A day treatment program is an important component on the continuum of care for young people with moderate to severe mental health issues. The aim of this research was to investigate whether adolescents who participate in a structured day treatment program demonstrate greater mental health gains than adolescents receiving less intensive outpatient treatment. In addition, the research investigated whether mental health gains were related to intake diagnosis and whether parents reported higher levels of mental health gain than the client in their self-report ratings. The setting for the research was The Cottage, an adolescent day treatment program, run by the Child and Adolescent Mental Health Service (CAMHS) in the Australian Capital Territory. The program provides intense multi-faceted treatment within a therapeutic milieu environment for clients aged 12-18 years with moderate to severe mental health issues. The study involved a Day Program group of 22 clients from The Cottage and included a comparison group of 20 outpatient clients from CAMHS. Results indicated that individuals in both treatment approaches had statistically significant reductions in anxiety and depression symptomology and improvements in outcome measures, but there were no significant differences between the two treatment groups. The data indicated a statistically significant difference in return to school rates, whereby approximately 82% of individuals in the day treatment program had returned to school/employment, whilst only 30% of individuals in outpatient treatment had returned to school/employment within three months post treatment. The results did not demonstrate that the degree of mental health gain was dependent upon intake diagnosis and although not statistically significant, parents rated their children as more severe in terms of psychopathology than the client.

This survey sought to determine the public perceptions and knowledge of counsellors on the Gold Coast and Northern New South Wales. Comprising of two studies, this paper extended on previous research conducted by Rogers and Sharpley (1983), Sharpley, Rogers and Evans (1984), and Sharpley (1986). Study I included a representative sample of 226 members of the general public, plus a sample of 105 medical practitioners. Respondents were asked to complete a 24-item questionnaire regarding their perceptions and knowledge of counsellors. Four questions were designed to investigate whether or not distinctions could be made between counsellors, psychologists, psychiatrists and social workers. An additional seven questions were included for only medical practitioners to answer and sought to determine whether or not, and under what circumstances, medical practitioners would refer to a counsellor. These questions were also concerned with establishing what value medical practitioners would place on having a counsellor working as a team member of their practice.The results of Study I indicated that both the general public and medical practitioners viewed counsellors positively. Results further showed that the confusion and lack of knowledge reported by respondents from the last Australian study conducted by Sharpley (1986), was no longer evident. Study II was designed to assess the validity of the reported sources that respondents from Study I indicated that they would utilise in order to access a counsellor. Three samples were involved in Study II. The first sample comprised of 60 medical receptionists, the second sample included 25 counsellors listed in the yellow pages telephone directory, while the third sample involved 6 community centres listed in the yellow pages telephone directory. However, the results of Study II showed that counsellors were not as readily accessible from these sources as was perceived by respondents from Study I. Hence, it could be concluded that counsellors need to involve themselves with promotion and education if they are to maintain the positive regard indicated by the respondents of this study.

Osteoporosis is a major public health concern, affecting over 200 million people worldwide. There is valid evidence outlining how osteoporosis can be diagnosed and managed, but gaps exist between evidence and practice. Graham’s “Knowledge to Action” (KTA) process for knowledge translation and the Medical Research Council (MRC) framework for complex interventions were used to address these gaps. The first 4 KTA steps were collapsed into 3 phases of the PhD research plan. In PhD Phase 1, a systematic review was conducted to identify tools that facilitate decision making in osteoporosis disease management (DM). Results showed that few DM tools exist, but promising strategies were those that incorporated reminders and education and targeted physicians and patients. PhD Phase 2 used the findings from the systematic review and consultation with clinical and human factors engineering experts to develop a conceptual design of the tool. Multiple components targeted to both physicians and patients at the point of care, and which could be used as a standalone system or modifiable for integration with electronic health record systems were outlined. PhD Phases 3a and 3b were devoted to the assessment of the barriers to knowledge. In Phase 3a, a qualitative study of focus groups was conducted with physicians to identify attitudes and perceived barriers to implementing decision support tools in practice, and to identify the features that should be included in the design. Findings from 4 focus groups combined with aging research, and input from design and information experts were used to transform the conceptual design into a functional prototype. In Phase 3b, each component of the prototype was tested in 3 usability evaluation studies using an iterative, participant-centered approach to assess how well the prototype met end users’ needs. Findings from the usability study informed the final prototype, which is ready for implementation as part of the post PhD plan to fulfill the requirements of the remaining steps of the KTA and MRC frameworks.

Background: Considerable attention has been paid to evaluating the roles and relationships of professionals participating in team-based or collaborative practice; however, less attention has been paid to exploring the patients’ views and impact of such practice despite claims of it being patient-centred. Objectives: To examine the relationship between patient and provider characteristics and patients’ ratings of measures of quality of care and integration, and to explore the patient views of care delivered in a patient-centred collaborative study involving chiropractors and physicians. Design: Cross-sectional survey. Method: A mixed methods sequential approach with a quantitative priority was used in data analysis. Quantitative data were collected from 2597 patients participating in a collaborative study involving chiropractors and physicians and 530 patients attending chiropractors not involved in collaborative care. All participants presented with musculoskeletal pain. The Primary Care Assessment Survey (PCAS) was modified and scores from six of its scales were used to assess attributes of quality patient-centred care between the two study groups. Qualitative transcript-based data from six purposefully selected focus groups was analyzed using an interpretivist approach. Results: The revised PCAS demonstrated acceptable psychometric properties. Patients in both study groups received quality, patient-centred care. Patients’ reporting being completely satisfied and feeling improved by their care was positively associated with rating chiropractors as high performers on all scales. Survey findings were confirmed in focus groups of study patients. Patients appreciated positive interpersonal interactions, sharing in the treatment decision-making process, having a choice in provider and treatment, and the provision of holistic care. Patients perceived that collaboration between chiropractors and physicians varied, favouring those who were co-located. Patients with chronic or co-morbid conditions desired greater involvement in their care. Patients felt sharing of clinical information was more important than co-location as facilitating coordination and integration of collaborative care. Conclusion: The study suggests that patients suffering from musculoskeletal pain benefit from interprofessional collaborative care that includes improved access to and choice of providers and treatment options, as well as enhanced interprofessional communication and coordination of care.

The purpose of this study was to explore the relationship between the formalization of inter-organizational partnerships and collaboration among staff members working together across primary care, mental health and addition organizations to provide services to adults with complex mental health and addiction needs. Phase I of the study provided an environmental scan of existing partnerships among Family Health Teams (FHTs) and Community Health Centres (CHCs), and the Mental Health and/or Addiction (MHA) organizations they partner with, in the province of Ontario (Canada). Phase II explored the relationship between formalization and a) administrative collaboration and b) and service delivery collaboration. The hypotheses proposed that staff members who are part of formalized partnerships would report higher levels of collaboration. Phase III explored how formal and informal partnerships and collaboration are experienced by the administrative and service provider staff members who work across FHTs, CHCs and MHAs organizations. Using a mixed methods approach, data were collected using electronic surveys and telephone interviews. The results of Phase I indicated that FHTs and CHCs in Ontario have between 1-3 partnerships with MHA organizations. Most are informal partnerships, have existed for less than 5 years, and most staff members (partners) interact on a monthly basis. The quantitative results of Phase II showed no significant relationship between formalization and either form of collaboration. The qualitative findings from Phase III provide two key contributions. First, the results of the interviews may help explain why collaboration was not higher in formalized partnerships, as demonstrated by the range of advantages and disadvantages experienced by administrators and service providers in both formal and informal partnerships. Second, the findings illuminate factors related to the process of creating and/or formalizing partnerships, suggesting that there may be other factors that mediate or have a direct impact on the relationship between formalization and collaboration. By bringing together the study findings, the study addresses a gap in the literature by proposing a pathway through which formalization may be associated with collaboration. The results of the study provide opportunities for future research to help improve the quality and accessibility of services to adults with complex mental health and addiction needs.

An acute demyelinating syndrome (ADS) in a child may be a monophasic illness or may represent the incident attack of multiple sclerosis (MS) – an inflammatory demyelinating neurodegenerative disorder affecting the brain, spinal cord and optic nerves. The central objective of this dissertation was to identify MRI parameters present at ADS that predict MS diagnosis. A scoring tool was first created containing 14 parameters identified from the literature and demonstrating substantial inter-rater agreement (Cohen’s kappa values ≥0.6). Children aged <16 years were enrolled at incident ADS and are currently followed for five years at 23 Canadian centers. Standardized MRI scans were acquired at onset and serially. MS was defined based on the occurrence of a second demyelinating attack or MRI evidence of new lesions in accordance with McDonald criteria for dissemination in time. Multivariable Cox proportional hazards regression models were used to identify MRI parameters that predicted MS diagnosis. Over 1100 MRI scans in 284 children with ADS were evaluated. To date, 57(20%) children have been diagnosed with MS. For those that developed MS, the median (IQR) time from incident attack to diagnosis was 6.2 (4.7-11.1) months. The presence of ≥1 T1-hypointense lesion (HR 20.6, 95% CI 5.5-78.0) and ≥1 T2 periventricular lesion (3.3, 1.3-8.8) were associated with an increased likelihood for MS diagnosis (sensitivity 84%, specificity 93%, PPV 76%, NPV 96%). The predictive parameters were validated in an independent Dutch cohort of 45 children with ADS (n=15, 33% MS): sensitivity 93%, specificity 87%, PPV 78%, NPV 96%. Finally, it was determined that the 2010 McDonald criteria are applicable for diagnosis of pediatric-onset MS diagnosis in older children with non-ADEM presentations. The work embodied herein emphasizes the value of MRI in predicting MS diagnosis in children with incident ADS. Early identification of children with MS is important for planning clinical care and will be valuable in future pediatric MS treatment trials.

Non-Small-Cell-Lung Cancer (NSCLC) patients with mutations in EGFR have greater response rates and survival when treated with the tyrosine kinase inhibitor erlotinib. To elucidate how erlotinib inhibits EGFR, this study included: 1) inhibiting an EGFR mutant cell line to reveal EGFR regulated phosphotyrosine (pY) sites; 2) comparing erlotinib sensitive and insensitive cell lines to reveal functionally important pY sites; 3) revealing novel pY sites. Observations were collected using the LTQ-Orbitrap mass spectrometer. This study identified five new EGFR regulated pY sites and five pY sites that correlated with erlotinib sensitivity; the majority of them are related to cell-cell interactions. By comparing all observed pY sites to the Phosphosite and PhosphoELM database, our results included 67 unregistered sites. This study has identified novel biomarkers and potential therapeutic targets, many of which were associated with cell migration and adhesion function. Further functional validation is necessary.

The objective of this thesis was to examine the role of ps20 in virus infections. We provide evidence that MHV-1 infection resulted in increased lung viral titers in ps20-/- mice. These data highlight an antiviral role for ps20 in MHV-1 infection. We also observed an increase in the percentage of GR1+ neutrophils infiltrating the BAL and in the lung draining lymph node of ps20-/- mice, on day 2 post-infection. In vitro, gene expression analysis identified an increase in expression of CXCL1 and CXCL2 in MHV-1 infected ps20-/- fibroblasts. These data suggest a role for ps20 in regulating neutrophil chemotactic factors, and migration. Next, we examined influenza A/WSN/33, and provide evidence that ps20 functions as a proviral factor. In vivo, ps20-/- mice infected with influenza A/WSN/33 exhibited decreased lung viral titers. These data suggest that ps20 functions as either a proviral or antiviral agent, dependent on the infecting virus.

There is limited information regarding the provision of rehabilitation services in long-term care (LTC) to meet the needs of residents living with stroke. This project assessed service availability within Ontario-based homes and examined the relationship between service comprehensiveness and functional outcome for residents with rehabilitation potential. The first phase involved survey development and distribution to a sample of homes to assess comprehensiveness. The second phase linked survey findings and administrative data to determine whether comprehensiveness (measured using an index score derived from survey responses) was correlated with change in functional status using linear regression modeling. There was marked variability in service comprehensiveness across responding homes (n=32 of 154 homes; 21%). No significant linear correlation was shown between comprehensiveness and change in ADL function (n=178). Although our study failed to show an association, rehabilitation should be considered an important aspect of LTC programming and should adhere to practice standards where possible.

Objectives: CDUs have been implemented to address ED wait times. The objectives of this study were to investigate ED team members’ perceptions on the implementation of CDUs as well as the impact of CDUs on the delivery of emergency care. Methods: A case study design and change theories found in the literature were used to investigate the implementation of CDUs in four hospitals. Semi-structured interviews with ED team members led to the creation of themes for analysis. Results: Analysis demonstrated that patient flow, work processes and communication contribute to the type of CDU set-up, whether it is a co-located or virtual CDU. The sustainability of CDUs relies on communication and a common vision in the fulfillment of purposes and goals. Conclusions: This study contributes to the understanding of the implementation of CDUs. The application of change frameworks assists with the identification of key success factors for implementing and sustaining change.