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McLeod SL, Tarride JE, Mondoux S, Paterson JM, Plumptre L, Borgundvaag E, Dainty KN, McCarron J, Ovens H, Hall JN. Health care utilization and outcomes of patients seen by virtual urgent care versus in-person emergency department care. CMAJ 2023; 195:E1463-E1474. [PMID: 37931947 PMCID: PMC10627570 DOI: 10.1503/cmaj.230492] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Virtual urgent care (VUC) is intended to support diversion of patients with low-acuity complaints and reduce the need for in-person emergency department visits. We aimed to describe subsequent health care utilization and outcomes of patients who used VUC compared with similar patients who had an in-person emergency department visit. METHODS We used patient-level encounter data that were prospectively collected for patients using VUC services provided by 14 pilot programs in Ontario, Canada. We linked the data to provincial administrative databases to identify subsequent 30-day health care utilization and outcomes. We defined 2 subgroups of VUC users; those with a documented prompt referral to an emergency department by a VUC provider, and those without. We matched patients in each cohort to an equal number of patients presenting to an emergency department in person, based on encounter date, medical concern and the logit of a propensity score. For the subgroup of patients not promptly referred to an emergency department, we matched patients to those who were seen in an emergency department and then discharged home. RESULTS Of the 19 595 patient VUC visits linked to administrative data, we matched 2129 patients promptly referred to the emergency department by a VUC provider to patients presenting to the emergency department in person. Index visit hospital admissions (9.4% v. 8.7%), 30-day emergency department visits (17.0% v. 17.5%), and hospital admissions (12.9% v. 11.0%) were similar between the groups. We matched 14 179 patients who were seen by a VUC provider with no documented referral to the emergency department. Patients seen by VUC were more likely to have a subsequent in-person emergency department visit within 72 hours (13.7% v. 7.0%), 7 days (16.5% v. 10.3%) and 30 days (21.9% v. 17.9%), but hospital admissions were similar within 72 hours (1.1% v. 1.3%), and higher within 30 days for patients who were discharged home from the emergency department (2.6% v. 3.4%). INTERPRETATION The impact of the provincial VUC pilot program on subsequent health care utilization was limited. There is a need to better understand the inherent limitations of virtual care and ensure future virtual providers have timely access to in-person outpatient resources, to prevent subsequent emergency department visits.
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Affiliation(s)
- Shelley L McLeod
- Schwartz/Reisman Emergency Medicine Institute (McLeod, Ovens), Sinai Health; Division of Emergency Medicine (McLeod, Ovens), Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; McMaster Chair in Health Technology Management (Tarride), Department of Health Research Methods, Evidence and Impact, Centre for Health Economics and Policy Analysis, and Department of Emergency Medicine (Mondoux), St. Joseph's Healthcare Hamilton, Department of Medicine, McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mondoux), University of Toronto; ICES Central (Paterson, Plumptre, Borgundvaag); Institute of Health Policy, Management and Evaluation (Paterson, Dainty), University of Toronto; North York General Hospital (Dainty); Ontario Health (McCarron); Department of Emergency Medicine (Hall), Sunnybrook Health Sciences Centre; Department of Medicine (Hall), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.
| | - Jean-Eric Tarride
- Schwartz/Reisman Emergency Medicine Institute (McLeod, Ovens), Sinai Health; Division of Emergency Medicine (McLeod, Ovens), Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; McMaster Chair in Health Technology Management (Tarride), Department of Health Research Methods, Evidence and Impact, Centre for Health Economics and Policy Analysis, and Department of Emergency Medicine (Mondoux), St. Joseph's Healthcare Hamilton, Department of Medicine, McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mondoux), University of Toronto; ICES Central (Paterson, Plumptre, Borgundvaag); Institute of Health Policy, Management and Evaluation (Paterson, Dainty), University of Toronto; North York General Hospital (Dainty); Ontario Health (McCarron); Department of Emergency Medicine (Hall), Sunnybrook Health Sciences Centre; Department of Medicine (Hall), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Shawn Mondoux
- Schwartz/Reisman Emergency Medicine Institute (McLeod, Ovens), Sinai Health; Division of Emergency Medicine (McLeod, Ovens), Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; McMaster Chair in Health Technology Management (Tarride), Department of Health Research Methods, Evidence and Impact, Centre for Health Economics and Policy Analysis, and Department of Emergency Medicine (Mondoux), St. Joseph's Healthcare Hamilton, Department of Medicine, McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mondoux), University of Toronto; ICES Central (Paterson, Plumptre, Borgundvaag); Institute of Health Policy, Management and Evaluation (Paterson, Dainty), University of Toronto; North York General Hospital (Dainty); Ontario Health (McCarron); Department of Emergency Medicine (Hall), Sunnybrook Health Sciences Centre; Department of Medicine (Hall), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - J Michael Paterson
- Schwartz/Reisman Emergency Medicine Institute (McLeod, Ovens), Sinai Health; Division of Emergency Medicine (McLeod, Ovens), Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; McMaster Chair in Health Technology Management (Tarride), Department of Health Research Methods, Evidence and Impact, Centre for Health Economics and Policy Analysis, and Department of Emergency Medicine (Mondoux), St. Joseph's Healthcare Hamilton, Department of Medicine, McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mondoux), University of Toronto; ICES Central (Paterson, Plumptre, Borgundvaag); Institute of Health Policy, Management and Evaluation (Paterson, Dainty), University of Toronto; North York General Hospital (Dainty); Ontario Health (McCarron); Department of Emergency Medicine (Hall), Sunnybrook Health Sciences Centre; Department of Medicine (Hall), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Lesley Plumptre
- Schwartz/Reisman Emergency Medicine Institute (McLeod, Ovens), Sinai Health; Division of Emergency Medicine (McLeod, Ovens), Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; McMaster Chair in Health Technology Management (Tarride), Department of Health Research Methods, Evidence and Impact, Centre for Health Economics and Policy Analysis, and Department of Emergency Medicine (Mondoux), St. Joseph's Healthcare Hamilton, Department of Medicine, McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mondoux), University of Toronto; ICES Central (Paterson, Plumptre, Borgundvaag); Institute of Health Policy, Management and Evaluation (Paterson, Dainty), University of Toronto; North York General Hospital (Dainty); Ontario Health (McCarron); Department of Emergency Medicine (Hall), Sunnybrook Health Sciences Centre; Department of Medicine (Hall), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Emily Borgundvaag
- Schwartz/Reisman Emergency Medicine Institute (McLeod, Ovens), Sinai Health; Division of Emergency Medicine (McLeod, Ovens), Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; McMaster Chair in Health Technology Management (Tarride), Department of Health Research Methods, Evidence and Impact, Centre for Health Economics and Policy Analysis, and Department of Emergency Medicine (Mondoux), St. Joseph's Healthcare Hamilton, Department of Medicine, McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mondoux), University of Toronto; ICES Central (Paterson, Plumptre, Borgundvaag); Institute of Health Policy, Management and Evaluation (Paterson, Dainty), University of Toronto; North York General Hospital (Dainty); Ontario Health (McCarron); Department of Emergency Medicine (Hall), Sunnybrook Health Sciences Centre; Department of Medicine (Hall), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Katie N Dainty
- Schwartz/Reisman Emergency Medicine Institute (McLeod, Ovens), Sinai Health; Division of Emergency Medicine (McLeod, Ovens), Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; McMaster Chair in Health Technology Management (Tarride), Department of Health Research Methods, Evidence and Impact, Centre for Health Economics and Policy Analysis, and Department of Emergency Medicine (Mondoux), St. Joseph's Healthcare Hamilton, Department of Medicine, McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mondoux), University of Toronto; ICES Central (Paterson, Plumptre, Borgundvaag); Institute of Health Policy, Management and Evaluation (Paterson, Dainty), University of Toronto; North York General Hospital (Dainty); Ontario Health (McCarron); Department of Emergency Medicine (Hall), Sunnybrook Health Sciences Centre; Department of Medicine (Hall), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Joy McCarron
- Schwartz/Reisman Emergency Medicine Institute (McLeod, Ovens), Sinai Health; Division of Emergency Medicine (McLeod, Ovens), Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; McMaster Chair in Health Technology Management (Tarride), Department of Health Research Methods, Evidence and Impact, Centre for Health Economics and Policy Analysis, and Department of Emergency Medicine (Mondoux), St. Joseph's Healthcare Hamilton, Department of Medicine, McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mondoux), University of Toronto; ICES Central (Paterson, Plumptre, Borgundvaag); Institute of Health Policy, Management and Evaluation (Paterson, Dainty), University of Toronto; North York General Hospital (Dainty); Ontario Health (McCarron); Department of Emergency Medicine (Hall), Sunnybrook Health Sciences Centre; Department of Medicine (Hall), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Howard Ovens
- Schwartz/Reisman Emergency Medicine Institute (McLeod, Ovens), Sinai Health; Division of Emergency Medicine (McLeod, Ovens), Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; McMaster Chair in Health Technology Management (Tarride), Department of Health Research Methods, Evidence and Impact, Centre for Health Economics and Policy Analysis, and Department of Emergency Medicine (Mondoux), St. Joseph's Healthcare Hamilton, Department of Medicine, McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mondoux), University of Toronto; ICES Central (Paterson, Plumptre, Borgundvaag); Institute of Health Policy, Management and Evaluation (Paterson, Dainty), University of Toronto; North York General Hospital (Dainty); Ontario Health (McCarron); Department of Emergency Medicine (Hall), Sunnybrook Health Sciences Centre; Department of Medicine (Hall), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
| | - Justin N Hall
- Schwartz/Reisman Emergency Medicine Institute (McLeod, Ovens), Sinai Health; Division of Emergency Medicine (McLeod, Ovens), Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.; McMaster Chair in Health Technology Management (Tarride), Department of Health Research Methods, Evidence and Impact, Centre for Health Economics and Policy Analysis, and Department of Emergency Medicine (Mondoux), St. Joseph's Healthcare Hamilton, Department of Medicine, McMaster University, Hamilton, Ont.; Dalla Lana School of Public Health (Mondoux), University of Toronto; ICES Central (Paterson, Plumptre, Borgundvaag); Institute of Health Policy, Management and Evaluation (Paterson, Dainty), University of Toronto; North York General Hospital (Dainty); Ontario Health (McCarron); Department of Emergency Medicine (Hall), Sunnybrook Health Sciences Centre; Department of Medicine (Hall), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont
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Stamenova V, Chu C, Borgundvaag E, Fleury C, Brual J, Bhattacharyya O, Tadrous M. Virtual care use prior to emergency department admissions during a stable COVID-19 period in Ontario, Canada. PLoS One 2023; 18:e0277065. [PMID: 37115759 PMCID: PMC10146565 DOI: 10.1371/journal.pone.0277065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 04/16/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND The increased use of telemedicine to provide virtual outpatient visits during the pandemic has led to concerns about potential increased emergency department (ED) admissions and outpatient service use prior to such admissions. We examined the frequency of virtual visits use prior to ED admissions and characterized the patients with prior virtual visit use and the physicians who provided these outpatient visits. METHODS We conducted a retrospective, population-based, cross-sectional analysis using linked health administrative data in Ontario, Canada to identify patients who had an ED admission between July 1 and September 30, 2021 and patients with an ED admissions during the same period in 2019. We grouped patients based on their use of outpatient services in the 7 days prior to admission and reported their sociodemographic characteristics and healthcare utilization. RESULTS There were 1,080,334 ED admissions in 2021 vs. 1,113,230 in 2019. In 2021, 74% of these admissions had no prior outpatient visits (virtual or in-person) within 7 days of admission, compared to 75% in 2019. Only 3% of ED admissions had both virtual and in-person visits in the 7 days prior to ED admission. Patients with prior virtual care use were more likely to be hospitalized than those without any outpatient care (13% vs 7.7.%). INTERPRETATION The net amount of ED admissions and outpatient care prior to admission remained the same over a period of the COVID-19 pandemic when cases were relatively stable. Virtual care seemed to be able to appropriately triage patients to the ED and virtual visits replaced in-person visits ahead of ED admissions, as opposed to being additive.
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Affiliation(s)
- Vess Stamenova
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | - Cherry Chu
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | | | - Cathleen Fleury
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | - Janette Brual
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
| | - Onil Bhattacharyya
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
- Department of Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mina Tadrous
- Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
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Borgundvaag E, Plumptre L, Paterson M, An D, McLeod S, Tarride JE, Atzema C, Schull M, Verma A, Hall J. Evaluation of low acuity patients discharged from a virtual emergency department at a major urban academic health sciences centre in Toronto, Canada. Int J Popul Data Sci 2022. [DOI: 10.23889/ijpds.v7i3.1926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
ObjectiveIn response to the COVID-19 pandemic, Sunnybrook Health Sciences Centre launched the first virtual emergency department (VED) in Toronto, Ontario. The objective of this pilot project was to leverage linked administrative data to describe the healthcare utilization of VED patients compared to matched patients who attended an ED in person.
ApproachEvaluation of the VED program was supported by the ICES Applied Health Research Question Program, which is funded by the Ontario Ministry of Health to answer questions directly related to Ontario healthcare policy, planning, or practice. VED visit records from December 2020 to May 2021 were linked with Ontario administrative data. VED patients with low acuity complaints were matched 1:1 with in-person ED comparators according to visit date, presenting complaint, and a propensity score that incorporated age, sex, comorbidities, and other important potential confounders. The primary outcomes were healthcare utilization within 7 days and all-cause mortality within 30 days.
ResultsOf the 609 eligible patients discharged from the VED, 600 (98.5%) were successfully matched to a comparator. Mean (SD) age was 43.0 (21.1) and 64.1% were female. In-person ED revisits and hospitalizations were similar for VED and comparator patients at 72 hours (ED: 12.1% vs. 11.3%; Δ 0.8%, 95%: -2.8, 4.5%; hospitalization: 1.2% vs. 1.5%; Δ 0.3%, 95%: -0.7, 1.4%,) and 7 days (ED: 16.1% vs. 14.4%; Δ 1.7, 95%: -2.4, 5.7%; hospitalization: 1.7% vs. 1.8%; Δ 0.2%, 95%: -0.1, 1.4%) following the index visit. The number of patients visiting a primary care provider within 7 days was also similar between groups (36.7% vs. 32.4%; Δ 4.3, 95%: -1.1, 9.8%). No patients died within 30 days.
Conclusion/ImplicationsVED patients and their matched comparators had similar healthcare utilization in the 7 days following their index ED visit. Methodology from this study will inform a province-wide evaluation of VED programs across Ontario.
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Jamal AJ, Faheem A, Farooqi L, Zhong XZ, Armstrong I, Boyd DA, Borgundvaag E, Coleman BL, Green K, Jayasinghe K, Johnstone J, Katz K, Kohler P, Li AX, Mataseje L, Melano R, Muller MP, Mulvey MR, Nayani S, Patel SN, Paterson A, Poutanen S, Rebbapragada A, Richardson D, Sarabia A, Shafinaz S, Simor AE, Willey BM, Wisely L, McGeer AJ. Household Transmission of Carbapenemase-producing Enterobacterales in Ontario, Canada. Clin Infect Dis 2021; 73:e4607-e4615. [PMID: 32869855 PMCID: PMC8662791 DOI: 10.1093/cid/ciaa1295] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 08/27/2020] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Data on household transmission of carbapenemase-producing Enterobacterales (CPE) remain limited. We studied risk of CPE household co-colonization and transmission in Ontario, Canada. METHODS We enrolled CPE index cases (identified via population-based surveillance from January 2015 to October 2018) and their household contacts. At months 0, 3, 6, 9, and 12, participants provided rectal and groin swabs. Swabs were cultured for CPE until September 2017, when direct polymerase chain reaction (PCR; with culture of specimens if a carbapenemase gene was detected) replaced culture. CPE risk factor data were collected by interview and combined with isolate whole-genome sequencing to determine likelihood of household transmission. Risk factors for household contact colonization were explored using a multivariable logistic regression model with generalized estimating equations. RESULTS Ninety-five households with 177 household contacts participated. Sixteen (9%) household contacts in 16 (17%) households were CPE-colonized. Household transmission was confirmed in 3/177 (2%) cases, probable in 2/177 (1%), possible in 9/177 (5%), and unlikely in 2/177 (1%). Household contacts were more likely to be colonized if they were the index case's spouse (odds ratio [OR], 6.17; 95% confidence interval [CI], 1.05-36.35), if their index case remained CPE-colonized at household enrollment (OR, 7.00; 95% CI, 1.92-25.49), or if they had at least 1 set of specimens processed after direct PCR was introduced (OR, 6.46; 95% CI, 1.52-27.40). CONCLUSIONS Nine percent of household contacts were CPE-colonized; 3% were a result of household transmission. Hospitals may consider admission screening for patients known to have CPE-colonized household contacts.
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Affiliation(s)
- Alainna J Jamal
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Microbiology, Sinai Health System, Toronto, Ontario, Canada
| | - Amna Faheem
- Department of Microbiology, Sinai Health System, Toronto, Ontario, Canada
| | - Lubna Farooqi
- Department of Microbiology, Sinai Health System, Toronto, Ontario, Canada
| | - Xi Zoe Zhong
- Department of Microbiology, Sinai Health System, Toronto, Ontario, Canada
| | - Irene Armstrong
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Communicable Disease Control, Toronto Public Health, Toronto, Ontario, Canada
| | - David A Boyd
- Antimicrobial Resistance and Nosocomial Infections, National Microbiology Laboratory, Winnipeg, Manitoba, Canada
| | - Emily Borgundvaag
- Department of Microbiology, Sinai Health System, Toronto, Ontario, Canada
| | - Brenda L Coleman
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Microbiology, Sinai Health System, Toronto, Ontario, Canada
| | - Karen Green
- Department of Microbiology, Sinai Health System, Toronto, Ontario, Canada
| | | | - Jennie Johnstone
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Microbiology, Sinai Health System, Toronto, Ontario, Canada
| | - Kevin Katz
- Department of Infection Prevention and Control, North York General Hospital, Toronto, Ontario, Canada
| | - Philipp Kohler
- Department of Microbiology, Sinai Health System, Toronto, Ontario, Canada
| | - Angel X Li
- Department of Microbiology, Sinai Health System, Toronto, Ontario, Canada
| | - Laura Mataseje
- Antimicrobial Resistance and Nosocomial Infections, National Microbiology Laboratory, Winnipeg, Manitoba, Canada
| | - Roberto Melano
- Bacteriology, Public Health Ontario Laboratory, Toronto, Ontario, Canada
| | - Matthew P Muller
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Infection Prevention and Control, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Michael R Mulvey
- Antimicrobial Resistance and Nosocomial Infections, National Microbiology Laboratory, Winnipeg, Manitoba, Canada
| | - Sarah Nayani
- Department of Microbiology, Sinai Health System, Toronto, Ontario, Canada
| | - Samir N Patel
- Bacteriology, Public Health Ontario Laboratory, Toronto, Ontario, Canada
| | - Aimee Paterson
- Department of Microbiology, Sinai Health System, Toronto, Ontario, Canada
| | - Susan Poutanen
- Department of Microbiology, Sinai Health System, Toronto, Ontario, Canada
| | - Anu Rebbapragada
- Scientific Affairs and Market Access, Hologic Inc., Toronto, Ontario, Canada
| | - David Richardson
- Department of Infection Prevention and Control, William Osler Health System, Brampton, Ontario, Canada
| | - Alicia Sarabia
- Department of Infection Prevention and Control, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Shumona Shafinaz
- Department of Microbiology, Sinai Health System, Toronto, Ontario, Canada
| | - Andrew E Simor
- Department of Infection Prevention and Control, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Barbara M Willey
- Department of Microbiology, Sinai Health System, Toronto, Ontario, Canada
| | - Laura Wisely
- Department of Microbiology, Sinai Health System, Toronto, Ontario, Canada
| | - Allison J McGeer
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Microbiology, Sinai Health System, Toronto, Ontario, Canada
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Schuurmans J, Borgundvaag E, Finaldi P, Senat-Delva R, Desauguste F, Badjo C, Lekkerkerker M, Grandpierre R, Lerebours G, Ariti C, Lenglet A. Risk factors for adverse outcomes in women with high-risk pregnancy and their neonates, Haiti. Rev Panam Salud Publica 2021; 45:e147. [PMID: 34840557 PMCID: PMC8612597 DOI: 10.26633/rpsp.2021.147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 07/21/2021] [Indexed: 11/24/2022] Open
Abstract
Objectives. To determine the prevalence of maternal death, stillbirth and low birthweight in women with (pre-)eclampsia and complicated pregnancies or deliveries in Centre de Références des Urgences Obstétricales, an obstetric emergency hospital in Port-au-Prince, Haiti, and to identify the main risk factors for these adverse pregnancy outcomes. Methods. We conducted a retrospective cohort study of pregnant women admitted to Centre de Référence des Urgences Obstétricales between 2013 and 2018 using hospital records. Risk factors investigated were age group, type of pregnancy (singleton, multiple), type of delivery and use of antenatal care services. Results. A total of 31 509 women and 24 983 deliveries were included in the analysis. Among these, 204 (0.6%) maternal deaths (648 per 100 000 women giving birth), 1962 (7.9%) stillbirths and 11 008 (44.1%) low birthweight neonates were identified. Of all admissions, 10 991 (34.9%) were women with (pre-)eclampsia. Caesarean section significantly increased the risk of maternal death in the women with a complicated pregnancy and women with (pre-)eclampsia, but reduced the risk of stillbirth in such women. Not attending antenatal care was associated with a significantly higher risk of stillbirth (odds ratio (OR) 4.82; 95% confidence interval (CI) 3.55–6.55) and low birthweight (OR 1.40; 95% CI 1.05–1.86) for women with complicated pregnancies. Conclusion. To prevent and treat pregnancy complications as early as possible, antenatal care attendance is crucial. Improving the quality of and access to antenatal care services and providing it free to all pregnant women in Haiti is recommended.
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Affiliation(s)
- Jorien Schuurmans
- Médecins Sans Frontières Port-au-Prince Haiti Médecins Sans Frontières, Port-au-Prince, Haiti
| | - Emily Borgundvaag
- Médecins Sans Frontières Port-au-Prince Haiti Médecins Sans Frontières, Port-au-Prince, Haiti
| | - Pasquale Finaldi
- Médecins Sans Frontières Port-au-Prince Haiti Médecins Sans Frontières, Port-au-Prince, Haiti
| | - Rodnie Senat-Delva
- Médecins Sans Frontières Port-au-Prince Haiti Médecins Sans Frontières, Port-au-Prince, Haiti
| | - Fedner Desauguste
- Médecins Sans Frontières Port-au-Prince Haiti Médecins Sans Frontières, Port-au-Prince, Haiti
| | - Colette Badjo
- Médecins Sans Frontières Port-au-Prince Haiti Médecins Sans Frontières, Port-au-Prince, Haiti
| | - Michiel Lekkerkerker
- Médecins Sans Frontières Amsterdam Netherlands Médecins Sans Frontières, Amsterdam, The Netherlands
| | - Reynaldo Grandpierre
- Ministère de la Santé Publique et de la Population Port-au-Prince Haiti Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti
| | - Gerald Lerebours
- National Bioethics Committee Port-au-Prince Haiti National Bioethics Committee, Port-au-Prince, Haiti
| | - Cono Ariti
- Centre for Trials Research Cardiff University School of Medicine Cardiff United Kingdom Centre for Trials Research, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Annick Lenglet
- Médecins Sans Frontières Amsterdam Netherlands Médecins Sans Frontières, Amsterdam, The Netherlands
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Borgundvaag E, Mak J, Kramer CK. Response to the Letter to the Editor from Fuller: "Metabolic Impact of Intermittent Fasting in Patients With Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis of Interventional Studies". J Clin Endocrinol Metab 2021; 106:e4306. [PMID: 34111272 DOI: 10.1210/clinem/dgab419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Emily Borgundvaag
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Canada
| | - Jessica Mak
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Canada
- Department of Internal Medicine, University of Toronto, Toronto, Canada
| | - Caroline K Kramer
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Canada
- Division of Endocrinology, University of Toronto, Toronto, Canada
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada
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Borgundvaag E, Mak J, Kramer CK. Response to Letter to the Editor from Varady et al: "Metabolic Impact of Intermittent Fasting in Patients with Type 2 Diabetes Mellitus: A Systematic Review and Meta-analysis of Interventional Studies". J Clin Endocrinol Metab 2021; 106:e4302-e4303. [PMID: 33950202 DOI: 10.1210/clinem/dgab299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Emily Borgundvaag
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Canada
| | - Jessica Mak
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Canada
- Department of Internal Medicine, University of Toronto, Toronto, Canada
| | - Caroline K Kramer
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Canada
- Division of Endocrinology, University of Toronto, Toronto, Canada
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada
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Borgundvaag E, Mak J, Kramer CK. Metabolic Impact of Intermittent Fasting in Patients With Type 2 Diabetes Mellitus: A Systematic Review and Meta-analysis of Interventional Studies. J Clin Endocrinol Metab 2021; 106:902-911. [PMID: 33319233 DOI: 10.1210/clinem/dgaa926] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Indexed: 02/11/2023]
Abstract
CONTEXT Intermittent fasting (IF) has been proposed as a weight-loss strategy with additional cardiometabolic benefits in individuals with obesity. Despite its growing popularity, the effect of IF in patients with type 2 diabetes (T2DM) remains unclear. OBJECTIVE We conducted a systematic review and meta-analysis to evaluate the metabolic impact of IF compared to standard diet in patients with T2DM. METHODS Embase, PubMed, and clinicaltrials.gov between 1950 and August 12, 2020 were searched for randomized, diet-controlled studies evaluating any IF intervention in adults with T2DM. We examined the impact of IF on weight loss and glucose-lowering by calculating pooled estimates of the absolute differences in body weight and glycated hemoglobin A1c (HbA1c) compared to a control group using a random-effects model. RESULTS Seven studies (n = 338 participants; mean body mass index [BMI] 35.65, mean baseline HbA1c 8.8%) met our inclusion criteria. IF induced a greater decrease in body weight by -1.89 kg (95% CI, -2.91 to -0.86 kg) compared to a regular diet, with no significant between-study heterogeneity (I2 21.0%, P = .28). The additional weight loss induced by IF was greater in studies with a heavier population (BMI > 36) (-3.43 kg [95% CI, -5.72 to -1.15 kg]) and in studies of shorter duration (≤ 4 months) (-3.73 kg [95% CI, -7.11 to -0.36 kg]). IF was not associated with further reduction in HbA1c compared to a standard diet (HbA1c -0.11% [95% CI, -0.38% to 0.17%]). CONCLUSION Current evidence suggests that IF is associated with greater weight loss in patients with T2DM compared with a standard diet, with a similar impact on glycemic control.
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Affiliation(s)
- Emily Borgundvaag
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Jessica Mak
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Ontario, Canada
- Department of Internal Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Caroline K Kramer
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Ontario, Canada
- Division of Endocrinology, University of Toronto, Toronto, Ontario, Canada
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
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9
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Lenglet A, Schuurmans J, Ariti C, Borgundvaag E, Charles K, Badjo C, Clezy K, Evens E, Senat-Delva R, Berthet M, Lekkerkerker M, McRae M, Wertheim H, Hopman J. Rectal screening displays high negative predictive value for bloodstream infection with (ESBL-producing) Gram-negative bacteria in neonates with suspected sepsis in a low-resource setting neonatal care unit. J Glob Antimicrob Resist 2020; 23:102-107. [PMID: 32890840 DOI: 10.1016/j.jgar.2020.08.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 08/07/2020] [Accepted: 08/19/2020] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES We analysed the concordance of rectal swab isolates and blood culture for Gram-negative bacteria (GNB) isolates in neonates with a suspicion of neonatal sepsis admitted to a neonatal care unit in Haiti. METHODS We matched pairs of blood and rectal samples taken on the date of suspected sepsis onset in the same neonate. We calculated the proportion of rectal isolates in concordance with the blood isolates by species and genus. We calculated the negative predictive value (NPV) for GNB and extended-spectrum β-lactamase (ESBL)-producing GNB for all rectal and blood isolate pairs in neonates with suspected sepsis. RESULTS We identified 238 blood and rectal samples pairs, with 238 blood isolate results and 309 rectal isolate results. The overall concordance in genus and species between blood and rectal isolates was 22.3% [95% confidence interval (CI) 17.4-28.0%] and 20.6% (95% CI 16.0-26.2%), respectively. The highest concordance between blood and rectal isolates was observed for samples with no bacterial growth (65%), followed byKlebsiella pneumoniae (18%) and Klebsiella oxytoca (12%). The NPV of detecting GNB bacterial isolates in rectal samples compared with those in blood samples was 81.6% and the NPV for ESBL-positive GNB was 92.6%. CONCLUSIONS The NPV of rectal swab GNB isolates was high in all patient groups and was even higher for ESBL-positive GNB. Clinicians can use the results from rectal swabs when taken simultaneously with blood samples during outbreaks to inform the (de-)escalation of antibiotic therapy in those neonates that have an ongoing sepsis profile.
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Affiliation(s)
- Annick Lenglet
- Médecins Sans Frontières, Amsterdam, The Netherlands; Medical Microbiology Department and Radboudumc Center for Infectious Diseases, Radboudumc, Nijmegen, The Netherlands.
| | | | - Cono Ariti
- Centre for Medical Education, Cardiff University School of Medicine, Cardiff, UK
| | | | | | | | - Kate Clezy
- Médecins Sans Frontières, Amsterdam, The Netherlands
| | | | | | | | | | - Melissa McRae
- Médecins Sans Frontières, Amsterdam, The Netherlands
| | - Heiman Wertheim
- Medical Microbiology Department and Radboudumc Center for Infectious Diseases, Radboudumc, Nijmegen, The Netherlands
| | - Joost Hopman
- Médecins Sans Frontières, Amsterdam, The Netherlands; Medical Microbiology Department and Radboudumc Center for Infectious Diseases, Radboudumc, Nijmegen, The Netherlands; Department of Patient Safety and Quality, Radboudumc, Nijmegen, The Netherlands
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Sheth PM, Douchant K, Uyanwune Y, Larocque M, Anantharajah A, Borgundvaag E, Dales L, McCreight L, McNaught L, Moore C, Ragan K, McGeer A, Broukhanski G. Correction: Evidence of transmission of Clostridium difficile in asymptomatic patients following admission screening in a tertiary care hospital. PLoS One 2019; 14:e0219579. [PMID: 31287834 PMCID: PMC6615625 DOI: 10.1371/journal.pone.0219579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0207138.].
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11
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Kohler PP, Melano RG, Patel SN, Shafinaz S, Faheem A, Coleman BL, Green K, Armstrong I, Almohri H, Borgia S, Borgundvaag E, Johnstone J, Katz K, Lam F, Muller MP, Powis J, Poutanen SM, Richardson D, Rebbapragada A, Sarabia A, Simor A, McGeer A. Emergence of Carbapenemase-Producing Enterobacteriaceae, South-Central Ontario, Canada 1. Emerg Infect Dis 2019; 24:1674-1682. [PMID: 30124197 PMCID: PMC6106407 DOI: 10.3201/eid2409.180164] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
We analyzed population-based surveillance data from the Toronto Invasive Bacterial Diseases Network to describe carbapenemase-producing Enterobacteriaceae (CPE) infections during 2007–2015 in south-central Ontario, Canada. We reviewed patients’ medical records and travel histories, analyzed microbiologic and clinical characteristics of CPE infections, and calculated incidence. Among 291 cases identified, New Delhi metallo-β-lactamase was the predominant carbapenemase (51%). The proportion of CPE-positive patients with prior admission to a hospital in Canada who had not received healthcare abroad or traveled to high-risk areas was 13% for patients with oxacillinase-48, 24% for patients with New Delhi metallo-β-lactamase, 55% for patients with Klebsiella pneumoniae carbapenemase, and 67% for patients with Verona integron-encoded metallo-β-lactamase. Incidence of CPE infection increased, reaching 0.33 cases/100,000 population in 2015. For a substantial proportion of patients, no healthcare abroad or high-risk travel could be established, suggesting CPE acquisition in Canada. Policy and practice changes are needed to mitigate nosocomial CPE transmission in hospitals in Canada.
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12
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Sheth PM, Douchant K, Uyanwune Y, Larocque M, Anantharajah A, Borgundvaag E, Dales L, McCreight L, McNaught L, Moore C, Ragan K, McGeer A, Broukhanski G. Evidence of transmission of Clostridium difficile in asymptomatic patients following admission screening in a tertiary care hospital. PLoS One 2019; 14:e0207138. [PMID: 30742636 PMCID: PMC6370182 DOI: 10.1371/journal.pone.0207138] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 10/25/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Clostridium difficile (CD) is the leading cause of infectious health-care associated diarrhea. However, little is known regarding CD carriage and transmission amongst asymptomatic colonizers. We evaluated carriage, characterized strains and examined epidemiologic linkages in asymptomatic colonized CD patients. METHODS Rectal swabs from asymptomatic patients admitted to the general medicine ward from April 1-June 30 2012 were collected. PCR-confirmed CD colonies were ribotyped and characterized by Modified-Multi Locus Variable Number Tandem Repeat Analysis (MMLVA). RESULTS 1549-swabs were collected from 474-patients. Overall, 50/474(10.6%) were CD PCR-positive, 24/50 were colonized at admission, while 26/50 were first identified > = 72 hours after admission. Amongst the 50 CD PCR-positive patients, 90% were asymptomatically colonized and 80% of individuals carried toxigenic CD-strains, including ribotype-027 (5/45:11%). MMLVA revealed five-clusters involving 15-patients harboring toxigenic (4/5) and non-toxigenic CD strains (1/5). In two clusters, patients were CD positive on admission while in the other three clusters involving 10 patients, we observed CD transmission from asymptomatically colonized patients to 8 previously CD-negative patients. CONCLUSIONS We identified increasing rates of colonization during admission to medical wards. MMLVA typing effectively discriminated between strains and suggests that 20% of patients with CD colonization acquired their strain(s) from asymptomatically colonized individuals in hospital.
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Affiliation(s)
- Prameet M. Sheth
- Department of Pathology and Molecular Medicine, Queen’s University, Kingston, Ontario, Canada
- Division of Microbiology, Kingston General Hospital, Kingston, Ontario, Canada
- * E-mail: (PMS); (AM); (GB)
| | - Katya Douchant
- Department of Pathology and Molecular Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Yvonne Uyanwune
- Public Health Ontario Laboratories, Toronto, Ontario, Canada
| | - Michael Larocque
- Department of Microbiology, Mt Sinai Hospital, Toronto, Ontario, Canada
| | | | - Emily Borgundvaag
- Department of Microbiology, Mt Sinai Hospital, Toronto, Ontario, Canada
| | - Lorraine Dales
- Department of Microbiology, Mt Sinai Hospital, Toronto, Ontario, Canada
| | - Liz McCreight
- Department of Microbiology, Mt Sinai Hospital, Toronto, Ontario, Canada
| | - Laura McNaught
- Department of Microbiology, Mt Sinai Hospital, Toronto, Ontario, Canada
| | - Christine Moore
- Department of Microbiology, Mt Sinai Hospital, Toronto, Ontario, Canada
| | - Kelsey Ragan
- Department of Microbiology, Mt Sinai Hospital, Toronto, Ontario, Canada
| | - Allison McGeer
- Department of Microbiology, Mt Sinai Hospital, Toronto, Ontario, Canada
- * E-mail: (PMS); (AM); (GB)
| | - George Broukhanski
- Public Health Ontario Laboratories, Toronto, Ontario, Canada
- * E-mail: (PMS); (AM); (GB)
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13
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Borghese MM, Borgundvaag E, McIsaac MA, Janssen I. Imputing accelerometer nonwear time in children influences estimates of sedentary time and its associations with cardiometabolic risk. Int J Behav Nutr Phys Act 2019; 16:7. [PMID: 30654817 PMCID: PMC6337764 DOI: 10.1186/s12966-019-0770-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 01/04/2019] [Indexed: 11/22/2022] Open
Abstract
Background A limitation of measuring sedentary time with an accelerometer is device removal. The resulting nonwear time is typically deleted from the data prior to calculating sedentary time. This could impact estimates of sedentary time and its associations with health indicators. We evaluated whether using multiple imputation to replace nonwear accelerometer epochs influences such estimates in children. Methods 452 children (50% male) aged 10–13 were tasked with wearing an accelerometer (15 s epochs) for 7 days. On average, 8% of waking time was classified as nonwear time. Sedentary time was derived from a “nonimputed” dataset using the typical approach of deleting epochs that occurred during nonwear time, as well as from an “imputed” dataset. In the imputed dataset, each nonwear epoch was re-classified as being as sedentary or not using multiple imputation (5 iterations) which was informed by the likelihood of a wear time epoch being classified as sedentary or not using parameter estimates from a logistic regression model. Estimates of sedentary time and associations between sedentary time and health indicators (cardiometabolic risk factor and internalizing mental health symptoms Z-scores) were compared between the nonimputed and imputed datasets. Results On average, sedentary time was 33 min/day higher in the imputed dataset than in the nonimputed dataset (632 vs. 599 min/day). The association between sedentary time and the cardiometabolic risk factor Z-score was stronger in the imputed vs. the nonimputed dataset (β = 0.137 vs. β = 0.092 per 60 min/day change, respectively). These findings were more pronounced among children who had < 7 days with ≥10 h of wear time. Conclusion Researchers should consider using multiple imputation to address accelerometer nonwear time, rather than deleting it, in order to derive more unbiased estimates of sedentary time and its associations with health indicators.
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Affiliation(s)
- M M Borghese
- School of Kinesiology and Health Studies, Queen's University, 28 Division St, Kingston, ON, Canada
| | - E Borgundvaag
- Department of Public Health Sciences, Queen's University, 99 University Avenue, Kingston, Ontario, Canada
| | - M A McIsaac
- Department of Public Health Sciences, Queen's University, 99 University Avenue, Kingston, Ontario, Canada
| | - I Janssen
- School of Kinesiology and Health Studies, Queen's University, 28 Division St, Kingston, ON, Canada.
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14
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Farooqi L, Faheem A, Armstrong I, Borgundvaag E, Coleman B, Green K, Jayasinghe K, Johnstone J, Katz K, Kohler P, Li A, Melano R, Muller M, Nayani S, Patel S, Paterson A, Poutanen S, Rebbapragada A, Richardson D, Sarabia A, Shafinaz S, Simor AE, Willey B, Wisely L, Zhong Z, McGeer A. 2165. Risk Factors for CPE Colonization in Household Contacts of CPE Colonized/Infected Patients. Open Forum Infect Dis 2018. [PMCID: PMC6253268 DOI: 10.1093/ofid/ofy210.1821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Carbapenemase-producing Enterobacteriaceae (CPE) are a global threat. Risk of transmission of CPE in households remains poorly understood Methods Population-based surveillance for CPE colonization/infection is conducted in Toronto/Peel Region, Canada. In households with ≥1 consenting household contact (HC), groin, rectal swabs and urine samples are submitted every 3 months for both IC and HC until the IC has three consecutive negative swab sets. Swabs/urines are incubated overnight in BHI, direct PCR for carbapenemase genes is performed; specimens positive for PCR are then cultured. Results Eighty-five households and 150 HC have been enrolled. Most common species/gene combinations in IC are: E. coli/NDM (33), E. coli/OXA48 (15), Klebsiella spp./NDM (11). HCs have a median of eight swabs (range 2–14). 12 (8%) HCs were colonized with CPE (median 1.5 pos samples, range 1–8). IC and HC had same gene in 11(92%) cases, and same species/gene in seven (58%) cases. NDM+OXA48 ICs were more likely to have CPE colonized HC, see table. CPE colonized HC were older, more likely to be the IC’s spouse (OR 32, 95% CI 4–260), and more likely to have travelled outside Canada (OR 9.7, 95% CI 1.2–78). Conclusion HC colonization with CPE is uncommon, but not rare, and may be associated with either household transmission, or co-exposure of HC and IC via travel. Spouses are most often colonized. Disclosures S. Poutanen, MERCK: Scientific Advisor, Speaker honorarium; COPAN: Speaker(but not part of a bureau), Travel reimbursement; Accelerate Diagnostics: Investigator, Research support; Bio-Rad: Investigator, Research support; bioMérieux: Investigator, Research support.
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Affiliation(s)
| | - Amna Faheem
- Infection Control, Mount Sinai Hospital, Toronto, ON, Canada
| | | | | | | | | | | | | | - Kevin Katz
- Department of Infection Control, North York General Hospital, Toronto, ON, Canada
| | - Philipp Kohler
- Toronto Invasive Bacterial Diseases Network, Toronto, ON, Canada
| | - Angel Li
- Mount Sinai Hospital, Toronto, ON, Canada
| | | | - Matthew Muller
- Infectious Diseases, St Michael’s Hospital, Toronto, ON, Canada
| | - Sarah Nayani
- Microbiology, Sinai Health System, Toronto, ON, Canada
| | | | | | | | | | | | | | | | - Andrew E Simor
- Microbiology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | | | - Zoe Zhong
- Sinai Health System, Toronto, ON, Canada
| | - Allison McGeer
- Infection Control, University of Toronto, Toronto, ON, Canada
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15
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Zhong Z, Faheem A, Farooqi L, Armstrong I, Borgundvaag E, Coleman B, Green K, Jayasinghe K, Johnstone J, Katz K, Kohler P, Li A, Melano R, Muller M, Nayani S, Patel S, Paterson A, Poutanen S, Rebbapragada A, Richardson D, Sarabia A, Shafinaz S, Simor AE, Willey B, Wisely L, Mcgeer A. 1205. Emergence of Carbapenemase Producing Enterobacteriaceae in South Central Ontario, Canada. Open Forum Infect Dis 2018. [PMCID: PMC6252420 DOI: 10.1093/ofid/ofy210.1038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background The spread of CPE is an increasing global threat to patient safety. We describe the introduction and evolution of CPE in south-central Ontario, Canada. Methods The Toronto Invasive Bacterial Diseases Network has performed population based surveillance for CPE in metropolitan Toronto and Peel region from first identified isolates in 2007. All laboratories test/refer all carbapenem non-susceptible Enterobacterial isolates for PCR testing for carbapenemases. Demographic and medical data and travel history are collected from chart review and patient/physician interview. Results Since 2007, 659 patients have been identified as colonized/infected with CPE; 362, 57%) have at least one clinical isolate. Annual incidence has increased from 0 in 2006 to 1.3 per 100,000 in 2016/17 (Figure 1). First bacteremia occurred in 2010, the incidence in 2017 was 0.14 per 100,000 population. 388 (59%) patients were male, median age was 70 years (range 3 months–100 years). Most common genes among first isolates were NDM (306, 46%), OX48 (149, 23%), KPC (122, 19%). Most common species were K. pneumoniae (268, 41%) and E. coli (259, 39%). Over time, second species/same gene were identified in 113 (16%) patients. In addition, 34/xxx patients with isolates with NDM and/or OXA-48 subsequently had a second isolate with a different gene/gene combination. Of 518 patients whose travel and hospitalization history are available, patients with VIM were less likely than other patients to have a foreign hospitalization or travel history (9/28 vs. 341/490, P < 0.0001). Patients with KPC were more likely to have a hospitalization history outside Canada and the Indian subcontinent (25/70, 36%), in Canada (47/164,29%) than to have no hospitalization in the last year (13/93, 14%), or a history of hospitalization in the Indian subcontinent (2/191, 1%) (P < 0.001). The number of incident patients with different hospitalization and travel history over time is shown in Figure 2. Conclusion CPE is increasingly recognized in southern Ontario, both in patients with a history of exposure in healthcare in other countries, and to healthcare in Canada. Intensification of control programs is urgently needed. Disclosures S. Poutanen, MERCK: Scientific Advisor, Speaker honorarium. COPAN: Speaker(but not part of a bureau), Travel reimbursement. Accelerate Diagnostics: Investigator, Research support. Bio-Rad: Investigator, Research support. bioMérieux: Investigator, Research support.
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Affiliation(s)
- Zoe Zhong
- Sinai Health System, Toronto, ON, Canada
| | - Amna Faheem
- Infection Control, Mount Sinai Hospital, Toronto, ON, Canada
| | | | | | | | | | | | | | | | - Kevin Katz
- Department of Infection Control, North York General Hospital, Toronto, ON, Canada
| | - Philipp Kohler
- Toronto Invasive Bacterial Diseases Network, Toronto, ON, Canada
| | - Angel Li
- Mount Sinai Hospital, Toronto, ON, Canada
| | | | - Matthew Muller
- Infectious Diseases, St Michael’s Hospital, Toronto, ON, Canada
| | - Sarah Nayani
- Microbiology, Sinai Heatlh System, Toronto, ON, Canada
| | | | | | | | | | | | | | | | - Andrew E Simor
- Microbiology, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | | | - Allison Mcgeer
- Infection Control, Sinai Health System, Toronto, ON, Canada
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Borgundvaag E, Faheem A, Shafinaz S, Armstrong I, Coleman B, Green K, Jayasinghe K, Johnstone J, Katz K, Kohler P, Mcgeer A, Melano R, Muller M, Patel S, Poutanen S, Rebbapragada A, Richardson D, Sarabia A, Simor AE, Willey B, Wisely L. Sensitivity of Different Anatomic Sites for Detection and Duration of Colonization with Carbapenemase-Producing Enterobacteriaceae (CPE). Open Forum Infect Dis 2017. [DOI: 10.1093/ofid/ofx163.212] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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17
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Matic N, Marchand-Austin A, Borgundvaag E, Mcgeer A, Patel S. Carbapenemase Gene Transfer among Canadian Patients Colonized or Infected with Carbapenemase-Producing Enterobacteriaceae. Open Forum Infect Dis 2017. [DOI: 10.1093/ofid/ofx163.206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Nancy Matic
- Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON, Canada
| | | | - Emily Borgundvaag
- Toronto Invasive Bacterial Diseases Network, Toronto, ON, Canada
- Infection Prevention and Control, Mount Sinai Health System, Toronto, ON, Canada
| | - Allison Mcgeer
- Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON, Canada
- Toronto Invasive Bacterial Diseases Network, Toronto, ON, Canada
- Infection Prevention and Control, Mount Sinai Health System, Toronto, ON, Canada
| | - Samir Patel
- Laboratory Medicine & Pathobiology, University of Toronto, Toronto, ON, Canada
- Public Health Ontario Laboratory, Toronto, ON, Canada
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Goodliffe L, Ragan K, Larocque M, Borgundvaag E, Khan S, Moore C, McCreight L, Coleman BL, McGeer AJ. Rate of healthcare worker-patient interaction and hand hygiene opportunities in an acute care setting. Infect Control Hosp Epidemiol 2014; 35:225-30. [PMID: 24521585 DOI: 10.1086/675286] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Identify factors affecting the rate of hand hygiene opportunities in an acute care hospital. DESIGN Prospective observational study. SETTING Medical and surgical in-patient units, medical-surgical intensive care unit (MSICU), neonatal intensive care unit (NICU), and emergency department (ED) of an academic acute care hospital from May to August, 2012. PARTICIPANTS Healthcare workers. METHODS One-hour patient-based observations measured patient interactions and hand hygiene opportunities as defined by the "Four Moments for Hand Hygiene." Rates of patient interactions and hand hygiene opportunities per patient-hour were calculated, examining variation by room type, healthcare worker type, and time of day. RESULTS During 257 hours of observation, 948 healthcare worker-patient interactions and 1,605 hand hygiene opportunities were identified. Moments 1, 2, 3, and 4 comprised 42%, 10%, 9%, and 39% of hand hygiene opportunities. Nurses contributed 77% of opportunities, physicians contributed 8%, other healthcare workers contributed 11%, and housekeeping contributed 4%. The mean rate of hand hygiene opportunities per patient-hour was 4.2 for surgical units, 4.5 for medical units, 5.2 for ED, 10.4 for NICU, and 13.2 for MSICU (P < .001). In non-ICU settings, rates of hand hygiene opportunities decreased over the course of the day. Patients with transmission-based precautions had approximately half as many interactions (rate ratio [RR], 0.55 [95% confidence interval (CI), 0.37-0.80]) and hand hygiene opportunities per hour (RR, 0.47 [95% CI, 0.29-0.77]) as did patients without precautions. CONCLUSIONS Measuring hand hygiene opportunities across clinical settings lays the groundwork for product use-based hand hygiene measurement. Additional work is needed to assess factors affecting rates in other hospitals and health care settings.
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Affiliation(s)
- Laura Goodliffe
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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