Track 6

Track 6

6.1. Improving Family Planning & Reproductive Care Outcomes for Women in Pakistan.
Abdullah Haroon (1), Rafat Jan Rukanuddin (2), Karyn Kaufman (3,4), Eileen K. Hutton (3,4)
(1)MD Program, University of Ottawa, Ottawa, Ontario, Canada
(2)National University of Medical Sciences, Rawalpindi, Punjab, Pakistan.
(3)McMaster Midwifery Research Center, McMaster University, Hamilton, Ontario, Canada
(4)Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada.

Introduction: Every year in Pakistan, a country of more than 200 million people, there are 4 million unintended pregnancies of which 25% end in induced abortion. 50% of these abortions are performed by midlevel providers with limited training. Such unsafe abortions lead to complications and contribute to 12% of all maternal deaths. A low contraceptive prevalence rate (41%), abortion stigma, and negative healthcare provider attitudes contribute to the high number of abortions. Objectives: To help mitigate these factors, an eBook targeted to midwives was produced. This knowledge translation project, funded by Grand Challenges Canada, was led by McMaster University and the Midwives Association of Pakistan with collaboration from SOGC. Methods: This is the first midwifery eBook developed exclusively for Pakistan and uses an innovative design to provide comprehensive information pertinent to family planning methods, post-abortion care, and counseling approaches. The eBook takes sociocultural norms and practices of the country into account and while it is written in English, it also provides 15 audios and 7 videos, recorded by the project team in Urdu, to facilitate the understanding of complex concepts. Other unique features include built-in self-testing and a navigation toolbar to minimize scrolling between chapters. Results: Upon completion, the eBook was pilot tested at 16 different workshops in 5 major cities of Pakistan, with a total of 532 participants comprising midwifery teachers, students, and practicing midwives. A mixed methods approach to the evaluation of the eBook was adopted. The feedback was overwhelmingly positive. Participants found the eBook’s design appealing and user-friendly, and its content easy to grasp and relevant to their practice. Conclusion: The eBook will continue to be disseminated free of cost to all learners. Preparation of a second edition is underway which will take into account the feedback collected during the pilot workshops.

Keywords: Ebook; women’s health; midwifery; contraception; unsafe abortion

6.2. Actinomycin D: From Antibiotic to Anticancer agent, to Possible Myotonic Dystrophy Type 1 Therapy?
David Ripsman (1), Karen Chiang (2,3), Pei Wang (4), Rob Macgregor (4) and Christopher Pearson (2,3)
(1) Faculty of Medicine, University of Ottawa, Ottawa, ON
(2)Faculty of Molecular Genetics, University of Toronto, Toronto, Ontario.
(3)Genetics and Genome Biology, The Hospital for Sick Children, Toronto, Ontario
(4)Faculty of Pharmacy, University of Toronto, Toronto, Ontario.

I Introduction: Myotonic dystrophy type 1 (DM1) is a progressive neuromuscular disease. DM1 is driven by a CTG trinucleotide repeat (TNR) expansion in the DMPK. Healthy individuals have short repeats (50-6000 repeats), which continue to expand, driving disease progression and severity. Hence arresting ongoing mutation could be beneficial. Expansions arise by aberrant processing of slipped-CTG DNA structures. Actinomycin D (ActD) binds to CTG repeats, blocking transcription of toxic-RNA. Our group demonstrated a selective CAG bindng compound, NA, bound selectively to a CAG repeat and drove contractions of an expanded pathogenic repeat in vivo. ActD’s binding to the CTG repeat may similarly promote contractions. Objective: To determine if ActD can selectively act on CTG repeats. Methods: ActD binding to CAG, CTG and DNA without repeats was measured by circular dichroism (CD). Effect of ActD on DNA repair protein binding to slipped-CTG, polymerase synthesis through CAG, CTG or no repeats and inhibitory effect on repair of a slipped-CTG and G-T mismatches in cell extracts was quantified. Results: CD analysis demonstrated that ActD preferentially binds CTG repeats over CAG or no repeats. ActD binding caused structural changes in all hairpins. ActD selectively inhibited repair protein binding to slipped-CTGs over G-T mismatches, blocked polymerization through CTG repeats over CAG and nonrepetitive DNA and inhibited repair of slipped-CTGs, which was more sensitive to ActD than inhibition of repair of G-T mismatches. Conclusion: ActD’s ability to selectively bind to CTG slip-outs, prevent binding of repair proteins, and block slip-out repair suggests ActD may reduce the lengths of the pathogenic DM1 repeat expansions, similar to NA. This effect may occur in addition to ActD’s known effect of reducing levels of toxic RNA production in DM1 models. ActD also showed some off-target effects that should be explored in future studies.

Keywords: Huntington’s disease, Actinomycin D, Trinucleotide repeats, DNA binding, DNA repair

6.3. Speed and Load Validation of a Refined Intravaginal Dynamometer Design.
Ana Brennan* (1, 2), Cat Czyrnyj (1, 2), Eric Lanteigne (1), Layla Mitri (1), Yousef Bader (1, 2), Dimtry Lomovtsev (1), Linda McLean (2, 3)
(1)Faculty of Engineering, University of Ottawa, Ottawa, ON
(2)Ottawa Carleton Institute of Biomedical Engineering, University of Ottawa, Ottawa, ON
(3)School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON.

Intravaginal dynamometers (IVDs) are the gold standard for assessing the forces generated by female pelvic floor muscles (PFMs). While most IVDs use one load cell instrumented on the posterior arm, we refined our design to include bilateral instrumented arms opened by two linear actuators. We hypothesized that an output display from two load cells would minimize error introduced by imbalanced loading between the arms. The study purpose was to validate the speed control and load output of our improved IVD using a conventional (no visual feedback) and an optimized (The user attempts to hold the IVD such that the displayed forces from the two arms are equal) protocol. Load measurements were validated against an Instron® Universal Tester using the posterior arm and the average of the two arms (APavg) over the normal operating range (0-24N). Device opening speeds were validated over the full range of opening distances (25-50mm) and speeds (10-50mm/s) with the arms loaded. Linear regression analyses were performed (α=0.05). Load validation: Slopes (β1) for forces measured in the optimized protocol were approximately one (1.05<β1<1.159, p<0.001) with no significant intercepts (β0) and excellent linear fit (0.973<adjR2<0.979). Despite excellent model fit ((0.901<adjR2<0.955), slopes for forces measured with the conventional protocol were substantially lower (0.668<β1<0.903; p<0.001) and were offset (posterior arm: β0=2.618N, p<0.001; APavg: β0=1.121N, p=0.014). Speed validation: Regressions between specified and measured speed generated excellent model fit (0.958<adjR2<0.991). Slopes for opening speed were lower at the lowest (25mm) opening distance (β1=0.859, p<0.001) and were approximately one at all other distances (1.007<β1<1.133, p<0.001); significant intercepts were observed for opening distances above 30mm (-2.232<β0<-4.170 mm/s; p<0.01). These results suggest that this new IVD design generates valid force and speed values during bench testing. Positioning the dynamometer through visually balancing the forces between the arms results in more accurate force outcomes.

Keywords: Biomechanics, dynamometer, pelvic floor, muscle strength, validity

6.4. Learning Histology in the 21st Century: “Microscopes or No Microscopes”.
Safaa El-Bialy (1,2), Onkar Bhanushali* (2), Xu Chi (2)
(1)Department of Innovation in Medical Education, University of Ottawa, Ottawa, ON
(2)Faculty of Medicine, University of Ottawa, Ottawa, ON.

Introduction: Despite changes in medical school curriculums causing a decrease in focus on the basic sciences, histology remains an indispensable science to be taught. The light microscope has been the primary laboratory instructional tool (Hussein et al, 2005). The long-term trend of declining laboratory teaching hours in medical schools has led to an increase in the use of various other forms of instruction (Bloodgood and Ogilvie, 2006). Objectives: Characterize the attitudes and perceptions of University of Ottawa pre-clerkship medical students on its histology curriculum and the use of light microscopy versus digital images in histology learning. Methods: After doing a pilot study (n=42/320), approximately 160 pre-clerkship second year medical students at the University of Ottawa were sent a survey which contained a combination of Likert-style, multiple choice, and short answer questions. Results: 58 students participated in the survey. 77.6% of students stated that histology is important in developing the knowledge base required for them to be a competent physician. 84.5% stated that their completion of the objectives was facilitated by classroom sessions. Although 58.6% of students did not participate in microscope sessions and 75.9% of students preferred the digital images to the use of light microscopes for learning purposes, 48.2% of students agreed and 43.1% of students were neutral that the opportunity to participate in histology microscope sessions should remain available to students. While 44.8% of students valued using a combination of microscopes and digital images, 41.4% were neutral. Conclusion: While microscopes may not be the preferred method of histology learning, pre-clerkship medical students still appreciated their involvement, and valued using a combination of microscopes and digital images for histology learning. This is beneficial to maintaining a balanced medical curriculum for histology.

Keywords: Medical education, Histology, Light microscopes, Digital images, Basic sciences

6.5. Let’s Talk about Sex: Differences in Healthcare use in Men and Women Living with Dementia.
Tammy X. Bui*(1), Geneviève Arsenault-Lapierre(1), Claire Godard-Sebillotte(1), Nadia Sourial(1), Louis Rochette(2), Victoria Massamba(2), Isabelle Vedel (1)
(1)McGill University.
(2) Institut national de sante publique du Quebec.

Background and Objectives: As the Canadian population ages, challenges have emerged with the quality and healthcare utilization of services for persons living with dementia (PWD). These challenges may be exacerbated when we consider the sex inequalities. A disconcerting trend in sex differences has arisen among older adult women, where they are more disadvantaged compared to older men when seeking and receiving treatment. The aims of this study are to describe the quality of dementia care and healthcare utilization among PWD by sex. Methods: The study will employ a repeated annual cross-sectional cohort design over 15 years using linked administrative databases to examine health service use data. All incident cases of dementia in community-dwelling persons aged 65 and over occurring between April 1st and March 31st for each year will be included. Dementia diagnosis will be ascertained using a validated algorithm. Quality of care indicators include: most regularly seen doctor (Overall UPC index), hospitalization for ambulatory care sensitive conditions, continuity of care , degree of coordination (30-day hospital readmission), first recording of dementia diagnosis in primary care, potentially inappropriate medication (e.g. Benzodiazepines, anti-psychotics), and place of death. Healthcare utilization indicators include: emergency department visits, hospitalizations, alternate level of care, visits to primary care physicians and cognition specialists, long-term care admission and mortality. Data will be stratified by sex. Anticipated Results: We will describe trends in the quality of care and healthcare utilization indicators for 237,259 people (62.7% are women). Patient characteristics as well as indicators of health service utilization will be described stratified by sex. For each indicator, graphs will be presented with an annual rate, adjusted for age and follow-up time in the study. Conclusion: Addressing the knowledge gap in the quality of care and healthcare utilization in PWD by sex is essential to clinicians to employ gender-specific care for PWD.

Keywords: Dementia, health service use

6.6. The implementation and distribution of an Information Technology maturity survey in Ontario’s long-term care sector: review and survey development.
Ramtin Hakimjavadi* (1); Gregory L Alexander (2); Mary Helmer-Smith (3); Justin Joschko (3); Sathya Karunananthan (3); Celeste Fung (4,5); Clare Liddy (3,5)
(1)Faculty of Medicine, University of Ottawa, Ontario, Canada
(2) School of Nursing, Columbia University, New York, New York, USA
(3) Bruyère Research Institute, Ottawa, Canada
(4) St. Patrick’s Home of Ottawa, Ottawa, Ontario, Canada
(5) Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada.

Long-term care (LTC) homes serve a vulnerable population that has been disproportionately affected by COVID-19. Health information technology (HIT) has the potential to improve the quality, safety and efficiency of care for LTC residents. However, the level of HIT adoption across Ontario’s LTC homes is inconsistent and poorly understood. An assessment of information technology (IT) maturity in Ontario’s LTC homes is therefore needed to quantify gaps and to inform programs attempting to implement more integrated HIT systems. A scoping literature search was conducted on PubMed to understand the evidence base for LTC HIT adoption in Ontario and to identify existing survey instruments for measuring HIT adoption in LTC facilities. Key search terms included “health information technology” and “long-term care”. Results were screened for relevant studies published after 2010, followed by a search of reference lists to capture additional articles published before 2010. In consultation with stakeholders, several key components of an ideal survey measuring HIT adoption were identified, and a validated survey instrument measuring IT maturity and the stage of IT maturity in LTC homes was selected. As the survey was developed in the US, two independent reviewers screened and took steps to adapt it and ensure it effectively assessed HIT in a Canadian LTC context. In collaboration with the original developer of the survey, several key changes were made including modifying the language, adapting demographic items to Ontario’s facilities, and adding items to assess use of IT tools specific to Ontario’s LTC homes.

Keywords: Information technology, long-term care, healthcare survey, survey development, provincial.

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