Joseph Cafazzo

• BASc, MHSc, PhD, PEng
• Managing Director at University Health Network

Background Type 2 diabetes (T2D) is a chronic disease that can be partially managed through healthy behaviors. However, the COVID-19 pandemic impacted how people managed T2D due to work and school closures and social isolation. Moreover, individuals with T2D were at increased risk of complications from COVID-19 and experienced worsened mental healt...

The multicomponent Remission Evaluation of Medical Interventions in T2D (REMIT) program has shown reduction of hazard of diabetes relapse by 34–43%, but could benefit from improved ability to scale, spread, and sustain it. This study explored, at the conceptualization phase, patient and health coach perspectives on the acceptability, adoption, feas...

Objective Health recommender systems (HRSs) are increasingly used to complement existing clinical decision-making processes, but their use for chronic diseases remains underexplored. Recognizing the importance of collaborative decision making (CDM) and patient engagement in chronic disease treatment, this review explored how HRSs support patients i...

Objective. The time during which adolescents and young adults (AYAs) living with Type 1 Diabetes (T1D) transition from pediatric to adult care is associated with blood sugar levels outside of target ranges, care gaps, and an increased risk of acute diabetes complications. The aim of this study was to understand (1) the perspectives of AYAs and prov...

Pediatric heart disease currently effects over one million infants, children, and adolescents in the United States alone. Unlike the adult population, pediatric patients face a more uncertain path with factors relating to their growth and maturation creating levels of complexity to their care management. With mobile phones increasingly being utiliz...

Background Virtual nurse-led care models designed with health care professionals (HCPs) and patients may support addressing unmet prostate cancer (PCa) survivor needs. Within this context, we aimed to better understand the optimal design of a service model for a proposed nurse-led PCa follow-up care platform (Ned Nurse). Methods A qualitative desc...

Background Indigenous people have displayed their strength through their holistic practices and spiritual connection to the land. Despite overcoming the impact of discriminatory and disempowering policies within Western institutions, Indigenous people continue to experience a higher risk of cardiovascular disease, compared to the general population...

Background In Uganda, limited healthcare access has created a significant burden for patients living with heart failure. With the increasing use of mobile phones, digital health tools could offer an accessible platform for individualized care support. In 2016, our multi-national team adapted a mobile phone-based program for heart failure self-care...

Background: Prostate cancer survivors (PCa) can experience a range of unmet needs over a long horizon of survivorship. Thin healthcare services and specialist-led follow-up care models may not adequately address these needs. Digitally mediated nurse-led virtual care models may help support PCa survivors who have unmet survivorship needs in current...

Background: Approximately one in eight Canadian males will be diagnosed with prostate cancer. Longer survivorship horizons and resource constraints are leading to increasing strain on current models of specialist-led follow-up care delivery. Nurse-led digital health innovations can reduce demand on specialists if co-designed with health care profes...

UNSTRUCTURED Background: International deployment of remote monitoring and virtual care (RMVC) technologies would efficiently harness their positive impact on outcomes. Since Canada and the UK have similar populations, healthcare systems, and digital health landscapes, transferring digital health innovations between them should be relatively straig...

BACKGROUND Comprehensive models of survivorship care are necessary to improve access and coordination of care and to address the complexity of physical and psychosocial problems and long-term health needs experienced by patients following cancer treatment. Our group is building a nurse-led virtual clinic to support men living with prostate cancer (...

Background The prevalence of heart failure (HF) is increasing in Uganda. Ugandan patients with HF report receiving limited information about their illness and associated self-care behaviours. Interventions targeted at improving HF self-care have been shown to improve patient quality of life and reduce hospitalizations in high-income countries. Howe...

Objectives We sought to examine the prevalence of prospective registration and publication rates in digital health trials. Materials and Methods We included 417 trials that enrolled participants in 2012 and were registered in any of the 17 WHO data provider registries. The evaluation of the prospective trial registration was based on the actual di...

Background: The prevalence of heart failure (HF) is increasing in Uganda. Ugandan patients with HF report receiving limited information about their illness, disease management, or empowerment to engage in self-care behaviors. Interventions targeted at improving HF self-care have been shown to improve patient quality of life and to reduce hospitaliz...

People with multiple chronic conditions often struggle with managing their health. The purpose of this research was to identify specific challenges of patients with multiple chronic conditions and to use the findings to form design principles for a telemonitoring system tailored for these patients. Semi-structured interviews with 15 patients with m...

Background: Clinical trials are key to advancing evidence-based medical research. The medical research literature has identified the impact and risks of publication bias in clinical trials. Selective publication for positive outcomes or non-publication of negative results could lead to misdirection of subsequent research, justify further research,...

Introduction The globally increasing prevalence of chronic kidney disease has resulted in an ever-growing demand for renal replacement therapy. Although programs are present around the world, there is a paucity of immersive educational programs that train clinicians and administrators to develop new home dialysis programs. Explore Home Dialysis (EH...

BACKGROUND A previously published pilot study showed a statistically significant difference between New York Heart Association (NYHA) functional class and step count activity measured by wrist-worn activity monitors in patients with heart failure (HF). However, the study’s small sample size severely limits scientific confidence in the generalizabil...

Background: The New York Heart Association (NYHA) functional classification system has poor inter-rater reproducibility. A previously published pilot study showed a statistically significant difference between the daily step counts of heart failure (with reduced ejection fraction) patients classified as NYHA functional class II and III as measured...

BACKGROUND Moderate to severe postoperative pain in children is common. Increased pediatric day surgeries have shifted postoperative pain management predominantly to the home setting. Smartphone technology has the potential to overcome barriers to pain care by increasing access to self-management. However, “pain apps” generally lack scientific evid...

BACKGROUND Telemonitoring (TM) of heart failure patients in a clinic setting has been shown to be effective if properly implemented, but little is known about the feasibility and impact of implementing TM through a home care nursing agency. OBJECTIVE The goal of this study was to determine the feasibility of implementing a smartphone-based TM syst...

BACKGROUND Clinical trials are key to advancing evidence-based medical research. The medical research literature has identified the impact and risks of publication bias in clinical trials. Selective publication for positive outcomes or non-publication of negative results could lead to misdirect subsequent research, justify further research, and res...

BACKGROUND Telemonitoring interventions for the management of heart failure have seen limited adoption in Canadian health systems, but isolated examples of telemonitoring programs do exist. An example of such a program was launched in a specialty heart failure clinic in Toronto, Canada, and a recent implementation evaluation concluded that reducing...

Background: Telemonitoring interventions for the management of heart failure have seen limited adoption in Canadian health systems, but isolated examples of telemonitoring programs do exist. An example of such a program was launched in a specialty heart failure clinic in Toronto, Canada, and a recent implementation evaluation concluded that reduci...

BACKGROUND Uncontrolled asthma poses substantial negative personal and health system impacts. Web-based technologies, including smartphones, are novel means to enable evidence-based care and improve patient outcomes. OBJECTIVE The aim of this study was to design, develop, and assess the utilization of an asthma collaborative self-management (CSM)...

Background Uncontrolled asthma poses substantial negative personal and health system impacts. Web-based technologies, including smartphones, are novel means to enable evidence-based care and improve patient outcomes. Objective The aim of this study was to design, develop, and assess the utilization of an asthma collaborative self-management (CSM)...

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Background Meta-analyses of telemonitoring for patients with heart failure conclude that it can lower the utilization of health services and improve health outcomes compared with the standard of care. A smartphone-based telemonitoring program is being implemented as part of the standard of care at a specialty care clinic for patients with heart fai...

BACKGROUND As most chemotherapy is administered in the outpatient setting, patients are required to manage related side effects at home without direct support from health professionals. The Advanced Symptom Management System (ASyMS) has been developed to facilitate the remote monitoring and management of chemotherapy-related toxicity in patients wi...

Background As most chemotherapy is administered in the outpatient setting, patients are required to manage related side effects at home without direct support from health professionals. The Advanced Symptom Management System (ASyMS) has been developed to facilitate the remote monitoring and management of chemotherapy-related toxicity in patients wi...

Background: Telemonitoring has shown promise for alleviating the burden of heart failure on individuals and health systems. However, real-world implementation of sustained programs is rare. Objective: The objective of this study was to evaluate the implementation of a mobile phone-based telemonitoring program, which has been implemented as part...

Background: Pain in adolescents with cancer is common and negatively impacts health-related quality of life. The Pain Squad+ smartphone app, capable of providing adolescents with real-time pain management support, was developed to enhance pain management using a phased approach (ie, systematic review, consensus conference and vetting, iterative us...

Purpose As radiotherapy treatment grows more complex over time, treatment delivery has become more susceptible to adverse events and patient safety risks due to use error. The radiotherapy monitoring and treatment delivery user interface explored in this study was redesigned using ecological interface design, a human factors engineering method, and...

Background: Patients with complex health care needs require the expertise of many health care providers. Communication, collaboration, and patient-centered care positively impact care quality and patient outcomes. Few technologies exist that facilitate collaboration between providers across settings of care and also engage the patient. We develope...

Background: Exercise capacity and raised heart rate (HR) are important prognostic markers in patients with heart failure (HF). There has been significant interest in wrist-worn devices that track activity and HR. Objective: We aimed to assess the feasibility and accuracy of HR and activity tracking of the Fitbit and Apple Watch. Methods: We co...

Background: The rising prevalence of chronic illnesses hinders the sustainability of the health care system because of the high cost of frequent hospitalizations of patients with complex chronic conditions. Clinical trials have demonstrated that telemonitoring can improve health outcomes, but they have generally been limited to single conditions s...

Background: By 2030, prostate cancer will be the most commonly diagnosed cancer in North America. To mitigate this impending challenge, comprehensive support mechanisms for disease- and treatment-specific changes in health and well-being must be proactively designed and thoughtfully implemented for streamlined survivorship care. mHealth apps have...

BACKGROUND Exercise capacity and raised heart rate (HR) are important prognostic markers in patients with heart failure (HF). There has been significant interest in wrist-worn devices that track activity and HR. OBJECTIVE We aimed to assess the feasibility and accuracy of HR and activity tracking of the Fitbit and Apple Watch. METHODS We conducte...

Background While optimal blood glucose control is known to reduce the long-term complications associated with type 1 diabetes mellitus, adolescents often struggle to achieve their blood glucose targets. However, their strong propensity toward technology presents a unique opportunity for the delivery of novel self-management interventions. To suppor...

OBJECTIVE To explore the impact of environmental design on doffing personal protective equipment in a simulated healthcare environment. METHODS A mixed-methods approach was used that included human-factors usability testing and qualitative questionnaire responses. A patient room and connecting anteroom were constructed for testing purposes. This e...

Purpose: A user-centered design approach was used to refine the mHealth Pain Squad+ real-time pain self-management app for adolescents with cancer for its usability (defined as being easy to use, easy to understand, efficient to complete, and acceptable). Method: Three iterative usability testing cycles involving adolescent observation and inter...

Background: Pain in adolescents with cancer (12-18 years) is common and negatively impacts health-related quality of life (HRQL). The Pain Squad+ smartphone app, which provides adolescents with real-time pain self-management support, was developed to address this issue. This study evaluated the implementation of the app to inform a future randomiz...

Background: The design complexity of critical care ventilators (CCVs) can lead to use errors and patient harm. In this study, we present the results of a comparison of four CCVs from market leaders, using a rigorous methodology for the evaluation of use safety and user experience of medical devices. Methods: We carried out a comparative usabilit...

Background: Randomized controlled trials (RCTs) have long been considered the primary research study design capable of eliciting causal relationships between health interventions and consequent outcomes. However, with a prolonged duration from recruitment to publication, high-cost trial implementation, and a rigid trial protocol, RCTs are perceive...

Background: Patients with type 2 diabetes mellitus (T2DM) struggle with the management of their condition due to difficulty relating lifestyle behaviors with glycemic control. While self-monitoring of blood glucose (SMBG) has proven to be effective for those treated with insulin, it has been shown to be less beneficial for those only treated with...

P1 Serologic evidence of gut-driven systemic inflammation in juvenile idiopathic arthritis Lampros Fotis, Nur Shaikh, Kevin Baszis, Anthony French, Phillip Tarr P2 Oral health and anti-citrullinated peptide antibodies (ACPA) in juvenile idiopathic arthritis Sriharsha Grevich, Peggy Lee, Sarah Ringold, Brian Leroux, Hannah Leahey, Megan Yuasa, Jessi...

OBJECTIVE To identify issues during donning and doffing of personal protective equipment (PPE) for infectious diseases and to inform PPE procurement criteria and design. DESIGN A mixed methods approach was used. Usability testing assessed the appropriateness, potential for errors, and ease of use of various combinations of PPE. A qualitative const...

Effective chronic disease management is essential to improve positive health outcomes, and incentive strategies are useful in promoting self-care with longevity. Gamification, applied with mHealth (mobile health) applications, has the potential to better facilitate patient self-management. This review article addresses a knowledge gap around the ef...

Background and objectives: Patient self-management has been shown to improve health outcomes. We developed a smartphone-based system to boost self-care by patients with CKD and integrated its use into usual CKD care. We determined its acceptability and examined changes in several clinical parameters. Design, setting, participants, & measurements:...

Background: Elevated blood pressure is one of the main risk factors for death globally. Behavioral neurocardiac training (BNT) is a complementary approach to blood pressure and stress management that is intended to exercise the autonomic reflexes, improve stress recovery, and lower blood pressure. BNT involves cognitive-behavioral therapy with a p...

Background: We describe the development and evaluation of a secure Web-based system for the purpose of collaborative care called Loop. Loop assembles the team of care with the patient as an integral member of the team in a secure space. Objective: The objectives of this paper are to present the iterative design of the separate views for health c...

Background Lifestyle behavior modification can reduce the risk of cardiovascular disease, one of the leading causes of death worldwide, by up to 80%. We hypothesized that a dynamic risk assessment and behavior change tool delivered as a mobile app, hosted by a reputable nonprofit organization, would promote uptake among community members. We also p...

Usability testing allows human factors professionals to identify and mitigate issues with the design and use of medical technology. The test results, however, can be paradoxical and therefore be misinterpreted, limiting their usefulness. The paradoxical findings can lead to products that are not aligned with the needs and constraints of their users...

A common perception is that the use of Internet-based self-care systems is best suited for a younger, tech-proficient population, and that these systems will increase the burden on patients with complex chronic conditions. The study stratified patients with diabetes into three regimens of use of an Internet-based diabetes self-care portal. Results...

PURPOSE/OBJECTIVES: To identify and appraise current evidence related to the effectiveness of psychological and physical (nonpharmacologic) pain management modalities for children and young adults with cancer .

Patients with diabetes often face serious complications due to limited self-management skills, the inability to adhere to care regimens, and psychosocial factors. Although regular self-monitoring of blood glucose is known to benefit patients receiving insulin therapy, its role in patients not treated with insulin has been unclear. However, recent s...

SESSION TITLE: 21st Century Technology SESSION TYPE: Original Investigation Slide PRESENTED ON: Wednesday, October 28, 2015 at 08:45 AM - 10:00 AM PURPOSE: Self-management is a key component of evidence-based care for patients living with COPD. Mobile-based applications with patient-specific information may support COPD patients in learning self-ma...

To gain insights into how technological communication tools impact effective communication among clinicians, which is critical for patient safety. This multi-site observational study analyzes inter-clinician communication and interaction with information technology, with a focus on the critical process of patient transfer from the Emergency Departm...

Background: The high prevalence rate of asthma represents a major societal burden. Advancements in information technology continue to affect the delivery of patient care in all areas of medicine. Internet-based solutions, social media, and mobile technology could address some of the problems associated with increasing asthma prevalence. Objective...

Clinical protocols for basal rate testing and adjustment are needed for effective insulin pump therapy. We evaluated the effects of a continuous glucose monitoring (CGM)-based semiautomated basal algorithm on glycemia. We developed and piloted a basal rate analyzer that interpreted CGM data from overnight fasts and recommended dose changes for subs...

Background Nurses are frequently interrupted during medication verification and administration; however, few interventions exist to mitigate resulting errors, and the impact of these interventions on medication safety is poorly understood. Objective The study objectives were to (A) assess the effects of interruptions on medication verification and...

Healthcare technologies have a reputation for being overly-complex, difficult-to-use, uninspired, and unusable. There is a significant opportunity to incorporate human-centered design into healthcare through the synthesis of deep healthcare domain expertise, visual and industrial design, human factors theory and practice, and an understanding of th...

Poor device design that fails to adequately account for user needs, cognition, and behavior is often responsible for use errors resulting in adverse events. This poor device design is also often latent, and could be responsible for "No Fault Found" (NFF) reporting, in which medical devices sent for repair by clinical users are found to be operating...

Computerized physician order entry (cpoe) systems allow for medical order management in a clinical setting. Use of a cpoe has been shown to significantly improve chemotherapy safety by reducing the number of prescribing errors. Usability of these systems has been identified as a critical factor in their successful adoption. However, there is a pauc...

Pain that occurs both within and outside of the hospital setting is a common and distressing problem for adolescents with cancer. The use of smartphone technology may facilitate rapid, in-the-moment pain support for this population. To ensure the best possible pain management advice is given, evidence-based and expert-vetted care algorithms and sys...

The pace of adoption of consumer health solutions appears to be slow, despite some documented success. Reasons why the health system is not embracing this success are complex but not entirely unexpected. The barriers continue to be more a reflection of the state of our health system itself than of the patients who are demanding more involvement in...

The western world enjoys a far greater degree of sophistication in computer technology than the developing world; challenges include the fact that infrastructure and resources in the developing world lag far behind; education to use and maintain the technology is often lacking; and cultural and societal issues prohibit its use. Questions include: W...

Can an app help manage diabetes? We discuss how the advent of mobile health apps in connecting patients to providers is creating new opportunities for the management of diabetes. Although there are promising outcomes, there is still much to be learned about how such technology could be fully exploited.

Despite advancements in the development of the artificial pancreas, barriers in the form of proprietary data and communication protocols of diabetes devices have made the integration of these components challenging. The Artificial Pancreas Standards and Technical Platform Project is an initiative funded by the JDRF Canadian Clinical Trial Network w...

Electroencephalography (EEG) testing in clinical labs makes use of large amplifiers and complex software for data acquisition. While there are new ambulatory electroencephalogram (EEG) systems, few have been directly compared to a gold standard system. Here, an ultra-low power wireless EEG system designed by Imec is tested against the gold standard...

Background: Communication and collaboration failures can have negative impacts on the efficiency of both individual clinicians and health care system delivery as well as on the quality of patient care. Recognizing the problems associated with clinical and collaboration communication, health care professionals and organizations alike have begun to l...

Objectives: Order sets are widely used in hospitals to enter diagnosis and treatment orders. To determine the effectiveness of order sets in improving guideline adherence, treatment outcomes, processes of care, efficiency, and cost, we conducted a systematic review of the literature. Methods: A comprehensive literature search was performed in va...

Implementation of an electronic health record (EHR) system is generally believed to improve the quality of patient care. However due to the variability of systems and users, there is little agreement on successful implementation. The purpose of this research is to evaluate the implementation of a BlackBerry hosted application enabling wireless docu...

Lowering blood pressure reduces cardiovascular risk, yet hypertension is poorly controlled in diabetic patients. In a pilot study we demonstrated that a home blood pressure telemonitoring system, which provided self-care messages on the smartphone of hypertensive diabetic patients immediately after each reading, improved blood pressure control. Mes...

The use of mHealth apps has shown improved health outcomes in adult populations with type 2 diabetes mellitus. However, this has not been shown in the adolescent type 1 population, despite their predisposition to the use of technology. We hypothesized that a more tailored approach and a strong adherence mechanism is needed for this group. To design...