Digital Monitoring of Stress Responses Among Nursing Professionals

Thank you for joining us for this special episode of Good Tech Compassionate Healthcare. In May of 2024, AMS Healthcare was thrilled to convene 170 healthcare stakeholders from across Ontario to delve into the timely and ethical scaling of AI in our healthcare sector. The insights we gained were invaluable. The conference revealed a consensus that there is an urgent need to deploy AI solutions in the most capacity-challenged areas of our healthcare system, particularly in primary care. This move is crucial to reducing workforce burnout and improving workflows. Many of the leaders that we spoke to at our conference were asked a series of questions about AI in healthcare, and we will be sharing their insightful responses in these special episodes. The leaders featured in Part Two are: Jennifer Gibson - Director of the University of Toronto Joint Centre for Bioethics Suresh Balu - Director for Duke Institute for Health Innovations Nicole Woods - Director of The Institute of Education Research at the University Health Network Carla Velastegui - Caregiver Advocate in the Digital Healthcare Sector Dr Amol Verma - Physician and Scientist at St. Michael's Hospital Unity Health Anna Foat - Patient Partner and Advocate Laura Desveaux - Science Lead and Learning Health System Program Lead at Trillium Health Partners amshealthcare.ca  

Thank you for joining us for this special episode of Good Tech Compassionate Healthcare. In May of 2024, AMS Healthcare was thrilled to convene 170 healthcare stakeholders from across Ontario to delve into the timely and ethical scaling of AI in our healthcare sector. The insights we gained were invaluable. The conference revealed a consensus that there is an urgent need to deploy AI solutions in the most capacity-challenged areas of our healthcare system, particularly in primary care. This move is crucial to reducing workforce burnout and improving workflows. Many of the leaders that we spoke to at our conference were asked a series of questions about AI in healthcare, and we will be sharing their insightful responses in these special episodes. The leaders featured in Part One are: Dr. Keith Thompson - Family Physician and Adjunct Faculty Professor at Western University Dr. Jaron Chong - Assistant Professor of Diagnostic Radiology at the Department of Medical Imaging at Western University Colleen Flood - Dean of the Faculty of Law Queen's University Phyllis Berck - Patient Partner with UHN Dr. Brian Hodges - Executive-Vice President of Education and Chief Medical Officer at University Health Network

In this conversation, Kieran Quinn, a general internist and palliative care clinician-scientist at Sinai Health in the Department of Medicine and at the Institute of Health Policy, Management, and Evaluation at the University of Toronto, and James Downer, a critical care and palliative care physician in Ottawa, discuss virtual end-of-life care during the COVID-19 pandemic. https://pcpcrc.ca/ - The Pan-Canadian Palliative Care Research Collaborative is a national network of researchers, healthcare providers, community stakeholders, and patient and caregiver partners who are passionate about palliative care research. Dr. Kieran Quinn is a General Internist and Palliative Care Clinician-Scientist at Sinai Health in the Department of Medicine and Institute of Health Policy, Management, and Evaluation at the University of Toronto and an Adjunct Scientist at the Institute for Clinical Evaluative Sciences (ICES). His research focuses on using advanced analytic methods and large administrative datasets to improve access and delivery of high-quality end-of-life care for patients with terminal noncancer illness, such as heart failure and dementia, and improving the recognition and care of people with post COVID-19 condition (long COVID). Dr. Quinn was awarded the Governor General's Gold Medal for Academic Excellence and the John Charles Polanyi Prize in Physiology and Medicine. He is co-lead of Canada's national research network on post COVID-19 condition and co-chair for the development of clinical practice guidelines for the treatment of post COVID-19 condition. He served as the Assistant Director of the Ontario COVID-19 Science Advisory Table, the Ontario Public Health Emergencies Science Advisory Committee, and as an Expert Member of the Chief Science Advisor's National Task Force on the Post COVID-19 Condition. His early research success includes over $28 million in competitive grant funding and 7 CIHR grants as the nominated principal applicant. He has mentored 12 trainees who have published and won several awards for their work together. He has 103 peer-reviewed publications, including 52 as first author or senior author in high-impact journals such as JAMA, JAMA Internal Medicine, and BMJ. Dr. James Downar is a Critical Care and Palliative Care physician in Ottawa. He graduated from McGill Medical School and completed residency training in Internal Medicine, Critical Care, and Palliative Care at the University of Toronto. He has a Master's degree in Bioethics from the Joint Centre for Bioethics at the University of Toronto. He is currently the Head of the Division of Palliative Care at the University of Ottawa and a Professor in the Department of Medicine. He is the chair of Palliative and End-of-Life Care at the University of Ottawa, the co-chair of the Pan-Canadian Palliative Care Research Collaborative, the chair of the Ethical Affairs committee of the Canadian Critical Care Society, and the co-chair of the Ontario Palliative Care Network's Provincial Education Steering Committee. He has authored more than 100 peer-reviewed publications, has been principal investigator on more than 20 peer-reviewed grants, and is a former Associated Medical Services Phoenix Fellow. Dr. Downar also led several provincial and national efforts to respond to the COVID-19 pandemic. He was involved in planning for medication shortages for both critical care and palliative care and led the development of a critical care triage system for the event of major surge in critically ill patients His research interests include communication and decision-making for seriously ill patients and their families; Palliative Care for the Critically Ill; and Palliative Care for Noncancer Illnesses. http://amshealthcare.ca/

In this conversation, Charlene Ronquillo, a Filipina scholar, registered nurse, and health implementation expert at the University of British Columbia School of Nursing, engages in a captivating dialogue with Chantelle Recsky, a dedicated nurse and postdoctoral research fellow. Together, they delve into the crucial topic of "Advancing Compassionate and Equitable Healthcare through Technology." Charlene, an AMS healthcare fellow and compassion and AI advocate, brings her extensive background as a health informatician, focusing on critical theory and implementation science. Her program of research is dedicated to ensuring the meaningful inclusion of non-dominant groups in the development of health technologies. Join them as they explore Charlene's recent work, which investigates the role of nursing data in shaping opportunities to embed health equity in machine learning algorithms and artificial intelligence for health systems. Chantelle, driven by her passion for improving healthcare, shares insights into collaborative research methods. As a postdoctoral research fellow hosted at BC Cancer in partnership with the UBC School of Nursing, Chantelle's research centers around the intersection of technology and quality of care. With a keen interest in the unintended consequences of advancing technologies in the health system, she contributes valuable perspectives to the discussion. Tune in for a thought-provoking exploration of compassionate, equitable, and inclusive technology use in healthcare, featuring two dynamic voices at the forefront of shaping the future of nursing and health informatics. Chantelle: https://cihr-irsc.gc.ca/e/51211.html Charlene: https://www.charleneronquillo.com/ Nursing & Artificial Intelligence Leadership (NAIL) Collaborative https://www.nailcollab.org/

In this conversation, Laura Sikstrom, a Medical Anthropologist and Project Scientist at The Krembil Center for Neuroinformatics at the Center for Addiction and Mental Health, and an AMS Healthcare fellow in Compassion and AI, speaks with Sean Hill, the Director of The Krembil Center for Neuroinformatics, Senior Scientist at the Center for Addiction and Mental Health, and Professor at the University of Toronto. They discuss the meaning of fairness in mental health and the concepts used to support. Dr. Laura Sikstrom is also an assistant professor (status-only) in the Department of Anthropology at the University of Toronto. Dr. Sikstrom also co-leads the Predictive Care Team at CAMH, which focuses on the intricate intersection of artificial intelligence (AI) and mental health care. By integrating computational techniques with ethnographic insights, this team investigates the potential and challenges of incorporating AI into mental health practice, with a focus on compassionate and equitable care. Dr. Sikstrom received funding from AMS Healthcare, Google, SSHRC and CIHR and is also a nominee for the prestigious Governor General's Gold Award.  Dr. Sean Hill is also a computational neuroscientist with experience in building large-scale computational models of brain circuitry. The Centre collaborates with clinicians and researchers, employing neuroinformatics, artificial intelligence, and multi-scale modeling, to develop data-driven definitions of brain disorders, predict patient trajectories, and transform mental health care. Dr. Hill applies large-scale data integration, neuroinformatics, multiscale brain modeling and machine learning to improve our understanding and treatment of mental health disorders. The Centre's mandate is to accelerate global collaborations in brain science using the power of big data and brain modeling to fundamentally change how mental illness is understood. Resources: Sikstrom, Laura, Marta M. Maslej, Zoe Findlay, Gillian Strudwick, Katrina Hui, Juveria Zaheer, Sean L. Hill, and Daniel Z. Buchman. 2023. "Predictive Care: A Protocol for a Computational Ethnographic Approach to Building Fair Models of Inpatient Violence in Emergency Psychiatry."  Sikstrom, Laura, Marta M. Maslej, Katrina Hui, Zoe Findlay, Daniel Z. Buchman, and Sean L. Hill. 2022. "Conceptualising Fairness: Three Pillars for Medical Algorithms and Health Equity."  What is 'AI' and what is it doing in psychiatry? A webinar presented at the RBC Patient & Family Learning Space, CAMH, November 2, 2022. https://www.youtube.com/watch?v=qVUs-BnGIOU What happens to our brains when we get depressed? The Walrus, 2021, by Simon Lewsen. https://thewalrus.ca/what-happens-to-our-brains-when-we-get-depressed/

In this conversation Dr. Kumanan Wilson, speaks to Jaron Chong, discuss the opportunities for generative AI in healthcare diagnosis, efficiencies and education today and tomorrow. Dr. Jaron Chong is an Assistant Professor of Diagnostic Radiology at the Department of Medical Imaging at Western University. He completed diagnostic radiology residency training at McGill University with a Body Cross-Sectional Imaging Fellowship at Yale New-Haven Hospital and a Masters in Health Informatics at the University of Toronto. His clinical interests include cross-sectional abdominal imaging, Abdominal/GU oncologic imaging in MRI and CT modalities, with research interests in the appropriate utilization of medical imaging and AI-assisted augmented radiology. He serves as the Chair of the Canadian Association of Radiology Standing Committee on Artificial Intelligence and Ad-Hoc Member of the Health Canada Scientific Advisory Committee on Digital Health Technologies. Dr. Kumanan Wilson is a board member at AMS.  He is the Interim CEO and Chief Scientific Officer, Bruyère Research Institute and VP Research and Academic Affairs, Bruyère Continuing Care. He had previously served as an innovation advisor for Bruyère. Dr. Wilson is also a specialist in General Internal Medicine at The Ottawa Hospital and a Full Professor and Faculty of Medicine Clinical Research Chair in Digital Health Innovation at the University of Ottawa. He is the co-founder and Chief Scientific Officer of CANImmunize, a science-based technology company specializing in immunization software. Dr. Wilson's research focuses on digital health, health data, immunization, pandemic preparedness and public health policy and innovation. He has received support from multiple organizations including the Canadian Institutes of Health Research (CIHR), the World Health Organization (WHO), The Bill and Melinda Gates Foundation and Canada's Immunity Task Force.

In this conversation, Ibukun Abejirinde, a scientist at the Institute for Health System Solutions at Women's College Hospital, and Assistant Professor at the Dalla Lana School of Public Health at the University of Toronto, and an AMS Healthcare Fellow in Compassion and AI chats with Terence Tang, a General Internal Medicine Physician at Trillium Health Partners, a Clinician Scientist at the Institute for Better Health and an AMS Healthcare Fellow in Compassion and AI. They discuss social determinants of health, health inequities, and digitally enabled models of care. Ibukun Abejirinde is an Implementation and Evaluation Scientist who works with policymakers, patients, community organizations, and researchers to find practical solutions to persistent and emergent problems in healthcare. Her research focus on innovative models of care that use digital technology. Specifically, how they impact health equity and health service delivery. Ultimately, her goal is to improve access to high-quality care for everyone, irrespective of where they live or where they are from. Dr. Abejirinde is currently a Scientist at the Institute for Health System Solutions, Women's College Hospital where her work informs the implementation, sustainability, and expansion of virtual care programs within and beyond Ontario. She is also an Assistant Professor (Status) at the Dalla Lana School of Public Health, University of Toronto. As a 2022 AMS Healthcare Fellow in Compassion and AI, her study is being conducted in partnership with three community partners, with the aim of understanding how immigrants and refugees to Canada experience virtual care and digital health compassion.  AMS Research Team Members - Ibukun Abejirinde (Scientist/Principal Investigator) - Emily Ha (Research Associate and PhD candidate, UoT) - Marlena Dang Nguyen (Equity Specialist and Research Coordinator) - Kyla Gaeul Lee (PhD student, UoT) - Isabelle Choon-Kon-Yune (Research Assistant) - Mohaddesa Khawari (Peer Researcher) AMS Study Research Partners 1. FCJ Refugee Centre Website 2. Crossroads Clinic, Women's College Hospital Website 3. Access Alliance Multicultural Health and Community Services Website AMS Research Advisory Team Members 1. Dr. Vanessa Redditt 2. Denise Zarn 3. Dr. Onil Bhattacharyya 4. Dr. Jay Shaw Readings and Resources 1. Abejirinde IO, Ha E, Nguyen MD, Kaur D, Redditt V. Beyond technology: Digital Health Compassion for Canadian Immigrants and Refugees. January 2023. Volume 19, Number 4. Canadian Diversity (pg. 10-12). https://km4s.ca/2023/04/beyond-technology-digital-health- compassion-for-canadian-immigrants-and-refugees/ 2. Panel Discussion. Digital Health Imperative - Equity and System Transformation. Access Alliance Multicultural Health and Community Services, Canada. All Staff Professional Development Day. November 2022. Summaries- blog and video clip 3. Hankivsky, O., Grace, D., Hunting, G. et al. An intersectionality-based policy analysis framework: critical reflections on a methodology for advancing equity. Int J Equity Health 13, 119 (2014). https://doi.org/10.1186/s12939-014-0119-x 4. Hodges BD, Paech G, Bennett J. Without Compassion, There Is No Healthcare: Compassionate Care in a Technological World. Edited by Brian D. Hodges, Gail Paech, and Jocelyn Bennett. McGill-Queen's University Press; 2020. 5. Crenshaw K. Demarginalizing the Intersection of Race and Sex: A Black Feminist Critique of Antidiscrimination Doctrine, Feminist Theory, and Antiracist Politics [1989]. In: 1st ed. Routledge; 1991:57-80. doi:10.4324/9780429500480-5 6. Singh P, King-Shier K, Sinclair S. The colours and contours of compassion: A systematic review of the perspectives of compassion among ethnically diverse patients and healthcare providers. Van Bogaert P, ed. PLoS ONE. 2018;13(5):e0197261. doi:10.1371/journal.pone.0197261 Want to connect? Are you attending the Metropolis Social Determinants of Health Conference in Gatineau Québec (October 2-3 2023)? Join our roundtable dialogue 11:00am - 12:15pm on October 2 nd titled "Reimagining Compassionate Healthcare for Immigrants: Lessons learned from Virtual Care" Contact: [email protected]   Terence Tang is a General Internal Medicine physician at Trillium Health Partners located in Mississauga, Ontario, and a Clinician Scientist at the Institute for Better Health.  He has training in informatics and has a passion of using digital technology to improve care delivery and population health.    Links:   Institute for Better Health (https://www.instituteforbetterhealth.com/)    A tool to capture social determinants of health by Upstream Lab (https://upstreamlab.org/project/spark/)

In this episode, Dr. Connie Schumacher, Assistant Professor of Nursing at Brock University and an AMS fellow in compassionate AI, and Dr. Andrew Costa, Associate Professor at McMaster University and the Research Director at the St. Joseph's Health System Center for Integrative Care in Hamilton and Connie's mentor, discuss Connie's research on compassion centered communication of risk and self administered online health assessments. St. Joseph's Center for Integrated Care - Centre for Integrated Care (stjoescic.ca) YourCare+ Check-Up Assessment -  YourCare+ (yourcareplus.ca) References Schumacher, C., Dash, D., Mowbray, F., Klea, L., & Costa, A. (2021). A qualitative study of home care client and caregiver experiences with a complex cardio-respiratory management model. BMC geriatrics, 21(1), 1-11.  Costa, A. P., Schumacher, C., Jones, A., Dash, D., Campbell, G., Junek, M., ... & Haughton, D. (2019). DIVERT-Collaboration Action Research and Evaluation (CARE) Trial Protocol: a multiprovincial pragmatic cluster randomised trial of cardiorespiratory management in home care. BMJ open, 9(12), e030301. Jones, A., Schumacher, C., Bronskill, S. E., Campitelli, M. A., Poss, J. W., Seow, H., & Costa, A. P. (2018). The association between home care visits and same-day emergency department use: a case–crossover study. CMAJ, 190(17), E525-E531.  Jones, A., Bronskill, S. E., Agarwal, G., Seow, H., Feeny, D., & Costa, A. P. (2019). The primary care and other health system use of home care patients: a retrospective cohort analysis. Canadian Medical Association Open Access Journal, 7(2), E360-E370.

Biographies Gillian Strudwick Bio Venkat Bhat   If you wish to participate in the study: https://www.honeybeetrials.com/researcher/018850/a-paid-digital-health-study-for- nurses Program: Interventional Neuropsychiatry Program Study Funder Department of Defense, Canada (IDeAS Program): https://www.canada.ca/en/department-national-defence/programs/defence-ideas/element/competitive-projects/challenges/moral-trauma-frontline-see-prevent-treat.html UHT-St. Michael's link to the Phase 1 of the current project (Phase 2): https://unityhealth.to/2021/08/vr-moral-distress-pandemic/ Useful Resources: https://covid19-sciencetable.ca/sciencebrief/burnout-in-hospital-based-healthcare- workers-during-covid-19/ https://pubmed.ncbi.nlm.nih.gov/35614505/ https://theconversation.com/high-rates-of-covid-19-burnout-could-lead-to-shortage-of- health-care-workers-166476 https://www.researchprotocols.org/2022/2/e32240/   Pertinent Publication Links: https://pubmed.ncbi.nlm.nih.gov/34871178/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9731177/ https://ieeexplore.ieee.org/stamp/stamp.jsp?arnumber=10095849 https://pubmed.ncbi.nlm.nih.gov/36310921/  

Welcome to our conversation titled, Digital Therapeutics Informed by Lived Experience. In this conversation Quynh Pham, Scientific Director and Principal Investigator at the Center for Digital Therapeutics at the University Health Network, and an AMS healthcare fellow and Compassionate AI, speaks with Joseph Cafazzo, Biomedical Engineer, Educator and Researcher, and the Wolfond Chair in Digital Health University Health Network. Quynh and Joe engage on digital health, digital therapeutics and the lived stories that have inspired their groundbreaking work. Twitter: @drquynhpham / @josephcafazzo Academic profiles: Quynh / Joe The Centre for Digital Therapeutics: https://www.centrefordigitaltherapeutics.ca/ The Medly digital therapeutic for heart failure management https://medly.ca/ Developing Digital Therapeutics: The University Health Network Experience: https://commercialbiotechnology.com/menuscript/index.php/jcb/article/view/1023 (PDF of paper attached) The Value of Technology to Support Dyadic Caregiving for Individuals Living With Heart Failure: Qualitative Descriptive Study: https://www.jmir.org/2022/9/e40108/ The Future of Virtual Care for Older Ethnic Adults Beyond the COVID-19 Pandemic: https://www.jmir.org/2022/1/e29876/ A Dyadic Digital Health Module for Chronic Disease Shared Care: Design Thinking: https://preprints.jmir.org/preprint/45035 3 Ways to Support Patient-Caregiver Pairs through Equitable Virtual Care: https://transformhf.ca/medly-caretown-virtual-care/