Mentoring Graduate Students to Become Effective Teaching Assistants: Developing and Implementing a Student-Centred Program for Nursing

Teaching in the health professions, including nursing, requires specialized educational strategies that meet the needs of the current generation of learners. Currently there is a shortage of experienced post-secondary educators in nursing, possibly exacerbated by inadequate Teaching Assistant (TA) professional development programs. Most literature describes TA professional development programs that involve undergraduate students employed as TAs, and few consider how programs can mentor graduate students to develop their instructional skills, contribute to courses, and enhance their careers. There are limited reports in the Canadian context. In this article we outline the rationale, development, and implementation of a Graduate Teaching Assistant (GTA) mentorship program for graduate students at a school of nursing located in western Canada. Our aim is to provide mentorship and experience in educational strategies to graduate students, to help mentor and educate future nursing educators who are experienced post-secondary teachers. We discuss the rationale for offering the GTA mentorship program, followed by a description of the GTA mentorship program components. We highlight the role of the Senior TA, an experienced GTA who takes a leadership role in coordinating the program. Importantly, we discuss how knowledge related to cultural safety is presented, and how it has been adapted over time to meet GTAs’ needs. Finally, we discuss the evolution of a school of nursing GTA mentorship program, located in western Canada and we describe future changes to the program in order to remain relevant to the needs of graduate students in nursing, faculty and administration, and undergraduate nursing students. L’enseignement dans les professions de la santé, y compris les sciences infirmières, nécessite des stratégies pédagogiques répondant aux besoins de la génération actuelle d’apprenantes. Nous connaissons actuellement une pénurie d’enseignantes en sciences infirmières, possiblement aggravée par l’inadéquation des programmes de développement professionnel pour les auxiliaires d’enseignement (Teaching Assistant; TA). La littérature sur le sujet décrit surtout les programmes de développement professionnel pour les étudiantes de premier cycle qui sont embauchées comme auxiliaires d’enseignement; peu considèrent la façon dont les programmes peuvent soutenir les étudiantes des cycles supérieurs pour leur permettre de développer leurs habiletés d’enseignement, de contribuer aux cours, et d’améliorer leurs perspectives de carrière. Peu de rapports font état du contexte canadien. Dans cet article, nous justifions et exposons brièvement l’élaboration et la mise en œuvre d’un programme de mentorat pour les auxiliaires d’enseignement qui sont étudiantes aux cycles supérieurs (Graduate Teaching Assistant; GTA) dans une école de sciences infirmières de l’Ouest canadien. Notre objectif est d’offrir du mentorat ainsi qu’une expérience permettant à des étudiantes des cycles supérieurs de pratiquer des stratégies pédagogiques, afin de contribuer à la formation de nouvelles enseignantes chevronnées en sciences infirmières. Nous présentons le rationnel pour offrir un tel programme de mentorat pour les étudiants des cycles supérieurs et en décrivons les composantes. Nous soulignons le rôle de l’auxiliaire sénior, une auxiliaire expérimentée jouant un rôle de leader dans la coordination du programme. Chose importante, nous discutons de la manière de présenter les connaissances sur la sécurité culturelle, ainsi que de l’adaptation au fil du temps pour répondre aux besoins des auxiliaires d’enseignement. Enfin, nous abordons l’évolution du programme de mentorat pour les étudiantes des cycles supérieurs d’une école de sciences infirmières de l’Ouest du Canada; nous décrivons également les changements qui seront apportés au programme, afin qu’il réponde toujours aux besoins des étudiantes des cycles supérieurs en sciences infirmières, du corps professoral, de la direction et des étudiantes du premier cycle

Is cancer stage data missing completely at random? A report from a large population-based cohort of non-small cell lung cancer

IntroductionPopulation-based datasets are often used to estimate changes in utilization or outcomes of novel therapies. Inclusion or exclusion of unstaged patients may impact on interpretation of these studies.MethodsA large population-based dataset in Ontario, Canada of non-small cell lung cancer patients was examined to evaluate the characteristics and outcomes of unstaged patients compared to staged patients. Multivariable Poisson regression was used to evaluate differences in patient-level characteristics between groups. Kaplan-Meier estimates of survival and log-rank statistics were utilized.ResultsIn our Ontario cohort of 51,152 patients with NSCLC, 11.2% (n=5,707) were unstaged, and there was evidence that stage data was not missing completely at random. Those without assigned stage were more likely than staged patients to be older (RR [95%CI]), (70-79 vs. 20-59: 1.51 [1.38-1.66]; 80+ vs. 20-59: 2.87 [2.62-3.15]), have a higher comorbidity index (Score 1-2 vs 0: 1.19 [1.12-1.27]; 3 vs. 0: 1.49 [1.38-1.60]), and have a lower socioeconomic class (4 vs. 1 (lowest): 0.91 [0.84-0.98]; 5 vs. 1 (lowest): 0.89 [0.83-0.97]). Overall survival of unstaged patients suggested a mixture of early and advanced stage, but with a large proportion that are probably stage IV patients with more rapid death than those with reported stage IV disease.ConclusionIn this case study, evaluation of stage-specific health care utilization and outcomes for staged patients with stage IV disease at the population level may have a bias as a distinct subset of stage IV patients with rapid death are likely among those without a documented stage in administrative data

Evaluating the effects of increasing physical activity to optimize rehabilitation outcomes in hospitalized older adults (MOVE Trial): Study protocol for a randomized controlled trial

Background: Older adults who have received inpatient rehabilitation often have significant mobility disability at discharge. Physical activity levels in rehabilitation are also low. It is hypothesized that providing increased physical activity to older people receiving hospital-based rehabilitation will lead to better mobility outcomes at discharge. Methods/Design: A single blind, parallel-group, multisite randomized controlled trial with blinded assessment of outcome and intention-to-treat analysis. The cost effectiveness of the intervention will also be examined. Older people (age >60 years) undergoing inpatient rehabilitation to improve mobility will be recruited from geriatric rehabilitation units at two Australian hospitals. A computer-generated blocked stratified randomization sequence will be used to assign 198 participants in a 1:1 ratio to either an 'enhanced physical activity' (intervention) group or a 'usual care plus' (control) group for the duration of their inpatient stay. Participants will receive usual care and either spend time each week performing additional physical activities such as standing or walking (intervention group) or performing an equal amount of social activities that have minimal impact on mobility such as card and board games (control group). Self-selected gait speed will be measured using a 6-meter walk test at discharge (primary outcome) and 6 months follow-up (secondary outcome). The study is powered to detect a 0.1 m/sec increase in self-selected gait speed in the intervention group at discharge. Additional measures of mobility (Timed Up and Go, De Morton Mobility Index), function (Functional Independence Measure) and quality of life will be obtained as secondary outcomes at discharge and tertiary outcomes at 6 months follow-up. The trial commenced recruitment on 28 January 2014. Discussion: This study will evaluate the efficacy and cost effectiveness of increasing physical activity in older people during inpatient rehabilitation. These results will assist in the development of evidenced-based rehabilitation programs for this population. Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12613000884707(Date of registration 08 August 2013); ClinicalTrials.gov Identifier NCT01910740(Date of registration 22 July 2013)

Cardiovascular risk and disease among people with mental illness in Canada

Objective: People with mental illness have poorer physical health and to suffer from higher rates of morbidity and mortality due to cardiovascular disease (CVD) than the general population. However, this has not been confirmed in a large, unselected community-based Canadian sample. The purpose of this study is to ascertain the association between mental illness and a history of heart disease and stroke, and 10-year and 30-year cardiovascular risk. Methods: Cross-sectional data of 36,984 respondents collected via the Canadian Community Health Survey Cycle 1.2 were analyzed. Mood and anxiety disorders were assessed with the World Mental Health – Composite International Diagnostic Interview instrument. Respondents’ self-reported diagnostic histories of schizophrenia, cardiovascular disease (CVD) (including heart disease and stroke), and cardiovascular risk (including diabetes, hypertension, treatment for hypertension, tobacco use and body mass index) were also ascertained. Framingham 10-year and 30-year risk prediction algorithms were used to calculate cardiovascular risk. A stratified multistage cluster sampling design was used. Descriptive statistics were used to estimate the prevalence of CVD across a range of mental illness and accounted for psychiatric comorbidity. Bivariate associations between mental illness and cardiovascular risk, heart disease and stroke were analyzed with logistic regression models. Results: Respondents who reported having any lifetime mental illness were twice as likely to have a history of heart disease (OR=2.0 [95% CI: 1.8, 2.2]) or stroke (OR = 2.3 [95% CI: 1.7, 3.0]), after controlling for sociodemographic differences, compared to people without a mental illness. Respondents with any mood or any anxiety disorder were one and a half times (OR = 1.5 [95% CI: 1.3, 1.8], OR = 1.5 [95% CI: 1.2, 1.8], respectively) more likely to have heart disease and almost two times (OR = 1.8 [95% CI: 1.1, 2.7], OR = 1.8 [95% CI: 1.1, 2.8], respectively) more likely to have had a stroke compared with people without mood or anxiety disorders, after adjusting for sociodemographic differences. When pairings were examined between psychiatric disorders, the association with heart disease and stroke was stronger compared with having the specific disorder alone. Respondents who were identified as having any lifetime mental disorder were less likely (OR = 0.8 [95% CI: 0.8, 0.9]) to be at high risk of developing CVD within 10 years. This same group was slightly more likely (OR = 1.2 [95% CI: 1.1, 1.4]) to be at high risk of developing CVD within 30 years. Conclusion: This descriptive study underscores the association between mental illness, CVD and cardiovascular risk and highlights some novel methods to examine cardiovascular health at a population level. The findings also serve as a call to action for all Canadian health professionals to work to improve the cardiovascular health of this population

Outpatient Tobacco Dependence Treatment for Individuals With Severe Mental Illness: The Butt Out Program Outcomes

Abstract: The Butt Out program is a tobacco dependence intervention that provides smoking cessation counselling and pharmacotherapy for clients with severe mental illness through Vancouver Community Mental Health Services. Participants received up to 24 weeks of pharmacotherapy for smoking cessation along with 12 weeks of behavioural therapy with another 12 weeks of group support. Based on an intent-to-treat analysis (n = 35), the end-of-treatment smoking abstinence rate was 8.6%. For individuals who completed the program (n = 28), the abstinence rate was 10.7%. Among program completers, 28.0% were able to achieve a 50% reduction to their baseline cigarette consumption. Due to the modest gains in abstinence and moderate improvements in smoking reduction achieved at the end of treatment, higher intensity programs of a longer duration may be indicated for future tobacco dependence interventions in psychiatric outpatient settings. [Francais] Les Vancouver Community Mental Health Services ont mis sur pied un programme appelé Butt Out qui consiste à offrir soutien et pharmacothérapie à des bénéficiaires souffrant de problèmes graves de santé mentale pour aider ceux-ci à cesser de fumer. Dans cet article, nous décrivons ce programme et nous analysons les résultats qu\u27il a permis d\u27obtenir auprès d\u27un groupe de participants. Ces participants ont pris pendant jusqu\u27à 24 semaines une médication pour les aider à se désaccoutumer du tabac, et ils ont suivi une thérapie comportementale pendant 12 semaines à la suite de laquelle ils ont participé à un groupe de soutien pendant 12 autres semaines. Sur la base de l\u27analyse des sujets retenus au début de l\u27essai clinique (n = 35), le taux d\u27abstinence au tabac à la fin du traitement a été de 8,6 %. Chez les individus qui ont terminé le programme (n = 28), ce taux a été de 10,7 %, et, parmi ces derniers, 28,0 % ont réduit de 50 % la consommation de cigarettes qu\u27ils faisaient au départ. Étant donné les gains modestes qu\u27a permis le traitement, en matière autant d\u27abstinence que de réduction de la consommation, nous pensons que des programmes plus intenses et de plus longue durée seraient nécessaires pour aider les patients externes en psychiatrie à lutter contre le tabagisme

Analysis of Alzheimer Disease Plasma Biomarker pTau‐181 in Individuals of Diverse Admixed Ancestral Backgrounds

Background Plasma proteins, including phosphorylated threonine‐181 of Tau (pTau181) are used as biomarkers for differential diagnosis and preclinical detection of Alzheimer disease (AD). However, observation and measurement of these biomarkers are mostly from individuals of non‐Hispanic, European ancestry. Given differences in AD risk, generalizability of these findings is not assured in individuals of diverse ancestry. This study evaluates the utility of plasma pTau181 in discriminating clinically diagnosed AD from cognitively intact, age‐matched controls in ancestrally diverse, admixed cohorts. Method We measured pTau181 with Simoa chemistry using the pTau181 AdvantageV2 on the Quanterix HD‐X. Our cohorts consisted of 642 African Americans (162 AD and 480 controls), 906 Puerto Ricans (385 AD and 521 controls), 149 Peruvians (49 AD and 100 controls), 60 Cubans (26 AD and 34 controls), 246 individuals of non‐Hispanic, European ancestry (22 AD and 224 controls), and 58 autopsy confirmed AD cases of European ancestry with plasma isolated from EDTA blood tubes. Samples were randomized, measurements performed in duplicate, and non‐parametric Kruskal‐Wallis tests used to detect differences in biomarker concentrations between cases and controls in each cohort. Result Median pTau levels in cases was higher than controls in all cohorts assayed: African Americans (2.30±1.14pg/mL vs 1.15±2.99pg/mL, pcorr=2.0x10‐27); Puerto Ricans (2.33±1.82pg/mL vs 1.44±1.21pg/mL, pcorr=8.2x10‐32); Peruvians (2.63±1.64pg/mL vs 2.13±1.42pg/mL, pcorr=0.02); Cubans (2.09±1.16pg/mL vs 1.35±0.67pg/mL, pcorr=0.02); and European ancestry (2.40pg/mL±0.78pg/mL vs 1.54pg/mL ±1.44pg/mL, pcorr=0.02). The pTau levels in the autopsy confirmed cases (2.96±2.29 pg/mL) were not significantly higher than AD cases in the other ancestries. Conclusion This study suggests pTau181 as a biomarker is generalizable across genetic ancestries, though potential sex and age effects remain to be determined. Ultimately, combining genomic and biomarker data, including pTau181 and other AD related plasma biomarkers such as Aβ40 and Aβ42, from diverse individuals will increase understanding of genetic risk and refine clinical diagnoses in individuals of diverse ancestries

Assessment of AD‐related plasma biomarkers in diverse ancestral populations

Background Plasma proteins as biomarkers for the differential diagnosis of AD from other similar neurodegenerative disorders, as well as the identification of preclinical AD, has recently been well supported across several large AD cohorts. However, these are composed primarily of individuals of non‐Hispanic European ancestry. Few studies have been performed in African‐American or Hispanic/Latinx AD populations to determine if plasma biomarkers are also useful in these populations. Given the differences in AD risk loci found across ancestries, the application of these biomarkers in diverse populations is not assured. Therefore, the aim of this study is to explore the utility of plasma biomarkers in AD, MCI and at‐risk family members from diverse ancestral backgrounds. Method As part of ongoing initiatives to understand AD in individuals of diverse ancestry, we are measuring the plasma level of biomarkers in a cohort of more than 3,000 individuals. This includes: 999 African Americans (248 AD cases, 591 controls, 160 MCI), 581 Puerto Ricans (223 AD cases, 208 controls, 150 MCI), 1052 Puerto Ricans in families (411 AD cases, 413 controls, 228 MCI), 98 Cubans (23 AD cases, 39 controls, 36 MCI), and 117 Peruvians (33 AD cases, 75 controls, 9 MCI). We will also have data on autopsy confirmed European AD cases (37) and a cohort of Amish individuals (∼400 AD cases, ∼200 MCI, and ∼500 controls). Plasma proteins tested are Aβ42, Aβ40, total Tau, and p‐Tau181 using Simoa chemistry assays (Quanterix HD‐X). All measurements are performed in duplicate and data analysis performed using HD‐X Analyzer Software v1.6. Result Measurement and analysis of biomarkers in this diverse dataset is currently underway and will be completed in a few months. These results will allow a direct comparison of biomarker analysis related to AD diagnosis between European, African, and Amerindian ancestries. Moreover, a family‐based design for over 1000 Puerto Rican individuals will be the first to identify potential heritable trends in biomarker levels. Conclusion This study is critical to being to understand how plasma biomarkers for AD may vary across diverse ancestries and whether previous findings will be generalizable and useful for all individuals, regardless of ancestry