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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. Source


Background: few studies have compared the discrimination of predictive scores of in-hospital mortality that used vital signs with those using laboratory results in different patient populations. Methods: a hypothesis generating retrospective observational cohort study. A score that only used vital signs was compared with three other scores that used laboratory changes in 44,985 medical and 20,432 surgical patients. Results: the discrimination of the score based only on vital signs was highest for the prediction of in-hospital death within 24 h. In contrast the, albeit lower, discrimination of scores based only on laboratory data remained constant for the prediction of death up to 30 days after hospital admission. Moreover, the discrimination of scores based only on laboratory data was higher in surgical than in medical patients. Conclusion: in acutely ill medical patients a vital sign based score appears to predict mortality within 24 h better than scores using laboratory data. This may be because in acutely ill patients vital sign changes indicate how well a patient is responding to a current insult. In contrast, for patients without acute illness laboratory data may be a more valuable indication of the patient's capacity to respond to insults in the future. © 2016 Elsevier Ireland Ltd. Source


Nabayigga B.,Medical Wards | 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. Source


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. Source


Opio M.O.,St. Josephs Kitovu Health Care Complex | Nansubuga G.,Medical Wards | 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. Source

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