Once our PSI Knowledge Translation (KT) Fellows take off from the starting line, they make strides as they move their knowledge translation activities and research program forward. As the finish line becomes clearer in their sight, we asked our fellows some questions to share their progress thus far, and what they look forward to in the remainder of their KT Fellowship.

What are some of your accomplishments from the KT Fellowship thus far?

The overarching objective of my research program, and my PSI Mid-Career KT Fellowship plan, is to use best practices in knowledge translation to support evidence-based implementation of effective prehabilitation for surgical patients in Ontario. I’m excited to report that, thanks to support from key funders like PSI, our team has made meaningful advancements toward this goal!

First, we have recently enrolled our 850th and final participant into the PREPARE Trial, an 11-center randomized controlled trial that is testing whether a home-based prehabilitation program specifically designed with, and for, older patients with frailty will lead to lower rates of patient reported disability after surgery and prevent post-surgery complications. This is currently the largest prehabilitation trial ever completed, and one of the largest trials ever specific to frailty. By early fall 2024 we will have final results, and our findings should immediately impact how we provide preoperative care for some of our highest-risk and most vulnerable surgical patients.

Next, through completion of this 850-patient trial carried out in hospitals throughout Ontario and across Canada, we’ve learned a lot about the practical aspects of delivering prehabilitation. Lessons learned include: (1) how to identify and enroll patients in prehabilitation programs far enough in advance of surgery that they have time to meaningfully improve their health before they go to the operating room; (2) how to deliver home-based prehabilitation to a diverse patient population spread widely across geographic areas; (3) what barriers patients face in trying to complete prehabilitation at home; and (4) how to support patients who have a variety of barriers to improving their exercise and nutritional behaviors in having high levels of adherence to their prehabilitation programs. Recognizing that an important secondary objective of our PREPARE trial would be not only to estimate whether prehabilitation works, but also to learn how to make it work most effectively, we had built structured assessments into our trial that are helping us to develop an evidence-based ‘prehabiliation playbook’ to support future implementation. As the PREPARE Trial winds down, we are beginning to bring these important process data and lessons learned together into a format that can inform our team’s future work, as well as the field of prehabilitation generally.

As our team’s approach to research is to constantly learn from our own experiences and the work of others in the field, while partnering with the patients, clinicians and health system leaders who will be directly involved in prehabilitation implementation, a big part of our work involves reviewing, analyzing, and synthesizing data from across the field of prehabilitation. This approach lets us identify key areas where new and more research is needed, while also allowing us to identify aspects of prehabiliation that are ready for implementation. Since being funded by PSI, our Canadian Prehabilitation Knowledge Network has completed a systematic review of all prehabilitation randomized trials ever conducted. In fact, we are now beginning to partner with groups that are involved in writing clinical practice guidelines to transform our review into a ‘living’ systematic review. Using this approach, every six months we update our search and identify all of the newly published prehabilitation trials. This allows us to have an up to date database of trials (currently numbering over 250) that our team, our partners and collaborators can use to inform their research, practice and guidelines in a tremendously efficient manner. For our team, we’ve just completed our first analyses of the database. These analyses have let us evaluate what combinations of prehabiliation components (i.e., exercise, nutrition, cognitive or psychosocial interventions), and individual components, are most likely to reduce complication rates and length of stay, and improve quality of life and physical recovery. Our findings show that on their own, exercise- and nutrition-based prehabilitation, along with multicomponent programs that include exercise, may improve outcomes in a clinically meaningful manner. Our review also demonstrates that the biggest knowledge gap that we face is an almost total lack of multicenter prehabiliation trials that can help us understand how to make prehabilitation work in the real world.

Lastly, and to help address the crucial lack of multicenter prehabiliation trials aligned with real world care, we launched the STRIVE Trial in January 2024. The STRIVE Trial is currently a 5-center trial of virtually supported home-based multimodal prehabilitation that is accessible to any adults preparing for major, elective surgery that aims to initially demonstrate that prehabilitation can be feasibly performed in a pragmatic setting (i.e., without all of the extra support and personnel that come with a tightly controlled trial). If the initial stage of the STRIVE Trial demonstrates feasibility, the trial will convert into a 12-center, pragmatic, registry-linked randomized that will evaluate whether real-world prehabilitation is effective in improving patient-reported recovery after surgery and reducing health system resource use. Findings from the STRIVE trial will be positioned for immediate translation into clinical practice.

Please describe any challenges/barriers that you have encountered thus far and what actions were/will be taken to resolve them?

Our research is informed by an integrated knowledge translation approach, meaning that all stages of our research include perspectives and input from patient partners and knowledge users who will help to implement our findings, like clinicians, health system leaders and other researchers. As such, we’ve found it very helpful to elicit opinions from our diverse partners to overcome barriers that we encounter.

Two examples that come to mind include analysis of our Canadian Prehabiliation Knowledge Network Review and design of the STRIVE Trial.

In preparing to analyze data for our systematic review, we knew that we would need to use complex statistical approaches to account for the many different types of prehabiliation interventions that exist, the different types of surgical patients who receive prehabilitation, and the variety of outcomes that our partners identified as critical to evaluate. A major challenge with using complex statistical analyses can be that their outputs are challenging to interpret. To finalize our approach to data analysis, we held a full team meeting in December 2023 to review the protocol that we’d developed as a team, as well as the initial descriptive data that we had available. Through open review of data, discussion of how statistical methods aligned with clinical interpretation, and small breakout session facilitated by our outstanding research staff, we were able to reach consensus as a group in terms of proceeding with a technique called network meta-analysis because the team felt comfortable with the underlying assumptions required and thought the approach would yield results most directly aligned with patient and clinical information needs.

In designing the STRIVE Trial, we wrestled with important questions about the types of patients that should be included in the trial and the outcomes that we should evaluate. With an executive committee guiding the trial that includes an amazing and engaged patient partner with lived experience having surgery (Ms. Gurlie Kidd: Why more patients are taking a front seat in the medical research | Ottawa Citizen), experts in prehabilitation, surgery, anesthesiology, and biostatistics, we had many perspectives to draw from. Together, reviewing data from our living review that suggested that all types of patients likely benefit from prehabilitation, we decided to be very inclusive in terms of eligibility criteria for the trial. Interestingly, in our experience with the trial to date, this decision has been validated as we’ve had enthusiastic uptake across patient risk groups. In terms of defining primary effectiveness outcomes, our patient-engagement work helped us to select a patient-reported measure of recovery as a primary outcome, but collaboration between our biostatistical leads, Ms. Kidd (our patient partner) and clinical experts helped us to define and prioritize secondary outcomes that would meet the information needs of different future knowledge users.

What are some items/deliverables that you look forward to coming to fruition in the remainder of your KT Fellowship?

Thanks to support from the PSI Mid-Career KT Fellowship, we hope to share a number of deliverables that will help to advance the science and practice of prehabiliation to the benefit of surgical patients in Ontario, Canada and around the world.

In 2024, we look forward to submission and subsequent publication of primary results from the PREPARE Trial, as well as results of our Canadian Prehabilitation Knowledge Network Systematic Review and Network Meta-Analysis. Prior to the completion of the fellowship, I expect that we will publish secondary and long-term outcome data from PREPARE, as well as initial feasibility results from STRIVE.

Having now established our overarching review as a living review, we also have analyses underway that are close to submission addressing questions around the type of patient, program and procedural factors that are associated with greatest benefit from exercise prehabilitation, and an overview of prehabilitation adherence, factors that improve adherence, and how reporting of prehabilitation adherence could be harmonized across the field.

Lastly, another important KT tool is production and dissemination of high-quality clinical practice guidelines, and I’ve been fortunate to be part of teams producing clinical practice guidelines related to prehabilitation. As a member of the American Society of Anesthesiologists’ Taskforce for the Clinical Practice Guideline for Perioperative Care of the Older Surgical Patient, I led the section on prehabilitation (expected publication in early 2025). I will also be contributing to prehabilitation clinical practice guidelines in the UK for cancer patients, due for publication in 2025.

What are some things that surprised you during your fellowship thus far?

Having the opportunity to run a large research program with lots of staff, partners, and interesting studies, I feel like most days bring at least one surprise! But for sure, some surprises over the first year of the Fellowship certainly stand out.

First, even though I’ve been involved in prehabilitation research for almost ten years, I am always surprised at the enthusiasm that patients have toward the opportunity to be involved in prehabilitation. While many trials (including some of our own that aren’t focused on prehab) face challenges recruiting enough participants, our experience with prehabilitation research has been that recruitment sometimes outpaces our expectations. Patients want access to prehabilitation, and in our experience, find that in addition to the exercise and nutritional support, being involved helps them to feel more empowered and meaningfully supported by the healthcare system.

Additionally, the speed with which some of our participants recover from having big, big surgeries is very inspiring. We’ve had people out golfing a couple of weeks after lung resections (How ‘prehab’ exercise could make surgery recovery easier | CTV News) and cross-country skiing five weeks after major bowel cancer surgery (Exercise before surgery? This cancer survivor is a believer | The Ottawa Hospital Foundation (ohfoundation.ca)). We’ve also learned some surprisingly practical lessons about helping patients to get the most out of prehab. While looking back it seems so obvious, by working with patients to get their structured feedback on their experience, we’ve developed better strategies to help people exercise even when it is too hot outside in summer and too cold outside in winter! I think that sometimes as clinicians, we give patients advice that seems so simple (“you should eat better and exercise more before surgery”). But the reality is that changing health behaviors is complex and influenced by so many factors, so unless we talk to the patients who are doing the hard work, we can’t really expect to develop programs that will be effective in real world care.

Once our PSI Knowledge Translation (KT) Fellows take off from the starting line, they make strides as they move their knowledge translation activities and research program forward. As the finish line becomes clearer in their sight, we asked our fellows some questions to share their progress thus far, and what they look forward to in the remainder of their KT Fellowship.

What are some of your accomplishments from the KT Fellowship thus far?

My overall goal for the PSI Graham Farquharson KT Fellowship is to develop and implement better guidance for emergency clinicians when they treat adult patients with bacterial skin and soft tissue infections (SSTIs), which are one of the top 10 reasons to visit a Canadian emergency department. I assembled a multidisciplinary Steering Committee involving key stakeholders: emergency physicians, infectious disease physicians, patient partners with lived experience, pharmacy, nursing, and implementation scientists.

We created a list of key health questions that are important in the diagnosis and management of three types of SSTIs: bacterial cellulitis, skin abscess and life-threatening necrotizing fasciitis. Following this, I identified existing guidelines in the literature for SSTIs. The highest quality guidelines were selected for adaptation using the CAN-IMPLEMENT process, which is a systematic approach to adapting existing guidelines to formulate recommendations for a specific setting and knowledge user.

Our group has now developed the Canadian Emergency Department Best Practices Checklist for Skin and Soft Tissue Infections (SSTI Checklist). This is the first Canadian guidance on diagnosis and management of SSTIs and has been fully endorsed by the Canadian Association of Emergency Physicians. The SSTI Checklist was just accepted for publication with the Canadian Journal of Emergency Medicine. This work has the potential to improve patient outcomes at a national level by improving diagnostic accuracy and treatment strategies, while decreasing intravenous antibiotic overuse, unnecessary hospitalization, and treatment failure.

Please describe any challenges/barriers that you have encountered thus far and what actions were/will be taken to resolve them?

The main barrier to successfully completing a large program of research is the time required given my clinical responsibilities. Fortunately, with the support of this PSI Graham Farquharson KT Fellowship, I have ample protected time to focus on these projects.

What are some items/deliverables that you look forward to coming to fruition in the remainder of your KT Fellowship?

As mentioned, the SSTI Checklist will be published in the next 1-2 months. This summer I will be interviewing emergency physicians to understand barriers and drivers to using the SSTI Checklist. This information will then be used to develop KT tools to better help emergency physicians to use the SSTI Checklist during their clinical practice. Following this, I will conduct a pilot cluster randomized trial using the KT tools we have developed for SSTI Checklist implementation in Canadian emergency departments.

Once our PSI Knowledge Translation (KT) Fellows take off from the starting line, they make strides as they move their knowledge translation activities and research program forward. As the finish line becomes clearer in their sight, we asked our fellows some questions to share their progress thus far, and what they look forward to in the remainder of their KT Fellowship.

What are some of your accomplishments from the KT Fellowship thus far?

FIRST60: Prehospital, Trauma, and Resuscitation Sciences

My biggest accomplishment of my KT Fellowship thus far was co-founding the FIRST60: Prehospital, Trauma, and Resuscitation Sciences research group (www.first60.ca). In May 2023, we held a strategic retreat at the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, bringing together investigators and clinicians passionate about advancing prehospital care, trauma, and resuscitation science. This event united experts from various disciplines, including emergency medicine, surgery, transfusion, paramedicine, and nursing, alongside specialists in knowledge translation, quality improvement, education, and clinical epidemiology. Our mission focused on translating scientific research into practical bedside care, aiming to improve patient outcomes from the time of injury or illness through the acute resuscitation. Emphasizing the critical “golden hour” after injury, we named the group FIRST60 as a nod to the crucial first 60 minutes following injury or illness.  As a group, since coming together in May 2023, we have had over 60 peer-reviewed publications and secured over $3.6 million dollars in research funding.

SWiFT Canada: Pioneering Prehospital Transfusion Trials in Canada

I am the Principal Investigator for Study of Whole blood in Frontline Trauma (SWiFT) Canada. Over the next year, this pilot study will assess prehospital whole blood versus component therapy (red blood cells + plasma) in traumatic hemorrhage for patients transported by air ambulance. Through this trial we have established a collaborative prehospital trauma network with the involvement of Ornge Air Ambulance, Canadian Blood Services and 6 lead trauma hospitals in Southern Ontario, marking a historic milestone as Canada’s inaugural prehospital transfusion clinical trial.

Driving Change in Prehospital Trauma Triage

Timely access to trauma centers is paramount in saving lives. However, for patients in Ontario, geographical constraints often impede prompt trauma care. I am actively investigating the effectiveness and efficiency of the Ontario Field Trauma Triage Standard, which guides paramedics in determining which patients should be directly transported to a trauma centre. Moreover, I am part of a working group that is advocating for revisions to the provincial Field Trauma Triage Standard to ensure alignment with the latest evidence-based practices.  Additionally, I am spearheading the development of a prehospital transfusion prediction score, overseen by one of my PhD students Melissa O’Neill. This innovative score aims to identify patients experiencing massive bleeding in the prehospital setting, enabling paramedics to promptly alert the receiving trauma team for enhanced preparedness and improved patient outcomes.

Please describe any challenges/barriers that you have encountered thus far and what actions were/will be taken to resolve them?

Research funding for trauma and prehospital care is critically low, and this lack of financial support poses significant challenges to advancing the field. The absence of dedicated large funding bodies that specifically highlight injury or prehospital systems of care further exacerbates this problem.  Unlike fields such as cancer or cardiovascular research, which benefit from substantial funding from large organizations, trauma and injury research does not have equivalent support. This is despite trauma and injury being a leading cause of death for young Canadians.  This disparity in funding sources makes it difficult for researchers to secure the necessary financial resources to conduct comprehensive studies. The scarcity of large funding bodies focusing specifically on injury or prehospital care results in limited grant opportunities, hindering the development of innovative treatments and care systems.

Despite the lack of large funding bodies, smaller funding sources, such as Physician Services Incorporated, play a crucial role in supporting early career researchers. Funding through the PSI KT Fellowship has been instrumental in my early research career success. Such funding provides critical financial support that enables researchers to initiate projects, gather preliminary data, and build a foundation for larger studies. This initial support is a key stepping stone to securing more substantial grants in the future.

What are some items/deliverables that you look forward to coming to fruition in the remainder of your KT Fellowship?

Looking ahead to the remainder of my KT Fellowship a few of my deliverables are:

• Launching the SWiFT Canada Study
• Piloting a provincial prehospital transfusion registry, to evaluate and inform best practices in prehospital transfusion in Ontario
• Continuing to grow the footprint of the FIRST60 research group

What are some things that surprised you during your fellowship thus far?

During KT Fellowship, I encountered several unexpected insights and experiences that significantly shaped my perspective on trauma and injury research.

The Complexity of Interdisciplinary Trauma Collaboration

One of the most surprising aspects was the complexity and necessity of interdisciplinary collaboration. Trauma and injury research require the integration of various fields, including emergency medicine, surgery, paramedicine, nursing, hematology, epidemiology, public health, and even engineering. Coordinating efforts across these disciplines was challenging but crucial for developing comprehensive solutions to complex problems.  Additionally, the data sources between prehospital and in-hospital are not well linked necessitating multiple data sharing agreements and substantial chart reviews to abstract essential data.

The Extent of Funding Challenges

I was aware of the funding challenges in trauma and injury research, but the extent of these challenges was more significant than I anticipated. Securing consistent funding was a continuous struggle, with many projects relying heavily on small, short-term grants. This reality underscored the importance of advocating for more substantial and stable funding sources.

The Impact of Technology and Data Analytics

The rapid advancement of technology and data analytics in trauma research was another unexpected discovery.  Machine learning and big data analytics are becoming indispensable in analyzing large datasets and identifying patterns that can inform better clinical practices and policies. These technologies opened new avenues for research that I had not initially considered, with many interesting machine learning projects on the horizon.

The Importance of Mentorship and Networking

Lastly, the importance of mentorship and networking in advancing my research career was a pleasant surprise. Having access to experienced mentors provided invaluable guidance, support, and opportunities for collaboration.  It also made the creation of the FIRST60 research group one of the most enjoyable aspects of my research career. Networking with peers and professionals in the field opened doors to new research possibilities and professional growth.

Once our PSI Knowledge Translation (KT) Fellows take off from the starting line, they make strides as they move their knowledge translation activities and research program forward. As the finish line becomes clearer in their sight, we asked our fellows some questions to share their progress thus far, and what they look forward to in the remainder of their KT Fellowship.

What are some of your accomplishments from the KT Fellowship thus far?

Publications

Since the outset of the project, I have authored/co-authored the following publications:

April 2024:

Implementation, Clinical Benefit and Safety of a D-Dimer-Focused Pulmonary Embolism Testing Pathway in the Emergency Department

Federico Germini, Fayad Al-Haimus, Yang Hu, Shawn Mondoux, Quazi Ibrahim, Noel Chan, Rick Ikesaka, Joshua Klyn, Natasha Clayton, Lehana Thabane, Kerstin de Wit

Annals of Emergency Medicine

January 2024:

The inseparability of context and clinical reasoning

Andrew Olson, Juliane E Kämmer, Ahmed Taher, Robert Johnston, Qian Yang, Shawn Mondoux, Sandra Monteiro

Journal of evaluation in clinical practice

Validating the Emergency Department Avoidability Classification (EDAC): A cluster randomized single-blinded agreement study

Ryan P Strum, Shawn Mondoux, Fabrice I Mowbray, Lauren E Griffith, Andrew Worster, Walter Tavares, Paul Miller, Komal Aryal, Ravi Sivakumaran, Andrew P Costa

PLoS One

December 2023:

GridlockED as an Intervention for Nurses (GAAIN) Study

Teresa M Chan, Nicole Bodnariuc, Nandini Nandeesha, Jennifer Kodis, Clare O’Connor, Shawn Mondoux, Alim Pardhan, Ruth Chen

The Journal of Continuing Education in Nursing

Health care utilization and outcomes of patients seen by virtual urgent care versus in-person emergency department care

SL McLeod, JE Tarride, S Mondoux, JM Paterson, L Plumptre, …

CMAJ

Development of a machine learning-based acuity score prediction model for virtual care settings

Justin N Hall, Ron Galaev, Marina Gavrilov, Shawn Mondoux

BMC Medical Informatics and Decision Making

November 2023:

Was virtual care as safe as in-person care? Analyzing patient outcomes at 7- and 30-days in Ontario during the SaRS-CoV-2 pandemic

Shawn Mondoux, Frank Battaglia, Anastasia Gayowsky, Natasha Clayton, Caillin Langmann, Paul Miller, Alim Pardhan, Julie Mathews, Alex Drossos and Keerat Grewal

Healthcare Quarterly, Longwoods

September 2023:

“It saved me from the emergency department”: A qualitative study of patient experience of virtual urgent care in Ontario

Katie N Dainty, M Bianca Seaton, Justin N Hall, Shawn Mondoux, Lency Abraham, Joy McCarron, Jean-Eric Tarride, Shelley L McLeod

PLoS One

Quantifying the escalating impact of paramedic transported emergency department visits for opioid-related conditions in Ontario, Canada: A population-based cohort study

Ryan P Strum, Shawn Mondoux, Fabrice I Mowbray, Paul Miller, Andrew Worster, Richard Ferron, Andrew P Costa

PLoS One

May 2023:

Storage conditions, sample integrity, interferences, and a decision tool for investigating unusual high-sensitivity cardiac troponin results

Matthew A Lafrenière, Vikas Tandon, Craig Ainsworth, Kazem Nouri, Shawn E Mondoux, Andrew Worster, Peter A Kavsak

Clinical Biochemistry

April 2023:

Digging into the complex problem of mental health presentations to pediatric emergency departments: a how-to guide

Shawn Mondoux, April Kam

Canadian Journal of Emergency Medicine

The COVID-19 impact and characterization on substance use-related emergency department visits for adolescents and young adults in Canada: Practical implications

Soyeon Kim, Natalie Rajack, Shawn E Mondoux, Vitor S Tardelli, Nathan J Kolla, Bernard Le Foll Journal of Evaluation in Clinical Practice

Identifying very-low-risk patients for future myocardial infarction or death Peter A Kavsak, Joshua O Cerasuolo, Mark K Hewitt, Shawn E Mondoux, Richard Perez, Hsien Seow, Craig Ainsworth, Jinhui Ma, Andrew Worster, Dennis T Ko

Canadian Journal of Cardiology

March 2023:

Evaluating emergency department transfers from urgent care centres: insights for paramedic integration with subacute healthcare

Ryan P Strum, Fabrice I Mowbray, Shawn E Mondoux, Andrew P Costa

BMJ Open Quality

January 2023:

Demographic characteristics, outcomes and experience of patients using virtual urgent care services from 14 emergency department led sites in Ontario

Shelley L McLeod, Shawn Mondoux, Justin N Hall, Katie Dainty, Joy McCarron, Jean-Eric Tarride, Lency Abraham, Sandy Tse, Rodrick Lim, Megan Fitzgibbon, Renee-Anne Montpellier, Leon Rivlin, Carla Rodriguez, Lisa Beck, Lianne McLean, Daniel Rosenfield, Shaun Mehta, Michelle Welsford, Cameron Thompson, Howard Ovens

Canadian Journal of Emergency Medicine

Media impact of research

December 2023

More Canadians have been using virtual care since the pandemic. Is it effective and safe? https://www.ctvnews.ca/health/new-canadian-research-suggests-virtual-care-is-effective-and-safe-1.6676  733 . Dec 7th 2023.

November 2023

McMaster study finds that virtual care is safe, being used effectively https://www.chch.com/mcmaster-study-finds-that-virtual-care-is-safe-being-used-effectively/ , Nov 27th 2023.

Medical care being delivered by phone and video is safe, concludes McMaster research

The Hamilton Spectator, Nov 27th 2023.

Prognostiq Health (previously Llif Healthcare)

As part of a larger and more concerted KT effort, and in line with the thesis put forward as part of my application for the fellowship, I have founded a company who is engaged in physician audit and feedback. The principle is to use EMR data to provide high-value feedback to clinicians with the goal of better situational awareness, improve patient care and decrease health system cost. In this way, we are engaging in the pragmatic act proposed in our application for research.

Current metrics:

• Reporting monthly emergency department practice data to over 100 MDs.
• Data holding in excess of 900,000 ED visits
• Current yearly ARR of $40,000 CAD
• Generated $380,000 CAD in seed-stage company revenue
• Over $250,000 CAD in non-dilutive business funding
• 5 employees

Newsworthy milestones:

• Prognostiq Health graduates as an alumnus from Canada’s most prestigious business incubator. We completed final selection for Creative Destruction Lab – Vancouver, Biomedical Engineering Stream in May 2024.
• Prognostiq Health is featured as a venture in the Halo Health Live 23 session. Halo Health is Canada’s only physician angel investment group, selecting among hundreds of ventures per year to find the most promising in the healthcare space.
• Prognostiq Health is selected as a feature vendor for the Digital Health Expo stage as part of the MaRS Impact Health 2024 conference. This conference features Canada’s most promosign and emergency health tech solutions.
• Prognostiq Health featured as a Beta startup company at Collision Conference 2024 in Toronto.
• Prognostiq Health selected as part of the 2024 cohort for the Canadian Entrepreneurs in Life Sciences Valley Ready (CELS-VR) program. This exposes Canadian companies to the tech ecosystem in Silicon Valley, enabling investment and market penetration.

Pending contracts – Prognostiq is poised to expand its implementation by integrating in the following health facilities:

• Newfoundland and Labrador Health Service
• Sunnybrook Health Sciences Center
• Queensway Carleton Hospital
• Royal Columbian Hospital – BC

Current impact:

• Early data from interventions has demonstrated:
  • a 10% increase in the number of patients seen per hour in participating emergency departments.
  • a 5% decrease in 72hr return rates in participating emergency departments

Media features:

• December 2022
  • IMPROVING IN-HOSPITAL PATIENT CARE USING DATA ANALYTICS
  • https://perspective.ca/improving-healthcare-st-josephs-hamilton/
• November 2022
  • McMaster Seed Fund invests $1.27 million in three startup companies
  • https://brighterworld.mcmaster.ca/articles/mcmaster-seed-fund-invests-1-27-million-in- three-startup-companies/

Please describe any challenges/barriers that you have encountered thus far and what actions were/will be taken to resolve them?

Research objectives:

• Drafting of subsequent articles is ongoing. Submission to follow
• No active issues at present.

Business objectives:

• Market penetration in healthcare takes a very long time

What are some items/deliverables that you look forward to coming to fruition in the remainder of your KT Fellowship?

A research trial with a US health center willing to pilot and try our technology. This will yield MD-centric and system centric endpoints which are likely to make us vastly more scalable in the US marketplace.

Within Canada, we look forward to integrations across multiple new sites.

What are some things that surprised you during your fellowship thus far?

That the opportunity to have impact has presented itself both in the form of research but also in the form of direct-to-MD solutions that are changing the face of healthcare delivery in participating centers.

Once our PSI Knowledge Translation (KT) Fellows take off from the starting line, they make strides as they move their knowledge translation activities and research program forward. As the finish line becomes clearer in their sight, we asked our fellows some questions to share their progress thus far, and what they look forward to in the remainder of their KT Fellowship.

What are some of your accomplishments from the KT Fellowship thus far?

I have held my PSI Fellowship for 2 years now.  It has allowed me to continue my research program.  Some of my accomplishments in the last two years have been:

• Supporting trainees:  during this time, I have supervised 3 Master’s students, 4 PhD students, 3 medical residents and 4 postdoc fellows.  I have co-supervised a number of others.
• Mentorship:  I have had the privilege to mentor several new investigators from across Canada
• High impact publications in the European Respiratory Journal, CMAJ, Chest and Thorax
• Opportunities to transfer our knowledge to action working with the Government of Ontario, the Canadian Thoracic Society and the Lung Foundation.

Please describe any challenges/barriers that you have encountered thus far and what actions were/will be taken to resolve them?

A challenge has been hiring qualified research personnel.  We have been able to resolve this, but it caused delays.

What are some items/deliverables that you look forward to coming to fruition in the remainder of your KT Fellowship?

I look forward to seeing the results of our national, multicentre study on Respiratory Long COVID.  Long COVID is a persistence of symptoms from acute COVID infection beyond 12 weeks that is not attributed to alternate diagnoses. Studies of Long COVID have been mostly limited to people requiring hospitalization, leaving little known about its impact on the 93% of Canadians managed as outpatients.  They have also used convenience samples, small samples and/or single study locations. We have recruited a random sample of over 500 participants from the community who have had COVID to better characterize respiratory Long COVID in the population.

What are some things that surprised you during your fellowship thus far?

Not surprised, but impressed by the greater access to data there seems to be now compared to just a few years ago.  Many of my studies use large databases of people with respiratory disease.  Just a few years ago, it was very difficult to access large databases because of privacy and security concerns.  While this is still the situation when accessing Ontario health administrative data, it seems that it is becoming easier to access anonymized data from other sources.  I think this is a great trend.

Once our PSI Knowledge Translation (KT) Fellows take off from the starting line, they make strides as they move their knowledge translation activities and research program forward. As the finish line becomes clearer in their sight, we asked our fellows some questions to share their progress thus far, and what they look forward to in the remainder of their KT Fellowship.

What are some of your accomplishments from the KT Fellowship thus far?

The KT fellowship has been such an important facilitator for my research program focused on child health equity. Having dedicated funded time for research is instrumental in the progress of research and its impact.

The PSI Graham Farquharson KT Fellowship has helped support my work with Connecting Families, a randomized controlled trial evaluating the impact of income support navigation for low-income families of young children on child and parent health. There is a pressing need for effective interventions to help mitigate child poverty that can be integrated in primary care and are rigorously evaluated. The pilot phase of this trial is complete and has informed the planning for the full trial, which is also underway. A manuscript has been published reporting the experiences of families with young children experiencing financial strain. Another manuscript reporting the quantitative results of the pilot is being prepared for submission.  Recruitment for the full trial is progressing very well.

The Fellowship has also supported Innovations for Community Resilience, Equity and Advocacy (I-CREAte), a community based participatory action research team that conducts meaningful and action-oriented research to improve the health and well-being of children, families, and communities (https://www.queensu.ca/i-create/). We have completed phase 1 of Engaging Families To Build Healthy Communities, which used multiple case studies and arts based methods to examine resilience among families experiencing individual or community adversity in the context of the COVID-19 pandemic and beyond. The knowledge dissemination phase has included hosting 11 community meetings with a range of participants including community members, service organizations, government and advocacy organizations. The feedback from these meetings will be used to prepare a searchable database of community led solutions, policy briefs, and infographics, as well as peer reviewed publications and conference presentations.

Additionally, the KT Fellowship has supported me in a project using electronic medical records to examine changes in the provision of preventive well child care for young children during the COVID-19 pandemic. Our team has examined changes in visit frequency, changes in growth patterns, and parent and clinician identified innovations to address access challenges during the pandemic. We have also developed methods for using natural language processing to derive breastfeeding and developmental outcomes in young children’s full charts (including narrative notes). Several manuscripts are in preparation.

What are some items/deliverables that you look forward to coming to fruition in the remainder of your KT Fellowship?

I anticipate completion of the Connecting Families study and dissemination of results to policy makers, clinicians and the academic community. This work promises to make an important contribution to evidence surrounding the effectiveness of interventions to address child poverty in primary care settings. These results have the potential to change practice and to support policy development in health services planning.

I also am working with a team conducting a systematic review of the diagnostic test properties of developmental screening tools in young children. The review will be very helpful in guiding primary care and public health practitioners in an evidence informed approach to developmental screening in young children.

What are some things that surprised you during your fellowship thus far?

Having support from PSI in this fellowship has meant that I have been able to be flexible and respond to unexpected opportunities that arise, which have the potential for significant impact.

Upon receiving their approval letters and sharing the exciting news of the award with their community, the PSI Knowledge Translation (KT) Fellows begin preparing to get settled in their place at the starting line. As they embark on their KT Fellowship journey, we asked them few questions to know them beyond their recipient biographies, as well as some notes they could pass on to future applicants.

Please use 3 words to describe how you feel as you begin your KT Fellowship.

Proud, excited, and curious (about what we will find!)

Why did you apply for the PSI KT Fellowship? How does this award align with your current research and career goals?

I applied for the Fellowship to gain valuable salary support, and because I was pursuing a project that I thought would fit well with the award opportunity. The focus on knowledge translation resonates with my work which is centered on improving the quality of care in the real world. The award is also a way to highlight my work, which is helpful for ongoing engagement of patients, caregivers, and knowledge users.

What are 3 to 5 general tips and notes you would pass on to those preparing their KT Fellowship application?

• Start early on your submission because there are a lot of documents required.
• I benefitted immensely from reviewing a colleague’s successful submission as I prepared my materials – if you know someone who was previously successful in this, I would recommend reaching out to them.
• Don’t be thrown off if there is some redundancy in the questions/materials, I found I did end up repeating myself in a few of the documents, and I guess that must have been alright because here I am.

Upon receiving their approval letters and sharing the exciting news of the award with their community, the PSI Knowledge Translation (KT) Fellows begin preparing to get settled in their place at the starting line. As they embark on their KT Fellowship journey, we asked them few questions to know them beyond their recipient biographies, as well as some notes they could pass on to future applicants.

Please use 3 words to describe how you feel as you begin your KT Fellowship.

• Empowered
• Resourced
• Valued

Why did you apply for the PSI Mid-Career KT Fellowship? How does this award align with your current research and career goals?

My application for the PSI Mid-Career KT Fellowship was motivated by my commitment to integrating social determinants of health into emergency department practices in Ontario, where I’ve witnessed the dire effects of poverty, homelessness, and other social issues on health outcomes. This fellowship aligns perfectly with my research into developing sustainable outreach programs that position outreach workers as central to effective healthcare delivery. The support from the fellowship is crucial to providing the protected time I need to do this work. Professionally, it propels my career goal of being a transformative leader in emergency medicine, advocating for systemic changes that ensure outreach workers are recognized as indispensable. Through this fellowship, I look forward to being able to secure the evidence and backing needed to advocate for policy changes that integrate and sustain outreach roles in healthcare, ultimately improving patient care and health outcomes across Ontario.

What are 3 to 5 general tips and notes you would pass on to those preparing their KT Fellowship application?

1. It is key for Knowledge Translation to involve the right people in the design, implementation and evaluation of your work and ensure that it is translated to the bedside and policy in an effective way.  You will learn the most from the patients and people with lived experience. Build your team deliberately and make sure they are compensated for their expertise.
2. Get input from all stakeholders on what the most important outcomes for them. Stakeholders include the communities who help design your treatments, interventions all the way to the people who need to sustainably fund them in the long term.
3. Get a lot of people to read your application to make sure you are communicating your work effectively. Ask them to reflect back what they think your proposal is. We get so stuck in our work that we sometimes forget to define or explain the most fundamental concepts in a grant or paper. Make it easy for the reviewers.
4. Leave time to enjoy the process. Grant proposals should be exciting to write as they essentially help you plan what you get to do in your academic work for the upcoming few years.