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Dainty K.N.,Li Ka Shing Knowledge Institute | Scales D.C.,Institute for Clinical Evaluative science | Brooks S.C.,Li Ka Shing Knowledge Institute | Needham D.M.,Johns Hopkins University | And 10 more authors.
Implementation Science | Year: 2011

Background: Advances in resuscitation science have dramatically improved survival rates following cardiac arrest. However, about 60% of adults that regain spontaneous circulation die before leaving the hospital. Recently it has been shown that inducing hypothermia in cardiac arrest survivors immediately following their arrival in hospital can dramatically improve both overall survival and neurological outcomes. Despite the strong evidence for its efficacy and the apparent simplicity of this intervention, recent surveys show that therapeutic hypothermia is delivered inconsistently, incompletely, and often with delay.Methods and design: This study will evaluate a multi-faceted knowledge translation strategy designed to increase the utilization rate of induced hypothermia in survivors of cardiac arrest across a network of 37 hospitals in Southwestern Ontario, Canada. The study is designed as a stepped wedge randomized trial lasting two years. Individual hospitals will be randomly assigned to four different wedges that will receive the active knowledge translation strategy according to a sequential rollout over a number of time periods. By the end of the study, all hospitals will have received the intervention. The primary aim is to measure the effectiveness of a multifaceted knowledge translation plan involving education, reminders, and audit-feedback for improving the use of induced hypothermia in survivors of cardiac arrest presenting to the emergency department. The primary outcome is the proportion of eligible OHCA patients that are cooled to a body temperature of 32 to 34°C within six hours of arrival in the hospital. Secondary outcomes will include process of care measures and clinical outcomes.Discussion: Inducing hypothermia in cardiac arrest survivors immediately following their arrival to hospital has been shown to dramatically improve both overall survival and neurological outcomes. However, this lifesaving treatment is frequently not applied in practice. If this trial is positive, our results will have broad implications by showing that a knowledge translation strategy shared across a collaborative network of hospitals can increase the number of patients that receive this lifesaving intervention in a timely manner.Trial Registration: ClinicalTrials.gov Trial Identifier: NCT00683683. © 2011 Dainty et al; licensee BioMed Central Ltd. Source

Watter S.,McMaster University | Heisz J.J.,McMaster University | Karle J.W.,McMaster University | Shedden J.M.,McMaster University | And 2 more authors.
Brain Research | Year: 2010

Over the past decade, neuroimaging and electrophysiological studies of working memory (WM) have made progress in distinguishing the neural substrates of central executive (CE) functions from substrates of temporary storage subsystems. However, the degree to which CE-related processes and their substrates may be further fractionated is less clear. The present study measured event-related potentials (ERPs) in a running memory paradigm, to study modality-specific CE-related processes in verbal and spatial WM. Participants were asked to remember either verbal (digit identity) or spatial (digit location) information for the first or last three items in a variable length sequence of spatially distributed digit stimuli. Modality-specific WM demand-sensitive ERP amplitude effects were selectively observed over left prefrontal areas under verbal WM performance and over right prefrontal areas under spatial WM performance. In addition, distinct patterns of item-by-item sensitivity under high-CE-demand conditions suggested qualitatively different processing strategies for verbal versus spatial tasks. These results suggest that both modality-specific and taskgeneral CE-related processes are likely operational in many WM situations and that careful dissociative methods will be needed to properly further fractionate and characterize these component CE-related processes and their neurological substrates. © 2010 Elsevier B.V. All rights reserved. Source

Razik R.,University of Toronto | Chong C.A.,Lakeridge Health Corporation | Nguyen G.C.,University of Toronto | Nguyen G.C.,Institute of Health Policy Management and Evaluation
Canadian Journal of Gastroenterology | Year: 2013

BACKGROUND: Traditionally regarded as a disease of the elderly, the incidence of diverticulitis of the colon has been on the rise, especially in younger cohorts. These patients have been found to experience a more aggressive disease course with more frequent hospitalization and greater need for surgical intervention. objective: To characterize factors that portend a poor prognosis in patients diagnosed with diverticulitis; in particular, to evaluate the role of demographic variables on disease course. METHODS: Using the Canadian Institute for Health Information Discharge Abstract Databases, readmission rates, length of stay, colectomy rates and mortality rates in patients hospitalized for diverticulitis were examined. Data were stratified according to age, sex and comorbidity (as defined by the Charlson index). RESULTS: In the cohort =30 years of age, a clear male predominance was apparent. Colectomy rate in the index admission, stratified according to age, demonstrated a J-shaped curve, with the highest rate in patients =30 years of age (adjusted OR 2.3 [95% CI 1.62 to 3.27]) compared with the 31 to 40 years of age group. In-hospital mortality increased with age. Cumulative rates of readmission at six and 12 months were 6.8% and 8.8%, respectively. CONCLUSION: In the present nationwide cohort study, younger patients (specifically those =30 years of age) were at highest risk for colectomy during their index admission for diverticulitis. It is unclear whether this observation was due to more virulent disease among younger patients, or surgeon and patient preferences. © 2013 Pulsus Group Inc. All rights reserved. Source

Silverman M.S.,University of Toronto | Silverman M.S.,Lakeridge Health Corporation | Davis I.,Dalhousie University | Pillai D.R.,University of Toronto | Pillai D.R.,Public Health England
Clinical Gastroenterology and Hepatology | Year: 2010

Background & Aims: Clostridium difficile infection (CDI) can relapse in patients with significant comorbidities. A subset of these patients becomes dependent on oral vancomycin therapy for prolonged periods with only temporary clinical improvement. These patients incur significant morbidity from recurrent diarrhea and financial costs from chronic antibiotic therapy. Methods: We sought to investigate whether self- or family-administered fecal transplantation by low volume enema could be used to definitively treat refractory CDI. Results: We report a case series (n = 7) where 100% clinical success was achieved in treating these individuals with up to 14 months of follow-up. Conclusions: Fecal transplantation by low volume enema is an effective and safe option for patients with chronic relapsing CDI, refractory to other therapies. Making this approach available in health care settings has the potential to dramatically increase the number of patients who could benefit from this therapy. © 2010 AGA Institute. Source

Nguyen G.C.,University of Toronto | Nguyen G.C.,Institute of Health Policy Management and Evaluation | Bollegala N.,University of Toronto | Chong C.A.,Lakeridge Health Corporation
Clinical Gastroenterology and Hepatology | Year: 2014

Background & Aims: Patients with inflammatory bowel diseases (IBD) are hospitalized frequently. We sought toidentify factors associated with risk for IBD-related readmission to the hospital. Methods: We performed a retrospective analysis of 26,403 patients hospitalized for IBD from 2004 through 2010 using the Canadian Institute for Health Information Discharge Abstract databases. We examined whether demographic factors, comorbidity, and hospital IBD admission volume were associated with readmission rates, length of stay, bowel resection, and mortality. Results: Young, middle-age, and elderly adults were more than twice as likely to undergo surgery during hospitalization than pediatric patients. Elderly patients with IBD had a nearly 40-fold greater in-hospital mortality than pediatric patients (odds ratio, 37.4; 95% confidence interval [CI], 5.17-270.0). In-hospital mortality was lower at hospitals with the highest volume of IBD patients than at those with low volume (odds ratio, 0.20; 95% CI, 0.05-0.97). Rates of readmission were lower for patients with ulcerative colitis than Crohn's disease (hazard ratio, 0.79; 95% CI, 0.72-0.86). The hazard ratios for readmission among young, middle-age, and elderly adults, compared with those of pediatric patients, were 0.79 (95% CI, 0.69-0.90), 0.57 (95% CI, 0.49-0.65), and 0.44 (95% CI, 0.37-0.53), respectively. Rates of readmission were lower at the highest-volume, compared with the lowest-volume, hospitals (hazard ratio, 0.78; 95% CI, 0.64-0.96). Conclusions: Based on a retrospective database analysis, pediatric patients with IBD are at greater risk for readmission to the hospital than older patients. Efforts should be made to determine whether factors that contribute to this risk are preventable. The lower risk of readmission at the highest-volume hospitals may reflect optimal management during hospitalization or follow-up evaluation. © 2014 AGA Institute. Source

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