College of Medicine - Master of Physician Assistant Studies Capstone Projects

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Open Access
A literature review evaluating the differences in mortality rates in urban versus rural patients with infective endocarditis in the United States of America
(2024-05-15) Bosc, Pierre
Introduction: Over the last two decades, the prevalence of infective endocarditis in the United States of America has increased. This has been largely due to the increased life expectancy, increased rate of cardiac surgeries and the intravenous drug-use epidemic. Overall, the mortality rates related to infective endocarditis are decreasing. However, there are no literature reviews assessing mortality rate differences between urban and rural patients with infective endocarditis. Objective: Review the literature to identify any differences in mortality rates between urban and rural patients with infective endocarditis in the United States of America, between 1999 and 2019. Methods: A PubMed database search was conducted using key terms “infective endocarditis”, “rural”, “non-urban” and “urban”. Filtering for “humans” and “publication within the last 10 years”, yielded 69 results, three of which were appropriate for inclusion in the study. Two other studies were obtained from a search on Google Scholar. Results: Despite an inconsistency in definitions for terms “urban” and “rural”, the literature suggests there is a slightly higher mortality rate in rural compared to urban patients with infective endocarditis in the United States of America between 1999 and 2019. Furthermore, there appears to be an increasing mortality rate in rural patients with infective endocarditis, compared to a declining mortality rate in urban patients with infective endocarditis. Conclusion: The results from this literature review suggest a slightly higher mortality rate in rural compared to urban patients with infective endocarditis, but further research is needed to determine the cause of these differences.
Open Access
A Literature Review: Barriers to Care Amongst Immigrant Women with Postpartum Depression in Canada
(2023-05-15) Rukhsar, Gul
Introduction: Postpartum depression (PPD) is a prevalent condition among new mothers, affecting 10-15% of the population. However, immigrant women are at a higher risk of developing PPD than non-immigrant women, with a 1.5-5 times greater likelihood. Access barriers such as social isolation, financial instability, and limited awareness of healthcare services hinder PPD care access for immigrant women. Although the Canadian Task Force Prevention Guidelines advocate for PPD screening, a lack of substantial research on its importance could potentially increase the challenges immigrant women encounter when seeking proper PPD care. Objective: For this literature review, several online databases were utilized. This review aims to identify the barriers immigrant women face when seeking help for postpartum depression and understand what would help meet the mental health needs of immigrant and refugee women during the postpartum period. Methods: Using key terms related to access barriers to postpartum depression care among immigrant women in Canada. This review searched several online databases, including PubMed, Scopus, and CINAHL. Six articles met the inclusion criteria and were analyzed. Results: Five studies explored the challenges immigrant women experience when seeking postpartum depression care in Canada, while one study investigated Canadian guidelines on the recommendation against screening for postpartum depression. However, only limited insight was given into its effects on the immigrant population. Three common themes that affected immigrant women's behaviour when seeking care were a cultural influence on PPD, lack of awareness about service accessibility and quality of care, and migrant-related issues such as language barriers and discrimination. Conclusion: This literature review highlights the multifaceted nature of the challenges faced by immigrant women in accessing postpartum care for depression in Canada. Factors such as language barriers, stigma, cultural influence on help-seeking behaviours, lack of awareness about available services, and migrant-related issues contribute to these challenges. The study underscores the need for culturally sensitive care that considers the unique experiences of immigrant women. Additionally, the findings highlight the importance of training healthcare professionals to improve their cultural understanding and awareness, which can help build trusting relationships with their patients. This review provides practical recommendations for improving care delivery and outcomes, including greater awareness about available services and incorporating PPD screening into Canadian guidelines.
Open Access
Access Barriers Among Indigenous Women Seeking Prenatal Care in Canada: A Literature Review
(2021-05-15) Jameson, Alexis
Introduction: Many expecting Indigenous women suffer from disproportionally high risks and adverse outcomes relative to non-Indigenous women when seeking adequate prenatal care due to access barriers in Canada’s healthcare system. Objective: The purpose of this literature review was to identify the barriers Indigenous women face when accessing prenatal care and to investigate programs and possible modifications to the health care system to improve prenatal care access for Indigenous women. The last objective was to determine if utilizing physician assistants may act as a potential solution to improving access to prenatal care for Indigenous women. Methods: A literature search using PubMed, Scopus, and CINAHL databases was performed using key terms pertaining to access barriers to prenatal care among Indigenous women in Canada. Five articles were found to meet the inclusion criteria and were analyzed in this literature review. Results: Three studies explored the challenges that Indigenous women experience when seeking prenatal care in Canada. Two studies investigated potential programming or system modifications to improve safe access to prenatal care among Indigenous women. Limited research was found regarding the use of physician assistants providing prenatal care among Indigenous women in Canada. Conclusion: The barriers to prenatal care among Indigenous women identified in this literature review fit under the social determinants of health, including transportation and geographical location, social support networks with family and providers, and lack of cultural awareness and understanding from providers. Strategies to improve access to prenatal care among Indigenous women included an interdisciplinary team using a holistic approach to provide culturally safe care to Indigenous women.
Open Access
Access Barriers Among Transgender and Gender Diverse Youth Seeking Gender-Affirming Care in Canada: A Literature Review
(2024-05-15) Furness, Gillian
Introduction: There are increasing numbers of Canadian youth who identify as genders different from their assigned sex at birth. As a result, healthcare providers are encountering more transgender and gender diverse (TGD) youth seeking gender-affirming healthcare. Unfortunately, due to the effects of gender identity-related stigma, as well as distress related to the development of secondary sex characteristics during puberty, TGD youth often have complex medical, psychological, and social needs, and face high levels of social adversity, adverse mental health outcomes, substance use, and suicidal ideation. Research provides increasing evidence that access to gender-affirming care (GAC) is crucial in improving the health and social functioning of TGD youth. Unfortunately, many Canadian TGD youth are unable to access the GAC that they need, due to numerous provider, patient and systemic barriers. Objectives: The purpose of this literature review is to identify the barriers that Canadian TGD youth face when accessing GAC, and to investigate possible solutions that can be implemented within the healthcare system to improve access to GAC for this population. Additionally, this literature review will investigate how Physician Assistants (PAs) may have a role in improving this population’s access to GAC. Methods: A literature search using PubMed and Scopus databases was performed using key terms pertaining to access barriers to gender-affirming care among TGD youth in Canada. Seven articles were found to meet the inclusion criteria and were analyzed in this literature review. Results: Seven studies explored the challenges that TGD youth in Canada experience when accessing gender-affirming care. Six studies investigated potential modifications that may be implemented to improve accessibility of GAC for TGD youth in Canada. No research was found concerning how PAs may assist in the provision of GAC for TGD youth in Canada. Conclusion: The barriers to GAC for TGD youth in Canada identified in this literature review concern delayed access to care, challenges related to systemic health system issues, lack of provider knowledge or sensitivity, and financial constraints. Strategies to improve access to GAC for TGD youth include increasing training and knowledge of all providers in GAC; advocating for policy changes to make GAC more accessible; and requiring staff of medical facilities to undergo gender-sensitivity training.
Open Access
Access Barriers to Primary Health Care: Indigenous People and the Role of the Physician Assistant in Northern Manitoba
(2015-04) Barnes, Christopher
This capstone project compares Manitoba and Alaska health care reform policy in the context of northern Indigenous Health. Additionally, this paper compares northern Manitoba and Alaska Physician Assistant utilization rates. Two questions are investigated: (i) ) Will the current primary care reform policy improve access barriers to primary care for northern and remote Indigenous communities in Manitoba and if not, what other options might be available? (ii) Are Physician Assistants utilized within northern and remote Indigenous communities in Manitoba to address current service delivery challenges? Indigenous people in Manitoba experience significant health inequities as reflected in health indicators published in government documents and academic papers. Despite Manitoba’s primary care reform policy and in light of a recent Auditor-General’s report on northern health care, current systems do not appear to be addressing these issues and access barriers exist. A review of the literature using internet search engines by key words was performed. Important government and health websites were reviewed. Key informants were sought who had expertise in Indigenous health care, health system reform and current Physician Assistant policy and training. The topics examined were: Indigenous sociopolitical perspective, the effects of racism and colonization on Canadian Indigenous people, current health care issues and health care reform initiatives in Manitoba. The following are four significant findings of this study: (i) it is not yet known if current primary health care reform policy will improve access barriers for northern and remote Indigenous communities in Manitoba due in part to the complexity of the federal/provincial/Indigenous peoples arrangement and because there is no pre or post data for the selected health indicator (ii) an option called the “Nuka System of Care” exists, is culturally relevant, is structured to address access barriers related to jurisdictional discrepancies and staffing shortages and has resulted in better health for the Alaska Natives (iii) there is evidence that Physician Assistants are underutilized to address service delivery challenges within northern and remote Indigenous communities in Manitoba (iv) both the “Nuka” system and Physician Assistants could help address access barriers and service delivery challenges for northern and remote Indigenous communities in Manitoba if adopted but further research and evaluation would be needed before policy change could occur.
Open Access
Acute rheumatic fever in indigenous children and young adults in Canada: a review of primary prevention strategies
(2020) Vuongphan, Lynn
Introduction: There is a growing disparity in the incidence of ARF between Indigenous and non-Indigenous people. ARF is common in school-aged children, particularly those who live in communities with overcrowded housing, poverty, and limited resources. In Manitoba, rates of ARF have greatly declined over the years; however, it continues to disproportionately affect First Nations (FN) people, especially in rural communities. There are currently no national or provincial ARF prevention strategies. Objective: To evaluate primary prevention strategies and programs for ARF targeting Indigenous communities. Methods: A literature review was conducted using the PubMed database for studies and trials. Keywords used were “streptococcal pharyngitis”, “rheumatic fever”, “rheumatic disease”, “primary prevention”. Articles that met the inclusion criteria were selected for review. Results: Five articles were reviewed. All studies utilized school-based sore throat clinics for the detection and diagnosis of streptococcal pharyngitis and subsequent secondary prophylaxis with antibiotics. Four studies found a significant reduction in the incidence of ARF with the schoolbased intervention group to detect and diagnose streptococcal throat infections. Conclusion: Data already exists showing the high incidence of ARF in FN people in Manitoba. School-based programs are effective in reducing the development of ARF. A coordinated effort is urgently needed to implement primary prevention programs in Manitoba.
Open Access
Assessing quality end-of-life communication and documentation in intensive care patients using a conceptual framework and quality indicators
(2019) Pham, Tammy
Most deaths in Canada occur in hospitals, and almost one in five occurs in intensive care units (ICUs). The goal of this study is to assess the quality of end-of-life (EOL) communication in two important groups in intensive care in Winnipeg: (i) those who live in personal care homes (PCH) and (ii) those with severe cardiovascular and/or respiratory failure placed on an artificial life support called extracorporeal membrane oxygenation (ECMO). Two domains of EOL communication were studied: Goals of Care Discussion (GOCD) and Documentation. We used a validated conceptual framework for the quality of EOL communication and documentation, operationalized by 18 specific quality indicators (QIs). We performed a retrospective, manual review of hospital charts (107 charts from the PCH subgroup and 103 charts from the ECMO subgroup) to extract these QIs. Overall, the quality of EOL communication and documentation was low. Despite the ECMO cohort being the sicker group with worse in-hospital mortality rates, the quality of EOL communication was significantly worse compared to PCH group. Quality of EOL communication was highly influenced by patient physiologic status adjusted for age, sex, year of admission, disease category, socioeconomic quintile and urban status.
Open Access
Assessing the use of tapered titanium stems in treating periprosthetic fractures
(2019) Derksen, Kieran
Background: Periprosthetic fractures are a late complication of total hip arthroplasty. There are a variety of surgical techniques and femoral component designs that can be used to treat them depending on surgeon preference and fracture type. Tapered titanium stems have shown promising results in recent studies for the treatment of periprosthetic fractures. Purpose: The objective of this retrospective study was to investigate the efficacy of using tapered titanium hip stems in a revision arthroplasty procedure for periprosthetic fracture repairs by assessing survivorship, radiographic findings, and self-reported functional outcomes at a post-operative period of at least 2 years. Methods: A total of 34 patients who received treatment for periprosthetic fractures between May 2008 and January 2016 were assessed for the use of tapered titanium stems. Survivability was determined and radiographs were evaluated for fracture union, stem subsidence, and osseous restoration. The Oxford questionnaire and satisfaction survey were used to determine quality of life, functionality, and pain scores. Results Three patients required early revisions after surgery for either trochanteric fracture and dislocation (5 months), infection (10 months), or aseptic loosening (4 months). Complete union was found in 88% of cases and bone stock was unchanged or increased in 91% of cases. Stem subsidence occurred in 44% of cases with a mean migration of 2.6 mm. Although there was a high occurrence of subsidence, the majority of cases measured less than 4 mm, and subsidence did not correlate with survivorship or clinical outcomes. The mean 2 year Oxford score was 37.8 of 48 and on average patients were either satisfied or very satisfied. Conclusions: This study reports encouraging radiographic and clinical results with minimum 2 year follow-up for the treatment of periprosthetic fractures with tapered titanium femoral stems.
Open Access
Barriers to accessing substance use disorder treatment: a providers perspective
(2020) Konzelman, Carmen
Substance use disorders are gaining significant attention in the recent years and as such, questions have been raised of how we can help alleviate the problem of addictions. Many barriers exist that make receiving adequate treatment difficult. This results in long-term struggles with addictions, financial stresses, detriments on the health of individuals and unfortunately can have fatal outcomes. This study focuses on the barriers that healthcare providers in Winnipeg, Manitoba and surrounding areas face when referring patients for addictions treatment. A survey was sent out by email to multiple providers practicing in various areas of medicine that deal with addictions in one form or another. Participants were asked to rate in order of significance multiple barriers that they have faced. Respondents indicated that treatment wait times/capacity was the most significant barrier. Second most significant was difficulties for providers in determining patient eligibility for certain centres, followed by providers understanding of options available and lastly, issues with ongoing communication between provider and patient. A section of the survey also allowed for participants to leave comments on additional barriers they found to be relevant to their practice.
Open Access
Beyond Blood Sugar Control: A Review of Metformin’s Therapeutic Potential in Age-Related Disease
(2024-05-15) Kozak, Mackenzie
Evidence has suggested that the pharmacokinetic mechanisms of metformin may show benefit in the etiology of chronic disease beyond that of diabetes control. This review investigates various clinical trials and analyses the efficacy of metformin in non-diabetic individuals focusing on cardiovascular disease, neurodegenerative disease, and lung neoplasm. Findings suggest an overall neutrality in the effects of metformin across the three analyzed aspects of chronic disease. Specifically, 38% of participants in the cardiovascular disease studies exhibited a favorable response to metformin. These benefits were observed in blood pressure control, left ventricular mass and NT-pro-BNP, with some evidence indicating an improved lipid profile. Additionally, 39% of participants in the neurodegenerative disease trials demonstrated positive outcomes. Significant enhancements were observed in cerebral blood flow within the orbitofrontal region, as well as executive function in Alzheimer’s disease patients. Mechanical power and duration in gait analysis in those with Myotonic dystrophy demonstrated beneficial outcomes. However, among participants with lung neoplasm, only 12% displayed overall benefit with metformin as an adjunct therapy. Findings suggested of six-month progression-free survival; however, conflicting data suggested a negative trend to the same parameter as well as overall survival. These findings may underscore the nuanced effects of metformin across different stages of disease and highlight the importance of considering various factors when evaluating therapeutic potential. In conclusion, while metformin shows promise in certain aspects of chronic disease, further research is needed to provide further insight into metformin’s role in chronic disease and prolonging health span.
Open Access
CASE STUDY INVESTIGATING DAILY FLUCTUATIONS IN CORE AND REGIONAL SKIN TEMPERATURES IN A PERSON WITH TETRAPLEGIA
(2023-05-15) Llew-Williams, Sarah
Introduction: Spinal cord injury (SCI) directly affects to a person’s ability to regulate core temperature, increasing their risk for hypo- and hyperthermia. Cognitive performance is also affected when exposed to low ambient temperatures. Although anecdotal reports of hypo- and hyperthermia exist, there are significant gaps in understanding how frequently core temperature fluctuations daily, and how varied ambient temperatures and exercise affect core temperature. An abbreviated literature review was conducted to partially address these gaps. Objective: To determine the presence of circadian rhythm and the effects of environmental temperature and exercise on the regulation of core temperature in a person with cervical SCI. Methods: An individual with cervical-level SCI had their core temperature continuously recorded over two seven-day periods during a warm (July) and a cold (November) season. Surface skin temperature and daily activity were also recorded in November. Daily minimum-maximum fluctuations were measured as well as periods of hypo- and hyperthermia. Results: Daily core temperature fluctuated an average 2.36°C ± 1.4°C in November, and 1.89°C ± 0.8°C in July. The participant demonstrated 17 instances of sub-normal core temperature and 3 instances of hyperthermia in November. An additional 12 instances of sub-normal core temperature and 12 instances of hyperthermia were observed in July. These findings demonstrate the relatively high frequency and duration of sub-normal and hyperthermic core temperatures experienced by this person with cervical SCI, despite taking steps to maintain a comfortable core temperature. Conclusion: These findings indicate temperature-related life quality of persons with cervical level SCI may be commonly and significantly impaired. This suggests the need to identify better means to monitor and pre-emptively regulate core temperatures in this population under different environmental conditions.
Open Access
CHARACTERISTICS AND OUTCOMES OF INDIVIDUALS WHO ENGAGE IN UFITT AFTERCARE FOLLOWING A MENTAL HEALTH CRISIS PRESENTATION
(2023-05-15) Ward, Julie
Introduction: The Urgent Follow-up Integrated Treatment Team (UFITT) program is the primary mental health follow-up program for individuals attending the Crisis Response Centre (CRC) and Health Sciences Centre emergency department. Although approximately 130 individuals are referred to the UFITT program each month, there is a high rate of no-shows. No research has been done on these individuals referred to UFITT regarding their demographics, characteristics, or what happens after their referral. This study aimed to better understand if there are common clinical and demographic characteristics that can be identified within the individuals that attend aftercare following their UFITT referral, compared to those that do not. Furthermore, it was hypothesized that individuals who do not engage in any part of the UFITT program represent with a mental health crisis faster and more often compared to those who do attend follow-up care through the program. Methods: The study period was from August 1 to November 30, 2022 and included all individuals who presented to either the Crisis Response Centre, emergency department, urgent care, or Crisis Stabilization Unit between August 1 and September 30, 2022 with a mental health crisis who were referred to and accepted by UFITT. These individuals were then divided into two cohorts, those that attended at least one visit to the UFITT program: “UFITT engagement”, and those that did not: “No UFITT engagement”. Using the CRC electronic health record program (Momentum), descriptive statistics were used to compare the two groups on clinical and sociodemographic characteristics at time of referral. Descriptive statistics were also used to compare the groups on the outcome of health service use within their 60-day follow-up period. Results: Of the 122 individuals, 73 (59.8%) did not engage in any UFITT services, while 49 (40.2%) of the remaining individuals engaged in one or more services offered by the UFITT program. The group that did not engage in UFITT follow-up were younger, more often unhoused, and had higher rates of personality disorders, previous hospitalizations, and almost half misused substances. Suicidal behavior did not distinguish the two groups. Twelve (16.4%) patients that had no UFITT engagement and 11 (22.4%) patients that engaged with UFITT services represented within 60 days of their initial presentation. There were more individuals who represented in the first 20 days in the No UFITT engagement group compared to the UFITT engaging group. Discussion: The first hypothesis is partially supported by the dissimilarities observed between cohorts as those in No UFITT were younger, had more previous hospitalizations, and higher rate of substance misuse. The results do not support the hypothesis that individuals who do not engage in UFITT aftercare return to the CRC more often. Although results provide support for the hypothesis that those not engaging with UFITT aftercare represent sooner, it is unknown if this is statistically significant. The No UFITT cohort was additionally observed to have marginally worse health outcomes. More research is needed to determine the significance of these dissimilarities.
Open Access
CHOLINESTERASE INHIBITORS: A LITERATURE REVIEW OF MEDICATION EFFICACY AND SAFETY FOR ALZHEIMER'S DISEASE
(2021-05-15) Wicklund, Ashley
Background: With a steady increase of seniors in Canada’s overall population, geriatric-associated illnesses such as Alzheimer’s disease (AD) will continue to rise. AD is a progressive neurodegenerative disorder that causes plaque build-up in the brain and subsequent cerebral atrophy. Currently, there are no treatments marketed to cure the disease, but rather to provide symptomatic relief. Cholinesterase inhibitors have been approved by the US FDA for mild, moderate, and severe AD. Previous studies have investigated the efficacy and safety profile of these medications. Methods: This literature review assessed existing meta-analyses using the PubMed database from 2015- 2020 using search terms ‘cholinesterase inhibitors effectiveness’ and ‘Alzheimer’s’. Outcomes included adverse events associated and change in cognitive function. Results: Five articles met the criteria for the study. All studies concluded there was at least mild or slight improvement on cognitive function with the use of the cholinesterase inhibitors and risks of adverse events were somewhat increased with their use but were likely mild. Conclusion: Given the mild improvement in cognitive functioning coupled with an overall increase in adverse events when compared to placebo, this risk-benefit relationship demonstrates mild evidence in their utility in Alzheimer’s Disease. However, due to the heterogenicity of the available literature, further high quality studies would be ideal to further explore their efficacy in Major Neurocognitive Disorder (NCD) due to Alzheimer’s Disease.
Open Access
Clinical Efficacy and Timing of Influenza Immunization in Cancer Patients Receiving Chemotherapy
(2015-04) Patterson, Curtis
Background: Cancer patients who are immunocompromised due to the nature of their malignancy or treatment with chemotherapy, are at increased of developing complications related to influenza infections. While the influenza vaccination has been shown to be safe in immunocompromised patients, recommendations regarding when to vaccinate patients with cancer are inconsistent, and there are currently no guidelines in place to guide clinical decision-making. This review seeks to assess the efficacy of the influenza vaccine and the proper timing of its administration to immunocompromised adult patients due to cancer. Methodology: A literature search was done of studies that assessed humoral seroconversion after vaccination and clinical effectiveness of the influenza vaccination in immunocompromised cancer patients. The studies included patients with solid tumors, hematological malignancies, and those who were post hematopoietic stem cell transplant. Results: The literature indicates chemotherapy patients generally showed decreased immune response to vaccination, when compared to healthy patients who had not been treated with chemotherapy. However, the aforementioned cancer patients did show adequate seroconversion and patients vaccinated early in their chemotherapy cycle (Day 4-5) as opposed to later (Day 16) had a greater serological response to the influenza vaccinate. Conclusion: The influenza vaccine has been confirmed to produce adequate overall antibody response in 3 chemotherapy patients and to be safe and effective. However, literature indicates it should generally be given early in relation to the chemotherapy cycle to achieve maximum effectiveness. The data supporting this assertion is limited, and the topic requires further study. In view of this, clinicians should consider the potential benefits of influenza immunization for patients being treated with chemotherapy.
Open Access
Complementary and integrative medicine best practice guidelines: changing oncology health care providers' knowledge, attitudes and practices
(2020) Hayward, Emilie
Complementary and integrative medicine (CIM) use is prevalent among cancer patients and oncology health care providers (HCP) need to be knowledgeable and address CIM use to provide safe, patient-centred care. This study assessed how the implementation of a CIM best practice guideline through an educational intervention and a CIM assessment form affected the knowledge, readiness, attitudes, and practices of 31 oncology HCP at a Canadian cancer centre. Using a before-after study design, participants’ self-reported knowledge, readiness, attitudes, and practices around CIM were assessed prior to the intervention and again three months later. After completing the education intervention and implementing the CIM assessment form over the 3-month time period, participants reported a significant improvement in CIM knowledge, readiness to support cancer patients’ CIM decisions, and willingness to consult with another HCP about CIM. However, participants’ attitudes towards CIM, and clinical practices such as asking about CIM use and providing CIM decision support did not significantly change. These findings highlight the importance of health professional education related to CIM in cancer care setting and the value of a CIM assessment tool to strengthen oncology HCPs’ knowledge about CIM, and increase their readiness to address cancer patients’ CIM use. Such standardized training also holds the potential to shift oncology HCPs’ clinical practice related to CIM and provide more comprehensive and safer patient care.
Open Access
Connection between Alzheimer’s Dementia and Postmenopausal Women: A Literature Review Assessing the Impact of Hormone Replacement Therapy on Cognition
(2024-05-15) Zamonsky, Arianna
Background: Dementia has been labelled an epidemic by the Alzheimer’s Society of Canada and is a significant public health concern for the aging population. Compared to the rest of the population, postmenopausal women are significantly impacted by Alzheimer’s Dementia (AD). Estrogen is a protective factor for brain atrophy, and low estrogen levels have been linked to a decline in cognition. Although studies have identified hormone replacement therapy (HRT) to be helpful for vasomotor symptoms (i.e. hot flashes) and genitourinary syndrome, there is no clear answer as to whether improving estrogen levels with HRT in postmenopausal women will prevent cognitive decline. Methods: The literature review includes English text articles from the PubMed database using the search terms ‘Hormone Replacement Therapy’ AND ‘Dementia’ AND ‘Post menopause’. Only RCT and clinical trials from 1999-2024 were included in this study. A total of ten articles were included and analyzed for this study, Results: Most studies used a reliable and valid cognitive assessment tool to assess cognitive function pre-and post-treatment. Conjugated equine estrogen (CEE) and 17 beta-estradiol were the most common. The studies have mixed results on how HRT impacts cognitive function. Conclusions: Given the number of mixed results from each study, the variability of HRT (i.e. dose, route, duration) and uncontrolled variable risk factors for dementia, the outcomes of this relationship need to be further investigated. Due to the heterogeneity of each study, further clinical trials will need to explore how HRT impacts cognitive performance in postmenopausal women.
Open Access
COVID-19 and the Disproportionate Impact Seen on the BIPOC Community A literature Review
(2022-05-15) Singh, Simran
Objectives: To highlight the ongoing health inequities experienced by the BIPOC community in Canada through the data collected from the COVID-19 pandemic. To demonstrate the disproportionate effect of COVID-19 on the BIPOC community, through the negative outcomes such as infection rates, hospitalization, ICU admission, and death. To correlate which non-medical factors contributed to the outcomes seen and what needs to be accomplished to mitigate future health crises. Methods: Literature review using the platform PubMed. Key terms used included “COVID-19 pandemic outcomes, COVID-19 and the BIPOC community, disproportionate outcomes of BIPOC community COVID-19, social determinants of health and COVID-19, healthy inequity and COVID-19.” Subsequently, 11 articles were deemed suitable for use in this review. Studies were focused on North American studies, particularly in Canada, but were not restricted to such. Results: The literature review identified that BIPOC individuals experienced disproportionate outcomes during the COVID-19 pandemic. They held greater infection rates, hospitalizations, and death compared to the white population of Canada. The non-medical factors which contributed to the poor outcomes seen during the pandemic included employment, neighbourhood, SES, and systemic racism in health care practices. Conclusions: The social determinants of health associated with the negative outcomes seen during the COVID-19 pandemic highlight changes that need to be taken to protect vulnerable communities. Negative outcomes can be prevented through collaborative measures to create safer employment strategies, safer neighbourhoods, and safer health care practices with the goal of eliminating systemic racism and creating health equity.
Open Access
COVID-19 VACCINE HESITANCY TRENDS AMONG CANADIAN HEALTHCARE WORKERS
(2023-05-15) Katako, Audrey
The novel coronavirus has been responsible for over 6 million deaths in the three years since the pandemic began. As vaccination efforts began in December of 2020, a wave of misinformation curtailed efforts to vaccine eligible adults across the globe, with healthcare workers not being immune to being influenced in this way. COVID-19 vaccine hesitancy among Canadian healthcare workers remains a poorly studied area. This systematic review aims to investigate what findings exists in the literature at present, and identify avenues for future research into strategies to combat this. A systematic literature review was conducted into existing publications using publicly available databases for article selection. Studies were systematically screened using the Covidence review platform and extracted data were analyzed in Microsoft Excel and International Business Machines’ Statistical Product and Service Solutions. Results identified a disparity between physician and nursing vaccine uptake rates as well as a dearth of information regarding physician assistant vaccine hesitancy. Male sex, age over 50 years old and employment in rehabilitation centres were all correlated with increased rates of vaccine acceptance. Potential areas of future research can help to highlight and test strategies to mitigate healthcare worker vaccine hesitancy which can be used to encourage improved uptake in future health crises.
Open Access
Current Impacts of The Health at Every Size Model Upon Adolescent Health Outcomes: A Literature Review
(2023-05-15) Wooldridge, Joelle
Introduction: Child and adolescent obesity is a global concern. The number of youths with obesity is increasing exponentially with subsequent increases in obesity related co-morbidities. Current approaches to treat obesity include weight-normative style interventions which provide no longterm benefits and have increased risk of physical and psychological harms. The Health at Every Size (HAES) model is a safe and inclusive alternative to traditional diet and exercise prescriptions. This approach has been shown to improve patients’ overall health within adult populations. Based on these prior studies, HAES shows great promise for use in adolescent health. Objective: The purpose of this review is to consolidate the current literature available pertaining to use of Health at Every Size and other weight-inclusive strategies within the adolescent population. Through analysis of current evidence, this literature review aims to determine which of the five principles of the Health at Every Size model are effective for improving overall health in the adolescent population. Methods: A literature search using PubMed, Wiley Online Library and the University of Manitoba Online Library databases was conducted using key terms pertaining to Health at Every Size ideology and its associated principles. Eleven articles and one clinical practice guideline were found to meet the inclusion criteria and were included in this literature review. Results: Common themes found across the twelve documents reviewed included positive outcomes in both mental health and sustainable personal care practices in the weight-inclusive intervention groups. Both weight-inclusive and weight-normative groups found improvements in physical health measures. There were minimal improvements in participant weight biases and stigmatization in intervention groups. Conclusion: The Health at Every Size approach to adolescent obesity and health enhancement is effective for improving physical and psychological health. In addition, it teaches sustainable health practices with very little risk to the patient. Adolescence is a time of great change and vulnerability and using an approach that is protective of long-term physical and psychological health outcomes is of the utmost importance. Further research is required on promotion and incorporation of this strategy into primary adolescent care.
Open Access
Current Management of Opioid Use Disorder and Barriers to Prescribing Opioid Agonist Therapy by Primary Care Providers in the Interlake-Eastern Health Region
(2022-08-26) Devaney, Brittany
Background: Opioid agonist therapy (OAT) is the first-line treatment for opioid use disorder. It has traditionally been provided through specialized addictions clinics, but more recently, there has been a push for primary care providers (PCPs) to take on this service. This has been met with reluctance by providers who cite a lack of adequate time, knowledge, and remuneration, among other barriers. Objective: The primary objective of this study was to explore provider-reported attitudes on and barriers to integrating OAT into primary care, specifically within the Interlake-Eastern Health Region (IERHA). The aim was to improve regional access by generating actionable recommendations to address these barriers. A secondary objective was to explore how PCPs currently manage opioid use disorder. Methods: This study employed a quality improvement design. Participants were purposively sampled from PCPs in the IERHA who did not have licensure to prescribe OAT. Structured individual interviews were conducted from May to June 2022. Transcripts were analyzed for overarching themes as they related to the study objectives. Results: Fourteen participants were included in the study. Fee-for-service providers were largely unwilling to prescribe OAT in the primary care setting and cited a multitude of factors for this such as lack of adequate remuneration, time, and perceived need. Notably, many providers were frustrated with the limited nature of mental health resources and expressed a sense of futility in providing OAT without these supports. Conclusion: Overall, fee-for-service providers in the IERHA expressed a myriad of barriers with respect to their unwillingness to prescribe OAT. At present, priority should be placed on contracted providers in expanding primary care access. Fee-for-service providers would be best utilized for maintenance prescriptions or OAT induction in a small number of less complex patients.

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