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Parsons Leigh J, FitzGerald EA, Moss SJ, Cherak MS, Brundin-Mather R, Dodds A, Stelfox HT, Dubé È, Fiest KM, Halperin DM, Ahmed SB, MacDonald SE, Straus SE, Manca T, Ng Kamstra J, Soo A, Longmore S, Kupsch S, Sept B, Halperin SA. The evolution of vaccine hesitancy through the COVID-19 pandemic: A semi-structured interview study on booster and bivalent doses. Hum Vaccin Immunother 2024; 20:2316417. [PMID: 38390696 PMCID: PMC10896168 DOI: 10.1080/21645515.2024.2316417] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 02/06/2024] [Indexed: 02/24/2024] Open
Abstract
We sought in-depth understanding on the evolution of factors influencing COVID-19 booster dose and bivalent vaccine hesitancy in a longitudinal semi-structured interview-based qualitative study. Serial interviews were conducted between July 25th and September 1st, 2022 (Phase I: univalent booster dose availability), and between November 21st, 2022 and January 11th, 2023 (Phase II: bivalent vaccine availability). Adults (≥18 years) in Canada who had received an initial primary series and had not received a COVID-19 booster dose were eligible for Phase I, and subsequently invited to participate in Phase II. Twenty-two of twenty-three (96%) participants completed interviews for both phases (45 interviews). Nearly half of participants identified as a woman (n = 11), the median age was 37 years (interquartile range: 32-48), and most participants were employed full-time (n = 12); no participant reported needing to vaccinate (with a primary series) for their workplace. No participant reported having received a COVID-19 booster dose at the time of their interview in Phase II. Three themes relating to the development of hesitancy toward continued vaccination against COVID-19 were identified: 1) effectiveness (frequency concerns; infection despite vaccination); 2) necessity (less threatening, low urgency, alternate protective measures); and 3) information (need for data, contradiction and confusion, lack of trust, decreased motivation). The data from interviews with individuals who had not received a COVID-19 booster dose or bivalent vaccine despite having received a primary series of COVID-19 vaccines highlights actionable targets to address vaccine hesitancy and improve public health literacy.
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Affiliation(s)
- Jeanna Parsons Leigh
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
- Canadian Center for Vaccinology & IWK Health Center, Halifax, Nova Scotia, Canada
| | - Emily A FitzGerald
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Stephana Julia Moss
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, Nova Scotia, Canada
- CRISMA Center, Department of Critical Care, University of Pittsburgh, Pittsburgh, USA
| | - Michal S Cherak
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, Nova Scotia, Canada
- Canadian Center for Vaccinology & IWK Health Center, Halifax, Nova Scotia, Canada
| | | | - Alexandra Dodds
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Ève Dubé
- Centre de Recherche du CHU de Québec, Université Laval, Québec, Canada
- Département d'anthropologie, Université Laval, Québec, Canada
| | - Kirsten M Fiest
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- Department of Psychiatry & Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Donna M Halperin
- Canadian Center for Vaccinology & IWK Health Center, Halifax, Nova Scotia, Canada
- Rankin School of Nursing, St. Francis Xavier University, Antigonish, Nova Scotia, Canada
| | - Sofia B Ahmed
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Shannon E MacDonald
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Terra Manca
- Faculty of Health Disciplines, Athabasca University, Athabasca, Alberta, Canada
- Sociology and Social Anthropology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Josh Ng Kamstra
- Department of Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Andrea Soo
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Health Services, Calgary, Alberta, Canada
| | - Shelly Longmore
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Shelly Kupsch
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Bonnie Sept
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Scott A Halperin
- Canadian Center for Vaccinology & IWK Health Center, Halifax, Nova Scotia, Canada
- Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Microbiology and Immunology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Bencsik C, Josephson C, Soo A, Ainsworth C, Savard M, van Diepen S, Kramer A, Kromm J. The Evolving Role of Electroencephalography in Post Arrest Care. Can J Neurol Sci 2024:1-37. [PMID: 38572611 DOI: 10.1017/cjn.2024.55] [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: 04/05/2024]
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Leigh JP, FitzGerald EA, Moss SJ, Brundin-Mather R, Dodds A, Stelfox HT, Dubé È, Fiest KM, Halperin D, Ahmed SB, MacDonald SE, Straus SE, Manca T, Kamstra JN, Soo A, Longmore S, Kupsch S, Sept B, Halperin S. Factors affecting hesitancy toward COVID-19 vaccine booster doses in Canada: a cross-national survey. Can J Public Health 2024; 115:26-39. [PMID: 37991692 PMCID: PMC10853155 DOI: 10.17269/s41997-023-00823-z] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 09/26/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVE COVID-19 transmission, emergence of variants of concern, and weakened immunity have led to recommended vaccine booster doses for COVID-19. Vaccine hesitancy challenges broad immunization coverage. We deployed a cross-national survey to investigate knowledge, beliefs, and behaviours toward continued COVID-19 vaccination. METHODS We administered a national, cross-sectional online survey among adults in Canada between March 16 and March 26, 2022. We utilized descriptive statistics to summarize our sample, and tested for demographic differences, perceptions of vaccine effectiveness, recommended doses, and trust in decisions, using the Rao-Scott correction for weighted chi-squared tests. Multivariable logistic regression was adjusted for relevant covariates to identify sociodemographic factors and beliefs associated with vaccine hesitancy. RESULTS We collected 2202 completed questionnaires. Lower education status (high school: odds ratio (OR) 1.90, 95% confidence interval (CI) 1.29, 2.81) and having children (OR 1.89, CI 1.39, 2.57) were associated with increased odds of experiencing hesitancy toward a booster dose, while higher income ($100,000-$149,999: OR 0.60, CI 0.39, 0.91; $150,000 or more: OR 0.49, CI 0.29, 0.82) was associated with decreased odds. Disbelief in vaccine effectiveness (against infection: OR 3.69, CI 1.98, 6.90; serious illness: OR 3.15, CI 1.69, 5.86), disagreeing with government decision-making (somewhat disagree: OR 2.70, CI 1.38, 5.29; strongly disagree: OR 4.62, CI 2.20, 9.7), and beliefs in over-vaccinating (OR 2.07, CI 1.53, 2.80) were found associated with booster dose hesitancy. CONCLUSION COVID-19 vaccine hesitancy may develop or increase regarding subsequent vaccines. Our findings indicate factors to consider when targeting vaccine-hesitant populations.
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Affiliation(s)
- Jeanna Parsons Leigh
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS, Canada.
- Department of Critical Care Medicine, Dalhousie University, Halifax, NS, Canada.
- Canadian Center for Vaccinology & IWK Health Centre, Halifax, NS, Canada.
| | - Emily A FitzGerald
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS, Canada
| | - Stephana J Moss
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS, Canada
- CRISMA Center, Department of Critical Care, University of Pittsburgh, Pittsburgh, USA
| | | | - Alexandra Dodds
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Ève Dubé
- Centre de Recherche du CHU de Québec, Université Laval, Québec, Canada
- Institut National de Santé Publique du Québec, Québec, Canada
| | - Kirsten M Fiest
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Department of Psychiatry & Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Donna Halperin
- Canadian Center for Vaccinology & IWK Health Centre, Halifax, NS, Canada
- Rankin School of Nursing, St. Francis Xavier University, Antigonish, NS, Canada
| | - Sofia B Ahmed
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Department of Medicine, University of Calgary, Calgary, AB, Canada
- Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada
| | - Shannon E MacDonald
- School of Public Health, University of Alberta, Edmonton, AB, Canada
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Terra Manca
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
- Sociology and Social Anthropology, Dalhousie University, Halifax, NS, Canada
| | - Josh Ng Kamstra
- Department of Surgery, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA
- Department of Surgery, The Queen's Medical Center, Honolulu, HI, USA
| | - Andrea Soo
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Health Services, Calgary, AB, Canada
| | - Shelly Longmore
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
| | - Shelly Kupsch
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
| | - Bonnie Sept
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
| | - Scott Halperin
- Canadian Center for Vaccinology & IWK Health Centre, Halifax, NS, Canada
- Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
- Department of Microbiology and Immunology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
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Parhar KKS, Knight GE, Soo A, Bagshaw SM, Zuege DJ, Niven DJ, Fiest KM, Stelfox HT. Designing a Behaviour Change Wheel guided implementation strategy for a hypoxaemic respiratory failure and ARDS care pathway that targets barriers. BMJ Open Qual 2023; 12:e002461. [PMID: 38160019 PMCID: PMC10759109 DOI: 10.1136/bmjoq-2023-002461] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 12/03/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND A significant gap exists between ideal evidence-based practice and real-world application of evidence-informed therapies for patients with hypoxaemic respiratory failure (HRF) and acute respiratory distress syndrome (ARDS). Pathways can improve the quality of care provided by helping integrate and organise the use of evidence informed practices, but barriers exist that can influence their adoption and successful implementation. We sought to identify barriers to the implementation of a best practice care pathway for HRF and ARDS and design an implementation science-based strategy targeting these barriers that is tailored to the critical care setting. METHODS The intervention assessed was a previously described multidisciplinary, evidence-based, stakeholder-informed, integrated care pathway for HRF and ARDS. A survey questionnaire (12 open text questions) was administered to intensive care unit (ICU) clinicians (physicians, nurses, respiratory therapists) in 17 adult ICUs across Alberta. The Behaviour Change Wheel, capability, opportunity, motivation - behaviour components, and Theoretical Domains Framework (TDF) were used to perform qualitative analysis on open text responses to identify barriers to the use of the pathway. Behaviour change technique (BCT) taxonomy, and Affordability, Practicality, Effectiveness and cost-effectiveness, Acceptability, Side effects and safety and Equity (APEASE) criteria were used to design an implementation science-based strategy specific to the critical care context. RESULTS Survey responses (692) resulted in 16 belief statements and 9 themes with 9 relevant TDF domains. Differences in responses between clinician professional group and hospital setting were common. Based on intervention functions linked to each belief statement and its relevant TDF domain, 26 candidate BCTs were identified and evaluated using APEASE criteria. 23 BCTs were selected and grouped to form 8 key components of a final strategy: Audit and feedback, education, training, clinical decision support, site champions, reminders, implementation support and empowerment. The final strategy was described using the template for intervention description and replication framework. CONCLUSIONS Barriers to a best practice care pathway were identified and were amenable to the design of an implementation science-based mitigation strategy. Future work will evaluate the ability of this strategy to improve quality of care by assessing clinician behaviour change via better adherence to evidence-based care.
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Affiliation(s)
- Ken Kuljit S Parhar
- Department of Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- University of Calgary O'Brien Institute for Public Health, Calgary, Alberta, Canada
| | - Gwen E Knight
- Department of Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Andrea Soo
- Department of Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Sean M Bagshaw
- Department of Critical Care Medicine, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
| | - Danny J Zuege
- Department of Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Daniel J Niven
- Department of Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- University of Calgary O'Brien Institute for Public Health, Calgary, Alberta, Canada
| | - Kirsten M Fiest
- Department of Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- University of Calgary O'Brien Institute for Public Health, Calgary, Alberta, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- University of Calgary O'Brien Institute for Public Health, Calgary, Alberta, Canada
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Power L, Ong J, Ganeshan D, Bruzzi J, Soo A, Rutherford R. The breathless patient with a sore neck. Ir Med J 2023; 116:881. [PMID: 38258909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
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Sauro KM, O'Rielly CM, Kersen J, Soo A, Bagshaw SM, Stelfox HT. Critical illness among patients experiencing homelessness: a retrospective cohort study. Crit Care 2023; 27:477. [PMID: 38053149 PMCID: PMC10699027 DOI: 10.1186/s13054-023-04753-7] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/20/2023] [Indexed: 12/07/2023] Open
Abstract
PURPOSE To understand the epidemiology and healthcare use of critically ill patients experiencing homelessness compared to critically ill patients with stable housing. METHODS This retrospective population-based cohort study included adults admitted to any ICU in Alberta, Canada, for a 3-year period. Administrative and clinical data from the hospital, ICU and emergency department were used to examine healthcare resource use (processes of care, ICU and hospital length of stay, hospital readmission and emergency room visits). Regression was used to quantify differences in healthcare use by housing status. RESULTS 2.3% (n = 1086) of patients admitted to the ICU were experiencing homelessness; these patients were younger, more commonly admitted for medical reasons and had fewer comorbidities compared to those with stable housing. Processes of care in the ICU were mostly similar, but healthcare use after ICU was different; patients experiencing homelessness who survived their index hospitalization were more than twice as likely to have a visit to the emergency department (OR = 2.3 times, 95% CI 2.0-2.6, < 0.001) or be readmitted to hospital (OR = 2.1, 95% CI 1.8-2.4, p < 0.001) within 30 days, and stayed 10.1 days longer in hospital (95% CI 8.6-11.6, p < 0.001), compared with those who have stable housing. CONCLUSIONS Patients experiencing homelessness have different characteristics at ICU admission and have similar processes of care in ICU, but their subsequent use of healthcare resources was higher than patients with stable housing. These findings can inform strategies to prepare patients experiencing homelessness for discharge from the ICU to reduce healthcare resource use after critical illness.
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Affiliation(s)
- K M Sauro
- Departments of Community Health Sciences, Surgery and Oncology, O'Brien Institute for Public Health and Arnie Charbonneau Cancer Institute, Cumming School of Medicine, University of Calgary, 3280 Hospital Dr. NW, Room 3D41, Calgary, AB, T2N 4Z6, Canada.
| | | | - J Kersen
- Department of Community Health Sciences and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - A Soo
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - S M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, AB, Canada
- Critical Care Strategic Clinical Network, Alberta Health Services, Alberta, Canada
| | - H T Stelfox
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, AB, Canada
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Parhar KKS, Soo A, Knight G, Fiest K, Niven DJ, Rubenfeld G, Scales D, Stelfox HT, Zuege DJ, Bagshaw S. Protocol and statistical analysis plan for the identification and treatment of hypoxemic respiratory failure and acute respiratory distress syndrome with protection, paralysis, and proning: A type-1 hybrid stepped-wedge cluster randomised effectiveness-implementation study. CRIT CARE RESUSC 2023; 25:207-215. [PMID: 38234326 PMCID: PMC10790012 DOI: 10.1016/j.ccrj.2023.10.008] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 10/30/2023] [Indexed: 01/19/2024]
Abstract
Objective To describe a study protocol and statistical analysis plan (SAP) for the identification and treatment of hypoxemic respiratory failure (HRF) and acute respiratory distress syndrome (ARDS) with protection, paralysis, and proning (TheraPPP) study prior to completion of recruitment, electronic data retrieval, and analysis of any data. Design TheraPPP is a stepped-wedge cluster randomised study evaluating a care pathway for HRF and ARDS patients. This is a type-1 hybrid effectiveness-implementation study design evaluating both intervention effectiveness and implementation; however primarily powered for the effectiveness outcome. Setting Seventeen adult intensive care units (ICUs) across Alberta, Canada. Participants We estimate a sample size of 18816 mechanically ventilated patients, with 11424 patients preimplementation and 7392 patients postimplementation. We estimate 2688 sustained ARDS patients within our study cohort. Intervention An evidence-based, stakeholder-informed, multidisciplinary care pathway called Venting Wisely that standardises diagnosis and treatment of HRF and ARDS patients. Main outcome measures The primary outcome is 28-day ventilator-free days (VFDs). The primary analysis will compare the mean 28-day VFDs preimplementation and postimplementation using a mixed-effects linear regression model. Prespecified subgroups include sex, age, HRF, ARDS, COVID-19, cardiac surgery, body mass index, height, illness acuity, and ICU volume. Results This protocol and SAP are reported using the Standard Protocol Items: Recommendations for Interventional Trials guidance and the Guidelines for the Content of Statistical Analysis Plans in Clinical Trials. The study received ethics approval and was registered (ClinicalTrials.gov-NCT04744298) prior to patient enrolment. Conclusions TheraPPP will evaluate the effectiveness and implementation of an HRF and ARDS care pathway.
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Affiliation(s)
- Ken Kuljit S. Parhar
- Department of Critical Care Medicine, University of Calgary & Alberta Health Services, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Andrea Soo
- Department of Critical Care Medicine, University of Calgary & Alberta Health Services, Calgary, Alberta, Canada
| | - Gwen Knight
- Department of Critical Care Medicine, University of Calgary & Alberta Health Services, Calgary, Alberta, Canada
| | - Kirsten Fiest
- Department of Critical Care Medicine, University of Calgary & Alberta Health Services, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Daniel J. Niven
- Department of Critical Care Medicine, University of Calgary & Alberta Health Services, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Gordon Rubenfeld
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto Ontario, Canada
| | - Damon Scales
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto Ontario, Canada
| | - Henry T. Stelfox
- Department of Critical Care Medicine, University of Calgary & Alberta Health Services, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Danny J. Zuege
- Department of Critical Care Medicine, University of Calgary & Alberta Health Services, Calgary, Alberta, Canada
- Critical Care Strategic Clinical Network, Alberta Health Services, Alberta, Canada
| | - Sean Bagshaw
- Critical Care Strategic Clinical Network, Alberta Health Services, Alberta, Canada
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta and Alberta Health Services, Edmonton, Canada
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Shahid A, Sept BG, Owen VS, Johnstone C, Paramalingam R, Moss SJ, Brundin-Mather R, Krewulak KD, Soo A, Parsons-Leigh J, Gélinas C, Fiest KM, Stelfox HT. Preliminary clinical testing to inform development of the Critical Care Pain Observation Tool for Families (CPOT-Fam). Can J Pain 2023; 7:2235399. [PMID: 37719471 PMCID: PMC10503446 DOI: 10.1080/24740527.2023.2235399] [Citation(s) in RCA: 1] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 06/16/2023] [Accepted: 07/07/2023] [Indexed: 09/19/2023]
Abstract
Introduction Many patients in the intensive care unit (ICU) cannot communicate. For these patients, family caregivers (family members/close friends) could assist in pain assessment. We previously adapted the Critical Care Pain Observation Tool (CPOT) for family caregiver use (CPOT-Fam). In this study, we conducted preliminary clinical evaluation of the CPOT-Fam to inform further tool development. Methods For preliminary testing, we collected (1) pain assessments of patients in the ICU from family caregivers (CPOT-Fam) and nurses (CPOT) and determined the degree of agreement (kappa coefficient, κ) and (2) collected openended feedback on the CPOT-Fam from family caregivers. For refinement, we used preliminary testing data to refine the CPOT-Fam with a multidisciplinary working group. Results We assessed agreement between family caregiver and nurse pain scores for 29 patients. Binary agreement (κ) between CPOT-Fam and CPOT item scores (scores ≥2 considered indicative of significant pain) was fair, κ = 0.43 (95% confidence interval [CI] 0.18-0.69). Agreement was highest for the CPOT-Fam items ventilator compliance/vocalization (weighted κ = 0.48, 95% CI 0.15-0.80) and lowest for muscle tension (weighted κ = 0.10, 95% [CI] -0.17 to 0.20). Most participants (n = 19; 69.0%) reported a very positive experience using the CPOT-Fam, describing it as "good" and "easy-to-use/clear/straightforward." We iteratively refined the CPOT-Fam over five cycles using the data collected until no further revisions were suggested. Conclusion Our preliminary clinical testing suggests that family involvement in pain assessment in the ICU is well perceived. The CPOT-Fam has been further refined and is now ready for clinical pilot testing to determine its feasibility and acceptability.
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Affiliation(s)
- Anmol Shahid
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, Calgary, Alberta, Canada
| | - Bonnie G. Sept
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, Calgary, Alberta, Canada
| | - Victoria S. Owen
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, Calgary, Alberta, Canada
| | - Corson Johnstone
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, Calgary, Alberta, Canada
| | - Rameiya Paramalingam
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, Calgary, Alberta, Canada
| | - Stephana J. Moss
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Rebecca Brundin-Mather
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, Calgary, Alberta, Canada
| | - Karla D. Krewulak
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, Calgary, Alberta, Canada
| | - Andrea Soo
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, Calgary, Alberta, Canada
| | - Jeanna Parsons-Leigh
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Céline Gélinas
- Ingram School of Nursing, McGill University, and Centre for Nursing Research and Lady Davis Institute, Jewish General Hospital–CIUSSS West-Central Montreal, Montreal, Quebec, Canada
| | - Kirsten M. Fiest
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, Calgary, Alberta, Canada
- Department of Psychiatry and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences and O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Henry T. Stelfox
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, Calgary, Alberta, Canada
- Department of Community Health Sciences and O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Kromm J, Bencsik C, Soo A, Ainsworth C, Savard M, van Diepen S, Kramer A. Somatosensory evoked potential for post-arrest neuroprognostication. Eur Heart J Acute Cardiovasc Care 2023; 12:532-539. [PMID: 37283039 DOI: 10.1093/ehjacc/zuad060] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 06/01/2023] [Indexed: 06/08/2023]
Affiliation(s)
- Julie Kromm
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Alberta Health Services, Alberta, Canada
| | - Caralyn Bencsik
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Health Services, Alberta, Canada
| | - Andrea Soo
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Health Services, Alberta, Canada
| | - Craig Ainsworth
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Martin Savard
- Département de Médecine, Université Laval, Quebec City, Quebec, Canada
| | - Sean van Diepen
- Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Andreas Kramer
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
- Alberta Health Services, Alberta, Canada
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10
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Jaworska N, Soo A, Stelfox HT, Burry LD, Fiest KM. Impacts of antipsychotic medication prescribing practices in critically ill adult patients on health resource utilization and new psychoactive medication prescriptions. PLoS One 2023; 18:e0287929. [PMID: 37384760 PMCID: PMC10310007 DOI: 10.1371/journal.pone.0287929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/15/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Antipsychotic medications are commonly prescribed to critically ill adult patients and initiation of new antipsychotic prescriptions in the intensive care unit (ICU) increases the proportion of patients discharged home on antipsychotics. Critically ill adult patients are also frequently exposed to multiple psychoactive medications during ICU admission and hospitalization including benzodiazepines and opioid medications which may increase the risk of psychoactive polypharmacy following hospital discharge. The associated impact on health resource utilization and risk of new benzodiazepine and opioid prescriptions is unknown. RESEARCH QUESTION What is the burden of health resource utilization and odds of new prescriptions of benzodiazepines and opioids up to 1-year post-hospital discharge in critically ill patients with new antipsychotic prescriptions at hospital discharge? STUDY DESIGN & METHODS We completed a multi-center, propensity-score matched retrospective cohort study of critically ill adult patients. The primary exposure was administration of ≥1 dose of an antipsychotic while the patient was admitted in the ICU and ward with continuation at hospital discharge and a filled outpatient prescription within 1-year following hospital discharge. The control group was defined as no doses of antipsychotics administered in the ICU and hospital ward and no filled outpatient prescriptions for antipsychotics within 1-year following hospital discharge. The primary outcome was health resource utilization (72-hour ICU readmission, 30-day hospital readmission, 30-day emergency room visitation, 30-day mortality). Secondary outcomes were administration of benzodiazepines and/or opioids in-hospital and following hospital discharge in patients receiving antipsychotics. RESULTS 1,388 propensity-score matched patients were included who did and did not receive antipsychotics in ICU and survived to hospital discharge. New antipsychotic prescriptions were not associated with increased health resource utilization or 30-day mortality following hospital discharge. There was increased odds of new prescriptions of benzodiazepines (adjusted odds ratio [aOR] 1.61 [95%CI 1.19-2.19]) and opioids (aOR 1.82 [95%CI 1.38-2.40]) up to 1-year following hospital discharge in patients continuing antipsychotics at hospital discharge. INTERPRETATION New antipsychotic prescriptions at hospital discharge are significantly associated with additional prescriptions of benzodiazepines and opioids in-hospital and up to 1-year following hospital discharge.
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Affiliation(s)
- Natalia Jaworska
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Health Services, Calgary, AB, Canada
| | - Andrea Soo
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Henry T. Stelfox
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Health Services, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Leslie Dan Faculty of Pharmacy, O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Lisa D. Burry
- Departments of Pharmacy and Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - Kirsten M. Fiest
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Health Services, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Leslie Dan Faculty of Pharmacy, O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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11
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Moss SJ, Racine N, Ahmed S, Birnie K, Cherak MS, Curran JA, Halperin D, Halperin SA, Harley M, Hu J, Leppan L, Nickel A, Russell K, Solis M, Smith S, Soo A, Stelfox M, Tutelman PR, Stelfox HT, Fiest KM, Parsons Leigh J. Codesigning a user-centred digital psychoeducational tool for youth mental well-being with families in Canada: study protocol for a sequential exploratory mixed methods study. BMJ Open 2023; 13:e072533. [PMID: 37369410 PMCID: PMC10410808 DOI: 10.1136/bmjopen-2023-072533] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
INTRODUCTION On 11 March 2020, WHO declared the novel coronavirus (COVID-19) disease a global pandemic. Governments globally implemented physical distancing measures and closure of public institutions that resulted in varying implications to youth mental well-being (eg, social isolation, reduced extracurricular activities). These impacts may have detrimental short-term and long-term effects on youth mental well-being; care for youth with mental health disorders was already overstretched, underfunded and fragmented before the pandemic and youth are not often considered in mental health initiatives. There is a pressing need to partner with youth and families to target and improve youth mental well-being prior to the onset of a mental health disorder, as well as to conduct research on youth mental well-being needs related to pandemic recovery. Here we present a protocol for partnering with youth and families to codesign a user-centred digital tool for youth mental well-being. METHODS AND ANALYSIS We will conduct a national research study to develop a catalogue of recommendations specific to supporting youth mental well-being, and a digital tool to support youth mental well-being through three phases of work: (1) expert consultation on data related to supporting youth mental well-being existing within our Pandemic Preparedness Research Program; (2) codesign of an innovative digital tool for youth mental well-being; and (3) assessment of the tool's usability and acceptability. ETHICS AND DISSEMINATION This study has been approved by the Dalhousie Research Ethics Board (2023-6538) and the Conjoint Health Research Ethics Board (23-0039). This study will complement ongoing foundational research in youth conducted by our team that involves partnering with youth and families to understand the unique implications of the pandemic on this population.
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Affiliation(s)
| | - Nicole Racine
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada
| | - Sofia Ahmed
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kathryn Birnie
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Michal S Cherak
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Janet A Curran
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Donna Halperin
- School of Nursing, St Francis Xavier University, Antigonish, Nova Scotia, Canada
| | - Scott A Halperin
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Micaela Harley
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jia Hu
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Laura Leppan
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Angie Nickel
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kristine Russell
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - May Solis
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Stacie Smith
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Andrea Soo
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Maia Stelfox
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Perri R Tutelman
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Kirsten M Fiest
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Ng-Kamstra JS, Soo A, McBeth P, Rotstein O, Zuege DJ, Gregson D, Doig CJ, Stelfox HT, Niven DJ. STOP Signs: A Population-based Interrupted Time Series Analysis of Antibiotic Duration for Complicated Intraabdominal Infection Before and After the Publication of a Landmark RCT. Ann Surg 2023; 277:e984-e991. [PMID: 35129534 PMCID: PMC10082058 DOI: 10.1097/sla.0000000000005231] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine if the STOP-IT randomized controlled trial changed antibiotic prescribing in patients with Complicated Intraabdominal Infection (CIAI). SUMMARY OF BACKGROUND DATA CIAI is common and causes significant morbidity. In May 2015, the STOP-IT randomized controlled trial showed equivalent outcomes between four-day and clinically determined antibiotic duration. METHODS This was a population-based retrospective cohort study using interrupted time series methods. The STOP-IT publication date was the exposure. Median duration of inpatient antibiotic prescription was the outcome. All adult patients admitted to four hospitals in Calgary, Canada between July 2012 and December 2018 with CIAI who survived at least four days following source control were included. Analysis was stratified by infectious source as appendix or biliary tract (group A) versus other (group B). RESULTS Among 4384 included patients, clinical and demographic attributes were similar before vs after publication. In Group A, median inpatient antibiotic duration was 3 days and unchanged from the beginning to the end of the study period [adjusted median difference -0.00 days, 95% confidence interval (CI) -0.37 - 0.37 days]. In Group B, antibiotic duration was shorter at the end of the study period (7.87 vs 6.73 days; -1.14 days, CI-2.37 - 0.09 days), however there was no change in trend following publication (-0.03 days, CI -0.16 - 0.09). CONCLUSIONS For appendiceal or biliary sources of CIAI, antibiotic duration was commensurate with the experimental arm of STOP-IT. For other sources, antibiotic duration was long and did not change in response to trial publication. Additional implementation science is needed to improve antibiotic stewardship.
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Affiliation(s)
- Joshua S Ng-Kamstra
- Department of Critical Care Medicine, University of Calgary, Calgary, AB
- The Queen's Medical Center, Honolulu, HI
- Department of Surgery, University of Hawaii, John A Burns School of Medicine, Honolulu, HI, USA
| | - Andrea Soo
- Department of Critical Care Medicine, University of Calgary, Calgary, AB
| | - Paul McBeth
- Department of Critical Care Medicine, University of Calgary, Calgary, AB
- Department of Surgery, University of Calgary, Calgary, AB; Keenan Research Centre for Biomedical Science, St Michael's Hospital, University of Toronto, Toronto, ON
| | - Ori Rotstein
- O'Brien Institute of Public Health, University of Calgary, Calgary, AB
| | - Danny J Zuege
- Department of Critical Care Medicine, University of Calgary, Calgary, AB
| | - Daniel Gregson
- Departments of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB; and
| | - Christopher James Doig
- Department of Critical Care Medicine, University of Calgary, Calgary, AB
- O'Brien Institute of Public Health, University of Calgary, Calgary, AB
| | - Henry T Stelfox
- Department of Critical Care Medicine, University of Calgary, Calgary, AB
- O'Brien Institute of Public Health, University of Calgary, Calgary, AB
| | - Daniel J Niven
- Department of Critical Care Medicine, University of Calgary, Calgary, AB
- O'Brien Institute of Public Health, University of Calgary, Calgary, AB
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Shahid A, Johnstone C, Sept BG, Kupsch S, Soo A, Fiest KM, Stelfox HT. Family coaching during Spontaneous Awakening Trials and Spontaneous Breathing Trials (FamCAB): pilot study protocol. BMJ Open 2023; 13:e068770. [PMID: 36806132 PMCID: PMC9943692 DOI: 10.1136/bmjopen-2022-068770] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
INTRODUCTION Many patients in the intensive care unit (ICU) require weaning from deep sedation (Spontaneous Awakening Trials, SATs) and mechanical ventilation (Spontaneous Breathing Trials, SBTs) in their journey to recovery. These procedures can be distressing for patients and their families. The presence of family members as 'coaches' during SATs/SBTs could provide patients with reassurance, reduce stress for patients and families and potentially improve procedural success rates. METHODS AND ANALYSIS This study will be executed in two phases:Development of a coaching module: a working group including patient partners (i.e., former ICU patients or family members of former ICU patients), researchers, and ICU clinicians will develop an educational module on family coaching during SATs/SBTs (FamCAB). This module will provide families of critically ill patients basic information about SATs/SBTs as well as coaching guidance.Pilot testing: family members of ICU patients will complete the FamCAB module and provide information on: (1) demographics, (2) anxiety and (3) satisfaction with care in the ICU. Family members will then coach the patient through the next clinically indicated SATs and/or SBTs. Information around duration of time and success rates of SATs and/or SBTs (ability to conduct a complete assessment) alongside feedback will be collected. ICU clinical staff (including physicians and nurses) will be asked for feedback on practicality and perceived benefits or drawbacks of family coaching during these procedures. Feasibility and acceptability of family coaching in SATs/SBTs will be determined. DISCUSSION The results of this work will inform whether a larger study to explore family coaching during SATs/SBTs is warranted. ETHICS AND DISSEMINATION This study has received ethical approval from the University of Calgary Conjoint Health Research Ethics Board. Results from this pilot study will be made available via peer-reviewed journals and presented at critical care conferences on completion.
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Affiliation(s)
- Anmol Shahid
- Department of Critical Care Medicine, University of Calgary & Alberta Health Services, Calgary, Alberta, Canada
| | - Corson Johnstone
- Department of Critical Care Medicine, University of Calgary & Alberta Health Services, Calgary, Alberta, Canada
| | - Bonnie G Sept
- Department of Critical Care Medicine, University of Calgary & Alberta Health Services, Calgary, Alberta, Canada
| | - Shelly Kupsch
- Department of Critical Care Medicine, University of Calgary & Alberta Health Services, Calgary, Alberta, Canada
| | - Andrea Soo
- Department of Critical Care Medicine, University of Calgary & Alberta Health Services, Calgary, Alberta, Canada
| | - Kirsten M Fiest
- Department of Critical Care Medicine, University of Calgary & Alberta Health Services, Calgary, Alberta, Canada
- Department of Psychiatry, Hotchkiss Brain Institute, and Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Henry Thomas Stelfox
- Department of Critical Care Medicine, University of Calgary & Alberta Health Services, Calgary, Alberta, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
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14
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Shahid A, Sept BG, Longmore S, Owen VS, Moss SJ, Soo A, Fiest KM, Gélinas C, Stelfox HT. Development and preclinical testing of the critical care pain observation tool for family caregiver use (CPOT-Fam). Health Sci Rep 2022; 6:e986. [PMID: 36514328 PMCID: PMC9732740 DOI: 10.1002/hsr2.986] [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] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 11/26/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022] Open
Abstract
Background and Aims Pain assessment in noncommunicative intensive care unit (ICU) patients is challenging. For these patients, family caregivers (i.e., family members, friends) may be able to assist in pain assessment by identifying individualistic signs of pain due to their intimate patient knowledge. This study adapted the critical care pain observation tool (CPOT) to facilitate pain assessment in adult ICU patients by family caregivers. Methods This study was conducted through three distinct phases: (1)CPOT adaptation for family caregiver use (to create the CPOT-Fam): A working group met monthly to adapt the CPOT and develop educational material and sample cases for practice scoring until consensus was reached.(2)CPOT-Fam preclinical testing: Family caregiver study participants viewed educational materials and scored four randomly selected sample cases using the CPOT-Fam. Scores were compared to reference scores to assess agreement and identify CPOT-Fam sections requiring revision. Open-ended feedback on the CPOT-Fam was collected.(3)CPOT-Fam revision: the CPOT-Fam was revised by the working group considering score agreement and feedback received from study participants. Results Of the n = 30 participants, n = 14 (47.0%) had experience with an ICU patient. Agreement between CPOT-Fam participant scores and reference scores were highest for the vocalization dimension (Is the patient making any sounds?; Intraclass correlation coefficient; ICC = 1.0) and lowest for the body movements dimension (What are the patient's body movements like?; ICC = 0.85. Participants indicated they found the CPOT-Fam to be "informative" and "easy-to-use" but "not graphic enough"; participants also indicated that descriptors like "lack of breath" and "struggling to move" are helpful with identifying individualistic behaviors of pain exhibited by their loved ones. Conclusion The CPOT-Fam shows ease of use and may be of value in involving family caregivers in ICU care. Clinical pilot testing is needed to determine feasibility and acceptability and identify further areas for refinement.
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Affiliation(s)
- Anmol Shahid
- Department of Critical Care Medicine, Cumming School of MedicineUniversity of Calgary & Alberta Health ServicesCalgaryAlbertaCanada
| | - Bonnie G. Sept
- Department of Critical Care Medicine, Cumming School of MedicineUniversity of Calgary & Alberta Health ServicesCalgaryAlbertaCanada
| | - Shelly Longmore
- Department of Critical Care Medicine, Cumming School of MedicineUniversity of Calgary & Alberta Health ServicesCalgaryAlbertaCanada
| | - Victoria S. Owen
- Department of Critical Care Medicine, Cumming School of MedicineUniversity of Calgary & Alberta Health ServicesCalgaryAlbertaCanada
| | - Stephana J. Moss
- Department of Critical Care Medicine, Cumming School of MedicineUniversity of Calgary & Alberta Health ServicesCalgaryAlbertaCanada
| | - Andrea Soo
- Department of Critical Care Medicine, Cumming School of MedicineUniversity of Calgary & Alberta Health ServicesCalgaryAlbertaCanada
| | - Kirsten M. Fiest
- Department of Critical Care Medicine, Cumming School of MedicineUniversity of Calgary & Alberta Health ServicesCalgaryAlbertaCanada,Department of Psychiatry, Hotchkiss Brain InstituteCumming School of MedicineCalgaryAlbertaCanada,Department of Community Health SciencesUniversity of CalgaryCalgaryAlbertaCanada
| | - Céline Gélinas
- Centre for Nursing Research and Lady Davis Institute, Ingram School of Nursing, Jewish General Hospital—CIUSSS West‐Central MontrealMcGill UniversityMontrealCanada
| | - Henry T. Stelfox
- Department of Critical Care Medicine, Cumming School of MedicineUniversity of Calgary & Alberta Health ServicesCalgaryAlbertaCanada,O'Brien Institute for Public HealthUniversity of CalgaryCalgaryAlbertaCanada
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15
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Shahid A, Owen VS, Sept BG, Longmore S, Soo A, Brundin-Mather R, Krewulak KD, Moss SJ, Plotnikoff KM, Gélinas C, Fiest KM, Stelfox HT. Study protocol: development and pilot testing of the Critical Care Pain Observation Tool for families (CPOT-Fam). Pilot Feasibility Stud 2022; 8:147. [PMID: 35842680 PMCID: PMC9287531 DOI: 10.1186/s40814-022-01102-3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 06/07/2022] [Indexed: 11/29/2022] Open
Abstract
Background Patients in the intensive care unit (ICU) often have limited ability to communicate making it more difficult to identify and effectively treat their pain. Family caregivers or close friends of critically ill patients may be able to identify signs of pain before the clinical care team and could potentially assist in routine pain assessments. This study will adapt the Critical Care Pain Observation Tool (CPOT) for use by family members to create the CPOT-Fam and compare family CPOT-Fam assessments with nurse-provided CPOT assessments for a given patient. Methods This study will be executed in two phases: 1) Development of the CPOT-Fam — A working group of patient partners, ICU clinicians, and researchers will adapt the CPOT for use by family caregivers (creating the CPOT-Fam) and produce an accompanying educational module to deliver information on pain and how to use the tool. The CPOT-Fam will undergo preclinical testing with participants (i.e., members of the public and family caregivers of critically ill adults), who will complete the educational module and provide CPOT-Fam scores on sample cases. Feedback on the CPOT-Fam will be collected. 2) Pilot testing the CPOT — Fam family caregivers of critically ill adults will complete the educational module and provide information on the following: (1) demographics, (2) anxiety, (3) caregiving self-efficacy, and (4) satisfaction with care in the ICU. Family caregivers will then provide a proxy assessment of their critically ill loved one’s pain through the CPOT-Fam and also provide a subjective (i.e., questionnaire-based including open-ended responses) account of their loved one’s pain status. A comparison (i.e., agreement) will be made between family caregiver provided CPOT-Fam scores and ICU nurse-provided CPOT scores (collected from the provincial health information system), calculated independently and blinded to one another. Feasibility and acceptability of the CPOT-Fam will be determined. Discussion The results of this work will produce a family caregiver CPOT (i.e., CPOT-Fam), determine feasibility and acceptability of the CPOT-Fam, and compare pain assessments conducted by family caregivers and ICU nurses. The results will inform whether a larger study to determine a role for family caregivers in ICU pain assessment using the CPOT-Fam is warranted. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-01102-3.
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Affiliation(s)
- Anmol Shahid
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, Calgary, Alberta, Canada
| | - Victoria S Owen
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, Calgary, Alberta, Canada
| | - Bonnie G Sept
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, Calgary, Alberta, Canada
| | - Shelly Longmore
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, Calgary, Alberta, Canada
| | - Andrea Soo
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, Calgary, Alberta, Canada
| | - Rebecca Brundin-Mather
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, Calgary, Alberta, Canada
| | - Karla D Krewulak
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, Calgary, Alberta, Canada
| | - Stephana J Moss
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, Calgary, Alberta, Canada.,Faculty of Health, School of Health Administration, Dalhousie University, Halifax, Canada
| | - Kara M Plotnikoff
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, Calgary, Alberta, Canada
| | - Céline Gélinas
- Centre for Nursing Research and Lady Davis Institute, Jewish General Hospital - CIUSSS West-Central-Montreal, Ingram School of Nursing, McGill University, Montreal, Canada
| | - Kirsten M Fiest
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, Calgary, Alberta, Canada.,Department of Psychiatry, Hotchkiss Brain Institute, Cumming School of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, Calgary, Alberta, Canada. .,O'Brien Institute for Public Health, Teaching, Research and Wellness Building, University of Calgary, Office 3E24, 3280 Hospital Drive NW, AB, T2N 4Z6, Calgary, Canada.
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16
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Shahid A, Sept B, Kupsch S, Brundin-Mather R, Piskulic D, Soo A, Grant C, Leigh JP, Fiest KM, Stelfox HT. Development and pilot implementation of a patient-oriented discharge summary for critically Ill patients. World J Crit Care Med 2022; 11:255-268. [PMID: 36051938 PMCID: PMC9305680 DOI: 10.5492/wjccm.v11.i4.255] [Citation(s) in RCA: 2] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/06/2022] [Accepted: 06/18/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients leaving the intensive care unit (ICU) often experience gaps in care due to deficiencies in discharge communication, leaving them vulnerable to increased stress, adverse events, readmission to ICU, and death. To facilitate discharge communication, written summaries have been implemented to provide patients and their families with information on medications, activity and diet restrictions, follow-up appointments, symptoms to expect, and who to call if there are questions. While written discharge summaries for patients and their families are utilized frequently in surgical, rehabilitation, and pediatric settings, few have been utilized in ICU settings.
AIM To develop an ICU specific patient-oriented discharge summary tool (PODS-ICU), and pilot test the tool to determine acceptability and feasibility.
METHODS Patient-partners (i.e., individuals with lived experience as an ICU patient or family member of an ICU patient), ICU clinicians (i.e., physicians, nurses), and researchers met to discuss ICU patients’ specific informational needs and design the PODS-ICU through several cycles of discussion and iterative revisions. Research team nurses piloted the PODS-ICU with patient and family participants in two ICUs in Calgary, Canada. Follow-up surveys on the PODS-ICU and its impact on discharge were administered to patients, family participants, and ICU nurses.
RESULTS Most participants felt that their discharge from the ICU was good or better (n = 13; 87.0%), and some (n = 9; 60.0%) participants reported a good understanding of why the patient was in ICU. Most participants (n = 12; 80.0%) reported that they understood ICU events and impacts on the patient’s health. While many patients and family participants indicated the PODS-ICU was informative and useful, ICU nurses reported that the PODS-ICU was “not reasonable” in their daily clinical workflow due to “time constraint”.
CONCLUSION The PODS-ICU tool provides patients and their families with essential information as they discharge from the ICU. This tool has the potential to engage and empower patients and their families in ensuring continuity of care beyond ICU discharge. However, the PODS-ICU requires pairing with earlier discharge practices and integration with electronic clinical information systems to fit better into the clinical workflow for ICU nurses. Further refinement and testing of the PODS-ICU tool in diverse critical care settings is needed to better assess its feasibility and its effects on patient health outcomes.
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Affiliation(s)
- Anmol Shahid
- Department of Critical Care Medicine, University of Calgary, Calgary T2N 4Z6, Alberta, Canada
| | - Bonnie Sept
- Department of Critical Care Medicine, University of Calgary, Calgary T2N 4Z6, Alberta, Canada
| | - Shelly Kupsch
- Department of Critical Care Medicine, University of Calgary, Calgary T2N 4Z6, Alberta, Canada
| | - Rebecca Brundin-Mather
- Department of Critical Care Medicine, University of Calgary, Calgary T2N 4Z6, Alberta, Canada
| | - Danijela Piskulic
- Department of Psychiatry, Hotchkiss Brain Institute, Calgary T2N 4Z6, Alberta, Canada
| | - Andrea Soo
- Department of Critical Care Medicine, University of Calgary, Calgary T2N 4Z6, Alberta, Canada
| | - Christopher Grant
- Department of Critical Care Medicine, University of Calgary, Calgary T2N 4Z6, Alberta, Canada
| | - Jeanna Parsons Leigh
- Department of Critical Care Medicine, University of Calgary, Calgary T2N 4Z6, Alberta, Canada
- School of Health Administration, Dalhousie University, Halifax B3H 4R2, Nova Scotia, Canada
| | - Kirsten M Fiest
- Department of Critical Care Medicine, University of Calgary, Calgary T2N 4Z6, Alberta, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, University of Calgary, Calgary T2N 4Z6, Alberta, Canada
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Leigh JP, Brundin-Mather R, Soo A, FitzGerald E, Mizen S, Dodds A, Ahmed S, Burns KEA, Plotnikoff KM, Rochwerg B, Perry JJ, Benham JL, Honarmand K, Hu J, Lang R, Stelfox HT, Fiest K. Public perceptions during the first wave of the COVID-19 pandemic in Canada: a demographic analysis of self-reported beliefs, behaviors, and information acquisition. BMC Public Health 2022; 22:699. [PMID: 35397530 PMCID: PMC8994420 DOI: 10.1186/s12889-022-13058-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 03/07/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Introduction
We explored associations between sociodemographic factors and public beliefs, behaviors, and information acquisition related to the coronavirus disease 2019 (COVID-19) to identify how the experiences of subpopulations in Canada may vary.
Methods
We administered a national online survey through Ipsos Incorporated to adults residing in Canada. Sampling was stratified by population age, sex, and regional distributions. We used descriptive statistics to summarize responses and test for differences based on gender, age, educational attainment, and household income using chi-squared tests, followed by weighted logistic regression.
Results
We collected 1996 eligible questionnaires between April 26th and May 1st, 2020. Respondents mean age was 50 years, 51% were women, 56% had a post-secondary degree, and 72% had a household income <$100,000. Our analysis found differences within the four demographic groups, with age effects most acutely evidenced. Respondents 65 years and older were more likely to perceive the pandemic as very serious, less likely to report declines in overall health, and more likely to intend to get vaccinated, compared to 18–29 year olds. Women overall were more likely to report negative outcomes than men, including stress due to the pandemic, and worsening social, mental/emotional, and spiritual health. Respondents 45 and older were more likely to seek and trust information from traditional Canadian news sources, while 18-29 year olds were more likely to seek and trust information on social media; overall, women and respondents with a post-secondary degree were more likely to access and trust online information from public health sites.
Conclusion
This study found important demographic differences in how adults living in Canada perceived the COVID-19 pandemic, the impacts on their health, and their preferences for information acquisition. Our results highlight the need to consider demographic characteristics in tailoring the format and information medium to improve large scale acceptance and uptake of mitigation and containment measures.
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Moss SJ, Rosgen BK, Lucini F, Krewulak KD, Soo A, Doig CJ, Patten SB, Stelfox HT, Fiest KM. Psychiatric Outcomes in ICU Patients With Family Visitation: A Population-Based Retrospective Cohort Study. Chest 2022; 162:578-587. [PMID: 35271840 DOI: 10.1016/j.chest.2022.02.051] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/26/2022] [Accepted: 02/22/2022] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Lack of family visitation in the ICU can have long-term consequences on patients in the ICU after discharge. The effect of family visitation on the incidence of patient psychiatric disorders is unknown. RESEARCH QUESTION What is the association between family visitation in the ICU and incidence of psychiatric outcomes in patients in the ICU 1 year after hospital discharge? STUDY DESIGN AND METHODS This study assessed a population-based retrospective cohort of adult patients admitted to the ICU from January 1, 2014, through May 30, 2017, surviving to hospital discharge with ICU length of stay of ≥ 3 days. To be eligible, patients needed to have minimum of 5 years of administrative data before ICU admission and a minimum of 1 year of follow-up data after hospital discharge. An internally validated algorithm that interpreted natural language in health records determined patients with or without in-person family (ie, relatives, friends) visitation during ICU stay. The primary outcome was risk of an incidence of psychiatric disorder (composite outcome), including anxiety, depressive, trauma- and stressor-related, psychotic, and substance use disorders, identified using coding algorithms for administrative databases. Propensity scores were used in inverse probability weighted logistic regression models, and average treatment effects were converted to risk ratios (RRs) with 95% CIs. Secondary outcomes were incidences of diagnoses by type of psychiatric disorder. RESULTS We included 14,344 patients with (96% [n = 13,771]) and without (4.0% [n = 573]) in-person family visitation who survived hospital discharge. More than one-third of patients received a diagnosis of any psychiatric disorder within 1 year after discharge (34.9%; 95% CI, 34.1%-35.6%). Patients most often received diagnoses of anxiety disorders (17.5%; 95% CI, 16.9%-18.1%) and depressive disorders (17.2%; 95% CI, 16.6%-17.9%). After inverse probability weighting of 13,731 patients, in-person family visitation was associated with a lower risk of received a diagnosis of any incident psychiatric disorder within 1 year after discharge (RR, 0.79; 95% CI, 0.68-0.92). INTERPRETATION ICU family visitation is associated with a decreased risk of psychiatric disorders in critically ill patients up to 1 year after hospital discharge.
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Affiliation(s)
- Stephana J Moss
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Brianna K Rosgen
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Filipe Lucini
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Karla D Krewulak
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Andrea Soo
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Christopher J Doig
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Scott B Patten
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada; Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Henry T Stelfox
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Kirsten M Fiest
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada; Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
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Ng JS, Soo A, McBeth PB, Rotstein OD, Zuege DJ, Gregson D, Doig C, Stelfox HT, Niven D. Did We STOP-IT? a Population-Based Interrupted Time Series Analysis of Antimicrobial Duration for Intra-abdominal Infections Before and after the Publication of a Landmark Randomized Controlled Trial. J Am Coll Surg 2021. [DOI: 10.1016/j.jamcollsurg.2021.08.161] [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: 11/30/2022]
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20
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Fiest KM, Krewulak KD, Makuk K, Jaworska N, Hernández L, Bagshaw SM, Burns KE, Cook DJ, Doig CJ, Fox-Robichaud A, Fowler RA, Kho ME, Parhar KKS, Rewa OG, Rochwerg B, Sept BG, Soo A, Spence S, West A, Stelfox HT, Parsons Leigh J. A Modified Delphi Process to Prioritize Experiences and Guidance Related to ICU Restricted Visitation Policies During the Coronavirus Disease 2019 Pandemic. Crit Care Explor 2021; 3:e0562. [PMID: 34712955 PMCID: PMC8547909 DOI: 10.1097/cce.0000000000000562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 12/21/2022] Open
Abstract
To create evidence-based consensus statements for restricted ICU visitation policies to support critically ill patients, families, and healthcare professionals during current and future pandemics. DESIGN Three rounds of a remote modified Delphi consensus process. SETTING Online survey and virtual polling from February 2, 2021, to April 8, 2021. SUBJECTS Stakeholders (patients, families, clinicians, researchers, allied health professionals, decision-makers) admitted to or working in Canadian ICUs during the coronavirus disease 2019 pandemic. MEASUREMENTS AND MAIN RESULTS During Round 1, key stakeholders used a 9-point Likert scale to rate experiences (1-not significant, 9-significant impact on patients, families, healthcare professionals, or patient- and family-centered care) and strategies (1-not essential, 9-essential recommendation for inclusion in the development of restricted visitation policies) and used a free-text box to capture experiences/strategies we may have missed. Consensus was achieved if the median score was 7-9 or 1-3. During Round 2, participants used a 9-point Likert scale to re-rate experiences/strategies that did not meet consensus during Round 1 (median score of 4-6) and rate new items identified in Round 1. During Rounds 2 and 3, participants ranked items that reached consensus by order of importance (relative to other related items and experiences) using a weighted ranking system (0-100 points). Participants prioritized 11 experiences (e.g., variability of family's comfort with technology, healthcare professional moral distress) and developed 21 consensus statements (e.g., communicate policy changes to the hospital staff before the public, permit visitors at end-of-life regardless of coronavirus disease 2019 status, creating a clear definition for end-of-life) regarding restricted visitation policies. CONCLUSIONS We have formulated evidence-informed consensus statements regarding restricted visitation policies informed by diverse stakeholders, which could enhance patient- and family-centered care during a pandemic.
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Affiliation(s)
- Kirsten M Fiest
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences & O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Department of Psychiatry & Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Karla D Krewulak
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Kira Makuk
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Natalia Jaworska
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Laura Hernández
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, AB, Canada
- Critical Care Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
| | - Karen E Burns
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Unity Health Toronto-St. Michael's Hospital, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Deborah J Cook
- Department of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada
| | - Christopher J Doig
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Alison Fox-Robichaud
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada
- Hamilton Health Sciences, Hamilton, ON, Canada
| | - Robert A Fowler
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Department of Critical Care Medicine and Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Michelle E Kho
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Ken Kuljit S Parhar
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Oleksa G Rewa
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, AB, Canada
- Critical Care Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
| | - Bram Rochwerg
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Bonnie G Sept
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Andrea Soo
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Sean Spence
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
| | - Andrew West
- Canadian Society of Respiratory Therapists, Saint John, NB, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, Alberta Health Services & University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences & O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Jeanna Parsons Leigh
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS, Canada
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Moss SJ, Krewulak KD, Stelfox HT, Ahmed SB, Anglin MC, Bagshaw SM, Burns KEA, Cook DJ, Doig CJ, Fox-Robichaud A, Fowler R, Hernández L, Kho ME, Kredentser M, Makuk K, Murthy S, Niven DJ, Olafson K, Parhar KKS, Patten SB, Rewa OG, Rochwerg B, Sept B, Soo A, Spence K, Spence S, Straus S, West A, Parsons Leigh J, Fiest KM. Restricted visitation policies in acute care settings during the COVID-19 pandemic: a scoping review. Crit Care 2021; 25:347. [PMID: 34563234 PMCID: PMC8465762 DOI: 10.1186/s13054-021-03763-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/07/2021] [Indexed: 11/12/2022]
Abstract
Background Restricted visitation policies in acute care settings because of the COVID-19 pandemic have negative consequences. The objective of this scoping review is to identify impacts of restricted visitation policies in acute care settings, and describe perspectives and mitigation approaches among patients, families, and healthcare professionals.
Methods We searched Medline, Embase, PsycINFO, Healthstar, CINAHL, Cochrane Central Register of Controlled Trials on January 01/2021, unrestricted, for published primary research records reporting any study design. We included secondary (e.g., reviews) and non-research records (e.g., commentaries), and performed manual searches in web-based resources. We excluded records that did not report primary data. Two reviewers independently abstracted data in duplicate. Results Of 7810 citations, we included 155 records. Sixty-six records (43%) were primary research; 29 (44%) case reports or case series, and 26 (39%) cohort studies; 21 (14%) were literature reviews and 8 (5%) were expert recommendations; 54 (35%) were commentary, editorial, or opinion pieces. Restricted visitation policies impacted coping and daily function (n = 31, 20%) and mental health outcomes (n = 29, 19%) of patients, families, and healthcare professionals. Participants described a need for coping and support (n = 107, 69%), connection and communication (n = 107, 69%), and awareness of state of well-being (n = 101, 65%). Eighty-seven approaches to mitigate impact of restricted visitation were identified, targeting families (n = 61, 70%), patients (n = 51, 59%), and healthcare professionals (n = 40, 46%). Conclusions Patients, families, and healthcare professionals were impacted by restricted visitation polices in acute care settings during COVID-19. The consequences of this approach on patients and families are understudied and warrant evaluation of approaches to mitigate their impact. Future pandemic policy development should include the perspectives of patients, families, and healthcare professionals. Trial registration: The review was registered on PROSPERO (CRD42020221662) and a protocol peer-reviewed prior to data extraction. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-021-03763-7.
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Affiliation(s)
- Stephana J Moss
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Karla D Krewulak
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sofia B Ahmed
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Melanie C Anglin
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, and Alberta Health Services, Edmonton, Canada
| | - Karen E A Burns
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada
| | - Deborah J Cook
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Christopher J Doig
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Robert Fowler
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Laura Hernández
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Michelle E Kho
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Maia Kredentser
- Department of Clinical Health Psychology, University of Manitoba, Manitoba, Canada
| | - Kira Makuk
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Srinivas Murthy
- Department of Pediatrics, University of British Columbia, British Columbia, Canada
| | - Daniel J Niven
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kendiss Olafson
- Department of Medicine, University of Manitoba, Manitoba, Canada
| | - Ken Kuljit S Parhar
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Scott B Patten
- Department of Psychiatry, Cumming School of Medicine, Cuthbertson and Fischer Chair in Pediatric Mental Health, University of Calgary, Calgary, AB, Canada
| | - Oleksa G Rewa
- Department of Critical Care Medicine, University of Alberta, Edmonton, AB, Canada
| | - Bram Rochwerg
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Bonnie Sept
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Andrea Soo
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Krista Spence
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sean Spence
- Chinook Regional Hospital, Lethbridge County, Alberta, Canada
| | - Sharon Straus
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Andrew West
- Canadian Society of Respiratory Therapists, Saint John, NB, Canada
| | - Jeanna Parsons Leigh
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Kirsten M Fiest
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
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22
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Moss SJ, Stelfox HT, Krewulak KD, Ahmed S, Anglin MC, Bagshaw SM, Barnes T, Burns KEA, Cook DJ, Crowe S, Doig CJ, Foster N, Fox-Robichaud A, Fowler R, Kredenster M, Murthy S, Niven D, Olafson K, Parhar KKS, Patten SB, Rewa O, Rochwerg B, Sept BG, Soo A, Spence K, Spence S, Straus SE, West A, Parsons Leigh J, Fiest KM. Impact of restricted visitation policies in hospitals on patients, family members and healthcare providers during the COVID-19 pandemic: a scoping review protocol. BMJ Open 2021; 11:e048227. [PMID: 34556510 PMCID: PMC8461363 DOI: 10.1136/bmjopen-2020-048227] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION Flexible visitation policies in hospitals are an important component of care that contributes to reduced stress and increased satisfaction among patients and their family members. Early evidence suggests restricted visitation policies enacted in hospitals during the COVID-19 pandemic are having unintended consequences on patients, family members and healthcare providers. There is a need for a comprehensive summary of the impacts of restricted visitation policies on key stakeholders and approaches to mitigate that impact. METHODS AND ANALYSIS We will conduct a scoping review as per the Arksey-O'Malley 5-stage scoping review method and the Scoping Review Methods Manual by the Joanna Briggs Institute. We will search relevant electronic databases (eg, CINAHL, MEDLINE, PsycINFO), grey literature and preprint repositories. We will include all study designs including qualitative and quantitative methodologies (excluding protocols) as well as reports, opinions and editorials, to identify the broad impact of restricted hospital visitation policies due to the COVID-19 pandemic on patients, family members or healthcare providers of hospitalised patients, and approaches taken or proposed to mitigate this impact. Two reviewers will calibrate the screening criteria and data abstraction form and will independently screen studies and abstract the data. Narrative synthesis with thematic analysis will be performed. ETHICS AND DISSEMINATION Ethical approval is not applicable as this review will be conducted on published literature only. This scoping review will identify, describe and categorise impacts of restricted hospital visitation policies due to the COVID-19 pandemic on patients, family members and healthcare providers of hospitalised patients, and approaches that have been taken to mitigate impact. We will provide a comprehensive synthesis by developing a framework of restricted visitation policies and associated impacts. Our results will inform the development of consensus statements on restricted visitation policies to be implemented in future pandemics. PROSPERO REGISTRATION NUMBER CRD42020221662.
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Affiliation(s)
- Stephana J Moss
- Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Henry T Stelfox
- Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Karla D Krewulak
- Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Sofia Ahmed
- Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Melanie C Anglin
- Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Sean M Bagshaw
- Critical Care Medicine, University of Alberta Faculty of Medicine & Dentistry, Edmonton, Alberta, Canada
| | - Tavish Barnes
- Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Karen E A Burns
- Medicine, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Deborah J Cook
- Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Sarah Crowe
- Nurse Practitioners, Royal Columbian Hospital, New Westminster, British Columbia, Canada
| | - Christopher J Doig
- Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Nadine Foster
- Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | | | - Robert Fowler
- Sunnybrook Health Sciences Institute, Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Maia Kredenster
- Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Srinivas Murthy
- Departments of Pediatrics and Critical Care Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Daniel Niven
- Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Kendiss Olafson
- Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ken Kuljit S Parhar
- Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Scott B Patten
- Psychiatry, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Oleska Rewa
- Critical Care Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Bram Rochwerg
- Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Bonnie G Sept
- Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Andrea Soo
- Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Krista Spence
- Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Sean Spence
- Critical Care Medicine, Chinook Regional Hospital, Lethbridge, Alberta, Canada
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Andrew West
- Respiratory Therapy, Canadian Society of Respiratory Therapists, Saint John, New Brunswick, Canada
| | - Jeanna Parsons Leigh
- Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Kirsten M Fiest
- Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
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Fiest KM, Soo A, Hee Lee C, Niven DJ, Ely EW, Doig CJ, Stelfox HT. Long-Term Outcomes in ICU Patients with Delirium: A Population-based Cohort Study. Am J Respir Crit Care Med 2021; 204:412-420. [PMID: 33823122 PMCID: PMC8480248 DOI: 10.1164/rccm.202002-0320oc] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rationale: Delirium is common in the ICU and portends worse ICU and hospital outcomes. The effect of delirium in the ICU on post-hospital discharge mortality and health resource use is less well known. Objectives: To estimate mortality and health resource use 2.5 years after hospital discharge in critically ill patients admitted to the ICU. Methods: This was a population-based, propensity score-matched, retrospective cohort study of adult patients admitted to 1 of 14 medical-surgical ICUs from January 1, 2014, to June 30, 2016. Delirium was measured by using the 8-point Intensive Care Delirium Screening Checklist. The primary outcome was mortality. The secondary outcome was a composite measure of subsequent emergency department visits, hospital readmission, or mortality. Measurements and Main Results: There were 5,936 propensity score-matched patients with and without a history of incident delirium who survived to hospital discharge. Delirium was associated with increased mortality 0-30 days after hospital discharge (hazard ratio, 1.44 [95% confidence interval, 1.08-1.92]). There was no significant difference in mortality more than 30 days after hospital discharge (delirium: 3.9%, no delirium: 2.6%). There was a persistent increased risk of emergency department visits, hospital readmissions, or mortality after hospital discharge (hazard ratio, 1.12 [95% confidence interval, 1.07-1.17]) throughout the study period. Conclusions: ICU delirium is associated with increased mortality 0-30 days after hospital discharge.
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Affiliation(s)
- Kirsten M Fiest
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada.,Department of Community Health Sciences.,O'Brien Institute for Public Health.,Department of Psychiatry, and.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrea Soo
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - Chel Hee Lee
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - Daniel J Niven
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada.,Department of Community Health Sciences.,O'Brien Institute for Public Health
| | - E Wesley Ely
- Tennessee Valley Veterans Affairs Geriatric Research Education Clinical Center, Nashville Tennessee; and.,Critical Illness, Brain Dysfunction, and Survivorship Center, Vanderbilt University Medical Center, Vanderbilt University, Nashville Tennessee
| | - Christopher J Doig
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada.,Department of Community Health Sciences.,O'Brien Institute for Public Health
| | - Henry T Stelfox
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada.,Department of Community Health Sciences.,O'Brien Institute for Public Health
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Abstract
OBJECTIVES We examined the relationship between dominant sedation strategy, risk of delirium and patient-centred outcomes in adults admitted to intensive care units (ICUs). DESIGN Retrospective propensity-matched cohort study. SETTING Mechanically ventilated adults (≥ 18 years) admitted to four Canadian hospital medical/surgical ICUs from 2014 to 2016 in Calgary, Alberta, Canada. PARTICIPANTS 2837 mechanically ventilated adults (≥ 18 years) requiring admission to a medical/surgical ICU were evaluated for the relationship between sedation strategy and delirium. INTERVENTIONS None. PRIMARY AND SECONDARY OUTCOME MEASURES The primary exposure was dominant sedation strategy, defined as the sedative infusion, including midazolam, propofol or fentanyl, with the longest duration before the first delirium assessment. The primary outcome was 'ever delirium' identified using the Intensive Care Delirium Screening Checklist. Secondary outcomes included mortality, length of stay (LOS), ventilation duration and days with delirium. The cohort was analysed in two propensity score (patient characteristics and therapies received) matched cohorts (propofol vs fentanyl and propofol vs midazolam). RESULTS 2837 patients (60.7% male; median age 57 years (IQR 43-68)) were considered for propensity matching. In propensity score-matched cohorts(propofol vs midazolam, n=712; propofol vs fentanyl, n=1732), the odds of delirium were significantly higher with midazolam (OR 1.46 (95% CI 1.06 to 2.00)) and fentanyl (OR 1.22 (95% CI 1.00 to 1.48)) compared with propofol dominant sedation strategies. Dominant sedation strategy with midazolam and fentanyl were associated with a longer duration of ventilation compared with propofol. Fentanyl was also associated with increased ICU mortality (OR 1.50, 95% CI 1.07 to 2.12)) ICU and hospital LOS compared with a propofol dominant sedation strategy. CONCLUSIONS We identified a novel association between fentanyl dominant sedation strategies and an increased risk of delirium, a composite outcome of delirium or death, duration of mechanical ventilation, ICU LOS and hospital LOS. Midazolam dominant sedation strategies were associated with increased delirium risk and mechanical ventilation duration.
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Affiliation(s)
- Colin Casault
- Department of Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Andrea Soo
- Department of Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Chel Hee Lee
- Department of Critical Care, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Philippe Couillard
- Department of Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Daniel Niven
- Department of Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Tom Stelfox
- Department of Critical Care, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Kirsten Fiest
- Department of Critical Care Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
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You D, Skeith L, Korley R, Cantle P, Lee A, McBeth P, McDonald B, Buckley R, Duffy P, Martin CR, Soo A, Schneider P. Identification of hypercoagulability with thrombelastography in patients with hip fracture receiving thromboprophylaxis. Can J Surg 2021; 64:E324-E329. [PMID: 34085509 PMCID: PMC8327983 DOI: 10.1503/cjs.021019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Venous thromboembolism (VTE) is the second most common complication after hip fracture surgery. We used thrombelastography (TEG), a wholeblood, point-of-care test that can provide an overview of the clotting process, to determine the duration of hypercoagulability after hip fracture surgery. Methods: In this prospective study, consecutive patients aged 51 years or more with hip fractures (trochanteric region or neck) amenable to surgical treatment who presented to the emergency department were eligible for enrolment. Thrombelastography, including calculation of the coagulation index (CI) (combination of 4 TEG parameters for an overall assessment of coagulation) was performed daily from admission until 5 days postoperatively, and at 2 and 6 weeks postoperatively. All patients received 28 days of thromboprophylaxis. We used single-sample t tests to compare mean maximal amplitude (MA) values (a measure of clot strength) to the hypercoagulable threshold of greater than 65 mm, a predictor of in-hospital VTE. Results: Of the 35 patients enrolled, 11 (31%) were hypercoagulable on admission based on an MA value greater than 65 mm, and 29 (83%) were hypercoagulable based on a CI value greater than 3.0; the corresponding values at 6 weeks were 23 (66%) and 34 (97%). All patients had an MA value greater than 65 mm at 2 weeks. Patients demonstrated normal coagulation on admission (mean MA value 62.2 mm [standard deviation (SD) 6.3 mm], p = 0.01) but became significantly hypercoagulable at 2 weeks (mean 71.6 mm [SD 2.6 mm], p < 0.001). There was a trend toward persistent hypercoagulability at 6 weeks (mean MA value 66.2 mm [SD 3.8 mm], p = 0.06). Conclusion: More than 50% of patients remained hypercoagulable 6 weeks after fracture despite thromboprophylaxis. Thrombelastography MA thresholds or a change in MA over time may help predict VTE risk; however, further study is needed.
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Affiliation(s)
- Daniel You
- From the Division of Orthopaedic Surgery, University of Calgary, Calgary, Alta. (You, Korley, Buckley, Duffy, Martin, Schneider); the Division of Hematology & Hematological Malignancies, University of Calgary, Calgary, Alta. (Skeith, Lee); the Section of General Surgery, University of Calgary, Calgary, Alta. (Cantle, McBeth); the Section of Vascular Surgery, University of Calgary, Calgary, Alta. (Cantle); and the Department of Critical Care, University of Calgary, Calgary, Alta. (McBeth, McDonald, Soo)
| | - Leslie Skeith
- From the Division of Orthopaedic Surgery, University of Calgary, Calgary, Alta. (You, Korley, Buckley, Duffy, Martin, Schneider); the Division of Hematology & Hematological Malignancies, University of Calgary, Calgary, Alta. (Skeith, Lee); the Section of General Surgery, University of Calgary, Calgary, Alta. (Cantle, McBeth); the Section of Vascular Surgery, University of Calgary, Calgary, Alta. (Cantle); and the Department of Critical Care, University of Calgary, Calgary, Alta. (McBeth, McDonald, Soo)
| | - Robert Korley
- From the Division of Orthopaedic Surgery, University of Calgary, Calgary, Alta. (You, Korley, Buckley, Duffy, Martin, Schneider); the Division of Hematology & Hematological Malignancies, University of Calgary, Calgary, Alta. (Skeith, Lee); the Section of General Surgery, University of Calgary, Calgary, Alta. (Cantle, McBeth); the Section of Vascular Surgery, University of Calgary, Calgary, Alta. (Cantle); and the Department of Critical Care, University of Calgary, Calgary, Alta. (McBeth, McDonald, Soo)
| | - Paul Cantle
- From the Division of Orthopaedic Surgery, University of Calgary, Calgary, Alta. (You, Korley, Buckley, Duffy, Martin, Schneider); the Division of Hematology & Hematological Malignancies, University of Calgary, Calgary, Alta. (Skeith, Lee); the Section of General Surgery, University of Calgary, Calgary, Alta. (Cantle, McBeth); the Section of Vascular Surgery, University of Calgary, Calgary, Alta. (Cantle); and the Department of Critical Care, University of Calgary, Calgary, Alta. (McBeth, McDonald, Soo)
| | - Adrienne Lee
- From the Division of Orthopaedic Surgery, University of Calgary, Calgary, Alta. (You, Korley, Buckley, Duffy, Martin, Schneider); the Division of Hematology & Hematological Malignancies, University of Calgary, Calgary, Alta. (Skeith, Lee); the Section of General Surgery, University of Calgary, Calgary, Alta. (Cantle, McBeth); the Section of Vascular Surgery, University of Calgary, Calgary, Alta. (Cantle); and the Department of Critical Care, University of Calgary, Calgary, Alta. (McBeth, McDonald, Soo)
| | - Paul McBeth
- From the Division of Orthopaedic Surgery, University of Calgary, Calgary, Alta. (You, Korley, Buckley, Duffy, Martin, Schneider); the Division of Hematology & Hematological Malignancies, University of Calgary, Calgary, Alta. (Skeith, Lee); the Section of General Surgery, University of Calgary, Calgary, Alta. (Cantle, McBeth); the Section of Vascular Surgery, University of Calgary, Calgary, Alta. (Cantle); and the Department of Critical Care, University of Calgary, Calgary, Alta. (McBeth, McDonald, Soo)
| | - Braedon McDonald
- From the Division of Orthopaedic Surgery, University of Calgary, Calgary, Alta. (You, Korley, Buckley, Duffy, Martin, Schneider); the Division of Hematology & Hematological Malignancies, University of Calgary, Calgary, Alta. (Skeith, Lee); the Section of General Surgery, University of Calgary, Calgary, Alta. (Cantle, McBeth); the Section of Vascular Surgery, University of Calgary, Calgary, Alta. (Cantle); and the Department of Critical Care, University of Calgary, Calgary, Alta. (McBeth, McDonald, Soo)
| | - Richard Buckley
- From the Division of Orthopaedic Surgery, University of Calgary, Calgary, Alta. (You, Korley, Buckley, Duffy, Martin, Schneider); the Division of Hematology & Hematological Malignancies, University of Calgary, Calgary, Alta. (Skeith, Lee); the Section of General Surgery, University of Calgary, Calgary, Alta. (Cantle, McBeth); the Section of Vascular Surgery, University of Calgary, Calgary, Alta. (Cantle); and the Department of Critical Care, University of Calgary, Calgary, Alta. (McBeth, McDonald, Soo)
| | - Paul Duffy
- From the Division of Orthopaedic Surgery, University of Calgary, Calgary, Alta. (You, Korley, Buckley, Duffy, Martin, Schneider); the Division of Hematology & Hematological Malignancies, University of Calgary, Calgary, Alta. (Skeith, Lee); the Section of General Surgery, University of Calgary, Calgary, Alta. (Cantle, McBeth); the Section of Vascular Surgery, University of Calgary, Calgary, Alta. (Cantle); and the Department of Critical Care, University of Calgary, Calgary, Alta. (McBeth, McDonald, Soo)
| | - C. Ryan Martin
- From the Division of Orthopaedic Surgery, University of Calgary, Calgary, Alta. (You, Korley, Buckley, Duffy, Martin, Schneider); the Division of Hematology & Hematological Malignancies, University of Calgary, Calgary, Alta. (Skeith, Lee); the Section of General Surgery, University of Calgary, Calgary, Alta. (Cantle, McBeth); the Section of Vascular Surgery, University of Calgary, Calgary, Alta. (Cantle); and the Department of Critical Care, University of Calgary, Calgary, Alta. (McBeth, McDonald, Soo)
| | - Andrea Soo
- From the Division of Orthopaedic Surgery, University of Calgary, Calgary, Alta. (You, Korley, Buckley, Duffy, Martin, Schneider); the Division of Hematology & Hematological Malignancies, University of Calgary, Calgary, Alta. (Skeith, Lee); the Section of General Surgery, University of Calgary, Calgary, Alta. (Cantle, McBeth); the Section of Vascular Surgery, University of Calgary, Calgary, Alta. (Cantle); and the Department of Critical Care, University of Calgary, Calgary, Alta. (McBeth, McDonald, Soo)
| | - Prism Schneider
- From the Division of Orthopaedic Surgery, University of Calgary, Calgary, Alta. (You, Korley, Buckley, Duffy, Martin, Schneider); the Division of Hematology & Hematological Malignancies, University of Calgary, Calgary, Alta. (Skeith, Lee); the Section of General Surgery, University of Calgary, Calgary, Alta. (Cantle, McBeth); the Section of Vascular Surgery, University of Calgary, Calgary, Alta. (Cantle); and the Department of Critical Care, University of Calgary, Calgary, Alta. (McBeth, McDonald, Soo)
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Parsons Leigh J, Brundin-Mather R, Whalen-Browne L, Kashyap D, Sauro K, Soo A, Petersen J, Taljaard M, Stelfox HT. Effectiveness of an Electronic Communication Tool on Transitions in Care From the Intensive Care Unit: Protocol for a Cluster-Specific Pre-Post Trial. JMIR Res Protoc 2021; 10:e18675. [PMID: 33416509 PMCID: PMC7822720 DOI: 10.2196/18675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Transitions in care are vulnerable periods in health care that can expose patients to preventable errors due to incomplete or delayed communication between health care providers. Transitioning critically ill patients from intensive care units (ICUs) to other patient care units (PCUs) is particularly risky, due to the high acuity of the patients and the diversity of health care providers involved in their care. Instituting structured documentation to standardize written communication between health care providers during transitions has been identified as a promising means to reduce communication breakdowns. We developed an evidence-informed, computer-enabled, ICU-specific structured tool-an electronic transfer (e-transfer) tool-to facilitate and standardize the composition of written transfer summaries in the ICUs of one Canadian city. The tool consisted of 10 primary sections with a user interface combination of structured, automated, and free-text fields. OBJECTIVE Our overarching goal is to evaluate whether implementation of our e-transfer tool will improve the completeness and timeliness of transfer summaries and streamline communications between health care providers during high-risk transitions. METHODS This study is a cluster-specific pre-post trial, with randomized and staggered implementation of the e-transfer tool in four hospitals in Calgary, Alberta. Hospitals (ie, clusters) were allocated randomly to cross over every 2 months from control (ie, dictation only) to intervention (ie, e-transfer tool). Implementation at each site was facilitated with user education, point-of-care support, and audit and feedback. We will compare transfer summaries randomly sampled over 6 months postimplementation to summaries randomly sampled over 6 months preimplementation. The primary outcome will be a binary composite measure of the timeliness and completeness of transfer summaries. Secondary measures will include overall completeness, timeliness, and provider ratings of transfer summaries; hospital and ICU lengths of stay; and post-ICU patient outcomes, including ICU readmission, adverse events, cardiac arrest, rapid response team activation, and mortality. We will use descriptive statistics (ie, medians and means) to describe demographic characteristics. The primary outcome will be compared within each hospital pre- and postimplementation using separate logistic regression models for each hospital, with adjustment for patient characteristics. RESULTS Participating hospitals were cluster randomized to the intervention between July 2018 and January 2019. Preliminary extraction of ICU patient admission lists was completed in September 2019. We anticipate that evaluation data collection will be completed by early 2021, with first results ready for publication in spring or summer 2021. CONCLUSIONS This study will report the impact of implementing an evidence-informed, computer-enabled, ICU-specific structured transfer tool on communication and preventable medical errors among patients transferred from the ICU to other hospital care units. TRIAL REGISTRATION ClinicalTrials.gov NCT03590002; https://www.clinicaltrials.gov/ct2/show/NCT03590002. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/18675.
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Affiliation(s)
- Jeanna Parsons Leigh
- School of Health Administration, Faculty of Health, Dalhousie University, Halifax, NS, Canada.,Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Rebecca Brundin-Mather
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Liam Whalen-Browne
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Devika Kashyap
- Critical Care Medicine, Alberta Health Services, Calgary, AB, Canada
| | - Khara Sauro
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada.,Arnie Charbonneau Cancer Institute, Health Research Innovation Centre, University of Calgary, Calgary, AB, Canada
| | - Andrea Soo
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Critical Care Medicine, Alberta Health Services, Calgary, AB, Canada
| | - Jennie Petersen
- Faculty of Applied Health Sciences, Brock University, St Catharines, ON, Canada
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Critical Care Medicine, Alberta Health Services, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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27
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Parsons Leigh J, Fiest K, Brundin-Mather R, Plotnikoff K, Soo A, Sypes EE, Whalen-Browne L, Ahmed SB, Burns KEA, Fox-Robichaud A, Kupsch S, Longmore S, Murthy S, Niven DJ, Rochwerg B, Stelfox HT. A national cross-sectional survey of public perceptions of the COVID-19 pandemic: Self-reported beliefs, knowledge, and behaviors. PLoS One 2020; 15:e0241259. [PMID: 33095836 PMCID: PMC7584165 DOI: 10.1371/journal.pone.0241259] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 10/12/2020] [Indexed: 01/11/2023] Open
Abstract
Introduction Efforts to mitigate the global spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing Corona Virus Disease-19 (COVID-19) have largely relied on broad compliance with public health recommendations yet navigating the high volume of evolving information can be challenging. We assessed self-reported public perceptions related to COVID-19 including, beliefs (e.g., severity, concerns, health), knowledge (e.g., transmission, information sources), and behaviors (e.g., physical distancing) to understand perspectives in Canada and to inform future public health initiatives. Methods We administered a national online survey aiming to obtain responses from 2000 adults in Canada. Respondent sampling was stratified by age, sex, and region. We used descriptive statistics to summarize responses and tested for regional differences using chi-squared tests, followed by weighted logistic regression. Results We collected 1,996 eligible questionnaires between April 26th and May 1st, 2020. One-fifth (20%) of respondents knew someone diagnosed with COVID-19, but few had tested positive themselves (0.6%). Negative impacts of pandemic conditions were evidenced in several areas, including concerns about healthcare (e.g. sufficient equipment, 52%), pandemic stress (45%), and worsening social (49%) and mental/emotional (39%) health. Most respondents (88%) felt they had good to excellent knowledge of virus transmission, and predominantly accessed (74%) and trusted (60%) Canadian news television, newspapers/magazines, or non-government news websites for COVID-19 information. We found high compliance with distancing measures (80% reported self-isolating or always physical distancing). We identified associations between region and self-reported beliefs, knowledge, and behaviors related to COVID-19. Discussion We found that information about COVID-19 is largely acquired through domestic news sources, which may explain high self-reported compliance with prevention measures. The results highlight the broader impact of a pandemic on the general public’s overall health and wellbeing, outside of personal infection. The study findings should be used to inform public health communications during COVID-19 and future pandemics.
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Affiliation(s)
- Jeanna Parsons Leigh
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
- * E-mail:
| | - Kirsten Fiest
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | | | - Kara Plotnikoff
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrea Soo
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Emma E. Sypes
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Liam Whalen-Browne
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sofia B. Ahmed
- Department of Medicine and Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Karen E. A. Burns
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
- Unity Health Toronto–St. Michael’s Hospital, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Alison Fox-Robichaud
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, Ontario, Canada
- Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Shelly Kupsch
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Shelly Longmore
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Srinivas Murthy
- Faculty of Medicine, University of British Columbia, Vancouver British Columbia, Canada
| | - Daniel J. Niven
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Bram Rochwerg
- Department of Medicine, Division of Critical Care, McMaster University, Hamilton, Ontario, Canada
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Henry T. Stelfox
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
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28
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Cherak SJ, Soo A, Brown KN, Ely EW, Stelfox HT, Fiest KM. Development and validation of delirium prediction model for critically ill adults parameterized to ICU admission acuity. PLoS One 2020; 15:e0237639. [PMID: 32813717 PMCID: PMC7437909 DOI: 10.1371/journal.pone.0237639] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 07/29/2020] [Indexed: 12/23/2022] Open
Abstract
Background Risk prediction models allow clinicians to forecast which individuals are at a higher risk for developing a particular outcome. We developed and internally validated a delirium prediction model for incident delirium parameterized to patient ICU admission acuity. Methods This retrospective, observational, fourteen medical-surgical ICU cohort study evaluated consecutive delirium-free adults surviving hospital stay with ICU length of stay (LOS) greater than or equal to 24 hours with both an admission APACHE II score and an admission type (e.g., elective post-surgery, emergency post-surgery, non-surgical) in whom delirium was assessed using the Intensive Care Delirium Screening Checklist (ICDSC). Risk factors included in the model were readily available in electric medical records. Least absolute shrinkage and selection operator logistic (LASSO) regression was used for model development. Discrimination was determined using area under the receiver operating characteristic curve (AUC). Internal validation was performed by cross-validation. Predictive performance was determined using measures of accuracy and clinical utility was assessed by decision-curve analysis. Results A total of 8,878 patients were included. Delirium incidence was 49.9% (n = 4,431). The delirium prediction model was parameterized to seven patient cohorts, admission type (3 cohorts) or mean quartile APACHE II score (4 cohorts). All parameterized cohort models were well calibrated. The AUC ranged from 0.67 to 0.78 (95% confidence intervals [CI] ranged from 0.63 to 0.79). Model accuracy varied across admission types; sensitivity ranged from 53.2% to 63.9% while specificity ranged from 69.0% to 74.6%. Across mean quartile APACHE II scores, sensitivity ranged from 58.2% to 59.7% while specificity ranged from 70.1% to 73.6%. The clinical utility of the parameterized cohort prediction model to predict and prevent incident delirium was greater than preventing incident delirium by treating all or none of the patients. Conclusions Our results support external validation of a prediction model parameterized to patient ICU admission acuity to predict a patients’ risk for ICU delirium. Classification of patients’ risk for ICU delirium by admission acuity may allow for efficient initiation of prevention measures based on individual risk profiles.
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Affiliation(s)
- Stephana J. Cherak
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Andrea Soo
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Health Services, Calgary, AB, Canada
| | - Kyla N. Brown
- PolicyWise for Children & Families, Calgary, AB, Canada
| | - E. Wesley Ely
- Tennessee Valley Veteran’s Affairs Geriatric Research Education Clinical Center, Nashville, TN, United States of America
- Critical Illness, Brain Dysfunction, and Survivorship Center, Vanderbilt University Medical Center, Nashville, TN, United States of America
| | - Henry T. Stelfox
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Alberta Health Services, Calgary, AB, Canada
| | - Kirsten M. Fiest
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- O’Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Alberta Health Services, Calgary, AB, Canada
- Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary AB, Canada
- * E-mail:
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Brown KN, Soo A, Faris P, Patten SB, Fiest KM, Stelfox HT. Association between delirium in the intensive care unit and subsequent neuropsychiatric disorders. Crit Care 2020; 24:476. [PMID: 32736572 PMCID: PMC7393876 DOI: 10.1186/s13054-020-03193-x] [Citation(s) in RCA: 9] [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] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 07/20/2020] [Indexed: 12/31/2022]
Abstract
Background Patients in the intensive care unit (ICU) are known to be at increased risk of developing delirium, but the risk of subsequent neuropsychiatric disorders is unclear. We therefore sought to examine the association between the presence of delirium in the ICU and incident neuropsychiatric disorders (including depressive, anxiety, trauma-and-stressor-related, and neurocognitive disorders) post-ICU stay among adult medical-surgical ICU patients. Methods Retrospective cohort study utilizing clinical and administrative data from both inpatient and outpatient healthcare visits to identify the ICU cohort and diagnostic information 5 years prior to and 1 year post-ICU stay. Patients ≥ 18 years of age admitted to one of 14 medical-surgical ICUs across Alberta, Canada, January 1, 2014–June 30, 2016, and survived to hospital discharge were included. The main outcome of interest was a new diagnosis of any neuropsychiatric disorder 1 year post-ICU stay. The exposure variable was delirium during the ICU stay identified through any positive delirium screen by the Intensive Care Unit Delirium Screening Checklist (ICDSC) during the ICU stay. Results Of 16,005 unique patients with at least one ICU admission, 4033 patients were included in the study of which 1792 (44%) experienced delirium during their ICU stay. The overall cumulative incidence of any neuropsychiatric disorder during the subsequent year was 19.7% for ICU patients. After adjusting for hospital characteristics using log-binomial regression, patients with delirium during the ICU stay had a risk ratio (RR) of 1.14 (95% confidence interval [CI] 0.98–1.33) of developing any neuropsychiatric disorder within 1 year post-ICU compared to those who did not experience delirium. Delirium was significantly associated with neurocognitive disorders (RR 1.59, 95% CI 1.08–2.35), but not depressive disorders (RR 1.16, 95% CI 0.92–1.45), anxiety (RR 1.16, 95% CI 0.92–1.47), and trauma-and-stressor-related (RR 0.82, 95% CI 0.53–1.28) disorders. Conclusions The diagnosis of new onset of neurocognitive disorders is associated with ICU-acquired delirium. In this study, significant associations were not observed for depressive, anxiety, and trauma-and-stressor-related disorders.
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Affiliation(s)
- Kyla N Brown
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Andrea Soo
- Alberta Health Services, Calgary, Alberta, Canada.,Department of Critical Care Medicine, University of Calgary, 3134 Hospital Drive, Calgary, Alberta, T2N 2T9, Canada
| | - Peter Faris
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.,Alberta Health Services, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Scott B Patten
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.,Alberta Health Services, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Kirsten M Fiest
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.,Alberta Health Services, Calgary, Alberta, Canada.,Department of Critical Care Medicine, University of Calgary, 3134 Hospital Drive, Calgary, Alberta, T2N 2T9, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.,Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Henry T Stelfox
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada. .,Alberta Health Services, Calgary, Alberta, Canada. .,Department of Critical Care Medicine, University of Calgary, 3134 Hospital Drive, Calgary, Alberta, T2N 2T9, Canada. .,O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.
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Cullivan S, Ahmed M, Weedle R, Bruzzi J, Phelan S, Da Costa M, Soo A, Breen D. The Role of Endobronchial Ultrasound in Early-Stage Non-Small Cell Lung Cancer. Ir Med J 2020; 113:122. [PMID: 35575042] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Aim The aim of this study is to assess the impact of EBUS on the concordance of clinical and pathological NSCLC staging in our center. Methods Data was collected retrospectively from the hospital database regarding patients who underwent surgical resection for early stage NSCLC between 2012 and 2017. Results A total of 251 patients were included. The mean age was 67 (±9), 55% (n=137) were male and 83% (n=209) were current/former smokers. In group A (n=154, 61%) clinical nodal stage (cN) was established from a combination of CT, PET CT and mediastinoscopy. Group B underwent additional EBUS (n=97, 39%). cN and pathological nodal staging (pN) were concordant in 78% (n=120) in group A versus 62% (n=60) in group B (p=0.009). Conclusion This study demonstrated higher rates of nodal discordance in patients who underwent EBUS which contrasts existing data that demonstrates improved concordance with EBUS. We describe these findings and potential explanations further in this study.
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Affiliation(s)
- S Cullivan
- Interventional Respiratory Unit, Department of Respiratory Medicine, Galway University Hospital, Galway, Ireland
| | - M Ahmed
- Interventional Respiratory Unit, Department of Respiratory Medicine, Galway University Hospital, Galway, Ireland
| | - R Weedle
- Department of Cardiothoracic Surgery, Galway University Hospital - Galway, Ireland
| | - J Bruzzi
- Department of Radiology, Galway University Hospital - Galway, Ireland
| | - S Phelan
- Department of Histopathology, Galway University Hospital - Galway, Ireland
| | - M Da Costa
- Department of Cardiothoracic Surgery, Galway University Hospital - Galway, Ireland
| | - A Soo
- Department of Cardiothoracic Surgery, Galway University Hospital - Galway, Ireland
| | - D Breen
- Interventional Respiratory Unit, Department of Respiratory Medicine, Galway University Hospital, Galway, Ireland
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Fiest KM, Krewulak KD, Sept BG, Spence KL, Davidson JE, Ely EW, Soo A, Stelfox HT. A study protocol for a randomized controlled trial of family-partnered delirium prevention, detection, and management in critically ill adults: the ACTIVATE study. BMC Health Serv Res 2020; 20:453. [PMID: 32448187 PMCID: PMC7245836 DOI: 10.1186/s12913-020-05281-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Received: 04/23/2020] [Accepted: 04/30/2020] [Indexed: 12/24/2022] Open
Abstract
Background Delirium is very common in critically ill patients admitted to the intensive care unit (ICU) and results in negative long-term outcomes. Family members are also at risk of long-term complications, including depression and anxiety. Family members are frequently at the bedside and want to be engaged; they know the patient best and may notice subtle changes prior to the care team. By engaging family members in delirium care, we may be able to improve both patient and family outcomes by identifying delirium sooner and capacitating family members in care. Methods The primary aim of this study is to determine the effect of family-administered delirium prevention, detection, and management in critically ill patients on family member symptoms of depression and anxiety, compared to usual care. One-hundred and ninety-eight patient-family dyads will be recruited from four medical-surgical ICUs in Calgary, Canada. Dyads will be randomized 1:1 to the intervention or control group. The intervention consists of family-partnered delirium prevention, detection, and management, while the control group will receive usual care. Delirium, depression, and anxiety will be measured using validated tools, and participants will be followed for 1- and 3-months post-ICU discharge. All analyses will be intention-to-treat and adjusted for pre-identified covariates. Ethical approval has been granted by the University of Calgary Conjoint Health Research Ethics Board (REB19–1000) and the trial registered. The protocol adheres to the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) checklist. Discussion Critically ill patients are frequently unable to participate in their own care, and partnering with their family members is particularly important for improving experiences and outcomes of care for both patients and families. Trial registration Registered September 23, 2019 on Clinicaltrials.gov NCT04099472.
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Affiliation(s)
- Kirsten M Fiest
- Department of Critical Care Medicine, University of Calgary & Alberta Health Services, Calgary, Canada. .,Department of Community Health Sciences & O'Brien Institute of Public Health, University of Calgary, Calgary, Canada. .,Department of Psychiatry & Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.
| | - Karla D Krewulak
- Department of Critical Care Medicine, University of Calgary & Alberta Health Services, Calgary, Canada
| | - Bonnie G Sept
- Department of Critical Care Medicine, University of Calgary & Alberta Health Services, Calgary, Canada
| | - Krista L Spence
- Department of Critical Care Medicine, University of Calgary & Alberta Health Services, Calgary, Canada
| | - Judy E Davidson
- Department of Psychiatry, UC San Diego School of Medicine, San Diego, California, USA
| | - E Wesley Ely
- Tennessee Valley Veteran's Affairs Geriatric Research Education Clinical Center (VA GRECC), Critical Illness, Brain Dysfunction, and Survivorship (CIBS) Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Andrea Soo
- Department of Critical Care Medicine, University of Calgary & Alberta Health Services, Calgary, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, University of Calgary & Alberta Health Services, Calgary, Canada.,Department of Community Health Sciences & O'Brien Institute of Public Health, University of Calgary, Calgary, Canada.,Department of Psychiatry & Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
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Hennessy DA, Soo A, Niven DJ, Jolley RJ, Posadas-Calleja J, Stelfox HT, Doig CJ. Socio-demographic characteristics associated with hospitalization for sepsis among adults in Canada: a Census-linked cohort study. Can J Anaesth 2020; 67:408-420. [PMID: 31792835 DOI: 10.1007/s12630-019-01536-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 10/16/2019] [Accepted: 10/22/2019] [Indexed: 02/01/2023] Open
Abstract
PURPOSE Sepsis is a considerable health system burden. Population-based epidemiological surveillance of sepsis is limited to basic data available in administrative databases. We sought to determine if routinely collected Census data, linked to hospitalization data, can provide a broad socio-demographic profile of patients admitted to Canadian hospitals with sepsis. METHODS Linking the 2006 long-form Canadian Census (most recent available for linkage) to the Discharge Abstract Data from 2006/2007 to 2008/2009, we created a population-based cohort of approximately 3,433,900 Canadians. Patients admitted to hospital with sepsis were identified using the Canadian Institute for Health Information administrative data definition. Age-standardized hospital admission rates for sepsis were calculated. Multivariable modelling was used to examine the relationship between Census characteristics and hospitalization with sepsis. RESULTS Of those individuals successfully linked to the 2006 long-form Canadian Census, 10,400 patients of 18 yr and older were admitted to hospital with sepsis between the fiscal years 2006/2007 and 2008/2009. These individuals represented a weighted count of approximately 49,000 Canadians from all provinces and territories, excluding Quebec. The age-standardized rate of sepsis hospitalization was 96 cases/100,000 population. Of these, 37/100,000 cases were classified as severe sepsis. The association of Census characteristics with sepsis hospitalization varied with age. In all age-specific models, male sex, never being married, visible minority status, having functional limitations, and not being in the labour force were associated with an increased odds of hospital admission. CONCLUSIONS Census data identified broad socio-demographic risk factors for admission to hospital with sepsis. Consideration should be given to incorporating Census data linked to administrative hospital data in population-based epidemiologic surveillance.
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Affiliation(s)
- Deirdre A Hennessy
- Health Analysis Division, Statistics Canada, 100 Tunney's Pasture Driveway, Ottawa, ON, K1A 0T6, Canada.
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
| | - Andrea Soo
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Daniel J Niven
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Rachel J Jolley
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Juan Posadas-Calleja
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Henry T Stelfox
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
| | - Christopher J Doig
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, AB, Canada
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Sauro KM, Soo A, Kramer A, Couillard P, Kromm J, Zygun D, Niven DJ, Bagshaw SM, Stelfox HT. Venous Thromboembolism Prophylaxis in Neurocritical Care Patients: Are Current Practices, Best Practices? Neurocrit Care 2020; 30:355-363. [PMID: 30276615 DOI: 10.1007/s12028-018-0614-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND/OBJECTIVES Venous thromboembolism (VTE) is a leading cause of preventable, in-hospital deaths; critically ill patients have a higher risk. Effective and efficient strategies to prevent VTE exist; however, neurocritical care patients present unique challenges due to competing risk of bleeding. The objective of this study was to examine current VTE prophylaxis practices among neurocritical care patients, concordance with guideline-recommended care, and the association with clinical outcomes. METHODS This retrospective cohort study of patients admitted to ten adult, medical-surgical and neurological intensive care units (ICUs) in nine hospitals between 2014 and 2017 using administrative and clinical data. Neurocritical care patients were classified based on the primary admission diagnosis. Concordance with guideline-recommended care was evaluated using recommendations from recent guidelines. RESULTS 20.0% of 23,191 patients were classified as neurocritical care. Among neurocritical care patients, pharmacological VTE prophylaxis was administered on 60.9% of all ICU days, mechanical VTE prophylaxis on 46.9%, and no VTE prophylaxis on 12.2% of all ICU days. Type of VTE prophylaxis was associated with sex, neurological diagnosis, and invasive neurological monitoring. Fifty-six percentage of ICU days were guideline concordant but concordance varied by recommendation (range 6-100%) and by type of VTE prophylaxis recommended (p = 0.05); among patients where guidelines recommended use of pharmacologic prophylaxis, care was concordant 26.6% of ICU days, whereas for mechanical prophylaxis it was concordant 80.5% of ICU days. There was an overall improvement in guideline concordance on 2.3% of ICU days after the publication of the Society of Neurocritical Care guideline (p = 0.005). CONCLUSIONS Neurocritical care patients commonly receive mechanical VTE prophylaxis despite guidelines recommending the use of pharmacological VTE prophylaxis. Our findings suggest uncertainty around best VTE prophylaxis practices for neurocritical care patients remains.
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Affiliation(s)
- K M Sauro
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada.
- Department of Community Health Science, O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada.
| | - A Soo
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
| | - A Kramer
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - P Couillard
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - J Kromm
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
| | - D Zygun
- Department of Critical Care Medicine, School of Public Health, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - D J Niven
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Science, O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - S M Bagshaw
- Department of Critical Care Medicine, School of Public Health, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - H T Stelfox
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Science, O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
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Au SS, Roze des Ordons AL, Amir Ali A, Soo A, Stelfox HT. Communication with patients' families in the intensive care unit: A point prevalence study. J Crit Care 2019; 54:235-238. [PMID: 31630072 DOI: 10.1016/j.jcrc.2019.08.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 06/17/2019] [Revised: 08/08/2019] [Accepted: 08/29/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE We aimed to describe point of care communication encounters with patients' families in centers with open visitation practices. MATERIALS AND METHODS Cross-sectional one-day point prevalence study in 14 Canadian adult intensive care units (ICUs) located in 7 academic and 7 community hospitals with open family visitation policies. RESULTS ICU bedside nurses working on a randomly selected weekday completed a survey reporting all observed communication between providers and patients' families. Family point of care communication encounters were measured for 146 of 159 patients (92%) admitted to the study ICUs. Most patients had family (98%) with the majority observed visiting on the study date (73%). Of patients with family (n = 143), direct in-person communication occurred 71% of the time, either via participation in rounds (23%), family meetings (24%), and/or informal updates (71%). 43% (n = 62) of families had direct communication with a physician or nurse practitioner. Nurses provided the largest portion of informal bedside updates (83%, n = 85) and supplemented family communication with phone calls (22%, n = 31). There was no communication contact for 13% (n = 19) of families. CONCLUSIONS ICUs adopt multiple ways of communicating with family members of critically ill patients. Significant interactions occur outside of traditional family meetings, in a less formal and more frequent fashion. Our study supports development of tools to support best practices within contemporary communication paradigms to support provider, patients and family needs.
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Affiliation(s)
- Selena S Au
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada.
| | - Amanda L Roze des Ordons
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada; Department of Oncology, Division of Palliative Care, University of Calgary, Calgary, Alberta, Canada
| | - Asma Amir Ali
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Andrea Soo
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
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Soo A, Zuege DJ, Fick GH, Niven DJ, Berthiaume LR, Stelfox HT, Doig CJ. Describing organ dysfunction in the intensive care unit: a cohort study of 20,000 patients. Crit Care 2019; 23:186. [PMID: 31122276 PMCID: PMC6533687 DOI: 10.1186/s13054-019-2459-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 04/26/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND Multiple organ dysfunction is a common cause of morbidity and mortality in intensive care units (ICUs). Original development of the Sequential Organ Failure Assessment (SOFA) score was not to predict outcome, but to describe temporal changes in organ dysfunction in critically ill patients. Organ dysfunction scoring may be a reasonable surrogate outcome in clinical trials but further exploration of the impact of case mix on the temporal sequence of organ dysfunction is required. Our aim was to compare temporal changes in SOFA scores between hospital survivors and non-survivors. METHODS We performed a population-based observational retrospective cohort study of critically ill patients admitted from January 1, 2004, to December 31, 2013, to 4 multisystem adult intensive care units (ICUs) in Calgary, Canada. The primary outcome was temporal changes in daily SOFA scores during the first 14 days of ICU admission. SOFA scores were modeled between hospital survivors and non-survivors using generalized estimating equations (GEE) and were also stratified by admission SOFA (≤ 11 versus > 11). RESULTS The cohort consisted of 20,007 patients with at least one SOFA score and was mostly male (58.2%) with a median age of 59 (interquartile range [IQR] 44-72). Median ICU length of stay was 3.5 (IQR 1.7-7.5) days. ICU and hospital mortality were 18.5% and 25.5%, respectively. Temporal change in SOFA scores varied by survival and admission SOFA score in a complicated relationship. Area under the receiver operating characteristic (ROC) curve using admission SOFA as a predictor of hospital mortality was 0.77. The hospital mortality rate was 5.6% for patients with an admission SOFA of 0-2 and 94.4% with an admission SOFA of 20-24. There was an approximately linear increase in hospital mortality for SOFA scores of 3-19 (range 8.7-84.7%). CONCLUSIONS Examining the clinical course of organ dysfunction in a large non-selective cohort of patients provides insight into the utility of SOFA. We have demonstrated that hospital outcome is associated with both admission SOFA and the temporal rate of change in SOFA after admission. It is necessary to further explore the impact of additional clinical factors on the clinical course of SOFA with large datasets.
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Affiliation(s)
- Andrea Soo
- Department of Critical Care Medicine, University of Calgary, McCaig Tower, Ground Floor, 3134 Hospital Drive NW, Calgary, Alberta, T2N 5A1, Canada.
| | - Danny J Zuege
- Department of Critical Care Medicine, University of Calgary, McCaig Tower, Ground Floor, 3134 Hospital Drive NW, Calgary, Alberta, T2N 5A1, Canada
| | - Gordon H Fick
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
| | - Daniel J Niven
- Department of Critical Care Medicine, University of Calgary, McCaig Tower, Ground Floor, 3134 Hospital Drive NW, Calgary, Alberta, T2N 5A1, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
| | - Luc R Berthiaume
- Department of Critical Care Medicine, University of Calgary, McCaig Tower, Ground Floor, 3134 Hospital Drive NW, Calgary, Alberta, T2N 5A1, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, University of Calgary, McCaig Tower, Ground Floor, 3134 Hospital Drive NW, Calgary, Alberta, T2N 5A1, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
| | - Christopher J Doig
- Department of Critical Care Medicine, University of Calgary, McCaig Tower, Ground Floor, 3134 Hospital Drive NW, Calgary, Alberta, T2N 5A1, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6, Canada
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Joyce DP, Weedle R, Cribben N, Parvanov P, White A, Soo A, Walsh SR, Curran E. Neuraxial haematoma in patients undergoing spinal or epidural anaesthesia for lower limb amputation/revascularisation during uninterrupted antiplatelet therapy: a systematic review. Anaesthesia 2019; 74:683-684. [PMID: 30957889 DOI: 10.1111/anae.14651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- D P Joyce
- Galway University Hospital, Galway, Ireland
| | - R Weedle
- Galway University Hospital, Galway, Ireland
| | - N Cribben
- Galway University Hospital, Galway, Ireland
| | - P Parvanov
- Galway University Hospital, Galway, Ireland
| | - A White
- Galway University Hospital, Galway, Ireland
| | - A Soo
- Galway University Hospital, Galway, Ireland
| | - S R Walsh
- Galway University Hospital, Galway, Ireland
| | - E Curran
- Galway University Hospital, Galway, Ireland
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Sauro K, Bagshaw SM, Niven D, Soo A, Brundin-Mather R, Parsons Leigh J, Cook DJ, Stelfox HT. Barriers and facilitators to adopting high value practices and de-adopting low value practices in Canadian intensive care units: a multimethod study. BMJ Open 2019; 9:e024159. [PMID: 30878979 PMCID: PMC6429967 DOI: 10.1136/bmjopen-2018-024159] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To compare and contrast illustrative examples of the adoption of high value practices and the de-adoption of low value practices. DESIGN (1) Retrospective, population-based audit of low molecular weight heparin (LMWH) for venous thromboembolism (VTE) prophylaxis (high value practice) and albumin for fluid resuscitation (low value practice) and (2) cross-sectional survey of healthcare providers. SETTING Data were collected from nine adult medical-surgical intensive care units (ICUs) in two large Canadian cities. Patients are managed in these ICUs by a group of multiprofessional and multidisciplinary healthcare providers. PARTICIPANTS Participants included 6946 ICU admissions and 309 healthcare providers from the same ICUs. MAIN OUTCOME MEASURES (1) The use of LMWH for VTE prophylaxis (per cent ICU days) and albumin for fluid resuscitation (per cent of patients); and (2) provider knowledge of evidence underpinning these practices, and barriers and facilitators to adopt and de-adopt these practices. RESULTS LMWH was administered on 38.7% of ICU days, and 20.0% of patients received albumin.Most participants had knowledge of evidence underpinning VTE prophylaxis and fluid resuscitation (59.1% and 84.2%, respectively). Providers perceived these practices to be followed. The most commonly reported barrier to adoption was insufficient knowledge/understanding (32.8%), and to de-adoption was clinical leader preferences (33.2%). On-site education was the most commonly identified facilitator for adoption and de-adoption (67.8% and 68.6%, respectively). CONCLUSIONS Despite knowledge of and self-reported adherence to best practices, the audit demonstrated opportunity to improve. Provider-reported barriers and facilitators to adoption and de-adoption are broadly similar.
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Affiliation(s)
- Khara Sauro
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sean M Bagshaw
- Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Daniel Niven
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrea Soo
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Jeanna Parsons Leigh
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Deborah J Cook
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Henry Thomas Stelfox
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
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Stelfox HT, Soo A, Niven DJ, Fiest KM, Wunsch H, Rowan KM, Bagshaw SM. Assessment of the Safety of Discharging Select Patients Directly Home From the Intensive Care Unit: A Multicenter Population-Based Cohort Study. JAMA Intern Med 2018; 178:1390-1399. [PMID: 30128550 PMCID: PMC6584269 DOI: 10.1001/jamainternmed.2018.3675] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
IMPORTANCE The safety of discharging adult patients recovering from critical illness directly home from the intensive care unit (ICU) is unknown. OBJECTIVE To compare the health care utilization and clinical outcomes for ICU patients discharged directly home from the ICU with those of patients discharged home via the hospital ward. DESIGN, SETTING, AND PARTICIPANTS Retrospective population-based cohort study of adult patients admitted to the ICU of 9 medical-surgical hospitals from January 1, 2014, to January 1, 2016, with 1-year follow-up after hospital discharge. All adult ICU patients were discharged home alive from hospital, and the propensity score matched cohort (1:1) was based on patient characteristics, therapies received in the ICU, and hospital characteristics. EXPOSURES Patient disposition on discharge from the ICU: directly home vs home via the hospital ward. MAIN OUTCOMES AND MEASURES The primary outcome was readmission to the hospital within 30 days of hospital discharge. The secondary outcomes were emergency department visit within 30 days and death within 1 year. RESULTS Among the 6732 patients included in the study, 2826 (42%) were female; median age, 56 years (interquartile range, 41-67 years); 922 (14%) were discharged directly home, with significant variation found between hospitals (range, 4.4%-44.0%). Compared with patients discharged home via the hospital ward, patients discharged directly home were younger (median age 47 vs 57 years; P < .001), more likely to be admitted with a diagnosis of overdose, substance withdrawal, seizures, or metabolic coma (32% [295] vs 10% [594]; P < .001), to have a lower severity of acute illness on ICU admission (median APACHE II score 15 vs 18; P < .001), and receive less than 48 hours of invasive mechanical ventilation (42% [389] vs 34% [1984]; P < .001). In the propensity score matched cohort (n = 1632), patients discharged directly home had similar length of ICU stay (median, 3.1 days vs 3.0 days; P = .42) but significantly shorter length of hospital stay (median, 3.3 days vs 9.2 days; P < .001) compared with patients discharged home via the hospital ward. There were no significant differences between patients discharged directly home or home via the hospital ward for readmission to the hospital (10% [n = 81] vs 11% [n = 92]; hazard ratio [HR], 0.88; 95% CI, 0.64-1.20) or emergency department visit (25% [n = 200] vs 26% [n = 212]; HR, 0.94; 95% CI, 0.81-1.09) within 30 days of hospital discharge. Four percent of patients in both groups died within 1 year of hospital discharge (n = 31 and n = 34 in the discharged directly home and discharged home via the hospital ward groups, respectively) (HR, 0.90; 95% CI, 0.60-1.35). CONCLUSIONS AND RELEVANCE The discharge of select adult patients directly home from the ICU is common, and it is not associated with increased health care utilization or increased mortality.
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Affiliation(s)
- Henry T Stelfox
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Alberta Health Services, Calgary, Alberta, Canada
| | - Andrea Soo
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Alberta Health Services, Calgary, Alberta, Canada
| | - Daniel J Niven
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Alberta Health Services, Calgary, Alberta, Canada
| | - Kirsten M Fiest
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Hannah Wunsch
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Anesthesia and Interdisciplinary Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kathryn M Rowan
- Intensive Care National Audit & Research Centre (ICNARC), London, England
| | - Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.,Alberta Health Services, Edmonton, Alberta, Canada
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Brundin-Mather R, Soo A, Zuege DJ, Niven DJ, Fiest K, Doig CJ, Zygun D, Boyd JM, Parsons Leigh J, Bagshaw SM, Stelfox HT. Secondary EMR data for quality improvement and research: A comparison of manual and electronic data collection from an integrated critical care electronic medical record system. J Crit Care 2018; 47:295-301. [PMID: 30099330 DOI: 10.1016/j.jcrc.2018.07.021] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [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: 04/20/2018] [Revised: 07/03/2018] [Accepted: 07/20/2018] [Indexed: 01/23/2023]
Abstract
PURPOSE This study measured the quality of data extracted from a clinical information system widely used for critical care quality improvement and research. MATERIALS AND METHODS We abstracted data from 30 fields in a random sample of 207 patients admitted to nine adult, medical-surgical intensive care units. We assessed concordance between data collected: (1) manually from the bedside system (eCritical MetaVision) by trained auditors, and (2) electronically from the system data warehouse (eCritical TRACER). Agreement was assessed using Cohen's Kappa for categorical variables and intraclass correlation coefficient (ICC) for continuous variables. RESULTS Concordance between data sets was excellent. There was perfect agreement for 11/30 variables (35%). The median Kappa score for the 16 categorical variables was 0.99 (IQR 0.92-1.00). APACHE II had an ICC of 0.936 (0.898-0.960). The lowest concordance was observed for SOFA renal and respiratory components (ICC 0.804 and 0.846, respectively). Score translation errors by the manual auditor were the most common source of data discrepancies. CONCLUSIONS Manual validation processes of electronic data are complex in comparison to validation of traditional clinical documentation. This study represents a straightforward approach to validate the use of data repositories to support reliable and efficient use of high quality secondary use data.
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Affiliation(s)
- Rebecca Brundin-Mather
- W21C Research & Innovation Centre, Cumming School of Medicine, University of Calgary, GD01-TRW Building, 3280 Hospital Dr NW, Calgary, AB T2N 4Z6, Canada
| | - Andrea Soo
- Department of Critical Care Medicine, University of Calgary, Foothills Medical Centre, Ground Floor-McCaig Tower, 1403-29 St NW, Calgary, AB T2N 5A1, Canada
| | - Danny J Zuege
- Department of Critical Care Medicine, University of Calgary, Foothills Medical Centre, Ground Floor-McCaig Tower, 1403-29 St NW, Calgary, AB T2N 5A1, Canada; eCritical Alberta Program, Alberta Health Services, Alberta, Canada
| | - Daniel J Niven
- Department of Critical Care Medicine, University of Calgary, Foothills Medical Centre, Ground Floor-McCaig Tower, 1403-29 St NW, Calgary, AB T2N 5A1, Canada; O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3rd Floor TRW Building, 3280 Hospital Dr NW, Calgary, AB T2N 4Z6, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3D10, 3280 Hospital Dr NW, Calgary, Alberta T2N 4Z6, Canada
| | - Kirsten Fiest
- Department of Critical Care Medicine, University of Calgary, Foothills Medical Centre, Ground Floor-McCaig Tower, 1403-29 St NW, Calgary, AB T2N 5A1, Canada
| | - Christopher J Doig
- Department of Critical Care Medicine, University of Calgary, Foothills Medical Centre, Ground Floor-McCaig Tower, 1403-29 St NW, Calgary, AB T2N 5A1, Canada
| | - David Zygun
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry and School of Public Health, University of Alberta, 2-124E Clinical Sciences Building, 8440-112 St NW, Edmonton, Alberta T6G 2B7, Canada; Alberta Health Services, Alberta, Canada
| | - Jamie M Boyd
- Department of Critical Care Medicine, University of Calgary, Foothills Medical Centre, Ground Floor-McCaig Tower, 1403-29 St NW, Calgary, AB T2N 5A1, Canada
| | - Jeanna Parsons Leigh
- Department of Critical Care Medicine, University of Calgary, Foothills Medical Centre, Ground Floor-McCaig Tower, 1403-29 St NW, Calgary, AB T2N 5A1, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3D10, 3280 Hospital Dr NW, Calgary, Alberta T2N 4Z6, Canada
| | - Sean M Bagshaw
- Department of Critical Care Medicine, Faculty of Medicine and Dentistry and School of Public Health, University of Alberta, 2-124E Clinical Sciences Building, 8440-112 St NW, Edmonton, Alberta T6G 2B7, Canada; School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405-87 Ave Edmonton, Alberta T6G 1C9, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, University of Calgary, Foothills Medical Centre, Ground Floor-McCaig Tower, 1403-29 St NW, Calgary, AB T2N 5A1, Canada; O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3rd Floor TRW Building, 3280 Hospital Dr NW, Calgary, AB T2N 4Z6, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3D10, 3280 Hospital Dr NW, Calgary, Alberta T2N 4Z6, Canada; Alberta Health Services, Alberta, Canada.
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Brown KN, Leigh JP, Kamran H, Bagshaw SM, Fowler RA, Dodek PM, Turgeon AF, Forster AJ, Lamontagne F, Soo A, Stelfox HT. Transfers from intensive care unit to hospital ward: a multicentre textual analysis of physician progress notes. Crit Care 2018; 22:19. [PMID: 29374498 PMCID: PMC5787341 DOI: 10.1186/s13054-018-1941-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 01/02/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Little is known about documentation during transitions of patient care between clinical specialties. Therefore, we examined the focus, structure and purpose of physician progress notes for patients transferred from the intensive care unit (ICU) to hospital ward to identify opportunities to improve communication breaks. METHODS This was a prospective cohort study in ten Canadian hospitals. We analyzed physician progress notes for consenting adult patients transferred from a medical-surgical ICU to hospital ward. The number, length, legibility and content of notes was counted and compared across care settings using mixed-effects linear regression models accounting for clustering within hospitals. Qualitative content analyses were conducted on a stratified random sample of 32 patients. RESULTS A total of 447 patient medical records that included 7052 progress notes (mean 2.1 notes/patient/day 95% CI 1.9-2.3) were analyzed. Notes written by the ICU team were significantly longer than notes written by the ward team (mean lines of text 21 vs. 15, p < 0.001). There was a discrepancy between documentation of patient issues in the last ICU and first ward notes; mean agreement of patient issues was 42% [95% CI 31-53%]. Qualitative analyses identified eight themes related to focus (central point - e.g., problem list), structure (organization, - e.g., note-taking style), and purpose (intention - e.g., documentation of patient course) of the notes that varied across clinical specialties and physician seniority. CONCLUSIONS Important gaps and variations in written documentation during transitions of patient care between ICU and hospital ward physicians are common, and include discrepancies in documentation of patient information.
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Au SS, Roze des Ordons A, Soo A, Guienguere S, Stelfox HT. Family participation in intensive care unit rounds: Comparing family and provider perspectives. J Crit Care 2016; 38:132-136. [PMID: 27888716 DOI: 10.1016/j.jcrc.2016.10.020] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [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: 04/24/2016] [Revised: 10/05/2016] [Accepted: 10/28/2016] [Indexed: 11/29/2022]
Abstract
PURPOSE To describe and compare intensive care unit (ICU) patient family member and provider experiences, preferences, and perceptions of family participation in ICU rounds. METHODS Cross-sectional survey of ICU family members and providers of patients admitted to 4 medical-surgical ICUs from September 2014 to March 2015. MEASUREMENTS AND MAIN RESULTS Surveys were completed by 63 (62%) family members and 258 (43%) providers. Provider respondents included physicians (9%), nurses (56%), respiratory therapists (24%), and other ICU team members (11%). Although 38% of providers estimated only moderate family member interest in participating in rounds, 97% of family members expressed high interest. Family members and providers reported listening (95% vs 96%; P=.594) and sharing information about the patient (82% vs 82%; P=.995) as appropriate roles for family members during rounds, but differed in their perceptions on asking questions (75% vs 86%; P=.043) and participating in decision making (36% vs 59%; P=.003). Compared with family members, providers were more likely to perceive family participation in rounds to cause family stress (7% vs 22%; P=.020) and confusion (0% vs 28%; P<.001). CONCLUSION Family members and providers share some perspectives on family participation in ICU rounds although other perspectives are discordant, with implications for communication strategies and collaborative decision making.
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Affiliation(s)
- Selena S Au
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada.
| | | | - Andrea Soo
- Department of Critical Care Medicine, Alberta Health Services, Calgary, Alberta, Canada
| | - Simon Guienguere
- Department of Critical Care Medicine, Alberta Health Services, Calgary, Alberta, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
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Maxwell CJ, Amuah JE, Hogan DB, Cepoiu-Martin M, Gruneir A, Patten SB, Soo A, Le Clair K, Wilson K, Hagen B, Strain LA. Elevated Hospitalization Risk of Assisted Living Residents With Dementia in Alberta, Canada. J Am Med Dir Assoc 2015; 16:568-77. [PMID: 25717011 DOI: 10.1016/j.jamda.2015.01.079] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [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: 10/05/2014] [Revised: 12/10/2014] [Accepted: 01/07/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Assisted living (AL) is an increasingly used residential option for older adults with dementia; however, lower staffing rates and service availability raise concerns that such residents may be at increased risk for adverse outcomes. Our objectives were to determine the incidence of hospitalization over 1 year for dementia residents of designated AL (DAL) facilities, compared with long-term care (LTC) facilities, and identify resident- and facility-level predictors of hospitalization among DAL residents. METHODS Participants were 609 DAL (mean age 85.7 ± 6.6 years) and 691 LTC (86.4 ± 6.9 years) residents with dementia enrolled in the Alberta Continuing Care Epidemiological Studies. Research nurses completed a standardized comprehensive assessment of residents and interviewed family caregivers at baseline (2006-2008) and 1 year later. Standardized administrator interviews provided facility level data. Hospitalization was determined via linkage with the provincial Inpatient Discharge Abstract Database. Multivariable Cox proportional hazards models were used to identify predictors of hospitalization. RESULTS The cumulative annual incidence of hospitalization was 38.6% (34.5%-42.7%) for DAL and 10.3% (8.0%-12.6%) for LTC residents with dementia. A significantly increased risk for hospitalization was observed for DAL residents aged 90+ years, with poor social relationships, less severe cognitive impairment, greater health instability, fatigue, high medication use (11+ medications), and 2+ hospitalizations in the preceding year. Residents from DAL facilities with a smaller number of spaces, no chain affiliation, and from specific health regions showed a higher risk of hospitalization. CONCLUSIONS DAL residents with dementia had a hospitalization rate almost 4-fold higher than LTC residents with dementia. Our findings raise questions about the ability of some AL facilities to adequately address the needs of cognitively impaired residents and highlight potential clinical, social, and policy areas for targeted interventions to reduce hospitalization risk.
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Affiliation(s)
- Colleen J Maxwell
- Schools of Pharmacy and Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
| | - Joseph E Amuah
- Health System Performance Branch, Canadian Institute for Health Information, Ottawa, Ontario, Canada
| | - David B Hogan
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada; Division of Geriatric Medicine, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Monica Cepoiu-Martin
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Andrea Gruneir
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Scott B Patten
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Andrea Soo
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Kenneth Le Clair
- Division of Geriatric Psychiatry, Queen's University and Center for Studies in Aging and Health, Providence Care, Kingston, Ontario, Canada
| | - Kimberley Wilson
- Department of Family Relations and Applied Nutrition, University of Guelph, Macdonald Institute, Guelph, Ontario, Canada
| | - Brad Hagen
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, Alberta, Canada
| | - Laurel A Strain
- Department of Sociology, University of Alberta, Edmonton, Alberta, Canada
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Samuel SM, Nettel-Aguirre A, Soo A, Hemmelgarn B, Tonelli M, Foster B. Avoidable hospitalizations in youth with kidney failure after transfer to or with only adult care. Pediatrics 2014; 133:e993-1000. [PMID: 24664091 DOI: 10.1542/peds.2013-2345] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Hospital admissions for ambulatory care-sensitive conditions (also called avoidable hospitalizations) are a measure of quality and access to outpatient care. We determined if young patients with end-stage renal disease (ESRD) are at increased risk of avoidable hospitalizations. METHODS A national organ failure registry was used to identify patients with ESRD onset at <22 years of age between April 1, 2001, and March 31, 2010, who had received care in an adult care facility after age 15 years. The cohort was linked to the national hospitalizations database to identify avoidable hospitalizations relevant for young patients with ESRD. Patients were followed up until death, loss to follow-up, or study end. Two groups were studied: (1) patients transferred from pediatric to adult care; and (2) patients receiving ESRD care exclusively in adult centers. We determined the association between overall and avoidable hospitalization rates and both age and transfer status by using Poisson regression models. RESULTS Our cohort included 349 patients. Among the 92 (26.4%) patients transferred to adult care during the study period, avoidable hospitalization rates were highest during the period 3 to <4 years after transfer (rate ratio: 3.19 [95% confidence interval: 1.42-7.18]) compared with the last year in pediatric care. Among the 257 (73.6%) patients who received ESRD care exclusively in adult centers, avoidable hospitalization rates increased with age. CONCLUSIONS Among those who were transferred to adult care, avoidable hospitalization rates increased after transfer. Avoidable hospitalization rates increased with age in ESRD patients who received care in adult centers. Young patients with ESRD are at increased risk of avoidable hospitalizations.
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Hogan DB, Amuah JE, Strain LA, Wodchis WP, Soo A, Eliasziw M, Gruneir A, Hagen B, Teare G, Maxwell CJ. High rates of hospital admission among older residents in assisted living facilities: opportunities for intervention and impact on acute care. Open Med 2014; 8:e33-45. [PMID: 25009683 PMCID: PMC4085093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Little is known about health or service use outcomes for residents of Canadian assisted living facilities. Our objectives were to estimate the incidence of admission to hospital over 1 year for residents of designated (i.e., publicly funded) assisted living (DAL) facilities in Alberta, to compare this rate with the rate among residents of long-term care facilities, and to identify individual and facility predictors of hospital admission for DAL residents. METHODS Participants were 1066 DAL residents (mean age ± standard deviation 84.9 ± 7.3 years) and 976 longterm care residents (85.4 ± 7.6 years) from the Alberta Continuing Care Epidemiological Studies (ACCES). Research nurses completed a standardized comprehensive assessment for each resident and interviewed family caregivers at baseline (2006 to 2008) and 1 year later. We used standardized interviews with administrators to generate facility- level data. We determined hospital admissions through linkage with the Alberta Inpatient Discharge Abstract Database. We used multivariable Cox proportional hazards models to identify predictors of hospital admission. RESULTS The cumulative annual incidence of hospital admission was 38.9% (95% confidence interval [CI] 35.9%- 41.9%) for DAL residents and 13.7% (95% CI 11.5%-15.8%) for long-term care residents. The risk of hospital admission was significantly greater for DAL residents with greater health instability, fatigue, medication use (11 or more medications), and 2 or more hospital admissions in the preceding year. The risk of hospital admission was also significantly higher for residents from DAL facilities with a smaller number of spaces, no licensed practical and/ or registered nurses on site (or on site less than 24 hours a day, 7 days a week), no chain affiliation, and from select health regions. INTERPRETATION The incidence of hospital admission was about 3 times higher among DAL residents than among long-term care residents, and the risk of hospital admission was associated with a number of potentially modifiable factors. These findings raise questions about the complement of services and staffing required within assisted living facilities and the potential impact on acute care of the shift from long-term care to assisted living for the facility-based care of vulnerable older people.
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Affiliation(s)
- David B Hogan
- David B. Hogan, MD, is a Professor and Brenda Strafford Foundation Chair in Geriatric Medicine, University of Calgary, Calgary, Alberta
| | - Joseph E Amuah
- Joseph E. Amuah, PhD, is a Senior Researcher with the Health System Performance Branch, Canadian Institute for Health Information, Ottawa, Ontario
| | - Laurel A Strain
- Laurel A. Strain, PhD, is a Professor with the Department of Sociology, University of Alberta, Edmonton, Alberta
| | - Walter P Wodchis
- Walter P. Wodchis, PhD, is an Associate Professor with the Institute of Health Policy, Management and Evaluation, University of Toronto; a Research Scientist with the Toronto Rehabilitation Institute; and an Adjunct Scientist with the Institute for Clinical Evaluative Sciences, Toronto, Ontario
| | - Andrea Soo
- Andrea Soo, MSc, is a PhD candidate with the Department of Community Health Sciences, University of Calgary, Calgary, Alberta
| | - Misha Eliasziw
- Misha Eliasziw, PhD, is an Associate Professor with the Department of Public Health and Community Medicine, Tufts University, Boston, Massachusetts
| | - Andrea Gruneir
- Andrea Gruneir, PhD, is a Scientist with the Women's College Research Institute, Women's College Hospital, University of Toronto; an Assistant Professor in the Institute of Health Policy, Management and Evaluation, University of Toronto; and an Adjunct Scientist with the Institute for Clinical Evaluative Sciences, Toronto, Ontario
| | - Brad Hagen
- Brad Hagen, PhD, is an Associate Professor with the Faculty of Health Sciences, University of Lethbridge, Lethbridge, Alberta
| | - Gary Teare
- Gary Teare, PhD, is Director of Measurement and Analysis, Saskatchewan Health Quality Council, and an Adjunct Professor with the College of Medicine and School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan
| | - Colleen J Maxwell
- Dr. Colleen J. Maxwell, University of Waterloo, 200 University Ave. W, Waterloo ON N2L 3G1;
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Schorr M, Hemmelgarn BR, Tonelli M, Soo A, Manns BJ, Bresee LC. Assessment of serum creatinine and kidney function among incident metformin users. Can J Diabetes 2013; 37:226-230. [PMID: 24070885 DOI: 10.1016/j.jcjd.2013.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 05/09/2013] [Accepted: 05/13/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Metformin is considered the first-line antihyperglycemic therapy for type 2 diabetes, but should be used with caution in people with renal insufficiency. Our study objective was to describe the proportion of patients who have an assessment of kidney function (serum creatinine [SCr] and estimated glomerular filtration rate [eGFR]) around the time of initiation of metformin in new users. METHODS We used data from the Alberta Kidney Disease Network to identify patients with diabetes (age, ≥66 y) with a new prescription for metformin from November 1, 2002, to March 31, 2008. We assessed whether SCr measurement was completed before and after metformin initiation. The eGFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation and categorized into CKD stages. Frequency of metformin use based on SCr measurement and CKD stage was reported using descriptive statistics. RESULTS A total of 22 051 subjects were identified as new metformin users. Overall, 25.4% (n=5608) had no measurement of SCr or assessment of eGFR before metformin prescription. In addition, of patients with an eGFR measurement, 38.7% (n=8544) of individuals had an eGFR of less than 60 mL/min/1.73 m(2). CONCLUSIONS One quarter of patients started on metformin did not have a SCr measurement completed beforehand. Also, metformin was used commonly among patients with diabetes and CKD, potentially putting these individuals at risk for adverse events.
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Affiliation(s)
- Melissa Schorr
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Brenda R Hemmelgarn
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Marcello Tonelli
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Andrea Soo
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Braden J Manns
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Lauren C Bresee
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
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Deved V, Jette N, Quan H, Tonelli M, Manns B, Soo A, Barnabe C, Hemmelgarn BR. Quality of care for First Nations and non-First Nations People with diabetes. Clin J Am Soc Nephrol 2013; 8:1188-94. [PMID: 23449766 PMCID: PMC3700698 DOI: 10.2215/cjn.10461012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [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] [Received: 10/11/2012] [Accepted: 01/28/2013] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Compared with non-First Nations, First Nations People with diabetes experience higher rates of kidney failure and death, which may be related to disparities in care. This study examined First Nations and non-First Nations People with diabetes for differences in quality indicators and their association with kidney failure and death. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Adults with diabetes and an outpatient creatinine in Alberta from 2005 to 2008 were identified. Logistic regression was used to determine the likelihood of process of care indicators (measurement of urine albumin/creatinine ratio [ACR], LDL, and hemoglobin A1C [A1C]) and surrogate outcome indicators (achievement of LDL and A1C targets). Cox regression was used to determine the association between lack of achievement of indicator targets and each of kidney failure and death. RESULTS This study identified 140,709 non-First Nations and 6574 First Nations People with diabetes. There was a significant interaction between First Nations status and CKD for the outcomes (P<0.01); therefore, results are stratified by CKD. Among participants without CKD, First Nations People were less likely to receive process of care indicators and achieve target A1C compared with non-First Nations People. For those with CKD, First Nations People were as likely to receive these indicators (other than LDL) and achieve LDL and A1C targets. Lack of LDL and A1C assessment and achievement of targets were associated with increased risk of kidney failure and death similarly for both groups. CONCLUSIONS Compared with non-First Nations, First Nations People with diabetes but without CKD experience disparities in assessment of quality indicators and achievement of A1C target.
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Affiliation(s)
- Vinay Deved
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; and
| | - Nathalie Jette
- Departments of Clinical Neurosciences
- Community Health Sciences, and
| | | | - Marcello Tonelli
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; and
| | - Braden Manns
- Community Health Sciences, and
- Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Cheryl Barnabe
- Community Health Sciences, and
- Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Brenda R. Hemmelgarn
- Community Health Sciences, and
- Medicine, University of Calgary, Calgary, Alberta, Canada
| | - for the Alberta Kidney Disease Network
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; and
- Departments of Clinical Neurosciences
- Community Health Sciences, and
- Medicine, University of Calgary, Calgary, Alberta, Canada
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Soo A, Baldeweg FC, Baldeweg SE. Echocardiography in patients with hyperprolactinaemia treated with dopamine agonists. What happens in daily clinical practice and what are the findings? Exp Clin Endocrinol Diabetes 2012. [DOI: 10.1055/s-0032-1330099] [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: 10/27/2022]
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Samuel SM, Hemmelgarn B, Nettel-Aguirre A, Foster B, Soo A, Alexander RT, Tonelli M. Association between residence location and likelihood of transplantation among pediatric dialysis patients. Pediatr Transplant 2012; 16:735-41. [PMID: 22489932 DOI: 10.1111/j.1399-3046.2012.01694.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Many children with ESRD reside far from a kidney transplant center. It is unknown whether this geographical barrier affects likelihood of transplantation. We used data from a national ESRD database. Patients ≤ 18 yr old who started renal replacement in nine Canadian provinces during 1992-2007 were followed until death or last contact. Primary outcome was kidney transplantation (living or deceased donor). Distance between nearest pediatric transplant center and each patient's residence was categorized as: <50, 50 to <150, 150 to <300, and ≥ 300 km. Using survival analysis, we compared likelihood of transplantation between whites and non-whites living in various distance categories. Among 728 patients, 52.2% were males and 62.5% were whites. Compared to white children living < 50 km from a transplant center, white (HR, 0.73; 95% CI, 0.56-0.95) and non-white (HR, 0.66; 95% CI, 0.48-0.92) children living ≥ 300 km away were less likely to receive a transplant. Non-white children living < 50 km away (HR, 0.59; 95% CI 0, 45-0.78) were also less likely to receive a transplant compared to otherwise similar whites living < 50 km away. Although equitable access to transplantation by residence location is observed among remote-dwelling adults with ESRD, white and non-white children with ESRD living ≥ 300 km from a transplant center were less likely to receive transplants.
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Alexander RT, Foster BJ, Tonelli MA, Soo A, Nettel-Aguirre A, Hemmelgarn BR, Samuel SM. Survival and transplantation outcomes of children less than 2 years of age with end-stage renal disease. Pediatr Nephrol 2012; 27:1975-83. [PMID: 22673972 DOI: 10.1007/s00467-012-2195-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Revised: 04/04/2012] [Accepted: 04/05/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Young children with end-stage renal disease (ESRD) requiring renal replacement therapy (RRT) have traditionally experienced high rates of morbidity and mortality; however, detailed long-term follow-up data is limited. METHODS Using a population-based retrospective cohort with data from a national organ failure registry and administrative data from Canada's universal health care system, we analysed the outcomes of 87 children starting RRT (before age 2 years) and followed them until death or date of last contact [median follow-up 4.7 years, interquartile range (IQR) 1.4-9.8). We assessed secular trends in survival and the influence of: (1) age at start of RRT and (2) etiology of ESRD with survival and time to transplantation. RESULTS Patients were mostly male (69.0 %) with ESRD predominantly due to renal malformations (54.0 %). Peritoneal dialysis was the most common initial RRT (83.9 %). Fifty-seven (65.5 %) children received a renal transplant (median age at first transplant: 2.7 years, IQR 2.0-3.3). During 490 patient-years of follow-up, there were 23 (26.4 %) deaths, of which 22 occurred in patients who had not received a transplant. Mortality was greater for patients commencing dialysis between 1992 and 1999 and among the youngest children starting RRT (0-3 months). Children with ESRD secondary to renal malformations had better survival than those with ESRD due to other causes. Among the transplanted patients, all but one survived to the end of the observation period. CONCLUSION Children who start RRT before 3 months of age have a high risk of mortality. Among our paediatric patient cohort, mortality rates were much lower among children who had received a renal transplant.
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Affiliation(s)
- R Todd Alexander
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.
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Samuel SM, Foster BJ, Hemmelgarn BR, Nettel-Aguirre A, Crowshoe L, Alexander RT, Soo A, Tonelli MA. Incidence and causes of end-stage renal disease among Aboriginal children and young adults. CMAJ 2012; 184:E758-64. [PMID: 22927509 DOI: 10.1503/cmaj.120427] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [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 Although Aboriginal adults have a higher risk of end-stage renal disease than non-Aboriginal adults, the incidence and causes of end-stage renal disease among Aboriginal children and young adults are not well described. METHODS We calculated age- and sex-specific incidences of end-stage renal disease among Aboriginal people less than 22 years of age using data from a national organ failure registry. Incidence rate ratios were used to compare rates between Aboriginal and white Canadians. To contrast causes of end-stage renal disease by ethnicity and age, we calculated the odds of congenital diseases, glomerulonephritis and diabetes for Aboriginal people and compared them with those for white people in the following age strata: 0 to less than 22 years, 22 to less than 40 years, 40 to less than 60 years and older than 60 years. RESULTS Incidence rate ratios of end-stage renal disease for Aboriginal children and young adults (age < 22 yr, v. white people) were 1.82 (95% confidence interval [CI] 1.40-2.38) for boys and 3.24 (95% CI 2.60-4.05) for girls. Compared with white people, congenital diseases were less common among Aboriginal people aged less than 22 years (odds ratio [OR] 0.56, 95% CI 0.36-0.86), and glomerulonephritis was more common (OR 2.18, 95% CI 1.55-3.07). An excess of glomerulonephritis, but not diabetes, was seen among Aboriginal people aged 22 to less than 40 years. The converse was true (higher risk of diabetes, lower risk of glomerulonephritis) among Aboriginal people aged 40 years and older. INTERPRETATION The incidence of end-stage renal disease is higher among Aboriginal children and young adults than among white children and young adults. This higher incidence may be driven by an increased risk of glomerulonephritis in this population.
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Affiliation(s)
- Susan M Samuel
- Division of Pediatric Nephrology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.
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