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1. A Canadian survey of perceptions and practices related to ordering of blood tests in the intensive care unit

Author

Rahman, M. Omair, Charbonney, Emannuel, Vaisler, Ryan, Khalifa, Abubaker, Alhazzani, Waleed, Gossack-Keenan, Kiera, Garland, Allan, Karachi, Timothy, Duan, Erick, Bagshaw, Sean M., Meade, Maureen O., Hillis, Chris, Kavsak, Peter, Born, Karen, Mbuagbaw, Lawrence, Siegal, Deborah, Millen, Tina, Scales, Damon, Amaral, Andre, English, Shane, McCredie, Victoria A., Dodek, Peter, Cook, Deborah J., and Rochwerg, Bram

Published
2024
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2. Wellness and Coping of Physicians Who Worked in ICUs During the Pandemic: A Multicenter Cross-Sectional North American Survey*

Author

Burns, Karen EA, Moss, Marc, Lorens, Edmund, Jose, Elizabeth Karin Ann, Martin, Claudio M, Viglianti, Elizabeth M, Fox-Robichaud, Alison, Mathews, Kusum S, Akgun, Kathleen, Jain, Snigdha, Gershengorn, Hayley, Mehta, Sangeeta, Han, Jenny E, Martin, Gregory S, Liebler, Janice M, Stapleton, Renee D, Trachuk, Polina, Vranas, Kelly C, Chua, Abigail, Herridge, Margaret S, Tsang, Jennifer LY, Biehl, Michelle, Burnham, Ellen L, Chen, Jen-Ting, Attia, Engi F, Mohamed, Amira, Harkins, Michelle S, Soriano, Sheryll M, Maddux, Aline, West, Julia C, Badke, Andrew R, Bagshaw, Sean M, Binnie, Alexandra, Carlos, W Graham, Çoruh, Başak, Crothers, Kristina, D’Aragon, Frederick, Denson, Joshua Lee, Drover, John W, Eschun, Gregg, Geagea, Anna, Griesdale, Donald, Hadler, Rachel, Hancock, Jennifer, Hasmatali, Jovan, Kaul, Bhavika, Kerlin, Meeta Prasad, Kohn, Rachel, Kutsogiannis, D James, Matson, Scott M, Morris, Peter E, Paunovic, Bojan, Peltan, Ithan D, Piquette, Dominique, Pirzadeh, Mina, Pulchan, Krishna, Schnapp, Lynn M, Sessler, Curtis N, Smith, Heather, Sy, Eric, Thirugnanam, Subarna, McDonald, Rachel K, McPherson, Katie A, Kraft, Monica, Spiegel, Michelle, Dodek, Peter M, and Society, for the Diversity-Related Research Committee of the Women in Critical Care Interest Group of the American Thoracic

Subjects
Health Services and Systems, Health Sciences, Clinical Research, Prevention, Adult, Male, Humans, Child, United States, Female, Cross-Sectional Studies, Pandemics, COVID-19, Burnout, Professional, Physicians, Intensive Care Units, Adaptation, Psychological, Surveys and Questionnaires, North America, burnout, coping, moral distress, pandemic, wellness, Diversity-Related Research Committee of the Women in Critical Care (WICC) Interest Group of the American Thoracic Society, Clinical Sciences, Nursing, Public Health and Health Services, Emergency & Critical Care Medicine, Clinical sciences
Abstract

ObjectivesFew surveys have focused on physician moral distress, burnout, and professional fulfilment. We assessed physician wellness and coping during the COVID-19 pandemic.DesignCross-sectional survey using four validated instruments.SettingSixty-two sites in Canada and the United States.SubjectsAttending physicians (adult, pediatric; intensivist, nonintensivist) who worked in North American ICUs.InterventionNone.Measurements and main resultsWe analysed 431 questionnaires (43.3% response rate) from 25 states and eight provinces. Respondents were predominantly male (229 [55.6%]) and in practice for 11.8 ± 9.8 years. Compared with prepandemic, respondents reported significant intrapandemic increases in days worked/mo, ICU bed occupancy, and self-reported moral distress (240 [56.9%]) and burnout (259 [63.8%]). Of the 10 top-ranked items that incited moral distress, most pertained to regulatory/organizational ( n = 6) or local/institutional ( n = 2) issues or both ( n = 2). Average moral distress (95.6 ± 66.9), professional fulfilment (6.5 ± 2.1), and burnout scores (3.6 ± 2.0) were moderate with 227 physicians (54.6%) meeting burnout criteria. A significant dose-response existed between COVID-19 patient volume and moral distress scores. Physicians who worked more days/mo and more scheduled in-house nightshifts, especially combined with more unscheduled in-house nightshifts, experienced significantly more moral distress. One in five physicians used at least one maladaptive coping strategy. We identified four coping profiles (active/social, avoidant, mixed/ambivalent, infrequent) that were associated with significant differences across all wellness measures.ConclusionsDespite moderate intrapandemic moral distress and burnout, physicians experienced moderate professional fulfilment. However, one in five physicians used at least one maladaptive coping strategy. We highlight potentially modifiable factors at individual, institutional, and regulatory levels to enhance physician wellness.

Published
2022

3. Differences in directives to limit treatment and discontinue mechanical ventilation between elderly and very elderly patients: a substudy of a multinational observational study

Author

Burns, Karen E. A., Cook, Deborah J., Xu, Keying, Dodek, Peter, Villar, Jesús, Jones, Andrew, and Kapadia, Farhad N.

Subjects
Aged patients -- Health aspects, Mortality -- Ontario -- United Kingdom -- India -- Australia -- Canada -- Spain, Hospital patients -- Health aspects, Tracheostomy -- Health aspects, Health care industry
Abstract

Purpose The aim of this study was to characterize differences in directives to limit treatments and discontinue invasive mechanical ventilation (IMV) in elderly (65-80 years) and very elderly (> 80 years) intensive care unit (ICU) patients. Methods We prospectively described new written orders to limit treatments, IMV discontinuation strategies [direct extubation, direct tracheostomy, spontaneous breathing trial (SBT), noninvasive ventilation (NIV) use], and associations between initial failed SBT and outcomes in 142 ICUs from 6 regions (Canada, India, United Kingdom, Europe, Australia/New Zealand, United States). Results We evaluated 788 (586 elderly; 202 very elderly) patients. Very elderly (vs. elderly) patients had similar withdrawal orders but significantly more withholding orders, especially cardiopulmonary resuscitation and dialysis, after ICU admission [67 (33.2%) vs. 128 (21.9%); p = 0.002]. Orders to withhold reintubation were written sooner in very elderly (vs. elderly) patients [4 (2-8) vs. 7 (4-13) days, p = 0.02]. Very elderly and elderly patients had similar rates of direct extubation [39 (19.3%) vs. 113 (19.3%)], direct tracheostomy [10 (5%) vs. 40 (6.8%)], initial SBT [105 (52%) vs. 302 (51.5%)] and initial successful SBT [84 (80%) vs. 245 (81.1%)]. Very elderly patients experienced similar ICU outcomes (mortality, length of stay, duration of ventilation) but higher hospital mortality [26 (12.9%) vs. 38 (6.5%)]. Direct tracheostomy and initial failed SBT were associated with worse outcomes. Regional differences existed in withholding orders at ICU admission and in withholding and withdrawal orders after ICU admission. Conclusions Very elderly (vs. elderly) patients had more orders to withhold treatments after ICU admission and higher hospital mortality, but similar ICU outcomes and IMV discontinuation. Significant regional differences existed in withholding and withdrawal practices., Author(s): Karen E. A. Burns [sup.1] [sup.2] [sup.3] [sup.4], Deborah J. Cook [sup.4] [sup.5], Keying Xu [sup.3] [sup.6], Peter Dodek [sup.7] [sup.8], Jesús Villar [sup.9] [sup.10], Andrew Jones [sup.11], Farhad [...]

Published
2023
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4. Frequency of screening and SBT Technique Trial—North American Weaning Collaboration (FAST-NAWC): an update to the protocol and statistical analysis plan

Author

Burns, Karen E. A., Lafrienier-Roula, Myriam, Hill, Nicholas S., Cook, Deborah J., Seely, Andrew J. E., Rochwerg, Bram, Mayette, Michael, D’Aragon, Frederick, Devlin, John W., Dodek, Peter, Tanios, Maged, Gouskos, Audrey, Turgeon, Alexis F., Aslanian, Pierre, Sia, Ying Tung, Beitler, Jeremy R., Hyzy, Robert, Criner, Gerard J., Kassis, Elias Baedorf, Tsang, Jennifer L. Y., Meade, Maureen O., Liebler, Janice M., Wong, Jessica T. Y., and Thorpe, Kevin E.

Published
2023
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6. Regional Practice Variation and Outcomes in the Standard Versus Accelerated Initiation of Renal Replacement Therapy in Acute Kidney Injury (STARRT-AKI) Trial: A Post Hoc Secondary Analysis

Author

Vaara, Suvi T., Serpa Neto, Ary, Bellomo, Rinaldo, Adhikari, Neill K. J., Dreyfuss, Didier, Gallagher, Martin, Gaudry, Stephane, Hoste, Eric, Joannidis, Michael, Pettilä, Ville, Wang, Amanda Y., Kashani, Kianoush, Wald, Ron, Bagshaw, Sean M., Ostermann, Marlies, Bagshaw, Sean M, Wald, Ron, Adhikari, Neill K.J., Bellomo, Rinaldo, Dreyfuss, Didier, Du, Bin, Gallagher, Martin P., Gaudry, Stéphane, Hoste, Eric A., Lamontagne, François, Joannidis, Michael, Liu, Kathleen D., McAuley, Daniel F., McGuinness, Shay P., Nichol, Alistair D., Ostermann, Marlies, Palevsky, Paul M., Qiu, Haibo, Pettilä, Ville, Schneider, Antoine G., Smith, Orla M., Vaara, Suvi T., Weir, Matthew, Bellomo, Rinaldo, Eastwood, Glenn M., Peck, Leah, Young, Helen, Kruger, Peter, Laurie, Gordon, Saylor, Emma, Meyer, Jason, Venz, Ellen, Wetzig, Krista, French, Craig, McGain, Forbes, Mulder, John, Fennessy, Gerard, Koottayi, Sathyajith, Bates, Samantha, Towns, Miriam, Morgan, Rebecca, Tippett, Anna, Udy, Andrew, Mason, Chris, Licari, Elisa, Gantner, Dashiell, McClure, Jason, Nichol, Alistair, McCracken, Phoebe, Board, Jasmin, Martin, Emma, Vallance, Shirley, Young, Meredith, Vladic, Chelsey, McGloughlin, Steve, Gattas, David, Buhr, Heidi, Coles, Jennifer, Hutch, Debra, Wun, James, Cole, Louise, Whitehead, Christina, Lowrey, Julie, Masters, Kristy, Gresham, Rebecca, Campbell, Victoria, Gutierrez, David, Brailsford, Jane, Forbes, Loretta, Murray, Lauren, Maguire, Teena, NiChonghaile, Martina, Orford, Neil, Bone, Allison, Elderkin, Tania, Salerno, Tania, Chimunda, Tim, Fletcher, Jason, Broadfield, Emma, Porwal, Sanjay, Knott, Cameron, Boschert, Catherine, Smith, Julie, Richardson, Angus, Hill, Dianne, Duke, Graeme, Oziemski, Peter, Cegarra, Santiago, Chan, Peter, Welsh, Deborah, Hunter, Stephanie, Roodenburg, Owen, Dyett, John, Kokotsis, Nicos, Moser, Max, Yang, Yang, Padayachee, Laven, Vetro, Joseph, Gangopadhyay, Himangsu, Kaufman, Melissa, Ghosh, Angaj, Said, Simone, Patel, Alpesh, Bihari, Shailesh, Matheson, Elisha, Jin, Xia, Shrestha, Tapaswi, Schwartz, Kate, Gallagher, Martin P., Cross, Rosalba, Cheung, Winston, Wong, Helen, Kol, Mark, Shah, Asim, Wang, Amanda Y., Endre, Zoltan, Bradford, Celia, Janin, Pierre, Finfer, Simon, Diel, Naomi, Gatward, Jonathan, Hammond, Naomi, Delaney, Anthony, Bass, Frances, Yarad, Elizabeth, Buscher, Hergen, Reynolds, Claire, Baker, Nerilee, Joannidis, Michael, Bellmann, Romuald, Peer, Andreas, Hasslacher, Julia, Koglberger, Paul, Klein, Sebastian, Zotter, Klemens, Brandtner, Anna, Finkenstedt, Armin, Ditlbacher, Adelheid, Hartig, Frank, Fries, Dietmar, Bachler, Mirjam, Schenk, Bettina, Wagner, Martin, Staudinger, Thomas, Tiller, Esther, Schellongowski, Peter, Bojic, Andja, Hoste, Eric A., Bracke, Stephanie, De Crop, Luc, Vermeiren, Daisy, Thome, Fernando, Chiella, Bianca, Fendt, Lucia, Antunes, Veronica, Maisonneuve-Rosemont, Lafrance, Jean-Philippe, Lamontagne, François, D’Aragon, Frédérick, St-Arnaud, Charles, Mayette, Michael, Carbonnaeu, Élaine, Marchand, Joannie, Masse, Marie-Hélène, Ladouceur, Marilène, Turgeon, Alexis F., Lauzier, François, Bellemare, David, Langis Francoeur, Charles, LeBlanc, Guillaume, Guilbault, Gabrielle, Grenier, Stéphanie, Cloutier, Eve, Boivin, Annick, Delisle-Thibault, Charles, Giannakouros, Panagiota, Costerousse, Olivier, Cailhier, Jean-François, Carrier, François-Martin, Ghamraoui, Ali, Lebrasseur, Martine, Benettaib, Fatna, Salamé, Maya, Boumahni, Dounia, Tung Sia, Ying, Naud, Jean-François, Roy, Isabelle, Stelfox, Henry T., Ruddell, Stacey, Manns, Braden J., Duggan, Shelley, Carney, Dominic, Barchard, Jennifer, Whitlock, Richard P., Belley-Cote, Emilie, Savija, Nevena, Sabev, Alexandra, Campbell, Troy, Creary, Thais, Devereaux, Kelson, Brodutch, Shira, Rigatto, Claudio, Paunovic, Bojan, Mooney, Owen, Glybina, Anna, Harasemiw, Oksana, Di Nella, Michelle, Harmon, John, Mehta, Navdeep, Lakatos, Louis, Haslam, Nicole, Lellouche, Francois, Simon, Mathieu, Tung, Ying, Lizotte, Patricia, Bourchard, Pierre-Alexandre, Rochwerg, Bram, Karachi, Tim, Millen, Tina, Muscedere, John, Maslove, David, Gordon Boyd, J., Sibley, Stephanie, Drover, John, Hunt, Miranda, Georgescu, Ilinca, Wax, Randy, Lenga, Ilan, Sridhar, Kavita, Steele, Andrew, Fusco, Kelly, Ghate, Taneera, Tolibas, Michael, Robinson, Holly, Weir, Matthew A., Taneja, Ravi, Ball, Ian M., Garg, Amit, Campbell, Eileen, Ovsenek, Athena, Bagshaw, Sean M., van Diepen, Sean, Baig, Nadia, Magder, Sheldon, Yao, Han, Alam, Ahsan, Campisi, Josie, MacIntyre, Erika, Rokosh, Ella, Scherr, Kimberly, Lapinsky, Stephen, Mehta, Sangeeta, Shah, Sumesh, Niven, Daniel J., Stelfox, Henry T., Ruddell, Stacey, Russell, Michael, Jim, Kym, Brown, Gillian, Oxtoby, Kerry, Hall, Adam, Benoit, Luc, Sokolowski, Colleen, Prasad, Bhanu, Rao, Jag, Giebel, Shelley, Kutsogiannis, Demetrios J., Thompson, Patricia, Thompson, Tayne, Cirone, Robert, Kavikondala, Kanthi, Soth, Mark, Clarke, France, Takaoka, Alyson, Wald, Ron, Mazer, David, Burns, Karen, Friedrich, Jan, Klein, David, Sandhu, Gyan, Santos, Marlene, Khalid, Imrana, Hodder, Jennifer, Dodek, Peter, Ayas, Najib, Alcuaz, Victoria, Suen, Gabriel, Rewa, Oleksa, Singh, Gurmeet, Norris, Sean, Gibson, Neil, Arias, Castro, Shami, Aysha, Pelletier, Celine, Adhikari, Neill K.J., Zahirieh, Alireza, Amaral, Andre, Marinoff, Nicole, Kaur, Navjot, Perez, Adic, Wang, Jane, Haljan, Gregory, Condin, Christopher, McIntyre, Lauralyn, Gomes, Brigette, Porteous, Rebecca, Watpool, Irene, Hiremath, Swapnil, Clark, Edward, Herridge, Margaret S., Backhouse, Felicity, Elizabeth Wilcox, M., Walczak, Karolina, Ki, Vincent, Sharman, Asheer, Romano, Martin, Bagshaw, Sean M., Noel Gibney, R.T., Romanovsky, Adam S., Rewa, Oleksa, McCoshen, Lorena, Baig, Nadia, Wood, Gordon, Ovakim, Daniel, Auld, Fiona, Carney, Gayle, Duan, Meili, Ji, Xiaojun, Guo, Dongchen, Qi, Zhili, Lin, Jin, Zhang, Meng, Dong, Lei, Liu, Jingfeng, Liu, Pei, Zhi, Deyuan, Bai, Guoqiang, Qiu, Yu, Yang, Ziqi, Bai, Jing, Liu, Zhuang, Zhuang, Haizhou, Wang, Haiman, Li, Jian, Zhao, Mengya, Zhou, Xiao, Shi, Xianqing, Ye, Baning, Liu, Manli, Wu, Jing, Fu, Yongjian, Long, Dali, Pan, Yu, Wang, Jinlong, Mei, Huaxian, Zhang, Songsong, Wen, Mingxiang, Yang, Enyu, Mu, Sijie, Li, Jianquan, Hu, Tingting, Qin, Bingyu, Li, Min, Wang, Cunzhen, Dong, Xin, Wang, Kaiwu, Wang, Haibo, Yang, Jianxu, Du, Bin, Wang, Chuanyao, Wang, Dongxin, Li, Nan, Yu, Zhui, Xu, Song, Yao, Lan, Hou, Guo, Liu, Zhou, Lu, Liping, Lian, Yingtao, Wang, Chunting, Zhang, Jichen, Ding, Ruiqi, Qi, Guoqing, Wang, Qizhi, Wang, Peng, Meng, Zhaoli, Chen, Man, Hu, Xiaobo, He, Xiandi, Zhao, Shibing, Hang, Lele, Li, Rui, Qin, Suhui, Lu, Kun, Dun, Shijuan, Liu, Cheng, Zhou, Qi, Chen, Zhenzhen, Mei, Jing, Zhang, Minwei, Xu, Hao, Lin, Jincan, Shi, Qindong, Fu, Lijuan, Zeng, Qinjing, Ma, Hongye, Yan, Jinqi, Gao, Lan, Liu, Hongjuan, Zhang, Lei, Li, Hao, He, Xiaona, Fan, Jingqun, Guo, Litao, Liu, Yu, Wang, Xue, Sun, Jingjing, Liu, Zhongmin, Yang, Juan, Ding, Lili, Sheng, Lulu, Liu, Xingang, Yan, Jie, Wang, Quihui, Wang, Yifeng, Zhao, Dan, Zhao, Shuangping, Hu, Chenghuan, Li, Jing, Deng, Fuxing, Qiu, Haibo, Yang, Yi, Mo, Min, Pan, Chun, Wu, Changde, Huang, Yingzi, Huang, Lili, Liu, Airan, Pettilä, Ville, Vaara, Suvi T., Korhonen, Anna-Maija, Törnblom, Sanna, Sutinen, Sari, Pettilä, Leena, Heinonen, Jonna, Lappi, Eliria, Suhonen, Taria, Karlsson, Sari, Hoppu, Sanna, Jalkanen, Ville, Kuitunen, Anne, Levoranta, Markus, Långsjö, Jaakko, Ristimäki, Sanna, Malila, Kaisa, Wootten, Anna, Varila, Simo, Järvisalo, Mikko J, Inkinen, Outi, Kentala, Satu, Leivo, Keijo, Haltia, Paivi, Dreyfuss, Didier, Ricard, Jean-Damien, Messika, Jonathan, Tiagarajah, Abirami, Emery, Malo, Dechanet, Aline, Gernez, Coralie, Roux, Damien, Martin-Lefevre, Laurent, Fiancette, Maud, Vinatier, Isabelle, Claude Lacherade, Jean, Colin, Gwenhaël, Lebert, Christine, Azais, Marie-Ange, Yehia, Aihem, Pouplet, Caroline, Henry- Lagarrigue, Matthieu, Seguin, Amélie, Crosby, Laura, Maizel, Julien, Titeca-Beauport, Dimitri, Combes, Alain, Nieszkowska, Ania, Masi, Paul, Demoule, Alexandre, Mayaux, Julien, Dres, Martin, Morawiec, Elise, Decalvele, Maxens, Demiri, Suela, Faure, Morgane, Marios, Clémence, Mallet, Maxime, Amélie Ordon, Marie, Morizot, Laura, Cantien, Marie, Pousset, François, Gaudry, Stéphane, Poirson, Florent, Cohen, Yves, Argaud, Laurent, Cour, Martin, Bitker, Laurent, Simon, Marie, Hernu, Romain, Baudry, Thomas, De La Salle, Sylvie, Robine, Adrien, Sedillot, Nicholas, Tchenio, Xavier, Bouisse, Camille, Roux, Sylvie, Barbar, Davide, Trusson, Rémi, Tamion, Fabienne, Grangé, Steven, Carpentier, Dorothée, Chevrel, Guillaume, Ensenyat-Martin, Luis, Marque, Sophie, Quenot, Jean-Pierre, Andreu, Pascal, Dargent, Auguste, Large, Audrey, Chudeau, Nicolas, Landais, Mickael, Derrien, Benoit, Christophe Callahan, Jean, Guitton, Christophe, Le Moal, Charlène, Robert, Alain, Asehnoune, Karim, Cinotti, Raphaël, Grillot, Nicolas, Demeure, Dominique, Vinsonneau, Christophe, Rahmani, Imen, Marzouk, Mehdi, Dekeyser, Thibault, Sejourne, Caroline, Verlay, Mélanie, Thevenin, Fabienne, Delecolle, Lucie, Didier Thevenin, Lens, Souweine, Bertrand, Coupez, Elisabeth, Adda, Mireille, Eraldi, Jean-Pierre, Marchalot, Antoine, De Prost, Nicolas, Mekontso Dessap, Armand, Razazi, Keyvan, Meziani, Ferhat, Boisrame-Helms, Julie, Clere-Jehl, Raphael, Delabranche, Xavier, Kummerlen, Christine, Merdji, Hamid, Monnier, Alexandra, Rabouel, Yannick, Rahmani, Hassene, Allam, Hayat, Chenaf, Samir, Franja, Vincenta, Pons, Bertrand, Carles, Michel, Martino, Frédéric, Richard, Régine, Zuber, Benjamin, Lacave, Guillaume, Lakhal, Karim, Rozec, Bertrand, Dang Van, Hoa, Boulet, Éric, Dubos, René, Fadel, Fouad, Cleophax, Cedric, Dufour, Nicolas, Grant, Caroline, Thuong, Marie, Reignier, Jean, Canet, Emmanuel, Nicolet, Laurent, Boulain, Thierry, Nay, Mai-Anh, Benzekri, Dalila, Barbier, François, Bretagnol, Anne, Kamel, Toufik, Mathonnet, Armelle, Muller, Grégoire, Skarzynski, Marie, Rossi, Julie, Pradet, Amandine, Dos Santos, Sandra, Guery, Aurore, Muller, Lucie, Felix, Luis, Bohé, Julien, Thiéry, Guillaume, Aissaoui, Nadia, Vimpere, Damien, Commeureuc, Morgane, Diehl, Jean-Luc, Guerot, Emmanuel, Liangos, Orfeas, Wittig, Monika, Zarbock, Alexander, Küllmar, Mira, van Waegeningh, Thomas, Rosenow, Nadine, Nichol, Alistair D., Brickell, Kathy, Doran, Peter, Murray, Patrick T., Landoni, Giovanni, Lembo, Rosalba, Zangrillo, Alberto, Monti, Giacomo, Tozzi, Margherita, Marzaroli, Matteo, Lombardi, Gaetano, Paternoster, Gianluca, Vitiello, Michelangelo, McGuinness, Shay, Parke, Rachael, Butler, Magdalena, Gilder, Eileen, Cowdrey, Keri-Anne, Wallace, Samantha, Hallion, Jane, Woolett, Melissa, Neal, Philippa, Duffy, Karina, Long, Stephanie, McArthur, Colin, Simmonds, Catherine, Chen, Yan, McConnochie, Rachael, Newby, Lynette, Knight, David, Henderson, Seton, Mehrtens, Jan, Morgan, Stacey, Morris, Anna, Vander Hayden, Kymbalee, Burke, Tara, Bailey, Matthew, Freebairn, Ross, Chadwick, Lesley, Park, Penelope, Rolls, Christine, Thomas, Liz, Buehner, Ulrike, Williams, Erin, Albrett, Jonathan, Kirkham, Simon, Jackson, Carolyn, Browne, Troy, Goodson, Jennifer, Jackson, David, Houghton, James, Callender, Owen, Higson, Vicki, Keet, Owen, Dominy, Clive, Young, Paul, Hunt, Anna, Judd, Harriet, Lawrence, Cassie, Olatunji, Shaanti, Robertson, Yvonne, Latimer-Bell, Charlotte, Hendry, Deborah, Mckay-Vucago, Agnes, Beehre, Nina, Lesona, Eden, Navarra, Leanlove, Robinson, Chelsea, Jang, Ryan, Junge, Andrea, Lambert, Bridget, Schneider, Antoine G., Thibault, Michel, Eckert, Philippe, Kissling, Sébastien, Polychronopoulos, Erietta, Poli, Elettra, Altarelli, Marco, Schnorf, Madeleine, Abed Mallaird, Samia, Heidegger, Claudia, Perret, Aurelie, Montillier, Philippe, Sangla, Frederic, Neils, Seigenthaller, De Watteville, Aude, Phull, Mandeep-Kaur, George, Aparna, Hussain, Nauman, Pogreban, Tatiana, Lobaz, Steve, Daniels, Alison, Cunningham, Mishell, Kerr, Deborah, Nicholson, Alice, Shanmugasundaram, Pradeep, Abrams, Judith, Manso, Katarina, Hambrook, Geraldine, McKerrow, Elizabeth, Salva, Juvy, Foulkes, Stephen, Wise, Matthew, Morgan, Matt, Brooks, Jenny, Cole, Jade, Michelle Davies, Tracy, Hill, Helen, Thomas, Emma, Vizcaychipi, Marcela, Baharlo, Behrad, Carungcong, Jaime, Costa, Patricia, Martins, Laura, Kapoor, Ritoo, Hazelton, Tracy, Moon, Angela, Musselwhite, Janine, Shelley, Ben, McCall, Philip, Ostermann, Marlies, Arbane, Gill, Bociek, Aneta, Marotti, Martina, Lim, Rosario, Campos, Sara, Grau Novellas, Neus, Cennamo, Armando, Slack, Andrew, Wyncoll, Duncan, Camporota, Luigi, Sparkes, Simon, Tilley, Rosalinde, Rattray, Austin, Moreland, Gayle, Duffy, Jane, McGonigal, Elizabeth, Hopkins, Philip, Finney, Clare, Smith, John, Noble, Harriet, Watson, Hayley, Harris, Claire-Louise, Clarey, Emma, Corcoran, Eleanor, Beck, James, Howcroft, Clare, Youngs, Nora, Wilby, Elizabeth, Ogg, Bethan, Wolverson, Adam, Lee, Sandra, Butler, Susie, Okubanjo, Maryanne, Hindle, Julia, Welters, Ingeborg, Williams, Karen, Johnson, Emily, Patrick-Heselton, Julie, Shaw, David, Waugh, Victoria, Stewart, Richard, Mwaura, Esther, Wren, Lynn, Mew, Louise, Sutherland, Sara-Beth, Adderley, Jane, Ruddy, Jim, Harkins, Margaret, Kaye, Callum, Scott, Teresa, Mitchell, Wendy, Anderson, Felicity, Willox, Fiona, Jagannathan, Vijay, Clark, Michele, Purv, Sarah, Sharman, Andrew, Meredith, Megan, Ryan, Lucy, Conner, Louise, Peters, Cecilia, Harvey, Dan, Roshdy, Ashraf, Collins, Amy, Sim, Malcolm, Henderson, Steven, Chee, Nigel, Pitts, Sally, Bowman, Katie, Dilawershah, Maria, Vamplew, Luke, Howe, Elizabeth, Rogers, Paula, Hernandez, Clara, Prendergast, Clara, Benton, Jane, Rosenberg, Alex, Forni, Lui G., Grant, Alice, Carvelli, Paula, Raithatha, Ajay, Bird, Sarah, Richardson, Max, Needham, Matthew, Hirst, Claire, Ball, Jonathan, Leaver, Susannah, Howlett, Luisa, Castro Delgado, Carlos, Farnell-Ward, Sarah, Farrah, Helen, Gray, Geraldine, Joseph, Gipsy, Robinson, Francesca, Tridente, Ascanio, Harrop, Clare, Shuker, Karen, McLaughlan, Derek, Ramsey, Judith, Meehan, Sharon, Oliver Rose, Bernd, Reece-Anthony, Rosie, Gurung, Babita, Whitehouse, Tony, Snelson, Catherine, Veenith, Tonny, Johnston, Andy, Cooper, Lauren, Carrera, Ron, Ellis, Karen, Fellows, Emma, Harkett, Samanth, Bergin, Colin, Spruce, Elaine, Despy, Liesl, Goundry, Stephanie, Dooley, Natalie, Mason, Tracy, Clark, Amy, Dignam, Gemma, Ward, Geraldine, Attwood, Ben, Parsons, Penny, Mason, Sophie, Margarson, Michael, Lord, Jenny, McGlone, Philip, Hodgson, Luke E., Chadbourn, Indra, Gomez, Raquel, Margalef, Jordi, Pretorius, Rinus, Hamshere, Alexandra, Carter, Joseph, Cahill, Hazel, Grainger, Lia, Howard, Kate, Forshaw, Greg, Guy, Zoe, Kashani, Kianoush B., Albright, Robert C., Amsbaugh, Amy, Stoltenberg, Anita, Niven, Alexander S., Lynch, Matthew, O’Mara, AnnMarie, Naeem, Syed, Sharif, Sairah, McKenney Goulart, Joyce, Lynch, Matthew, O’Mara, AnnMarie, Naeem, Syed, Sharif, Sairah, McKenney Goulart, Joyce, Tolwani, Ashita, Lyas, Claretha, Latta, Laura, Bihorac, Azra, Hashemighouchani, Haleh, Efron, Philip, Ruppert, Matthew, Cupka, Julie, Kiley, Sean, Carson, Joshua, White, Peggy, Omalay, George, Brown, Sherry, Velez, Laura, Marceron, Alina, Neyra, Javier A., Carlos Aycinena, Juan, Elias, Madona, Ortiz-Soriano, Victor M., Hauschild, Caroline, and Dorfman, Robert

Published
2024
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7. Definitions, rates and associated mortality of ICU-acquired pneumonia: A multicenter cohort study

Author

Johnstone, Jennie, Muscedere, John, Dionne, Joanna, Duan, Erick, Rochwerg, Bram, Centofanti, John, Oczkowski, Simon, Lauzier, Francois, Marshall, John, Heels-Ansdell, Diane, Daneman, Nick, Mehta, Sangeeta, Arabi, Yaseen, Zytaruk, Nicole, Dodek, Peter, Adhikari, Neill K., Karachi, Tim, Charbonney, Emmanuel, Stelfox, Henry T., Kristof, Arnold S., Ball, Ian, Hand, Lori, Fowler, Rob, Zarychanski, Ryan, Arnaud, Charles St, Takaoka, Alyson, Kutsogiannis, James, Khwaja, Kosar, Sligl, Wendy, Loubani, Osama, Tsang, Jennifer, Lamarche, Daphnee, Bowdish, Dawn, Surette, Michael, and Cook, Deborah

Published
2023
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14. High-cost users after sepsis: a population-based observational cohort study.

Author

Barrett, Kali A., Sheikh, Fatima, Chechulina, Victoria, Chung, Hannah, Dodek, Peter, Rosella, Laura, Thavorn, Kednapa, and Scales, Damon C.

Abstract

Background: High-cost users (HCU) represent important targets for health policy interventions. Sepsis is a life-threatening syndrome that is associated with high morbidity, mortality, and economic costs to the healthcare system. We sought to estimate the effect of sepsis on being a subsequent HCU. Methods: Using linked health-administrative databases, we conducted a population-based, propensity score-weighted cohort study of adults who survived a hospitalization in Ontario, Canada between January 2016 and December 2017. Sepsis was identified using a validated algorithm. The primary outcome was being a persistent HCU after hospital discharge (in the top 5% or 1% of total health care spending for 90 consecutive days), and the proportion of follow-up time since discharge as a HCU. Results: We identified 927,057 hospitalized individuals, of whom 79,065 had sepsis. Individuals who had sepsis were more likely to be a top 5% HCU for 90 consecutive days at any time after discharge compared to those without sepsis (OR 2.24; 95% confidence interval [CI] 2.04–2.46) and spent on average 42.3% of their follow up time as a top 5% HCU compared to 28.9% of time among those without sepsis (RR 1.46; 95% CI 1.45–1.48). Individuals with sepsis were more likely to be a top 1% HCU for 90 consecutive days compared to those without sepsis (10% versus 5.1%, OR 2.05 [95% CI 1.99–2.11]), and spent more time as a top 1% HCU (18.5% of time versus 10.8% of time, RR 1.68 [95% CI 1.65–1.70]). Conclusions: The sequelae of sepsis result in higher healthcare costs with important economic implications. After discharge, individuals who experienced sepsis are more likely to be a HCU and spend more time as a HCU compared to individuals who did not experience sepsis during hospitalization. [ABSTRACT FROM AUTHOR]

Published
2024
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15. Differences in Physician Burnout by Specialty: A Cross-Sectional Survey.

Author

Ghaseminejad, Farhad, Rich, Kira E., Rosenbaum, Debbie, Rydz, Emilia, Palepu, Anita, Dodek, Peter, Salmon, Amy, Leitch, Heather A., Townson, Andrea, Lacaille, Diane, Varshney, Vishal P., and Khan, Nadia A.

Subjects
MASLACH Burnout Inventory, COVID-19 pandemic, WORK-life balance, URBAN hospitals, PHYSICIANS
Abstract

BACKGROUND: The prevalence of physician burnout increased notably during the COVID-19 pandemic, but whether measures of burnout differed based on physician specialty is unknown. The authors sought to determine the prevalence of burnout, worklife conflict, and intention to quit among physicians from different specialties. METHODS: This is a cross-sectional online survey of physicians working at 2 urban hospitals in Vancouver, Canada, from August to October 2021. Responses were categorized by specialty (including surgical and nonsurgical), and data about whether physicians provided frontline patient care during COVID-19 were also included. Physician burnout was measured using the Maslach Burnout Inventory. RESULTS: The survey response rate was 42% (209/498). The overall prevalence of burnout was 69%. Burnout was not significantly different by specialty or between frontline COVID-19 specialties compared with other specialties. Physicians in surgical specialties were more likely to report work-life conflict than those in nonsurgical specialties (p = 0.012). Differences in intention to quit among specialties were not statistically significant. CONCLUSION: During the COVID-19 pandemic, physician burnout was high across physicians, without significant differences between specialties, highlighting the need to support all physicians. [ABSTRACT FROM AUTHOR]

Published
2024
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17. Enquête canadienne sur les perceptions et pratiques liées à la prescription de tests sanguins aux soins intensifs

Author

Rahman, M. Omair, primary, Charbonney, Emannuel, additional, Vaisler, Ryan, additional, Khalifa, Abubaker, additional, Alhazzani, Waleed, additional, Gossack-Keenan, Kiera, additional, Garland, Allan, additional, Karachi, Timothy, additional, Duan, Erick, additional, Bagshaw, Sean M., additional, Meade, Maureen O., additional, Hillis, Chris, additional, Kavsak, Peter, additional, Born, Karen, additional, Mbuagbaw, Lawrence, additional, Siegal, Deborah, additional, Millen, Tina, additional, Scales, Damon, additional, Amaral, Andre, additional, English, Shane, additional, McCredie, Victoria A., additional, Dodek, Peter, additional, Cook, Deborah J., additional, and Rochwerg, Bram, additional

Published
2024
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24. Examining mechanisms for gender differences in admission to intensive care units

Author

Hill, Andrea, Ramsey, Clare, Dodek, Peter, Kozek, Jean, Fransoo, Randy, Fowler, Robert, Doupe, Malcolm, Wong, Hubert, Scales, Damon, and Garland, Allan

Subjects
Home care -- Research -- Analysis, Nursing homes -- Research -- Analysis, Elderly -- Research -- Analysis, Nursing home patients -- Research -- Analysis, Pediatric cardiology -- Research -- Analysis, Epidemiology -- Research -- Analysis, Health care information services -- Research -- Analysis, Prejudice, Diseases, Married people, Home care services, Canadians, Child health, Business, Health care industry
Abstract

Objective: To evaluate whether the male predominance of older people admitted to intensive care units (ICUs) is due to gender differences in the presence of spouses, partners, or children; rates of gender-specific disease; or triage decisions made by health system personnel. Data Sources and Collection: Three population-based datasets, 2004-2012, of Canadians [greater than or equal to]65 years: provincial health care data from Manitoba (n = 250 190) and national data of nursing home residents (n = 133 982) and community-based home-care recipients (n = 210 090). Study Design: Retrospective observational study, using multivariable Cox proportional hazards and logistic regression. Principal Findings: Males predominated in ICU admissions: from Manitoba (hazard ratio [HR] = 1.87, 95% CI = 1.80-1.95), nursing homes (HR = 1.47, 1.35-1.60), and homecare (odds ratio = 1.14, 1.11-1.17). Adjustment for spouses, partners, and children did not attenuate this effect. The HR for gender was lower by 13.5 percent, relative, after excluding ICU care for cardiac causes. Male predominance was not present during a second ICU admission among survivors of a first ICU-containing hospitalization (HR = 1.07, 0.96-1.20). Conclusions: In three older cohorts, the male predominance of ICU admission was not explained by gender differences in the presence of a spouse, partner, or children, or cardiac disease rates. The third finding suggests that triage bias is unlikely to be responsible for the male predominance. KEYWORDS acute inpatient care, epidemiology, gender/sex differences in health and health care, 1 | INTRODUCTION Since the 1980 publication of the Black Report, (1) there has been a growing awareness of social inequalities in health and health care use. Although ethnicity, age, [...]

Published
2020
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27. The association between platelet transfusions and bleeding in critically ill patients with thrombocytopenia

Author

Arnold, Donald M., Lauzier, Francois, Albert, Martin, Williamson, David, Li, Na, Zarychanski, Ryan, Doig, Chip, McIntyre, Lauralyn, Freitag, Andreas, Crowther, Mark, Saunders, Lois, Clarke, France, Bellomo, Rinaldo, Qushmaq, Ismael, Lopes, Renato D., Heels‐Ansdell, Diane, Webert, Kathryn, Cook, Deborah, Hall, Rick, Rocker, Graeme, Julien, Lisa, Wright, Debbie, Roy, Caroline, Theriault, Judy, Pleasance, Susan, Meade, Maureen, Hand, Lori, Wynne, Christine, Duffett, Mark, Kho, Michelle, Zytaruk, Nicole, Granton, John, Matte, Andrea, Farias, Paulina, Chu, Leslie, Brockest, Nancy, Go, Stephanie, McGrath‐Chong, Margaret, Dennis, Madison, Lipkus, Marc, Stern, Emily, Albert, Ryan, Langevin, Stephan, Turgeon, Alexis F, Tremblay, Marie‐Claude, Blais, Martine, Beauparlant, Maxime, Asselin, Julie, Gagne, Chantal, Thibodeau, Marie, Poirier, Germain, Spearson, Sandrine, Neas, Isabelle, Pagliarello, Joe, Hébert, Paul, Watpool, Irene, McArdle, Tracy, Gaudert, Claude, Marchand, Paule, Davidson, Carson, Lewis, Mary‐Jo, Murphy, Erin, Foxall, Julia, Skrobik, Yoanna, Harvey, Johanne, Chitu, Stefania, Williams, Virginie, Sirois, Carole, Nadon, Carole, Dolle, Stephanie, Gosselin, Audrey‐Anne, Deroy, Patrice, Mehta, Geeta, Shah, Sumesh, Ethier, Cheryl, Tirgari, Sam, Steinberg, Lindsay, McDonald, Rod, Sivanantham, Vidhya, Bandayrel, Kristofer, Quittnat Pelletier, Friederike, Kramer‐Kile, Marnie, Brown, Maedean, Kim, Scott, Fowler, Rob, Marinoff, Nicole, Code, Karen, Bojilov, Boris, Parsotam, Derek, Marshall, John, Smith, Orla, Fry, Beth, Porretta, Kerri, Lee, Yoon, Morrissey, Jeanna, Wen, Victoria, Muscedere, John, Hunt, Miranda, Fleury, Susan, Godfrey, Nicole, Hammond, Sharlene, Mann, Elizabeth, Myers, Monica, Robinson, Amber, Griesdale, Donald, Chittock, Dean, Dhingra, Vinay, Foster, Denise, Gardner, Maureen, Logie, Susan, Autio, Roger, Davies, Dara, Ganz, Pia, Smith, Laurie, Dodek, Peter, Alcuaz, Victoria, Ashley, Betty Jean, Mans, Sheilagh, Ferguson, Niall, Stevenson, James, Elman, Joel, Karachi, Timothy, Millen, Tina, Tkaczyk, Andrea, Jacka, Mike, Irwin, Marleen, Chan, Carmen, Sonnema, Leeca, Marsh, Kelly, Maurer, Jennifer, Kreidl, Tamara, Varden, Candice, Kinjerski, Carey, Doig, Christopher, Ruddell, Stacy, Knox, Linda, Wilson, Crystal, Champagne, Kevin, Wood, Gordon, Auld, Fiona, Atkins, Leslie, Paunovic, Bojan, Marten, Nicole, Wiebe, Kym, McDonald, Ellen, Keenan, Sean, Reynolds, Steven, Svetik, Miroslav, Van Osch, Mary, Kutsogiannis, Jim, Thompson, Patrica, Whalen, Norine, Lellouche, Francois, Ferland, Marie‐Claude, Dussault, Patrick, Jacob, Caroline, Morneau, Marie‐Eve, Laberge, Nancy, Khwaja, Kosar, Banici, Laura, Havell, Lena, Lesur, Olivier, Lamontagne, Francois, Proulx, Sandra, Hollinger, Gerald, Shende, Vasanti, Belcastro, Vanessa, Plaxton, Bill, Foss, Anders, Eisenstat, Jonathan, Doerle, Tammy, Sharpe, Michael, Madady, Mona, Cooper, Jamie, Davies, Andrew, Vallance, Shirley, Weatherburn, Cindy, Board, Jasmin, Bennett, Victoria, Finfer, Simon, Ramakrishnan, Naresh, Bird, Simon, Potter, Julie, O’Connor, Anne, Ankers, Susan, Cade, Jack, Barge, Deborah, Caf, Tania, Howe, Belinda, Eastwood, Glenn, Peck, Leah, Goldsmith, Donna, O’Sullivan, Kim, Ernest, David, Radford, Sam, Whitfield, Ann, Cross, Anthony, Eliott, Suzanne, Sidhu, Jaspreet, Mercer, Inga, Hamilton, Angela, Botha, John, Vuat, Jodi, Allsop, Sharon, Fowler, Nina, Crozier, Tim, Barrett, Jonathan, Wright, Chris, Galt, Pauline, Culhane, Carly, Ioannidis, Rebecca, Burton, Sue, Reily, Marnie, Weeraratna, Cyveen, Seppelt, Ian, Weisbrodt, Leonie, Bond, Robyn, Hospital, Nepean, Rivett, Justine, O’Connor, Stephanie, Poole, Alex, Woolfe, Clive, Rajbhandari, Dorrilyn, Rees, Caitlin, Edington, John, Fletcher, Jason, Smith, Julie, Boschert, Catherine, Reece, Graham, Sara, Treena, Nand, Kiran, Bersten, Andrew, Gallus, Alex, Matheson, Elisha, O’Callaghan, Margie, Orford, Neil, Elderkin, Tania, Fraser, Melissa, Bone, Allison, Salerno, Tania, Kinmonth, Anne, Arora, Subhash, O’Bree, Bridget, Shepherd, Katherine, –Quinn, Alan, Sterba, Martin, Johnson, Bronwyn Ruth, Xu, Renee, Hill, Francisco, Ramadoss, Rajaram, Wood, Josette, da Rocha, Marcelo Garcia, Kramer, Andréa, Hädrich, Martha, Brandao, Nilton, Teixeira, Cassiano, Roehrig, Cíntia, Zeni, Juliana, da Silva, Suzana Alves, Filho, Rubens Costa, Correa, Renato, Moreira, Alves, Gomes, Plínio N., Biondi, Rodrigo, Berwanger, Otavio, Romano, Edson, Buehler, Anna Maria, Guimarães, Helio Penna, Truffa, Adriano, Nakamura, Rosana, Barbosa, Lillian Mazza, Brennick, Jean, Bassi, Sawsan, Alsultan, Mohammed, Arabi, Yaseen, Brits, Riette, Alhashemi, Jamal, Shalabi, Sanaa, Mandourah, Yasser, Shaikh, Nadeem, Al‐Hazmi, Manal, Ali Al‐Azem, M., Wyngaard, Trevor, Smithson, Barbara, Vlahakis, Nicholas E, Meade, Laurie, Cox, Michael, O’Brien, Jackie, Krause, Catherine, Nates, Joseph, Haque, Sajid, Mooring, Deidre, Erfe, Rose, Nickerson, Paula, Sherry, Tony, Smith, John, Sanderson, Barnaby, Ng, Josephine, Brooks, John, Lim, Ling, and Lei, Katie

Published
2017
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29. In symptomatic patients on as-needed inhaled corticosteroids-formoterol, VAS asthma is associated with small airways resistance.

Author

Vardaloglu, Ilgim, Sousa-Pinto, Bernardo, Bousquet, Jean, Dodek, Peter, Bedbrook, Anna, Karatas, Mert, and Gemicioglu, Bilun

Subjects
AIRWAY resistance (Respiration), ASTHMATICS, ASTHMA, VISUAL analog scale
Abstract

Impulse oscillometry (IOS) can demonstrate small airways disease even when spirometry values are normal. However, it is unknown if the absence of symptoms excludes increased small airways resistance in asthma patients. We aimed to correlate symptoms (assessed through visual analogue scales) with measures of small airways resistance in patients with asthma and to determine whether less symptomatic patients have increased small airways resistance. We conducted a single center, prospective cohort study. We included controlled asthma patients on as-needed inhaled corticosteroids-formoterol. Patients were evaluated on their symptom VASs, Spirometry and IOS (with R5-R20% measuring small airways resistance) which were measured both in periods when they were less symptomatic and symptomatic. Symptoms were assessed using MASK-air®, an mHealth app that includes a daily monitoring questionnaire with validated VASs. We correlated MASK-air VASs with small airways resistance. We assessed 29 patients. There was a significant correlation between VAS asthma and R5-R20% in symptomatic periods (r = 0.43; 95% CI = 0.13;0.68, p = 0.019), but not in less symptomatic periods (0.04; 95% CI-0.40;0.46; p = 0.825). In less symptomatic periods, patients presenting with low VAS asthma (VAS < 30) displayed a lower median R5-R20% than the remainder (0.26 versus 0.35), as well as a lower R5% (0.13 versus 0.15) (p < 0.001). In 68.9% of less symptomatic patients, R5-R20 values remained higher than normal values. In symptomatic patients on as-needed inhaled corticosteroids-formoterol, VAS asthma was associated with small airways resistance. However, even if these patients are less symptomatic, small airways resistance may be higher than normal. Since SAD significantly affects asthma control, patients should be carefully followed-up, even in less symptomatic periods. [ABSTRACT FROM AUTHOR]

Published
2024
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33. Feasibility and acceptability of implementing a practice guideline for the use of high flow nasal cannula in critically ill patients who have hypoxemia: a multi-centre study in Nepal

Author

Aryal, Diptesh, primary, Koirala, Kanchan, additional, Luitel, Subekshya, additional, Sitoula, Kabita, additional, Thapa, Kaveri, additional, Rai, Namrata, additional, Bhandari, Nisha, additional, Khadka Basnet, Ruku, additional, Dhakal, Sabina, additional, Amatya, Samina, additional, Shrestha, Sujita, additional, Khanal, Kishor, additional, Gamage Dona, Dilanthi, additional, Haniffa, Rashan, additional, Beane, Abi, additional, and Dodek, Peter, additional

Published
2023
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34. Differences in Directives to Limit Treatment and Discontinue Mechanical Ventilation Between Elderly and Very Elderly Patients: A Multinational Observational Study

Author

Burns, Karen E, primary, Cook, Deborah J, additional, Xu, Keying, additional, Dodek, Peter, additional, Villar, Jesus, additional, Jones, Andrew, additional, Kapadia, Farhad N, additional, Gattas, David J., additional, Epstein, Scott K, additional, Pelosi, Paolo, additional, Kefala, Kalliroi, additional, Meade, Maureen, additional, and Rizvi, Leena, additional

Published
2023
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43. Safety and efficiency of implementation of high-sensitivity troponin T in the assessment of emergency department patients with cardiac chest pain

Author

Scheuermeyer, Frank X., Mattman, Andre, Humphries, Karin, Ramanathan, Krishnan, Kaila, Kendeep, Dodek, Peter, Grunau, Brian, Grafstein, Eric, Innes, Grant, and Christenson, Jim

Abstract

Background: For emergency department (ED) patients with cardiac chest pain, introduction of high-sensitivity troponin (hsTnT) pathways has been associated with reductions in length of stay of less than 1 h. Methods: At two urban Canadian sites, we introduced hsTnT on January 26, 2016. While the prior diagnostic algorithm required troponin testing at 0 and 6 h, serial hsTnT serial testing was conducted at 0 and 3 h. We identified consecutive patients who presented with cardiac chest pain from January 1, 2015, to March 31, 2017, along with 30-day outcomes. The primary outcome was a missed 30-day major adverse cardiac event, (MACE) defined as death, revascularization, or readmission for myocardial infarction occurring in a patient-discharged home with a minimizing diagnosis and without cardiac-specific follow-up. Secondary outcomes included admission rate, ED length of stay, and MACE. We compared pre- and post- implementation periods using descriptive methods and repeated this analysis in patients with noncardiac chest pain. Results: We collected 5585 patients with cardiac chest pain, (2678 pre- and 2907 post-introduction) and 434 had (7.8%, 95% CI 7.1 to 8.5%) MACE, with 1 missed MACE. (0.2%, 95% CI 0.04 to 1.3%). Admission rate was stable at 24.1% pre- and 23.7% while median length of stay decreased from 464 to 285 min, a difference of 179 min. (95% CI 61 to 228 min). For 11,611 patients with noncardiac chest pain, admission rate (9%) and length of stay (191 versus 193 min) remained constant. Conclusions: Implementation of hsTnT for evaluation of ED chest pain patients was safe and associated with a 3-h decrease in length of stay.

Published
2024
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44. Mortality Risk Profiles for Sepsis: A Novel Longitudinal and Multivariable Approach

Author

Liaw, Patricia C., Fox-Robichaud, Alison E., Liaw, Kao-Lee, McDonald, Ellen, Dwivedi, Dhruva J., Zamir, Nasim M., Pepler, Laura, Gould, Travis J., Xu, Michael, Zytaruk, Nicole, Medeiros, Sarah K., McIntyre, Lauralyn, Tsang, Jennifer, Dodek, Peter M., Winston, Brent W., Martin, Claudio, Fraser, Douglas D., Weitz, Jeffrey I., Lellouche, Francois, Cook, Deborah J., and Marshall, John

Published
2019
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48. Clinician perspectives on protocols designed to minimize sedation

Author

Rose, Louise, Fitzgerald, Emma, Cook, Deborah, Kim, Scott, Steinberg, Marilyn, Devlin, John W., Ashley, Betty Jean, Dodek, Peter, Smith, Orla, Poretta, Kerri, Lee, Yoon, Burns, Karen, Harvey, Johanne, Skrobik, Yoanna, Fergusson, Dean, Meade, Maureen, Kraguljac, Alan, Burry, Lisa, and Mehta, Sangeeta

Published
2015
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50. A multi-center prospective cohort study of patient transfers from the intensive care unit to the hospital ward

Author

Stelfox, Henry T., Leigh, Jeanna Parsons, Dodek, Peter M., Turgeon, Alexis F., Forster, Alan J., Lamontagne, Francois, and Fowler, Rob A.

Subjects
Medical research -- Analysis -- Surveys, Medicine, Experimental -- Analysis -- Surveys, Medical records -- Analysis -- Surveys, Nurses -- Surveys, Health care industry
Abstract

Purpose To provide a 360-degree description of ICU-to-ward transfers. Methods Prospective cohort study of 451 adults transferred from a medical-surgical ICU to a hospital ward in 10 Canadian hospitals July 2014-January 2016. Transfer processes documented in the medical record. Patient (or delegate) and provider (ICU/ward physician/nurse) perspectives solicited by survey 24-72 h after transfer. Results Medical records (100%) and survey responses (ICU physicians-80%, ICU nurses-80%, ward physicians-46%, ward nurses-64%, patients-74%) were available for most transfers. The median time from initiation to completion of transfer was 25 h (IQR 6-52). ICU physicians and nurses reported communicating with counterparts via telephone (78 and 75%) when transfer was requested (82 and 24%) or accepted (31 and 59%) and providing more elements of clinical information than ward physicians (mean 4.7 vs. 3.9, p < 0.001) and nurses (5.0 vs. 4.4, p < 0.001) reported receiving. Patients were more likely to report satisfaction with the transfer when they received more information (OR 1.32, 95% CI 1.18-1.48), had their questions addressed (OR 3.96, 95% CI 1.33-11.84), met the ward physician prior to transfer (OR 4.61, 95% CI 2.90-7.33), and were assessed by a nurse within 1 h of ward arrival (OR 4.70, 95% CI 2.29-9.66). Recommendations for improvement included having a documented care plan travel with the patient (all stakeholders), standardized face-to-face handover (physicians), avoiding transfers at shift change (nurses) and informing patients about pending transfers in advance (patients). Conclusions ICU-to-ward transfers are characterized by failures of patient flow and communication; experienced differently by patients, ICU/ward physicians and nurses, with distinct suggestions for improvement., Author(s): Henry T. Stelfox [sup.1], Jeanna Parsons Leigh [sup.2], Peter M. Dodek [sup.3], Alexis F. Turgeon [sup.4], Alan J. Forster [sup.5], Francois Lamontagne [sup.6], Rob A. Fowler [sup.7], Andrea Soo [...]

Published
2017
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