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Cyr S, Marcil MJ, Houchi C, Marin MF, Rosa C, Tardif JC, Guay S, Guertin MC, Genest C, Forest J, Lavoie P, Labrosse M, Vadeboncoeur A, Selcer S, Ducharme S, Brouillette J. Evolution of burnout and psychological distress in healthcare workers during the COVID-19 pandemic: a 1-year observational study. BMC Psychiatry 2022; 22:809. [PMID: 36539718 PMCID: PMC9763813 DOI: 10.1186/s12888-022-04457-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Long-term psychological impacts of the COVID-19 pandemic on healthcare workers remain unknown. We aimed to determine the one-year progression of burnout and mental health since pandemic onset, and verify if protective factors against psychological distress at the beginning of the COVID-19 pandemic (Cyr et al. in Front Psychiatry; 2021) remained associated when assessed several months later. METHODS We used validated questionnaires (Maslach Burnout Inventory, Hospital Anxiety and Depression and posttraumatic stress disorder [PTSD] Checklist for DSM-5 scales) to assess burnout and psychological distress in 410 healthcare workers from Quebec, Canada, at three and 12 months after pandemic onset. We then performed multivariable regression analyses to identify protective factors of burnout and mental health at 12 months. As the equivalent regression analyses at three months post-pandemic onset had already been conducted in the previous paper, we could compare the protective factors at both time points. RESULTS Prevalence of burnout and anxiety were similar at three and 12 months (52% vs. 51%, p = 0.66; 23% vs. 23%, p = 0.91), while PTSD (23% vs. 11%, p < 0.0001) and depression (11% vs. 6%, p = 0.001) decreased significantly over time. Higher resilience was associated with a lower probability of all outcomes at both time points. Perceived organizational support remained significantly associated with a reduced risk of burnout at 12 months. Social support emerged as a protective factor against burnout at 12 months and persisted over time for studied PTSD, anxiety, and depression. CONCLUSIONS Healthcare workers' occupational and mental health stabilized or improved between three and 12 months after the pandemic onset. The predominant protective factors against burnout remained resilience and perceived organizational support. For PTSD, anxiety and depression, resilience and social support were important factors over time.
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Affiliation(s)
- Samuel Cyr
- grid.482476.b0000 0000 8995 9090Research Centre, Montreal Heart Institute, 5000 Belanger street, Montreal, Québec, H1T 1C8 Canada ,grid.14848.310000 0001 2292 3357Faculty of Pharmacy, Université de Montréal, P.O. Box 6128, Downtown Branch, Montreal, Québec, H3C 3J7 Canada
| | - Marie-Joelle Marcil
- grid.482476.b0000 0000 8995 9090Research Centre, Montreal Heart Institute, 5000 Belanger street, Montreal, Québec, H1T 1C8 Canada ,grid.14848.310000 0001 2292 3357Department of Psychiatry and Addiction, Université de Montréal, Roger-Gaudry Pavilion, Faculty of Medicine, P.O. Box 6128, Downtown Branch, Montréal, Québec, H3C 3J7 Canada
| | - Cylia Houchi
- grid.482476.b0000 0000 8995 9090Research Centre, Montreal Heart Institute, 5000 Belanger street, Montreal, Québec, H1T 1C8 Canada ,grid.14848.310000 0001 2292 3357Department of Psychiatry and Addiction, Université de Montréal, Roger-Gaudry Pavilion, Faculty of Medicine, P.O. Box 6128, Downtown Branch, Montréal, Québec, H3C 3J7 Canada
| | - Marie-France Marin
- grid.14848.310000 0001 2292 3357Department of Psychiatry and Addiction, Université de Montréal, Roger-Gaudry Pavilion, Faculty of Medicine, P.O. Box 6128, Downtown Branch, Montréal, Québec, H3C 3J7 Canada ,grid.38678.320000 0001 2181 0211Department of Psychology, UQAM, 100 Sherbrooke Street West, Montréal, Québec, H2X 3P2 Canada ,grid.414210.20000 0001 2321 7657Research Centre, Institut universitaire en santé mentale de Montréal, 7331 Hochelaga Street, Montreal, Québec, H1N 3V2 Canada
| | - Camille Rosa
- Montreal Health Innovations Coordinating Centre, 5000 Belanger street, Montreal, Québec, H1T 1C8 Canada
| | - Jean-Claude Tardif
- grid.482476.b0000 0000 8995 9090Research Centre, Montreal Heart Institute, 5000 Belanger street, Montreal, Québec, H1T 1C8 Canada ,grid.14848.310000 0001 2292 3357Faculty of Medicine, Université de Montréal, P.O. Box 6128, Downtown Branch, Montreal, Québec, H3C 3J7 Canada
| | - Stéphane Guay
- grid.14848.310000 0001 2292 3357Department of Psychiatry and Addiction, Université de Montréal, Roger-Gaudry Pavilion, Faculty of Medicine, P.O. Box 6128, Downtown Branch, Montréal, Québec, H3C 3J7 Canada ,grid.414210.20000 0001 2321 7657Centre d’étude sur le Trauma, Research Centre, Institut universitaire en santé mentale de Montréal, 7331 Hochelaga Street, Montreal, Québec, H1N 3V2 Canada
| | - Marie-Claude Guertin
- Montreal Health Innovations Coordinating Centre, 5000 Belanger street, Montreal, Québec, H1T 1C8 Canada
| | - Christine Genest
- grid.414210.20000 0001 2321 7657Centre d’étude sur le Trauma, Research Centre, Institut universitaire en santé mentale de Montréal, 7331 Hochelaga Street, Montreal, Québec, H1N 3V2 Canada ,grid.14848.310000 0001 2292 3357Faculty of Nursing, Université de Montréal, Marguerite-d’Youville Pavilion, P.O. Box 6128, Downtown Branch, Montreal, Québec, H3C 3J7 Canada
| | - Jacques Forest
- Department of Organization and Human Resources, ESG UQAM, P.O. Box 8888, Downtown Branch, Montreal, Québec, H3C 3P8 Canada
| | - Patrick Lavoie
- grid.482476.b0000 0000 8995 9090Research Centre, Montreal Heart Institute, 5000 Belanger street, Montreal, Québec, H1T 1C8 Canada ,grid.14848.310000 0001 2292 3357Faculty of Nursing, Université de Montréal, Marguerite-d’Youville Pavilion, P.O. Box 6128, Downtown Branch, Montreal, Québec, H3C 3J7 Canada
| | - Mélanie Labrosse
- grid.14848.310000 0001 2292 3357Faculty of Medicine, Université de Montréal, P.O. Box 6128, Downtown Branch, Montreal, Québec, H3C 3J7 Canada ,grid.411418.90000 0001 2173 6322Department of Pediatrics, Division of Emergency Medicine, Centre Hospitalier Universitaire Sainte-Justine, 3175 Côte-Sainte-Catherine Road, Montreal, Québec, H3T 1C5 Canada
| | - Alain Vadeboncoeur
- grid.482476.b0000 0000 8995 9090Research Centre, Montreal Heart Institute, 5000 Belanger street, Montreal, Québec, H1T 1C8 Canada ,grid.14848.310000 0001 2292 3357Faculty of Medicine, Université de Montréal, P.O. Box 6128, Downtown Branch, Montreal, Québec, H3C 3J7 Canada
| | - Shaun Selcer
- grid.482476.b0000 0000 8995 9090Research Centre, Montreal Heart Institute, 5000 Belanger street, Montreal, Québec, H1T 1C8 Canada ,grid.14848.310000 0001 2292 3357Faculty of Medicine, Université de Montréal, P.O. Box 6128, Downtown Branch, Montreal, Québec, H3C 3J7 Canada
| | - Simon Ducharme
- grid.412078.80000 0001 2353 5268Department of Psychiatry, Douglas Mental Health University Institute, McGill University, 6875 LaSalle Boulevard, Verdun, Québec, H4H 1R3 Canada ,grid.416102.00000 0004 0646 3639McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, 3801 University St, Montreal, Québec, H3A 2B4 Canada
| | - Judith Brouillette
- Research Centre, Montreal Heart Institute, 5000 Belanger street, Montreal, Québec, H1T 1C8, Canada. .,Department of Psychiatry and Addiction, Université de Montréal, Roger-Gaudry Pavilion, Faculty of Medicine, P.O. Box 6128, Downtown Branch, Montréal, Québec, H3C 3J7, Canada.
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Shaukat Ali A, Finnerty V, Harel F, Marquis-Gravel G, Vadeboncoeur A, Pelletier-Galarneau M. Impact of rubidium imaging availability on management of patients with acute chest pain. J Nucl Cardiol 2022; 29:3281-3290. [PMID: 35199279 PMCID: PMC8865882 DOI: 10.1007/s12350-022-02923-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 01/21/2022] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Evaluate the impact of 82-Rubidium positron emission tomography (PET) myocardial perfusion imaging (MPI) availability on patient management presenting at the emergency department (ED) with chest pain (CP). METHODS This is a single-center retrospective study of clinical databases. Patients presenting with CP with a non-definitive suspicion of acute coronary syndrome (ACS) at the ED between April 2016 and February 2020 were divided into 2 groups based on PET availability. The proportion of invasive coronary angiography (ICA) without significant coronary artery disease (CAD), length of stay (LoS), and additional downstream testing were evaluated. RESULTS There were 21,242 ED visits for CP without definitive ACS: 5,492 when PET is not available and 15,750 when PET is available. When PET is available, proportion of patients undergoing a MPI study was greater (20.7% vs 17.6%, P<0.0001), proportion of ICA without significant CAD was similar (18.5% vs 21.4%, P=0.24), and median ED LoS was shorter (16.6 vs 18.1 hours, P=0.03). Patients undergoing SPECT MPI had significantly more downstream testing (8.9% vs 6.4%, P=0.003) and a higher rate of coronary angiogram without significant CAD (21.2% vs 14.2%, P=0.09) compared to those who underwent PET MPI. CONCLUSION Availability of PET MPI was associated with an increased number of MPI referral from the ED, similar rates of ICA without significant CAD, decreased LoS, and fewer downstream testing.
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Affiliation(s)
- Akasha Shaukat Ali
- Department of Medical Imaging, Montreal Heart Institute, Montreal, QC H1T 1C8 Canada
| | - Vincent Finnerty
- Department of Medical Imaging, Montreal Heart Institute, Montreal, QC H1T 1C8 Canada
| | - Francois Harel
- Department of Medical Imaging, Montreal Heart Institute, Montreal, QC H1T 1C8 Canada
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Vadeboncoeur A, Marcil MJ, Cyr S, Gupta M, Cournoyer A, Minichiello A, Larose D, Sirois-Leclerc J, Tardif JC, Morin J, Masson V, Cossette M, Brouillette J. Trajectory of patients consulting the emergency department for high blood pressure values. CAN J EMERG MED 2022; 24:515-519. [PMID: 35503402 PMCID: PMC9345802 DOI: 10.1007/s43678-022-00307-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 03/24/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Emergency department (ED) visits for high blood pressure are increasing in frequency. We aimed to map those patients' trajectory, from referral sources to the type of care received at the ED to anticipated actions for future high blood pressure concerns, and to better understand their reasons for consulting the ED for high blood pressure values. METHODS Between 2018 and 2020, patients who presented to the Montreal Heart Institute's ED for elevated blood pressure were recruited in a prospective observational study including a post hoc structured telephone interview and medical chart review. Five possible referral sources were predetermined. We provided proportions and 95% confidence intervals. RESULTS A total of 100 patients were recruited (female: 59%, mean age: 69 ± 12). A majority (93%, 95% CI 88-98%) possessed a home blood pressure device, among which 46% (95% CI 36-56%) remembered receiving advice for its use. The main referral sources for high blood pressure to the ED were self-reference (53%, 95% CI 43-63%), advice of a lay person (19%, 95% CI 11-27%) or a nurse (13%, 95% CI 6-20%). Mainly, patients reported being concerned by concomitant symptoms or experiencing acute medical consequences (44%, 95% CI 34-54%), having followed the recommendation of a third party (33%, 95% CI 24-42%), or having concerns about their medication (6%, 95% CI 1-11%). Two weeks following their ED visits, consulting ED remained the main choice for future concerns about high blood pressure for 27% of participants. When specifically asked if they would return to the ED for elevated blood pressure, 73% (95% CI 64-83%) said yes. CONCLUSIONS Most patients who consulted the ED for elevated blood pressure values were self-referred. More can be done to promote blood pressure education, effective use of personal blood pressure devices, and recommendations for patients and health professionals when confronted with high blood pressure results.
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Affiliation(s)
- Alain Vadeboncoeur
- Research Centre, Montréal Heart Institute, Université de Montréal, 5000 Belanger Street, Montréal, QC, H1T 1C8, Canada
| | - Marie-Joelle Marcil
- Research Centre, Montréal Heart Institute, Université de Montréal, 5000 Belanger Street, Montréal, QC, H1T 1C8, Canada.,Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - Samuel Cyr
- Research Centre, Montréal Heart Institute, Université de Montréal, 5000 Belanger Street, Montréal, QC, H1T 1C8, Canada.,Faculty of Pharmacy, Université de Montréal, Montréal, QC, Canada
| | - Mona Gupta
- Centre de recherche, Centre Hospitalier de L'Université de Montréal, Montréal, QC, Canada
| | - Alexis Cournoyer
- Centre de recherche, Hôpital du Sacré-Cœur de Montréal, Université de Montréal, Montréal, QC, Canada
| | - Anthony Minichiello
- Research Centre, Montréal Heart Institute, Université de Montréal, 5000 Belanger Street, Montréal, QC, H1T 1C8, Canada
| | - Dominic Larose
- Research Centre, Montréal Heart Institute, Université de Montréal, 5000 Belanger Street, Montréal, QC, H1T 1C8, Canada
| | - Julie Sirois-Leclerc
- Research Centre, Montréal Heart Institute, Université de Montréal, 5000 Belanger Street, Montréal, QC, H1T 1C8, Canada
| | - Jean-Claude Tardif
- Research Centre, Montréal Heart Institute, Université de Montréal, 5000 Belanger Street, Montréal, QC, H1T 1C8, Canada
| | - Josée Morin
- Research Centre, Montréal Heart Institute, Université de Montréal, 5000 Belanger Street, Montréal, QC, H1T 1C8, Canada
| | - Violaine Masson
- Centre de recherche, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, QC, Canada
| | - Mariève Cossette
- Montreal Health Innovations Coordinating Center, Montréal, QC, Canada
| | - Judith Brouillette
- Research Centre, Montréal Heart Institute, Université de Montréal, 5000 Belanger Street, Montréal, QC, H1T 1C8, Canada. .,Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada.
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Marcil MJ, Cyr S, Marin MF, Rosa C, Tardif JC, Guay S, Guertin MC, Genest C, Forest J, Lavoie P, Labrosse M, Vadeboncoeur A, Selcer S, Ducharme S, Brouillette J. Hair cortisol change at COVID-19 pandemic onset predicts burnout among health personnel. Psychoneuroendocrinology 2022; 138:105645. [PMID: 35134663 PMCID: PMC8697418 DOI: 10.1016/j.psyneuen.2021.105645] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/23/2021] [Accepted: 12/21/2021] [Indexed: 12/05/2022]
Abstract
BACKGROUND The COVID-19 pandemic has put chronic pressure on worldwide healthcare systems. While the literature regarding the prevalence of psychological distress and associated risk factors among healthcare workers facing COVID-19 has exploded, biological variables have been mostly overlooked. METHODS 467 healthcare workers from Quebec, Canada, answered an electronic survey covering various risk factors and mental health outcomes three months after the onset of the COVID-19 pandemic. Of them, 372 (80%) provided a hair sample, providing a history of cortisol secretion for the three months preceding and following the pandemic's start. We used multivariable regression models and a receiver operating characteristic curve to study hair cortisol as a predictor of burnout and psychological health, together with individual, occupational, social, and organizational factors. RESULTS As expected, hair cortisol levels increased after the start of the pandemic, with a median relative change of 29% (IQR = 3-59%, p < 0.0001). There was a significant association between burnout status and change in cortisol, with participants in the second quarter of change having lower odds of burnout. No association was found between cortisol change and post-traumatic stress disorder, anxiety, and depression symptoms. Adding cortisol to individual-occupational-socio-organizational factors noticeably enhanced our burnout logistic regression model's predictability. CONCLUSION Change in hair cortisol levels predicted burnout at three months in health personnel at the onset of the COVID-19 pandemic. This non-invasive biological marker of the stress response could be used in further clinical or research initiatives to screen high-risk individuals to prevent and control burnout in health personnel facing an important stressor.
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Affiliation(s)
- Marie-Joëlle Marcil
- Research Centre, Montreal Heart Institute, 5000 Bélanger Street, Montréal, H1T 1C8 Québec, Canada,Department of Psychiatry and Addiction, Université de Montréal, Roger-Gaudry Pavilion, Faculty of Medicine, P.O. Box 6128, Downtown Branch, Montréal, H3C 3J7 Québec, Canada
| | - Samuel Cyr
- Research Centre, Montreal Heart Institute, 5000 Bélanger Street, Montréal, H1T 1C8 Québec, Canada,Faculty of Pharmacy, Université de Montréal, P.O. Box 6128, Downtown Branch, Montréal, H3C 3J7 Québec, Canada
| | - Marie-France Marin
- Department of Psychiatry and Addiction, Université de Montréal, Roger-Gaudry Pavilion, Faculty of Medicine, P.O. Box 6128, Downtown Branch, Montréal, H3C 3J7 Québec, Canada,Department of Psychology, UQAM, 100 Sherbrooke Street West, Montréal, H2X 3P2 Québec, Canada,Research Centre, Institut universitaire en santé mentale de Montréal, 7331 Hochelaga Street, Montréal, H1N 3V2 Québec, Canada
| | - Camille Rosa
- Montreal Health Innovations Coordinating Centre, 5000 Bélanger Street, Montréal, H1T 1C8 Québec, Canada
| | - Jean-Claude Tardif
- Research Centre, Montreal Heart Institute, 5000 Bélanger Street, Montréal, H1T 1C8 Québec, Canada,Faculty of Medicine, Université de Montréal, P.O. Box 6128, Downtown Branch, Montréal, H3C 3J7 Québec, Canada
| | - Stéphane Guay
- Department of Psychiatry and Addiction, Université de Montréal, Roger-Gaudry Pavilion, Faculty of Medicine, P.O. Box 6128, Downtown Branch, Montréal, H3C 3J7 Québec, Canada,Centre d’étude sur le Trauma, Research Centre, Institut universitaire en santé mentale de Montréal, 7331 Hochelaga Street, Montréal, H1N 3V2 Québec, Canada
| | - Marie-Claude Guertin
- Montreal Health Innovations Coordinating Centre, 5000 Bélanger Street, Montréal, H1T 1C8 Québec, Canada
| | - Christine Genest
- Centre d’étude sur le Trauma, Research Centre, Institut universitaire en santé mentale de Montréal, 7331 Hochelaga Street, Montréal, H1N 3V2 Québec, Canada,Faculty of Nursing, Université de Montréal, Marguerite-d'Youville Pavilion, P.O. Box 6128, Downtown Branch, Montréal, H3C 3J7 Québec, Canada
| | - Jacques Forest
- Department of Organization and Human Resources, ESG UQAM, P.O. Box 8888, Downtown Branch, Montréal, H3C 3P8 Québec, Canada
| | - Patrick Lavoie
- Research Centre, Montreal Heart Institute, 5000 Bélanger Street, Montréal, H1T 1C8 Québec, Canada,Faculty of Nursing, Université de Montréal, Marguerite-d'Youville Pavilion, P.O. Box 6128, Downtown Branch, Montréal, H3C 3J7 Québec, Canada
| | - Mélanie Labrosse
- Faculty of Medicine, Université de Montréal, P.O. Box 6128, Downtown Branch, Montréal, H3C 3J7 Québec, Canada,Division of Emergency Medicine, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, 3175 Côte-Sainte-Catherine Road, Montréal, H3T 1C5 Québec, Canada
| | - Alain Vadeboncoeur
- Research Centre, Montreal Heart Institute, 5000 Bélanger Street, Montréal, H1T 1C8 Québec, Canada,Faculty of Medicine, Université de Montréal, P.O. Box 6128, Downtown Branch, Montréal, H3C 3J7 Québec, Canada
| | - Shaun Selcer
- Research Centre, Montreal Heart Institute, 5000 Bélanger Street, Montréal, H1T 1C8 Québec, Canada,Faculty of Medicine, Université de Montréal, P.O. Box 6128, Downtown Branch, Montréal, H3C 3J7 Québec, Canada
| | - Simon Ducharme
- Department of Psychiatry, Douglas Mental Health University Institute, McGill University, 6875 LaSalle Boulevard, Verdun, H4H 1R3 Québec, Canada,McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, 3801 University St, Montréal, H3A 2B4 Québec, Canada
| | - Judith Brouillette
- Research Centre, Montreal Heart Institute, 5000 Bélanger Street, Montréal, H1T 1C8 Québec, Canada; Department of Psychiatry and Addiction, Université de Montréal, Roger-Gaudry Pavilion, Faculty of Medicine, P.O. Box 6128, Downtown Branch, Montréal, H3C 3J7 Québec, Canada.
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Cetin-Sahin D, McCusker J, Ciampi A, Cossette S, Vadeboncoeur A, Vu TTM, Veillette N, Ducharme F, Belzile E, Lachance PA, Mah R, Berthelot S. Front-line emergency department nurses' and physicians' assessments of processes of elder-friendly care for quality improvement. Int Emerg Nurs 2021; 58:101049. [PMID: 34509169 DOI: 10.1016/j.ienj.2021.101049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 06/10/2021] [Accepted: 06/23/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Geriatric emergency department (ED) care has gained increasing importance and interest due to increasing visits in seniors. AIM Among ED front-line nurses and physicians, to assess and compare ratings of elder-friendly care process indicators, variability in ratings, and concurrent validity of ratings. METHODS Four Quebec EDs' full-time registered nurses and physicians rated their geriatric care using 9 subscales. Nurse and physician subscale scores were compared. Inter-rater variability within disciplines and variability between nurses and physicians were measured. Associations between the subscale scores and perceived overall quality of care were tested. RESULTS 38 nurses and 36 physicians completed the survey (83% of 89 eligible). Scores differed by discipline for 3 of 9 subscales computed; nurses had higher mean scores on Protocols, Family-Centered Discharge, and Staff Education. Very high variation for Staff Education was found within disciplines. Variations for Family-Centered Discharge differed significantly between nurses and physicians. Almost all subscale scores were significantly positively associated with perceived overall quality of care. CONCLUSIONS ED nurses and physicians rate geriatric care components similarly except for protocols, discharge processes, and continuing education. The subscales have concurrent validity. Results suggest a need for improvement in continuing educational strategies with a particular attention to discharge processes.
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Affiliation(s)
- Deniz Cetin-Sahin
- St. Mary's Research Centre, St. Mary's Hospital Center, 3830 Avenue Lacombe, Suite 4720, Montreal, QC H3T 1M5, Canada; Department of Family Medicine, McGill University, 5858 chemin de la Côte-des-Neiges, Montreal, QC H3S 1Z1, Canada; Center for Research in Aging, Donald Berman Maimonides Geriatric Centre, 5795 Avenue Caldwell, Côte Saint-Luc, QC H4W 1W3, Canada.
| | - Jane McCusker
- St. Mary's Research Centre, St. Mary's Hospital Center, 3830 Avenue Lacombe, Suite 4720, Montreal, QC H3T 1M5, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Avenue des Pins Ouest, Montreal, QC H3A 1A2, Canada.
| | - Antonio Ciampi
- St. Mary's Research Centre, St. Mary's Hospital Center, 3830 Avenue Lacombe, Suite 4720, Montreal, QC H3T 1M5, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Avenue des Pins Ouest, Montreal, QC H3A 1A2, Canada.
| | - Sylvie Cossette
- University of Montreal, 2900 Edouard Montpetit Blvd, Montreal, QC H3T 1J4, Canada; Montreal Heart Institute Research Center, 5000 rue Bélanger, Montreal, QC H1T 1C8, Canada.
| | - Alain Vadeboncoeur
- University of Montreal, 2900 Edouard Montpetit Blvd, Montreal, QC H3T 1J4, Canada; Emergency Department, Montreal Heart Institute, rue 5000 Bélanger, Montreal, QC H1T 1C8, Canada.
| | - T T Minh Vu
- University of Montreal, 2900 Edouard Montpetit Blvd, Montreal, QC H3T 1J4, Canada; Research Centre, Institut universitaire de gériatrie de Montréal, 4545 chemin Queen Mary, Montreal, QC H3W 1W6, Canada; Centre hospitalier de l'Université de Montréal, 1051 Rue Sanguinet, Montreal, QC H2X 3E4, Canada.
| | - Nathalie Veillette
- University of Montreal, 2900 Edouard Montpetit Blvd, Montreal, QC H3T 1J4, Canada; Research Centre, Institut universitaire de gériatrie de Montréal, 4545 chemin Queen Mary, Montreal, QC H3W 1W6, Canada.
| | - Francine Ducharme
- University of Montreal, 2900 Edouard Montpetit Blvd, Montreal, QC H3T 1J4, Canada; Research Centre, Institut universitaire de gériatrie de Montréal, 4545 chemin Queen Mary, Montreal, QC H3W 1W6, Canada; Faculty of Nursing, Université de Montréal, Pavillon Marguerite-d'Youville, 2375, chemin de la Côte-Ste-Catherine, Montreal, QC H3T 1A8, Canada.
| | - Eric Belzile
- St. Mary's Research Centre, St. Mary's Hospital Center, 3830 Avenue Lacombe, Suite 4720, Montreal, QC H3T 1M5, Canada.
| | - Paul-André Lachance
- University of Montreal, 2900 Edouard Montpetit Blvd, Montreal, QC H3T 1J4, Canada; Hôpital Cité-de-la-Santé, 1755 Boulevard René-Laennec, Laval, QC H7M 3L9, Canada.
| | - Rick Mah
- St. Mary's Hospital Center, 3830 Avenue Lacombe, Emergency Department, Montreal, QC H3T 1M5, Canada; Department of Emergency Medicine, Faculty of Medicine, McGill University, 1001, boul. Décarie, D05.2017.2, Montreal, QC H4A 3J1, Canada.
| | - Simon Berthelot
- Centre de recherche du Centre hospitalier universitaire de Québec-Université Laval, 2705, boulevard Laurier, Quebec City, QC G1V 4G2, Canada.
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Stiell IG, Eagles D, Nemnom MJ, Brown E, Taljaard M, Archambault PM, Birnie D, Borgundvaag B, Clark G, Davis P, Godin D, Hohl C, Mathieu B, McRae AD, Mercier E, Morris J, Parkash R, Perry JJ, Rowe BH, Thiruganasambandamoorthy V, Scheuermeyer F, Sivilotti MLA, Vadeboncoeur A. Adverse Events Associated With Electrical Cardioversion in Patients With Acute Atrial Fibrillation and Atrial Flutter. Can J Cardiol 2021; 37:1775-1782. [PMID: 34474123 DOI: 10.1016/j.cjca.2021.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/24/2021] [Accepted: 08/26/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND We sought to evaluate safety of electrical cardioversion (ECV) for patients with acute atrial fibrillation (AF) or atrial flutter (AFL) in the emergency department (ED). METHODS This was an analysis of data from 4 multicentre AF/AFL studies conducted from 2008 to 2019 at 23 large EDs. We included adult patients who received attempts at ECV and who had presented acutely after symptom onset. Staff manually reviewed study and clinical records to abstract data. RESULTS We evaluated 1736 ECV cases with a mean age of 60.1 years and 67.1% male. The overall success of ECV was 90.2% (95% confidence interval 88.7%-91.6%), with 4.9% of patients admitted. ED physicians performed the ECV in 95.2% and provided sedation in 96.5%; 13.9% (12.3%-15.7%) of cases experienced important adverse events that required treatment, and 0.4% were classified as life threatening. Another 5.6% had adverse events that did not require treatment. Logistic regression found that the RAFF-3 study cohort (odds ratio [OR] 2.0), age ≥ 85 years (OR 2.1), coronary artery disease (OR 1.5), midazolam (OR 1.9), and fentanyl (OR 1.5) were associated with important adverse events. CONCLUSIONS This large evaluation of the safety of ECV for acute AF/AFL in the ED found that while serious adverse events were rare, there were a concerning number of events following sedation that required intervention. Physicians should be aware that older age, coronary artery disease, and fentanyl are associated with higher risks of important adverse events. This study provides more information for shared decision making discussions with patients when choosing between drug-shock and shock-only cardioversion strategies.
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Affiliation(s)
- Ian G Stiell
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
| | - Debra Eagles
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Marie-Joe Nemnom
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Erica Brown
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Patrick M Archambault
- Département de Médecine Familiale et de Médicine d'Urgence, Centre de Recherche du Centre Intégré de Santé et de Services Sociaux de Chaudière-Appalaches, Université Laval, Québec City, Québec, Canada; Département d'Anesthésiologie et de Soins Intensifs, Centre de Recherche du Centre Intégré de Santé et de Services Sociaux de Chaudière-Appalaches, Université Laval, Québec City, Québec, Canada
| | - David Birnie
- Division of Cardiology, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Bjug Borgundvaag
- Division of Emergency Medicine, University of Toronto, Schwartz/Reisman Emergency Medicine Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Gregory Clark
- Department of Emergency Medicine, McGill University Health Centre, Montréal, Québec, Canada
| | - Philip Davis
- Department of Emergency Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Corinne Hohl
- Department of Emergency Medicine, Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bernard Mathieu
- Département de Médecine de Famille et de Médecine d'Urgence, Université de Montréal, Montréal, Québec, Canada
| | - Andrew D McRae
- Department of Emergency Medicine, and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Eric Mercier
- Department of Emergency Medicine, Centre for Clinical Epidemiology and Evaluation, Université Laval, Québec City, Québec, Canada; Département de Médecine Familiale et de Médecine d'Urgence, Centre de Recherche du CHU de Québec, Université Laval, Québec City, Québec, Canada
| | - Judy Morris
- Département de Médecine de Famille et de Médecine d'Urgence, Université de Montréal, Montréal, Québec, Canada
| | - Ratika Parkash
- Division of Cardiology, Department of Medicine, Dalhousie University, Dartmouth, Nova Scotia, Canada
| | - Jeffrey J Perry
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Brian H Rowe
- Department of Emergency Medicine, and School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | | | - Frank Scheuermeyer
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marco L A Sivilotti
- Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada
| | - Alain Vadeboncoeur
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada
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7
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Stiell IG, de Wit K, Scheuermeyer FX, Vadeboncoeur A, Angaran P, Eagles D, Graham ID, Atzema CL, Archambault PM, Tebbenham T, McRae AD, Cheung WJ, Parkash R, Deyell MW, Baril G, Mann R, Sahsi R, Upadhye S, Brown E, Brinkhurst J, Chabot C, Skanes A. 2021 CAEP Acute Atrial Fibrillation/Flutter Best Practices Checklist. CAN J EMERG MED 2021; 23:604-610. [PMID: 34383280 PMCID: PMC8423652 DOI: 10.1007/s43678-021-00167-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 06/16/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Ian G Stiell
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.
- Clinical Epidemiology Unit, The Ottawa Hospital, F657, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada.
| | - Kerstin de Wit
- Department of Emergency Medicine, Queen's University, Kingston, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Frank X Scheuermeyer
- Department of Emergency Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Alain Vadeboncoeur
- Université de Montréal, Montreal, QC, Canada
- Department of Emergency Medicine, Montreal Heart Institute, Montreal, QC, Canada
| | - Paul Angaran
- Division of Cardiology, Terrence Donnelly Heart Centre, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Debra Eagles
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Ian D Graham
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Clare L Atzema
- Division of Emergency Medicine, University of Toronto, Toronto, ON, Canada
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
| | - Patrick M Archambault
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC, Canada
| | - Troy Tebbenham
- Peterborough Regional Health Centre, Peterborough, ON, Canada
| | - Andrew D McRae
- Department of Emergency Medicine, University of Calgary, Calgary, AB, Canada
| | - Warren J Cheung
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Ratika Parkash
- Division of Cardiology, Dalhousie University, Halifax, NS, Canada
| | - Marc W Deyell
- Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, BC, Canada
| | | | - Rick Mann
- Trillium Health Partners, Mississauga Hospital, Mississauga, ON, Canada
| | - Rupinder Sahsi
- Division of Emergency Medicine, Department of Family Medicine, McMaster University, Hamilton, ON, Canada
- St. Mary's General Hospital, Kitchener, ON, Canada
| | - Suneel Upadhye
- Division of Emergency Medicine, McMaster University, Hamilton, ON, Canada
| | - Erica Brown
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | | | - Allan Skanes
- Division of Cardiology, Western University, London, ON, Canada
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8
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Stiell IG, Sivilotti MLA, Taljaard M, Birnie D, Vadeboncoeur A, Hohl CM, McRae AD, Morris J, Mercier E, Macle L, Brison RJ, Thiruganasambandamoorthy V, Rowe BH, Borgundvaag B, Clement CM, Brinkhurst J, Brown E, Nemnom MJ, Wells GA, Perry JJ. A randomized, controlled comparison of electrical versus pharmacological cardioversion for emergency department patients with acute atrial flutter. CAN J EMERG MED 2021; 23:314-324. [PMID: 33959925 DOI: 10.1007/s43678-020-00067-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 12/09/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Acute atrial flutter has one-tenth the prevalence of acute atrial fibrillation in the emergency department (ED) but shares many management strategies. Our aim was to compare conversion from acute atrial flutter to sinus rhythm between pharmacological cardioversion followed by electrical cardioversion (Drug-Shock), and electrical cardioversion alone (Shock-Only). METHODS We conducted a randomized, blinded, placebo-controlled comparison of attempted pharmacological cardioversion with IV procainamide followed by electrical cardioversion if necessary, and placebo infusion followed by electrical cardioversion. We enrolled stable patients with a primary diagnosis of acute acute atrial flutter at 11 academic EDs. The primary outcome was conversion to normal sinus rhythm. FINDINGS From July 2013 to October 2018, we enrolled 76 patients, and none were lost to follow-up. Comparing the Drug-Shock to the Shock-Only group, conversion to sinus rhythm occurred in 33 (100%) versus 40 (93%) (absolute difference 7.0%; 95% CI - 0.6 to 14.6; P = 0.25). Median time to conversion from start of infusion in the Drug-Shock group was 24 min (IQR 21-82) but only 9 (27%) cases were converted with IV procainamide. Patients in both groups had similar outcomes at 14 days; there were no strokes or deaths. INTERPRETATION This trial found that the Drug-Shock strategy is potentially superior but that either approach to immediate rhythm control in the ED for patients with acute acute atrial flutter is highly effective, rapid, and safe in restoring sinus rhythm and allowing patients to go home and return to normal activities. Unlike the case of atrial fibrillation, we found that IV procainamide alone was infrequently effective.
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Affiliation(s)
- Ian G Stiell
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada. .,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
| | | | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - David Birnie
- Division of Cardiology, University of Ottawa Heart Institute, University of Ottawa, Ottawa, ON, Canada
| | - Alain Vadeboncoeur
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, QC, Canada
| | - Corinne M Hohl
- Department of Emergency Medicine, Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Andrew D McRae
- Department of Emergency Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Judy Morris
- Department of Family Medicine and Emergency Medicine, Université de Montréal, Montréal, QC, Canada
| | - Eric Mercier
- Department of Family Medicine and Emergency Medicine, Centre de Recherche du CHU de Québec, Université Laval, Québec, QC, Canada
| | - Laurent Macle
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, QC, Canada
| | - Robert J Brison
- Department of Emergency Medicine, Queen's University, Kingston, ON, Canada
| | - Venkatesh Thiruganasambandamoorthy
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Brian H Rowe
- Department of Emergency Medicine and School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Bjug Borgundvaag
- Division of Emergency Medicine, Schwartz/Reisman Emergency Medicine Institute, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Catherine M Clement
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Jennifer Brinkhurst
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Erica Brown
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Marie-Joe Nemnom
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - George A Wells
- University of Ottawa Heart Institute, University of Ottawa, Ottawa, ON, Canada
| | - Jeffrey J Perry
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
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9
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Cyr S, Marcil MJ, Marin MF, Tardif JC, Guay S, Guertin MC, Rosa C, Genest C, Forest J, Lavoie P, Labrosse M, Vadeboncoeur A, Selcer S, Ducharme S, Brouillette J. Factors Associated With Burnout, Post-traumatic Stress and Anxio-Depressive Symptoms in Healthcare Workers 3 Months Into the COVID-19 Pandemic: An Observational Study. Front Psychiatry 2021; 12:668278. [PMID: 34305675 PMCID: PMC8295587 DOI: 10.3389/fpsyt.2021.668278] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/31/2021] [Indexed: 12/25/2022] Open
Abstract
Objective: This study examined how best to identify modifiable protective and risk factors for burnout in healthcare workers in the face of the COVID-19 pandemic. Individual, occupational, organizational and social factors were investigated. The study also assessed the impact of these factors on post-traumatic stress disorder (PTSD), anxiety, and depression. Methods: Healthcare workers in the Quebec (Canada) healthcare system were recruited between May 21 to June 5, 2020. Participants answered an electronic survey 3 months after the COVID-19 epidemic outbreak began in Canada. Using the Maslach Burnout Inventory, PTSD Checklist for DSM-5, and Hospital Anxiety and Depression Scale, we studied the prevalence of burnout, PTSD, anxiety and depression in this cohort. Multivariable logistic or linear regression models including resilience, social and organizational support, workload and access to mental health help, simulation techniques and protective personal equipment (PPE) as well as perception of PPE security were conducted for each outcome. Results: In mid-June 2020, 467 participants completed the survey. We found that half (51.8%) of the respondents experienced burnout characterized by emotional exhaustion and/or depersonalization at least once a week. In total, 158 healthcare workers (35.6%) displayed severe symptoms of at least one of the mental health disorders (24.3% PTSD, 23.3% anxiety, 10.6% depression). Resilience (OR = 0.69, 95% CI: [0.55-0.87]; p = 0.002) and perceived organizational support (OR = 0.75, 95% CI: [0.61-0.93]; p = 0.009) were significantly associated with burnout and other outcomes. Social support satisfaction, perception of PPE security, work type and environment, mental health antecedents and reassignment were associated with PTSD and/or anxiety and/or depression, but not burnout. Conclusion: Future studies should address primarily resilience and perceived organizational support to promote mental health and prevent burnout, PTSD, anxiety and depression.
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Affiliation(s)
- Samuel Cyr
- Research Center, Montreal Heart Institute, Montreal, QC, Canada.,Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada
| | - Marie-Joelle Marcil
- Research Center, Montreal Heart Institute, Montreal, QC, Canada.,Department of Psychiatry and Addiction, Université de Montréal, Montreal, QC, Canada
| | - Marie-France Marin
- Department of Psychiatry and Addiction, Université de Montréal, Montreal, QC, Canada.,Department of Psychology, Université du Québec à Montréal, Montreal, QC, Canada.,Research Center, Institut universitaire en santé mentale de Montréal, Montreal, QC, Canada
| | - Jean-Claude Tardif
- Research Center, Montreal Heart Institute, Montreal, QC, Canada.,Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Stéphane Guay
- Department of Psychiatry and Addiction, Université de Montréal, Montreal, QC, Canada.,Centre D'étude sur le Trauma, Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada
| | | | - Camille Rosa
- Montreal Health Innovations Coordinating Center, Montreal, QC, Canada
| | - Christine Genest
- Faculty of Nursing, Université de Montréal, Montreal, QC, Canada
| | - Jacques Forest
- Department of Organization and Human Resources, ESG UQAM, Montreal, QC, Canada
| | - Patrick Lavoie
- Research Center, Montreal Heart Institute, Montreal, QC, Canada.,Faculty of Nursing, Université de Montréal, Montreal, QC, Canada
| | - Mélanie Labrosse
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.,Division of Emergency Medicine, Department of Pediatrics, Centre hospitalier universitaire Sainte-Justine, Montreal, QC, Canada
| | - Alain Vadeboncoeur
- Research Center, Montreal Heart Institute, Montreal, QC, Canada.,Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Shaun Selcer
- Research Center, Montreal Heart Institute, Montreal, QC, Canada.,Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Simon Ducharme
- Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada.,McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Judith Brouillette
- Research Center, Montreal Heart Institute, Montreal, QC, Canada.,Department of Psychiatry and Addiction, Université de Montréal, Montreal, QC, Canada
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10
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Stiell IG, Sivilotti MLA, Taljaard M, Birnie D, Vadeboncoeur A, Hohl CM, McRae AD, Rowe BH, Brison RJ, Thiruganasambandamoorthy V, Macle L, Borgundvaag B, Morris J, Mercier E, Clement CM, Brinkhurst J, Sheehan C, Brown E, Nemnom MJ, Wells GA, Perry JJ. Electrical versus pharmacological cardioversion for emergency department patients with acute atrial fibrillation (RAFF2): a partial factorial randomised trial. Lancet 2020; 395:339-349. [PMID: 32007169 DOI: 10.1016/s0140-6736(19)32994-0] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 10/28/2019] [Accepted: 11/22/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Acute atrial fibrillation is the most common arrythmia treated in the emergency department. Our primary aim was to compare conversion to sinus rhythm between pharmacological cardioversion followed by electrical cardioversion (drug-shock), and electrical cardioversion alone (shock-only). Our secondary aim was to compare the effectiveness of two pad positions for electrical cardioversion. METHODS We did a partial factorial trial of two protocols for patients with acute atrial fibrillation at 11 academic hospital emergency departments in Canada. We enrolled adult patients with acute atrial fibrillation. Protocol 1 was a randomised, blinded, placebo-controlled comparison of attempted pharmacological cardioversion with intravenous procainamide (15 mg/kg over 30 min) followed by electrical cardioversion if necessary (up to three shocks, each of ≥200 J), and placebo infusion followed by electrical cardioversion. For patients having electrical cardioversion, we used Protocol 2, a randomised, open-label, nested comparison of anteroposterior versus anterolateral pad positions. Patients were randomly assigned (1:1, stratified by study site) for Protocol 1 by on-site research personnel using an online electronic data capture system. Randomisation for Protocol 2 occurred 30 min after drug infusion for patients who had not converted and was stratified by site and Protocol 1 allocation. Patients and all research and emergency department staff were masked to treatment allocation for Protocol 1. The primary outcome was conversion to normal sinus rhythm for at least 30 min at any time after randomisation and up to a point immediately after three shocks. Protocol 1 was analysed by intention to treat and Protocol 2 excluded patients who did not receive electrical cardioversion. This study is registered at ClinicalTrials.gov, number NCT01891058. FINDINGS Between July 18, 2013, and Oct 17, 2018, we enrolled 396 patients, and none were lost to follow-up. In the drug-shock group (n=204), conversion to sinus rhythm occurred in 196 (96%) patients and in the shock-only group (n=192), conversion occurred in 176 (92%) patients (absolute difference 4%; 95% CI 0-9; p=0·07). The proportion of patients discharged home was 97% (n=198) versus 95% (n=183; p=0·60). 106 (52%) patients in the drug-shock group converted after drug infusion only. No patients had serious adverse events in follow-up. The different pad positions in Protocol 2 (n=244), had similar conversions to sinus rhythm (119 [94%] of 127 in anterolateral group vs 108 [92%] of 117 in anteroposterior group; p=0·68). INTERPRETATION Both the drug-shock and shock-only strategies were highly effective, rapid, and safe in restoring sinus rhythm for patients in the emergency department with acute atrial fibrillation, avoiding the need for return to hospital. The drug infusion worked for about half of patients and avoided the resource intensive procedural sedation required for electrical cardioversion. We also found no significant difference between the anterolateral and anteroposterior pad positions for electrical cardioversion. Immediate rhythm control for patients in the emergency department with acute atrial fibrillation leads to excellent outcomes. FUNDING Heart and Stroke Foundation of Canada and the Canadian Institutes of Health Research.
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Affiliation(s)
- Ian G Stiell
- Department of Emergency Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.
| | | | - Monica Taljaard
- Clinical Epidemiology Program, School of Epidemiology and Public Health, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - David Birnie
- Division of Cardiology, University of Ottawa, Ottawa, ON, Canada
| | - Alain Vadeboncoeur
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, QC, Canada
| | - Corinne M Hohl
- Department of Emergency Medicine, Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Andrew D McRae
- Department of Emergency Medicine, and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Brian H Rowe
- Department of Emergency Medicine, and School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Robert J Brison
- Department of Emergency Medicine, Queen's University, Kingston, ON, Canada
| | | | - Laurent Macle
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, QC, Canada
| | - Bjug Borgundvaag
- Division of Emergency Medicine, University of Toronto, Schwartz/Reisman Emergency Medicine Institute, Mount Sinai Hospital, Toronto, ON, Canada
| | - Judy Morris
- Department of Family Medicine and Emergency Medicine, Université de Montréal, Montréal, QC, Canada
| | - Eric Mercier
- Department of Family Medicine and Emergency Medicine, Centre de Recherche du CHU de Québec, Université Laval, Québec, QC, Canada
| | - Catherine M Clement
- Clinical Epidemiology Program, School of Epidemiology and Public Health, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Jennifer Brinkhurst
- Clinical Epidemiology Program, School of Epidemiology and Public Health, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Connor Sheehan
- Clinical Epidemiology Program, School of Epidemiology and Public Health, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Erica Brown
- Clinical Epidemiology Program, School of Epidemiology and Public Health, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Marie-Joe Nemnom
- Clinical Epidemiology Program, School of Epidemiology and Public Health, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - George A Wells
- University of Ottawa Heart Institute, University of Ottawa, Ottawa, ON, Canada
| | - Jeffrey J Perry
- Department of Emergency Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
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11
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Cetin-Sahin D, Ducharme F, McCusker J, Veillette N, Cossette S, Vu TTM, Vadeboncoeur A, Lachance PA, Mah R, Berthelot S. Experiences of an Emergency Department Visit Among Older Adults and Their Families: Qualitative Findings From a Mixed-Methods Study. J Patient Exp 2019; 7:346-356. [PMID: 32821794 PMCID: PMC7410141 DOI: 10.1177/2374373519837238] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Emergency department (ED) visits are critical events for older adults, but little is known regarding their experiences, particularly about their physical needs, the involvement of accompanying family members, and the transition back to the community. Objective To explore experiences of an ED visit among patients aged 75 and older. Methods In a mixed-methods study, a cohort of patients aged 75 and older (or a family member) discharged from the ED back to the community was recruited from 4 urban EDs. A week following discharge, structured telephone interviews supplemented with open-ended questions were conducted. A subsample (76 patients, 32 family members) was purposefully selected. Verbatim transcripts of responses to the open-ended questions were thematically analyzed. Results Experiences related to physical needs included comfort, equipment supporting mobility and autonomy, help when needed, and access to drink and food. Family members required opportunities to provide patient support and greater involvement in their care. At discharge, patients/families required adequate discharge education, resolution of their health problem, information on medications, and greater certainty about planned follow-up medical and home care services. Conclusions Our findings suggest several areas that could be targeted to improve patient and family perceptions of the care at an ED visit.
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Affiliation(s)
- Deniz Cetin-Sahin
- St. Mary's Research Centre, Montreal, Quebec, Canada.,McGill University, Montreal, Quebec, Canada.,Center for Research in Aging, Donald Berman Maimonides Geriatric Centre, Montreal, Quebec, Canada
| | - Francine Ducharme
- University of Montreal, Montreal, Quebec, Canada.,Research Centre, Institut universitaire de gériatrie de Montréal, Montreal, Quebec, Canada
| | - Jane McCusker
- St. Mary's Research Centre, Montreal, Quebec, Canada.,McGill University, Montreal, Quebec, Canada
| | - Nathalie Veillette
- University of Montreal, Montreal, Quebec, Canada.,Research Centre, Institut universitaire de gériatrie de Montréal, Montreal, Quebec, Canada
| | - Sylvie Cossette
- University of Montreal, Montreal, Quebec, Canada.,Montreal Heart Institute Research Center, Montreal, Quebec, Canada
| | - T T Minh Vu
- University of Montreal, Montreal, Quebec, Canada.,Research Centre, Institut universitaire de gériatrie de Montréal, Montreal, Quebec, Canada.,Centre hospitalier de l'université de Montréal, Montreal, Quebec, Canada
| | - Alain Vadeboncoeur
- University of Montreal, Montreal, Quebec, Canada.,Emergency Medicine Services, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Paul-André Lachance
- University of Montreal, Montreal, Quebec, Canada.,Hôpital de la Cité-de-la-Santé, Laval, Quebec, Canada
| | - Rick Mah
- St. Mary's Hospital Center, Montreal, Quebec, Canada
| | - Simon Berthelot
- Centre de recherche du CHU de Québec-Université Laval, Quebec, Canada
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12
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Cournoyer A, Notebaert É, de Montigny L, Ross D, Cossette S, Londei-Leduc L, Iseppon M, Lamarche Y, Sokoloff C, Potter BJ, Vadeboncoeur A, Larose D, Morris J, Daoust R, Chauny JM, Piette É, Paquet J, Cavayas YA, de Champlain F, Segal E, Albert M, Guertin MC, Denault A. Impact of the direct transfer to percutaneous coronary intervention-capable hospitals on survival to hospital discharge for patients with out-of-hospital cardiac arrest. Resuscitation 2018; 125:28-33. [DOI: 10.1016/j.resuscitation.2018.01.048] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 01/11/2018] [Accepted: 01/29/2018] [Indexed: 01/22/2023]
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Morgan SG, Gagnon MA, Charbonneau M, Vadeboncoeur A. Evaluating the effects of Quebec's private-public drug insurance system. CMAJ 2017; 189:E1259-E1263. [PMID: 29018085 DOI: 10.1503/cmaj.170726] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Steven G Morgan
- School of Population and Public Health (Morgan), University of British Columbia, Vancouver, BC; School of Public Policy and Administration (Gagnon), Carleton University, Ottawa, Ont.; Karl Polanyi Institute of Political Economy (Charbonneau), Concordia University; Family and Emergency Medicine Department (Vadeboncoeur), Montreal University, Montréal, Que.
| | - Marc-André Gagnon
- School of Population and Public Health (Morgan), University of British Columbia, Vancouver, BC; School of Public Policy and Administration (Gagnon), Carleton University, Ottawa, Ont.; Karl Polanyi Institute of Political Economy (Charbonneau), Concordia University; Family and Emergency Medicine Department (Vadeboncoeur), Montreal University, Montréal, Que
| | - Mathieu Charbonneau
- School of Population and Public Health (Morgan), University of British Columbia, Vancouver, BC; School of Public Policy and Administration (Gagnon), Carleton University, Ottawa, Ont.; Karl Polanyi Institute of Political Economy (Charbonneau), Concordia University; Family and Emergency Medicine Department (Vadeboncoeur), Montreal University, Montréal, Que
| | - Alain Vadeboncoeur
- School of Population and Public Health (Morgan), University of British Columbia, Vancouver, BC; School of Public Policy and Administration (Gagnon), Carleton University, Ottawa, Ont.; Karl Polanyi Institute of Political Economy (Charbonneau), Concordia University; Family and Emergency Medicine Department (Vadeboncoeur), Montreal University, Montréal, Que
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McCusker J, Minh Vu TT, Veillette N, Cossette S, Vadeboncoeur A, Ciampi A, Cetin-Sahin D, Belzile E. Elder-Friendly Emergency Department: Development and Validation of a Quality Assessment Tool. J Am Geriatr Soc 2017; 66:394-400. [PMID: 28960240 DOI: 10.1111/jgs.15137] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To develop and validate a comprehensive quality assessment tool for emergency department (ED) geriatric care. DESIGN Four-step study: (1) Content development of tool by a multidisciplinary panel, (2) survey of ED lead physicians and nurses, (3) development of subscales using principal component analysis and clinical judgment, (4) reliability and validity assessment. SETTING Province of Quebec, Canada. PARTICIPANTS Lead ED nurses and physicians at 76 Quebec EDs who participated in a 2013/14 survey (66% of 116 adult nonpsychiatric EDs in the province). MEASUREMENTS Geriatric care items (n = 62) grouped into seven preliminary content areas (screening and assessment, clinical protocols, discharge planning, staffing, physical environment, continuing education, quality assessment), lead nurse and physician perceptions of the quality of ED geriatric care, institutional prioritization of geriatric care, and ED type. RESULTS Thirteen subscales were developed; most were associated with ED type and quality indicators. CONCLUSION Thirteen subscales for geriatric ED services are proposed for evaluation in various ED settings.
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Affiliation(s)
- Jane McCusker
- St. Mary's Research Centre, Montreal, Quebec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - T T Minh Vu
- Faculté des sciences infirmières, Université de Montréal, Montreal, Canada.,Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montreal, Canada.,Centre Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Nathalie Veillette
- Faculté des sciences infirmières, Université de Montréal, Montreal, Canada.,Centre de Recherche, Institut Universitaire de Gériatrie de Montréal, Montreal, Canada
| | - Sylvie Cossette
- Faculté des sciences infirmières, Université de Montréal, Montreal, Canada.,Research Centre, Montreal Heart Institute, Montreal, Canada
| | - Alain Vadeboncoeur
- Faculté des sciences infirmières, Université de Montréal, Montreal, Canada.,Center for Research in Aging, Donald Berman Maimonides Geriatric Centre, Montreal, Canada
| | - Antonio Ciampi
- St. Mary's Research Centre, Montreal, Quebec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Deniz Cetin-Sahin
- St. Mary's Research Centre, Montreal, Quebec, Canada.,Emergency Medicine Services, Montreal Heart Institute, Montreal, Canada
| | - Eric Belzile
- St. Mary's Research Centre, Montreal, Quebec, Canada
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McCusker J, Vadeboncoeur A, Cossette S, Veillette N, Ducharme F, Minh Vu TT, Ciampi A, Cetin‐Sahin D, Belzile E. Changes in Emergency Department Geriatric Services in Quebec and Correlates of These Changes. J Am Geriatr Soc 2017; 65:1448-1454. [DOI: 10.1111/jgs.14818] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 11/21/2016] [Accepted: 12/06/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Jane McCusker
- St. Mary's Research Centre Montreal Canada
- McGill University Montreal Canada
| | - Alain Vadeboncoeur
- Université de Montréal Montreal Canada
- Emergency Medicine Services Montreal Heart Institute Montreal Canada
| | - Sylvie Cossette
- Université de Montréal Montreal Canada
- Montreal Heart Institute Research Center Montreal Canada
| | - Nathalie Veillette
- Université de Montréal Montreal Canada
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal Montreal Canada
| | - Francine Ducharme
- Université de Montréal Montreal Canada
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal Montreal Canada
| | - Thien Tuong Minh Vu
- Université de Montréal Montreal Canada
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal Montreal Canada
- Centre hospitalier de l'Université de Montréal Montreal Canada
| | - Antonio Ciampi
- St. Mary's Research Centre Montreal Canada
- McGill University Montreal Canada
| | - Deniz Cetin‐Sahin
- St. Mary's Research Centre Montreal Canada
- Center for Research in Aging Donald Berman Maimonides Geriatric Centre Montreal Canada
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16
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Sainte-Croix D, Brousselle A, Duhoux A, Hudon C, Vadeboncoeur A, Breton M, Champagne G, Contandriopoulos D. A contingency theory model of primary physicians compensation mix. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw165.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Foldes-Busque G, Hamel S, Belleville G, Fleet R, Poitras J, Chauny JM, Vadeboncoeur A, Lavoie KL, Marchand A. Factors associated with pain level in non-cardiac chest pain patients with comorbid panic disorder. Biopsychosoc Med 2016; 10:30. [PMID: 27777612 PMCID: PMC5070074 DOI: 10.1186/s13030-016-0081-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 10/12/2016] [Indexed: 12/02/2022] Open
Abstract
Background Panic disorder (PD) is highly prevalent in patients with non-cardiac chest pain (NCCP). This study aims to explore the role of psychological factors (PD intensity, anxiety sensitivity, heart-related fear, attention and avoidance) common to NCCP and PD in predicting chest pain levels in patients with both conditions. Methods This association was investigated in emergency department patients with NCCP and PD receiving either evidence-based treatment of PD or treatment as usual. Patients were assessed at baseline and 14 weeks later for post-treatment. Results Only heart-focused fear and attention for cardiac sensations independently explained a significant portion of the variance in baseline pain (n = 66). At 3 months follow-up (n = 53), changes in heart-related fear was the only factor independently associated with changes in chest pain intensity. Even in patients with PD, fear specific to cardiac sensations seems to play a central role in determining NCCP intensity. Conclusion These results suggest that the efficacy of intervention for patients with PD and comorbid NCCP could be improved by targeting heart-related fear and attention. Trial registration NCT00736346
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Affiliation(s)
- Guillaume Foldes-Busque
- School of Psychology, Université Laval, 2325, rue des Bibliothèques, Bureau 1116, Québec, G1V 0A6 Canada ; Research Centre of the University Affiliated Hospital Hôtel-Dieu de Lévis, 143 rue Wolfe, Lévis, Québec G6V 3Z1 Canada
| | - Stéphanie Hamel
- School of Psychology, Université Laval, 2325, rue des Bibliothèques, Bureau 1116, Québec, G1V 0A6 Canada ; Research Centre of the University Affiliated Hospital Hôtel-Dieu de Lévis, 143 rue Wolfe, Lévis, Québec G6V 3Z1 Canada
| | - Geneviève Belleville
- School of Psychology, Université Laval, 2325, rue des Bibliothèques, Bureau 1116, Québec, G1V 0A6 Canada
| | - Richard Fleet
- Research Chair in Emergency Medicine of Laval University, University Affiliated Hospital Hôtel-Dieu de Lévis, 143 rue Wolfe, Lévis, Québec G6V 3Z1 Canada ; Department of Family and Emergency Medicine, Université Laval, 1050 Avenue de la Médecine, Bureau 4617, Québec, G1V 0A6 Canada
| | - Julien Poitras
- Research Centre of the University Affiliated Hospital Hôtel-Dieu de Lévis, 143 rue Wolfe, Lévis, Québec G6V 3Z1 Canada ; Department of Family and Emergency Medicine, Université Laval, 1050 Avenue de la Médecine, Bureau 4617, Québec, G1V 0A6 Canada
| | - Jean-Marc Chauny
- Research Centre, Montreal Sacré-Coeur Hospital, 5400 Boulevard Gouin Ouest, local K-3000, Montréal, Québec H4J 1C5 Canada
| | - Alain Vadeboncoeur
- Research Centre, Montreal Heart Institute, 5000 rue Bélanger, Montréal, Québec H1T 1C8 Canada
| | - Kim L Lavoie
- Research Centre, Montreal Sacré-Coeur Hospital, 5400 Boulevard Gouin Ouest, local K-3000, Montréal, Québec H4J 1C5 Canada ; Research Centre, Montreal Heart Institute, 5000 rue Bélanger, Montréal, Québec H1T 1C8 Canada ; Psychology Department, Université du Québec à Montréal, C.P. 8888 succursale Centre-ville, Montréal, Québec H3C 3P8 Canada
| | - André Marchand
- Psychology Department, Université du Québec à Montréal, C.P. 8888 succursale Centre-ville, Montréal, Québec H3C 3P8 Canada ; Fernand-Séguin Research Centre, Louis-Hippolyte Lafontaine Hospital, 7331 rue Hochelaga, Montréal, Québec H1N 3V2 Canada
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Cossette S, Vadeboncoeur A, Frasure-Smith N, McCusker J, Perreault D, Guertin MC. Randomized controlled trial of a nursing intervention to reduce emergency department revisits. CAN J EMERG MED 2015; 17:13-20. [PMID: 25781379 DOI: 10.2310/8000.2013.131291] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine whether a nursing intervention delivered at emergency department (ED) discharge would reduce ED revisits. METHOD A randomized study was conducted in the ED of a tertiary cardiac hospital in Montreal, Quebec. Between November 2006 and March 2010, 3,795 patients were assessed for eligibility based on two risk factors for ED revisits (≥1 ED visit in the past year and ≥6 medications); 132 were randomized to the experimental group (EG) and 133 to the control group (CG). The intervention included one nurse-patient meeting before leaving the ED, with two additional telephone contacts over the next 2 weeks. The primary outcome was time to ED revisits within 30 days after discharge. Secondary outcomes included time to ED revisits over 90, 180, and 365 days and hospitalizations over 30, 90, 180, and 365 days. RESULTS A planned interim analysis that stopped the study with half of the planned sample showed that the time to ED revisits was similar in both groups at 30 days (p=0.81; revisits: 18.2% in EG, 19.6% in CG), 90 days (p=0.44), 180 days (p=0.98), and 365 days (p=0.75). The only difference identified was a lower hospitalization proportion at 180 days in the EG group (13.6% v. 24.1%; p=0.038). CONCLUSIONS These findings are consistent with previous research showing that few ED-based interventions are successful in reducing ED returns. Factors other than those targeted by the intervention, including an improvement in usual care, may explain the findings.
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Affiliation(s)
- Sylvie Cossette
- *Faculty of Nursing,University of Montreal, andMontreal Heart Institute Research Center
| | | | - Nancy Frasure-Smith
- ‡Faculty of Psychiatry and Nursing,McGill University, andCentre hospitalier de l'Université de Montréal, andMontreal Heart Institute Research Center
| | - Jane McCusker
- §Department of Epidemiology,Biostatistics, and Occupational Health,McGill University, andSt. Mary's Research Centre
| | | | - Marie-Claude Guertin
- ∥Department of Biostatistics,Montreal Health Innovations Coordinating Center,Montreal,QC
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de Champlain F, Boothroyd LJ, Vadeboncoeur A, Huynh T, Nguyen V, Eisenberg MJ, Joseph L, Boivin JF, Segal E. Computerized interpretation of the prehospital electrocardiogram: predictive value for ST segment elevation myocardial infarction and impact on on-scene time. CAN J EMERG MED 2015; 16:94-105. [DOI: 10.2310/8000.2013.131031] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
ABSTRACTIntroduction:Computerized interpretation of the prehospital electrocardiogram (ECG) is increasingly being used in the basic life support (BLS) ambulance setting to reduce delays to treatment for patients suspected of ST segment elevation myocardial infarction (STEMI).Objectives:To estimate 1) predictive values of computerized prehospital 12-lead ECG interpretation for STEMI and 2) additional on-scene time for 12-lead ECG acquisition.Methods:Over a 2-year period, 1,247 ECGs acquired by primary care paramedics for suspected STEMI were collected. ECGs were interpreted in real time by the GEMarquette 12SL ECG analysis program. Predictive values were estimated with a bayesian latent class model incorporating the computerized ECG interpretations, consensus ECG interpretations by study cardiologists, and hospital diagnosis. On-scene time was compared for ambulance-transported patients with (n 5 985) and without (n 5 5,056) prehospital ECGs who received prehospital aspirin and/or nitroglycerin.Results:The computer's positive and negative predictive values for STEMI were 74.0% (95% credible interval [CrI] 69.6–75.6) and 98.1% (95% CrI 97.8–98.4), respectively. The sensitivity and specificity were 69.2% (95% CrI 59.0–78.5) and 98.9% (95% CrI 98.1–99.4), respectively. Prehospital ECGs were associated with a mean increase in on-scene time of 5.9 minutes (95% confidence interval 5.5–6.3).Conclusions:The predictive values of the computerized prehospital ECG interpretation appear to be adequate for diversion programs that direct patients with a positive result to hospitals with angioplasty facilities. The estimated 26.0% chance that a positive interpretation is false is likely too high for activation of a catheterization laboratory from the field. Acquiring prehospital ECGs does not substantially increase on-scene time in the BLS setting.
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Huynh T, Tardif JC, Segal E, L’Allier P, Nguyen M, Dery JP, Afilalo M, Mansour S, Montigny M, Eisenberg M, Ross D, Whittom L, Kouz S, Harvey R, Vadeboncoeur A, Lauzon C, Lynch A, Schampaert E. KNOWLEDGE TRANSLATION TO REDUCE DELAYS OF PRIMARY PERCUTANEOUS CORONARY INTERVENTION IN PATIENTS WITH MYOCARDIAL INFARCTION WITH ST-SEGMENT ELEVATION: INSIGHTS FROM THE AMI-ON TIME STUDY. J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)60134-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cossette S, Frasure-Smith N, Vadeboncoeur A, McCusker J, Guertin MC. The impact of an emergency department nursing intervention on continuity of care, self-care capacities and psychological symptoms: secondary outcomes of a randomized controlled trial. Int J Nurs Stud 2015; 52:666-76. [PMID: 25613830 DOI: 10.1016/j.ijnurstu.2014.12.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 12/11/2014] [Accepted: 12/19/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND As yet there is no firm evidence about the types of intervention that can reduce emergency room revisits. However, the literature on emergency room revisits suggests patient difficulties with managing their health problems and treatments after discharge may play a role. OBJECTIVES We carried out a randomized trial of an emergency department-based nursing intervention, but results showed no reduction in revisits (primary outcome). This paper describes the secondary outcomes of the trial: patient perceptions of continuity of care, illness perceptions, self-care capacities, psychological symptoms and medication adherence 30 days after emergency room discharge. DESIGN Randomized, controlled trial. SETTINGS The trial was conducted in the emergency department of a tertiary cardiac hospital in Montreal, Canada between November 2007 and March 2010. PARTICIPANTS The study involved 203 patients, including 108 in the experimental group and 95 in the control group. METHODS The intervention included one nurse patient encounter before discharge and two phone calls in the 10 days after discharge. Participants provided data 30 days post-discharge on secondary outcomes potentially related to emergency department revisits. RESULTS Although, as previously reported, the intervention had no impact on the primary outcome of emergency department revisits, the present study demonstrated a significant positive effect on patients' perceived continuity of care (p=.033), self-care capacities (p=.037), anxiety (p=.007) and depressive symptoms (p=.043), and the illness perceptions treatment control subscale (p=.037). No differences were found for other illness perception subscales or medication adherence (all p's>.05). CONCLUSION Although the intervention did not influence emergency department revisits it did improve secondary outcomes, suggesting pathways for future research.
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Affiliation(s)
- Sylvie Cossette
- Faculty of Nursing, University of Montreal, Montreal Heart Institute Research Center, Canada.
| | - Nancy Frasure-Smith
- Psychiatry and Nursing, McGill University, Centre hospitalier de l'Université de Montréal and Montreal Heart Institute Research Center, Canada
| | | | - Jane McCusker
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, St. Mary's Research Centre, Canada
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McCusker J, Vadeboncoeur A, Lévesque JF, Ciampi A, Belzile E. Increases in emergency department occupancy are associated with adverse 30-day outcomes. Acad Emerg Med 2014; 21:1092-100. [PMID: 25308131 DOI: 10.1111/acem.12480] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 06/06/2014] [Accepted: 06/06/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The associations between emergency department (ED) crowding and patient outcomes have not been investigated comprehensively in different types of ED. The study objective was to examine the associations of changes over time in ED occupancy with patient outcomes in a sample of EDs that vary by size and location. A secondary objective was to explore whether the relationship between ED occupancy and patient outcomes differed by ED characteristics (size/type and medical and nursing staffing ratios). METHODS Using linked administrative databases, the authors constructed a cohort of 677,475 patients who visited one of 42 hospital EDs with complete data for 2005 on ED bed and waiting room occupancy. Crowding was measured with the relative occupancy ratio separately for ED bed and waiting room patients, defined as the ratio of ED occupancy on the day of the index ED visit to the average annual occupancy at that same ED. Multivariable logistic regression (adjusting for patient and ED characteristics) was used to analyze 30-day outcomes: mortality, return ED visits, and hospital admission at the first return ED visit. RESULTS After adjustment for ED and patient characteristics, a 10% increase in ED bed relative occupancy ratio was associated with 3% increases in death and hospital admission at a return visit. A 10% increase in ED waiting room crowding was associated with a small decrease in return visits. There was a stronger association between bed crowding and mortality among larger EDs. CONCLUSIONS In Quebec EDs, increases in bed occupancy are associated with an increase in the rates of 30-day adverse outcomes, even after adjustment for patient and ED characteristics. The results raise important concerns about the quality of care during periods of ED crowding.
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Affiliation(s)
- Jane McCusker
- The Department of Epidemiology; Biostatistics and Occupational Health; McGill University; Montréal Québec
- St. Mary's Research Centre; Montréal Québec
| | - Alain Vadeboncoeur
- Emergency Medicine Services; Montreal Institute of Cardiology; Montréal Québec
| | - Jean-Frédéric Lévesque
- The Centre de Recherche du CHUM et Institut National de Santé Publique du Québec; Montréal Québec Canada
| | - Antonio Ciampi
- The Department of Epidemiology; Biostatistics and Occupational Health; McGill University; Montréal Québec
- St. Mary's Research Centre; Montréal Québec
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Huynh T, Tardif J, Segal E, Nguyen M, Dery J, Afilalo M, Mansour S, Montigny M, Harvey R, Kouz S, Eisenberg M, Lynch A, Whittom L, Vadeboncoeur A, Lauzon C, Schampaert E. KNOWLEDGE TRANSLATION TO REDUCE DELAYS OF PRIMARY PERCUTANEOUS CORONARY INTERVENTION IN PATIENTS IN QUÉBEC - INSIGHTS FROM THE AMI ON TIME STUDY. Can J Cardiol 2014. [DOI: 10.1016/j.cjca.2014.07.429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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McCusker J, Verdon J, Vadeboncoeur A, Lévesque JF, Sinha SK, Kim KY, Belzile E. The elder-friendly emergency department assessment tool: development of a quality assessment tool for emergency department-based geriatric care. J Am Geriatr Soc 2012; 60:1534-9. [PMID: 22860623 DOI: 10.1111/j.1532-5415.2012.04058.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To develop and conduct a preliminary validation of selected subscales of an elder-friendly emergency department (ED) assessment tool. DESIGN Content validation of tool by an international panel. Construct validation using care ratings of ED lead physicians and nurses. SETTING Quebec, Canada. PARTICIPANTS The international panel comprised 34 clinicians, administrators, and researchers. The construct validation was based on a 2006 survey of ED lead physicians and nurses at all 103 EDs in the province, of whom 68 (66%) supplied complete data. MEASUREMENTS The initial tool included five subscales: ED staffing, screening and assessment, discharge planning, community services, and care philosophy. Differences in subscale scores were examined according to ED size, and of these scores were correlated with care ratings made by lead physicians and nurses. RESULTS The average scores for three subscales (ED staffing, discharge planning, and community services) varied according to ED size. After adjustment for ED size, three subscales (screening and assessment, discharge planning, and community services) were correlated with ED nurse or physician care ratings. A preliminary tool, taking into account all factors, is proposed. CONCLUSION This study provides preliminary evidence of the validity of three subscales of the proposed elder-friendly ED assessment tool. Results suggest that ED size should be considered in interpreting these subscales. Further evaluation and validation of the proposed tool will be needed to further its utility in helping to focus the quality improvement efforts of clinicians, managers, and administrators related to the care they provide older adults.
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Affiliation(s)
- Jane McCusker
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada.
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Borges Da Silva R, McCusker J, Roberge D, Ciampi A, Vadeboncoeur A, Lévesque JF, Belzile E. Classification of emergency departments according to their services for community-dwelling seniors. Acad Emerg Med 2012; 19:552-61. [PMID: 22594359 DOI: 10.1111/j.1553-2712.2012.01343.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The goal was to develop a classification of emergency departments (EDs) based on their organization of services for seniors discharged to the community. METHODS This was a secondary analysis of data collected in a survey of key informants (chief physicians and head nurses) in EDs in Quebec on the organization of services for community-dwelling seniors discharged to the community. Organizational characteristics were classified a priori in the following three categories: 1) availability of human resources, 2) care processes, and 3) links to community services. A multifactorial analysis (MFA) was used to analyze the variables by category and globally, thus investigating not only the relationships between variables within each category, but also the relationships between different categories. The authors then proceeded to classify EDs using Ward's method (hierarchical ascendant classification) applied to reduced data dimensions. RESULTS The sample consisted of 103 EDs. Analyses were carried out on data from the 68 (66%) of these EDs that supplied complete data. These 68 EDs did not differ in terms of their size or geographical location from the 35 other departments that supplied incomplete or no data. We identified three groups of EDs: most specialized (with regard to internal staff and care processes) and less community-oriented (n = 12), moderately specialized and less community-oriented (n = 28), and least specialized and more community-oriented (n = 28). CONCLUSIONS This classification of EDs with respect to their organization of services for community-dwelling seniors may be helpful to those planning services, to decision-makers, and to researchers. The three groups of EDs identified in this study represent three types of organizations with differing assets and limitations. The generalizability of these groups to other settings and the implications for patient outcomes should be investigated.
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Affiliation(s)
- Roxane Borges Da Silva
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Quebec, Canada.
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McCusker J, Roberge D, Ciampi A, Silva RBD, Vadeboncoeur A, Larouche D, Lévesque JF, Belzile E. Outcomes of community-dwelling seniors vary by type of emergency department. Acad Emerg Med 2012; 19:304-12. [PMID: 22435863 DOI: 10.1111/j.1553-2712.2012.01295.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The specific objectives were: 1) to compare the characteristics and 6-month outcomes of community-dwelling seniors in Quebec, Canada, who visited three different emergency department (ED) types and 2) to explore whether the differences in outcomes by ED type were seen among subgroups of seniors. METHODS The three types of ED were most specialized, less community-oriented (n = 12); moderately specialized, less community-oriented (n = 28); and least specialized, more community-oriented (n = 28). Administrative databases were used to create a cohort of 223,120 seniors who visited these 68 EDs during a 14-month period. Using a multilevel approach, the following patient characteristics were compared across ED types: sociodemographic (age, sex, urban vs. rural residence, proximity to ED); medical diagnoses and comorbidity burden; and utilization of hospital and physician services during the 16 months before the index ED visit. Cox regression analysis was used to model the relationships between ED type and two 6-month outcomes, adjusting for patient characteristics: 1) serious outcomes (death, acute or long term-care admission) among all individuals who made an index visit and 2) outpatient ED visits (without hospital admission) among those discharged either from the ED or hospital. Interactions between ED type and patient age, sex, urban-rural residence, and comorbidity burden were explored. RESULTS Compared to patients treated at the least specialized EDs, those at the most specialized EDs were more often urban-dwelling, resided outside the health service area of the ED, and had the highest disease burden and prior specialist utilization. Those treated at the moderately specialized EDs were intermediate between these two groups. During the 6 months after the ED visit, the rate of serious outcomes was higher and the rate of outpatient ED visits was lower for the most specialized compared to the least specialized EDs, even after adjustment for patient characteristics. The differences in these outcomes by ED type were attenuated among older patients and those with greater comorbidity. CONCLUSIONS More vulnerable community-dwelling seniors tend to be treated in more specialized EDs, which have worse linkages to community services. Improved linkages between more specialized EDs and the community (physicians, home care, and other services) and increased access to community services may improve outcomes in this population. Seniors treated at more specialized EDs were more likely to experience serious outcomes, but were less likely to make a return outpatient ED visit.
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Affiliation(s)
- Jane McCusker
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.
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McCusker J, Tousignant P, Borgès Da Silva R, Ciampi A, Lévesque JF, Vadeboncoeur A, Sanche S. Factors predicting patient use of the emergency department: a retrospective cohort study. CMAJ 2012; 184:E307-16. [PMID: 22353588 DOI: 10.1503/cmaj.111069] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Many studies have shown the tendency for people without a regular care provider or primary physician to make greater use of emergency departments. We sought to determine the effects of three aspects of care provided by primary physicians (physician specialty, continuity of care and comprehensiveness of care) on their patients' use of the emergency department. METHODS Using provincial administrative databases, we created a cohort of 367,315 adults aged 18 years and older. Participants were residents of urban areas of Quebec. Affiliation with a primary physician, the specialty of this physician (i.e., family physician v. specialist), continuity of care (as measured using the Usual Provider Continuity index) and comprehensiveness of care (i.e., number of complete annual examinations) were measured among participants (n = 311,701) who had visited a physician three or more times during a two-year baseline period. We used multivariable negative binomial regression to investigate the relationships between measures of care and the number of visits to emergency departments during a 12-month follow-up period. RESULTS Among participants under 65 years of age, emergency department use was higher for those not affiliated than for those affiliated with a family physician (incidence rate ratio [IRR] 1.11, 95% confidence interval [CI] 1.05-1.16) or a specialist (IRR 1.10, 95% CI 1.04-1.17). Among patients aged 65 years and older, having a specialist primary physician, as opposed to a family physician, predicted increased use of the emergency department (IRR 1.13, 95% CI 1.09-1.17). Greater continuity of care with a family physician predicted less use of the emergency department only among participants who made 25 or more visits to a physician during the baseline period. Greater continuity of care with a specialist predicted less use of the emergency department overall, particularly among participants with intermediate numbers of multimorbidities and admissions to hospital. Greater comprehensiveness of care by family physicians predicted less use of the emergency department. INTERPRETATION Efforts to increase the proportion of adults affiliated with a family physician should target older adults, people who visit physicians more frequently and people with multiple comorbidities and admissions to hospital.
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Affiliation(s)
- Jane McCusker
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, and St. Mary's Research Centre, Montréal, Que.
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Pelland MÈ, Marchand A, Lessard MJ, Belleville G, Chauny JM, Vadeboncoeur A, Poitras J, Foldes-Busque G, Bacon SL, Lavoie KL. Efficacy of 2 interventions for panic disorder in patients presenting to the ED with chest pain. Am J Emerg Med 2011; 29:1051-61. [DOI: 10.1016/j.ajem.2010.06.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Accepted: 06/27/2010] [Indexed: 11/28/2022] Open
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Cossette S, Vadeboncoeur A, McCusker J, Frasure-Smith N, Perreault D, Kayser J, Mailhot T, Guertin MC. N006 The effect of a transitional care nursing intervention to reduce emergency department revisits in a tertiary cardiac hospital: A randomized controlled trial. Can J Cardiol 2011. [DOI: 10.1016/j.cjca.2011.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Bacon SL, Lavoie KL, Arsenault A, Dupuis J, Pilote L, Laurin C, Gordon J, Gautrin D, Vadeboncoeur A. The research on endothelial function in women and men at risk for cardiovascular disease (REWARD) study: methodology. BMC Cardiovasc Disord 2011; 11:50. [PMID: 21831309 PMCID: PMC3170269 DOI: 10.1186/1471-2261-11-50] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Accepted: 08/10/2011] [Indexed: 11/10/2022] Open
Abstract
Background Endothelial function has been shown to be a highly sensitive marker for the overall cardiovascular risk of an individual. Furthermore, there is evidence of important sex differences in endothelial function that may underlie the differential presentation of cardiovascular disease (CVD) in women relative to men. As such, measuring endothelial function may have sex-specific prognostic value for the prediction of CVD events, thus improving risk stratification for the overall prediction of CVD in both men and women. The primary objective of this study is to assess the clinical utility of the forearm hyperaemic reactivity (FHR) test (a proxy measure of endothelial function) for the prediction of CVD events in men vs. women using a novel, noninvasive nuclear medicine -based approach. It is hypothesised that: 1) endothelial dysfunction will be a significant predictor of 5-year CVD events independent of baseline stress test results, clinical, demographic, and psychological variables in both men and women; and 2) endothelial dysfunction will be a better predictor of 5-year CVD events in women compared to men. Methods/Design A total of 1972 patients (812 men and 1160 women) undergoing a dipyridamole stress testing were recruited. Medical history, CVD risk factors, health behaviours, psychological status, and gender identity were assessed via structured interview or self-report questionnaires at baseline. In addition, FHR was assessed, as well as levels of sex hormones via blood draw. Patients will be followed for 5 years to assess major CVD events (cardiac mortality, non-fatal MI, revascularization procedures, and cerebrovascular events). Discussion This is the first study to determine the extent and nature of any sex differences in the ability of endothelial function to predict CVD events. We believe the results of this study will provide data that will better inform the choice of diagnostic tests in men and women and bring the quality of risk stratification in women on par with that of men.
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Affiliation(s)
- Simon L Bacon
- Montreal Behavioural Medicine Centre, Montreal, Canada.
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Tanon AA, Champagne F, Contandriopoulos AP, Pomey MP, Vadeboncoeur A, Nguyen H. Patient safety and systematic reviews: finding papers indexed in MEDLINE, EMBASE and CINAHL. Qual Saf Health Care 2010; 19:452-61. [PMID: 20457733 DOI: 10.1136/qshc.2008.031401] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To develop search strategies for identifying papers on patient safety in MEDLINE, EMBASE and CINAHL. METHODS Six journals were electronically searched for papers on patient safety published between 2000 and 2006. Identified papers were divided into two gold standards: one to build and the other to validate the search strategies. Candidate terms for strategy construction were identified using a word frequency analysis of titles, abstracts and keywords used to index the papers in the databases. Searches were run for each one of the selected terms independently in every database. Sensitivity, precision and specificity were calculated for each candidate term. Terms with sensitivity greater than 10% were combined to form the final strategies. The search strategies developed were run against the validation gold standard to assess their performance. A final step in the validation process was to compare the performance of each strategy to those of other strategies found in the literature. RESULTS We developed strategies for all three databases that were highly sensitive (range 95%-100%), precise (range 40%-60%) and balanced (the product of sensitivity and precision being in the range of 30%-40%). The strategies were very specific and outperformed those found in the literature. CONCLUSION The strategies we developed can meet the needs of users aiming to maximise either sensitivity or precision, or seeking a reasonable compromise between sensitivity and precision, when searching for papers on patient safety in MEDLINE, EMBASE or CINAHL.
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Affiliation(s)
- A A Tanon
- Department of Health Administration, Faculty of Medicine, University of Montreal, PO Box 6128, Succ Centre-ville, Montreal, Quebec, Canada.
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Bonin JP, Dominique T, Lesage A, Fortier M, Roch L, Vadeboncoeur A, Pélissier E, Perreault M, Poirier LR, Semaan W, Noiseux S. [Mental health. Difficulties in evaluation in triage]. Perspect Infirm 2010; 7:42-48. [PMID: 20120177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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McCusker J, Roberge D, Vadeboncoeur A, Verdon J. Safety of discharge of seniors from the emergency department to the community. ACTA ACUST UNITED AC 2009; 12 Spec No Patient:24-32. [PMID: 19667774 DOI: 10.12927/hcq.2009.20963] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study investigated the safety of discharge of seniors (aged 65 and over) from Quebec emergency departments (EDs) to the community. Data from a 2006 survey of key informants at 103 Quebec adult non-psychiatric EDs were linked to data on a sample of 172,927 seniors who were discharged home from one of the EDs during the period February 2004-January 2005. During the 30 days after the ED visit, 1.0% of patients died, 5.0% returned to the ED and were admitted to hospital, 16.0% returned to the ED but were not admitted and 29.2% were prescribed a potentially inappropriate medication. Larger, urban EDs treated a higher-risk patient population (older, greater co-morbidity), and these seniors had worse outcomes. A minority of EDs, regardless of their size and the characteristics of patients treated, systematically provided services to improve the safety of discharge. Resources and services need to be improved in EDs, particularly those that serve higher-risk populations (e.g., systematic approaches to the identification and management of high-risk seniors, with appropriate referrals to community services), in the hospital (e.g., increased accessibility to acute care beds) and in the community (e.g., increased accessibility to home care, outpatient geriatric assessment and primary medical care).
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Affiliation(s)
- Jane McCusker
- Department of Clinical Epidemiology and Community Studies at St. Mary's Hospital in Montreal and is Professor in the Department of Epidemiology, Biostatistics and Occupational Health at McGill University
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McCusker J, Ionescu-Ittu R, Ciampi A, Vadeboncoeur A, Roberge D, Larouche D, Verdon J, Pineault R. Hospital Characteristics and Emergency Department Care of Older Patients Are Associated with Return Visits. Acad Emerg Med 2007. [DOI: 10.1111/j.1553-2712.2007.tb01802.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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McCusker J, Ionescu-Ittu R, Ciampi A, Vadeboncoeur A, Roberge D, Larouche D, Verdon J, Pineault R. Hospital characteristics and emergency department care of older patients are associated with return visits. Acad Emerg Med 2007; 14:426-33. [PMID: 17369450 DOI: 10.1197/j.aem.2006.11.020] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To explore hospital characteristics and indicators of emergency department (ED) care of older patients associated with return visits to the ED. METHODS Provincial databases in the province of Quebec, Canada, and a survey of ED geriatric services were linked at the individual and hospital level, respectively. All general acute care adult hospitals with at least 100 eligible patients who visited an ED during 2001 were included (N = 80). The study population (N = 140,379) comprised community-dwelling individuals aged 65 years and older who made an initial ED visit in 2001 and were discharged home. Characteristics of the hospitals included location, number of ED beds, ED resources, and geriatric services in the hospital and the ED. Indicators of ED care at the initial visit included day of the visit, availability of hospital beds, and relative crowding. The main outcome was time to first return ED visit; the authors also analyzed the type of return visit (with or without hospital admission at return visit, and return visits within seven days). RESULTS In multilevel multivariate analyses adjusting for patient characteristics (sociodemographic, ED diagnosis, comorbidity, prior health services utilization), the following variables were independently associated (p < 0.05) with a shorter time to first return ED visit: more limited ED resources, fewer than 12 ED beds, no geriatric unit, no social worker in the ED, fewer available hospital beds at the time of the ED visit, and an ED visit on a weekend. CONCLUSIONS In general, more limited ED resources and indicators of ED care (weekend visits, fewer available hospital beds) are associated with return ED visits in seniors, although the magnitude of the effects is generally small.
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Affiliation(s)
- Jane McCusker
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada.
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Ly HQ, Denault A, Dupuis J, Vadeboncoeur A, Harel F, Arsenault A, Gibson CM, Bonan R. A pilot study: the Noninvasive Surface Cooling Thermoregulatory System for Mild Hypothermia Induction in Acute Myocardial Infarction (the NICAMI Study). Am Heart J 2005; 150:933. [PMID: 16290966 DOI: 10.1016/j.ahj.2005.02.049] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2004] [Accepted: 02/14/2005] [Indexed: 11/20/2022]
Abstract
BACKGROUND Hypothermia reduces metabolic demands, limits reperfusion injury, and helps salvage the injured myocardium during ST-elevation myocardial infarction (STEMI). The aim of this study was to assess early induction of noninvasive mild hypothermia in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention (PCI). METHODS This was a safety and feasibility study of the Medivance Arctic Sun noninvasive thermoregulatory system (Medivance Inc, Louisville, Colo), used as adjunctive therapy in patients with first-time STEMI. Cooling was initiated by circulating chilled water through the Arctic Sun Energy Transfer Pads placed on the patient before primary PCI. Target temperature was 34.5 degrees C, maintained during 3 hours. Shivering was controlled with intravenous meperidine, and meperidine-related nausea was prevented with intravenous ondansetron. RESULTS Nine patients underwent successful noninvasive surface cooling. All patients were Killip class I with a mean age of 62 years (8/9 males). Successful primary stenting was performed in all patients with glycoprotein inhibitors administered in 6 of 9 cases. Mean cooling time from induction to target temperature was 79 minutes (49 minutes in the last 4 enrolled cases). Mean total cooling duration was 267 minutes. Mean peak troponin T was 5.81 microg/L. Final TIMI flow grade 3 and final TIMI perfusion grade 3 were achieved in 9 of 9 patients and in 3 of 9 patients, respectively. Mean infarct size (by Myoview single photon emission computed tomography scans) was 23%. No hemodynamic or arrhythmic instability were documented. CONCLUSION Mild hypothermia can be safely induced with noninvasive surface cooling in patients with STEMI undergoing primary PCI, allowing earlier myocardial protection before mechanical reperfusion therapy.
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Affiliation(s)
- Hung Q Ly
- Department of Medicine, Montreal Heart Institute, Montreal, Quebec, Canada
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Brewer P, Vadeboncoeur A. Abstrick of the month. CAN J EMERG MED 2003; 5:133. [PMID: 17475109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
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