Nessim S.J.,McGill University |
Komenda P.,St Boniface General Hospital |
Komenda P.,Seven Oaks General Hospital |
Rigatto C.,St Boniface General Hospital |
And 5 more authors.
Peritoneal Dialysis International | Year: 2013
Background: Data on obesity as a risk factor for peritonitis and catheter infections among peritoneal dialysis (PD) patients are limited. Furthermore, little is known about the microbiology of PD-related infections among patients with a high body mass index (BMI). Methods: Using a cohort that included all adult patients residing in the province of Manitoba who received PD during the period 1997 - 2007, we studied the relationship between BMI and PD-related infections. After categorizing patients into quartiles of BMI, a multivariate Cox regression model was used to determine the independent relationship between BMI and peritonitis or exit-site infection (ESI). We also studied whether increasing BMI was associated with a propensity to infections with particular organisms. Results: Among 990 PD patients, 938 (95%) had accurate BMI data available. Those 938 patients experienced 1338 peritonitis episodes and 1194 exit-site infections. In unadjusted analyses, patients in the highest BMI quartile (median: 33.5; interquartile range: 31.9 - 36.4) had an increased risk of peritonitis overall, and also an increased risk of peritonitis with gram-positive organisms and coagulase-negative Staphylococcus (CNS). After multivariate adjustment for age, sex, diabetes, cause of renal disease, Aboriginal race, PD modality, and S. aureus nasal carriage, the relationship between overall peritonitis risk and BMI disappeared, but the increased risk of CNS peritonitis among patients in the highest BMI quartile persisted (hazard ratio: 1.80; 95% confidence interval: 1.06 to 3.06; p = 0.03). There was no increased risk of ESI among patients in the highest BMI quartile on univariate analysis or after multivariate adjustment. Conclusions: Among Canadian PD patients, obesity was not associated with an increased risk of peritonitis overall, but may be associated with a higher risk of CNS peritonitis. © 2013 International Society for Peritoneal Dialysis.
Sepehri A.,University of British Columbia |
Beggs T.,Royal College of Surgeons in Ireland |
Hassan A.,Dalhousie University |
Rigatto C.,Seven Oaks General Hospital |
And 5 more authors.
Journal of Thoracic and Cardiovascular Surgery | Year: 2014
Objective Current preoperative assessments for cardiac surgery, such as the European System for Cardiac Operative Risk Evaluation II and the Society of Thoracic Surgeons risk score, are limited in their ability to predict postoperative outcomes. This is thought to be due to the reliance on chronological age as a predictor of health. In geriatrics, frailty assessments have been developed as a tool in determining physiologic functioning capacity. Whether or not frailty predicts postoperative outcomes independent of existing cardiac preoperative risk scores remains unknown.© 2014 The American Association for Thoracic Surgery Methods We performed a systematic review to determine the association of frailty with negative postoperative outcomes such as major adverse cardiac and cerebrovascular events (MACCE) in patients undergoing cardiac surgery. We searched PubMed, EMBASE, the Cochrane library, and Ageline from inception until July 2013 and screened 5913 abstracts for potential inclusion. Of these, 6 studies examined the relationship between objective frailty assessments and postoperative outcomes. Our included studies evaluated 4756 patients undergoing cardiac surgery.Results Frailty, defined using multiple criteria, had a strong positive relationship with the risk of MACCE (odds ratio, 4.89; 95% confidence interval, 1.64-14.60). Relationships were stronger in older patients undergoing transcatheter aortic valve replacement (TAVR) than younger patients undergoing coronary artery bypass grafting and valvular surgery (hazard ratio for frailty in TAVR, 3.31-4.89 vs hazard ratio for non-TAVR, 1.10-3.16).Conclusions Patients deemed frail, determined using an objective assessment tool, have a higher likelihood of experiencing mortality, morbidity, functional decline, and MACCE following cardiac surgery, regardless of definition. Further study is needed to determine which components of frailty are most predictive of negative postoperative outcomes before integration in risk prediction scores.
Tangri N.,Seven Oaks General Hospital |
Kitsios G.D.,Lahey Clinic Medical Center |
Inker L.A.,Tufts Medical Center |
Griffith J.,Northeastern University |
And 6 more authors.
Annals of Internal Medicine | Year: 2013
Background: Patients with chronic kidney disease (CKD) are at increased risk for kidney failure, cardiovascular events, and all-cause mortality. Accurate models are needed to predict the individual risk for these outcomes. Purpose: To systematically review risk prediction models for kidney failure, cardiovascular events, and death in patients with CKD. Data Sources: MEDLINE search of English-language articles pub-lished from 1966 to November 2012. Study Selection: Cohort studies that examined adults with any stage of CKD who were not receiving dialysis and had not had a transplant; had at least 1 year of follow-up; and reported on a model that predicted the risk for kidney failure, cardiovascular events, or all-cause mortality. Data Extraction: Reviewers extracted data on study design, popu-lation characteristics, modeling methods, metrics of model perfor-mance, risk of bias, and clinical usefulness. Data Synthesis: Thirteen studies describing 23 models were found. Eight studies (11 models) involved kidney failure, 5 studies (6 models) involved all-cause mortality, and 3 studies (6 models) in-volved cardiovascular events. Measures of estimated glomerular filtration rate or serum creatinine level were included in 10 studies (17 models), and measures of proteinuria were included in 9 studies (15 models). Only 2 studies (4 models) met the criteria for clinical usefulness, of which 1 study (3 models) presented reclassification indices with clinically useful risk categories. Limitation: A validated risk-of-bias tool and comparisons of the performance of different models in the same validation population were lacking. Conclusion: Accurate, externally validated models for predicting risk for kidney failure in patients with CKD are available and ready for clinical testing. Further development of models for cardiovascu-lar events and all-cause mortality is needed. © 2013 American College of Physicians.
Lloyd A.,University of Manitoba |
Komenda P.,University of Manitoba |
Komenda P.,Seven Oaks General Hospital
Canadian Journal of Diabetes | Year: 2015
Diabetic chronic kidney disease (CKD) is the cause of kidney failure in approximately 35% of Canadian patients requiring dialysis. Traditionally, only a minority of patients with type 2 diabetes and CKD progress to kidney failure because they die of a cardiovascular event first. However, with contemporary therapies for diabetes and cardiovascular disease, this may no longer be true. The classic description of diabetic CKD is the development of albuminuria followed by progressive kidney dysfunction in a patient with longstanding diabetes.Many exciting candidate agents are under study to halt the progression of diabetic CKD; current therapies center on optimizing glycemic control, renin angiotensin system inhibition, blood pressure control and lipid management. Lifestyle modifications, such as salt and protein restriction as well as smoking cessation, may also be of benefit. Unfortunately, these accepted therapies do not entirely halt the progression of diabetic CKD.Also unfortunately, the presence of CKD in general is under-recognized by primary care providers, which can lead to late referral, missed opportunities for preventive care and inadvertent administration of potentially harmful interventions. Not all patients require referral to nephrology for diagnosis and management, but modern risk-prediction algorithms, such as the kidney failure risk equation, may help to guide referral appropriateness and dialysis modality planning in subspecialty nephrology multidisciplinary care clinics. © 2015 Canadian Diabetes Association.
Benson E.E.,Seven Oaks General Hospital |
McMillan D.E.,University of Manitoba |
Ong B.,University of Manitoba
American Journal of Nursing | Year: 2012
Background: Total knee arthroplasty (TKA) is a procedure with associated risks of inadvertent perioperative hypothermia and significant postoperative pain. Hypothermia may affect patients' experience of postoperative pain, although the link is not well understood. Objective: The aim of this prospective, randomized controlled trial was to determine the efficacy of a patient-controlled active warming gown in optimizing patients' perioperative body temperature and in diminishing postoperative pain after TKA. Methods: Thirty patients who would be undergoing TKA received either a standard hospital gown and prewarmed standard cotton blanket (n = 15) or a patient-controlled, forced-air warming gown (n = 15). Results: Although pain scores were not significantly different in the two groups (P = 0.08), patients who received warming gowns had higher temperatures (P < 0.001) in the postanesthesia care unit, used less opioid (P = 0.05) after surgery, and reported more satisfaction (P = 0.004) with their thermal comfort than did patients who received standard blankets. These findings indicate that patient-controlled, forced-air warming gowns can enhance perioperative body temperature and improve patient satisfaction. Patients who use warming gowns may also need less opioid to manage their postoperative pain. Conclusions: Nurses should ensure that effective patient warming methods are employed in all patients, particularly in patients with compromised thermoregulatory systems (such as older adults), and in surgeries considered to be exceptionally painful (such as TKA).
Macdonald K.,University of Manitoba |
Bass J.,University of Manitoba |
Maloney T.,Seven Oaks General Hospital
Medical Reference Services Quarterly | Year: 2016
There is limited literature on hospital archives projects. Hospitals understandably have a strong focus on patient care, but there is still a critical need to keep institutional archives. Among their many uses, institutional archives preserve corporate memory, provide evidence of interactions with community, and assist in contemporary decision making. This column describes a university-hospital partnership to undertake a one-year project to preserve, detail, and digitize ten boxes, or approximately 3.8 meters, of materials dating from 1980 to 2006. This project serves as a model for other hospital or health care facilities wanting to preserve and more actively engage with their archival collections. © 2016, Published with license by Taylor & Francis.
Rigatto C.,Seven Oaks General Hospital |
Sood M.M.,University of Manitoba |
Tangri N.,Seven Oaks General Hospital
Current Opinion in Nephrology and Hypertension | Year: 2012
Purpose of Review: This review aims to describe the challenges and highlight recent advances in the field of risk prediction for patients with chronic kidney disease (CKD). We first focus on methods of model development and metrics of model performance in general, and then highlight important risk prediction tools for patients with CKD, for prediction of kidney failure and all-cause mortality. Recent Findings: Investigators have used data from patients with CKD stages 1-5 and developed models for predicting the progression to kidney failure and all-cause mortality. Models for kidney failure have included estimated glomerular filtration rate, albuminuria, demographic and laboratory variables, and have achieved excellent discrimination. In contrast, model performance for prediction of all-cause mortality has been relatively modest. No validated models exist for predicting the risk of cardiovascular events in patients with CKD. Summary: Models for predicting kidney failure in patients with CKD are highly accurate and clinically usable. The kidney failure risk equation includes routinely collected laboratory data and can predict the progression of CKD to kidney failure with accuracy. Additional validation of the risk equation and development of new models for all-cause mortality and cardiovascular events in patients with CKD are needed. © 2012 Wolters Kluwer Health | Lippincott Williams and Wilkins.
Xu Y.,Seven Oaks General Hospital |
Arora R.C.,St Boniface General Hospital |
Hiebert B.M.,St Boniface General Hospital |
Lerner B.,Seven Oaks General Hospital |
And 6 more authors.
European Heart Journal Cardiovascular Imaging | Year: 2014
Objectives We performed a systematic review and meta-analysis to understand the role of flow-mediated dilatation (FMD) of the brachial artery (BA) and peripheral arterial tonometry (PAT) in predicting adverse events, including cardiovascular (CV) events and all-cause mortality. Background FMD of the BA and PAT are non-invasive measures of endothelial function. Impairment of endothelial function is associated with increased CV events. While FMD is the more widely used and studied technique, PAT offers several advantages. The purpose of this systematic review and meta-analysis is to determine whether brachial FMD and PAT are independent risk factors for future CV events and mortality. Methods Multiple electronic data bases were searched for articles relatingFMDor PATtoCVevents. Datawere extracted on study characteristics, study quality, and study outcomes. Relative risks (RRs) from individual studies were combined and a pooled multivariate RR was calculated. Results Thirty-six studies for FMD were included in the systematic review, of which 32 studies consisting of 15, 191 individuals were meta-analysed. The pooled RR of CV events and all-cause mortality per 1% increase in brachial FMD, adjusting for potential confounders, was 0.90 (0.88-0.92). In contrast, only three studies evaluated the prognostic value of PAT forCV events, and the pooled RR per 0.1 increase in reactive hyperaemia index was 0.85 (0.78-0.93). Conclusion BrachialFMDand PAT are independent predictors of CVevents and all-cause mortality. Further research to evaluate the prognostic utility of PATis necessary to compareit with FMDas a non-invasive endothelial function test in clinical practice. © The Author 2014.
Manyanga T.,University of Manitoba |
Manyanga T.,Seven Oaks General Hospital |
Froese M.,Seven Oaks General Hospital |
Zarychanski R.,University of Manitoba |
And 4 more authors.
BMC Complementary and Alternative Medicine | Year: 2014
Background: The utility of acupuncture in managing osteoarthritis symptoms is uncertain. Trial results are conflicting and previous systematic reviews may have overestimated the benefits of acupuncture.Methods: Two reviewers independently identified randomized controlled trials (up to May 2014) from multiple electronic sources (including PubMed/Medline, EMBASE, and CENTRAL) and reference lists of relevant articles, extracted data and assessed risk of bias (Cochrane's Risk of Bias tool). Pooled data are expressed as mean differences (MD), with 95% confidence intervals (CI) (random-effects model).Results: We included 12 trials (1763 participants) comparing acupuncture to sham acupuncture, no treatment or usual care. We adjudicated most trials to be unclear (64%) or high (9%) risk of bias. Acupuncture use was associated with significant reductions in pain intensity (MD -0.29, 95% CI -0.55 to -0.02, I2 0%, 10 trials, 1699 participants), functional mobility (standardized MD -0.34, 95% CI -0.55 to -0.14, I2 70%, 9 trials, 1543 participants), health-related quality of life (standardized MD -0.36, 95% CI -0.58 to -0.14, I2 50%, 3 trials, 958 participants). Subgroup analysis of pain intensity by intervention duration suggested greater pain intensity reduction with intervention periods greater than 4 weeks (MD -0.38, 95% CI -0.69 to -0.06, I2 0%, 6 trials, 1239 participants).Conclusions: The use of acupuncture is associated with significant reductions in pain intensity, improvement in functional mobility and quality of life. While the differences are not as great as shown by other reviews, current evidence supports the use of acupuncture as an alternative for traditional analgesics in patients with osteoarthritis.Systematic review registration: CRD42013005405. © 2014 Manyanga et al.; licensee BioMed Central Ltd.
PubMed | Seven Oaks General Hospital, University of Manitoba and Ottawa Hospital Research Institute
Type: Journal Article | Journal: CMAJ open | Year: 2015
End-stage renal disease (ESRD) is a major public health problem with increasing prevalence and costs. An understanding of the long-term trends in dialysis rates and outcomes can help inform health policy. We determined the optimal case definition for the diagnosis of ESRD using administrative claims data in the province of Manitoba over a 7-year period.We determined the sensitivity, specificity, predictive value and overall accuracy of 4administrative case definitions for the diagnosis of ESRD requiring chronic dialysis over different time horizons from Jan. 1, 2004, to Mar. 31, 2011. The Manitoba Renal Program Database served as the gold standard for confirming dialysis status.During the study period, 2562 patients were registered as recipients of chronic dialysis in the Manitoba Renal Program Database. Over a 1-year period (2010), the optimal case definition was any 2 claims for outpatient dialysis, and it was 74.6% sensitive (95% confidence interval [CI] 72.3%-76.9%) and 94.4% specific (95% CI 93.6%-95.2%) for the diagnosis of ESRD. In contrast, a case definition of at least 2 claims for dialysis treatment more than 90 days apart was 64.8% sensitive (95% CI 62.2%-67.3%) and 97.1% specific (95% CI 96.5%-97.7%). Extending the period to 5 years greatly improved sensitivity for all case definitions, with minimal change to specificity; for example, for the optimal case definition of any 2 claims for dialysis treatment, sensitivity increased to 86.0% (95% CI 84.7%-87.4%) at 5 years.Accurate case definitions for the diagnosis of ESRD requiring dialysis can be derived from administrative claims data. The optimal definition required any 2 claims for outpatient dialysis. Extending the claims period to 5 years greatly improved sensitivity with minimal effects on specificity for all case definitions.