91 results on '"Vandemheen K"'
Search Results
2. Early Diagnosis and Treatment of COPD and Asthma - A Randomized, Controlled Trial.
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Aaron, S. D., Vandemheen, K. L., Whitmore, G. A., Bergeron, C., Boulet, L.-P., Côté, A., Mclvor, R. A., Penz, E., Field, S. K., Lemière, C., Mayers, I., Bhutani, M., Azher, T., Lougheed, M. D., Gupta, S., Ezer, N., Licskai, C. J., Hernandez, P., Ainslie, M., and Alvarez, G. G.
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WHEEZE , *NICOTINE replacement therapy , *CHRONIC obstructive pulmonary disease , *MEDICAL personnel , *EARLY diagnosis , *ASTHMA , *CHRONIC care model , *OBSTRUCTIVE lung diseases - Abstract
The article offers information on a study that used a case-finding method to identify adults in the community with respiratory symptoms but without a diagnosed lung disease. Topics include the study's methodology, which involved enrollment in a randomized trial to determine if early diagnosis and treatment reduce health care utilization and improve outcomes, and the results, which showed lower health care utilization.
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- 2024
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3. Disease Burden in Individuals with Symptomatic Undiagnosed Asthma or Chronic Obstructive Pulmonary Disease
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AL-Habeeb, F.F., primary, Whitmore, G.A., additional, Vandemheen, K., additional, Fitzgerald, M., additional, Bergeron, C., additional, Lemiere, C., additional, Boulet, L.-P., additional, Field, S.K., additional, Penz, E.D., additional, McIvor, A., additional, Gupta, S., additional, Mayers, I., additional, Bhutani, M., additional, Hernandez, P., additional, Lougheed, D., additional, Lisckai, C., additional, Azher, T., additional, Ainslie, M., additional, Fraser, I.M., additional, Mahdavian, M., additional, and Aaron, S.D., additional
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- 2022
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4. Asthma Symptom Perception in Individuals with Respiratory Symptoms and Normal Spirometry
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Min, B., primary, Boulay, M.-E., additional, Cote, A., additional, Fitzgerald, J.M., additional, Bergeron, C., additional, Lemiere, C., additional, Norman, P., additional, Day, A., additional, Vandemheen, K., additional, Aaron, S.D., additional, Boulet, L.-P., additional, and Lougheed, M.D., additional
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- 2022
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5. Association Between Objectively-Measured Lung Function and Sleep Disorder Symptoms in a Community-Based Multi-Site Cohort Study
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Mazzola, R., primary, Aaron, S., additional, Vandemheen, K., additional, Chin, M., additional, Mulpuru, S., additional, FitzGerald, J.M., additional, Bergeron, C., additional, Lemière, C., additional, Boulet, L.-P., additional, Field, S.K., additional, Penz, E., additional, McIvor, R.A., additional, Gupta, S., additional, Mayers, I., additional, Bhutani, M., additional, Hernandez, P., additional, Lougheed, M.D., additional, Licskai, C.J., additional, Azher, T., additional, Ainslie, M., additional, Fraser, I., additional, Mahdavian, M., additional, and Kendzerska, T., additional
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- 2022
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6. A threshold regression model for recurrent exacerbations in chronic obstructive pulmonary disease
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Aaron, S.D., Ramsay, T., Vandemheen, K., and Whitmore, G.A.
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- 2010
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7. Assessment of Airway Inflammation and Hyperresponsiveness in Subjects with Respiratory Symptoms and Normal Spirometry
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Boulet, L.-P., primary, Boulay, M.-E., additional, Cote, A., additional, FitzGerald, M., additional, Bergeron, C., additional, Lemiere, C., additional, Lougheed, D., additional, Vandemheen, K., additional, and Aaron, S.D., additional
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- 2021
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8. Persistency of Pseudomonas aeruginosa in sputum cultures and clinical outcomes in adult patients with cystic fibrosis
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Burkett, A., Vandemheen, K. L., Giesbrecht-Lewis, T., Ramotar, K., Ferris, W., Chan, F., Doucette, S., Fergusson, D., and Aaron, S. D.
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- 2012
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9. Combination antibiotic susceptibility of biofilm-grown Burkholderia cepacia and Pseudomonas aeruginosa isolated from patients with pulmonary exacerbations of cystic fibrosis
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Dales, L., Ferris, W., Vandemheen, K., and Aaron, S. D.
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- 2009
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10. TRANSLATING RESEARCH INTO PRACTICE: IMPLEMENTING A DECISION AID FOR ADULT CYSTIC FIBROSIS PATIENTS: 588
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Vandemheen, K., Stacey, D., Hennessey, R., Gooyers, T., Salgado, J., Freitag, A., Pakhale, S., Berthiaume, Y., Brown, N., and Aaron, S.
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- 2011
11. PERSISTENCY OF PSEUDOMONAS AERUGINOSA IN SPUTUM CULTURES AND CLINICAL OUTCOMES IN ADULT PATIENTS WITH CYSTIC FIBROSIS: 286
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Burkett, A., Vandemheen, K., Lewis-Giesbrecht, T., Ramotar, K., Ferris, W., Chan, F., Doucette, S., Fergusson, D., and Aaron, S. D.
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- 2011
12. Cost effectiveness of therapy with combinations of long acting bronchodilators and inhaled steroids for treatment of COPD
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Najafzadeh, M, Marra, C A, Sadatsafavi, M, Aaron, S D, Sullivan, S D, Vandemheen, K L, Jones, P W, and Fitzgerald, J M
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- 2008
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13. RANDOMIZED CONTROLLED TRIAL OF A DECISION AID FOR CYSTIC FIBROSIS PATIENTS CONSIDERING REFERRAL FOR LUNG TRANSPLANTATION: 542⋆
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Vandemheen, K., OʼConnor, A., Bell, S., Freitag, A., Bye, P., Jeannneret, A., Berthiaume, Y., Neil, B., Wilcox, P., Ryan, G., Brager, N., Rabin, H., Morrison, N., Gibson, P., Jackson, M., Paterson, N., Middleton, P., Poirier, C., Tullis, E., and Aaron, S.
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- 2008
14. TREATMENT OF CYSTIC FIBROSIS EXACERBATIONS USING BIOFILM ANTIBIOTIC SUSCEPTIBILITY TESTING: 442⋆
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Keays, T., Ferris, W., Vandemheen, K. L., Chan, F., Yeung, S., Mah, T., Ramotar, K., Saginur, R., and Aaron, S.
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- 2008
15. EPIDEMIC STRAINS OF P. AERUGINOSA IN ADULT CF PATIENTS IN ONTARIO, CANADA-PREVALENCE AND EPIDEMIOLOGY: 354
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Aaron, S., Vandemheen, K., Ramotar, K., Giesbrecht, T., Tullis, L., Freitag, A., Paterson, N., Ferris, W., Lougheed, D., Jackson, M., and Kumar, V.
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- 2008
16. Counting, analysing and reporting exacerbations of COPD in randomised controlled trials
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Aaron, S D, Fergusson, D, Marks, G B, Suissa, S, Vandemheen, K L, Doucette, S, Maltais, F, Bourbeau, J F, Goldstein, R S, Balter, M, O’Donnell, D, and FitzGerald, M
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- 2008
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17. Predictors of pulmonary exacerbations in patients with cystic fibrosis infected with multi-resistant bacteria
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Block, J K, Vandemheen, K L, Tullis, E, Fergusson, D, Doucette, S, Haase, D, Berthiaume, Y, Brown, N, Wilcox, P, Bye, P, Bell, S, Noseworthy, M, Pedder, L, Freitag, A, Paterson, N, and Aaron, S D
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- 2006
18. DEVELOPMENT OF A DECISION AID FOR ADULT CYSTIC FIBROSIS PATIENTS CONSIDERING REFERRAL FOR LUNG TRANSPLANTATION: 570
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Vandemheen, K., Aaron, S., OʼConnor, A., Tullis, E., and Poirier, C.
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- 2006
19. Placebo Effects in Clinical Trials Evaluating Patients with Uncontrolled Persistent Asthma
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Luc, F., primary, Prieur, E., additional, Whitmore, G.A., additional, Gibson, P.G., additional, Vandemheen, K., additional, and Aaron, S.D., additional
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- 2019
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20. State of the Art Compendium: Canadian Thoracic Society Recommendations for Management of Chronic Obstructive Pulmonary Disease
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O Donnell, D. E., Shawn Aaron, Bourbeau, J., Hernandez, P., Marciniuk, D., Balter, M., Ford, G., Gervais, A., Goldstein, R., Hodder, R., Maltais, F., Road, J., Mckay, V., Schenkel, J., Ariel, A., Day, A., Lacasse, Y., Levy, R., Lien, D., Miller, J., Rocker, G., Sinuff, T., Stewart, P., Voduc, N., Abboud, R., Becklake, M., Borycki, E., Brooks, D., Bryan, S., Calcutt, L., Chapman, K., Choudry, N., Couet, A., Coyle, S., Craig, A., Crawford, I., Dean, M., Grossman, R., Haffner, J., Heyland, D., Hogg, D., Holroyde, M., Kaplan, A., Kayser, J., Lein, D., Lowry, J., Mcdonald, L., Macfarlane, A., Mcivor, A., Rea, J., Reid, D., Rouleau, M., Samis, L., Sin, D., Vandemheen, K., Wedzicha, J. A., and Weiss, K.
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Pulmonary and Respiratory Medicine ,Spirometry ,Canada ,medicine.medical_specialty ,medicine.medical_treatment ,Disease ,Diseases of the respiratory system ,Pulmonary Disease, Chronic Obstructive ,Pharmacotherapy ,Patient Education as Topic ,Quality of life ,Risk Factors ,medicine ,Humans ,Pulmonary rehabilitation ,Intensive care medicine ,Societies, Medical ,Terminal Care ,COPD ,RC705-779 ,medicine.diagnostic_test ,business.industry ,Oxygen Inhalation Therapy ,medicine.disease ,Respiration, Artificial ,respiratory tract diseases ,Respiratory failure ,Smoking cessation ,Smoking Cessation ,business ,Lung Transplantation - Abstract
Chronic obstructive pulmonary disease (COPD) is a common cause of disability and death in Canada. Moreover, morbidity and mortality from COPD continue to rise, and the economic burden is enormous. The main goal of the Canadian Thoracic Society’s evidence-based guidelines is to optimize early diagnosis, prevention and management of COPD in Canada. The main message of the guidelines is that COPD is a preventable and treatable disease. Targeted spirometry is strongly recommended to expedite early diagnosis in smokers and former smokers who develop respiratory symptoms, and who are at risk for COPD. Smoking cessation remains the single most effective intervention to reduce the risk of COPD and to slow its progression. Education, especially self-management plans, are key interventions in COPD. Therapy should be escalated on an individual basis in accordance with the increasing severity of symptoms and disability. Long-acting anticholinergics and beta-2-agonist inhalers should be prescribed for patients who remain symptomatic despite short-acting bronchodilator therapy. Inhaled steroids should not be used as first line therapy in COPD, but have a role in preventing exacerbations in patients with more advanced disease who suffer recurrent exacerbations. Acute exacerbations of COPD cause significant morbidity and mortality and should be treated promptly with bronchodilators and a short course of oral steroids; antibiotics should be prescribed for purulent exacerbations. Patients with advanced COPD and respiratory failure require a comprehensive management plan that incorporates structured end-of-life care. Management strategies, consisting of combined modern pharmacotherapy and nonpharmacotherapeutic interventions (eg, pulmonary rehabilitation and exercise training) can effectively improve symptoms, activity levels and quality of life, even in patients with severe COPD.
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- 2004
21. Variation in emergency department use of cervical spine radiography for alert, stable trauma patients
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Ian Stiell, Wells, G. A., Vandemheen, K., Laupacis, A., Brison, R., Eisenhauer, M. A., Greenberg, G. H., Macphail, L., Douglas Mcknight, R., Reardon, M., Verbeek, R., Worthington, J., and Lesiuk, H.
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Adult ,Aged, 80 and over ,Male ,Patient Transfer ,Canada ,Adolescent ,Research ,Middle Aged ,Radiography ,Spinal Injuries ,Cervical Vertebrae ,Prevalence ,Humans ,Female ,Letters ,Emergency Service, Hospital ,Aged ,Retrospective Studies - Abstract
OBJECTIVE: To, assess the emergency department use of cervical spine radiography for alert, stable adult trauma patients in terms of utilization, yield for injury and variation in practices among hospitals and physicians. DESIGN: Retrospective survey of health records. SETTING: Emergency departments of 6 teaching and 2 community hospitals in Ontario and British Columbia. PATIENTS: Consecutive alert, stable adult trauma patients seen with potential cervical spine injury between July 1, 1994, and June 30, 1995. MAIN OUTCOME MEASURES: Total number of eligible patients, referral for cervical spine radiography (overall, by hospital and by physician), presence of cervical spine injury, patient characteristics and hospitals associated with use of radiography. RESULTS: Of 6855 eligible patients, cervical spine radiography was ordered for 3979 (58.0%). Only 60 (0.9%) patients were found to have an acute cervical spine injury (fracture, dislocation or ligamentous instability); 98.5% of the radiographic films were negative for any significant abnormality. The demographic and clinical characteristics of the patients were similar across the 8 hospitals, and no cervical spine injuries were missed. Significant variation was found among the 8 hospitals in the rate of ordering radiography (p < 0.0001), from a low of 37.0% to a high of 72.5%. After possible differences in case severity and patient characteristics at each hospital were controlled for, logistic regression analysis revealed that 6 of the hospitals were significantly associated with the use of radiography. At 7 hospitals, there was significant variation in the rate of ordering radiography among the attending emergency physicians (p < 0.05), from a low of 15.6% to a high of 91.5%. CONCLUSIONS: Despite considerable variation among institutions and individual physicians in the ordering of cervical spine radiography for alert, stable trauma patients with similar characteristics, no cervical spine injuries were missed. The number of radiographic films showing signs of abnormality was extremely low at all hospitals. The findings suggest that cervical spine radiography could be used more efficiently, possibly with the help of a clinical decision rule.
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- 1997
22. Multicentre trial to introduce the Ottawa ankle rules for use of radiography in acute ankle injuries. Multicentre Ankle Rule Study Group
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Stiell, I., Wells, G., Laupacis, A., Brison, R., Verbeek, R., Vandemheen, K., and Naylor, C. D.
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Ontario ,Emergency Medical Services ,Decision Making ,Radiography ,Fractures, Bone ,Treatment Outcome ,Clinical Protocols ,Feasibility Studies ,Humans ,Ankle Injuries ,Practice Patterns, Physicians' ,Emergency Service, Hospital ,Referral and Consultation ,Research Article ,Follow-Up Studies - Abstract
OBJECTIVE--To assess the feasibility and impact of introducing the Ottawa ankle rules to a large number of physicians in a wide variety of hospital and community settings over a prolonged period of time. DESIGN--Multicentre before and after controlled clinical trial. SETTING--Emergency departments of eight teaching and community hospitals in Canadian communities (population 10,000 to 3,000,000). SUBJECTS--All 12,777 adults (6288 control, 6489 intervention) seen with acute ankle injuries during two 12 month periods before and after the intervention. INTERVENTION--More than 200 physicians of varying experience were taught to order radiography according to the Ottawa ankle rules. MAIN OUTCOME MEASURES--Referral for ankle and foot radiography. RESULTS--There were significant reductions in use of ankle radiography at all eight hospitals and within a priori subgroups: for all hospitals combined 82.8% control v 60.9% intervention(P < 0.001); for community hospitals 86.7% v 61.7%; (P < 0.001); for teaching hospitals 77.9% v 59.9%; (P < 0.001); for emergency physicians 82.1% v 61.6%; (P < 0.001); for family physicians 84.3% v 60.1%; (P < 0.001); and for housestaff 82.3% v 60.1%; (P < 0.001). Compared with patients without fracture who had radiography during the intervention period those who had no radiography spent less time in the emergency department (54.0 v 86.9 minutes; P < 0.001) and had lower medical charges ($70.20 v $161.60; P < 0.001). There was no difference in the rate of fractures diagnosed after discharge from the emergency department (0.5 v 0.4%). CONCLUSIONS--Introduction of the Ottawa ankle rules proved to be feasible in a large variety of hospital and community settings. Use of the rules over a prolonged period of time by many physicians of varying experience led to a decrease in ankle radiography, waiting times, and costs without an increased rate of missed fractures. The multiphase methodological approach used to develop and implement these rules may be applied to other clinical problems.
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- 1995
23. Persistency of Pseudomonas aeruginosa in sputum cultures and clinical outcomes in adult patients with cystic fibrosis
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Burkett, A., primary, Vandemheen, K. L., additional, Giesbrecht-Lewis, T., additional, Ramotar, K., additional, Ferris, W., additional, Chan, F., additional, Doucette, S., additional, Fergusson, D., additional, and Aaron, S. D., additional
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- 2011
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24. Exacerbation frequency and clinical outcomes in adult patients with cystic fibrosis
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de Boer, K., primary, Vandemheen, K. L., additional, Tullis, E., additional, Doucette, S., additional, Fergusson, D., additional, Freitag, A., additional, Paterson, N., additional, Jackson, M., additional, Lougheed, M. D., additional, Kumar, V., additional, and Aaron, S. D., additional
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- 2011
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25. Confirmation of asthma in an era of overdiagnosis
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Luks, V. P., primary, Vandemheen, K. L., additional, and Aaron, S. D., additional
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- 2010
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26. Methodological issues in therapeutic trials of COPD
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Suissa, S., primary, Ernst, P., additional, Vandemheen, K. L., additional, and Aaron, S. D., additional
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- 2008
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27. The Ontario trial of active compression-decompression cardiopulmonary resuscitation for in-hospital and prehospital cardiac arrest.
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Stiell IG, Hebert PC, Wells GA, Laupacis A, Vandemheen K, Dreyer JF, Eisenhauer MA, Gibson J, Higginson LAJ, Kirby AS, Mahon JL, Maloney JP, Weitzman BN, Stiell, I G, Hébert, P C, Wells, G A, Laupacis, A, Vandemheen, K, Dreyer, J F, and Eisenhauer, M A
- Abstract
Objective: To compare the impact of active compression-decompression (ACD) cardiopulmonary resuscitation (CPR) and standard CPR on the outcomes of in-hospital and prehospital victims of cardiac arrest.Design: Randomized controlled trial with blinding of allocation using a sealed container.Settings: (1) Emergency departments, wards, and intensive care units of 5 university hospitals and (2) all locations outside hospitals in 2 midsized cities.Patients: A total of 1784 adults who had cardiac arrest.Intervention: Patients received either standard or ACD CPR throughout resuscitation.Main Outcome Measures: Survival for 1 hour and to hospital discharge and the modified Mini-Mental State Examination (MMSE).Results: All characteristics were similar in the standard and ACD CPR groups for the 773 in-hospital patients and the 1011 prehospital patients. For in-hospital patients, there were no significant differences between the standard (n = 368) and ACD (n = 405) CPR groups in survival for 1 hour (35.1% vs 34.6%; P = .89), in survival until hospital discharge (11.4% vs 10.4%; P = .64), or in the median MMSE score of survivors (37 in both groups). For patients who collapsed outside the hospital, there were also no significant differences between the standard (n = 510) and ACD (n = 501) CPR groups in survival for 1 hour (16.5% vs 18.2%; P = .48), in survival to hospital discharge (3.7% vs 4.6%; P = .49), or in the median MMSE score of survivors (35 in both groups). Exploration of clinically important subgroups failed to identify any patients who appeared to benefit from ACD CPR.Conclusions: ACD CPR did not improve survival or neurologic outcomes in any group of patients with cardiac arrest. [ABSTRACT FROM AUTHOR]- Published
- 1996
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28. The Ontario trial of active compression-decompression cardiopulmonary resuscitation for in-hospital and prehospital cardiac arrest
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Stiell, IG, primary, Hebert, PC, additional, Wells, GA, additional, Laupacis, A, additional, Vandemheen, K, additional, Dreyer, JF, additional, Eisenhauer, MA, additional, Gibson, J, additional, Higginson, LAJ, additional, Kirby, AS, additional, Mahon, JL, additional, Maloney, JP, additional, and Weitzman, BN, additional
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- 1996
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29. O-53 The Ontario trial of active compression-decompression cardiopulmonary resuscitation for in hospital cardiac arrest
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Stiell, I, primary, Hébert, P, additional, Wells, G, additional, Laupacis, A, additional, Vandemheen, K, additional, Weitzman, B, additional, Maloney, J, additional, Mahon, J, additional, Kirby, A, additional, Higginson, L, additional, Gibson, J, additional, Eisenhauer, M, additional, and Dreyer, J, additional
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- 1996
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30. Multicentre trial to introduce the Ottawa ankle rules for use of radiography in acute ankle injuries
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Stiell, I., primary, Wells, G., additional, Laupacis, A., additional, Brison, R., additional, Verbeek, R., additional, Vandemheen, K., additional, and Naylor, C D., additional
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- 1995
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31. A comparison of obese and nonobese people with asthma: exploring an asthma-obesity interaction.
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Pakhale S, Doucette S, Vandemheen K, Boulet LP, McIvor RA, Fitzgerald JM, Hernandez P, Lemiere C, Sharma S, Field SK, Alvarez GG, Dales RE, Aaron SD, Pakhale, Smita, Doucette, Steve, Vandemheen, Katherine, Boulet, Louise-Philippe, McIvor, R Andrew, Fitzgerald, J Mark, and Hernandez, Paul
- Abstract
Objective: The objectives of our study were to compare patient characteristics and severity of disease in obese and normal-weight-confirmed people with asthma and to explore reasons for misdiagnosis of asthma, including potential interactions with obesity.Methods: We randomly selected patients with physician-diagnosed asthma from eight Canadian cities. Asthma diagnosis was confirmed via a sequential lung function testing algorithm. Logistic analysis was conducted to compare obese and normal-weight-confirmed people with asthma and to assess characteristics associated with misdiagnosis of asthma. Interaction with obesity was investigated.Results: Complete assessments were obtained on 496 subjects who reported physician-diagnosed asthma (242 obese and 254 normal-weight subjects); 346 had asthma confirmed with sequential lung testing, and in 150 subjects a diagnosis of asthma was ruled out. Obese subjects with asthma were significantly more likely to be men, have a history of hypertension and gastroesophageal reflux disease, and have a lower FEV(1) compared with normal-weight subjects with asthma. Older subjects, men, and subjects with higher FEV(1) were more likely to have received misdiagnoses of asthma. Obesity was not an independent predictor of misdiagnosis, however there was an interaction between obesity and urgent visits for respiratory symptoms. The odds ratio for receiving a misdiagnosis of asthma for obese individuals as compared with normal-weight individuals was 4.08 (95% CI, 1.23-13.5) for those with urgent visits in the past 12 months.Conclusions: Obese people with asthma have lower lung function and more comorbidities compared with normal-weight people with asthma. Obese individuals who make urgent visits for respiratory symptoms are more likely to receive a misdiagnosis of asthma. [ABSTRACT FROM AUTHOR]- Published
- 2010
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32. Adult cystic fibrosis exacerbations and new strains of Pseudomonas aeruginosa.
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Aaron SD, Ramotar K, Ferris W, Vandemheen K, Saginur R, Tullis E, Haase D, Kottachchi D, St. Denis M, and Chan F
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We hypothesized that in adults with cystic fibrosis, the acquisition of a new strain of Pseudomonas aeruginosa may be associated with a pulmonary exacerbation. Eighty-four patients who were chronically infected with P. aeruginosa were prospectively followed from eight centers over a 26-month period. Patients had sputum cultures performed every 3 months while clinically stable and at the time of an exacerbation. Forty patients (48%) had an exacerbation requiring intravenous antibiotics during the study period, and in 36 of these patients, their P. aeruginosa isolates were genetically typeable by pulsed-field gel electrophoresis. In 34 of the 36 patients (94%), P. aeruginosa recovered during clinical stability and at exacerbation were of the same genotype. In only two patients (6%; 95% confidence interval, 0-18%) was a new P. aeruginosa clone cultured during an exacerbation that had not been cultured during clinical stability. There were no significant differences in antibiotic susceptibilities, measured as mean minimal inhibitory concentrations, for isolates retrieved during clinically stable periods compared with isolates retrieved during exacerbations. We conclude that for the majority of adult patients with cystic fibrosis a new pulmonary exacerbation is not caused by the acquisition of a new strain of P. aeruginosa. [ABSTRACT FROM AUTHOR]
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- 2004
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33. Do Advanced Cardiac Life Support Drugs Increase Resuscitation Rates From In-Hospital Cardiac Arrest?
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van Walraven, C., Stiell, I.G., Wells, G.A., Hebert, P.C., and Vandemheen, K.
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Study objective: The benefit of Advanced Cardiac Life Support (ACLS) medications during cardiac resuscitation is uncertain. The objective of this study was to determine whether the use of these medications increased resuscitation from in-hospital cardiac arrest. Methods: A prospective cohort of patients undergoing cardiac arrest in 1 of 5 academic hospitals was studied. Patient and arrest factors related to resuscitation outcome were recorded. We determined the association of the administration of ACLS drugs (epinephrine, atropine, bicarbonate, calcium, lidocaine, and bretylium) with survival at 1 hour after resuscitation. Results: Seven hundred seventy-three patients underwent cardiac resuscitation, with 269 (34.8%) surviving for 1 hour. Use of epinephrine, atropine, bicarbonate, calcium, and lidocaine was associated with a decreased chance of successful resuscitation (P <.001 for all except lidocaine, P <.01). While controlling for significant patient factors (age, gender, and previous cardiac or respiratory disease) and arrest factors (initial cardiac rhythm, and cause of arrest), multivariate logistic regression demonstrated a significant association between unsuccessful resuscitation and the use of epinephrine (odds ratio .08 [95% confidence interval .04-.14]), atropine (.24 [.17-.35]), bicarbonate (.31 [.21-.44]), calcium (.32 [.18-.55]), and lidocaine (.48 [.33-.71]). Drug effects did not improve when patients were grouped by their initial cardiac rhythm. Cox proportional hazards models that controlled for significant confounders demonstrated that survivors were significantly less likely to receive epinephrine (P <.001) or atropine (P <.001) throughout the arrest. Conclusion: We found no association between standard ACLS medications and improved resuscitation from in-hospital cardiac arrest. Randomized clinical trials are needed to determine whether other therapies can improve resuscitation from cardiac arrest when compared with the presently used ACLS drugs. [van Walraven C, Stiell IG, Wells GA, Hebert PC, Vandemheen K, for the OTAC Study Group: Do Advanced Cardiac Life Support drugs increase resuscitation rates from in-hospital cardiac arrest? Ann Emerg Med November 1998;32:544-553.]
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- 1998
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34. Variation in ED Use of Computed Tomography for Patients With Minor Head Injury
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Stiell, I.G., Wells, G.A., Vandemheen, K., Laupacis, A., Brison, R., Eisenhauer, M.A., Greenberg, G.H., MacPhail, I., McKnight, R., Reardon, M., Verbeek, R., Worthington, J., and Lesiuk, H.
- Abstract
Study objective: To determine the frequency of utilization, yield for brain injury, incidence of missed injury, and variation in the use of computed tomography (CT) for ED patients with minor head injury. Methods: This retrospective health records survey was conducted over a 12-month period in the EDs at seven Canadian teaching institutions. Included in this review were adult patients who sustained acute minor head injury, defined as witnessed loss of consciousness or amnesia and a Glasgow Coma Scale score of 13 or greater. Data were collected by research assistants who were trained to select cases and abstract data in a standardized fashion according to a resource manual. Subsequently, patient eligibility was reviewed by the study coordinator and principal investigator. Results: Of the 1,699 patients seen, 521 (30.7%) were referred for CT, and 418 (79.8%) of these scans were negative for any type of brain injury. Overall, 105 (6.2%) of these patients sustained acute brain injury, including 9 (.5%) with an epidural hematoma. Cochran's Q test for homogeneity demonstrated significant variation between the seven centers for rate of ordering CT (P<.0001), from a low of 15.9% to a high of 70.4%. All five cases of ''missed'' hematoma occurred at the institutions with the highest and third highest rates of CT use. After controlling for possible differences in case severity and patient characteristics at each hospital, logistic regression analysis revealed that five of seven hospitals were significantly associated with use of CT (respective odds ratios [OR], .4, .5, .5, 3.2, and 4.7). Three of the centers (two with the highest ordering rates) showed significant heterogeneity in the ordering of CT among their attending staff physicians, from a low of 6.5% to a high of 80.0%. Conclusion: There was considerable variation among institutions and individual physicians in the ordering of CT for patients with minor head injury. Although emergency physicians were selective when ordering CT, the yield of radiography was very low at all hospitals. None of the cases of ''missed'' intracranial hematoma came from the lowest ordering institutions, indicating that patients may be managed safely with a selective approach to CT use. These findings suggest great potential for more standardized and efficient use of CT of the head, possibly through the use of a clinical decision rule. [Stiell IG, Wells GA, Vandemheen K, Laupacis A, Brison R, Eisenhauer MA, Greenberg GH, MacPhail I, McKnight RD, Reardon M, Verbeek R, Worthington J, Lesiuk H: Variation in ED use of computed tomography for patients with minor head injury. Ann Emerg Med July 1997;30:14-22.]
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- 1997
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35. The Canadian C-spine rule for radiography in alert and stable trauma patients
- Author
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Ian Stiell, Wells, G. A., Vandemheen, K. L., Clement, C. M., Lesiuk, H., Maio, V. J., Laupacis, A., Schull, M., Mcknight, R. D., Verbeek, R., Brison, R., Cass, D., Dreyer, J., Eisenhauer, M. A., Greenberg, G. H., Macphail, I., Morrison, L., Reardon, M., and Worthington, J.
36. (Correcting) misdiagnoses of asthma: a cost effectiveness analysis
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Vandemheen Katherine, Coyle Douglas, Sumner Amanda, Pakhale Smita, and Aaron Shawn
- Subjects
Asthma cost ,Canadian asthma cost ,asthma cost savings ,asthma secondary screening ,economic analysis ,epidemiology of asthma ,Diseases of the respiratory system ,RC705-779 - Abstract
Abstract Background The prevalence of physician-diagnosed-asthma has risen over the past three decades and misdiagnosis of asthma is potentially common. Objective: to determine whether a secondary-screening-program to establish a correct diagnosis of asthma in those who report a physician diagnosis of asthma is cost effective. Method Randomly selected physician-diagnosed-asthmatic subjects from 8 Canadian cities were studied with an extensive diagnostic algorithm to rule-in, or rule-out, a correct diagnosis of asthma. Subjects in whom the diagnosis of asthma was excluded were followed up for 6-months and data on asthma medications and heath care utilization was obtained. Economic analysis was performed to estimate the incremental lifetime costs associated with secondary screening of previously diagnosed asthmatic subjects. Analysis was from the perspective of the Canadian healthcare system and is reported in Canadian dollars. Results Of 540 randomly selected patients with physician diagnosed asthma 150 (28%; 95%CI 19-37%) did not have asthma when objectively studied. 71% of these misdiagnosed patients were on some asthma medications. Incorporating the incremental cost of secondary-screening for the diagnosis of asthma, we found that the average cost savings per 100 individuals screened was $35,141 (95%CI $4,588-$69,278). Conclusion Cost savings primarily resulted from lifetime costs of medication use averted in those who had been misdiagnosed.
- Published
- 2011
- Full Text
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37. Multi analyte profiling and variability of inflammatory markers in blood and induced sputum in patients with stable COPD
- Author
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Nikolcheva Tania, Avnur Zafrira, Zhang Chun, Ramsay Timothy, Vandemheen Katherine L, Aaron Shawn D, and Quinn Anthony
- Subjects
Diseases of the respiratory system ,RC705-779 - Abstract
Abstract Background We analyzed serial concentrations of multiple inflammatory mediators from serum and induced sputum obtained from patients with stable COPD and controls. The objective was to determine which proteins could be used as reliable biomarkers to assess COPD disease state and severity. Methods Forty-two subjects; 21 with stable COPD and 21 controls, were studied every 2 weeks over a 6-week period. Serum and induced sputum were obtained at each of 3 visits and concentrations of 19 serum and 22 sputum proteins were serially assessed using multiplex immunoassays. We used linear mixed effects models to test the distribution of proteins for an association with COPD and disease severity. Measures of within- and between-subject coefficients of variation were calculated for each of the proteins to assess reliability of measurement. Results There was significant variability in concentrations of all inflammatory proteins over time, and variability was greater for sputum proteins (median intra-subject coefficient of variation 0.58) compared to proteins measured in serum (median intra-subject coefficient of variation 0.32, P = 0.03). Of 19 serum proteins and 22 sputum proteins tested, only serum CRP, myeloperoxidase and VEGF and sputum IL-6, IL-8, TIMP-1, and VEGF showed acceptable intra and inter-patient reliability and were significantly associated with COPD, the severity of lung function impairment, and dyspnea. Conclusions Levels of many serum and sputum biomarkers cannot be reliably ascertained based on single measurements. Multiple measurements over time can give a more reliable and precise estimate of the inflammatory burden in clinically stable COPD patients.
- Published
- 2010
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- View/download PDF
38. The Canadian CT Head Rule for patients with minor head injury.
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Stiell, Ian G, Wells, George A, Vandemheen, Katherine, Clement, Catherine, Lesiuk, Howard, Laupacis, Andreas, McKnight, R Douglas, Verbeek, Richard, Brison, Robert, Cass, Daniel, Eisenhauer, Mary A, Greenberg, Gary H, Worthington, James, Stiell, I G, Wells, G A, Vandemheen, K, Clement, C, Lesiuk, H, Laupacis, A, and McKnight, R D
- Subjects
- *
HEAD injuries , *TOMOGRAPHY , *EMERGENCY medicine , *DIAGNOSTIC services - Abstract
Background: There is much controversy about the use of computed tomography (CT) for patients with minor head injury. We aimed to develop a highly sensitive clinical decision rule for use of CT in patients with minor head injuries.Methods: We carried out this prospective cohort study in the emergency departments of ten large Canadian hospitals and included consecutive adults who presented with a Glasgow Coma Scale (GCS) score of 13-15 after head injury. We did standardised clinical assessments before the CT scan. The main outcome measures were need for neurological intervention and clinically important brain injury on CT.Findings: The 3121 patients had the following characteristics: mean age 38.7 years); GCS scores of 13 (3.5%), 14 (16.7%), 15 (79.8%); 8% had clinically important brain injury; and 1% required neurological intervention. We derived a CT head rule which consists of five high-risk factors (failure to reach GCS of 15 within 2 h, suspected open skull fracture, any sign of basal skull fracture, vomiting >2 episodes, or age >65 years) and two additional medium-risk factors (amnesia before impact >30 min and dangerous mechanism of injury). The high-risk factors were 100% sensitive (95% CI 92-100%) for predicting need for neurological intervention, and would require only 32% of patients to undergo CT. The medium-risk factors were 98.4% sensitive (95% CI 96-99%) and 49.6% specific for predicting clinically important brain injury, and would require only 54% of patients to undergo CT.Interpretation: We have developed the Canadian CT Head Rule, a highly sensitive decision rule for use of CT. This rule has the potential to significantly standardise and improve the emergency management of patients with minor head injury. [ABSTRACT FROM AUTHOR]- Published
- 2001
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39. Effects of weight loss on airway responsiveness in obese adults with asthma: does weight loss lead to reversibility of asthma?
- Author
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Pakhale S, Baron J, Dent R, Vandemheen K, and Aaron SD
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- Adult, Body Mass Index, Bronchial Provocation Tests, Comorbidity, Female, Forced Expiratory Volume physiology, Humans, Male, Methacholine Chloride adverse effects, Middle Aged, Prospective Studies, Quality of Life, Respiratory Hypersensitivity chemically induced, Severity of Illness Index, Treatment Outcome, Vital Capacity physiology, Asthma epidemiology, Asthma physiopathology, Obesity epidemiology, Obesity physiopathology, Respiratory Hypersensitivity physiopathology, Weight Loss physiology
- Abstract
Background: The growing epidemics of obesity and asthma are major public health concerns. Although asthma-obesity links are widely studied, the effects of weight loss on asthma severity measured by airway hyperresponsiveness (AHR) have received limited attention. The main study objective was to examine whether weight reduction reduces asthma severity in obese adults with asthma., Methods: In a prospective, controlled, parallel-group study, we followed 22 obese participants with asthma aged 18 to 75 years with a BMI ≥ 32.5 kg/m2 and AHR (provocative concentration of methacholine causing a 20% fall in FEV1 [PC20] < 16 mg/mL). Sixteen participants followed a behavioral weight reduction program for 3 months, and six served as control subjects. The primary outcome was change in AHR over 3 months. Changes in lung function, asthma control, and quality of life were secondary outcomes., Results: At study entry, participant mean ± SD age was 44 ± 9 years, 95% were women, and mean BMI was 45.7 ± 9.2 kg/m2. After 3 months, mean weight loss was 16.5 ± 9.9 kg in the intervention group, and the control group had a mean weight gain of 0.6 ± 2.6 kg. There were significant improvements in PC20 (P = .009), FEV1 (P = .009), FVC (P = .010), asthma control (P < .001), and asthma quality of life (P = .003) in the intervention group, but these parameters remained unchanged in the control group. Physical activity levels also increased significantly in the intervention group but not in the control group., Conclusions: Weight loss in obese adults with asthma can improve asthma severity, AHR, asthma control, lung function, and quality of life. These findings support the need to actively pursue healthy weight-loss measures in this population.
- Published
- 2015
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40. Effect of infection with transmissible strains of Pseudomonas aeruginosa on lung transplantation outcomes in patients with cystic fibrosis.
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Srour N, Chaparro C, Vandemheen K, Singer LG, Keshavjee S, and Aaron SD
- Subjects
- Adult, Female, Humans, Male, Preoperative Period, Pseudomonas aeruginosa pathogenicity, Treatment Outcome, Cystic Fibrosis complications, Lung Transplantation, Postoperative Complications epidemiology, Postoperative Complications etiology, Pseudomonas Infections complications, Pseudomonas Infections transmission, Pseudomonas aeruginosa classification
- Abstract
Background: Compared with patients infected with unique strains of Pseudomonas aeruginosa, patients with cystic fibrosis who are infected with transmissible strains of P aeruginosa, such as the Liverpool epidemic strain, have a 3-fold greater risk of death or lung transplant. We aimed to determine if pre-operative infection with transmissible strains of P aeruginosa was similarly associated with poor health outcomes after lung transplant., Methods: We had prospectively identified and characterized endobronchial infections in 446 adult cystic fibrosis patients in Ontario, Canada, from September 2005 until December 2009. P aeruginosa isolated from sputum taken at 3-month intervals was genotyped, and patients were characterized as being infected with 1 of 2 transmissible strains or, alternatively, with unique strains of P aeruginosa. We monitored patients until 2013 and collected data on patients from the cohort who subsequently received a lung transplant. The primary outcome was survival after transplantation., Results: We identified 56 lung transplant recipients from the cohort of 446 patients, including 18 infected with transmissible strains of P aeruginosa and 26 infected with unique P aeruginosa strains. Post-transplant survival at 3 years was 86% in the transmissible group and 84% in the unique group (p = 0.65). No significant differences between groups were found regarding bronchiolitis obliterans-free survival, the frequency of acute rejection episodes, the frequency of post-transplant respiratory tract infection, or the rate of change of post-transplant forced expiratory volume in 1 second., Conclusions: Pre-operative infection with transmissible strains of P aeruginosa is not associated with poorer post-transplant outcomes compared with patients infected with unique strains of P aeruginosa., (Copyright © 2015 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2015
- Full Text
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41. (Correcting) misdiagnoses of asthma: a cost effectiveness analysis.
- Author
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Pakhale S, Sumner A, Coyle D, Vandemheen K, and Aaron S
- Subjects
- Algorithms, Anti-Asthmatic Agents economics, Asthma epidemiology, Canada epidemiology, Cost-Benefit Analysis, Health Care Costs, Humans, Mass Screening methods, Prevalence, Retrospective Studies, Asthma diagnosis, Asthma economics, Diagnostic Errors economics, Mass Screening economics
- Abstract
Background: The prevalence of physician-diagnosed-asthma has risen over the past three decades and misdiagnosis of asthma is potentially common., Objective: to determine whether a secondary-screening-program to establish a correct diagnosis of asthma in those who report a physician diagnosis of asthma is cost effective., Method: Randomly selected physician-diagnosed-asthmatic subjects from 8 Canadian cities were studied with an extensive diagnostic algorithm to rule-in, or rule-out, a correct diagnosis of asthma. Subjects in whom the diagnosis of asthma was excluded were followed up for 6-months and data on asthma medications and heath care utilization was obtained. Economic analysis was performed to estimate the incremental lifetime costs associated with secondary screening of previously diagnosed asthmatic subjects. Analysis was from the perspective of the Canadian healthcare system and is reported in Canadian dollars., Results: Of 540 randomly selected patients with physician diagnosed asthma 150 (28%; 95%CI 19-37%) did not have asthma when objectively studied. 71% of these misdiagnosed patients were on some asthma medications. Incorporating the incremental cost of secondary-screening for the diagnosis of asthma, we found that the average cost savings per 100 individuals screened was $35,141 (95%CI $4,588-$69,278)., Conclusion: Cost savings primarily resulted from lifetime costs of medication use averted in those who had been misdiagnosed.
- Published
- 2011
- Full Text
- View/download PDF
42. Characterization of clonal strains of Pseudomonas aeruginosa isolated from cystic fibrosis patients in Ontario, Canada.
- Author
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Beaudoin T, Aaron SD, Giesbrecht-Lewis T, Vandemheen K, and Mah TF
- Subjects
- Anti-Bacterial Agents pharmacology, Bacterial Proteins genetics, Bacterial Proteins metabolism, Biofilms, Canada, Drug Resistance, Bacterial, Gene Expression Regulation, Bacterial, Humans, Microbial Sensitivity Tests, Ontario, Pseudomonas aeruginosa drug effects, Pseudomonas aeruginosa genetics, Pseudomonas aeruginosa physiology, Cystic Fibrosis microbiology, Pseudomonas Infections microbiology, Pseudomonas aeruginosa isolation & purification
- Abstract
Pseudomonas aeruginosa is an opportunistic pathogen that can form biofilms in the lungs and airways of cystic fibrosis (CF) patients, resulting in chronic endobronchial infection. Two clonal strains of P. aeruginosa, named type A and type B, have recently been identified and have been found to infect more than 20% of CF patients in Ontario, Canada. In this study, 4 type A and 4 type B isolates retrieved from 8 CF patients in Ontario, Canada, were characterized. All 8 isolates grew well in rich medium and formed biofilms in vitro. Antibiotic resistance profiles of bacteria grown in biofilms and planktonic culture were studied via minimal bactericidal concentration assays for tobramycin, gentamicin, and ciprofloxacin. Compared to laboratory strains of P. aeruginosa, all 8 isolates showed increased resistance to all antibiotics studied in both biofilm and planktonic assays. Gene expression analysis of mexX, representing the MexXY-OprM efflux pump, and mexA, representing MexAB-OprM, revealed that these genes were up-regulated in the 8 clinical isolates. These results suggest clonal type A and type B isolates of P. aeruginosa isolated from CF patients in Ontario, Canada, show a multidrug resistance pattern that can be partially explained as being due to the increased expression of common antibiotic efflux systems.
- Published
- 2010
- Full Text
- View/download PDF
43. Infection with Burkholderia cepacia complex bacteria and pulmonary exacerbations of cystic fibrosis.
- Author
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St Denis M, Ramotar K, Vandemheen K, Tullis E, Ferris W, Chan F, Lee C, Slinger R, and Aaron SD
- Subjects
- Adolescent, Adult, Anti-Bacterial Agents therapeutic use, Burkholderia Infections drug therapy, Burkholderia Infections microbiology, Burkholderia cepacia complex drug effects, Burkholderia cepacia complex genetics, Cystic Fibrosis drug therapy, DNA, Bacterial genetics, Disease Progression, Drug Resistance, Bacterial, Electrophoresis, Gel, Pulsed-Field, Female, Follow-Up Studies, Genotype, Humans, Male, Polymerase Chain Reaction, Prognosis, Prospective Studies, Rec A Recombinases genetics, Recurrence, Burkholderia Infections complications, Burkholderia cepacia complex isolation & purification, Cystic Fibrosis complications, Sputum microbiology
- Abstract
Background: Studies have shown that cystic fibrosis (CF) patients who are chronically infected with Burkholderia cepacia complex bacteria may potentially acquire new strains of B cepacia. Our objective was to determine whether pulmonary exacerbations of CF are associated with acquisition of new B cepacia strains or with B cepacia strain replacement., Methods: Thirty-six patients from seven centers who were chronically infected with B cepacia complex bacteria were prospectively followed up over a 38-month period. Patients had sputum cultures performed every 3 months while clinically stable and at the time of a pulmonary exacerbation. Each B cepacia complex isolate was speciated by polymerase chain reaction amplification of the recA gene to determine species status and was genotyped by pulsed-field gel electrophoresis to determine strain type., Results: Thirty-five of 36 patients (97%) had chronic infection with Burkholderia cenocepacia III-A during clinical stability. All 36 patients maintained the same species and strain of B cepacia complex at the time of exacerbation as was found during clinical stability. B cepacia complex isolates retrieved during exacerbations were significantly less susceptible to ciprofloxacin, chloramphenicol, piperacillin, meropenem, and tobramycin compared to isolates retrieved from the same patients during clinical stability., Conclusion: Adult CF patients infected with B cenocepacia maintain the same strain of B cenocepacia during exacerbations; pulmonary exacerbations are not caused by acquisition of a new B cepacia species or strain. B cepacia isolates retrieved during exacerbations may be more resistant to antibiotics.
- Published
- 2007
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- View/download PDF
44. Sex differences in the clinical presentation and management of airflow obstruction.
- Author
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Dales RE, Mehdizadeh A, Aaron SD, Vandemheen KL, and Clinch J
- Subjects
- Airway Obstruction diagnosis, Airway Obstruction drug therapy, Airway Obstruction epidemiology, Female, Forced Expiratory Volume, Humans, Male, Middle Aged, Ontario, Rural Population, Sex Factors, Smoking drug therapy, Smoking epidemiology, Spirometry methods, Airway Obstruction physiopathology, Smoking physiopathology
- Abstract
The aim of the present study was to explore differences in the clinical expression, clinical diagnoses and management of airway diseases in a primary-care setting. Patients aged >or=35 yrs who had ever smoked were enrolled when they presented for any reason to one of eight rural primary-care practices. Respiratory symptom questionnaires and spirometry were administered. In total, 1,034 patients had acceptable and reproducible spirometry, of whom 550 (53%) were males and 484 (47%) were females. Males smoked more than females (41.2 versus 29.2 pack-yrs) respectively, and were more likely to have a pre-bronchodilator forced expiratory volume in one second/forced vital capacity <0.70 at 22.4 versus 11.8%, respectively. However, more females than males reported breathlessness (51.0 versus 42.8%, respectively), a prior diagnosis compatible with airflow obstruction and taking respiratory medications (23.4 versus 14.9%, respectively). In conclusion, the current results suggest that females are more likely than males to report breathlessness and be prescribed respiratory medications independent of differences in the severity of airflow obstruction.
- Published
- 2006
- Full Text
- View/download PDF
45. The Canadian Optimal Therapy of COPD Trial: design, organization and patient recruitment.
- Author
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Aaron SD, Vandemheen K, Fergusson D, Fitzgerald M, Maltais F, Bourbeau J, Goldstein R, McIvor A, Balter M, and O'donnell D
- Subjects
- Canada, Double-Blind Method, Economics, Pharmaceutical, Humans, Multicenter Studies as Topic, Outcome Assessment, Health Care, Prospective Studies, Research Design, Tiotropium Bromide, Bronchodilator Agents administration & dosage, Patient Selection, Pulmonary Disease, Chronic Obstructive drug therapy, Randomized Controlled Trials as Topic economics, Scopolamine Derivatives administration & dosage
- Abstract
Background: There are no published studies that have assessed whether adding long-acting beta 2-agonist bronchodilators and/or inhaled steroids to chronic therapy with tiotropium would provide additional clinical benefit to patients with moderate to severe chronic obstructive pulmonary disease (COPD)., Methods: The Canadian Optimal Therapy of COPD Trial is a randomized, prospective, double-blind, placebo-controlled, multicentre trial funded by the Canadian Institutes of Health Research that has been designed to determine which combination of inhaled medications will most effectively prevent exacerbations and optimize disease-specific quality of life in patients with COPD. The trial is the first to evolve from the Canadian Thoracic Society Clinical Trials Group. The study will randomize 432 patients with moderate to severe COPD to one of three parallel treatment arms for 52 weeks: tiotropium and fluticasone/salmeterol; tiotropium and salmeterol; or tiotropium and placebo inhaler. The participants will be allowed to use salbutamol as required throughout the trial period., Outcomes: The primary outcome measure is the proportion of patients in the three treatment groups who experienced a respiratory exacerbation within 52 weeks of randomization. Other outcomes that will be assessed over the 52-week trial period will include: changes in disease-specific quality of life and changes in dyspnea, health care use and changes in lung function. A pharmacoeconomic analysis will also be performed to evaluate the cost of these therapies., Results: The study commenced recruitment in October 2003. It is currently operating at 22 centres across Canada and has randomized 137 patients during the first four months of recruitment. Recruitment is scheduled to continue until April 2005 or until 432 patients have been randomized., Conclusion: The present randomized, placebo-controlled trial offers a unique opportunity to answer the question, what is the best combination of inhaled medications to use for COPD patients? It is hoped that optimal use of inhaled medications will improve patient health and quality of life, reduce patient respiratory exacerbations, and ultimately, reduce health care resource use.
- Published
- 2004
- Full Text
- View/download PDF
46. Sputum versus bronchoscopy for diagnosis of Pseudomonas aeruginosa biofilms in cystic fibrosis.
- Author
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Aaron SD, Kottachchi D, Ferris WJ, Vandemheen KL, St Denis ML, Plouffe A, Doucette SP, Saginur R, Chan FT, and Ramotar K
- Subjects
- Adult, Biopsy, Bronchi pathology, Bronchoalveolar Lavage, Chronic Disease, Drug Resistance, Microbial, Female, Genotype, Humans, Male, Microbial Sensitivity Tests, Pseudomonas Infections complications, Pseudomonas aeruginosa genetics, Biofilms, Bronchoscopy, Cystic Fibrosis complications, Pseudomonas Infections diagnosis, Pseudomonas aeruginosa isolation & purification, Sputum microbiology
- Abstract
The present authors hypothesised that bronchoscopy with protected specimen brush may sample biofilm-forming bacteria adherent to the airway wall, whereas traditional sputum collection may not. Pseudomonas aeruginosa obtained from sputum, bronchoalveolar lavage and protected brush, taken from the right upper lung bronchus of 12 adult patients with cystic fibrosis, were compared. Retrieved bacteria were genotyped, and grown in planktonic cultures and as biofilms, and susceptibilities to individual antibiotics and to antibiotic combinations were determined. Bacterial cultures obtained using bronchoscopy did not yield any new strains of bacteria that were not also found in sputum. A total of 10 patients (83%) had a single strain of P. aeruginosa found using sputum, bronchoalveolar lavage and protected brush techniques, and two patients (17%) had two strains recovered in sputum, but only one strain was recovered using bronchoscopic techniques. Susceptibility to single antibiotics and to antibiotic combinations were not different between planktonically or biofilm-grown bacteria derived from sputum, as compared to those obtained by bronchoalveolar lavage and protected brush. In conclusion, sputum collection provides as much information as bronchoscopy for characterising the genotype and antibiotic susceptibility of chronic Pseudomonas aeruginosa infection in patients with stable cystic fibrosis.
- Published
- 2004
- Full Text
- View/download PDF
47. State of the Art Compendium: Canadian Thoracic Society recommendations for the management of chronic obstructive pulmonary disease.
- Author
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O'Donnell DE, Aaron S, Bourbeau J, Hernandez P, Marciniuk D, Balter M, Ford G, Gervais A, Goldstein R, Hodder R, Maltais F, Road J, McKay V, Schenkel J, Ariel A, Day A, Lacasse Y, Levy R, Lien D, Miller J, Rocker G, Sinuff T, Stewart P, Voduc N, Abboud R, Ariel A, Becklake M, Borycki E, Brooks D, Bryan S, Calcutt L, Chapman K, Choudry N, Couet A, Coyle S, Craig A, Crawford I, Dean M, Grossman R, Haffner J, Heyland D, Hogg D, Holroyde M, Kaplan A, Kayser J, Lein D, Lowry J, McDonald L, MacFarlane A, McIvor A, Rea J, Reid D, Rouleau M, Samis L, Sin D, Vandemheen K, Wedzicha JA, and Weiss K
- Subjects
- Canada epidemiology, Humans, Lung Transplantation, Oxygen Inhalation Therapy, Patient Education as Topic, Pulmonary Disease, Chronic Obstructive diagnosis, Pulmonary Disease, Chronic Obstructive epidemiology, Pulmonary Disease, Chronic Obstructive prevention & control, Respiration, Artificial, Risk Factors, Smoking Cessation, Societies, Medical, Terminal Care, Pulmonary Disease, Chronic Obstructive drug therapy, Pulmonary Disease, Chronic Obstructive rehabilitation
- Abstract
Chronic obstructive pulmonary disease (COPD) is a common cause of disability and death in Canada. Moreover, morbidity and mortality from COPD continue to rise, and the economic burden is enormous. The main goal of the Canadian Thoracic Society's evidence-based guidelines is to optimize early diagnosis, prevention and management of COPD in Canada. The main message of the guidelines is that COPD is a preventable and treatable disease. Targeted spirometry is strongly recommended to expedite early diagnosis in smokers and former smokers who develop respiratory symptoms, and who are at risk for COPD. Smoking cessation remains the single most effective intervention to reduce the risk of COPD and to slow its progression. Education, especially self-management plans, are key interventions in COPD. Therapy should be escalated on an individual basis in accordance with the increasing severity of symptoms and disability. Long-acting anticholinergics and beta-2-agonist inhalers should be prescribed for patients who remain symptomatic despite short-acting bronchodilator therapy. Inhaled steroids should not be used as first line therapy in COPD, but have a role in preventing exacerbations in patients with more advanced disease who suffer recurrent exacerbations. Acute exacerbations of COPD cause significant morbidity and mortality and should be treated promptly with bronchodilators and a short course of oral steroids; antibiotics should be prescribed for purulent exacerbations. Patients with advanced COPD and respiratory failure require a comprehensive management plan that incorporates structured end-of-life care. Management strategies, consisting of combined modern pharmacotherapy and nonpharmacotherapeutic interventions (eg, pulmonary rehabilitation and exercise training) can effectively improve symptoms, activity levels and quality of life, even in patients with severe COPD.
- Published
- 2004
- Full Text
- View/download PDF
48. Single and combination antibiotic susceptibilities of planktonic, adherent, and biofilm-grown Pseudomonas aeruginosa isolates cultured from sputa of adults with cystic fibrosis.
- Author
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Aaron SD, Ferris W, Ramotar K, Vandemheen K, Chan F, and Saginur R
- Subjects
- Drug Resistance, Multiple, Bacterial, Humans, Microbial Sensitivity Tests methods, Pseudomonas Infections microbiology, Pseudomonas aeruginosa growth & development, Pseudomonas aeruginosa physiology, Sputum microbiology, Anti-Bacterial Agents pharmacology, Bacterial Adhesion drug effects, Biofilms drug effects, Cystic Fibrosis microbiology, Pseudomonas aeruginosa drug effects
- Abstract
Evidence suggests that Pseudomonas aeruginosa bacteria form biofilms within the airways of adults with cystic fibrosis (CF). The objective of this study was to determine whether clinical isolates of P. aeruginosa recovered from adults with CF have similar susceptibilities to individual antibiotics and to antibiotic combinations when grown as adherent monolayers or as biofilms compared to when they are grown using planktonic methods. Twelve multiresistant P. aeruginosa isolates, one mucoid and one nonmucoid from each of six CF patients, were grown conventionally under planktonic conditions, as adherent bacterial monolayers, and as biofilms. Each bacterial isolate remained genotypically identical despite being cultured under planktonic, adherent, or biofilm growth conditions. Isolates grown as adherent monolayers and as biofilms were less susceptible to bactericidal killing by individual antibiotics compared to those grown planktonically. More importantly, biofilm-grown bacteria, but not adherent monolayer-grown bacteria, were significantly less susceptible to two- and three-drug combinations of antibiotics than were planktonically grown bacteria (P = 0.005). We conclude that biofilm-grown bacteria derived from patients with CF show decreased susceptibility to the bactericidal effects of antibiotic combinations than do adherent and planktonically grown bacteria.
- Published
- 2002
- Full Text
- View/download PDF
49. The Canadian C-spine rule for radiography in alert and stable trauma patients.
- Author
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Stiell IG, Wells GA, Vandemheen KL, Clement CM, Lesiuk H, De Maio VJ, Laupacis A, Schull M, McKnight RD, Verbeek R, Brison R, Cass D, Dreyer J, Eisenhauer MA, Greenberg GH, MacPhail I, Morrison L, Reardon M, and Worthington J
- Subjects
- Adult, Aged, Canada, Cervical Vertebrae diagnostic imaging, Female, Humans, Male, Middle Aged, Outcome and Process Assessment, Health Care, Prospective Studies, Radiography standards, Regression Analysis, Risk Assessment, Sensitivity and Specificity, Tomography, X-Ray Computed, Craniocerebral Trauma diagnostic imaging, Decision Support Techniques, Emergency Medical Services standards, Neck Injuries diagnostic imaging, Traumatology standards, Wounds, Nonpenetrating diagnostic imaging
- Abstract
Context: High levels of variation and inefficiency exist in current clinical practice regarding use of cervical spine (C-spine) radiography in alert and stable trauma patients., Objective: To derive a clinical decision rule that is highly sensitive for detecting acute C-spine injury and will allow emergency department (ED) physicians to be more selective in use of radiography in alert and stable trauma patients., Design: Prospective cohort study conducted from October 1996 to April 1999, in which physicians evaluated patients for 20 standardized clinical findings prior to radiography. In some cases, a second physician performed independent interobserver assessments., Setting: Ten EDs in large Canadian community and university hospitals., Patients: Convenience sample of 8924 adults (mean age, 37 years) who presented to the ED with blunt trauma to the head/neck, stable vital signs, and a Glasgow Coma Scale score of 15., Main Outcome Measure: Clinically important C-spine injury, evaluated by plain radiography, computed tomography, and a structured follow-up telephone interview. The clinical decision rule was derived using the kappa coefficient, logistic regression analysis, and chi(2) recursive partitioning techniques., Results: Among the study sample, 151 (1.7%) had important C-spine injury. The resultant model and final Canadian C-Spine Rule comprises 3 main questions: (1) is there any high-risk factor present that mandates radiography (ie, age >/=65 years, dangerous mechanism, or paresthesias in extremities)? (2) is there any low-risk factor present that allows safe assessment of range of motion (ie, simple rear-end motor vehicle collision, sitting position in ED, ambulatory at any time since injury, delayed onset of neck pain, or absence of midline C-spine tenderness)? and (3) is the patient able to actively rotate neck 45 degrees to the left and right? By cross-validation, this rule had 100% sensitivity (95% confidence interval [CI], 98%-100%) and 42.5% specificity (95% CI, 40%-44%) for identifying 151 clinically important C-spine injuries. The potential radiography ordering rate would be 58.2%., Conclusion: We have derived the Canadian C-Spine Rule, a highly sensitive decision rule for use of C-spine radiography in alert and stable trauma patients. If prospectively validated in other cohorts, this rule has the potential to significantly reduce practice variation and inefficiency in ED use of C-spine radiography.
- Published
- 2001
- Full Text
- View/download PDF
50. Vasopressin versus epinephrine for inhospital cardiac arrest: a randomised controlled trial.
- Author
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Stiell IG, Hébert PC, Wells GA, Vandemheen KL, Tang AS, Higginson LA, Dreyer JF, Clement C, Battram E, Watpool I, Mason S, Klassen T, and Weitzman BN
- Subjects
- Aged, Arrhythmias, Cardiac etiology, Cognition Disorders diagnosis, Cognition Disorders etiology, Double-Blind Method, Female, Heart Arrest complications, Heart Arrest mortality, Humans, Hypertension etiology, Infarction etiology, Male, Mental Status Schedule, Mesentery blood supply, Middle Aged, Ontario epidemiology, Safety, Survival Analysis, Time Factors, Treatment Outcome, Epinephrine therapeutic use, Heart Arrest drug therapy, Hospitalization, Resuscitation methods, Vasopressins therapeutic use
- Abstract
Background: Survival rates for cardiac arrest patients, both in and out of hospital, are poor. Results of a previous study suggest better outcomes for patients treated with vasopressin than for those given epinephrine, in the out-of-hospital setting. Our aim was to compare the effectiveness and safety of these drugs for the treatment of in-patient cardiac arrest., Methods: We did a triple-blind randomised trial in the emergency departments, critical care units, and wards of three Canadian teaching hospitals. We assigned adults who had cardiac arrest and required drug therapy to receive one dose of vasopressin 40 U or epinephrine 1 mg intravenously, as the initial vasopressor. Patients who failed to respond to the study intervention were given epinephrine as a rescue medication. The primary outcomes were survival to hospital discharge, survival to 1 h, and neurological function. Preplanned subgroup assessments included patients with myocardial ischaemia or infarction, initial cardiac rhythm, and age., Findings: We assigned 104 patients to vasopressin and 96 to epinephrine. For patients receiving vasopressin or epinephrine survival did not differ for hospital discharge (12 [12%] vs 13 [14%], respectively; p50.67; 95% CI for absolute increase in survival 211.8% to 7.8%) or for 1 h survival (40 [39%] vs 34 [35%]; p50.66; 210.9% to 17.0%); survivors had closely similar median mini-mental state examination scores (36 [range 19-38] vs 35 [20-40]; p50.75) and median cerebral performance category scores (1 vs 1)., Interpretation: We failed to detect any survival advantage for vasopressin over epinephrine. We cannot recommend the routine use of vasopressin for inhospital cardiac arrest patients, and disagree with American Heart Association guidelines, which recommend vasopressin as alternative therapy for cardiac arrest.
- Published
- 2001
- Full Text
- View/download PDF
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