Sharon E. Straus’s research while affiliated with University of Toronto and other places

What is this page?


This page lists works of an author who doesn't have a ResearchGate profile or hasn't added the works to their profile yet. It is automatically generated from public (personal) data to further our legitimate goal of comprehensive and accurate scientific recordkeeping. If you are this author and want this page removed, please let us know.

Publications (843)


An evaluation of barriers and facilitators to implementing multiplex rapid antigen testing for SARS-CoV-2 and influenza A and B in congregate living settings
  • Article
  • Full-text available

April 2025

·

25 Reads

Yasmin Garad

·

Andreea A. Manea

·

Negin Pak

·

[...]

·

Introduction Point of care multiplex rapid antigen testing (RAT) is a tool that can be used to mitigate and respond to facility-based infectious disease outbreaks. However, little is known about how to optimally implement this testing in congregate living settings (CLSs), including long term care homes (LTCHs), retirement homes (RHs), and shelters serving people experiencing homelessness. Our objective was to explore the barriers and facilitators to implementing a new device for multiplex RAT for COVID-19 and influenza across CLSs in the Greater Toronto Area, Canada. Materials and methods Using key informant interviews, we assessed barriers and facilitators to implementing multiplex RAT across CLSs. Qualitative coding using the framework approach was used to identify themes. We used the Theoretical Domains Framework (TDF) and the Consolidated Framework for Implementation Research (CFIR) to identify individual and contextual-level barriers and facilitators to implementation. Identified barriers were then mapped to implementation strategies using theoretically-rooted frameworks and tools. Results We completed 45 interviews with staff at CLSs (8 LTCHs, 4 RHs, 12 shelters) between January 2022 and March 2023. Four barriers to RAT implementation in CLSs emerged including: limited material resources for implementation; insufficient staff capacity to perform RAT testing; complexity of RAT implementation; and reluctance among staff to adopt a new testing process. Five facilitators to implementation were described including: training and implementation support for staff at the CLSs; site-level implementation champions; access to materials to support testing; perceived advantages of simultaneous testing for COVID-19 and influenza; and the usability and functionality of the RAT testing device. Twenty implementation strategies were identified through implementation strategy mapping. Discussion Multiplex RAT options can empower CLS staff to promptly identify and respond to viral respiratory outbreaks. The use of evidence-based implementation strategies can enhance the effectiveness of using multiplex RAT to control outbreaks in CLSs.

Download

Age-adjusted prevalence ratios
Demographic Characteristics
Patterns of SARS-CoV-2 seropositivity among essential workers in long term care and retirement homes in Ontario, Canada: A descriptive cross-sectional study

March 2025

·

14 Reads

Understanding patterns of SARS-CoV-2 seroprevalence among Long-Term Care Home and Retirement Home (LTCH/RH) staff is critical to designing effective public health interventions. We estimated SARS-CoV-2 seroprevalence among LTCH/RH staff in Ontario, Canada between May 2021-October 2022 using a cross-sectional analysis. Eligible participants completed a demographic questionnaire and provided a dried blood spot sample. Positive seroprevalence was defined as the proportion of individuals in a population who were positive for a SARS-CoV-2 infection, determined using anti-nucleocapsid total IgG antibodies analyzed with a validated chemiluminescent ELISA. We report age-adjusted prevalence ratios [PR; confidence interval, CI] by participant socio-demographic, household, neighbourhood, and occupational characteristics and stratified the analyses over two time periods (period 1: 2021-05-17 to 2021-12-31; period 2: 2022-01-02 to 2022-10-25). A total of 603 staff were included in our analysis; n=235 (39%) were enrolled in period 1 and n=368 (61%) were enrolled in period 2. Seroprevalence was 24% and 44% in periods 1 and 2, respectively. Age-adjusted prevalence ratios were nearly 2-fold higher among Black [PR 1.78; CI 1.28-2.48], East and Southeast Asian [PR 1.55, CI 1.18-2.04] and other racialized participants [PR 1.42, CI 1.03-1.96] compared to White participants. We did not observe a pattern across household characteristics, although we observed a trend towards higher seropositivity among participants living in COVID-19 hotspots. Prevalence ratios were lower for participants in higher income neighbourhoods [PR 0.72, CI 0.58-0.98]. We did not observe variability in seroprevalence across occupational characteristics with the exception of paid sick leave which was higher among participants with home-provided paid sick leave at the time of the survey [PR 0.58, CI 0.45-0.75]. Among LTCH/RH staff, we found important sources of variability of SARS-CoV-2 seroprevalence and strong correlations with socioeconomic disparities. Our findings show the importance of designing equity-rooted health interventions that recognize the intersection between community and the workplace.


Cost-Effectiveness of the Geriatrician-Led Comprehensive Geriatric Assessment in Different Healthcare Settings: An Economic Evaluation

March 2025

·

15 Reads

Journal of the American Geriatrics Society

Background With a shortage of geriatricians, the appropriate distribution of geriatricians across healthcare settings (e.g., acute care, rehabilitation, or community clinics) is unknown. Our objective was to determine which setting(s) geriatricians should preferentially staff to be most economically attractive for the Canadian healthcare system. Methods We conducted a cost‐effectiveness analysis using a two‐dimensional microsimulation model. The model simulated a population of frail adults aged ≥ 65 years. The simulation was done over a lifetime horizon from the Ontario public payer perspective. Strategies included (1) usual care (baseline proportions of geriatrician CGAs in each setting), (2) acute care only (100% receive CGA in acute care), (3) community care only, (4) rehabilitation only, (5) acute care and community combined, (6) acute care and rehabilitation combined, (7) community and rehabilitation combined, and (8) acute care, community, and rehabilitation combined. Primary model outputs included quality‐adjusted life months (QALMs), lifetime costs, and incremental cost‐effectiveness ratios (ICERs). Results The acute care and rehabilitation combined strategy was undominated at a lifetime cost of C139,987andwithaneffectivenessof42.09QALM.AtanICERofC139,987 and with an effectiveness of 42.09 QALM. At an ICER of C1203 per QALM, the combination strategy of acute care, rehabilitation, and community clinics was cost‐effective relative to acute care and rehabilitation, assuming a cost‐effectiveness threshold of C4167perQALM(equivalenttoC4167 per QALM (equivalent to C50,000 per quality‐adjusted life year). The other six strategies were dominated. When individually compared to usual care, all of the strategies were dominant or cost‐effective. Conclusions An undominated strategy of staffing geriatricians was in the acute care and rehabilitation settings, with the option of adding community clinics if cost and resources permit.


Figure 1 The example model used to demonstrate gains in efficiency for dynamic cycle length (DCL) and hybrid model structures (DCL plus pseudo-discrete event simulation elements [DCL-pDES]) relative to a fixed cycle length (FCL) structure. (A) Structure for FCL and DCL models, in which for the former, cycle lengths are the same for all nonabsorbing states while in the latter, cycle lengths have values that are local to each nonabsorbing state. (B) Structure for the DCLpDES model. Absorption from the ''Home'' state is modeled as a single step whose duration is sampled from a Gompertz distribution.
Figure 3 Kernel density plot of quality-adjusted life expectancy (QALE) outputs across 5,000 replicates of the 3 model strictures, fixed cycle length (fcl), dynamic cycle length (dclfullyr) and the hybrid model structure (DCL plus pseudodiscrete event simulation elements; dclpdes).
Figure 4 A graph for a single replicate of the surgical wait-list example model with numbers of active (''evaluated'') individuals as a function of model runtime in weeks for the fixed exit (blue), fixed entry (orange), and fixed entry plus phantoms structures (gray).
Changing Time Representation in Microsimulation Models

February 2025

·

19 Reads

Medical Decision Making

Background In microsimulation models of diseases with an early, acute phase requiring short cycle lengths followed by a chronic phase, fixed short cycles may lead to computational inefficiency. Examples include epidemic or resource constraint models with early short cycles where long-term economic consequences are of interest for individuals surviving the epidemic or ultimately obtaining the resource. In this article, we demonstrate methods to improve efficiency in such scenarios. Furthermore, we show that care must be taken when applying these methods to epidemic or resource constraint models to avoid bias. Methods To demonstrate efficiency, we compared the model runtime among 3 versions of a microsimulation model: with short fixed cycles for all states (FCL), with dynamic cycle length (DCL) defined locally for each state, and with DCL features plus a discrete-event-like hybrid component. To demonstrate bias mitigation, we compared discounted lifetime costs for 3 versions of a resource constraint model: with a fixed horizon where simulation stops, with a fixed entry horizon beyond which new individuals could not enter the model, and with a fixed entry horizon plus a mechanism to maintain a constant level of competition for the resource after the horizon. Results The 3 versions of the microsimulation model had average runtimes of 515 (95% credible interval [CI]: 477 to 545; FCL), 2.70 (95% CI: 1.48 to 2.92; DCL), and 1.45 (95% CI: 1.26 to 2.61; DCL-pseudo discrete event simulation) seconds, respectively. The first 2 resource constraint versions underestimated costs relative to the constant competition version: 20,055(9520,055 (95% CI: 19,000 to 21,120), 27,030 (95% CI: 24,680to24,680 to 29,412), and 33,424(9533,424 (95% CI: 27,510 to $44,484), respectively. Limitations The magnitude of improvements in efficiency and reduction in bias may be model specific. Conclusion Changing time representation in microsimulation may offer computational advantages. Highlights Short cycle lengths may be required to model the acute phase of an illness but lead to computational inefficiency in a subsequent chronic phase in microsimulation models. A solution is to create state-specific cycle lengths so that cycle lengths change dynamically as the simulation progresses. Computational efficiency can be enhanced further by using a hybrid model containing discrete-event-simulation-like features. Hybrid models can efficiently handle events subsequent to exit from an epidemic or resource constraint model provided steps are taken to mitigate potential bias.


Figure 1. Flow diagram illustrating the individual steps involved in the updated PRISMA-NMA process.
Updating the PRISMA reporting guideline for network meta-analysis: a scoping review

February 2025

·

118 Reads

STANDFIRST This scoping review represents the initial step in updating the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) extension for network meta-analysis (NMA) to improve the usability and relevance of systematic reviews with NMA for diverse audiences. The update will address gaps in reporting, such as documenting methods for assessing NMA homogeneity and transitivity, defining intervention nodes, and considering advances in statistical modeling. It will align with PRISMA 2020 and incorporate input from diverse knowledge users, including patients and the public. This scoping review included 61 studies, comprising 23 guidance documents and 38 overviews of reviews evaluating the completeness of reporting and methodological quality of published NMAs. We identified 37 additional NMA items for inclusion in the next step—the Delphi survey. Building on a 2014 scoping review by our team, we incorporated recent studies to inform the PRISMA-NMA update, adhering to established standards for guideline development. SUMMARY POINTS Network meta-analyses (NMAs) are increasingly prominent in evidence synthesis, but their methodological transparency and reporting completeness remain inconsistent, which affects the reliability of results. This scoping review highlights the need to update PRISMA-NMA to address evolving methodologies (e.g., component NMA) and reporting challenges to improve accessibility and utility of NMA findings. The review underscores progress and gaps in NMA reporting since the 2015 PRISMA-NMA extension, focusing on synthesis methods, homogeneity, consistency and transitivity assessments, and network geometry. Key recommendations, such as defining pre-specified nodes, specifying statistical methods, and addressing competing interests, were often overlooked in NMA reporting, but addressing these gaps could enhance transparency, reproducibility, and trust in NMA results.



Accuracy of rapid antigen testing for COVID-19 in shelter settings

January 2025

·

29 Reads

Background The COVID-19 pandemic disproportionally affected congregate living settings, including shelters. COVID-19 transmission can have more adverse outcomes in these settings due to the vulnerability of residents. Point of care rapid antigen testing (RAT) represents a strategy with potential benefits for COVID-19 detection in shelters, including rapid results, ease of use, cost-effectiveness, and early detection. Objectives Our primary objective was to assess the real-world test accuracy of RAT for COVID-19 using the Quidel Sofia 2 Flu + SARS Antigen fluorescent immunoassay (Sofia RAT) compared to polymerase chain reaction (PCR) testing among shelter residents in Ontario, Canada. Study Design A consecutive sample of 102 residents across six shelters who were symptomatic for, or exposed to COVID-19 were included. The RAT and PCR samples were taken on the same day for each participant. Results from the Sofia RAT were compared to PCR test results to determine test accuracy. Participant demographic data could not be collected due to workforce constraints. Results We reported our methods and findings using the QUality Assessment tool of Diagnostic Accuracy Studies (QUADAS-2) guidelines. Sofia 2 RAT specificity was 97.9% (95% CI: 92.7% to 99.7%) for COVID-19 compared to PCR. Due to a lack of true positive cases, sensitivity could not accurately be calculated (0.00% (95% CI: 0.00% to 52.2%)). Conclusion These data suggest that the Sofia RAT is a highly specific test for COVID-19. Keywords Rapid antigen testing (RAT), Homeless shelter, Test accuracy, COVID-19 detection, SARS-CoV-2


Healthcare providers' perceptions of COVID-19 stigma affecting patients.
Healthcare providers' perceptions and experiences of stigma.
Stigma and fear during the COVID-19 pandemic: a qualitative study on the perceptions of healthcare workers in Canada and Singapore

January 2025

·

22 Reads

Introduction We sought to explore healthcare providers (HCPs)' perceptions of and experiences with stigma during the COVID-19 pandemic in Canada and Singapore. Methods We conducted a qualitative study (May 2020–February 2021) with HCPs in Canada and Singapore and developed a semi-structured interview guide rooted in the Health Stigma and Discrimination Framework (HSDF). We recruited participants online and through word of mouth via newsletters, blogs and social media. Participants were eligible to participate if they worked as a healthcare provider in Singapore or Canada during COVID-19. Following participant consent, data were recorded, transcribed verbatim, and coded using a framework approach. Coded data were charted into a framework matrix and used to compare themes in each country. Results We conducted 51 interviews (23 in Canada; 28 in Singapore). HCPs perceived that patient fears coupled with mistrust of the health system impacted health behaviors. HCPs reported discrimination and stigmatization of population subsets. In Singapore, this included Chinese tourists and migrant workers and in Canada, this included people of Chinese ethnicity and people experiencing homelessness. This stigma was often attributed to pre-existing prejudices including perceptions that these populations were at increased risk of COVID-19 or not adhering to public health recommendations. HCPs feared spreading COVID-19 to family, peers and patients, often resulting in participants choosing to isolate from social circles. HCPs in both countries experienced occupation-based stigma, including stigma related to public health practices (masking, testing); in Canada, this intersected with race-based prejudice for participants of Chinese ethnicity. HCPs in both samples witnessed and experienced stigmatizing behavior; some participants also experienced discrimination. Conclusions Secondary stigma related to occupation was experienced by HCPs during COVID-19. HCPs experienced intersecting stigma based on race/ethnicity and observed stigmatization of marginalized patient populations. Most themes were consistent across Canada and Singapore. Strategies to mitigate COVID-19 related stigma toward HCPs and at-risk patient populations are warranted.


Update to the PRISMA guidelines for network meta-analyses and scoping reviews and development of guidelines for rapid reviews: a scoping review protocol

January 2025

·

404 Reads

·

1 Citation

JBI Evidence Synthesis

Objective The objective of this scoping review is to develop a list of items for potential inclusion in the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) reporting guidelines for network meta-analysis (NMA), scoping reviews (ScRs), and rapid reviews (RRs). Introduction The PRISMA extensions for NMA and ScRs were published in 2015 and 2018. However, since then, their methodologies and innovations, including automation, have evolved. There is no reporting guideline for RRs. In 2020, an updated PRISMA statement was published, reflecting advances in the conduct and reporting of systematic reviews. These advances are not yet incorporated into these PRISMA extensions. We will update our previous methods scoping reviews to inform the update of PRISMA-NMA and PRISMA-ScR as well as the development of the PRISMA-RR reporting guidelines. Inclusion criteria This review will include any study designs evaluating the completeness of reporting, or offering reporting guidance, or assessing methods relevant to NMA, ScRs, or RRs. Editorial guidelines and tutorials that describe items related to reporting completeness will also be eligible. Methods We will follow the JBI guidance for scoping reviews. For each PRISMA extension, we will (1) search multiple electronic databases from inception, (2) search for unpublished studies, and (3) scan the reference lists of included studies. There will be no language limitations. Screening and data extraction will be conducted by 2 researchers independently. A third researcher will resolve discrepancies. We will conduct frequency analyses of the identified items. The final list of items will be considered for potential inclusion in the relevant PRISMA reporting guidelines. Review registration NMA protocol (OSF: https://doi.org/10.17605/OSF.IO/7BKWY); ScR protocol (OSF: https://doi.org/10.17605/OSF.IO/MTA4P); RR protocol (OSF: https://doi.org/10.17605/OSF.IO/3JCPE); EQUATOR registration link: https://www.equator-network.org/library/reporting-guidelines-under-development/reporting-guidelines-under-development-for-systematic-reviews/


Perspectives on which health settings geriatricians should staff: a qualitative study of patients, care providers and health administrators

January 2025

·

27 Reads

BMC Geriatrics

Background With a shortage of geriatricians and an aging population, strategies are needed to optimise the distribution of geriatricians across different healthcare settings (acute care, rehabilitation and community clinics). The perspectives of knowledge users on staffing geriatricians in different healthcare settings are unknown. We aimed to understand the acceptability and feasibility (including barriers and facilitators) of implementing a geriatrician-led comprehensive geriatric assessment (CGA) in acute care, rehabilitation, and community clinic settings. Methods A qualitative description approach was used to explore the experience of those implementing (administrative staff), providing (healthcare providers), and receiving (patients/family caregivers) a geriatrician-led CGA in acute care, rehabilitation and community settings. Semi-structured interviews were conducted in Toronto, Canada. The theoretical domains framework and consolidated framework for implementation research informed the interview guide development. Analysis was conducted using a thematic approach. Results Of the 27 participants (8 patients/caregivers, 9 physicians, 10 administrators), the mean age was 53 years and 14 participants (52%) identified as a woman (13 [48%] identified as a man). CGAs were generally perceived as acceptable but there was a divergence in opinion about which healthcare setting was most important for geriatricians to staff. Acute care was reported to be most important by some because no other care provider has the intersection of acute medicine skills with geriatric training. Others reported that community clinics were most important to manage geriatric syndromes before hospitalization was necessary. The rehabilitation setting appeared to be viewed as important but as a secondary setting. Facilitators to implementing a geriatrician-led CGA included (i) a multidisciplinary team, (ii) better integration with primary care, (iii) a good electronic patient record system, and (iv) innovative ways to identify patients most in need of a CGA. Barriers to implementing a geriatrician-led CGA included (i) lack of resources or administrative support, (ii) limited team building, and (iii) consultative model where recommendations were made but not implemented. Conclusions Overall, participants found CGAs acceptable yet had different preferences of which setting to prioritise staffing if there was a shortage of geriatricians. The main barriers to implementing the geriatrician-led CGA related to lack of resources. Clinical trial number Not applicable.


Citations (61)


... In 2019, the WHO identified vaccine hesitancy as one of the top ten threats to global health [12]. Miscommunication, along with the widespread dissemination of fake news, inaccurate information, and conspiracy theories, has seriously undermined public trust in science and health institutions [13]. Conspiracy beliefs, in particular, play a crucial role in fueling vaccine mistrust and hesitancy by promoting the idea that vaccines are harmful, unnecessary, or part of a larger scheme orchestrated by governments, pharmaceutical companies, or other powerful entities [14][15][16][17]. ...

Reference:

COVID-19 Vaccine Uptake Rates and Associated Factors in Racially Diverse Parents in Canada: The Threat From Conspiracy Beliefs and Racial Discrimination
Considering the impact of vaccine communication in the COVID-19 pandemic among adults in Canada: A qualitative study of lessons learned for future vaccine campaigns

... Third, formalizing resource-sharing practices, such as curated repositories of recommended readings and webtools, could streamline consultations (36). Expanding mentorship networks and expert connections would also strengthen capacity-building efforts (37). Finally, these results can inform the development of standardized DIS consultation frameworks that can be adapted and scaled across different institutions (2). ...

Building capacity in dissemination and implementation research: the presence and impact of advice networks

... This perspective does not align with findings from the economic evaluation, which found the combination of acute care and rehabilitation to be optimal. Furthermore, in a recent systematic review [51], geriatric rehabilitation was found to be effective in reducing mortality, long-term care admission, and improving function. Of the included geriatric rehabilitation trials, 69% included a geriatrician [51]. ...

Effectiveness of geriatric rehabilitation in inpatient and day hospital settings: a systematic review and meta-analysis

BMC Medicine

... NMA has been around for more than 2 decades and has become a well-established method of evidence synthesis to inform clinicians' decisions, clinical practice guidelines and health technology assessment. However, NMA methodology is continuously evolving, and several methodological challenges remain to be addressed [3,4]. Therefore, despite NMA in not new, some users may feel frightened with their methods. ...

Two decades of network meta-analysis: Roadmap to their applications and challenges
  • Citing Article
  • July 2024

Research Synthesis Methods

... Outcomes, including benefit, risk and burden of interventions, become less predictable in older adults living with multimorbidity and clinicians must apply guidelines thoughtfully. 37 Improvements in disease-specific outcomes do not necessarily correspond to enhancements that matters to older adults. 38 Risk assessment prior to TAVI in patients with cognitive impairment is challenging due to contradicting outcomes and few studies of high quality. ...

New horizons in clinical practice guidelines for use with older people

Age and Ageing

... Access to support systems, such as caregiver support groups and respite care, can help mitigate the effects of social isolation. These resources provide opportunities for caregivers to connect with others in similar situations and take breaks from their caregiving duties [29,30]. ...

Interventions that have potential to help older adults living with social frailty: a systematic scoping review

BMC Geriatrics

... Vveinhardt and Deikus (2023b) explored religious strategies to be implemented in the workplace for workplace mobbing. Others have explored genderbased interventions for gender equity in the workplace (Tricco et al., 2024). While generation-based interventions are scarce, strategic interventions for meaningful work must be explored and applied based on the context of the organization including relevant factors such as male-female employee ratio, religious and spiritual beliefs. ...

Interventions on gender equity in the workplace: a scoping review

BMC Medicine

... Several references reported that turmeric rhizome contains α-curcumene as a bioactive compound that proves efficacious for health treatment for humans with health disorders such as Parkinson's disease [11][12][13], antiviral, anti-inflammatory, and antioxidant effects for human cells infected by SARS-CoV-2 virus [14], as well as treatment for Alzheimer disorder [15][16]. In addition, curcumin has the potential for human longevity, antiaging effect [17], neuroprotective effect [18], and inhibits the growth of cancer cells [19][20] and digestive disorders [21]. ...

A systematic review of the efficacy and safety of turmeric in the treatment of digestive disorders
  • Citing Article
  • March 2024

... The number of COVID-19 vaccine doses received emerged as a pivotal factor in enhancing confidence across various dimensions, from vaccine safety to the trustworthiness of health authorities. This echoes the broader literature indicating that positive experiences with healthcare systems, including vaccination, can reinforce trust in public health measures [36][37][38]. However, our study uniquely contributes to the understanding that delays in routine vaccinations for children during the pandemic significantly affected parents' confidence, underscoring the critical role of maintaining vaccination schedules for sustaining public trust. ...

The evolution of vaccine hesitancy through the COVID-19 pandemic: A semi-structured interview study on booster and bivalent doses

... It requires thorough understanding of sono-anatomy, excellent hand-eye co-ordination and recognition of proper local anaesthetic deposition at the target structure [1]. Lack of effective education and training interventions are common barriers to the consistent provision of ultrasound-guided regional anaesthesia [2][3][4][5]. Previous systematic reviews on ultrasound-guided regional anaesthesia show that simulation-based training improves knowledge, behaviour and patient outcomes compared with traditional methods (e.g. ...

Using implementation science to promote the use of the fascia iliaca blocks in hip fracture care
  • Citing Article
  • December 2023

Canadian Anaesthetists? Society Journal