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Mizubuti GB, Maxwell S, Shatenko S, Braund H, Phelan R, Ho AMH, Dalgarno N, Hobbs H, Szulewski A, Haji F, Arellano R. Competencies for proficiency in basic point-of-care ultrasound in anesthesiology: national expert recommendations using Delphi methodology. Can J Anaesth 2024:10.1007/s12630-024-02746-w. [PMID: 38632162 DOI: 10.1007/s12630-024-02746-w] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/27/2024] [Accepted: 01/30/2024] [Indexed: 04/19/2024] Open
Abstract
PURPOSE Point-of-care ultrasound (POCUS) allows for rapid bedside assessment and guidance of patient care. Recently, POCUS was included as a mandatory component of Canadian anesthesiology training; however, there is no national consensus regarding the competencies to guide curriculum development. We therefore aimed to define national residency competencies for basic perioperative POCUS proficiency. METHODS We adopted a Delphi process to delineate relevant POCUS competencies whereby we circulated an online survey to academic anesthesiologists identified as POCUS leads/experts (n = 25) at all 17 Canadian anesthesiology residency programs. After reviewing a list of competencies derived from the Royal College of Physicians and Surgeons of Canada's National Curriculum, we asked participants to accept, refine, delete, or add competencies. Three rounds were completed between 2022 and 2023. We discarded items with < 50% agreement, revised those with 50-79% agreement based upon feedback provided, and maintained unrevised those items with ≥ 80% agreement. RESULTS We initially identified and circulated (Round 1) 74 competencies across 19 clinical domains (e.g., basics of ultrasound [equipment, nomenclature, clinical governance, physics]; cardiac [left ventricle, right ventricle, valve assessment, pericardial effusion, intravascular volume status] and lung ultrasound anatomy, image acquisition, and image interpretation; and clinical applications [monitoring and serial assessments, persistent hypotension, respiratory distress, cardiac arrest]). After three Delphi rounds (and 100% response rate maintained), panellists ultimately agreed upon 75 competencies. CONCLUSION Through national expert consensus, this study identified POCUS competencies suitable for curriculum development and assessment in perioperative anesthesiology. Next steps include designing and piloting a POCUS curriculum and assessment tool(s) based upon these nationally defined competencies.
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Affiliation(s)
- Glenio B Mizubuti
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, ON, Canada.
- Department of Anesthesiology and Perioperative Medicine, Kingston Health Sciences Centre, Kingston General Hospital Site, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada.
| | - Sarah Maxwell
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, ON, Canada
| | - Sergiy Shatenko
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, ON, Canada
| | - Heather Braund
- Faculty of Health Sciences, Office of Professional Development and Educational Scholarship, Queen's University, Kingston, ON, Canada
| | - Rachel Phelan
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, ON, Canada
| | - Anthony M-H Ho
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, ON, Canada
| | - Nancy Dalgarno
- Faculty of Health Sciences, Office of Professional Development and Educational Scholarship, Queen's University, Kingston, ON, Canada
| | - Hailey Hobbs
- Department of Critical Care Medicine, POCUS Fellowship Program Director, Queen's University, Kingston, ON, Canada
| | - Adam Szulewski
- Departments of Emergency Medicine and Psychology, Educational Scholarship Lead & Resuscitation and Reanimation Medicine Fellowship Program Director, Queen's University, Kingston, ON, Canada
| | - Faizal Haji
- Division of Neurosurgery, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Ramiro Arellano
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, ON, Canada
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Subramanian L, Coo H, Jane A, Flemming JA, Acker A, Hoggan B, Griffiths R, Sehgal A, Mulder D. Celiac Disease and Inflammatory Bowel Disease are Associated with Increased Risk of Eating Disorders: An Ontario Health Administrative Database Study. Clin Transl Gastroenterol 2024:01720094-990000000-00247. [PMID: 38557476 DOI: 10.14309/ctg.0000000000000700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 03/18/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Previous national registry studies have reported an increased risk of eating disorders in immune-mediated conditions (inflammatory bowel disease [IBD] and celiac disease). Our objective was to examine the association between immune-mediated GI diseases and incident eating disorders in Ontario. METHODS This was a retrospective matched cohort study of individuals <50 years of age with a diagnosis of an immune-mediated GI disease between 2002 and 2020 ("cases"). Those with a pre-existing eating disorder were excluded. Cases (n=83,920) were matched with controls (n=167,776) based on birth year, sex, and region of residence. Incidence rate ratio and hazard ratio were estimated using Poisson regression model and adjusted Cox proportional models, respectively. RESULTS Over the follow-up period (up to January 31, 2022), 161 cases and 160 controls were identified with eating disorders. The overall incidence rate ratio (95% CI, p-value) of eating disorders in immune-mediated GI disease was 1.99 (1.6-2.5, p<0.001). The adjusted hazard ratios for eating disorder in cases with immune-mediated GI diseases was 1.98 (1.6-2.5, p<0.001). In the pediatric group of incident cases (≤18 years of age), overall adjusted hazard ratio was 2.62 (1.9-3.7, p<0.001)) compared to 1.56 (1.02-2.4, p=0.041) for adults (>18 years of age). The largest hazard ratio of 4.11 (1.6-10.3, p=0.003) was observed for pediatric incident cases of ulcerative colitis. CONCLUSION IBD and celiac disease are associated with the development of eating disorders. The magnitude of the association was stronger in the pediatric age group, underscoring the need for early screening and detection.
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Affiliation(s)
| | - Helen Coo
- Department of Pediatrics, Queen's University, Kingston, Ontario, Canada
| | - Alanna Jane
- Department of Pediatrics, Queen's University, Kingston, Ontario, Canada
| | - Jennifer A Flemming
- Gastrointestinal Diseases Research Unit, Faculty of Health Sciences, Queen's University, Ontario, Canada
- Institute of Clinical Evaluative Sciences (ICES), Ontario, Canada
| | - Amy Acker
- Department of Pediatrics, Queen's University, Kingston, Ontario, Canada
| | - Benjamin Hoggan
- Institute of Clinical Evaluative Sciences (ICES), Ontario, Canada
| | | | - Anupam Sehgal
- Department of Pediatrics, Queen's University, Kingston, Ontario, Canada
| | - Daniel Mulder
- Department of Pediatrics, Queen's University, Kingston, Ontario, Canada
- Gastrointestinal Diseases Research Unit, Faculty of Health Sciences, Queen's University, Ontario, Canada
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3
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Martin MI, Mauer-Vakil D, Borkhoff CM, Parkin PC, Bayoumi I. Connecting families: a qualitative study examining the experiences of parenting young children under financial strain in Ontario, Canada. BMC Public Health 2024; 24:913. [PMID: 38549075 PMCID: PMC10976761 DOI: 10.1186/s12889-024-18463-4] [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: 06/20/2023] [Accepted: 03/27/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND There is little research investigating the subjective experiences of parenting young children while living in poverty and experiencing financial strain using qualitative methodologies. Therefore, the objective of this study was to employ a qualitative approach to provide a nuanced and balanced view on the topic of parenting young children under financial strain in the Canadian context. METHODS We conducted a qualitative study using semi-structured interviews between July and August 2021 in Kingston, Ontario, Canada. Sixteen participants aged 20-39 self-identified as living under financial strain while parenting a child aged 2-5 years. A qualitative inductive thematic analysis was undertaken with a focus on describing the contents of the data. RESULTS Four major themes emerged from the data: experience of being a parent, impact of financial strain on the family unit, impact of financial strain on the children, and impact of financial strain on the parent. Numerous deleterious physical, mental, and material impacts on the family unit and parent were identified, however parent-perceived impacts of financial strain on their children were minimal. Parents described striking levels of resourcefulness and resiliency in providing the necessities for their families, absorbing the most significant impacts of financial strain through the phenomenon of self-sacrifice. CONCLUSION The impacts of financial strain on families with young children are far reaching. Further research into the impacts of self-sacrifice on parents experiencing financial strain are needed to better understand this issue, and to inform social programming and resources that could help alleviate the deleterious impacts of poverty on parent mental, social, and physical health.
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Affiliation(s)
- Mary I Martin
- Centre for Studies in Primary Care, Queen's University, 220 Bagot St, K7L 5E9, Kingston, ON, P.O. Bag 8888, Canada
| | - Dane Mauer-Vakil
- Centre for Studies in Primary Care, Queen's University, 220 Bagot St, K7L 5E9, Kingston, ON, P.O. Bag 8888, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Cornelia M Borkhoff
- Pediatric Outcomes Research Team (PORT), Division of Pediatric Medicine and SickKids Research Institute, Hospital for Sick Children, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Patricia C Parkin
- Pediatric Outcomes Research Team (PORT), Division of Pediatric Medicine and SickKids Research Institute, Hospital for Sick Children, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Department of Pediatrics, Temetry Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Imaan Bayoumi
- Centre for Studies in Primary Care, Queen's University, 220 Bagot St, K7L 5E9, Kingston, ON, P.O. Bag 8888, Canada.
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4
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Moloney M, Morra A, Morkem R, Queenan J, Gupta S, To T, Digby G, Barber D, Lougheed MD. Validation of adult asthma case definitions for primary care sentinel surveillance. Allergy Asthma Clin Immunol 2023; 19:95. [PMID: 37957742 PMCID: PMC10644606 DOI: 10.1186/s13223-023-00854-8] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 11/01/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Most asthma diagnoses and patient care take place in primary care settings. Electronic medical records (EMRs) offer an opportunity to utilize technology to improve asthma diagnosis and care. The purpose of this study was to create and validate separate case definitions for suspected and confirmed asthma in primary care EMRs, to enable surveillance, benchmarking, and quality improvement in primary care settings. The objective of this study was to develop a case definition for suspected and confirmed asthma for use in a primary care sentinel surveillance system. METHODS A single chart abstractor conducted a manual audit of 776 randomly selected patient charts from an academic primary care practice EMR in Kingston, Ontario. Following the single chart abstractor classification, a consensus on chart classification as "not asthma", "suspected asthma", or "confirmed asthma" was achieved between the abstractor, a family physician, and a respirologist using Canadian Thoracic Society (CTS) criteria. Case definition algorithms based on billing codes, clinical data elements and medications were applied to the site's Canadian Primary Care Sentinel Surveillance Network (CPCSSN) data for the same charts and compared to abstractor classifications to determine each algorithm's measurement properties. RESULTS The prevalence of suspected and confirmed asthma were 7.3% (n = 54) and 2.4% (n = 18), respectively. None of the proposed case definitions could differentiate between suspected and confirmed asthma. One algorithm consisting of billing, clinical, and medication elements had the highest Youden's Index for either suspected or confirmed asthma. The algorithm had a sensitivity of 81%, a specificity of 96%, positive predictive value of 71%, negative predictive value of 98%, and a Youden's Index of 0.77 for combined suspected or confirmed asthma cases. CONCLUSION An EMR case definition for suspected or confirmed adult asthma has been validated for use in CPCSSN. Implementation of this case definition will enable the development of a surveillance electronic tool (eTool) for adult asthma that can foster quality improvement.
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Affiliation(s)
- Max Moloney
- Asthma Research Unit, Kingston General Hospital, Kingston Health Sciences Centre at Queen's University, 72 Stuart Street, Kingston, ON, K7L 2V7, Canada.
- Division of Respirology, Department of Medicine, Queen's University, Kingston, ON, Canada.
| | - Alison Morra
- Asthma Research Unit, Kingston General Hospital, Kingston Health Sciences Centre at Queen's University, 72 Stuart Street, Kingston, ON, K7L 2V7, Canada
- Division of Respirology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Rachael Morkem
- Canadian Primary Care Sentinel Surveillance Network (Eastern Ontario Network), Kingston, ON, Canada
| | - John Queenan
- Department of Family Medicine, Queen's University, Kingston, ON, Canada
| | - Samir Gupta
- Division of Respirology, Department of Medicine, St. Michael's Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Teresa To
- Child Health Evaluative Science, The Hospital for Sick Children, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Geneviève Digby
- Division of Respirology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - David Barber
- Department of Family Medicine, Queen's University, Kingston, ON, Canada
- Canadian Primary Care Sentinel Surveillance Network (Eastern Ontario Network), Kingston, ON, Canada
| | - M Diane Lougheed
- Asthma Research Unit, Kingston General Hospital, Kingston Health Sciences Centre at Queen's University, 72 Stuart Street, Kingston, ON, K7L 2V7, Canada
- Division of Respirology, Department of Medicine, Queen's University, Kingston, ON, Canada
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5
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Jansen-van Vuuren RD, Jedlovčnik L, Košmrlj J, Massey TE, Derdau V. Deuterated Drugs and Biomarkers in the COVID-19 Pandemic. ACS Omega 2022; 7:41840-41858. [PMID: 36440130 PMCID: PMC9685803 DOI: 10.1021/acsomega.2c04160] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 10/18/2022] [Indexed: 06/07/2023]
Abstract
Coronavirus disease 2019 (COVID-19) is a highly contagious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Initially identified in Wuhan (China) in December 2019, COVID-19 rapidly spread globally, resulting in the COVID-19 pandemic. Carriers of the SARS-CoV-2 can experience symptoms ranging from mild to severe (or no symptoms whatsoever). Although vaccination provides extra immunity toward SARS-CoV-2, there has been an urgent need to develop treatments for COVID-19 to alleviate symptoms for carriers of the disease. In seeking a potential treatment, deuterated compounds have played a critical role either as therapeutic agents or as internal MS standards for studying the pharmacological properties of new drugs by quantifying the parent compounds and metabolites. We have identified >70 examples of deuterium-labeled compounds associated with treatment of COVID-19. Of these, we found 9 repurposed drugs and >20 novel drugs studied for potential therapeutic roles along with a total of 38 compounds (drugs, biomarkers, and lipids) explored as internal mass spectrometry standards. This review details the synthetic pathways and modes of action of these compounds (if known), and a brief analysis of each study.
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Affiliation(s)
- Ross D. Jansen-van Vuuren
- Faculty
of Chemistry and Chemical Technology, University
of Ljubljana, Večna pot 113, Ljubljana 1000, Slovenia
- Department
of Chemistry, Queen’s University, 90 Bader Lane, Kingston, Ontario K7L
3N6, Canada
| | - Luka Jedlovčnik
- Faculty
of Chemistry and Chemical Technology, University
of Ljubljana, Večna pot 113, Ljubljana 1000, Slovenia
| | - Janez Košmrlj
- Faculty
of Chemistry and Chemical Technology, University
of Ljubljana, Večna pot 113, Ljubljana 1000, Slovenia
| | - Thomas E. Massey
- Department
of Biomedical and Molecular Sciences, School of Medicine, Queen’s University, Botterell Hall, 18 Stuart Street, Kingston, Ontario K7L 3N6, Canada
| | - Volker Derdau
- Research
& Development, Integrated Drug Discovery, Isotope Chemistry, Sanofi-Aventis Deutschland GmbH, Industriepark Höchst G876, Frankfurt/Main 65926, Germany
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6
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Parr AC, Calancie OG, Coe BC, Khalid-Khan S, Munoz DP. Impulsivity and Emotional Dysregulation Predict Choice Behavior During a Mixed-Strategy Game in Adolescents With Borderline Personality Disorder. Front Neurosci 2022; 15:667399. [PMID: 35237117 PMCID: PMC8882924 DOI: 10.3389/fnins.2021.667399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 12/28/2021] [Indexed: 11/13/2022] Open
Abstract
Impulsivity and emotional dysregulation are two core features of borderline personality disorder (BPD), and the neural mechanisms recruited during mixed-strategy interactions overlap with frontolimbic networks that have been implicated in BPD. We investigated strategic choice patterns during the classic two-player game, Matching Pennies, where the most efficient strategy is to choose each option randomly from trial-to-trial to avoid exploitation by one’s opponent. Twenty-seven female adolescents with BPD (mean age: 16 years) and twenty-seven age-matched female controls (mean age: 16 years) participated in an experiment that explored the relationship between strategic choice behavior and impulsivity in both groups and emotional dysregulation in BPD. Relative to controls, BPD participants showed marginally fewer reinforcement learning biases, particularly decreased lose-shift biases, increased variability in reaction times (coefficient of variation; CV), and a greater percentage of anticipatory decisions. A subset of BPD participants with high levels of impulsivity showed higher overall reward rates, and greater modulation of reaction times by outcome, particularly following loss trials, relative to control and BPD participants with lower levels of impulsivity. Additionally, BPD participants with higher levels of emotional dysregulation showed marginally increased reward rate and increased entropy in choice patterns. Together, our preliminary results suggest that impulsivity and emotional dysregulation may contribute to variability in mixed-strategy decision-making in female adolescents with BPD.
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Affiliation(s)
- Ashley C. Parr
- Centre for Neuroscience Studies, Queen’s University, Kingston, ON, Canada
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
- Division of Child and Youth Mental Health, Kingston Health Sciences Centre, Kingston, ON, Canada
- *Correspondence: Ashley C. Parr,
| | - Olivia G. Calancie
- Centre for Neuroscience Studies, Queen’s University, Kingston, ON, Canada
- Division of Child and Youth Mental Health, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Brian C. Coe
- Centre for Neuroscience Studies, Queen’s University, Kingston, ON, Canada
| | - Sarosh Khalid-Khan
- Centre for Neuroscience Studies, Queen’s University, Kingston, ON, Canada
- Division of Child and Youth Mental Health, Kingston Health Sciences Centre, Kingston, ON, Canada
| | - Douglas P. Munoz
- Centre for Neuroscience Studies, Queen’s University, Kingston, ON, Canada
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON, Canada
- Douglas P. Munoz,
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7
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Philip G, Djerboua M, Carlone D, Flemming JA. Validation of a hierarchical algorithm to define chronic liver disease and cirrhosis etiology in administrative healthcare data. PLoS One 2020; 15:e0229218. [PMID: 32069337 PMCID: PMC7028265 DOI: 10.1371/journal.pone.0229218] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 01/31/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND AIMS Chronic liver disease (CLD) and cirrhosis are leading causes of death globally with the burden of disease rising significantly over the past several decades. Defining the etiology of liver disease is important for understanding liver disease epidemiology, healthcare planning, and outcomes. The aim of this study was to validate a hierarchical algorithm for CLD and cirrhosis etiology in administrative healthcare data. METHODS Consecutive patients with CLD or cirrhosis attending an outpatient hepatology clinic in Ontario, Canada from 05/01/2013-08/31/2013 underwent detailed chart abstraction. Gold standard liver disease etiology was determined by an attending hepatologist as hepatitis C (HCV), hepatitis B (HBV), alcohol-related, non-alcoholic fatty liver disease (NAFLD)/cryptogenic, autoimmune or hemochromatosis. Individual data was linked to routinely collected administrative healthcare data at ICES. Diagnostic accuracy of a hierarchical algorithm incorporating both laboratory and administrative codes to define etiology was evaluated by calculating sensitivity, specificity, positive (PPV) and negative predictive values (NPV), and kappa's agreement. RESULTS 442 individuals underwent chart abstraction (median age 53 years, 53% cirrhosis, 45% HCV, 26% NAFLD, 10% alcohol-related). In patients with cirrhosis, the algorithm had adequate sensitivity/PPV (>75%) and excellent specificity/NPV (>90%) for all etiologies. In those without cirrhosis, the algorithm was excellent for all etiologies except for hemochromatosis and autoimmune diseases. CONCLUSIONS A hierarchical algorithm incorporating laboratory and administrative coding can accurately define cirrhosis etiology in routinely collected healthcare data. These results should facilitate health services research in this growing patient population.
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Affiliation(s)
- George Philip
- Translational Institute of Medicine, Queen’s University, Kingston, Ontario, Canada
| | | | - David Carlone
- Departments of Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Jennifer A. Flemming
- Translational Institute of Medicine, Queen’s University, Kingston, Ontario, Canada
- ICES, Queen’s University, Kingston, Ontario, Canada
- Departments of Medicine, Queen’s University, Kingston, Ontario, Canada
- Departments of Public Health Sciences, Queen’s University, Kingston, Ontario, Canada
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Semrau JS, Scott SH, Hamilton AG, Petsikas D, Payne DM, Bisleri G, Saha T, Boyd JG. Road to recovery: a study protocol quantifying neurological outcome in cardiac surgery patients and the role of cerebral oximetry. BMJ Open 2019; 9:e032935. [PMID: 31796491 PMCID: PMC6924829 DOI: 10.1136/bmjopen-2019-032935] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Patients undergoing cardiac surgery may experience both short-term and long-term postoperative neurological problems. However, the underlying cause of this impairment is unclear. Regional cerebral oxygen saturation (rSO2) levels may play a role in the development of acute dysfunction, known as postoperative delirium, in addition to longer term outcomes after cardiac surgery. Yet the degree of impairment has been difficult to define, partly due to subjective methods of assessments. This study aims to fill this knowledge gap by determining the relationship between rSO2, postoperative delirium and long-term neurological outcome after cardiac surgery using quantitative robotic technology. METHODS AND ANALYSIS 95 patients scheduled for elective cardiac surgery will be recruited for this single-centre prospective observational study. Patients will be assessed before as well as 3 and 12 months after their surgery using the Kinarm End-Point Lab and standardised tasks. Intraoperatively, rSO2 and other haemodynamic data will be collected for the duration of the procedure. Following their operation, patients will also be screened daily for delirium during their hospital stay. ETHICS AND DISSEMINATION This study has been approved by the Health Sciences Research Ethics Board at Queen's University (DMED-1672-14). The results of this study will be published in a peer-review journal and presented at international and/or national conferences as poster or oral presentations. Participants wishing to know the results of this study will be contacted directly on data publication. TRIAL REGISTRATION NUMBER NCT04081649.
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Affiliation(s)
- Joanna S Semrau
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
| | - Stephen H Scott
- Centre for Neuroscience Studies, Queen's University, Kingston, Ontario, Canada
- Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - Andrew G Hamilton
- Cardiac Surgery, Kingston General Hospital, Kingston, Ontario, Canada
- Surgery, Queen's University, Kingston, Ontario, Canada
| | - Dimitri Petsikas
- Cardiac Surgery, Kingston General Hospital, Kingston, Ontario, Canada
- Surgery, Queen's University, Kingston, Ontario, Canada
| | - Darrin M Payne
- Cardiac Surgery, Kingston General Hospital, Kingston, Ontario, Canada
- Surgery, Queen's University, Kingston, Ontario, Canada
| | - Gianluigi Bisleri
- Cardiac Surgery, Kingston General Hospital, Kingston, Ontario, Canada
- Surgery, Queen's University, Kingston, Ontario, Canada
| | - Tarit Saha
- Anesthesiology and Perioperative Medicine, Kingston General Hospital, Kingston, Ontario, Canada
- Anesthesiology and Perioperative Medicine, Queen's University, Kingston, Ontario, Canada
| | - John Gordon Boyd
- Critical Care Medicine, Kingston General Hospital, Kingston, Ontario, Canada
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9
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Kroll RR, McKenzie ED, Boyd JG, Sheth P, Howes D, Wood M, Maslove DM. Use of wearable devices for post-discharge monitoring of ICU patients: a feasibility study. J Intensive Care 2017; 5:64. [PMID: 29201377 PMCID: PMC5698959 DOI: 10.1186/s40560-017-0261-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 11/08/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Wearable devices generate signals detecting activity, sleep, and heart rate, all of which could enable detailed and near-continuous characterization of recovery following critical illness. METHODS To determine the feasibility of using a wrist-worn personal fitness tracker among patients recovering from critical illness, we conducted a prospective observational study of a convenience sample of 50 stable ICU patients. We assessed device wearability, the extent of data capture, sensitivity and specificity for detecting heart rate excursions, and correlations with questionnaire-derived sleep quality measures. RESULTS Wearable devices were worn over a 24-h period, with excellent capture of data. While specificity for the detection of tachycardia was high (98.8%), sensitivity was low to moderate (69.5%). There was a moderate correlation between wearable-derived sleep duration and questionnaire-derived sleep quality (r = 0.33, P = 0.03). Devices were well-tolerated and demonstrated no degradation in quality of data acquisition over time. CONCLUSIONS We found that wearable devices could be worn by patients recovering from critical illness and could generate useful data for the majority of patients with little adverse effect. Further development and study are needed to better define and enhance the role of wearables in the monitoring of post-ICU recovery. TRIAL REGISTRATION Clinicaltrials.gov, NCT02527408.
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Affiliation(s)
- Ryan R. Kroll
- Department of Critical Care Medicine, Queen’s University and Kingston Health Sciences Centre, Kingston, Ontario Canada
| | | | - J. Gordon Boyd
- Department of Critical Care Medicine, Queen’s University and Kingston Health Sciences Centre, Kingston, Ontario Canada
- Department of Medicine, Queen’s University and Kingston Health Sciences Centre, Kingston, Ontario Canada
| | - Prameet Sheth
- Department of Pathology and Molecular Medicine, Queen’s University and Health Sciences Centre, Kingston, Ontario Canada
| | - Daniel Howes
- Department of Critical Care Medicine, Queen’s University and Kingston Health Sciences Centre, Kingston, Ontario Canada
- Department of Emergency Medicine, Queen’s University and Kingston Health Sciences Centre, Kingston, Ontario Canada
| | - Michael Wood
- Department of Neuroscience, Queen’s University, Kingston, Ontario Canada
| | - David M. Maslove
- Department of Critical Care Medicine, Queen’s University and Kingston Health Sciences Centre, Kingston, Ontario Canada
- Department of Medicine, Queen’s University and Kingston Health Sciences Centre, Kingston, Ontario Canada
- Kingston Health Sciences Centre, Kingston General Hospital, Davies 2, 76 Stuart St., Kingston, Ontario K7L 2V7 Canada
| | - for the WEARable Information Technology for hospital INpatients (WEARIT-IN) study group
- Department of Critical Care Medicine, Queen’s University and Kingston Health Sciences Centre, Kingston, Ontario Canada
- School of Medicine, Queen’s University, Kingston, Ontario Canada
- Department of Medicine, Queen’s University and Kingston Health Sciences Centre, Kingston, Ontario Canada
- Department of Pathology and Molecular Medicine, Queen’s University and Health Sciences Centre, Kingston, Ontario Canada
- Department of Emergency Medicine, Queen’s University and Kingston Health Sciences Centre, Kingston, Ontario Canada
- Department of Neuroscience, Queen’s University, Kingston, Ontario Canada
- Kingston Health Sciences Centre, Kingston General Hospital, Davies 2, 76 Stuart St., Kingston, Ontario K7L 2V7 Canada
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