Sacha Dubois

Lakehead University Thunder Bay Campus · School of Nursing

The path to long-term care (LTC) may be challenging, especially when transferring from inpatient mental health care. Here, eligibility and placement determinations may not fit within typical decision trees. This article outlines a process to visualize individual barriers to LTC placement. These visualizations facilitate discussion and planning to r...

Identifying older adults who may be unsafe to drive remains a difficult task. Gibbons et al. (2017, American Journal of Occupational Therapy) used serial trichotomization based on five cognitive tests to determine if drivers should: 1) continue driving, 2) undergo further evaluation, or 3) stop driving. The tests included the Trail-making-tests A a...

Aims: We conducted this review to characterize the quality of evidence about associations between diabetes and safe driving, and to evaluate how these findings are reflected within current guidelines available to support clinicians and their patients with diabetes. Methods: The first stage entailed a systematic search and review of the literatur...

Background: The use of an effective antimicrobial preoperative skin preparation solution is essential in preventing infections after surgery, but the findings in the literature regarding efficacy are not necessarily applicable to surgery involving the hip. The purpose of the present study was twofold: 1) to examine the native bacteria on the skin...

Objective: The objective of this study was to examine the association between distracted driving and crash responsibility across the whole age span after adjusting for several driver characteristics and the potential influence of alcohol and drugs. Methods: Using data from the Fatality Analysis Reporting System for the years 2010 to 2019, we estima...

Background and aims: While endoscopic retrograde cholangiopancreatography (ERCP) is a valuable diagnostic and therapeutic tool in primary sclerosing cholangitis (PSC), there is conflicting data on associated adverse events. The aims of this systematic review and meta-analysis are to (1) compare ERCP-related adverse events in patients with and with...

Adults with chronic kidney disease (CKD) are at high risk of pneumococcal infections and recommended to receive pneumococcal immunization. Some studies suggest that previous immunization with 23-valent pneumococcal polysaccharide vaccine (PPV23) may decrease the immunogenicity of 13-valent pneumococcal conjugate vaccine (PCV13). Via quantitation of...

Background Endoscopic retrograde cholangiopancreatography (ERCP) is a valuable diagnostic and therapeutic tool in primary sclerosing cholangitis (PSC). Although the complications of ERCP are well known in the general population, there is conflicting data regarding complications in patients with PSC. Factors that predict ERCP-related adverse events...

While some evidence suggests a relationship between spiritual intelligence and depression, overall, research has yielded inconclusive results. We set out to expand the literature by further exploring this relationship in a Canadian sample. We also aimed to investigate the moderating effect of gender, shedding additional light on an interaction most...

Introduction: Depression symptoms are common for older adults with memory difficulties and their caregivers. Mindfulness-based cognitive therapy (MBCT) reduces the risk of relapse in recurrent depression and improves depression symptoms. We explored recruitment and retention success and preliminary effect sizes of MBCT on depression and anxiety sy...

Background: Studies have reported poor sensitivity and specificity of the Screen for the Identification of Cognitively Impaired Medically At-Risk Drivers, a modification of the DemTech (SIMARD-MD) to screen for drivers with cognitive impairment. The purpose of this study was to determine whether the SIMARD-MD can accurately predict pass/fail on a...

Background: Our goal was to examine the relationship between age and engine displacement in cubic centimeters (CCs) and crash responsibility. Methods: Male motorcyclists, aged 16-94, involved in a fatal crash in the United States (1987-2015) who tested negative for both drugs and alcohol were included. Employing a case control design, cases had...

Background: For about 25 000 Ontarians living in remote northern First Nations communities, seeing a doctor in an emergency department requires flying in an airplane or helicopter. This study describes the demographic and epidemiologic characteristics of patients transported from these communities to access hospital-based emergency medical care....

Background Despite the use of pneumococcal vaccines, indigenous populations are consistently disproportionately affected by invasive pneumococcal disease (IPD). With recent changes in Ontario’s provincial pneumococcal vaccination program, we sought to evaluate the epidemiology and burden of IPD in northwestern Ontario (NWO) Canada – a region that c...

Objective: We explored the association between body mass index (BMI) and the odds of a driver being fatally injured in a motor vehicle crash (MVC) after controlling for driver, crash, and vehicle factors known to independently contribute to injury severity. We hypothesized that BMI would be related to risk of fatal injury after controlling for othe...

Objective: The aim of this study was to illustrate the use of serial trichotomization with five common tests of cognition to achieve greater precision in screening for fitness to drive. Method: We collected data (using the Montreal Cognitive Assessment, Motor-Free Visual Perception Test, Clock-Drawing Test, Trail Making Test Part A and B [Trails...

Mindfulness-based interventions (MBIs) improve depression symptoms after traumatic brain injury (TBI), with medium to large effect sizes. The goal of this study was to determine the clinical significance of individual changes in depression symptoms by examining data from three studies. Three criteria were used to assess the clinical significance of...

For 2 × 2 tables, Egon Pearson's N - 1 chi-squared statistic is theoretically more sound than Karl Pearson's chi-squared statistic, and provides more accurate p values. Moreover, Egon Pearson's N - 1 chi-squared statistic is equal to the Mantel-Haenszel chi-squared statistic for a single 2 × 2 table, and as such, is often available in statistical s...

SESSION TITLE: Process Improvement in Obstructive Lung Disease Education, Pneumonia Readmissions and Rapid Response Systems II SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM PURPOSE: Use of the Modified Early Warning Score (MEWS) has been shown to reduce the number of Code Blue events ou...

AbstrAct The treatment efficacy of mindfulness for improved quality of life and health-related symptoms has reliably been found in the literature. Questionnaires have been developed to assess both state mindfulness (Toronto Mindfulness Scale, TMS) and trait mindfulness (Philadelphia Mindfulness Scale, PHLMS). The objective of this study was to dire...

Background/objectives: Driving under the influence of alcohol or cannabis alone is associated with increased crash risk. This study explores the combined influence of low levels of alcohol (BAC≤0.08) and cannabis on crash risk. Materials and methods: Drivers aged 20 years or older who had been tested for both drugs and alcohol after involvement...

Background: Perimenopausal women can experience rapid bone loss at skeletal sites with both cortical and cancellous bone, increasing the prevalence of osteoporosis following menopause. Methods: We conducted a 12-month randomized placebo-controlled trial evaluating the effects of alendronate 70 mg with 2800 IU cholecalciferol administered once pe...

We sought to determine if we could reduce symptoms of depression in individuals with a traumatic brain injury using mindfulness-based cognitive therapy. The study was conducted in a community setting. We enrolled adults with symptoms of depression after a traumatic brain injury. We conducted a randomized controlled trial; participants were randomiz...

Mindfulness-based cognitive therapy (MBCT) is a relatively new therapeutic approach that is rooted in mindfulness-based stress reduction and cognitive behavioral therapy. Leading MBCT requires a radically different method than other forms of group facilitation. We are currently conducting a multi-site, randomized controlled trial (RCT) of a mindful...

Commercial motor vehicle (CMV) drivers, particularly drivers of large trucks continue to be a population of concern regarding traffic safety despite the reduction in large truck crash rates over the past decade. Medication and drug use while driving is one important risk factor for large truck crashes. Work-related exposures, such as vibration, man...

Using 1975–2008 data from the United States’ Fatality Analysis Reporting System, we examined fatality trends, projected future fatality trends to 2025, and estimated the number of fatalities expected if fatalities had continued to occur at the 1975 rate. Driver and passenger fatalities were stratified by sex and age group before fitting models to t...

Objective: Fifteen-passenger vans (15-PVs) are a convenient and economical way to transport small groups of people and many educational, community, and health organizations utilize them. Given recent tragic crashes involving 15-PVs, many organizations are reconsidering their use. The goal of this study was to examine driver, vehicle, and crash cha...

Introduction: Given the monotony and extended driving periods inherent in transport truck driving, drivers might rely on stimulants to sustain attention and combat fatigue. Research indicates that stimulant use improves some cognitive functions but impairs driving ability and is linked to crashes. The research on crash responsibility among stimula...

Objectives: Psychotic symptoms associated with Alzheimer Disease (AD) contribute to excess functional dependence. Longitudinal studies have generally examined the association between rates of functional decline and the occurrence of psychotic symptoms from either a single evaluation or from multiple evaluations rather than through changes in frequ...

We wished to determine the extent to which number of passengers, driver age, and sex were associated with aggressive driving actions (ADAs) in young drivers involved in a fatal crash. We used U.S. fatal-crash data from Fatality Analysis Reporting System (FARS), 1991 -2008. Proxy measures of aggressive driving included ADA presence and speed differe...

CONTEXT: Current therapies for traumatic brain injury (TBI) include pharmacotherapy, psychotherapy, and cognitive rehabilitation. Unfortunately, psychological and emotional issues regularly go untreated in individuals with TBI even after they receive treatment for physical, behavioral, and cognitive issues. Mindfulness-based cognitive therapy (MBCT...

In regression models with first-order terms only, the coefficient for a given variable is typically interpreted as the change in the fitted value of Y for a one-unit increase in that variable, with all other variables held constant. Therefore, each regression coefficient represents the difference between two fitted values of Y. But the coefficients...

Abstract: The stigma associated with mental illness impacts individuals with serious mental illness (SMI). We developed a questionnaire to explore stigma from the perspective of individuals with SMI. In the first of two studies, we examined content validity, internal consistency, and convergent validity. In Study 2 we explored test-retest reliabil...

Osteonecrosis of the jaw (ONJ) in association with use of bisphosphonate (BP) has been described primarily in cancer patients receiving high-dose intravenous BP. The frequency of the condition in patients with osteoporosis appears to be low. We evaluated the frequency of BP-associated ONJ in Ontario in the cancer population and in those receiving B...

To examine the relationship between the combination of alcohol and benzodiazepines and the risk of committing an unsafe driver action. We used data from the Fatality Analysis Reporting System (1993-2006) on drivers aged 20 or older who were tested for both alcohol and drugs. Using a case-control design, we compared drivers who had at least one unsa...

Aggrenox is used in the secondary prevention of stroke. Acute renal failure, potentially associated with Aggrenox, has been observed in several patients. The objective of this study was to determine if Aggrenox was associated with acute renal failure and to determine whether it was acetylsalicylic acid, dipyridamole or the combination that led to d...

Currently, most epidemiological research into the impact of opioid analgesics on road safety has focused on the association between opioid use and traffic crash occurrence. Yet, the role of opioid analgesics on crash responsibility is still not properly understood. Therefore, we examined the impact of opioid analgesics on drivers (all had a confirm...

To determine the skeletal effects of alendronate therapy in men with primary hyperparathyroidism (PHPT) in comparison with those in postmenopausal women. There essentially are no published data on the effects of bisphosphonate therapy in men with PHPT. We previously conducted a double-blind, randomized, single- crossover trial of alendronate, 10 mg...

Benzodiazepines are prescribed to relieve anxiety and aid sleep. Studies demonstrate that benzodiazepines increase odds of crash involvement, but little evidence exists regarding their impact on crash responsibility. We examined the impact of benzodiazepines on crash responsibility by drug half-life and driver age, using a case-control design with...

Aim: To describe symptom improvement and change in function in patients referred to a shared mental health care service (SMHC) that provided psychiatric consultation and brief counselling. Method: Pre (N = 1,310) and post (N = 395) measurements and comparisons with normative samples using the Patient Health Questionnaire (PHQ) and World Health Orga...

This paper outlines the development of an algorithm to determine appropriate levels of care (LOC) for individuals with a serious mental illness (SMI). The algorithm, drew on several domains of the Resident Assessment Instrument-Mental Health (RAI-MH) to support a statistical model that would explain a maximum of variance with the gold standard, a c...

There is epidemiological evidence suggesting an association between aluminum in drinking water and Alzheimer's disease (AD), and between aluminum in dialysate and dialysis dementia. The exact role of aluminum in the pathogenesis of these and other dementias is not clear. This study examined the acute effects of aluminum on cognitive function in pat...

The delivery of mental health services is often provided through agencies set up to serve both young and older adults. Young and older adults with a severe mental illness (SMI) have different needs; this study was designed to identify important differences. This is a descriptive study based on a representative sample of mental health services users...

Background: Our objective was to describe the frequency of behavioural and psychological symptoms of dementia (BPSD) in community-dwelling elderly adults with cognitive impairment and to determine whether these symptoms and behaviours assemble into distinct, clinically relevant categories.Methods: BPSD were measured using the Dysfunctional Behaviou...

Cannabis is known to have detrimental effects on human performance and may also affect driving adversely. However, studies designed to examine this issue have provided equivocal findings. We set up this study to further determine the effect of cannabis on driving. We used a cross-sectional, case-control design with drivers aged 20-49 who were invol...

Depression is common in elderly people but physicians may not screen for it because of the length of time required by current screening instruments. We have developed a short screening instrument for depression for use in elderly people with normal cognition, mild cognitive impairment or early dementia. Participants were aged 55 years or more, had...

Because of increasing waiting times for adjuvant radiation in the province of Ontario, patients from one Canadian centre were referred to two centres in the United States. This situation provided an opportunity to compare radiation practices. We performed a retrospective review of radiation prescribed to patients following breast-conserving surgery...

Increasing data suggest that visual attention may be impaired in some older drivers, and that such impairment may be related to poorer driving abilities and a higher crash risk. Because effective scanning of the environment is important for safe driving, the authors sought to examine the relationship between a reflexive visual attention mechanism a...

This study was carried out to determine why women caring for men report more burden than other caregivers, and to further examine the role of care-recipient problem behaviors as determinants of burden. A sample of 557 primary caregivers of community-dwelling individuals referred to a memory clinic was used. All care-recipients had a diagnosis of Al...

Despite considerable debate in the medical literature about the educational utility of pharmaceutical representatives (PR), little is known about their attitudes towards their role as marketers and/or educators, their ability to provide comprehensive information about products and their learning needs. A survey. Questionnaires were mailed to 606 PR...

Few interventions have been designed and tested to improve recruitment to clinical trials in oncology. The multiple factors influencing patients' decisions have made the prioritization of specific interventions challenging. The present study was undertaken to identify the independent predictors of a cancer patient's decision to enter a randomized c...

Primary hyperparathyroidism (PHPT) is often associated with reduced bone mineral density (BMD). A randomized, double-blind, placebo-controlled trial was conducted to determine whether alendronate (ALN), 10 mg daily, maintains or improves BMD in patients with PHPT. Eligible patients had asymptomatic PHPT and did not meet surgical guidelines or refus...

The long-term results of randomized trials have demonstrated equivalent survival rates for mastectomy and breast-conserving therapy for the treatment of early stage breast cancer. Consequently, the choice of treatment should be based on a patient's preferences. To evaluate the impact of a decision aid regarding the different surgical treatment opti...

Alzheimer's disease (AD) is associated with dependence in activities of daily living (ADL). In addition to the cognitive impairment resulting from AD, the presence of psychotic symptoms may further increase this dependence. The objective of this study was to quantify the additional contribution of psychotic symptoms to dependence in ADL. We analyze...

Background: Many clinicians and researchers use self-reports from patients. However, these self-reports may not be valid if patients are seriously cognitively impaired. We conducted the following study to determine the mental status level where self-reported data from the Geriatric Depression Scale (GDS) become invalid. Methods: This study was bas...

Inappropriate prescribing has been estimated to be as high as 40% in long-term care. The purpose of this study was to develop a computer program that identifies potentially inappropriate drug prescriptions and to test its reliability. Potentially inappropriate prescriptions were identified based on modified McLeod guidelines. A database from one ph...

This study measured the validity of a new instrument, the Assessment Instrument for Drug Detailing (AIDD), used by doctors to score the quality of drug detailing provided by pharmaceutical representatives in their offices. Five pharmaceutical representatives provided "good, medium, and poor" details to 135 family doctors in their offices, who were...

The purpose of the study was to develop a short and a screening version of the Zarit Burden Interview (ZBI) that would be suitable across diagnostic groups of cognitively impaired older adults, and that could be used for cross-sectional, longitudinal, and intervention studies. We used data from 413 caregivers of cognitively impaired older adults re...

Objective: To develop an instrument that reliably measures barriers to advance directive implementation in different health care settings. • Design: Items identified based on literature review and interviews with health care professionals were compiled in an item-reduction instrument. Those identified most frequently as barriers to advance directi...

We contrasted the experience of 63 pairs of primary and secondary caregivers caring for older adults with Alzheimer's disease, to better understand the nature of the burden experienced by each group. Primary and secondary caregivers appraised independence in activities of daily living and behavior problems of care recipients as similar. However, pr...

Although advance directives are commonly used in the community, little is known about the effects of their systematic implementation. To examine the effect of systematically implementing an advance directive in nursing homes on patient and family satisfaction with involvement in decision making and on health care costs. Randomized controlled trial...