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Cetin-Sahin D, Karanofsky M, Cummings GG, Vedel I, Wilchesky M. Measuring Potentially Avoidable Acute Care Transfers From Long-Term Care Homes in Quebec: a Cross Sectional Study. Can Geriatr J 2023; 26:339-349. [PMID: 37662066 PMCID: PMC10444526 DOI: 10.5770/cgj.26.620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023] Open
Abstract
Background Potentially avoidable emergency department transfers (PAEDTs) and hospitalizations (PAHs) from long-term care (LTC) homes are two key quality improvement metrics. We aimed to: 1) Measure proportions of PAEDTs and PAHs in a Quebec sample; and 2) Compare them with those reported for the rest of Canada. Methods We conducted a repeated cross-sectional study of residents who were received at one tertiary hospital between April 2017 and March 2019 from seven LTC homes in Quebec, Canada. The MedUrge emergency department database was used to extract transfers and resident characteristics. Using published definitions, PAEDTs and PAHs were identified from principal emergency department and hospitalization diagnoses, respectively. PAEDT and PAH proportions were compared to those reported by the Canadian Institute for Health Information. Results A total of 1,233 transfers by 692 residents were recorded, among which 36.3% were classified as being potentially avoidable: 22.8% 'PAEDT only', 11.6% 'both PAEDT & PAH', and 1.9% 'PAH only'. Shortness of breath was the most common reason for transfer. Pneumonia was the most common diagnosis from the 'both PAEDT & PAH' category. PAEDTs and PAHs accounted for 95% and 37% of potentially avoidable transfers, respectively. Among 533 hospitalizations, 31.3% were PAHs. These proportions were comparable to the rest of Canada, with some differences in proportions of transfers due to congestive heart failure, urinary tract infection, and implanted device management. Conclusions PAEDTs far outweigh PAHs in terms of frequency, and their monitoring is important for quality assurance as they may inform LTC-level interventions aimed at their reduction.
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Affiliation(s)
- Deniz Cetin-Sahin
- Department of Family Medicine, McGill University, Montreal, QC
- Donald Berman Maimonides Geriatric Centre for Research in Aging, Montreal, QC
| | - Mark Karanofsky
- Department of Family Medicine, McGill University, Montreal, QC
- Herzl Family Practice Centre, Jewish General Hospital CIUSSS Centre-Ouest-de-l’Île-de-Montréal, Montreal, QC
| | | | - Isabelle Vedel
- Department of Family Medicine, McGill University, Montreal, QC
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC
| | - Machelle Wilchesky
- Department of Family Medicine, McGill University, Montreal, QC
- Donald Berman Maimonides Geriatric Centre for Research in Aging, Montreal, QC
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC
- Division of Geriatric Medicine, McGill University, Montreal, QC, Canada
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Kröger E, Wilchesky M, Morin M, Carmichael PH, Marcotte M, Misson L, Plante J, Voyer P, Durand P. The OptimaMed intervention to reduce medication burden in nursing home residents with severe dementia: results from a pragmatic, controlled study. BMC Geriatr 2023; 23:520. [PMID: 37641020 PMCID: PMC10464023 DOI: 10.1186/s12877-023-04222-4] [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: 10/05/2022] [Accepted: 08/07/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Nursing home (NH) residents with severe dementia use many medications, sometimes inappropriately within a comfort care approach. Medications should be regularly reviewed and eventually deprescribed. This pragmatic, controlled trial assessed the effect of an interprofessional knowledge exchange (KE) intervention to decrease medication load and the use of medications of questionable benefit among these residents. METHODS A 6-month intervention was performed in 4 NHs in the Quebec City area, while 3 NHs, with comparable admissions criteria, served as controls. Published lists of "mostly", "sometimes" or "exceptionally" appropriate medications, tailored for NH residents with severe dementia, were used. The intervention included 1) information for participants' families about medication use in severe dementia; 2) a 90-min KE session for NH nurses, pharmacists, and physicians; 3) medication reviews by NH pharmacists using the lists; 4) discussions on recommended changes with nurses and physicians. Participants' levels of agitation and pain were evaluated using validated scales at baseline and the end of follow-up. RESULTS Seven (7) NHs and 123 participants were included for study. The mean number of regular medications per participant decreased from 7.1 to 6.6 in the intervention, and from 7.7 to 5.9 in the control NHs (p-value for the difference in differences test: < 0.05). Levels of agitation decreased by 8.3% in the intervention, and by 1.4% in the control NHs (p = 0.026); pain levels decreased by 12.6% in the intervention and increased by 7% in the control NHs (p = 0.049). Proportions of participants receiving regular medications deemed only exceptionally appropriate decreased from 19 to 17% (p = 0.43) in the intervention and from 28 to 21% (p = 0.007) in the control NHs (p = 0.22). The mean numbers of regular daily antipsychotics per participant fell from 0.64 to 0.58 in the intervention and from 0.39 to 0.30 in the control NHs (p = 0.27). CONCLUSIONS This interprofessional intervention to reduce inappropriate medication use in NH residents with severe dementia decreased medication load in both intervention and control NHs, without important concomitant increase in agitation, but mixed effects on pain levels. Practice changes and heterogeneity within these 7 NHs, and a ceiling effect in medication optimization likely interfered with the intervention. TRIAL REGISTRATION The study is registered at ClinicalTrials.gov: # NCT05155748 (first registration 03-10-2017).
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Affiliation(s)
- Edeltraut Kröger
- Centre d'excellence sur le vieillissement de Québec, CIUSSSCN, Hôpital du Saint-Sacrement, 1050, Chemin Sainte-Foy, Québec (Québec), G1S 4L8, Canada.
- Université Laval, Faculté de pharmacie, Pavillon Ferdinand Vandry, 1050 Avenue de La Médecine, Québec, Québec, G1V 0A6, Canada.
- Institut sur le vieillissement et la participation sociale des aînés, Université Laval, Hôpital du Saint-Sacrement, bureau L2-42, 1050, Chemin Sainte-Foy, Québec (Québec), G1S 4L8, Canada.
| | - Machelle Wilchesky
- McGill University, Faculty of Medicine and Health Sciences, 3605, Chemin de La Montagne, Montreal (Québec), H3G 2M1, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, 3755 Chem. de La Côte-Sainte-Catherine, Montréal, (Québec), H3T 1E2, Canada
| | - Michèle Morin
- Centre d'excellence sur le vieillissement de Québec, CIUSSSCN, Hôpital du Saint-Sacrement, 1050, Chemin Sainte-Foy, Québec (Québec), G1S 4L8, Canada
- Institut sur le vieillissement et la participation sociale des aînés, Université Laval, Hôpital du Saint-Sacrement, bureau L2-42, 1050, Chemin Sainte-Foy, Québec (Québec), G1S 4L8, Canada
- Donald Berman Maimonides Centre for Research in Aging, 5795 Av. Caldwell, Côte Saint-Luc, Montreal (Québec), H4W 1W3, Canada
| | - Pierre-Hugues Carmichael
- Centre d'excellence sur le vieillissement de Québec, CIUSSSCN, Hôpital du Saint-Sacrement, 1050, Chemin Sainte-Foy, Québec (Québec), G1S 4L8, Canada
| | - Martine Marcotte
- Centre d'excellence sur le vieillissement de Québec, CIUSSSCN, Hôpital du Saint-Sacrement, 1050, Chemin Sainte-Foy, Québec (Québec), G1S 4L8, Canada
| | - Lucie Misson
- Centre d'excellence sur le vieillissement de Québec, CIUSSSCN, Hôpital du Saint-Sacrement, 1050, Chemin Sainte-Foy, Québec (Québec), G1S 4L8, Canada
| | - Jonathan Plante
- Centre d'excellence sur le vieillissement de Québec, CIUSSSCN, Hôpital du Saint-Sacrement, 1050, Chemin Sainte-Foy, Québec (Québec), G1S 4L8, Canada
- Université Laval, Faculté de pharmacie, Pavillon Ferdinand Vandry, 1050 Avenue de La Médecine, Québec, Québec, G1V 0A6, Canada
| | - Philippe Voyer
- Centre d'excellence sur le vieillissement de Québec, CIUSSSCN, Hôpital du Saint-Sacrement, 1050, Chemin Sainte-Foy, Québec (Québec), G1S 4L8, Canada
- Université Laval, Faculté de pharmacie, Pavillon Ferdinand Vandry, 1050 Avenue de La Médecine, Québec, Québec, G1V 0A6, Canada
- Université Laval, Faculté de médecine, Pavillon Ferdinand Vandry, 1050 Avenue de La Médecine, Québec (Québec), G1V 0A6, Canada
| | - Pierre Durand
- Centre d'excellence sur le vieillissement de Québec, CIUSSSCN, Hôpital du Saint-Sacrement, 1050, Chemin Sainte-Foy, Québec (Québec), G1S 4L8, Canada
- Université Laval, Faculté de pharmacie, Pavillon Ferdinand Vandry, 1050 Avenue de La Médecine, Québec, Québec, G1V 0A6, Canada
- Donald Berman Maimonides Centre for Research in Aging, 5795 Av. Caldwell, Côte Saint-Luc, Montreal (Québec), H4W 1W3, Canada
- Université Laval, Faculté des sciences infirmières, Pavillon Ferdinand Vandry, 1050 Avenue de La Médecine, Québec (Québec), G1V 0A6, Canada
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Cetin-Sahin D, Cummings GG, Gore G, Vedel I, Karanofsky M, Voyer P, Gore B, Lungu O, Wilchesky M. Taxonomy of Interventions to Reduce Acute Care Transfers From Long-term Care Homes: A Systematic Scoping Review. J Am Med Dir Assoc 2023; 24:343-355. [PMID: 36758622 DOI: 10.1016/j.jamda.2022.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/22/2022] [Accepted: 12/31/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To develop a taxonomy of interventions aimed at reducing emergency department (ED) transfers and/or hospitalizations from long-term care (LTC) homes. DESIGN A systematic scoping review. SETTING AND PARTICIPANTS Permanent LTC home residents. METHODS Experimental and comparative observational studies were searched in MEDLINE, CINAHL, Embase Classic + Embase, the Cochrane Library, PsycINFO, Social Work Abstracts, AMED, Global Health, Health and Psychosocial Instruments, Joanna Briggs Institute EBP Database, Ovid Healthstar, and Web of Science Core Collection from inception until March 2020. Forward/backward citation tracking and gray literature searches strengthened comprehensiveness. The Mixed Methods Appraisal Tool was used to assess study quality. Intervention categories and components were identified using an inductive-deductive thematic analysis. Categories were informed by 3 intervention dimensions: (1) "when/at what point(s)" on the continuum of care they occur, (2) "for whom" (ie, intervention target resident populations), and (3) "how" these interventions effect change. Components were informed by the logistical elements of the interventions having the potential to influence outcomes. All interventions were mapped to the developed taxonomy based on their categories, components, and outcomes. Distributions of components by category and study year were graphically presented. RESULTS Ninety studies (25 randomized, 23 high quality) were included. Six intervention categories were identified: advance care planning; palliative and end-of-life care; onsite care for acute, subacute, or uncontrolled chronic conditions; transitional care; enhanced usual care (most prevalent, 31% of 90 interventions); and comprehensive care. Four components were identified: increasing human resource capacity (most prevalent, 93%), training or reorganization of existing staff, technology, and standardized tools. The use of technology increased over time. Potentially avoidable ED transfers and/or hospitalizations were measured infrequently as primary outcomes. CONCLUSIONS AND IMPLICATIONS This proposed taxonomy can guide future intervention designs. It can also facilitate systematic reviews and precise effect size estimations for homogenous interventions when outcomes are comparable.
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Affiliation(s)
- Deniz Cetin-Sahin
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada; Donald Berman Maimonides Centre for Research in Aging, Montreal, Quebec, Canada
| | - Greta G Cummings
- College of Health Sciences, University of Alberta, Edmonton, Canada
| | - Genevieve Gore
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Isabelle Vedel
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Mark Karanofsky
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada; Herzl Family Practice Centre, Jewish General Hospital CIUSSS Centre Ouest de l'ile de Montreal, Montreal, Quebec, Canada
| | - Phillippe Voyer
- Faculty of Nursing, Université Laval, Quebec City, Quebec, Canada
| | - Brian Gore
- Donald Berman Maimonides Centre for Research in Aging, Montreal, Quebec, Canada
| | - Ovidiu Lungu
- Department of Psychiatry, Université de Montréal, Montreal, Quebec, Canada
| | - Machelle Wilchesky
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada; Donald Berman Maimonides Centre for Research in Aging, Montreal, Quebec, Canada; Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada; Division of Geriatric Medicine, McGill University, Montreal, Quebec, Canada.
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Rahimi S, Chu C, Grad R, Karanofsky M, Arsenault M, Ronquillo C, Vedel I, McGilton K, Wilchesky M. Explainable Machine Learning Model to Predict COVID-19 Severity Among Older Adults in the Province of Quebec. Ann Fam Med 2023; 21:3619. [PMID: 36972530 PMCID: PMC10549471 DOI: 10.1370/afm.21.s1.3619] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/18/2023] Open
Abstract
Context: Patients over the age of 65 years are more likely to experience higher severity and mortality rates than other populations from COVID-19. Clinicians need assistance in supporting their decisions regarding the management of these patients. Artificial Intelligence (AI) can help with this regard. However, the lack of explainability-defined as "the ability to understand and evaluate the internal mechanism of the algorithm/computational process in human terms"-of AI is one of the major challenges to its application in health care. We know little about application of explainable AI (XAI) in health care. Objective: In this study, we aimed to evaluate the feasibility of the development of explainable machine learning models to predict COVID-19 severity among older adults. Design: Quantitative machine learning methods. Setting: Long-term care facilities within the province of Quebec. Participants: Patients 65 years and older presented to the hospitals who had a positive polymerase chain reaction test for COVID-19. Intervention: We used XAI-specific methods (e.g., EBM), machine learning methods (i.e., random forest, deep forest, and XGBoost), as well as explainable approaches such as LIME, SHAP, PIMP, and anchor with the mentioned machine learning methods. Outcome measures: Classification accuracy and area under the receiver operating characteristic curve (AUC). Results: The age distribution of the patients (n=986, 54.6% male) was 84.5□19.5 years. The best-performing models (and their performance) were as follows. Deep forest using XAI agnostic methods LIME (97.36% AUC, 91.65 ACC), Anchor (97.36% AUC, 91.65 ACC), and PIMP (96.93% AUC, 91.65 ACC). We found alignment with the identified reasoning of our models' predictions and clinical studies' findings-about the correlation of different variables such as diabetes and dementia, and the severity of COVID-19 in this population. Conclusions: The use of explainable machine learning models, to predict the severity of COVID-19 among older adults is feasible. We obtained a high-performance level as well as explainability in the prediction of COVID-19 severity in this population. Further studies are required to integrate these models into a decision support system to facilitate the management of diseases such as COVID-19 for (primary) health care providers and evaluate their usability among them.
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Puterman-Salzman L, Katz J, Bergman H, Grad R, Khanassov V, Gore G, Vedel I, Wilchesky M, Armanfard N, Ghourchian N, Abbasgholizadeh Rahimi S. Artificial Intelligence for Detection of Dementia Using Motion Data: A Scoping Review. Dement Geriatr Cogn Dis Extra 2023; 13:28-38. [PMID: 37927529 PMCID: PMC10624450 DOI: 10.1159/000533693] [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: 04/10/2023] [Accepted: 08/07/2023] [Indexed: 11/07/2023] Open
Abstract
Background Dementia is a neurodegenerative disease resulting in the loss of cognitive and psychological functions. Artificial intelligence (AI) may help in detection and screening of dementia; however, little is known in this area. Objectives The objective of this study was to identify and evaluate AI interventions for detection of dementia using motion data. Method The review followed the framework proposed by O'Malley's and Joanna Briggs Institute methodological guidance for scoping reviews. We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist for reporting the results. An information specialist performed a comprehensive search from the date of inception until November 2020, in five bibliographic databases: MEDLINE, EMBASE, Web of Science Core Collection, CINAHL, and IEEE Xplore. We included studies aimed at the deployment and testing or implementation of AI interventions using motion data for the detection of dementia among a diverse population, encompassing varying age, sex, gender, economic backgrounds, and ethnicity, extending to their health care providers across multiple health care settings. Studies were excluded if they focused on Parkinson's or Huntington's disease. Two independent reviewers screened the abstracts, titles, and then read the full-texts. Disagreements were resolved by consensus, and if this was not possible, the opinion of a third reviewer was sought. The reference lists of included studies were also screened. Results After removing duplicates, 2,632 articles were obtained. After title and abstract screening and full-text screening, 839 articles were considered for categorization. The authors categorized the papers into six categories, and data extraction and synthesis was performed on 20 included papers from the motion tracking data category. The included studies assessed cognitive performance (n = 5, 25%); screened dementia and cognitive decline (n = 8, 40%); investigated visual behaviours (n = 4, 20%); and analyzed motor behaviors (n = 3, 15%). Conclusions We presented evidence of AI systems being employed in the detection of dementia, showcasing the promising potential of motion tracking within this domain. Although some progress has been made in this field recently, there remain notable research gaps that require further exploration and investigation. Future endeavors need to compare AI interventions using motion data with traditional screening methods or other tech-enabled dementia detection mechanisms. Besides, future works should aim at understanding how gender and sex, and ethnic and cultural sensitivity can contribute to refining AI interventions, ensuring they are accessible, equitable, and beneficial across all society.
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Affiliation(s)
| | - Jory Katz
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Howard Bergman
- Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Roland Grad
- Department of Family Medicine, McGill University, Montreal, QC, Canada
- Jewish General Hospital, Lady Davis Institute for Medical Research, Montreal, QC, Canada
| | | | - Genevieve Gore
- Schulich Library of Physical Sciences, Life Sciences and Engineering, McGill University, Montreal, QC, Canada
| | - Isabelle Vedel
- Department of Family Medicine, McGill University, Montreal, QC, Canada
- Jewish General Hospital, Lady Davis Institute for Medical Research, Montreal, QC, Canada
| | - Machelle Wilchesky
- Department of Family Medicine, McGill University, Montreal, QC, Canada
- Jewish General Hospital, Lady Davis Institute for Medical Research, Montreal, QC, Canada
- Division of Geriatric Medicine, McGill University, Montreal, QC, Canada
- Donald Berman Maimonides Centre for Research in Aging, Montreal, QC, Canada
| | - Narges Armanfard
- Mila - Quebec AI Institute, Montreal, QC, Canada
- Department of Electrical and Computer Engineering, McGill University, Montreal, QC, Canada
| | | | - Samira Abbasgholizadeh Rahimi
- Department of Family Medicine, McGill University, Montreal, QC, Canada
- Jewish General Hospital, Lady Davis Institute for Medical Research, Montreal, QC, Canada
- Mila - Quebec AI Institute, Montreal, QC, Canada
- Faculty of Dentistry Medicine and Oral Health Sciences, McGill University, Montreal, QC, Canada
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Bakouny Z, Labaki C, Grover P, Awosika J, Gulati S, Hsu CY, Alimohamed SI, Bashir B, Berg S, Bilen MA, Bowles D, Castellano C, Desai A, Elkrief A, Eton OE, Fecher LA, Flora D, Galsky MD, Gatti-Mays ME, Gesenhues A, Glover MJ, Gopalakrishnan D, Gupta S, Halfdanarson TR, Hayes-Lattin B, Hendawi M, Hsu E, Hwang C, Jandarov R, Jani C, Johnson DB, Joshi M, Khan H, Khan SA, Knox N, Koshkin VS, Kulkarni AA, Kwon DH, Matar S, McKay RR, Mishra S, Moria FA, Nizam A, Nock NL, Nonato TK, Panasci J, Pomerantz L, Portuguese AJ, Provenzano D, Puc M, Rao YJ, Rhodes TD, Riely GJ, Ripp JJ, Rivera AV, Ruiz-Garcia E, Schmidt AL, Schoenfeld AJ, Schwartz GK, Shah SA, Shaya J, Subbiah S, Tachiki LM, Tucker MD, Valdez-Reyes M, Weissmann LB, Wotman MT, Wulff-Burchfield EM, Xie Z, Yang YJ, Thompson MA, Shah DP, Warner JL, Shyr Y, Choueiri TK, Wise-Draper TM, Gandhi R, Gartrell BA, Goel S, Halmos B, Makower DF, O' Sullivan D, Ohri N, Portes M, Shapiro LC, Shastri A, Sica RA, Verma AK, Butt O, Campian JL, Fiala MA, Henderson JP, Monahan RS, Stockerl-Goldstein KE, Zhou AY, Bitran JD, Hallmeyer S, Mundt D, Pandravada S, Papaioannou PV, Patel M, Streckfuss M, Tadesse E, Gatson NTN, Kundranda MN, Lammers PE, Loree JM, Yu IS, Bindal P, Lam B, Peters MLB, Piper-Vallillo AJ, Egan PC, Farmakiotis D, Arvanitis P, Klein EJ, Olszewski AJ, Vieira K, Angevine AH, Bar MH, Del Prete SA, Fiebach MZ, Gulati AP, Hatton E, Houston K, Rose SJ, Steve Lo KM, Stratton J, Weinstein PL, Garcia JA, Routy B, Hoyo-Ulloa I, Dawsey SJ, Lemmon CA, Pennell NA, Sharifi N, Painter CA, Granada C, Hoppenot C, Li A, Bitterman DS, Connors JM, Demetri GD, Florez (Duma) N, Freeman DA, Giordano A, Morgans AK, Nohria A, Saliby RM, Tolaney SM, Van Allen EM, Xu WV, Zon RL, Halabi S, Zhang T, Dzimitrowicz H, Leighton JC, Graber JJ, Grivas P, Hawley JE, Loggers ET, Lyman GH, Lynch RC, Nakasone ES, Schweizer MT, Vinayak S, Wagner MJ, Yeh A, Dansoa Y, Makary M, Manikowski JJ, Vadakara J, Yossef K, Beckerman J, Goyal S, Messing I, Rosenstein LJ, Steffes DR, Alsamarai S, Clement JM, Cosin JA, Daher A, Dailey ME, Elias R, Fein JA, Hosmer W, Jayaraj A, Mather J, Menendez AG, Nadkarni R, Serrano OK, Yu PP, Balanchivadze N, Gadgeel SM, Accordino MK, Bhutani D, Bodin BE, Hershman DL, Masson C, Alexander M, Mushtaq S, Reuben DY, Bernicker EH, Deeken JF, Jeffords KJ, Shafer D, Cárdenas AI, Cuervo Campos R, De-la-Rosa-Martinez D, Ramirez A, Vilar-Compte D, Gill DM, Lewis MA, Low CA, Jones MM, Mansoor AH, Mashru SH, Werner MA, Cohen AM, McWeeney S, Nemecek ER, Williamson SP, Peters S, Smith SJ, Lewis GC, Zaren HA, Akhtari M, Castillo DR, Cortez K, Lau E, Nagaraj G, Park K, Reeves ME, O'Connor TE, Altman J, Gurley M, Mulcahy MF, Wehbe FH, Durbin EB, Nelson HH, Ramesh V, Sachs Z, Wilson G, Bardia A, Boland G, Gainor JF, Peppercorn J, Reynolds KL, Rosovsky RP, Zubiri L, Bekaii-Saab TS, Joyner MJ, Riaz IB, Senefeld JW, Shah S, Ayre SK, Bonnen M, Mahadevan D, McKeown C, Mesa RA, Ramirez AG, Salazar M, Shah PK, Wang CP, Bouganim N, Papenburg J, Sabbah A, Tagalakis V, Vinh DC, Nanchal R, Singh H, Bahadur N, Bao T, Belenkaya R, Nambiar PH, O’Cearbhaill RE, Papadopoulos EB, Philip J, Robson M, Rosenberg JE, Wilkins CR, Tamimi R, Cerrone K, Dill J, Faller BA, Alomar ME, Chandrasekhar SA, Hume EC, Islam JY, Ajmera A, Brouha SS, Cabal A, Choi S, Hsiao A, Jiang JY, Kligerman S, Park J, Razavi P, Reid EG, Bhatt PS, Mariano MG, Thomson CC, Glace M(G, Knoble JL, Rink C, Zacks R, Blau SH, Brown C, Cantrell AS, Namburi S, Polimera HV, Rovito MA, Edwin N, Herz K, Kennecke HF, Monfared A, Sautter RR, Cronin T, Elshoury A, Fleissner B, Griffiths EA, Hernandez-Ilizaliturri F, Jain P, Kariapper A, Levine E, Moffitt M, O'Connor TL, Smith LJ, Wicher CP, Zsiros E, Jabbour SK, Misdary CF, Shah MR, Batist G, Cook E, Ferrario C, Lau S, Miller WH, Rudski L, Santos Dutra M, Wilchesky M, Mahmood SZ, McNair C, Mico V, Dixon B, Kloecker G, Logan BB, Mandapakala C, Cabebe EC, Jha A, Khaki AR, Nagpal S, Schapira L, Wu JTY, Whaley D, Lopes GDL, de Cardenas K, Russell K, Stith B, Taylor S, Klamerus JF, Revankar SG, Addison D, Chen JL, Haynam M, Jhawar SR, Karivedu V, Palmer JD, Pillainayagam C, Stover DG, Wall S, Williams NO, Abbasi SH, Annis S, Balmaceda NB, Greenland S, Kasi A, Rock CD, Luders M, Smits M, Weiss M, Chism DD, Owenby S, Ang C, Doroshow DB, Metzger M, Berenberg J, Uyehara C, Fazio A, Huber KE, Lashley LN, Sueyoshi MH, Patel KG, Riess J, Borno HT, Small EJ, Zhang S, Andermann TM, Jensen CE, Rubinstein SM, Wood WA, Ahmad SA, Brownfield L, Heilman H, Kharofa J, Latif T, Marcum M, Shaikh HG, Sohal DPS, Abidi M, Geiger CL, Markham MJ, Russ AD, Saker H, Acoba JD, Choi H, Rho YS, Feldman LE, Gantt G, Hoskins KF, Khan M, Liu LC, Nguyen RH, Pasquinelli MM, Schwartz C, Venepalli NK, Vikas P, Zakharia Y, Friese CR, Boldt A, Gonzalez CJ, Su C, Su CT, Yoon JJ, Bijjula R, Mavromatis BH, Seletyn ME, Wood BR, Zaman QU, Kaklamani V, Beeghly A, Brown AJ, Charles LJ, Cheng A, Crispens MA, Croessmann S, Davis EJ, Ding T, Duda SN, Enriquez KT, French B, Gillaspie EA, Hausrath DJ, Hennessy C, Lewis JT, Li X(L, Prescott LS, Reid SA, Saif S, Slosky DA, Solorzano CC, Sun T, Vega-Luna K, Wang LL, Aboulafia DM, Carducci TM, Goldsmith KJ, Van Loon S, Topaloglu U, Moore J, Rice RL, Cabalona WD, Cyr S, Barrow McCollough B, Peddi P, Rosen LR, Ravindranathan D, Hafez N, Herbst RS, LoRusso P, Lustberg MB, Masters T, Stratton C. Interplay of Immunosuppression and Immunotherapy Among Patients With Cancer and COVID-19. JAMA Oncol 2023; 9:128-134. [PMID: 36326731 PMCID: PMC9634600 DOI: 10.1001/jamaoncol.2022.5357] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [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: 04/04/2022] [Accepted: 08/11/2022] [Indexed: 11/06/2022]
Abstract
Importance Cytokine storm due to COVID-19 can cause high morbidity and mortality and may be more common in patients with cancer treated with immunotherapy (IO) due to immune system activation. Objective To determine the association of baseline immunosuppression and/or IO-based therapies with COVID-19 severity and cytokine storm in patients with cancer. Design, Setting, and Participants This registry-based retrospective cohort study included 12 046 patients reported to the COVID-19 and Cancer Consortium (CCC19) registry from March 2020 to May 2022. The CCC19 registry is a centralized international multi-institutional registry of patients with COVID-19 with a current or past diagnosis of cancer. Records analyzed included patients with active or previous cancer who had a laboratory-confirmed infection with SARS-CoV-2 by polymerase chain reaction and/or serologic findings. Exposures Immunosuppression due to therapy; systemic anticancer therapy (IO or non-IO). Main Outcomes and Measures The primary outcome was a 5-level ordinal scale of COVID-19 severity: no complications; hospitalized without requiring oxygen; hospitalized and required oxygen; intensive care unit admission and/or mechanical ventilation; death. The secondary outcome was the occurrence of cytokine storm. Results The median age of the entire cohort was 65 years (interquartile range [IQR], 54-74) years and 6359 patients were female (52.8%) and 6598 (54.8%) were non-Hispanic White. A total of 599 (5.0%) patients received IO, whereas 4327 (35.9%) received non-IO systemic anticancer therapies, and 7120 (59.1%) did not receive any antineoplastic regimen within 3 months prior to COVID-19 diagnosis. Although no difference in COVID-19 severity and cytokine storm was found in the IO group compared with the untreated group in the total cohort (adjusted odds ratio [aOR], 0.80; 95% CI, 0.56-1.13, and aOR, 0.89; 95% CI, 0.41-1.93, respectively), patients with baseline immunosuppression treated with IO (vs untreated) had worse COVID-19 severity and cytokine storm (aOR, 3.33; 95% CI, 1.38-8.01, and aOR, 4.41; 95% CI, 1.71-11.38, respectively). Patients with immunosuppression receiving non-IO therapies (vs untreated) also had worse COVID-19 severity (aOR, 1.79; 95% CI, 1.36-2.35) and cytokine storm (aOR, 2.32; 95% CI, 1.42-3.79). Conclusions and Relevance This cohort study found that in patients with cancer and COVID-19, administration of systemic anticancer therapies, especially IO, in the context of baseline immunosuppression was associated with severe clinical outcomes and the development of cytokine storm. Trial Registration ClinicalTrials.gov Identifier: NCT04354701.
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Affiliation(s)
- Ziad Bakouny
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Chris Labaki
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Punita Grover
- Division of Hematology/Oncology, University of Cincinnati Cancer Center, Cincinnati, Ohio
| | - Joy Awosika
- Division of Hematology/Oncology, University of Cincinnati Cancer Center, Cincinnati, Ohio
| | - Shuchi Gulati
- Division of Hematology/Oncology, University of Cincinnati Cancer Center, Cincinnati, Ohio
| | - Chih-Yuan Hsu
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Saif I Alimohamed
- Wake Forest Baptist Comprehensive Cancer Center, Winston-Salem, North Carolina
| | - Babar Bashir
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Mehmet A Bilen
- Winship Cancer Institute, Emory University, Atlanta, Georgia
| | | | | | - Aakash Desai
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | - Arielle Elkrief
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | - Omar E Eton
- Hartford Healthcare Cancer Institute, Hartford, Connecticut
| | | | | | | | | | | | | | | | | | | | | | - Mohamed Hendawi
- Aurora Cancer Center, Advocate Aurora Health, Milwaukee, Wisconsin
| | - Emily Hsu
- Hartford Healthcare Cancer Institute, Hartford, Connecticut
| | - Clara Hwang
- Henry Ford Cancer Institute, Detroit, Michigan
| | - Roman Jandarov
- Division of Hematology/Oncology, University of Cincinnati Cancer Center, Cincinnati, Ohio
| | | | | | - Monika Joshi
- Penn State Cancer Institute, Hershey, Pennsylvania
| | - Hina Khan
- Brown University and Lifespan Cancer Institute, Providence, Rhode Island
| | - Shaheer A Khan
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, New York
| | - Natalie Knox
- Loyola University Medical Center, Maywood, Illinois
| | - Vadim S Koshkin
- UCSF, Helen Diller Comprehensive Cancer Center, San Francisco
| | | | - Daniel H Kwon
- UCSF, Helen Diller Comprehensive Cancer Center, San Francisco
| | - Sara Matar
- Hollings Cancer Center, MUSC, Charleston
| | - Rana R McKay
- Moores Cancer Center, UCSD, San Diego, California
| | - Sanjay Mishra
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Feras A Moria
- McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Nora L Nock
- Case Comprehensive Cancer Center, Department of Population and Quantitative Health Sciences, Cleveland, Ohio
| | | | - Justin Panasci
- Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | | | | | | | | | - Yuan J Rao
- George Washington University, Washington, DC
| | | | | | - Jacob J Ripp
- University of Kansas Medical Center, Kansas City
| | - Andrea V Rivera
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, Pennsylvania
| | | | - Andrew L Schmidt
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Gary K Schwartz
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, New York
| | | | - Justin Shaya
- Moores Cancer Center, UCSD, San Diego, California
| | - Suki Subbiah
- Stanley S. Scott Cancer Center, LSU, New Orleans, Louisiana
| | - Lisa M Tachiki
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | | | | | | | | | - Zhuoer Xie
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - Michael A Thompson
- Aurora Cancer Center, Advocate Aurora Health, Milwaukee, Wisconsin.,Tempus Labs, Chicago, Illinois
| | - Dimpy P Shah
- Mays Cancer Center, UT Health, San Antonio, Texas
| | | | - Yu Shyr
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Toni K Choueiri
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Trisha M Wise-Draper
- Division of Hematology/Oncology, University of Cincinnati Cancer Center, Cincinnati, Ohio
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Omar Butt
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ang Li
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Eric Lau
- for the COVID-19 and Cancer Consortium
| | | | - Kyu Park
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ting Bao
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ji Park
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Erin Cook
- for the COVID-19 and Cancer Consortium
| | | | - Susie Lau
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Anup Kasi
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Li C Liu
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | - Chris Su
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Tan Ding
- for the COVID-19 and Cancer Consortium
| | | | | | | | | | | | | | | | | | | | | | - Sara Saif
- for the COVID-19 and Cancer Consortium
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Guénette L, Kröger E, Bonnan D, Maheu A, Morin M, Bélanger L, Vedel I, Wilchesky M, Sirois C, Durand É, Couturier Y, Sourial N. Reorganizing pharmaceutical care in family medicine groups for seniors with or at risk of major neurocognitive disorders: a mixed-methods study protocol (Preprint). JMIR Res Protoc 2022; 11:e42577. [DOI: 10.2196/42577] [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] [Received: 09/09/2022] [Revised: 10/05/2022] [Accepted: 10/20/2022] [Indexed: 11/07/2022] Open
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Wilchesky M, Ballard SA, Voyer P, McCusker J, Lungu O, Champoux N, Vu TTM, Cole MG, Monette J, Ciampi A, Belzile E, Carmichael PH, McConnell T. The PREvention Program for Alzheimer's RElated Delirium (PREPARED) cluster randomized trial: a study protocol. BMC Geriatr 2021; 21:645. [PMID: 34784897 PMCID: PMC8594158 DOI: 10.1186/s12877-021-02558-3] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 10/15/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Delirium is a significant cause of morbidity and mortality among older people admitted to both acute and long-term care facilities (LTCFs). Multicomponent interventions have been shown to reduce delirium incidence in the acute care setting (30-73%) by acting on modifiable risk factors. Little work, however, has focused on using this approach to reduce delirium incidence in LTCFs. METHODS The objective is to assess the effectiveness of the multicomponent PREPARED Trial intervention in reducing the following primary outcomes: incidence, severity, duration, and frequency of delirium episodes in cognitively impaired residents. This 4-year, parallel-design, cluster randomized study will involve nursing staff and residents in 45-50 LTCFs in Montreal, Canada. Participating public and private LTCFs (clusters) that provide 24-h nursing care will be assigned to either the PREPARED Trial intervention or the control (usual care) arm of the study using a covariate constrained randomization procedure. Approximately 400-600 LTC residents aged 65 and older with dementia and/or cognitive impairment will be enrolled in the study and followed for 18 weeks. Residents must be at risk of delirium, delirium-free at baseline and have resided at the facility for at least 2 weeks. Residents who are unable to communicate verbally, have a history of specific psychiatric conditions, or are receiving end-of-life care will be excluded. The PREPARED Trial intervention consists of four main components: a decision tree, an instruction manual, a training package, and a toolkit. Primary study outcomes will be assessed weekly. Functional autonomy and cognitive levels will be assessed at the beginning and end of follow-up, while information pertaining to modifiable delirium risk factors, medical consultations, and facility transfers will be collected retrospectively for the duration of the follow-up period. Primary outcomes will be reported at the level of intervention assignment. All researchers analyzing the data will be blinded to group allocation. DISCUSSION This large-scale intervention study will contribute significantly to the development of evidence-based clinical guidelines for delirium prevention in this frail elderly population, as it will be the first to evaluate the efficacy of a multicomponent delirium prevention program translated into LTC clinical practice on a large scale. TRIAL REGISTRATION NCT03718156 , ClinicalTrials.gov .
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Affiliation(s)
- Machelle Wilchesky
- Centre for Research in Aging, Donald Berman Maimonides Geriatric Centre, 5795 Ave Caldwell, Montreal, QC, H4W 1W3, Canada.
- Department of Family Medicine, McGill University, 5858 Côte-des-Neiges Road, Montreal, QC, H3S 1Z1, Canada.
- Division of Geriatric Medicine, McGill University, Jewish General Hospital, 3755 Cote St. Catherine Road, Room E-0012, Montreal, QC, H3T 1E2, Canada.
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, 3755 Cote St. Catherine Road, Montreal, QC, H3T 1E2, Canada.
| | - Stephanie A Ballard
- Centre for Research in Aging, Donald Berman Maimonides Geriatric Centre, 5795 Ave Caldwell, Montreal, QC, H4W 1W3, Canada
- Department of Family Medicine, McGill University, 5858 Côte-des-Neiges Road, Montreal, QC, H3S 1Z1, Canada
| | - Philippe Voyer
- Faculty of Nursing Sciences, Laval University, Pavillon Ferdinand-Vandry, 1050 avenue de la Médecine, local 3645, Québec, QC, G1V 0A6, Canada
- Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 1050 chemin Sainte-Foy, L2-30, Quebec City, QC, G1S 4L8, Canada
| | - Jane McCusker
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Ave W, Montreal, QC, H3A 1A2, Canada
- St. Mary's Research Centre, 3830 Avenue Lacombe, Hayes Pavilion, suite 4720, Montreal, QC, H3T 1M5, Canada
| | - Ovidiu Lungu
- Centre for Research in Aging, Donald Berman Maimonides Geriatric Centre, 5795 Ave Caldwell, Montreal, QC, H4W 1W3, Canada
- Functional Neuroimaging Unit, Centre de recherche de l'Institut universitaire de gériatrie de Montréal, 4565 Queen Mary Rd, Montreal, QC, H3W 1W5, Canada
- Department of Psychiatry, Université de Montréal, Pavillon Roger-Gaudry, Faculté de Medicine, C.P. 6128, succursale Centre-ville, Montreal, QC, H3C 3J7, Canada
| | - Nathalie Champoux
- Faculty of Medicine, Université de Montréal, 2900 Boulevard Edouard-Montpetit, Montreal, QC, H3T 1J4, Canada
| | - T T Minh Vu
- Centre de recherche du CHUM, 91000, rue Saint-Denis, Montréal, QC, H2X 0A9, Canada
| | - Martin G Cole
- Department of Psychiatry, McGill University, Ludmer Research & Training Building, 1033 Pine Avenue West, Montreal, QC, H3A 1A, Canada
| | - Johanne Monette
- Division of Geriatric Medicine, McGill University, Jewish General Hospital, 3755 Cote St. Catherine Road, Room E-0012, Montreal, QC, H3T 1E2, Canada
| | - Antonio Ciampi
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 1020 Pine Ave W, Montreal, QC, H3A 1A2, Canada
- St. Mary's Research Centre, 3830 Avenue Lacombe, Hayes Pavilion, suite 4720, Montreal, QC, H3T 1M5, Canada
| | - Eric Belzile
- St. Mary's Research Centre, 3830 Avenue Lacombe, Hayes Pavilion, suite 4720, Montreal, QC, H3T 1M5, Canada
| | - Pierre-Hugues Carmichael
- Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 1050 chemin Sainte-Foy, L2-30, Quebec City, QC, G1S 4L8, Canada
| | - Ted McConnell
- Division of General Internal Medicine, McGill University, 1001 Decarie Boulevard, Montreal, QC, H4A 3J1, Canada
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Mah J, Lieu A, Palayew M, Alipour P, Kong LY, Song S, Palayew A, Tutt-Guérette MA, Yang SS, Wilchesky M, Lipes J, Azoulay L, Greenaway C. Comparison of hospitalized patients with COVID-19 who did and did not live in residential care facilities in Montréal: a retrospective case series. CMAJ Open 2021; 9:E718-E727. [PMID: 34257090 PMCID: PMC8313094 DOI: 10.9778/cmajo.20200244] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND As in other jurisdictions, the demographics of people infected with SARS-CoV-2 changed in Quebec over the course of the first COVID-19 pandemic wave, and affected those living in residential care facilities (RCFs) disproportionately. We evaluated the association between clinical characteristics and outcomes of hospitalized patients with COVID-19, comparing those did or did not live in RCFs. METHODS We conducted a retrospective case series of all consecutive adults (≥ 18 yr) admitted to the Jewish General Hospital in Montréal with laboratory-confirmed SARS-CoV-2 infection from Mar. 4 to June 30, 2020, with in-hospital follow-up until Aug. 6, 2020. We collected patient demographics, comorbidities and outcomes (i.e., admission to the intensive care unit, mechanical ventilation and death) from medical and laboratory records and compared patients who did or did not live in public and private RCFs. We evaluated factors associated with the risk of in-hospital death with a Cox proportional hazard model. RESULTS In total, 656 patients were hospitalized between March and June 2020, including 303 patients who lived in RCFs and 353 patients who did not. The mean age was 72.9 (standard deviation 18.3) years (range 21 to 106 yr); 349 (53.2%) were female and 118 (18.0%) were admitted to the intensive care unit. The overall mortality rate was 23.8% (156/656), but was higher among patients living in RCFs (36.6% [111/303]) compared with those not living in RCFs (12.7% [45/353]). Increased risk of death was associated with age 80 years and older (hazard ratio [HR] 2.39, 95% confidence interval [CI] 1.35-4.24), male sex (HR 1.74, 95% CI 1.25-2.41), the presence of 4 or more comorbidities (HR 2.01, 95% CI 1.18-3.42) and living in an RCF (HR 1.62, 95% CI 1.09-2.39). INTERPRETATION During the first wave of the COVID-19 epidemic in Montréal, more than one-third of RCF residents hospitalized with SARS-CoV-2 infection died during hospitalization. Policies and practices that prevent future outbreaks of SARS-CoV-2 infection in this setting must be implemented to prevent high mortality in this vulnerable population.
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Affiliation(s)
- Jordan Mah
- Faculty of Medicine (Mah, Lieu, M. Palayew, Alipour, Kong, Yang, Wilchesky, Lipes, Greenaway), McGill University; Division of Respirology (M. Palayew), Jewish General Hospital, Montréal; Lady Davis Institute for Medical Research (Kong, Song, Tutt-Guérette, Wilchesky, Lipes, Azoulay, Greenaway), Jewish General Hospital; Division of Infectious Diseases (Kong, Greenaway), Jewish General Hospital; Department of Epidemiology and Biostatistics and Occupational Health (A. Palayew, Azoulay, Greenaway), McGill University; Department of Anesthesia (Yang), Jewish General Hospital; Division of Critical Care (Yang, Lipes), Jewish General Hospital; Donald Berman Maimonides Centre for Research in Aging (Wilchesky); Gerald Bronfman Department of Oncology (Azoulay), McGill University, Montréal, Que
| | - Anthony Lieu
- Faculty of Medicine (Mah, Lieu, M. Palayew, Alipour, Kong, Yang, Wilchesky, Lipes, Greenaway), McGill University; Division of Respirology (M. Palayew), Jewish General Hospital, Montréal; Lady Davis Institute for Medical Research (Kong, Song, Tutt-Guérette, Wilchesky, Lipes, Azoulay, Greenaway), Jewish General Hospital; Division of Infectious Diseases (Kong, Greenaway), Jewish General Hospital; Department of Epidemiology and Biostatistics and Occupational Health (A. Palayew, Azoulay, Greenaway), McGill University; Department of Anesthesia (Yang), Jewish General Hospital; Division of Critical Care (Yang, Lipes), Jewish General Hospital; Donald Berman Maimonides Centre for Research in Aging (Wilchesky); Gerald Bronfman Department of Oncology (Azoulay), McGill University, Montréal, Que
| | - Mark Palayew
- Faculty of Medicine (Mah, Lieu, M. Palayew, Alipour, Kong, Yang, Wilchesky, Lipes, Greenaway), McGill University; Division of Respirology (M. Palayew), Jewish General Hospital, Montréal; Lady Davis Institute for Medical Research (Kong, Song, Tutt-Guérette, Wilchesky, Lipes, Azoulay, Greenaway), Jewish General Hospital; Division of Infectious Diseases (Kong, Greenaway), Jewish General Hospital; Department of Epidemiology and Biostatistics and Occupational Health (A. Palayew, Azoulay, Greenaway), McGill University; Department of Anesthesia (Yang), Jewish General Hospital; Division of Critical Care (Yang, Lipes), Jewish General Hospital; Donald Berman Maimonides Centre for Research in Aging (Wilchesky); Gerald Bronfman Department of Oncology (Azoulay), McGill University, Montréal, Que
| | - Pouria Alipour
- Faculty of Medicine (Mah, Lieu, M. Palayew, Alipour, Kong, Yang, Wilchesky, Lipes, Greenaway), McGill University; Division of Respirology (M. Palayew), Jewish General Hospital, Montréal; Lady Davis Institute for Medical Research (Kong, Song, Tutt-Guérette, Wilchesky, Lipes, Azoulay, Greenaway), Jewish General Hospital; Division of Infectious Diseases (Kong, Greenaway), Jewish General Hospital; Department of Epidemiology and Biostatistics and Occupational Health (A. Palayew, Azoulay, Greenaway), McGill University; Department of Anesthesia (Yang), Jewish General Hospital; Division of Critical Care (Yang, Lipes), Jewish General Hospital; Donald Berman Maimonides Centre for Research in Aging (Wilchesky); Gerald Bronfman Department of Oncology (Azoulay), McGill University, Montréal, Que
| | - Ling Yuan Kong
- Faculty of Medicine (Mah, Lieu, M. Palayew, Alipour, Kong, Yang, Wilchesky, Lipes, Greenaway), McGill University; Division of Respirology (M. Palayew), Jewish General Hospital, Montréal; Lady Davis Institute for Medical Research (Kong, Song, Tutt-Guérette, Wilchesky, Lipes, Azoulay, Greenaway), Jewish General Hospital; Division of Infectious Diseases (Kong, Greenaway), Jewish General Hospital; Department of Epidemiology and Biostatistics and Occupational Health (A. Palayew, Azoulay, Greenaway), McGill University; Department of Anesthesia (Yang), Jewish General Hospital; Division of Critical Care (Yang, Lipes), Jewish General Hospital; Donald Berman Maimonides Centre for Research in Aging (Wilchesky); Gerald Bronfman Department of Oncology (Azoulay), McGill University, Montréal, Que
| | - Sunny Song
- Faculty of Medicine (Mah, Lieu, M. Palayew, Alipour, Kong, Yang, Wilchesky, Lipes, Greenaway), McGill University; Division of Respirology (M. Palayew), Jewish General Hospital, Montréal; Lady Davis Institute for Medical Research (Kong, Song, Tutt-Guérette, Wilchesky, Lipes, Azoulay, Greenaway), Jewish General Hospital; Division of Infectious Diseases (Kong, Greenaway), Jewish General Hospital; Department of Epidemiology and Biostatistics and Occupational Health (A. Palayew, Azoulay, Greenaway), McGill University; Department of Anesthesia (Yang), Jewish General Hospital; Division of Critical Care (Yang, Lipes), Jewish General Hospital; Donald Berman Maimonides Centre for Research in Aging (Wilchesky); Gerald Bronfman Department of Oncology (Azoulay), McGill University, Montréal, Que
| | - Adam Palayew
- Faculty of Medicine (Mah, Lieu, M. Palayew, Alipour, Kong, Yang, Wilchesky, Lipes, Greenaway), McGill University; Division of Respirology (M. Palayew), Jewish General Hospital, Montréal; Lady Davis Institute for Medical Research (Kong, Song, Tutt-Guérette, Wilchesky, Lipes, Azoulay, Greenaway), Jewish General Hospital; Division of Infectious Diseases (Kong, Greenaway), Jewish General Hospital; Department of Epidemiology and Biostatistics and Occupational Health (A. Palayew, Azoulay, Greenaway), McGill University; Department of Anesthesia (Yang), Jewish General Hospital; Division of Critical Care (Yang, Lipes), Jewish General Hospital; Donald Berman Maimonides Centre for Research in Aging (Wilchesky); Gerald Bronfman Department of Oncology (Azoulay), McGill University, Montréal, Que
| | - Marc Antoine Tutt-Guérette
- Faculty of Medicine (Mah, Lieu, M. Palayew, Alipour, Kong, Yang, Wilchesky, Lipes, Greenaway), McGill University; Division of Respirology (M. Palayew), Jewish General Hospital, Montréal; Lady Davis Institute for Medical Research (Kong, Song, Tutt-Guérette, Wilchesky, Lipes, Azoulay, Greenaway), Jewish General Hospital; Division of Infectious Diseases (Kong, Greenaway), Jewish General Hospital; Department of Epidemiology and Biostatistics and Occupational Health (A. Palayew, Azoulay, Greenaway), McGill University; Department of Anesthesia (Yang), Jewish General Hospital; Division of Critical Care (Yang, Lipes), Jewish General Hospital; Donald Berman Maimonides Centre for Research in Aging (Wilchesky); Gerald Bronfman Department of Oncology (Azoulay), McGill University, Montréal, Que
| | - Stephen Su Yang
- Faculty of Medicine (Mah, Lieu, M. Palayew, Alipour, Kong, Yang, Wilchesky, Lipes, Greenaway), McGill University; Division of Respirology (M. Palayew), Jewish General Hospital, Montréal; Lady Davis Institute for Medical Research (Kong, Song, Tutt-Guérette, Wilchesky, Lipes, Azoulay, Greenaway), Jewish General Hospital; Division of Infectious Diseases (Kong, Greenaway), Jewish General Hospital; Department of Epidemiology and Biostatistics and Occupational Health (A. Palayew, Azoulay, Greenaway), McGill University; Department of Anesthesia (Yang), Jewish General Hospital; Division of Critical Care (Yang, Lipes), Jewish General Hospital; Donald Berman Maimonides Centre for Research in Aging (Wilchesky); Gerald Bronfman Department of Oncology (Azoulay), McGill University, Montréal, Que
| | - Machelle Wilchesky
- Faculty of Medicine (Mah, Lieu, M. Palayew, Alipour, Kong, Yang, Wilchesky, Lipes, Greenaway), McGill University; Division of Respirology (M. Palayew), Jewish General Hospital, Montréal; Lady Davis Institute for Medical Research (Kong, Song, Tutt-Guérette, Wilchesky, Lipes, Azoulay, Greenaway), Jewish General Hospital; Division of Infectious Diseases (Kong, Greenaway), Jewish General Hospital; Department of Epidemiology and Biostatistics and Occupational Health (A. Palayew, Azoulay, Greenaway), McGill University; Department of Anesthesia (Yang), Jewish General Hospital; Division of Critical Care (Yang, Lipes), Jewish General Hospital; Donald Berman Maimonides Centre for Research in Aging (Wilchesky); Gerald Bronfman Department of Oncology (Azoulay), McGill University, Montréal, Que
| | - Jed Lipes
- Faculty of Medicine (Mah, Lieu, M. Palayew, Alipour, Kong, Yang, Wilchesky, Lipes, Greenaway), McGill University; Division of Respirology (M. Palayew), Jewish General Hospital, Montréal; Lady Davis Institute for Medical Research (Kong, Song, Tutt-Guérette, Wilchesky, Lipes, Azoulay, Greenaway), Jewish General Hospital; Division of Infectious Diseases (Kong, Greenaway), Jewish General Hospital; Department of Epidemiology and Biostatistics and Occupational Health (A. Palayew, Azoulay, Greenaway), McGill University; Department of Anesthesia (Yang), Jewish General Hospital; Division of Critical Care (Yang, Lipes), Jewish General Hospital; Donald Berman Maimonides Centre for Research in Aging (Wilchesky); Gerald Bronfman Department of Oncology (Azoulay), McGill University, Montréal, Que
| | - Laurent Azoulay
- Faculty of Medicine (Mah, Lieu, M. Palayew, Alipour, Kong, Yang, Wilchesky, Lipes, Greenaway), McGill University; Division of Respirology (M. Palayew), Jewish General Hospital, Montréal; Lady Davis Institute for Medical Research (Kong, Song, Tutt-Guérette, Wilchesky, Lipes, Azoulay, Greenaway), Jewish General Hospital; Division of Infectious Diseases (Kong, Greenaway), Jewish General Hospital; Department of Epidemiology and Biostatistics and Occupational Health (A. Palayew, Azoulay, Greenaway), McGill University; Department of Anesthesia (Yang), Jewish General Hospital; Division of Critical Care (Yang, Lipes), Jewish General Hospital; Donald Berman Maimonides Centre for Research in Aging (Wilchesky); Gerald Bronfman Department of Oncology (Azoulay), McGill University, Montréal, Que
| | - Christina Greenaway
- Faculty of Medicine (Mah, Lieu, M. Palayew, Alipour, Kong, Yang, Wilchesky, Lipes, Greenaway), McGill University; Division of Respirology (M. Palayew), Jewish General Hospital, Montréal; Lady Davis Institute for Medical Research (Kong, Song, Tutt-Guérette, Wilchesky, Lipes, Azoulay, Greenaway), Jewish General Hospital; Division of Infectious Diseases (Kong, Greenaway), Jewish General Hospital; Department of Epidemiology and Biostatistics and Occupational Health (A. Palayew, Azoulay, Greenaway), McGill University; Department of Anesthesia (Yang), Jewish General Hospital; Division of Critical Care (Yang, Lipes), Jewish General Hospital; Donald Berman Maimonides Centre for Research in Aging (Wilchesky); Gerald Bronfman Department of Oncology (Azoulay), McGill University, Montréal, Que.
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10
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Benedetti A, Wu Y, Levis B, Wilchesky M, Boruff J, Ioannidis JPA, Patten SB, Cuijpers P, Shrier I, Gilbody S, Ismail Z, McMillan D, Mitchell N, Ziegelstein RC, Thombs BD. Diagnostic accuracy of the Geriatric Depression Scale-30, Geriatric Depression Scale-15, Geriatric Depression Scale-5 and Geriatric Depression Scale-4 for detecting major depression: protocol for a systematic review and individual participant data meta-analysis. BMJ Open 2018; 8:e026598. [PMID: 30518594 PMCID: PMC6286470 DOI: 10.1136/bmjopen-2018-026598] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION The 30-item Geriatric Depression Scale (GDS-30) and the shorter GDS-15, GDS-5 and GDS-4 are recommended as depression screening tools for elderly individuals. Existing meta-analyses on the diagnostic accuracy of the GDS have not been able to conduct subgroup analyses, have included patients already identified as depressed who would not be screened in practice and have not accounted for possible bias due to selective reporting of results from only better-performing cut-offs in primary studies. Individual participant data meta-analysis (IPDMA), which involves a standard systematic review, then a synthesis of individual participant data, rather than summary results, could address these limitations. The objective of our IPDMA is to generate accuracy estimates to detect major depression for all possible cut-offs of each version of the GDS among studies using different reference standards, separately and among participant subgroups based on age, sex, dementia diagnosis and care settings. In addition, we will use a modelling approach to generate individual participant probabilities for major depression based on GDS scores (rather than a dichotomous cut-off) and participant characteristics (eg, sex, age, dementia status, care setting). METHODS AND ANALYSIS Individual participant data comparing GDS scores to a major depression diagnosis based on a validated structured or semistructured diagnostic interview will be sought via a systematic review. Data sources will include Medline, Medline In-Process & Other Non-Indexed Citations, PsycINFO and Web of Science. Bivariate random-effects models will be used to estimate diagnostic accuracy parameters for each cut-off of the different versions of the GDS. Prespecified subgroup analyses will be conducted. Risk of bias will be assessed with the Quality Assessment of Diagnostic Accuracy Studies-2 tool. ETHICS AND DISSEMINATION The findings of this study will be of interest to stakeholders involved in research, clinical practice and policy. PROSPERO REGISTRATION NUMBER CRD42018104329.
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Affiliation(s)
- Andrea Benedetti
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Respiratory Epidemiology and Clinical Research Unit, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Yin Wu
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Brooke Levis
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Machelle Wilchesky
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Jill Boruff
- Schulich Library of Science and Engineering, McGill University, Montreal, Quebec, Canada
| | - John P A Ioannidis
- Stanford Prevention Research Center, Department of Medicine, and Department of Health Research and Policy, Stanford School of Medicine, Stanford, California, USA
- Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, USA
| | - Scott B Patten
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Psychiatry, University of Calgary, Calgary, Canada
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology and Amsterdam Public Health research institute, VU University Amsterdam, Amsterdam, The Netherlands
| | - Ian Shrier
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Simon Gilbody
- Hull York Medical School and Department of Health Sciences, The University of York, York, UK
| | - Zahinoor Ismail
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Psychiatry, University of Calgary, Calgary, Canada
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
| | - Dean McMillan
- Hull York Medical School and Department of Health Sciences, The University of York, York, UK
| | | | - Roy C Ziegelstein
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Brett D Thombs
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Department of Medicine, McGill University, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Department of Psychology, McGill University, Montreal, Canada
- Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada
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11
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Wilchesky M, Mueller G, Morin M, Marcotte M, Voyer P, Aubin M, Carmichael PH, Champoux N, Monette J, Giguère A, Durand P, Verreault R, Arcand M, Kröger E. The OptimaMed intervention to reduce inappropriate medications in nursing home residents with severe dementia: results from a quasi-experimental feasibility pilot study. BMC Geriatr 2018; 18:204. [PMID: 30180821 PMCID: PMC6123948 DOI: 10.1186/s12877-018-0895-z] [Citation(s) in RCA: 17] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 08/27/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Medication regimens in nursing home (NH) residents with severe dementia should be frequently reviewed to avoid inappropriate medication, overtreatment and adverse drug events, within a comfort care approach. This study aimed at testing the feasibility of an interdisciplinary knowledge exchange (KE) intervention using a medication review guidance tool categorizing medications as either "generally", "sometimes" or "exceptionally" appropriate for NH residents with severe dementia. METHODS A quasi-experimental feasibility pilot study with 44 participating residents aged 65 years or over with severe dementia was carried out in three NH in Quebec City, Canada. The intervention comprised an information leaflet for residents' families, a 90-min KE session for NH general practitioners (GP), pharmacists and nurses focusing on the medication review guidance tool, a medication review by the pharmacists for participating residents with ensuing team discussion on medication changes, and a post-intervention KE session to obtain feedback from team staff. Medication regimens and levels of pain and of agitation of the participants were evaluated at baseline and at 4 months post-intervention. A questionnaire for team staff explored perceived barriers and facilitators. Statistical differences in measures comparing pre and post-intervention were assessed using paired t-tests and Cochran's-Q tests. RESULTS The KE sessions reached 34 NH team staff (5 GP, 4 pharmacists, 6 heads of care unit and 19 staff nurses). Forty-four residents participated in the study and were followed for a mean of 104 days. The total number of regular medications was 372 pre and 327 post-intervention. The mean number of regular medications per resident was 7.86 pre and 6.81 post-intervention. The odds ratios estimating the risks of using any regular medication or a "sometimes appropriate" medication post-intervention were 0.81 (95% CI: 0.71-0.92) and 0.83 (95% CI: 0.74-0.94), respectively. CONCLUSION A simple KE intervention using a medication review guidance tool categorizing medications as being either "generally", "sometimes" or "exceptionally" appropriate in severe dementia was well received and accompanied by an overall reduction in medication use by NH residents with severe dementia. Levels of agitation were unaffected and there was no clinically significant changes in levels of pain. Staff feedback provided opportunities to improve the intervention.
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Affiliation(s)
- Machelle Wilchesky
- Department of Family Medicine and Division of Geriatric Medicine, McGill University, 5858, Chemin de la Côte-des-Neiges, Montreal, Quebec, H3S 1Z1, Canada.,Donald Berman Maimonides Centre for Research in Aging, 5795 Caldwell Avenue, Montreal, Quebec, H4W 1W3, Canada
| | - Gerhard Mueller
- Department of Nursing Science and Gerontology, UMIT-The Health & Life Sciences University, Eduard-Wallnoefer-Zentrum 1, A-6060, Hall in Tyrol, Tyrol, Austria
| | - Michèle Morin
- Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 1050, Chemin Ste-Foy, room L2-30, Quebec City, Quebec, G1S 4L8, Canada.,Laval University, 1050, avenue de la Médecine, Quebec City, Quebec, G1V 0A6, Canada
| | - Martine Marcotte
- Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 1050, Chemin Ste-Foy, room L2-30, Quebec City, Quebec, G1S 4L8, Canada
| | - Philippe Voyer
- Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 1050, Chemin Ste-Foy, room L2-30, Quebec City, Quebec, G1S 4L8, Canada.,Laval University, 1050, avenue de la Médecine, Quebec City, Quebec, G1V 0A6, Canada
| | - Michèle Aubin
- Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 1050, Chemin Ste-Foy, room L2-30, Quebec City, Quebec, G1S 4L8, Canada
| | - Pierre-Hugues Carmichael
- Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 1050, Chemin Ste-Foy, room L2-30, Quebec City, Quebec, G1S 4L8, Canada
| | - Nathalie Champoux
- Faculté de médecine, Université de Montréal, 2900 Boulevard Edouard-Montpetit, Montreal, Quebec, H3T 1J4, Canada
| | - Johanne Monette
- Division of Geriatric Medicine, McGill University, Jewish General Hospital, 3755 Côte-Ste-Catherine, Montreal, Quebec, H3T 1E2, Canada
| | - Anik Giguère
- Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 1050, Chemin Ste-Foy, room L2-30, Quebec City, Quebec, G1S 4L8, Canada.,Laval University, 1050, avenue de la Médecine, Quebec City, Quebec, G1V 0A6, Canada
| | - Pierre Durand
- Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 1050, Chemin Ste-Foy, room L2-30, Quebec City, Quebec, G1S 4L8, Canada.,Laval University, 1050, avenue de la Médecine, Quebec City, Quebec, G1V 0A6, Canada
| | - René Verreault
- Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 1050, Chemin Ste-Foy, room L2-30, Quebec City, Quebec, G1S 4L8, Canada.,Laval University, 1050, avenue de la Médecine, Quebec City, Quebec, G1V 0A6, Canada
| | - Marcel Arcand
- Centre de recherche sur le vieillissement, affilié à l'Université de Sherbrooke, 1036, rue Belvédère Sud, Sherbrooke, Quebec, J1H 4C4, Canada
| | - Edeltraut Kröger
- Centre d'excellence sur le vieillissement de Québec, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 1050, Chemin Ste-Foy, room L2-30, Quebec City, Quebec, G1S 4L8, Canada. .,Laval University, 1050, avenue de la Médecine, Quebec City, Quebec, G1V 0A6, Canada.
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12
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Andersen KM, Filion KB, Kröger E, Champoux N, Reynier P, Wilchesky M. O3‐02‐02: TREATMENT INITIATION CHARACTERISTICS OF ANTI‐DEMENTIA DRUG THERAPIES IN THE UNITED KINGDOM: A POPULATION‐BASED INCEPTION COHORT. Alzheimers Dement 2018. [DOI: 10.1016/j.jalz.2018.06.2777] [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: 11/16/2022]
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13
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Ballard SA, Yaffe MJ, August L, Cetin-Sahin D, Wilchesky M. Adapting the Elder Abuse Suspicion Index© for Use in Long-Term Care: A Mixed-Methods Approach. J Appl Gerontol 2017; 38:1472-1491. [PMID: 29165023 DOI: 10.1177/0733464817732443] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Currently available elder abuse screening and identification tools have limitations for use in long-term care (LTC). This mixed-methods study sought to explore the appropriateness of using the Elder Abuse Suspicion Index© (a suspicion tool originally created for use with older adults in the ambulatory setting with Mini-Mental State Examination scores ≥ 24) with similarly cognitively functioning persons residing in LTC. Results were informed by a literature review, Internet-based consultations with elder abuse experts across Canada (n = 19), and data obtained from two purposively selected focus groups (n = 7 local elder abuse experts; n = 7 experienced front-line LTC clinicians). Analyses resulted in the development of a nine-question tool, the EASI-ltc, designed to raise suspicion of EA in cognitively intact older adults residing in LTC (with little or no cognitive impairment). Notable modifications to the original Elder Abuse Suspicion Index© (EASI) included three new questions to further address neglect and psychological abuse, and a context-specific preamble to orient responders.
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Affiliation(s)
- Stephanie A Ballard
- 1 McGill University, Montreal, Québec, Canada.,2 Donald Berman Maimonides Geriatric Centre for Research in Aging, Montreal, Québec, Canada
| | - Mark J Yaffe
- 1 McGill University, Montreal, Québec, Canada.,3 St. Mary's Hospital Center, Montreal, Québec, Canada
| | - Linda August
- 4 Centre intégré universitaire de santé et de services sociaux Centre-Ouest-de-l'île-de-Montréal, Montreal, Québec, Canada
| | - Deniz Cetin-Sahin
- 2 Donald Berman Maimonides Geriatric Centre for Research in Aging, Montreal, Québec, Canada
| | - Machelle Wilchesky
- 1 McGill University, Montreal, Québec, Canada.,2 Donald Berman Maimonides Geriatric Centre for Research in Aging, Montreal, Québec, Canada.,5 Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Québec, Canada
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14
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Cetin-Sahin D, Lungu O, Peretti M, Gore G, Gore B, Voyer P, Wilchesky M. EFFECTIVENESS OF INTERVENTIONS TO REDUCE ACUTE CARE TRANSFERS FROM NURSING HOMES: A META-ANALYSIS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.4449] [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: 11/13/2022] Open
Affiliation(s)
- D. Cetin-Sahin
- Donald Berman Maimonides Centre for Research in Aging, Montreal, Quebec, Canada,
| | - O. Lungu
- Université de Montréal, Montreal, Quebec, Canada,
- Donald Berman Maimonides Centre for Research in Aging, Montreal, Quebec, Canada,
| | - M. Peretti
- McGill University, Department of Family Medicine,
Montreal, Quebec, Canada,
- Donald Berman Maimonides Centre for Research in Aging, Montreal, Quebec, Canada,
| | - G. Gore
- McGill University, Montreal, Quebec, Canada
| | - B. Gore
- Donald Berman Maimonides Centre for Research in Aging, Montreal, Quebec, Canada,
| | - P. Voyer
- Université Laval, Québec, Quebec, Canada,
| | - M. Wilchesky
- McGill University, Department of Family Medicine,
Montreal, Quebec, Canada,
- Donald Berman Maimonides Centre for Research in Aging, Montreal, Quebec, Canada,
- Lady Davis Institute for Medical Research, Montreal, Quebec, Canada,
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15
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Cole MG, McCusker J, Wilchesky M, Voyer P, Monette J, Champoux N, Vu M, Ciampi A, Belzile E. Use of medications that antagonize mediators of inflammatory responses may reduce the risk of delirium in older adults: a nested case-control study. Int J Geriatr Psychiatry 2017; 32:208-213. [PMID: 27001903 DOI: 10.1002/gps.4468] [Citation(s) in RCA: 2] [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: 10/06/2015] [Revised: 02/23/2016] [Accepted: 02/23/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The objective of this study is to explore whether the use of medications that antagonize mediators of inflammatory responses reduces the risk of delirium in older adults. METHODS A nested case-control study was conducted using data from a prospective study of delirium in older long-term care residents from 7 long-term care facilities in Montreal and Quebec City, Canada. The Confusion Assessment Method was used to diagnose incident delirium. The use of medications that antagonize mediators of inflammatory responses was determined by examining facility pharmacy databases and coding medications received daily by each resident. Risk sets were built using incidence density sampling: each risk set consisted of a case with incident delirium and all controls without incident delirium at the same date and facility. Conditional logistic regression was used to assess the association of exposure to inflammation antagonist medications with the incidence of delirium. RESULTS Of 254 residents, 95 developed incident delirium during 24 weeks (cases); each case was matched with up to 35 controls. Unadjusted and adjusted odds ratios (95% CI) of delirium for residents exposed to at least one inflammation antagonist medication were 0.53 (0.34, 0.81) and 0.60 (0.38, 0.92), respectively. Estimates of the risk of incident delirium associated with specific medications and medication classes were mostly protective but not statistically significant. CONCLUSION The use of medications that antagonize mediators of inflammatory responses may reduce the risk of delirium in older adults. Despite study limitations, the findings merit further investigation using larger patient samples, more precise measures of exposure and better control of potential confounding variables. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Martin G Cole
- Department of Psychiatry, St. Mary's Hospital Center and McGill University, Montreal, Quebec.,St. Mary's Research Centre, St Mary's Hospital Center, Montreal, Quebec
| | - Jane McCusker
- St. Mary's Research Centre, St Mary's Hospital Center, Montreal, Quebec.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec
| | - Machelle Wilchesky
- Division of Geriatric Medicine, Sir Mortimer B Davis Jewish General Hospital, Montreal, Quebec.,Donald Berman Maimonides Geriatric Center, Montreal, Quebec
| | - Philippe Voyer
- Faculty of Nursing Sciences, Laval University, Montreal, Quebec
| | - Johanne Monette
- Division of Geriatric Medicine, Sir Mortimer B Davis Jewish General Hospital, Montreal, Quebec.,Donald Berman Maimonides Geriatric Center, Montreal, Quebec
| | - Nathalie Champoux
- Institut Universitaire de Gériatrie de Montréal; Département de médecine familiale, Université de Montréal, Montreal, Quebec
| | - Minh Vu
- Division of Geriatric Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec.,Department of Medicine, Université de Montréal, Montreal, Quebec
| | - Antonio Ciampi
- St. Mary's Research Centre, St Mary's Hospital Center, Montreal, Quebec.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec
| | - Eric Belzile
- St. Mary's Research Centre, St Mary's Hospital Center, Montreal, Quebec
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16
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Kröger E, Mouls M, Wilchesky M, Berkers M, Carmichael PH, van Marum R, Souverein P, Egberts T, Laroche ML. Adverse Drug Reactions Reported With Cholinesterase Inhibitors. Ann Pharmacother 2015; 49:1197-206. [DOI: 10.1177/1060028015602274] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: No worldwide pharmacovigilance study evaluating the spectrum of adverse drug reactions (ADRs) induced by cholinesterase inhibitors (ChEI) in Alzheimer’s disease has been conducted since their emergence on the market. Objective: To describe ChEI related ADRs in Alzheimer’s disease (donepezil, rivastigmine, and galantamine) and characterize their seriousness as reported by national pharmacovigilance systems to VigiBase, a World Health Organization International Drug Monitoring Program database, between 1998 and 2013. Methods: All ChEI related reports, submitted to VigiBase between 1998 and 2013 from the five continents were extracted. Analyses were carried out for general, serious, and nonserious ADRs. Results: A total of 18 955 reports (43 753 ADRs) from 58 countries were reported: 60.1% in women; mean age 77.4 ± 9.1 years. Most reports originated from Europe (47.6%) and North America (40.4%). Rivastigmine and donepezil were involved in most reports (41.4% each). The most frequently reported ADRs were neuropsychiatric (31.4%), gastrointestinal (15.9%), general (11.9%), and cardiovascular (11.7%) disorders. During the 2006-2013 period, serious ADRs remained more often reported than nonserious ones; the most serious were neuropsychiatric (34.0%), general (14.0%), cardiovascular (12.1%), and gastrointestinal (11.6%) disorders. Medication errors were reported in 2.0% of serious cases. Death occurred in 2.3% of the reports. Conclusions: This international pharmacovigilance study highlights the ADR pattern induced by ChEIs. Neuropsychiatric events were the most frequently reported ADRs. Serious cardiovascular events were frequently reported, suggesting that their significance has probably been previously underestimated. Given the frailty of the patients and the frequent comedications, caution is advised before introducing a ChEI.
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Affiliation(s)
- Edeltraut Kröger
- Centre de Recherche du CHU de Québec, Canada
- Université Laval, Québec, Canada
| | - Marie Mouls
- Service de Pharmacologie-Toxicologie-Pharmacovigilance, Limoges, France
| | - Machelle Wilchesky
- McGill University, Montréal, Canada
- Centre for Clinical Epidemiology Jewish General Hospital–Lady Davis Research Institute, Montréal, Canada
- Donald Berman Maimonides Geriatric Centre, Montréal, Canada
| | | | | | - Rob van Marum
- Jeroen-Bosch Ziekenhuis, ‘s-Hertogenbosch, Netherlands
- EMGO Institute for Health and Care Research VU University Medical Center Amsterdam, Netherlands
| | | | - Toine Egberts
- Utrecht University, Netherlands
- University Medical Centre, Utrecht, Netherlands
| | - Marie-Laure Laroche
- Service de Pharmacologie-Toxicologie-Pharmacovigilance, Limoges, France
- Université de Limoges, Limoges, France
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Lungu O, Bruneau MA, Ballard S, Voyer P, Landreville P, Verreault R, Gore B, Champoux N, Desrosiers J, Kröger E, Monette J, Peretti M, Wilchesky M. P4‐055: Changes in neuropsychiatric subsyndromes in long‐term care residents with dementia across the circadian cycle. Alzheimers Dement 2015. [DOI: 10.1016/j.jalz.2015.06.1760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Ovidiu Lungu
- Centre for Research in Aging - Donald Berman Maimonides Geriatric CentreMontrealQCCanada
- Université de MontréalMontrealQCCanada
| | | | - Stephanie Ballard
- Centre for Research in Aging - Donald Berman Maimonides Geriatric CentreMontrealQCCanada
| | | | | | - René Verreault
- Université LavalQuebec CityQCCanada
- Centre d'Excellence sur le Vieillissement du CHU de QuébecQuébecQCCanada
| | - Brian Gore
- Centre for Research in Aging - Donald Berman Maimonides Geriatric CentreMontrealQCCanada
| | | | | | - Edeltraut Kröger
- Université LavalQuebec CityQCCanada
- Centre d'Excellence sur le Vieillissement du CHU de QuébecQuébecQCCanada
| | | | - Matteo Peretti
- Centre for Research in Aging - Donald Berman Maimonides Geriatric CentreMontrealQCCanada
| | - Machelle Wilchesky
- Centre for Research in Aging - Donald Berman Maimonides Geriatric CentreMontrealQCCanada
- McGill UniversityMontrealQCCanada
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18
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Kröger E, Wilchesky M, Marcotte M, Voyer P, Morin M, Champoux N, Monette J, Aubin M, Durand PJ, Verreault R, Arcand M. Medication Use Among Nursing Home Residents With Severe Dementia: Identifying Categories of Appropriateness and Elements of a Successful Intervention. J Am Med Dir Assoc 2015; 16:629.e1-17. [DOI: 10.1016/j.jamda.2015.04.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 04/02/2015] [Accepted: 04/02/2015] [Indexed: 12/20/2022]
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Wilchesky M, Lungu O. Predictive and concurrent validity of the Braden scale in long-term care: A meta-analysis. Wound Repair Regen 2015; 23:44-56. [DOI: 10.1111/wrr.12261] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 01/08/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Machelle Wilchesky
- Centre for Research in Aging; Donald Berman Maimonides Geriatric Centre
- Department of Medicine, Division of Geriatric Medicine; McGill University
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital
| | - Ovidiu Lungu
- Centre for Research in Aging; Donald Berman Maimonides Geriatric Centre
- Department of Psychiatry; University of Montreal; Montreal Quebec Canada
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Fournier JP, Wilchesky M, Patenaude V, Suissa S. Concurrent Use of Benzodiazepines and Antidepressants and the Risk of Motor Vehicle Accident in Older Drivers: A Nested Case-Control Study. Neurol Ther 2015; 4:39-51. [PMID: 26847674 PMCID: PMC4470976 DOI: 10.1007/s40120-015-0026-0] [Citation(s) in RCA: 7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Aging of the population results in an increase in senior drivers. Elderly are frequently treated with benzodiazepines and antidepressants. The objective of this study was to determine whether the concurrent use of benzodiazepines and antidepressants is associated with motor vehicle accidents (MVAs) in the elderly. METHODS This was a nested case-control study within a cohort of drivers aged 67-84 years between 1990 and 2000, identified from the Société de l'Assurance Automobile du Québec and the Régie de l'Assurance Maladie du Québec databases. First cases of MVAs during follow-up were matched with up to ten controls from the cohort. Odds ratios (ORs) for the association between MVA and the use of benzodiazepines and antidepressants were estimated using conditional logistic regression. RESULTS The cohort included 373,818 drivers, with 74,503 MVA cases matched with 744,663 controls. The risk of MVA was higher in current users of long-acting benzodiazepines [OR 1.23; 95% confidence interval (CI) 1.16-1.29] than in current users of short-acting benzodiazepines (OR 1.05; 95% CI 1.02-1.08). The risk of MVA was increased in current users of selective serotonin reuptake inhibitors (SSRIs; OR 1.13; 95% CI 1.04-1.22), while it was not in current users of tricyclic antidepressants (TCAs; OR 1.04; 95% CI 0.96-1.14). The highest ORs of MVA were observed in long-acting benzodiazepines users concurrently using SSRIs (OR 1.37; 95% CI 1.07-1.77, P value for interaction = 0.964) or TCAs (OR 1.54; 95% CI 1.21-1.95, P value for interaction = 0.077). CONCLUSION Use of long-acting benzodiazepines is associated with an increased risk of MVA in the elderly, particularly in those concurrently using SSRIs or TCAs.
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Affiliation(s)
- Jean-Pascal Fournier
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Machelle Wilchesky
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Canada.,Donald Berman Maimonides Geriatric Center, McGill University, Montreal, QC, Canada.,Department of Medicine, McGill University, Montreal, QC, Canada
| | - Valérie Patenaude
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Canada
| | - Samy Suissa
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Canada. .,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada.
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Abenhaim H, Wilchesky M, Platt R, Eberg M, Tulandi T, Suissa S, Filion K. 801: Effect of cesarean deliveries on the risk of hospital admissions for small bowel obstruction. Am J Obstet Gynecol 2015. [DOI: 10.1016/j.ajog.2014.10.1007] [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: 11/26/2022]
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Voyer P, Mercier J, Roy S, Claveau D, Kasprzak L, Lépine H, Mignault J, Rey S, Fortin MC, Desrochers A, Wilchesky M, Tremblay L, Savoie M, Roy O, Morin D. [Defending the promotion of clinical judgement]. Perspect Infirm 2014; 11:27-32. [PMID: 25269236] [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: 06/03/2023]
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Orriols L, Wilchesky M, Lagarde E, Suissa S. Prescription of antidepressants and the risk of road traffic crash in the elderly: a case-crossover study. Br J Clin Pharmacol 2014; 76:810-5. [PMID: 24148104 DOI: 10.1111/bcp.12090] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [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: 06/22/2012] [Accepted: 02/03/2013] [Indexed: 11/28/2022] Open
Abstract
AIM To investigate the impact of antidepressants on the risk of road traffic crash in the elderly. METHODS Reports from the Universal Quebec Automobile Insurance Agency database were matched with data on antidepressant prescription from the Quebec Health Insurance Agency. The case-crossover analysis consisted in comparing exposure during a period immediately before the crash with exposure during earlier periods, for the same subject. RESULTS One hundred and nine thousand four hundred and six drivers between 66 and 84 years of age involved in a traffic crash between 1988 and 2000 were included. Two thousand nine hundred and nineteen (2.7%) were exposed to an antidepressant on the day of the crash. Case-crossover analysis found an increased risk of crash in drivers with a prescription of antidepressants before their crash when compared with a prescription of antidepressants 4 to 8 months before the crash (OR = 1.19, 95% CI 1.08, 1.30 to 1.42. 95% CI 1.30, 1.55). With the most recent control periods, results were not significant. CONCLUSION A patient's mental state is probably more similar between two periods that are close to each other than up to 8 months before. Consequently, the risk of crash is likely to be linked to symptoms of depression.
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Affiliation(s)
- Ludivine Orriols
- University Bordeaux, ISPED, Bordeaux, France; INSERM, Equipe PPCT, ISPED, Centre INSERM U897-Epidemiologie-Biostatistique, Bordeaux, France
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Wilchesky M, Ernst P, Brophy JM, Platt RW, Suissa S. Educating the Adolescent and Young Adult With Cystic Fibrosis About Their Reproductive Risks and Options: Response. Chest 2013; 143:580. [DOI: 10.1378/chest.12-2495] [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: 11/01/2022] Open
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Wilchesky M, Ernst P, Brophy JM, Platt RW, Suissa S. Bronchodilator use and the risk of arrhythmia in COPD: part 2: reassessment in the larger Quebec cohort. Chest 2012; 142:305-311. [PMID: 22871756 DOI: 10.1378/chest.11-1597] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [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 A previous study suggested a potential increased risk of cardiac arrhythmia with new use of long-acting β-agonists and ipratropium bromide in patients with COPD, although conclusions were limited by the small cohort size. METHODS We reassessed this association in a larger cohort formed from the health-care databases of the province of Quebec, Canada. We identified a cohort of patients with COPD aged ≥ 67 years who began treatment between 1990 and 1999 and followed them until December 2003. A nested case-control approach matched each subject who developed severe arrhythmia during follow-up with 20 control subjects from the cohort on age, sex, and calendar time. The rate ratio (RR) of arrhythmia associated with new use of bronchodilators was estimated using conditional logistic regression, adjusting for COPD disease severity, cardiovascular disease, and other comorbidities. RESULTS The cohort included 76,661 patients with COPD, of whom 5,307 developed an arrhythmia (10.3 arrhythmias per 1,000 per year), 621 of which were fatal. The rate of cardiac arrhythmias was elevated with the new use of short-acting (RR, 1.27; 95% CI, 1.03-1.57) and long-acting (RR, 1.47; 95% CI, 1.01-2.15) β-agonists. The rate was slightly elevated, although not statistically significantly, with new use of ipratropium bromide (RR, 1.23; 95% CI, 0.95-1.57) and methylxanthines (RR, 1.28; 95% CI, 0.93-1.77). These effects waned with longer-term use. CONCLUSIONS New use of short- and long-acting β-agonists may slightly increase the risk of cardiac arrhythmia in patients with COPD. It remains unclear whether ipratropium bromide also increases this risk, despite the use of a larger study population.
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Affiliation(s)
- Machelle Wilchesky
- Donald Berman Maimonides Geriatric Centre, McGill University, QC, Canada; Centre for Clinical Epidemiology, Jewish General Hospital-Lady Davis Research Institute, Montreal, QC, Canada
| | - Pierre Ernst
- Department of Medicine, McGill University, QC, Canada; Centre for Clinical Epidemiology, Jewish General Hospital-Lady Davis Research Institute, Montreal, QC, Canada
| | - James M Brophy
- Department of Medicine, McGill University, QC, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, QC, Canada
| | - Robert W Platt
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, QC, Canada; Department of Pediatrics, McGill University, QC, Canada
| | - Samy Suissa
- Department of Medicine, McGill University, QC, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, QC, Canada; Centre for Clinical Epidemiology, Jewish General Hospital-Lady Davis Research Institute, Montreal, QC, Canada.
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Lapi F, Wilchesky M, Kezouh A, Benisty JI, Ernst P, Suissa S. Fluoroquinolones and the Risk of Serious Arrhythmia: A Population-Based Study. Clin Infect Dis 2012; 55:1457-65. [DOI: 10.1093/cid/cis664] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Gaskins AJ, Wilchesky M, Mumford SL, Whitcomb BW, Browne RW, Wactawski-Wende J, Perkins NJ, Schisterman EF. Endogenous reproductive hormones and C-reactive protein across the menstrual cycle: the BioCycle Study. Am J Epidemiol 2012; 175:423-31. [PMID: 22306563 DOI: 10.1093/aje/kwr343] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
C-reactive protein (CRP) is one of the most commonly used markers of acute phase reaction in clinical settings and predictors of cardiovascular risk in healthy women; however, data on its physiologic regulation in premenopausal women are sparse. The objective of this study was to evaluate the association between endogenous reproductive hormones and CRP in the BioCycle Study (2005-2007). Women aged 18-44 years from western New York were followed prospectively for up to 2 menstrual cycles (n = 259). Serum levels of CRP, estradiol, progesterone, luteinizing hormone, and follicle-stimulating hormone were measured up to 8 times per cycle, timed by fertility monitors. CRP levels varied significantly across the cycle (P < 0.001). More women were classified as being at elevated risk of cardiovascular disease (CRP, >3 mg/L) during menses compared with other phases (12.3% vs. 7.4%; P < 0.001). A 10-fold increase in estradiol was associated with a 24.3% decrease in CRP (95% confidence interval: 19.3, 29.0). A 10-fold increase in luteal progesterone was associated with a 19.4% increase in CRP (95% confidence interval: 8.4, 31.5). These results support the hypothesis that endogenous estradiol might have antiinflammatory effects and highlight the need for standardization of CRP measurement to menstrual cycle phase in reproductive-aged women.
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Affiliation(s)
- Audrey J Gaskins
- Division of Epidemiology, Statistics, and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
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Abstract
OBJECTIVES Few studies have attempted to validate the diagnostic information contained within medical service claims data, and only a small proportion of these have attempted to do so using the medical chart as a gold standard. The goal of this study is to determine the sensitivity and specificity of medical services claims diagnoses for surveillance of 14 drug disease contraindications used in drug utilization review, the Charlson comorbidity index and the Johns Hopkins Adjusted Care Group Case-Mix profile (ADGs). STUDY DESIGN AND SETTING Diagnoses were abstracted from the medical charts of 14,980 patients, and were used as the "gold standard," against which diagnoses obtained from the administrative database for the same patients were compared. RESULTS Conditions associated with drug disease contraindications with the exception of hypertension and chronic obstructive pulmonary disease (COPD) showed a specificity of 90% or higher. Sensitivity of claims data was substantially lower, with glaucoma, hypertension, and diabetes being the most sensitive conditions at 76, 69, and 64%, respectively. Each of the 18 disease conditions contained in the Charlson comorbidity index showed high specificity, but sensitivity was more variable among conditions as well as by coding definitions. Although ADG specificity was also high, the vast majority of ADGs had sensitivities of less than 60%. CONCLUSION The administrative data was found to have diagnoses and conditions that were highly specific but that vary greatly by condition in terms of sensitivity. To appropriately obtain diagnostic profiles, it is recommended that data pertaining to all physician billings be used.
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Affiliation(s)
- Machelle Wilchesky
- Department of Epidemiology and Biostatistics, McGill University, Morrice House, 1140 Pine Avenue West, Montreal, QCH3A 1A3, Canada
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MacKenzie TA, Willan AR, Wilchesky M. Use of severity to evaluate appropriateness of admissions and length of stay. Healthc Manage Forum 1991; 4:31-4. [PMID: 10112778 DOI: 10.1016/s0840-4704(10)61253-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
We undertook a case study for a Canadian teaching hospital to see if use of a severity of illness system could facilitate management of utilization practice in the hospital. The two issues selected were low severity emergency room admissions and length of stay on medical services. Use of a severity system allows for comparisons within case mix groups and also should control for large differences in severity within CMGs. The results of the study were consistent with the prior expectation of the hospital with respect to the relative efficiency of the physicians under study.
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