Sumit R Majumdar

University of Manitoba, Winnipeg, Manitoba, Canada

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Publications (335)2122.67 Total impact

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    ABSTRACT: Background: Early readmissions to hospital post-discharge are common, and clinicians cannot accurately predict their occurrence. We examined whether patients who feel unready at the time of discharge have increased readmissions or death within 30 days. Patients and methods: Prospective cohort study of adult patients discharged home from two tertiary care hospitals in Edmonton, Alberta, Canada, between October, 2013 and November, 2014. Patient-reported discharge readiness was measured with an 11-point Likert response scale, with scores < 7 indicating subjective unreadiness. The primary outcome was readmission or death within 30 days. Logistic regression models were adjusted for age, sex, and a validated risk prediction score for post-discharge events (LACE index). Results: Of 495 patients (mean age 62 years, 51% female, mean Charlson comorbidities = 2.8), 112 (23%) reported being unready for discharge. Risk factors for being unready at discharge were cognitive impairment (mild vs none), low satisfaction with health care services, depression, lower education, previous hospital admissions (12m), and persistent symptoms or disability. At 30-days, 85 patients (17%) had been readmitted or died, with no significant difference between patients who felt unready or ready (15% vs 18%, adjusted odds ratio = 0.84, 95% CI 0.46-1.54, p = 0.59). Conclusions: Although nearly one quarter of hospitalized medical patients reported being unready at the time of discharge, they did not experience any higher risk of readmission or death in the first 30 days post-discharge, compared with patients who felt ready for discharge.
    The American journal of medicine 09/2015; DOI:10.1016/j.amjmed.2015.08.018 · 5.00 Impact Factor
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    ABSTRACT: Randomized controlled trials are considered the "gold standard" for scientific rigor in the assessment of benefits and harms of interventions in healthcare. They may not always be feasible, however, when evaluating quality improvement interventions in real-world healthcare settings. Non-randomized controlled trials (NCTs) are designed to answer questions of effectiveness of interventions in routine clinical practice to inform a decision or process. The on-off NCT design is a relatively new design where participant allocation is by alternation. In alternation, eligible patients are allocated to the intervention "on" or control "off " groups in time series dependent sequential clusters. We used two quality improvement studies undertaken in a Canadian primary care setting to illustrate the features of the on-off design. We also explored the perceptions and experiences of healthcare providers tasked with implementing the on-off study design. The on-off design successfully allocated patients to intervention and control groups. Imbalances between baseline variables were attributed to chance, with no detectable biases. However, healthcare providers' perspectives and experiences with the design in practice reveal some conflict. Specifically, providers described the process of allocating patients to the off group as unethical and immoral, feeling it was in direct conflict with their professional principle of providing care for all. The degree of dissatisfaction seemed exacerbated by: 1) the patient population involved (e.g., patient population viewed as high-risk (e.g., depressed or suicidal)), 2) conducting assessments without taking action (e.g., administering the PHQ-9 and not acting on the results), and 3) the (non-blinded) allocation process. Alternation, as in the on-off design, is a credible form of allocation. The conflict reported by healthcare providers in implementing the design, while not unique to the on-off design, may be alleviated by greater emphasis on the purpose of the research and having research assistants allocate patients and collect data instead of the healthcare providers implementing the trial. In addition, consultation with front-line staff implementing the trials with an on-off design on appropriateness to the setting (e.g., alignment with professional values and the patient population served) may be beneficial. Health Eating and Active Living with Diabetes: identifier: NCT00991380 Date registered: 7 October 2009. Controlled trial of a collaborative primary care team model for patients with diabetes and depression: Identifier: NCT01328639 Date registered: 30 March 2011.
    Trials 08/2015; 16(1):375. DOI:10.1186/s13063-015-0904-x · 1.73 Impact Factor
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    Sana Vahidy · Sumit R Majumdar · Raj S Padwal ·
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    ABSTRACT: Background/Objectives. The objective of this study was to compare casual BP taken in a bariatric clinic to standardized guideline-concordant BP. Subjects/Methods. A cross sectional analysis was performed using baseline data from a weight management trial. Patients were recruited from a Canadian bariatric care program. Standardized BP was performed using a Watch BP oscillometric device. Casual in-clinic BP single readings, taken using a Welch Allyn oscillometric device, were chart-abstracted. Paired t-tests, Bland-Altman plots, and Pearson's correlations were used for analysis. Results. Data from 134 patients were analyzed. Mean age was 41.5 ± 8.9 y, mean BMI was 46.8 ± 6.5 kg/m(2), and 40 (30%) had prior hypertension. Mean casual in-clinic BP was 128.8 ± 14.1/81.6 ± 9.9 mmHg and mean standardized BP was 133.2 ± 15.0/82.0 ± 10.3 mmHg (difference of -4.3 ± 12.0 for systolic (p < 0.0001) and -0.4 ± 10.0 mmHg for diastolic BP (p = 0.6)). Pearson's coefficients were 0.66 (p < 0.0001) for SBP and 0.50 (p < 0.0001) for DBP. 28.4% of casual versus 26.9% of standardized measurements were ≥140/90 mmHg (p < 0.0001). Conclusion. In this bariatric clinic, casual BP was unexpectedly lower than standardized BP. This could potentially lead to the underdiagnosis of hypertension.
    International Journal of Hypertension 08/2015; 2015(56):801709. DOI:10.1155/2015/801709
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    ABSTRACT: To better understand the factors that affect care and outcomes in patients with type 2 diabetes, we developed the prospective Alberta's Caring for Diabetes (ABCD) cohort to collect, monitor and analyze data concerning several sociodemographic, behavioural, psychosocial, clinical and physiological factors that might influence diabetes care and outcomes. We recruited 2040 individuals with type 2 diabetes through primary care networks, diabetes clinics and public advertisements. Data are being collected through self-administered surveys, including standardized measures of health status and self-care behaviours, and will eventually be linked to laboratory and administrative healthcare data and other novel databases. The average age of respondents was 64.4 years (SD=10.7); 45% were female, and 91% were white, with average duration of diabetes of 12 years (SD=10.0). The majority (76%) were physically inactive, and 10% were smokers. Most (88%) reported 2 or more chronic conditions in addition to diabetes, and 18% screened positively for depressive symptoms. The majority (92%) consented to future linkage with administrative data. Based on the literature and comparison with other surveys, the cohort appeared to fairly represent the general Alberta population with diabetes. The ABCD cohort will serve as the basis for explorations of the multidimensional and dynamic nature of diabetes care and complications. These data will contribute to broader scientific literature and will also help to identify local benchmarks and targets for intervention strategies, helping to guide policies and resource allocation related to the care and management of patients with type 2 diabetes in Alberta, Canada. Copyright © 2015 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.
    Canadian Journal of Diabetes 08/2015; DOI:10.1016/j.jcjd.2015.05.005 · 2.00 Impact Factor
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    ABSTRACT: We evaluated the implementation of an efficacious collaborative care model for patients with diabetes and depression in a controlled trial in 4 community-based primary care networks (PCNs) in Alberta, Canada. Similar to previous randomized trials, the nurse care manager-led TeamCare intervention demonstrated statistically significant improvements in depressive symptoms compared with usual care. We contextualized TeamCare’s effectiveness by describing implementation fidelity at the organizational and patient levels.
    07/2015; 39. DOI:10.1016/j.jcjd.2015.05.004
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    ABSTRACT: Although there have been tremendous advances in diabetes care, including the development of efficacious interventions, there remain considerable challenges in translating these advances into practice. Four primary care networks (PCNs) in Alberta implemented 2 quality-improvement interventions focused on lifestyle and depression as part of the Alberta's Caring for Diabetes (ABCD) project. We used the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) framework to evaluate adoption of the quality-improvement interventions in the PCN setting. We undertook semistructured interviews with PCN staff (n=24); systematic documentation (e.g. field notes) and formal reflections by the research team (n=4). Content analysis was used to interrogate the data. The Ready? Set? Go! construct summarizes our findings well. We observed that the participating PCNs were in a favourable position to adopt the 2 interventions successfully. We implemented strategies to promote adoption (Ready), and respondents reported prioritization and willingness to initiate the interventions based on positive indicators (Set). Regardless, the interplay of organizational stability, leadership support, existing physician culture and organizational context influenced the overall degree of adoption of the interventions across the PCNs (Go). Our findings suggest that implementation of quality-improvement interventions into settings similar to the PCNs we studied will have the greatest likelihood of success when there is priority alignment, genuine and sustained leadership support and an innovative organizational culture. However, the stability of organizations may affect the degree to which staff can adopt quality-improvement interventions successfully, so organizational stability should be assessed on an ongoing basis. Copyright © 2015 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.
    07/2015; 39. DOI:10.1016/j.jcjd.2015.05.002
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    ABSTRACT: Patient registries are considered an important foundation of chronic disease management, and diabetes patient registries are associated with better processes and outcomes of care. The purpose of this article is to describe the development and use of registries in the Alberta's Caring for Diabetes (ABCD) project to identify and reach target populations for quality-improvement interventions in the primary care setting. We applied the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) framework and expanded the definition of reach beyond the individual (i.e. patient) level to include the ability to identify target populations at an organizational level. To characterize reach and the implementation of registries, semistructured interviews were conducted with key informants, and a usual-care checklist was compiled for each participating Primary Care Network (PCN). Content analysis was used to analyze qualitative data. Using registries to identify and recruit participants for the ABCD interventions proved challenging. The quality of the registries depended on whether physicians granted PCN access to patient lists, the strategies used in development, the reliability of diagnostic information and the data elements collected. In addition, once a diabetes registry was developed, there was limited ability to update it. Proactive management of chronic diseases like diabetes requires the ability to reach targeted patients at the population level. We observed several challenges to the development and application of patient registries. Given the importance of valid registries, strong collaborations and novel strategies that involve policy-makers, PCNs and providers are needed to help find solutions to improve registry quality and resolve maintenance issues. Copyright © 2015 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.
    07/2015; 39. DOI:10.1016/j.jcjd.2015.05.001
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    ABSTRACT: To study the impact of a 2009 policy change in British Columbia (BC) that allowed pharmacists to independently renew certain prescriptions for chronic conditions. Population-based analysis. BC, Canada. All residents of BC (more than 3.9 million). Prescription drug use data were collected from the PharmaNet database. This database contains a record of all ambulatory prescription drug dispensations in BC including a variable indicating whether a pharmacist renewed the prescription. We studied pharmaceutical and physician insurance claims datasets for all BC residents for 2 years following the 2009 policy change. We assessed the number and types of drugs renewed by pharmacists, and whether these complied with the policy. Further, we matched pharmacist-renewed prescriptions to equivalent potentially renewable prescriptions and assessed the impact on ambulatory physician visits. Over the first 2 years, pharmacists renewed 150,950 prescriptions in BC. Almost one-half of these renewals did not appear to match the conditions set out in the new regulatory policy (n = 69,970, 47%). Those that did match the conditions (n = 80,980, 53%) represented a very small proportion of the 47 million prescriptions that pharmacists could have renewed (0.17%). The most frequently renewed medications were treatments for dyslipidemias, hypertension, diabetes, and gastroesophageal reflux disease. Pharmacist-renewed prescriptions were preceded by a 30% relative decrease in ambulatory physician visits in the week before dispensing, but there was also a 17% relative increase in visits in the week following the pharmacist-renewed prescription. Overall, the use of pharmacist renewals was very low and one-half of the renewals were not policy-concordant. Pharmacist renewals were associated with the intended reductions in physician visits before dispensing, but there was also an unintended increase in visits after dispensing. These findings suggest that future policies such as this one need to be differently designed and closely monitored.
    Journal of the American Pharmacists Association 06/2015; 55(4):e333-e339. DOI:10.1331/JAPhA.2015.14262 · 1.24 Impact Factor
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    Stephen B Soumerai · Douglas Starr · Sumit R Majumdar ·

    Preventing chronic disease 06/2015; 12(6):E101. DOI:10.5888/pcd12.150187 · 2.12 Impact Factor
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    ABSTRACT: This study evaluated age- and sex-adjusted changes in total hip and spine bone mineral density (BMD) within 1year of total knee arthroplasty (TKA) using a prospective, longitudinal cohort with a one-year follow-up. Preoperatively, subjects underwent routine bone mineral densitometry of their hip and spine, which was repeated 12months postoperatively. Of 108 subjects, 97 (90%) completed BMD testing. Total hip BMD decreased significantly over time (1.80% change, P<0.001) with females losing more than males (P<0.001). The pattern was similar, but attenuated in the spine. Subjects undergoing primary cemented TKA had significant bone loss in the hip within 12months, beyond that expected with age. Copyright © 2015. Published by Elsevier Inc.
    The Journal of arthroplasty 06/2015; DOI:10.1016/j.arth.2015.06.026 · 2.67 Impact Factor
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    ABSTRACT: Information on the long-term prognosis after community-acquired pneumonia (CAP) is limited. To determine if CAP increases adverse long-term outcomes relative to a control population. Between 2000-2002, 6078 adults with CAP from 6 hospitals and 7 Emergency Departments in Edmonton (Alberta, Canada) were prospectively recruited and matched on age, sex, and site of treatment with 5 non-pneumonia controls (n=29,402). Mortality, hospitalizations and Emergency Department admissions through to 2012 were evaluated using multivariable Cox proportional hazards analyses adjusted for socioeconomic status and comorbidities. Average age was 59 years [2 682 (44%) 65 years], 3214 (53%) were male, and 3425 (56%) were managed as outpatients. Over a median of 9.8 years, 2858 CAP patients died compared with 9399 controls (absolute risk difference 30 per 1000 patient years (py); adjusted hazard ratio (aHR) 1.65, 95%CI 1.57 to 1.73, p<0.001). CAP patients <25 years old had the lowest absolute rate difference for mortality (4 per 1000 patient years (py); aHR 2.40) while patients >80 years had the highest absolute rate difference (92 per 1000 py; aHR 1.42). Absolute rates of all-cause hospitalization, Emergency Department visits, and CAP related visits, were all significantly higher in CAP patients compared to controls (P<0.001 for all comparisons). Our results indicate that an episode of CAP confers a high risk of long-term adverse events compared to the general population who have not experienced CAP and this is irrespective of age.
    American Journal of Respiratory and Critical Care Medicine 06/2015; 192(5). DOI:10.1164/rccm.201501-0140OC · 13.00 Impact Factor
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    ABSTRACT: Readmissions after hospital discharge are common and costly, but prediction models are poor at identifying patients at high risk of readmission. We evaluated the impact of frailty on readmission or death within 30 days after discharge from general internal medicine wards. We prospectively enrolled patients discharged from 7 medical wards at 2 teaching hospitals in Edmonton. Frailty was defined by means of the previously validated Clinical Frailty Scale. The primary outcome was the composite of readmission or death within 30 days after discharge. Of the 495 patients included in the study, 162 (33%) met the definition of frailty: 91 (18%) had mild, 60 (12%) had moderate, and 11 (2%) had severe frailty. Frail patients were older, had more comorbidities, lower quality of life, and higher LACE scores at discharge than those who were not frail. The composite of 30-day readmission or death was higher among frail than among nonfrail patients (39 [24.1%] v. 46 [13.8%]). Although frailty added additional prognostic information to predictive models that included age, sex and LACE score, only moderate to severe frailty (31.0% event rate) was an independent risk factor for readmission or death (adjusted odds ratio 2.19, 95% confidence interval 1.12-4.24). Frailty was common and associated with a substantially increased risk of early readmission or death after discharge from medical wards. The Clinical Frailty Scale could be useful in identifying high-risk patients being discharged from general internal medicine wards. © 8872147 Canada Inc.
    Canadian Medical Association Journal 05/2015; 187(11). DOI:10.1503/cmaj.150100 · 5.96 Impact Factor
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    ABSTRACT: To identify which activities produced a significant improvement in blood pressure control in patients with type 2 diabetes when pharmacists were added to primary care teams. This prespecified, secondary analysis evaluated medication management data from a randomized controlled trial. The primary outcome was a change in treatment, defined as addition, dosage increase, or switching of an antihypertensive medication during the 1-year study period. The secondary outcome was a change in antihypertensive medication adherence using the medication possession ratio (MPR). The 200 evaluable trial patients had a mean age of 59 (SD, 11) years, 44% were men, and mean blood pressure was 130 (SD, 16)/74 (SD, 10) mm Hg at baseline. Treatment changes occurred in 45 (42%) of 107 patients in the intervention group and 24 (26%) of 93 patients in the control group (RR, 1.63; 95% CI, 1.08-2.46). Addition of a new medication was the most common type of change, occurring in 34 (32%) patients in the intervention group and 17 (18%) patients in the control group (P = 0.029). Adherence to antihypertensive medication was high at baseline (MPR, 93%). Although medication adherence improved in the intervention group (MPR, 97%) and declined in the control group (MPR, 91%), the difference between groups was not significant (P = 0.21). The observed improvement in blood pressure control when pharmacists were added to primary care teams was likely achieved through antihypertensive treatment changes and not through improvements in antihypertensive medication adherence.
    Journal of the American Pharmacists Association 04/2015; 55(3):e301-e304. DOI:10.1331/JAPhA.2015.14225 · 1.24 Impact Factor

  • Canadian Journal of Diabetes 04/2015; 39:S30. DOI:10.1016/j.jcjd.2015.01.121 · 2.00 Impact Factor
  • Fatima Al Sayah · Sumit R Majumdar · Leonard E Egede · Jeffrey A Johnson ·
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    ABSTRACT: Inadequate health literacy has been associated with poorer health behaviors and outcomes in individuals with diabetes or depression. This study was conducted to examine the associations between inadequate health literacy and behavioral and cardiometabolic parameters in individuals with type 2 diabetes and to explore whether these associations are affected by concurrent depression. The authors used cross-sectional data from a study of 343 predominantly African Americans with type 2 diabetes. Inadequate health literacy was significantly and modestly associated with diabetes knowledge (r = -0.34) but weakly associated with self-efficacy (r = 0.16) and depressive symptoms (r = 0.24). In multivariate regression models, there were no associations between health literacy and A1c, blood pressure, or body mass index or control of any of these parameters. There was no evidence that depression was an effect-modifier of the associations between health literacy and outcomes. Although inadequate health literacy was modestly associated with worse knowledge and weakly associated with self-efficacy, it was not associated with any of the cardiometabolic parameters the authors studied. Because this study showed no association between health literacy and behavioral and cardiometabolic outcomes, it is unseemly and premature to embark on trials or controlled interventions to improve health literacy for the purposes of improving patient-related outcomes in diabetes.
    Journal of Health Communication 03/2015; 20(5):1-8. DOI:10.1080/10810730.2015.1012235 · 1.61 Impact Factor
  • Fatima Al Sayah · Sumit R Majumdar · Jeffrey A Johnson ·
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    ABSTRACT: To examine the relationship of inadequate health literacy (HL) with changes in depressive symptoms, health-related quality of life and cardiometabolic outcomes in patients with type 2 diabetes mellitus recently screened positive for depression. Secondary analysis of data from a clinical trial (N=154) that compared a collaborative team care model and enhanced usual care for primary care for patients with type 2 diabetes and depression. The exposure of interest was inadequate HL, defined as a total summative score of 9 or more on the 3 brief screening questions. Outcomes of interest were differences in the changes in depressive symptoms (Patient Health Questionnaire-9 (PHQ-9) at 12 months, health-related quality of life (short-form health survey 12 [SF-12]) and European Quality of Life-5 Dimensions questionnaire (EQ-5D), glycemic control (A1C), low-density lipoprotein cholesterol and systolic blood pressure. The average age of patients was 58 years; 56% were women and were predominantly white. Only a small proportion (n=24; 16%) had inadequate HL. In adjusted random effects models, there were no statistically significant or clinically important differences in all outcomes between the HL groups. The between-group differences in change over 1 year were -0.55 points for PHQ-9; 0.76 points for physical and 0.56 points for mental summaries of the SF-12; 0.03 points for EQ-5D; -0.17 for A1C; -0.08 mmol/L for low-density lipoprotein; and -1.94 mm Hg for systolic blood pressure. Among primary care patients with type 2 diabetes who had been screened recently as being positive for depression, it is unlikely that HL impacts health outcomes over 1 year. Copyright © 2015 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.
    03/2015; 39(4). DOI:10.1016/j.jcjd.2014.11.005
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    ABSTRACT: To examine the prevalence of multimorbidity (≥2 chronic conditions) in severely obese patients and its associations with weight loss and health status over 2 years. In a prospective cohort including 500 severely obese adults, self-reported prevalence of 20 chronic conditions was calculated at baseline and 2 years. Multivariable logistic regression models were fitted to test the covariate-adjusted associations between ≥5% weight reduction and reduction in multimorbidity and the association between health status (visual analogue scale [VAS]) and reduction in multimorbidity over 2 years. After 2 years, mean weight change was -12.9 ±18.7 kg, 53% had ≥5% weight reduction, mean change in VAS was 11.5 ± 21.2, and 53.5% had ≥10% increase in VAS. Multimorbidity was reported in 95.4% and 92.8% patients at baseline and 2 years, respectively. Weight loss (≥5%) over 2 years was associated with reduction in multimorbidity (adjusted OR = 1.7, 95% CI 1.1-2.7). Reduction in multimorbidity was associated with clinically important improvements (≥10% increase in VAS) in health status (adjusted OR = 2.5, 95% CI 1.6, 4.0). Multimorbidity is common in severely obese patients. Having ≥5% weight reduction over 2 years was associated with a reduction in multimorbidity, which was also associated with improvements in health status. © 2015 The Obesity Society.
    Obesity 02/2015; 23(3). DOI:10.1002/oby.21008 · 3.73 Impact Factor
  • Finlay A McAlister · Erik Youngson · Raj S Padwal · Sumit R Majumdar ·
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    ABSTRACT: Hospitals reduce staffing levels and services on weekends. This raises the question of whether weekend discharges may be inadequately prepared and thus at higher risk for adverse events postdischarge. To compare death or nonelective readmission rates 30 days after weekend versus weekday discharge. Retrospective cohort. All teaching hospitals in Alberta, Canada. General internal medicine (GIM) discharges (only 1 per patient). Analyses were adjusted for demographics, comorbidity, and length of stay based on a previously validated index. Of 7991 patients (mean age, 62.1 years; 51.9% male; mean Charlson 2.56; 57.5% LACE ≥10) discharged from 7 teaching hospitals, 1146 (14.3%) were discharged on a weekend. Although they had substantially shorter lengths of stay (5.64 days, 95% confidence interval [CI]: 5.35-5.93 vs 7.86 days, 95% CI: 7.71-8.00, adjusted P value < 0.0001) and were less likely to be discharged with homecare support (10.9% vs 19.3%) or to long-term care facilities (3.1% vs 7.8%), patients discharged on weekends exhibited similar rates of death or readmission at 30 days compared to those discharged on weekdays (10.6% vs 13.2%, adjusted odds ratio [aOR]: 0.94, 95% CI: 0.77-1.16), even among the 4591 patients deemed to be at high risk for postdischarge events based on LACE (length of hospital stay, acuity of admission, comorbidity burden quantified using the Charlson Comorbidity Index, and emergency department visits in the 6 months prior to admission) score ≥10 (16.8% vs 16.5% for weekday discharges, aOR: 1.09 [95% CI: 0.85-1.41]). GIM patients discharged from teaching hospitals on weekends have shorter lengths of stay and exhibit similar postdischarge outcomes as patients discharged on weekdays. Journal of Hospital Medicine 2014. © 2014 Society of Hospital Medicine. © 2014 Society of Hospital Medicine.
    Journal of Hospital Medicine 02/2015; 10(2). DOI:10.1002/jhm.2310 · 2.30 Impact Factor
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    ABSTRACT: Frailty is a multidimensional syndrome characterized by loss of physiologic reserve that gives rise to vulnerability to poor outcomes. We aimed to examine the association between frailty and long-term health-related quality-of-life among survivors of critical illness. Prospective multicenter observational cohort study. ICUs in six hospitals from across Alberta, Canada. Four hundred twenty-one critically ill patients who were 50 years or older. None. Frailty was operationalized by a score of more than 4 on the Clinical Frailty Scale. Health-related quality-of-life was measured by the EuroQol Health Questionnaire and Short-Form 12 Physical and Mental Component Scores at 6 and 12 months. Multiple logistic and linear regression with generalized estimating equations was used to explore the association between frailty and health-related quality-of-life. In total, frailty was diagnosed in 33% (95% CI, 28-38). Frail patients were older, had more comorbidities, and higher illness severity. EuroQol-visual analogue scale scores were lower for frail compared with not frail patients at 6 months (52.2 ± 22.5 vs 64.6 ± 19.4; p < 0.001) and 12 months (54.4 ± 23.1 vs 68.0 ± 17.8; p < 0.001). Frail patients reported greater problems with mobility (71% vs 45%; odds ratio, 3.1 [1.6-6.1]; p = 0.001), self-care (49% vs 15%; odds ratio, 5.8 [2.9-11.7]; p < 0.001), usual activities (80% vs 52%; odds ratio, 3.9 [1.8-8.2]; p < 0.001), pain/discomfort (68% vs 47%; odds ratio, 2.0 [1.1-3.8]; p = 0.03), and anxiety/depression (51% vs 27%; odds ratio, 2.8 [1.5-5.3]; p = 0.001) compared with not frail patients. Frail patients described lower health-related quality-of-life on both physical component score (34.7 ± 7.8 vs 37.8 ± 6.7; p = 0.012) and mental component score (33.8 ± 7.0 vs 38.6 ± 7.7; p < 0.001) at 12 months. Frail survivors of critical illness experienced greater impairment in health-related quality-of-life, functional dependence, and disability compared with those not frail. The systematic assessment of frailty may assist in better informing patients and families on the complexities of survivorship and recovery.
    Critical Care Medicine 01/2015; 43(5). DOI:10.1097/CCM.0000000000000860 · 6.31 Impact Factor
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    William D Leslie · Sumit R Majumdar · Suzanne N Morin · Lisa M Lix ·
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    ABSTRACT: Context: Intuitively, rapid bone mineral density (BMD) loss should predict fracture risk independently of current BMD, but studies have not confirmed this. We hypothesized that measurement error when characterizing rates of BMD loss might explain this paradox. Objective: To examine the importance of measurement error in predicting BMD loss. Design and Setting: Retrospective registry study using BMD results for Manitoba, Canada. Patients: Untreated women age 50 years and older with three femoral neck BMD tests. Main Outcome Measures: Correlation in annualized rates of BMD change for interval 1 (first to second scan) versus interval 2 (second to third scan) with confirmatory model-based simulations that varied measurement error and testing intervals. Results: Five hundred forty two women with a mean age of 62 years had BMD measurements separated by a mean of 3.5 years for interval 1 and 3.4 years for interval 2. Mean femoral neck BMD loss was stable (-0.5% per year for interval 1, -0.6% per year for interval 2) with a weak negative correlation between intervals (r = -0.11, P = .01). There were no significant correlations for BMD change at the total hip (r = 0.01, P = .74) or total spine (r = -0.01, P = .77). Simulations showed low explained variation for BMD change between intervals 1 and 2 (<20%). To explain 50% of the variation of BMD change between intervals 1 and 2 required a BMD measurement error ≤0.008 g/cm(2) or a BMD testing interval ≥5 years. Conclusions: The low correlation between past and future BMD loss helps explain why the rate of BMD loss is unlikely to be helpful for refining fracture risk.
    Journal of Clinical Endocrinology &amp Metabolism 01/2015; 100(2):jc20143777. DOI:10.1210/jc.2014-3777 · 6.21 Impact Factor

Publication Stats

10k Citations
2,122.67 Total Impact Points


  • 2015
    • University of Manitoba
      • Department of Internal Medicine
      Winnipeg, Manitoba, Canada
    • Royal Alexandra Hospital
      Edmonton, Alberta, Canada
  • 2001-2015
    • University of Alberta
      • • Division of General Internal Medicine
      • • Department of Medicine
      • • Department of Public Health Sciences
      Edmonton, Alberta, Canada
  • 2013
    • TEC Edmonton
      Edmonton, Alberta, Canada
  • 2010
    • Glenrose Rehabilitation Hospital
      Edmonton, Alberta, Canada
  • 2004-2006
    • Institute of Health Economics
      Edmonton, Alberta, Canada
  • 2003-2005
    • Harvard Medical School
      Boston, Massachusetts, United States
  • 2002
    • University of Toronto
      Toronto, Ontario, Canada
    • University Health Network
      • Department of Medicine
      Toronto, Ontario, Canada