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Charles Ratzlaff,
Jacqueline Simatovic, Hubert Wong,
Linda Li,
Allison Ezzat,
Dolores Langford,
John M Esdaile,
Carol Kennedy,
Patrick Embley,
Darryl Caves,
Trish Hopkins,
Jolanda Cibere
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ABSTRACT: PURPOSE: To assess the inter-rater reliability of hip exam tests used to assess femoroacetabular impingement (FAI) among clinicians from different disciplines. METHODS: Twelve subjects were examined by nine clinicians using 12 hip tests drawn from a review of the literature and consultation with experts in hip pain and FAI. Examiners assessed both hips of each subject and were blinded to subject history. The order in which subjects were seen, the order of tests and the order of the two hips within each subject were all randomized. Inter-rater reliability (IRR) for the 10 categorical tests was summarized using overall raw agreement (ORA), positive agreement (PA) (agreement on abnormal findings) and negative agreement (NA) (agreement on normal findings). An ORA of > 0.75 was considered to indicate adequate reliability. For the two ROM outcomes, IRR was summarized using the median of the absolute difference (MAD) in measurements obtained by any two examiners on any patient. MAD reflects the "typical" difference (in degrees) between two raters. RESULTS: Adequate reliability (ORA > 0.75) was achieved for 6 of the 10 hip exam tests with categorical outcomes. Positive agreement ranged from 0.35 to 0.84, while negative agreement ranged from 0.62 to 0.99. For the ROM outcomes examiners were, on average, within 5° of each other for flexion, and 7° for internal rotation. CONCLUSIONS: The results provide evidence that the most common hip exam tests would likely be sufficiently reliable to allow agreement between examiners when discriminating between painful FAI and normal hips in a clinical setting. © 2013 by the American College of Rheumatology.
Arthritis care & research. 04/2013;
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ABSTRACT: PURPOSE: The purpose of this study was to determine the attributable intensive care unit (ICU) and hospital length of stay and mortality of ICU-acquired Clostridium difficile infection (CDI). MATERIALS AND METHODS: In this retrospective cohort study of 3 tertiary and 3 community ICUs, we screened all patients admitted between April 2006 and December 2011 for ICU-acquired CDI. Using both complete and matched cohort designs and Cox proportional hazards analysis, we determined the association between CDI and ICU and hospital length of stay and mortality. Adjustment or matching variables were site, age, sex, severity of illness, and year of admission; any infection as an ICU admitting or acquired diagnosis before the diagnosis of CDI and diagnosis of CDI were time-dependent exposures. RESULTS: Of 15314 patients admitted to the ICUs during the study period, 236 developed CDI in the ICU. In the complete cohort analysis, the hazard ratios (95% confidence interval) for CDI related to ICU and hospital discharge were 0.82 (0.72, 0.94) and 0.83 (0.73, 0.95), respectively (0.5 additional ICU days and 3.4 hospital days), and related to death in ICU and hospital, they were 1.00 (0.73, 1.38) and 1.19 (0.93, 1.52), respectively. In the matched analysis, the hazard ratios for CDI related to ICU and hospital discharge were 0.91 (0.81, 1.03) and 0.98 (0.85, 1.13), respectively, and related to death in ICU and hospital, they were 1.18 (0.85, 1.63) and 1.08 (0.82, 1.43), respectively. CONCLUSIONS: C difficile infection acquired in ICU is associated with an increase in length of ICU and hospital stay but not with any difference in ICU or hospital mortality.
Journal of critical care 01/2013; · 2.13 Impact Factor
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Epidemiology Research International. 07/2012; Volume 2012 (2012),(Article ID 610405):14 pages.
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ABSTRACT: Family satisfaction with critical care is influenced by a variety of factors. We investigated the relationship between measures of organizational and safety culture, and family satisfaction in critical care. We further explored differences in this relationship depending on intensive care unit survival status and length of intensive care unit stay of the patient.
Cross-sectional surveys.
Twenty-three tertiary and community intensive care units within three provinces in Canada.
One thousand two-hundred eighty-five respondents from 2374 intensive care unit clinical staff, and 880 respondents from 1381 family members of intensive care unit patients.
None.
Intensive care unit staff completed the Organization and Management of Intensive Care Units survey and the Hospital Survey on Patient Safety Culture. Family members completed the Family Satisfaction in the Intensive Care Unit 24, a validated survey of family satisfaction. A priori, we analyzed adjusted relationships between each domain score from the culture surveys and either satisfaction with care or satisfaction with decision-making for each of four subgroups of family members according to patient descriptors: intensive care unit survivors who had length of intensive care unit stay <14 days or >14 days, and intensive care unit nonsurvivors who had length of stay <14 days or ≥14 days. We found strong positive relationships between most domains of organizational and safety culture, and satisfaction with care or decision-making for family members of intensive care unit nonsurvivors who spent at least 14 days in the intensive care unit. For the other three groups, there were only a few weak relationships between domains of organizational and safety culture and family satisfaction.
Our findings suggest that the effect of organizational culture on care delivery is most easily detectable by family members of the most seriously ill patients who interact frequently with intensive care unit staff, who are intensive care unit nonsurvivors, and who spend a longer time in the intensive care unit. Positive relationships between measures of organizational and safety culture and family satisfaction suggest that by improving organizational culture, we may also improve family satisfaction.
Critical care medicine 05/2012; 40(5):1506-12. · 6.37 Impact Factor
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ABSTRACT: The objectives of this study are to describe organizational and safety culture in Canadian intensive care units (ICUs), to correlate culture with the number of beds and physician management model in each ICU, and to correlate organizational culture and safety culture.
In this cross-sectional study, surveys of organizational and safety culture were administered to 2374 clinical staff in 23 Canadian tertiary care and community ICUs. For the 1285 completed surveys, scores were calculated for each of 34 domains. Average domain scores for each ICU were correlated with number of ICU beds and with intensivist vs nonintensivist management model. Domain scores for organizational culture were correlated with domain scores for safety culture.
Culture domain scores were generally favorable in all ICUs. There were moderately strong positive correlations between number of ICU beds and perceived effectiveness at recruiting/retaining physicians (r = 0.58; P < .01), relative technical quality of care (r = 0.66; P < .01), and medical director budgeting authority (r = 0.46; P = .03), and moderately strong negative correlations with frequency of events reported (r = -0.46; P = .03), and teamwork across hospital units (r = -0.51; P = .01). There were similar patterns for relationships with intensivist management. For most pairs of domains, there were weak correlations between organizational and safety culture.
Differences in perceptions between staff in larger and smaller ICUs highlight the importance of teamwork across units in larger ICUs.
Journal of critical care 09/2011; 27(1):11-7. · 2.13 Impact Factor
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ABSTRACT: Use of sedation protocols is associated with fewer mechanical ventilation days in critically ill patients. Canadian intensive care units (ICUs) often have a higher nurse-patient ratio and more specialised training of ICU nurses than French ICUs. Considering these differences, the purpose of this study was to compare implementation of sedation protocols as indicated by frequency of sedation assessment and response to levels of sedation between a Canadian and a French ICU.
This was a retrospective observational study of 30 patients who were mechanically ventilated for at least 24 h in each of two tertiary care ICUs in Vancouver, Canada and Montpellier, France. The authors tabulated all Richmond Agitation-Sedation Scale scores, frequency of score measurement, target scores, frequency and magnitude of scores that were out of target range, and the response to these scores within 1 h of measurement. Practices between the two hospitals were compared using regression modelling, adjusting for patient age, sex, and Acute Physiology and Chronic Health Evaluation (APACHE) II score.
Although sedation scores were measured more frequently in the Canadian ICU, there were fewer appropriate adjustments in medications in response to scores that were outside the target range in this ICU than in the French ICU, which had a lower nurse-patient ratio and no specialised training of nurses (OR 0.26 (95% CI 0.13 to 0.50) for scores that were higher than target, and OR 0.14 (95% CI 0.07 to 0.28) for scores that were lower than target).
Differences in sedation management between these ICUs are likely related to factors other than nurse-patient ratio or specialised training of ICU nurses.
BMJ quality & safety 08/2011; 21(9):715-21.
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ABSTRACT: To evaluate the prevalence of bone marrow lesions (BML) and their association with pain severity in a population-based cohort of symptomatic early knee osteoarthritis (OA).
Subjects with knee pain (n = 255), age 40-79 years, were evaluated by radiograph and magnetic resonance imaging (MRI) and classified into OA stages: no OA (NOA), preradiographic OA (PROA), and radiographic OA (ROA). BML were graded 0-3 (none, mild, moderate, severe) in 6 regions and defined as (1) BMLsum = the sum of 6 scores; and (2) BMLmax = the worst score at any region. Pain was assessed by the Western Ontario and McMaster Universities OA Index (WOMAC). Linear regression analysis was completed to assess the association of Total WOMAC Pain (primary outcome) versus BMLsum or BMLmax. Secondary outcomes were WOMAC Pain on Walking and WOMAC Pain on Climbing Stairs. All analyses were adjusted for age, sex, body mass index, OA stage, joint effusion, and meniscal damage.
BML were present in 11% of NOA, 38% of PROA, and 71% of ROA subjects (p < 0.001). No association was seen for BMLsum or BMLmax versus Total WOMAC Pain or Pain on Walking. However, BMLsum was associated with Pain on Climbing Stairs [regression coefficients (RC) = 0.09, 95% CI 0.00-0.18]. BMLmax was associated with Pain on Climbing Stairs, with the strongest association for severe BML (RC 0.60, 95% CI 0.04-1.17).
BML were present in 38% of PROA and 71% of ROA subjects in this symptomatic knee cohort. BML were significantly associated with Pain on Climbing Stairs but not Total WOMAC or Pain on Walking.
The Journal of Rheumatology 03/2011; 38(6):1079-85. · 3.69 Impact Factor
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ABSTRACT: To determine the natural history of cartilage damage and of osteoarthritis (OA) progression using magnetic resonance imaging (MRI); to evaluate whether OA progression varies by stage of disease.
A population-based cohort with knee pain was assessed clinically, with X-ray (Kellgren-Lawrence [KL] grading) and MRI. Cartilage was graded 0-3 on six joint surfaces. Frequency of cartilage damage change was determined for each joint site. Progression of OA was defined as a worsening of MRI cartilage damage by ≥1 grade in at least two joint sites or ≥2 grades in at least one joint site. The association of KL grade with OA progression was evaluated using parametric lifetime regression analysis.
163 subjects were assessed at baseline and follow-up (mean 3.2 years). KL grade ≥2 was present in 39.4% at baseline. An increase in cartilage damage by ≥1 grade was seen in 8.0-14.1% of subjects at different joint sites. OA progression on MRI was present in 15.5%. Baseline KL grade was a significant predictor of OA progression with hazard ratio (HR) of 6.5 (95% confidence interval [CI] 1.4-30.7), 6.1 (95% CI 1.3-28.9), and 9.2 (95% CI 1.9-44.9) for KL grades 1, 2 and ≥3, respectively.
A low OA progression rate was seen over 3 years in this population-based symptomatic cohort. Radiographic severity, including KL grade 1, was a significant predictor of OA progression. Future interventions aimed at reducing progression will need to target not only radiographic OA, but also those with early abnormalities suggestive of pre-radiographic OA.
Osteoarthritis and Cartilage 02/2011; 19(6):683-8. · 3.90 Impact Factor
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ABSTRACT: Nurses in the intensive care unit (ICU) commonly work frequent 12 h shifts, potentially leading to fatigue and reduced vigilance. The authors hypothesised that rates of hypoglycaemia in patients receiving an insulin infusion would be associated with the intensity of work of the bedside nurse in the preceding 72 h.
The authors identified ICU patients who had hypoglycaemia (glucose ≤3.5 mmol/l, 63 mg/dl) between October 2006 and June 2007. The number of shifts worked in the previous 72 h was calculated for the nurse caring for the patient when the event occurred (case shift). For each case shift, the authors identified up to three control shifts (24, 48 and 72 h before the event in the same patient) and calculated the number of shifts worked by nurses on these shifts in the previous 72 h. Conditional logistic regression was used to determine whether the number of shifts worked was associated with hypoglycaemia.
There were 41 events (32 patients). Each additional shift worked in the previous 72 h was associated with a significantly increased risk of hypoglycaemia (OR = 1.65/shift, 95% CI 1.01 to 2.68, p = 0.04) after controlling for nurse age and experience. The association was greater for the 23 events associated with an error in management according to the insulin protocol (OR = 2.93/shift, 1.15 to 7.44, p = 0.02) compared with events not associated with an error (OR = 1.34/shift, 0.73 to 2.45, p = 0.34).
Intensive nursing work schedules are associated with hypoglycaemic events in ICU patients.
Quality and Safety in Health Care 12/2010; 19(6):e42. · 1.68 Impact Factor
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Jolanda Cibere,
Hongbin Zhang,
Anona Thorne, Hubert Wong,
Joel Singer,
Jacek A Kopec,
Ali Guermazi,
Charles Peterfy,
Savvakis Nicolaou,
Peter L Munk,
John M Esdaile
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ABSTRACT: To determine the prevalence of pre-radiographic osteoarthritis (ROA) and ROA of the knee in a symptomatic population-based cohort, and to evaluate the clinical correlates of pre-ROA and ROA.
Subjects ages 40-79 years with knee pain were recruited as a random population sample and classified using magnetic resonance cartilage (MRC) scores (range 0-4) and Kellgren/Lawrence (K/L) scale grades (range 0-4) as no OA (MRC score<2, K/L grade<2), pre-ROA (MRC score ≥2, K/L grade<2), and ROA (MRC score≥2, K/L grade≥2). Logistic regression was used to evaluate the association of clinical variables with cartilage defects, comparing subjects with any cartilage defects (pre-ROA/ROA) with those without, and to determine associations with individual OA subgroups.
Of 255 symptomatic subjects, no OA, pre-ROA, and ROA were seen in 13%, 49%, and 38%, respectively. The prevalence of pre-ROA/ROA compared with no OA was associated with age (odds ratio [OR] 2.89, 95% confidence interval [95% CI] 1.59-5.26), sports activity (OR 1.35, 95% CI 1.07-1.70), abnormal gait (OR 10.86, 95% CI 1.46-1,388.4), effusion (OR 16.58, 95% CI 2.22-2,120.5), and flexion contracture (OR 2.37, 95% CI 1.50-3.73). The prevalence of ROA versus no OA was significantly associated with age, body mass index, pain frequency, pain duration, severe knee injury, sports activity, gait, effusion, bony swelling, crepitus, flexion contracture, and flexion. The prevalence of pre-ROA versus no OA was increased with age, sports activity, effusion, and flexion contracture, and reduced with valgus malalignment.
Cartilage defects were highly prevalent in this symptomatic population-based cohort, with 49% of subjects having pre-ROA and 38% having ROA. Prevalent cartilage defects were significantly associated with age, sports activity, abnormal gait, effusion, and flexion contracture.
Arthritis care & research. 12/2010; 62(12):1691-8.
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ABSTRACT: Medication errors (MEs) and adverse drug events (ADEs) are both common and under-reported in the intensive care setting. The definitions of these terms vary substantially in the literature. Many methods have been used to estimate their incidence.
A systematic review was done to assess methods used for tracking unintended drug events in intensive care units (ICUs). Studies published up to 22 June 2007 were identified by searching eight online databases, including Medline. In total, 613 studies were evaluated for inclusion by two reviewers.
The authors selected 29 papers to analyse; all studies took place in an ICU, were reproducible and reported ICU-specific rates of events. Rates of MEs varied from 8.1 to 2344 per 1000 patient-days, and ADEs from 5.1 to 87.5 per 1000 patient-days. The definitions of ADE and ME in the studies varied widely.
Much variation exists in reported rates and definitions of ADEs and MEs in ICUs. Some of this variation may be due to a lack of standard definitions for ADEs and MEs, and methods for detecting them. Further standardisation is needed before these methods can be used to evaluate process improvements.
Quality and Safety in Health Care 10/2010; 19(5):e7. · 1.68 Impact Factor
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ABSTRACT: The aims of this study were to determine if there is seasonal variation in the number of intensive care unit (ICU) admissions for community-acquired pneumonia (CAP) and if there is a relationship between these admissions and weather or reports of influenza-like illness in the community.
In this time series analysis in 3 medical-surgical ICUs (8, 13, and 20 beds) in the Vancouver region, we included patients admitted to adult ICUs for CAP between January 2002 and March 2006. We used Poisson regression to analyze the association between weekly number of ICU admissions for CAP, and average temperature, range in temperature, total precipitation, and cases of influenza-like illness/100 physician visits reported by sentinel physicians in the community.
In 740 patients admitted to ICUs for CAP, admissions peaked each year in the winter-spring months. In multivariate models, a sine function with a single annual peak was independently associated with number of patients admitted to ICU for CAP (rate ratio [95% confidence interval], 1.12 [1.00, 1.26]), but neither the weather measurements nor the weekly rate of reported influenza-like illness was significantly associated.
Intensive care unit admissions for CAP are seasonal, but neither weather measurements nor weekly rate of reported influenza-like illness in the community is associated with these admissions.
Journal of critical care 10/2010; 26(3):228-33. · 2.13 Impact Factor
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Vilte E Barakauskas,
Clare L Beasley,
Alasdair M Barr,
Athena R Ypsilanti,
Hong-Ying Li,
Allen E Thornton, Hubert Wong,
Gorazd Rosokilja,
J John Mann,
Branislav Mancevski,
Zlatko Jakovski,
Natasha Davceva,
Boro Ilievski,
Andrew J Dwork,
Peter Falkai,
William G Honer
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ABSTRACT: Abnormalities of amount and function of presynaptic terminals may have an important role in the mechanism of illness in schizophrenia. The SNARE proteins (SNAP-25, syntaxin, and VAMP) are enriched in presynaptic terminals, where they interact to form a functional complex to facilitate vesicle fusion. SNARE protein amounts are altered in the cortical regions in schizophrenia, but studies of protein-protein interactions are limited. We extended these investigations to the striatal regions (such as the nucleus accumbens, ventromedial caudate (VMC), and dorsal caudate) relevant to disease symptoms. In addition to measuring SNARE protein levels, we studied SNARE protein-protein interactions using a novel ELISA method. The possible effect of antipsychotic treatment was investigated in parallel in the striatum of rodents that were administered haloperidol and clozapine. In schizophrenia samples, compared with controls, SNAP-25 was 32% lower (P=0.015) and syntaxin was 26% lower (P=0.006) in the VMC. In contrast, in the same region, SNARE protein-protein interactions were higher in schizophrenia (P=0.008). Confocal microscopy of schizophrenia and control VMC showed qualitatively similar SNARE protein immunostaining. Haloperidol treatment of rats increased levels of SNAP-25 (mean 24%, P=0.003), syntaxin (mean 18%, P=0.010), and VAMP (mean 16%, P=0.001), whereas clozapine increased only the VAMP level (mean 13%, P=0.004). Neither drug altered SNARE protein-protein interactions. These results indicate abnormalities of amount and interactions of proteins directly related to presynaptic function in the VMC in schizophrenia. SNARE proteins and their interactions may be a novel target for the development of therapeutics.
Neuropsychopharmacology: official publication of the American College of Neuropsychopharmacology 04/2010; 35(5):1226-38. · 6.99 Impact Factor
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ABSTRACT: To evaluate the impact of prolonged continuous wakefulness on resident performance under controlled experimental conditions.
Experimental within-subjects comparison.
High-fidelity patient simulator.
Twelve residents in an Internal Medicine Program at various stages of training (range, 1-35 mos).
Performance was studied during 26 hrs of continuous wakefulness at four time points (8:00-10:00 am, 2:00-4:00 pm, 2:00-4:00 am, and 8:00-10:00 am the next day) using high-fidelity patient simulation. At each session, residents managed eight simulated dysrhythmias according to advanced cardiac life support protocols (advanced cardiac life support scenarios) and then managed a simulated critically ill patient (e.g., patient with meningitis) to test more complicated clinical decision-making (complex scenario). The frequency of previously defined major medical errors (i.e., action or inaction that likely would have resulted in significant harm in a real patient) was assessed by a scorer blinded to the time of the session. For each complex scenario, a global score between 0 and 100 was also given for overall performance. The impact of wakefulness on performance was assessed by using longitudinal mixed-effects models.
For the complex scenarios, the mean number of errors increased from 0.92 +/- 0.90 in the first session to 1.58 +/- 0.79 in the fourth session (p = .09), and mean global score decreased from 56.8 +/- 14.6 to 49.6 +/- 12.6 (p = .02). For the advanced cardiac life support scenarios, the mean number of major errors committed in the advanced cardiac life support scenarios decreased during the study period (p = .01). However, essentially all of the improvement occurred between the first and second time points, suggesting that a substantial learning effect accounted for the findings.
During prolonged continuous wakefulness of medical residents, clinical performance in the management of a simulated critically ill patient deteriorates. The practice of scheduling residents for extended work shifts (>24 hrs) should be reconsidered.
Critical care medicine 03/2010; 38(3):766-70. · 6.37 Impact Factor
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ABSTRACT: Data from the British Columbia Linked Health Database were analyzed to determine if size of hospital is associated with in-hospital death of critically ill adults whose admitting diagnosis is congestive heart failure (CHF). Patients who were <19 years of age, transferred from or to other hospitals, or who developed CHF as a complication were excluded. In unadjusted logistic regression analysis of 2616 patients, the odds ratio (OR) for in-hospital death associated with a doubling of the number of hospital beds was 1.12 (95% confidence interval [CI] = 1.03-1.23; P = .01). After adjustment for age, sex, CHF-specific comorbidity index, number of cardiac and noncardiac procedures, number of hospital admissions for CHF in the preceding year, and socioeconomic variables, the OR was 1.08 (95% CI = 0.96-1.20; P = .21). The conclusion is that the adjusted rate of in-hospital deaths for this patient group does not differ significantly based solely on the number of acute hospital beds.
American Journal of Medical Quality 02/2010; 25(2):95-101. · 1.64 Impact Factor
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ABSTRACT: Patients in the intensive care unit (ICU) have complex problems and experience many medical errors. Currently, little is known about the measurement of medication errors and adverse drug events in Canadian ICUs.
To investigate methods of measuring medication errors and adverse drug events in ICUs in Canada.
A questionnaire was constructed and uploaded to an online survey tool, SurveyMonkey. Through the mailing list software of the Critical Care Pharmacy Specialty Network of the Canadian Society of Hospital Pharmacists, the survey was sent by e-mail to 146 pharmacists working in 79 ICUs across Canada; 2 reminder e-mails followed. The survey was open from July 18 to September 18, 2007.
A total of 34 individual responses were received from 31 (39%) of the 79 ICUs. Responses were from academic hospitals (11/31 [35%]), community teaching hospitals (9/31 [29%]), and community nonteaching hospitals (11/31 [35%]). Twenty-six (84%) of the 31 responding ICUs had a process for tracking medication errors and adverse drug events: non-anonymous voluntary reporting (19 or 73%), direct observation (14 or 54%), anonymous voluntary reporting (12 or 46%), chart review (6 or 23%), computerized system (3 or 12%), trigger tools (2 or 8%), pharmacist intervention (2 or 8%), and weekly ICU "safety huddles" (1 or 4%). Fourteen (54%) of the 26 ICUs that had a method of measuring medication errors and adverse drug events had implemented changes to address identified problems.
Most respondents were measuring the frequency of medication errors and adverse drug events, but a wide variety of methods were in use. Only about half of the ICUs had implemented changes as a result of these measurements. There is an opportunity to improve standardization of the measurement of medication errors and adverse drug events in Canadian ICUs.
The Canadian journal of hospital pharmacy 01/2010; 63(1):20-4.
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ABSTRACT: Although reliability of severity of illness and predicted probability of hospital mortality have been assessed, interrater reliability of the abstraction of primary and other intensive care unit (ICU) admitting diagnoses and underlying comorbidities has not been studied.
Patient data from one ICU were originally abstracted and entered into an electronic database by an ICU nurse. A research assistant reabstracted patient demographics, ICU admitting diagnoses and underlying comorbidities, and elements of Acute Physiology and Chronic Health Evaluation II (APACHE II) score from 100 random patients of 474 admitted during 2005 using an identical electronic database. Chamberlain's percent positive agreement was used to compare diagnoses and comorbidities between the 2 data abstractors. A kappa statistic was calculated for demographic variables, Glasgow Coma Score, APACHE II chronic health points, and HIV status. Intraclass correlation was calculated for acute physiology points and predicted probability of hospital mortality.
Percent positive agreement for ICU primary and other admitting diagnoses ranged from 0% (primary brain injury) to 71% (sepsis), and for underlying comorbidities, from 40% (coronary artery bypass graft) to 100% (HIV). Agreement as measured by kappa statistic was strong for race (0.81) and age points (0.95), moderate for chronic health points (0.50) and HIV (0.66), and poor for Glasgow Coma Score (0.36). Intraclass correlation showed a moderate-high agreement for acute physiology points (0.88) and predicted probability of hospital mortality (0.71).
Reliability for ICU diagnoses and elements of the APACHE II score is related to the objectivity of primary data in the medical charts.
Journal of critical care 08/2009; 24(3):401-7. · 2.13 Impact Factor
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ABSTRACT: The aim of this study is to determine if more males than females are admitted to adult intensive care units (ICUs).
In 9 tertiary and community hospitals in British Columbia, Canada, we expressed the number of patients admitted to hospital and to ICU from 1998 to 2008 as a proportion of the population of the main regions served by these hospitals, and for ICU patients in 1 tertiary hospital, as a proportion of the hospital population. Patients not residing in the region of this tertiary hospital or whose addresses were unknown and admissions for sex-specific diagnoses were excluded from the main analyses. Male proportion was divided by female proportion for age groups by decade. Multivariate regression was used to determine the association between sex and admission to ICU after adjustment for confounders.
Normalized male-to-female ratio of ICU admissions to the 9 hospitals was greater than 1. In the tertiary hospital analyzed in more detail, the male-to-female ratio for admissions to hospital or to ICU, normalized to the population in the community or hospital, respectively, was greater than 1 for all age groups, and this ratio increased with age. After adjustment for covariates, males and females less than 80 years of age were roughly equally likely to be admitted to ICU from hospital, but in patients aged 80 or older, men were much more likely than women to be admitted (odds ratio, 2.14; 95% confidence interval, 1.56-2.94).
More men than women are admitted to ICUs; this difference is especially prominent in elderly patients.
Journal of critical care 06/2009; 24(4):630.e1-8. · 2.13 Impact Factor
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Jolanda Cibere,
Hongbin Zhang,
Patrick Garnero,
A Robin Poole,
Tatiana Lobanok,
Tore Saxne,
Virginia B Kraus,
Amanda Way,
Anona Thorne, Hubert Wong,
Joel Singer,
Jacek Kopec,
Ali Guermazi,
Charles Peterfy,
Savvakis Nicolaou,
Peter L Munk,
John M Esdaile
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ABSTRACT: To evaluate 10 biomarkers in magnetic resonance imaging (MRI)-determined, pre-radiographically defined osteoarthritis (pre-ROA) and radiographically defined OA (ROA) in a population-based cohort of subjects with symptomatic knee pain.
Two hundred one white subjects with knee pain, ages 40-79 years, were classified into OA subgroups according to MRI-based cartilage (MRC) scores (range 0-4) and Kellgren/Lawrence (K/L) grades of radiographic severity (range 0-4): no OA (MRC score 0, K/L grade<2), pre-ROA (MRC score>or=1, K/L grade<2), or ROA (MRC score>or=1, K/L grade>or=2). Urine and serum samples were assessed for levels of the following biomarkers: urinary biomarkers C-telopeptide of type II collagen (uCTX-II), type II and types I and II collagen cleavage neoepitopes (uC2C and uC1,2C, respectively), and N-telopeptide of type I collagen, and serum biomarkers sC1,2C, sC2C, C-propeptide of type II procollagen (sCPII), chondroitin sulfate 846 epitope, cartilage oligomeric matrix protein, and hyaluronic acid. Multicategory logistic regression was performed to evaluate the association of OA subgroup with individual biomarker levels and biomarker ratios, adjusted for age, sex, and body mass index.
The risk of ROA versus no OA increased with increasing levels of uCTX-II (odds ratio [OR] 3.12, 95% confidence interval [95% CI] 1.35-7.21), uC2C (OR 2.13, 95% CI 1.04-4.37), and uC1,2C (OR 2.07, 95% CI 1.06-4.04), and was reduced in association with high levels of sCPII (OR 0.53, 95% CI 0.30-0.94). The risk of pre-ROA versus no OA increased with increasing levels of uC2C (OR 2.06, 95% CI 1.05-4.01) and uC1,2C (OR 2.06, 95% CI 1.12-3.77). The ratios of type II collagen degradation markers to collagen synthesis markers were better than individual biomarkers at differentiating the OA subgroups, e.g., the ratio of [uCTX-II][uC1,2C] to sCPII was associated with a risk of ROA versus no OA of 3.47 (95% CI 1.34-9.03) and a risk of pre-ROA versus no OA of 2.56 (95% CI 1.03-6.40).
Different cartilage degradation markers are associated with pre-ROA than are associated with ROA, indicating that their use as diagnostic markers depends on the stage of OA. Biomarker ratios contrasting cartilage degradation with cartilage synthesis are better able to differentiate OA stages compared with levels of the individual markers.
Arthritis & Rheumatism 04/2009; 60(5):1372-80. · 7.87 Impact Factor
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Geoffrey N Smith, Hubert Wong,
G William MacEwan,
Lili C Kopala,
Thomas S Ehmann,
Allen E Thornton,
Donna J Lang,
Alasdair M Barr,
Ric Procyshyn,
Jehanine C Austin,
Sean W Flynn,
William G Honer
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ABSTRACT: Cigarette smoking is common in psychotic disorders and may be initiated in an attempt to control features of illness. However, genetic, obstetric and early life conditions are risks for starting to smoke in the general population but their role in psychotic patients is unclear.
Smoking history and the putative predictors of starting to smoke were assessed in a community-wide sample of 115 first episode psychosis patients. The proportion that initiated smoking was compared with that from population surveys and the impact of risk factors was assessed within the patient sample.
Most patients began smoking before illness onset and the proportion who initiated smoking was significantly high by the onset of a functional decline. Gestational tobacco exposure was a risk for smoking and was also associated with low birthweight, poor academic achievement, and obesity. Low familial socioeconomic position but not familial psychiatric problems also predicted smoking initiation.
In most cases, smoking preceded illness onset and was not a response to early features of illness. General population predictors of starting to smoke were also associated with smoking initiation in psychotic patients. Of these risks, exposure to tobacco during gestation is noteworthy in that it affects brain development and is associated with cognitive, behavioral, psychiatric and general health problems. In addition, nicotine interacts with other substances of abuse. The initiation of smoking before illness onset and the association with developmental problems raises the question of whether cigarette smoking influences some aspects of illness in patients with psychosis.
Schizophrenia Research 02/2009; 108(1-3):258-64. · 4.75 Impact Factor
