or a lower availability of non-ED health services. The clusters are not all likely to have occurred by chance, and further investigation and intervention could occur to reduce ED presentations for AFF.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Alberta ; Atrial Fibrillation/therapy ; Atrial Flutter/therapy ; Emergency Service, Hospital/statistics & numerical data ; Female ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Spatial Analysis
Language	English
Publishing date	2015-08
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1329813-6
ISSN	1553-2712 ; 1069-6563
ISSN (online)	1553-2712
ISSN	1069-6563
DOI	10.1111/acem.12731
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