In Brief

November 2016   Comments

Autism, ADHD and OCD: Insights into brain impairments
A non-invasive technique to monitor migraines and epilepsy
Weaker beer, better harm reduction?
Preventing a previously unpreventable cause of heart failure
Hope for new treatment of Crohn’s disease
Published research from CNA members


Autism, ADHD and OCD: Insights into brain impairments

A team of Toronto scientists has found similarities in the brain impairments of children and adolescents with autism spectrum disorder, attention deficit hyperactivity disorder (ADHD) and obsessive compulsive disorder (OCD). The study, published in the American Journal of Psychiatry, involved imaging of the brains of 200 young people. The researchers found impairments in the main white matter tract connecting the right and left hemispheres in the brains of participants with one of the three disorders but not in the brains of those in the control group.

Together, autism, ADHD and OCD affect roughly 15 per cent of children and youth. Many of the behaviours that contribute to impairment, such as attention problems or social difficulties, occur across these developmental conditions. The researchers found that subjects with greater brain impairment had poorer functioning in daily life, regardless of their diagnosis. This study points to the potential that treatments targeting a spectrum of behaviours may be relevant for all three conditions.


A non-invasive technique to monitor migraines and epilepsy

A low-frequency brainwave linked to migraines and epilepsy, known as cortical spreading depression, is best studied by placing electrodes directly on the surface of the brain. However, researchers from the University of British Columbia and from Germany and Iran have discovered that equally reliable data can be captured through electrodes placed only on the scalp.

As described in Neuroscience, the researchers designed an AC/DC amplifier to acquire electrical signals from scalp electrodes used on anesthetized rats. The amplifier detected signals in a much broader frequency range than the standard clinical electroencephalogram (EEG) system. The investigators induced cortical spreading depression in the rats and then compared recordings from the scalp electrodes with recordings from electrodes placed directly on the animals’ brains.

According to the research team, their technique will enable cortical spreading depression to be studied non-invasively, at a diagnostic cost similar to that associated with the standard EEG method. The technique could contribute to the development of drugs to treat migraine and epilepsy that target cortical spreading depression and to a better understanding of other neurological disorders.


Weaker beer, better harm reduction?

Could a small drop in the alcohol content of beer or other drinks reduce the harmful effects of alcohol in society at large? Evidence reviewed by a team of researchers mostly from the Centre for Addiction and Mental Health in Toronto suggests the answer might be yes. As reported in Lancet Gastroenterology & Hepatology, the investigators found studies indicating that consumers cannot distinguish between beers of different strengths; concerns that people would drink larger volumes of the low-alcohol beer to compensate or switch to other beverages with more alcohol were not warranted. The investigators noted that offering alcohol-free drinks as a cheaper alternative in bars or restaurants is a less promising alternative; there is limited evidence that this approach affects drinking levels or alcohol-related harms.

According to the researchers, there is more incentive for the alcohol industry to get on board with the proposal to reduce the alcohol content of drinks than with other policy measures such as higher taxation, limitations on access and marketing restrictions. The industry would not lose sales, its profit margins might increase and its image would not be negatively affected. This approach could thus constitute a rare win-win situation for the alcohol industry and public health.


Preventing a previously unpreventable cause of heart failure

Research from the University of Alberta and McGill University has opened the door to the future prevention of cardiac fibrosis, a condition leading to heart failure for which there is currently no treatment. In a study published in PLOS ONE, the researchers discovered the specific triggers for the development of fibrosis, which accelerates heart failure. They were able to prevent cardiac fibrosis from occurring in mice by blocking the triggers through the use of a specific kind of bile acid.

The team is now conducting studies to see if the therapeutic effect can be achieved in humans. They aim to gain a better understanding of how bile acids prevent cardiac fibrosis from occurring: they want to figure out what happens within the heart cells at the molecular level. They then hope to work with cardiologists to move the research into clinical trials involving chemotherapy and heart transplant patients, who are known to be at high risk of developing cardiac fibrosis.


Hope for new treatment of Crohn’s disease

Scientists from the University of British Columbia and from Australia have made a discovery that could potentially lead to treatments for a debilitating complication of Crohn’s disease. The intestines of some patients can become blocked by thickened and scarred connective tissue, a condition known as intestinal fibrosis. The researchers reported in Science Immunology that they discovered a mutation that prevented mice from developing fibrosis after being infected with a type of salmonella that produces symptoms mimicking those of Crohn’s. The mutation had switched off a hormone receptor responsible for stimulating part of the body’s immune response.

Drugs are available that may be able to block that receptor in normal cells and prevent fibrotic disease. The investigators hope their discovery can be applied to other types of tissue that undergo fibrosis, in liver cirrhosis and chronic kidney disease, for instance. The lead author noted that fibrosis also occurs during normal aging: if they can reverse it, they have essentially found a way to promote regeneration rather than degeneration.


Published research from CNA members

Rashotte, J., Varpio, L., Day, K., Kuziemsky, C., Parush, A., Elliott-Miller, P., … Roffey, T. (2016). Mapping communication spaces: The development and use of a tool for analyzing the impact of EHRs on interprofessional collaborative practice. International Journal of Medical Informatics, 93, 2-13. doi:10.1016/j.ijmedinf.2016.05.003

Introduction: Members of the healthcare team must access and share patient information to coordinate interprofessional collaborative practice (ICP). Although some evidence suggests that electronic health records (EHRs) contribute to in-team communication breakdowns, EHRs are still widely hailed as tools that support ICP. If EHRs are expected to promote ICP, researchers must be able to longitudinally study the impact of EHRs on ICP across communication types, users, and physical locations.

Objective: This paper presents a data collection and analysis tool, named the Map of the Clinical Interprofessional Communication Spaces (MCICS), which supports examining how EHRs impact ICP over time, and across communication types, users, and physical locations.

Methods: The tool’s development evolved during a large prospective longitudinal study conducted at a Canadian pediatric academic tertiary-care hospital. This two-phased study [i.e., pre-implementation (phase 1) and post implementation (phase 2)] of an EHR employed a constructivist grounded theory approach and triangulated data collection strategies (i.e., non-participant observations, interviews, think-alouds, and document analysis). The MCICS was created through a five-step process: (i) preliminary structural development based on the use of the paper-based chart (phase 1); (ii) confirmatory review and modification process (phase 1); (iii) ongoing data collection and analysis facilitated by the map (phase 1); (iv) data collection and modification of map based on impact of EHR (phase 2); and (v) confirmatory review and modification process (phase 2).

Results: Creating and using the MCICS enabled our research team to locate, observe, and analyze the impact of the EHR on ICP, (a) across oral, electronic, and paper communications, (b) through a patient’s passage across different units in the hospital, (c) across the duration of the patient’s stay in hospital, and (d) across multiple healthcare providers. By using the MCICS, we captured a comprehensive, detailed picture of the clinical milieu in which the EHR was implemented, and of the intended and unintended consequences of the EHR’s deployment. The map supported our observations and analysis of ICP communication spaces, and of the role of the patient chart in these spaces.

Conclusions: If EHRs are expected to help resolve ICP challenges, it is important that researchers be able to longitudinally assess the impact of EHRs on ICP across multiple modes of communication, users, and physical locations. Mapping the clinical communication spaces can help EHR designers, clinicians, educators and researchers understand these spaces, appreciate their complexity, and navigate their way towards effective use of EHRs as means for supporting ICP. We propose that the MCICS can be used “as is” in other academic tertiary-care pediatric hospitals, and can be tailored for use in other healthcare institutions.

Abstract reprinted with permission

comments powered by Disqus