Thunder Bay Regional Health Science Center

Thunder Bay, Canada

Thunder Bay Regional Health Science Center

Thunder Bay, Canada
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Kellett J.,Thunder Bay Regional Health science Center | Wang F.,Lakehead University | Woodworth S.,University College Cork | Huang W.,Lakehead University
Resuscitation | Year: 2013

Background: It is not known how often, to what extent and over what time frame any early warning scores change in surgical patients, and what the implications of these changes are. Setting: Thunder Bay Regional Health Sciences Centre, Ontario, Canada. Methods: The changes in the first three recordings of the abbreviated version of the VitalPAC™ Early Warning Score (ViEWS) after admission to hospital of 18,827 surgical patients, and their relationship to subsequent in-hospital mortality were examined. Results: In the 2.0 SD 2.4. h between admission and the second recording the score changed in 12.6% of patients. If the initial abbreviated ViEWS was ≤2 points (78% of all patients) the in-hospital mortality was 0.5%, and not significantly different in the 3.7% of patients that either increased or decreased their score. Patients who had an initial score ≥3 had a significantly higher overall in-hospital mortality (odds ratio 5.48, Chi-square 120.72, p< 0.0001). Of these patients, those with a lower second score (42.3% of patients) had a significantly lower in-hospital mortality than those with an unchanged second score (i.e. 1.5% versus 3.3%, odds ratio 0.43, Chi-square 11.08, p< 0.001). Conclusion: The abbreviated ViEWS score measured on admission identifies the majority of surgical patients who are at low risk of in-hospital death. Patients with an initial abbreviated ViEWS ≥3 who do not reduce their score within 2-3. h of admission have a further significantly increased mortality. © 2012 Elsevier Ireland Ltd.


Ahmed S.Z.,Thunder Bay Regional Health science Center
Canadian Journal of Infectious Diseases and Medical Microbiology | Year: 2015

Blastomycosis is an invasive fungal disease caused by Blastomyces dermatitidis and the recently discovered Blastomyces gilchristii. The medical charts of 64 patients with confirmed cases of blastomycosis in northwestern Ontario during a 10-year period (2004 to 2014) were retrospectively reviewed. The number of patients diagnosed with blastomycosis in Ontario was observed to have increased substantially compared with before 1990, when blastomycosis was removed from the list of reportable diseases. Aboriginals were observed to be disproportionately represented in the patient population. Of the patients whose smoking status was known, 71.4% had a history of smoking. 59.4% of patients had underlying comorbidities and a higher comorbidity rate was observed among Aboriginal patients. The case-fatality rate from direct complications of blastomycosis disease was calculated to be 20.3%; this case-fatality rate is the highest ever to be reported in Canada and more than double that of previously published Canadian studies. The clinical characteristics of 64 patients diagnosed with blastomycosis are summarized.


Kellett J.,Thunder Bay Regional Health science Center | Woodworth S.,University College Cork | Wang F.,Lakehead University | Huang W.,Lakehead University
Resuscitation | Year: 2013

Background: The best performing early warning score is Vitalpac™ Early Warning Score (ViEWS). However, it is not known how often, to what extent and over what time frame any early warning scores change, and what the implications of these changes are. Setting: Thunder Bay Regional Health Sciences Center, Ontario, Canada. Methods: The changes in the first three complete sets of the six variables required to retrospectively calculate the abbreviated version of ViEWS (that did not include mental status) after admission to hospital of 18,853 acutely ill medical patients, and their relationship to subsequent in-hospital mortality were examined. Results: In the 10.4 SD 20.1 (median 5.0) hours between admission and the second recording the score changed in only 5.9% of patients and these changes were of no prognostic value. By the time of the third recording 34.9 SD 21.7 (median 30.0) hours after admission a change in score was clearly associated with a corresponding change in in-hospital mortality (e.g. for patients with an initial score of 5 an increase between the first and third recording of ≥4 points was associated with an increased mortality (OR 6.5 95% CI 2.3-15.9, p<0.00001), whereas a reduction of ≤-4 points was associated with a reduced mortality (OR 0.4 95% CI 0.2-0.9, p 0.03)). Conclusion: After a median interval of 30. h both the initial abbreviated ViEWS recording and subsequent changes in it both predict clinical outcome. It remains to be determined what interventions during this time frame will improve patient outcomes. © 2012 Elsevier Ireland Ltd.


Murray A.,Dundalk Institute of Technology | Kellett J.,Thunder Bay Regional Health science Center | Huang W.,Lakehead University | Woodworth S.,University College Cork | Wang F.,Lakehead University
Resuscitation | Year: 2014

Background: It is not known how often, to what extent and over what time frame any early warning scores change, and what the implications of these changes are. Setting: Thunder Bay Regional Health Sciences Center, Ontario, Canada. Methods: The averaged vital signs measured over different time periods of 44,531 consecutive acutely ill medical admissions were determined and then combined to calculate the averaged abbreviated version of the Vitalpac™ early warning score (AbEWS) during each time period examined. Results: 18% of all in-hospital deaths within 30 days are in patients with a low AbEWS on admission. Those admitted with a low AbEWS are more likely to increase their score and those admitted with a high score are more likely to lower it. Paradoxically, patients who have an averaged score over the first 6. h in hospital that is lower than on admission have increased in-hospital mortality. Thereafter patients with an increase in the averaged score have almost twice the mortality of those with a decreased score. 4.7% of patients have a low averaged score on the day they die. Conclusion: AbEWS, without clinical judgment, cannot be used to detect those patients who do not need to be admitted to hospital or are suitable for discharge. A period of observation of at least 12. h is required before the trajectory of AbEWS is of prognostic value, and any "improvement" that occurs before this time may be illusory. © 2013 Elsevier Ireland Ltd.


Decarlo C.A.,Thunder Bay Regional Research Institute | Rosa B.,Lakehead University | Jackson R.,Thunder Bay Regional Research Institute | Niccoli S.,Thunder Bay Regional Research Institute | And 2 more authors.
Clinical and Developmental Immunology | Year: 2012

The human papillomavirus (HPV) directly infects cervical keratinocytes and interferes with TLR signalling. To shed light on the effect of HPV on upstream receptors, we evaluated TLRs 1-9 gene expression in HPV-negative normal and HPV-positive pre-malignant and malignant ex vivo cervical tissue. Quantitative real-time polymerase chain reaction was performed separately for epithelial and stromal tissue compartments. Differences in gene expression were analyzed by the Jonckheere-Terpstra trend test or the Student's t -test for pairwise comparison. Laser capture microdissection revealed an increase in TLR3 and a decrease in TLR1 mRNA levels in dysplastic and carcinoma epithelium, respectively. In the stroma, a trend of increasing TLR 1, 2, 5, 6, and 9 mRNA levels with disease severity was found. These findings implicate the involvement of TLR3 and TLR1 in early and late cervical carcinogenesis, respectively, suggesting that stromal upregulation of TLRs may play a role in cervical disease progression. Copyright © 2012 Correne A. DeCarlo et al.


Opio M.O.,St Josephs Kitovu Health Care Complex | Nansubuga G.,St Josephs Kitovu Health Care Complex | Kellett J.,Thunder Bay Regional Health science Center
Resuscitation | Year: 2013

Background: The VitalPAC™ Early Warning Score (ViEWS) has an area under the receiver operator characteristic curve (AUROC) for death of acute unselected medical patients within 24. h of 88% and the UK National Early Warning Scores is based on it. The score's discrimination has been validated on patients in the developed world, but nothing is known of its performance in resource-poor hospitals. Methods: ViEWS was validated in 844 acutely ill medical patients admitted to Kitovu Hospital, Masaka, Uganda. Results: The AUROC for death within 24. h of admission was 88.6% (95% CI 82.5-94.7%). The inability to walk without help was found to be an additional independent predictor of in-hospital mortality, and ViEWS modified to include it had an AUROC for death within 24. h of 91.9% (95% CI 86.5-97.2%). Conclusion: The discrimination of ViEWS in a resource poor sub-Saharan Africa hospital is the same as in the developed world. Inability to walk without help was found to be an additional independent predictor of mortality. © 2013 Elsevier Ireland Ltd.


Nabayigga B.,St Josephs Kitovu Health Care Complex | Kellett J.,Thunder Bay Regional Health science Center | Opio M.O.,St Josephs Kitovu Health Care Complex
European Journal of Internal Medicine | Year: 2016

Background Mortality, the first level of the first tier of the Outcomes Measures Hierarchy used to assess the value of health care, is the only hospital outcome usually measured. Gait and alertness after discharge are important to patients; they capture much of the second level of the first tier of the hierarchy, and are required to more fully assess the benefits, value and quality of care. Aim To assess the alertness, gait and mortality of severely ill patients at two months after admission to a resource poor sub-Saharan hospital. Methods 193 severely ill patients admitted to a Ugandan hospital were followed up for up to 60 days. Results 34% of patients died, 52% were alert and calm with a stable independent gait, 2% had an unstable gait, 6% were bedridden and 7% were lost to follow-up within 60 days of admission: 7.4% of patients discharged alert with a stable gait died within 30 days and 13.9% within 60 days; 26.9% of patients discharged without a stable gait died within 60 days. Sixty day mortality was 5% if patients had a stable independent gait on admission, 25% if they had an unstable gait or needed help to walk, and 50% if they were bedridden. Simple logistic regression models based on cheap easily available data predicted 30 day mortality, alertness and gait (c statistic of both models 0.89 SE 0.03). Conclusion In a resource poor setting gait and alertness assessments are of prognostic value, and practical and informative methods of patient follow-up. © 2015 European Federation of Internal Medicine.


Clynch N.,Dundalk Institute of Technology | Kellett J.,Thunder Bay Regional Health science Center
International Journal of Medical Informatics | Year: 2015

Even though it takes up such a large part of all clinicians' working day the medical literature on documentation and its value is sparse. Methods: Medline searches combining the terms medical records, documentation, time, and value or efficacy or benefit yielded only 147 articles. This review is based on the relevant articles selected from this search and additional studies gathered from the personal experience of the authors and their colleagues. Results: Documentation now occupies a quarter to half of doctors' time yet much of the information collected is of dubious or unproven value. Most medical records departments still use the traditional paper chart, and there is considerable debate on the benefits of electronic medical records (EMRs). Although EMRs contains a lot more information than a paper record clinicians do not find it easy to getting useful information out of them. Unlike the paper chart narrative is difficult to enter into most EMRs so that they do not adequately communicate the patient's "story" to clinicians. Recent innovations have the potential to address these issues. Conclusion: Although documentation is widespread throughout the health care industry there has been almost no formal research into its value, on how to enhance its value, or on whether the time spent on it has negative effects on patient care. © 2014 Elsevier Ireland Ltd.


Opio M.O.,St Josephs Kitovu Health Care Complex | Nansubuga G.,St Josephs Kitovu Health Care Complex | Kellett J.,Thunder Bay Regional Health science Center
European Journal of Internal Medicine | Year: 2014

Background the development of validated early warning scores that only require the measurement of vital signs at the bedside has provided for the first time a practical and affordable method of comparing the outcomes of similar patients admitted to hospital in the developed and developing world. Methods we compared the outcomes of patients with the same abbreviated version of the VitalPAC™ early warning score at the time of hospital admission in a Canadian and Ugandan hospital. 844 acutely ill medical patients admitted to Kitovu Hospital, Masaka, Uganda and 48,696 patients admitted to the Thunder Bay Regional Health Sciences Centre (TBRHSC), Ontario, Canada were examined. Results apart from those patients with an abbreviated ViEWS value of 10 there was no statistically significant difference in the in-hospital mortality of Kitvou and TBRHSC patients with the same score on admission. Using arbitrary ranges of the abbreviated ViEWS the 30 day Kaplan-Meier survival curves of Kitovu patients were either the same or better than those of TBRHSC patients. Conclusion the in-hospital mortality of patients with the same abbreviated ViEWS on hospital admission is similar in TBRHSC and Kitovu Hospital. © 2013 European Federation of Internal Medicine.


Kellett J.,Nenagh Hospital | Kim A.,Thunder Bay Regional Health science Center
Resuscitation | Year: 2012

Background: The early warning score derived from 198,755 vital sign sets in the Vitalpac™ database (ViEWS) has an area under the receiver operator characteristic curve (AUROC) for death of acute unselected medical patients within 24. h of 88%. Methods: This study validated an abbreviated version of ViEWS, which did not include mental status, in 75,419 consecutive patients admitted to the Thunder Bay Regional Health Sciences Center between 2005 and 2010. Results: The abbreviated score had an AUROC for death within 48. h of admission of 93% for all patients and 89% for medical patients - there were no significant differences in the discrimination of the score between surgical and medical patients or patients admitted to different medical sub-specialty services. The AUROC for intensive care patients, however, was significantly lower at 72%. Although medical patients appeared to have a higher mortality than surgical patients with the same score, these only reached statistical significance for surgical patients with a score between 3 and 10 points, stroke patients between 3 and 6 points, oncology patients between 7 and 10 points, and ICU patients with 3 or more points. Conclusion: The abbreviated ViEWS score has comparable discrimination to the original score and has reasonable " goodness of fit" for most patients except for those requiring intensive care. © 2011 Elsevier Ireland Ltd.

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