Statistics and software seem an unlikely combination for addressing chronic pain. But for more than 15 years, Elizabeth VanDenKerkhof, a Professor of Nursing with a cross-appointment in Anesthesiology and Perioperative Medicine and clinician researcher in the Kingston General Hospital Research Institute, has been investigating how data and technology at the point of care can both improve patient care and enhance understanding of the myriad factors behind the complexities of pain.

A doctorate in public health from Johns Hopkins University who specializes in the epidemiology of pain, Dr. VanDenKerkhof was part of a university-hospital team in the Queen’s Department of Anesthesiology and Perioperative Medicine who broke new ground in patient care at the turn of the millennium by developing an electronic documentation tool for use with an acute pain management system.  

“My role was to make sure the technology captured the data for tracking, management and research into pain,” Dr. VanDenKerkhof explains. Initially developed to care for patients with post-operative and acute pain, the approach has now been adopted at many other points of care, and is in use in hospitals in Montreal and Ottawa.

Virtually unheard-of in pre-smartphone days, the handheld technology was not initially welcomed with open arms, she says. But the experience of developing and implementing that novel tool opened up new avenues of research, by virtue of its ability to capture and store data in real time. It has also led to numerous investigations into the effects of technology on patient care and professional practice. 

More than a decade later, the tool continues to contribute to acute and chronic pain research and enhance pain management.

“We started doing studies in 2001, and we now have 12 years of point-of-care data,” she says. “It enables us to look at statistics, such as the trajectory of pain intensity after surgery and average number of clinician visits – which can be a measure of pain severity -- or to track adverse events such as respiratory depression or allergic reactions. There’s nothing that we know of elsewhere that captures pain data to the same extent at the point of care.”

Dr. VanDenKerkhof continues to integrate technology, and study its effects, in conjunction with her investigations into chronic pain. Her primary research program looks at the epidemiology of chronic post-surgical pain in women to identify subgroups at high risk for developing chronic pain after surgery, and how those women use health care resources before and after surgery.

This story is the sixth in a series on the KGH Research Institute, a collaboration between Queen’s and Kingston General Hospital, and the clinician-scientists recruited to work in the centre.

Queen’s University researcher Karen Yeates has received $1 million in funding to develop a mobile platform to record and monitor the health of pregnant women. The five-year project will implement and test ways of improving the monitoring of pregnant women in Tanzania for preeclampsia-eclampsia and other important health outcomes.

One in five maternal and child deaths in Tanzania – one of the poorest countries in sub-Saharan Africa – are caused by preeclampsia-eclampsia. This condition is common in both developed and developing countries and is a major killer of women in lower resource settings such as Tanzania.  If unrecognized, and left untreated, preeclampsia can lead to poor outcomes or death in women and their newborns.  Preeclampsia is a condition in pregnancy that is often recognized by the rising blood pressure of a woman in the last few months of pregnancy.

“Many women in Tanzania deliver their babies outside of a health centre, usually at home, and have limited access during the pregnancy for health-care providers to detect rising blood pressure and its complications,” Dr. Yeates says. “Making the diagnosis of preeclampsia through blood pressure monitoring and treating it appropriately is a key step in preventing maternal deaths and poor outcomes in newborns.”

Dr. Yeates already has a research program in Tanzania that is using mobile phone technology to connect people with high blood pressure to health-care providers and the health-care system.  She hopes to use this knowledge and her mobile platform to reach women who do not have good access to perinatal health-care services. In fact, African countries have been widespread “adopters” of mobile technology and 80 per cent of people in sub-Saharan African have access to cellphones and one third of those devices are smartphones.

“Using a mobile health platform, we are going to tackle this issue,” Dr. Yeates says. “We want to connect women with health-care providers to monitor blood pressure and general health of pregnant women and their babies. Our team will try to close the health-care gap using technology.”

Dr. Yeates is working with Graeme Smith (Department of Obstetrics and Gynecology), Chandra Tayade (Biomedical and Molecular Sciences) and Jessica Sleeth (Office of Global Health) from Queen’s University and partnering with Godfrey Mbaruku, an obstetrician working with the Ifakara Health Institute in Tanzania. The Tanzanian Ministry of Health and Social Welfare are also involved in the project.

“During the first year we will be conducting a health system appraisal to learn how a pregnant woman currently navigates the health system and figuring out the logistics to determine how best to make this program work,” Dr. Yeates says. “Once the five years is finished, the success of the program will be based on how many lives were saved.”

Canadian Prime Minister Stephen Harper announced last week that Dr. Yeates’ project and 19 other projects would each receive $1 million to focus on improving maternal, newborn and child health on a global scale. The $20 million funding announcement is part of a seven year, $36 million program administered by the Department of Foreign Affairs, Trade and Development Canada (DFATD), the International Development Research Centre (IDRC) and the Canadian Institutes of Health Research (CIHR).

A new report from Queen’s University law professor Kathleen Lahey shows women in Alberta have been disproportionately impacted by the 2001 shift to a flat tax in the province. As a result, women in the western province face higher income gaps, unpaid work gaps and after-tax income gaps than other women in Canada.

 “From the perspective of both fiscal stability and equity, the changes made 15 years ago to how the Alberta government collects revenues have proven disastrous,” says Professor Lahey. “In moving to a single corporate and personal income tax regime, the government has walked away from at least $6 billion in annual revenues - roughly the size of the forecasted deficit for next year – and actually increased the tax burden for those income-earners at the bottom end of the scale, who are predominantly women.”

Professor Lahey argues that these tax changes, when combined with a lack of affordable childcare spaces, a series of tax and transfer measures that essentially encourage women’s unpaid work, and the lack of effective mechanisms at the provincial level to implement gender equity commitments, have resulted in a troubling slide in women’s economic equality in Alberta since its peak in the mid-1990s.

The report concludes with a series of 14 recommendations that Professor Lahey says the government could implement in the upcoming budget to reverse the decades-long slide in gender equality in Alberta. Those recommendations include:

• Replacing the current flat tax system with graduated corporate and personal income taxes.
• Rejecting the introduction of new sales taxes or provincial consumption taxes.
• Restructuring all joint tax and benefit measures that discourage women’s participation in the paid workforce.

“Alberta’s latest fiscal crisis is actually the perfect opportunity to correct the ill-advised policies of the past that have created the situation Alberta now finds itself in,” says Professor Lahey. “Fortunately, many of the same policies that can finally get the province off of its overdependence on unstable resource revenues can also begin to reverse the shameful lack of economic equality between men and women in Alberta.”

Professor Lahey is presenting the report, The Alberta Disadvantage: Gender, Taxation and Income Inequality, on Wednesday, March 4 at the University of Alberta’s Parkland Institute. For more information, view the report here.