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Batista R, Hsu AT, Bouchard L, Reaume M, Rhodes E, Sucha E, Guerin E, Prud'homme D, Manuel DG, Tanuseputro P. Ascertaining the Francophone population in Ontario: validating the language variable in health data. BMC Med Res Methodol 2024; 24:98. [PMID: 38678174 DOI: 10.1186/s12874-024-02220-7] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 04/15/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Language barriers can impact health care and outcomes. Valid and reliable language data is central to studying health inequalities in linguistic minorities. In Canada, language variables are available in administrative health databases; however, the validity of these variables has not been studied. This study assessed concordance between language variables from administrative health databases and language variables from the Canadian Community Health Survey (CCHS) to identify Francophones in Ontario. METHODS An Ontario combined sample of CCHS cycles from 2000 to 2012 (from participants who consented to link their data) was individually linked to three administrative databases (home care, long-term care [LTC], and mental health admissions). In total, 27,111 respondents had at least one encounter in one of the three databases. Language spoken at home (LOSH) and first official language spoken (FOLS) from CCHS were used as reference standards to assess their concordance with the language variables in administrative health databases, using the Cohen kappa, sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPV). RESULTS Language variables from home care and LTC databases had the highest agreement with LOSH (kappa = 0.76 [95%CI, 0.735-0.793] and 0.75 [95%CI, 0.70-0.80], respectively) and FOLS (kappa = 0.66 for both). Sensitivity was higher with LOSH as the reference standard (75.5% [95%CI, 71.6-79.0] and 74.2% [95%CI, 67.3-80.1] for home care and LTC, respectively). With FOLS as the reference standard, the language variables in both data sources had modest sensitivity (53.1% [95%CI, 49.8-56.4] and 54.1% [95%CI, 48.3-59.7] in home care and LTC, respectively) but very high specificity (99.8% [95%CI, 99.7-99.9] and 99.6% [95%CI, 99.4-99.8]) and predictive values. The language variable from mental health admissions had poor agreement with all language variables in the CCHS. CONCLUSIONS Language variables in home care and LTC health databases were most consistent with the language often spoken at home. Studies using language variables from administrative data can use the sensitivity and specificity reported from this study to gauge the level of mis-ascertainment error and the resulting bias.
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Affiliation(s)
- Ricardo Batista
- Institut du Savoir Montfort, Ottawa, ON, Canada.
- ICES uOttawa, Ottawa, ON, Canada.
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
- Institut du Savoir Montfort, ICES and Ottawa Hospital Research Institute, 1053 Carling Ave Box 693, 2-006 Admin Services Building, Ottawa, ON, K1Y 4E9, Canada.
| | - Amy T Hsu
- ICES uOttawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Elizabeth Bruyère Research Institute, Ottawa, ON, Canada
| | - Louise Bouchard
- Institut du Savoir Montfort, Ottawa, ON, Canada
- School of Social and Anthropological Studies, University of Ottawa, Ottawa, ON, Canada
| | | | - Emily Rhodes
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | - Eva Guerin
- Institut du Savoir Montfort, Ottawa, ON, Canada
| | - Denis Prud'homme
- Institut du Savoir Montfort, Ottawa, ON, Canada
- Université de Moncton, Moncton, New Brunswick, Canada
| | - Douglas G Manuel
- ICES uOttawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Statistics Canada, Ottawa, ON, Canada
| | - Peter Tanuseputro
- ICES uOttawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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Zur G, Charbonnier G, Fageeh A, Diouf A, Brun-Vergara ML, Lesiuk H, Drake B, Santos M, Mikhael N, Budiansky D, Rhodes E, Fahed R, Mendes Pereira V. Stent-assisted Woven EndoBridge embolization for the treatment of pulsatile tinnitus caused by an ipsilateral high-riding jugular bulb. Interv Neuroradiol 2024:15910199241245156. [PMID: 38576332 DOI: 10.1177/15910199241245156] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024] Open
Abstract
PURPOSE Pulsatile tinnitus can be caused by a high-riding jugular bulb (HRJB), characterized by the superior position of the jugular bulb in the petrous temporal bone. The anatomical position and morphology of this entity make it challenging for endovascular treatment. We report our experience with two patients successfully treated with a stent-assisted Woven EndoBridge (WEB; Microvention, Tustin, CA, USA) device. MATERIALS AND METHODS We describe two cases of HRJB in patients presenting with disabling pulsatile tinnitus. Temporary balloon occlusion of the jugular bulb prior to the intervention reduced tinnitus intensity. Both patients were subsequently treated under general anesthesia with the WEB device deployed in the HRJB which was held by a stent deployed in the sigmoid sinus. RESULTS Both procedures were successful with good positioning of the WEB device and no procedural complications. Both patients had complete resolution of pulsatile tinnitus immediately after the procedure. Follow-up imaging showed successful occlusion of the venous cavity with a widely patent stent. CONCLUSION Among patients with pulsatile tinnitus caused by an ipsilateral HRJB, a stent-assisted WEB device seems to be a viable endovascular option with angiographic and clinical success.
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Affiliation(s)
- Gil Zur
- Interventional Neuroradiology, The Ottawa Hospital-Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - Guillaume Charbonnier
- Division of Neurosurgery, Department of Surgery, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Areej Fageeh
- Interventional Neuroradiology, The Ottawa Hospital-Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - Ange Diouf
- Interventional Neuroradiology, The Ottawa Hospital-Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - Maria Lucia Brun-Vergara
- Interventional Neuroradiology, The Ottawa Hospital-Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - Howard Lesiuk
- Interventional Neuroradiology, The Ottawa Hospital-Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
- Division of Neurosurgery, Department of Surgery, The Ottawa Hospital-Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - Brian Drake
- Interventional Neuroradiology, The Ottawa Hospital-Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
- Division of Neurosurgery, Department of Surgery, The Ottawa Hospital-Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - Marlise Santos
- Interventional Neuroradiology, The Ottawa Hospital-Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - Nicole Mikhael
- Interventional Neuroradiology, The Ottawa Hospital-Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
- Division of Neurosurgery, Department of Surgery, The Ottawa Hospital-Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - Dan Budiansky
- Interventional Neuroradiology, The Ottawa Hospital-Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
- Division of Neurosurgery, Department of Surgery, The Ottawa Hospital-Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - Emily Rhodes
- Interventional Neuroradiology, The Ottawa Hospital-Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
- Division of Neurology, Department of Medicine, The Ottawa Hospital-Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - Robert Fahed
- Interventional Neuroradiology, The Ottawa Hospital-Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
- Division of Neurology, Department of Medicine, The Ottawa Hospital-Ottawa Hospital Research Institute and University of Ottawa, Ottawa, Ontario, Canada
| | - Vitor Mendes Pereira
- Division of Neurosurgery, Department of Surgery, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
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Li W, Qureshi D, Rhodes E, Imsirovic H, Isenberg SR, Tanuseputro P. Place of Death and Place of Care at the End of Life: Are They Correlated? A Retrospective Cohort Study of Ontario Decedents. J Palliat Med 2024; 27:224-230. [PMID: 37967408 DOI: 10.1089/jpm.2023.0167] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023] Open
Abstract
Background: Dying in nonpalliative acute care is generally considered inappropriate and avoidable. Place of death, a commonly reported big-dot indicator of end-of-life care quality, is often used as a proxy for place of care despite no empirical evidence for their correlations. Thus, we examined the correlations between place of death and place of care in the last month of life. We also investigated anecdotal claims that individuals cared in acute care often get discharged to die at home, and vice versa. Methods: We conducted a retrospective cohort study of Ontario decedents (18+) who died between January 1, 2015 and December 31, 2017. We identified individuals who died in nonpalliative acute care, palliative care unit, subacute care, long-term care (LTC), and the community. We calculated the number of days decedents spent in each setting in their last month of life, and used descriptive analyses to investigate their correlations. Results: Decedent's place of death generally correlated with their place of care in the last month of life-individuals who died in a particular setting spent more time in that setting than individuals who died elsewhere. Furthermore, 75.0% of individuals who spent more than two weeks of their last month in acute care died in acute care. Among individuals who died in the community and in LTC, 65.4% and 75.0%, respectively, spent zero days in acute care. Interpretation: We showed that place of death can be a useful high-level performance indicator, by itself and as a proxy for place of care, to gauge end-of-life quality and service provision/implementation.
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Affiliation(s)
- Wenshan Li
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Danial Qureshi
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Emily Rhodes
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Haris Imsirovic
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- ICES uOttawa, Ottawa, Ontario, Canada
| | - Sarina R Isenberg
- Bruyère Research Institute, Ottawa, Ontario, Canada
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Peter Tanuseputro
- Bruyère Research Institute, Ottawa, Ontario, Canada
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Vinao-Carl M, Gal-Shohet Y, Rhodes E, Li J, Hampshire A, Sharp D, Grossman N. Just a phase? Causal probing reveals spurious phasic dependence of sustained attention. Neuroimage 2024; 285:120477. [PMID: 38072338 DOI: 10.1016/j.neuroimage.2023.120477] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/14/2023] [Accepted: 11/26/2023] [Indexed: 12/26/2023] Open
Abstract
For over a decade, electrophysiological studies have reported correlations between attention / perception and the phase of spontaneous brain oscillations. To date, these findings have been interpreted as evidence that the brain uses neural oscillations to sample and predict upcoming stimuli. Yet, evidence from simulations have shown that analysis artefacts could also lead to spurious pre-stimulus oscillations that appear to predict future brain responses. To address this discrepancy, we conducted an experiment in which visual stimuli were presented in time to specific phases of spontaneous alpha and theta oscillations. This allowed us to causally probe the role of ongoing neural activity in visual processing independent of the stimulus-evoked dynamics. Our findings did not support a causal link between spontaneous alpha / theta rhythms and behaviour. However, spurious correlations between theta phase and behaviour emerged offline using gold-standard time-frequency analyses. These findings are a reminder that care should be taken when inferring causal relationships between neural activity and behaviour using acausal analysis methods.
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Affiliation(s)
- M Vinao-Carl
- Department of Brain Sciences, Imperial College London, London, UK; UK Dementia Research Institute, (UK DRI), Imperial College London, London, UK.
| | - Y Gal-Shohet
- Department of Medical Physics and Engineering, University College London, London, UK
| | - E Rhodes
- Department of Brain Sciences, Imperial College London, London, UK; UK Dementia Research Institute, (UK DRI), Imperial College London, London, UK
| | - J Li
- Department of Brain Sciences, Imperial College London, London, UK; UK Dementia Research Institute, (UK DRI), Imperial College London, London, UK
| | - A Hampshire
- Department of Brain Sciences, Imperial College London, London, UK
| | - D Sharp
- Department of Brain Sciences, Imperial College London, London, UK; UK Dementia Research Institute, (UK DRI), Imperial College London, London, UK; UK Dementia Research Institute, Care Research and Technology Centre (UK DRI-CRT), Imperial College London, London, UK
| | - N Grossman
- Department of Brain Sciences, Imperial College London, London, UK; UK Dementia Research Institute, (UK DRI), Imperial College London, London, UK.
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5
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Batista R, Reaume M, Roberts R, Seale E, Rhodes E, Sucha E, Pugliese M, Kendall CE, Bjerre LM, Bouchard L, Prud'homme D, Manuel DG, Tanuseputro P. Prevalence and patterns of multimorbidity among linguistic groups of patients receiving home care in Ontario: a retrospective cohort study. BMC Geriatr 2023; 23:725. [PMID: 37946126 PMCID: PMC10634019 DOI: 10.1186/s12877-023-04267-5] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 08/30/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Prior studies have demonstrated the negative impact of language barriers on access, quality, and safety of healthcare, which can lead to health disparities in linguistic minorities. As the population ages, those with multiple chronic diseases will require increasing levels of home care and long-term services. This study described the levels of multimorbidity among recipients of home care in Ontario, Canada by linguistic group. METHODS Population-based retrospective cohort of 510,685 adults receiving home care between April 1, 2010, to March 31, 2018, in Ontario, Canada. We estimated and compared prevalence and characteristics of multimorbidity (2 or more chronic diseases) across linguistic groups (Francophones, Anglophones, Allophones). The most common combinations and clustering of chronic diseases were examined. Logistic regression models were used to explore the main predictors of 'severe' multimorbidity (defined as the presence of five or more chronic diseases). RESULTS The proportion of home care recipients with multimorbidity and severe multimorbidity was 92% and 44%, respectively. The prevalence of multimorbidity was slightly higher among Allophones (93.6%) than among Anglophones (91.8%) and Francophones (92.4%). However, Francophones had higher rates of cardiovascular and respiratory disease (64.9%) when compared to Anglophones (60.2%) and Allophones (61.5%), while Anglophones had higher rates of cancer (34.2%) when compared to Francophones (25.2%) and Allophones (24.3%). Relative to Anglophones, Allophones were more likely to have severe multimorbidity (adjusted OR = 1.04, [95% CI: 1.02-1.06]). CONCLUSIONS The prevalence of multimorbidity among Ontarians receiving home care services is high; especially for whose primary language is a language other than English or French (i.e., Allophones). Understanding differences in the prevalence and characteristics of multimorbidity across linguistic groups will help tailor healthcare services to the unique needs of patients living in minority linguistic situations.
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Affiliation(s)
- Ricardo Batista
- Institut du Savoir Montfort, Hôpital Montfort, 202-745A Ch. Montréal Road, Ottawa, ON, K1K 0T1, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Michael Reaume
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | | | - Emily Seale
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Emily Rhodes
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | | | - Claire E Kendall
- Institut du Savoir Montfort, Hôpital Montfort, 202-745A Ch. Montréal Road, Ottawa, ON, K1K 0T1, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Lise M Bjerre
- Institut du Savoir Montfort, Hôpital Montfort, 202-745A Ch. Montréal Road, Ottawa, ON, K1K 0T1, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Louise Bouchard
- Institut du Savoir Montfort, Hôpital Montfort, 202-745A Ch. Montréal Road, Ottawa, ON, K1K 0T1, Canada
- School of Social and Anthropological Studies, University of Ottawa, Ottawa, ON, Canada
| | - Denis Prud'homme
- Institut du Savoir Montfort, Hôpital Montfort, 202-745A Ch. Montréal Road, Ottawa, ON, K1K 0T1, Canada
- Université de Moncton, Nouveau-Brunswick, Canada
| | - Douglas G Manuel
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Peter Tanuseputro
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.
- ICES uOttawa, Ottawa, ON, Canada.
- Bruyère Research Institute, Ottawa, ON, Canada.
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
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Wulczyn F, Zhou X, McClanahan J, Huhr S, Hislop K, Moore F, Rhodes E. Race, Poverty, and Foster Care Placement in the United States: Longitudinal and Cross-Sectional Perspectives. Int J Environ Res Public Health 2023; 20:6572. [PMID: 37623160 PMCID: PMC10454367 DOI: 10.3390/ijerph20166572] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/08/2023] [Accepted: 08/08/2023] [Indexed: 08/26/2023]
Abstract
Although the connections between race, poverty, and foster care placement seem obvious, the link has not in fact been studied extensively. To address this gap, we view poverty and placement through longitudinal and cross-sectional lenses to more accurately capture how changes in poverty rates relate to changes in placement frequency. The longitudinal study examines the relationship between poverty rate changes and changes in the placement of Black and White children between 2000 and 2015. The cross-sectional study extends the longitudinal analysis by using a richer measure of socio-ecological diversity and more recent foster care data. Using Poisson regression models, we assess the extent to which changes in race-differentiated child poverty rates are correlated with Black and White child placement frequencies and placement disparities. Regardless of whether one looks longitudinally or cross-sectionally, we find that Black children are placed in foster care more often than White children. Higher White child poverty rates are associated with substantially reduced placement differences; however, higher Black child poverty rates are associated with relatively small changes in placement disparity. Black and White child placement rates are more similar in counties with the fewest socio-ecological assets.
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Affiliation(s)
- Fred Wulczyn
- Center for State Child Welfare Data, Chapin Hall Center for Children, University of Chicago, Chicago, IL 60637, USA; (J.M.); (S.H.); (K.H.); (F.M.)
| | - Xiaomeng Zhou
- Center for State Child Welfare Data, Chapin Hall Center for Children, University of Chicago, Chicago, IL 60637, USA; (J.M.); (S.H.); (K.H.); (F.M.)
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Madken M, Mallick R, Rhodes E, Mahdavi R, Bader Eddeen A, Hundemer GL, Kelly DM, Karaboyas A, Robinson B, Bieber B, Molnar AO, Badve SV, Tanuseputro P, Knoll G, Sood MM. Development and Validation of a Predictive Risk Algorithm for Bleeding in Individuals on Long-term Hemodialysis: An International Prospective Cohort Study (BLEED-HD). Can J Kidney Health Dis 2023; 10:20543581231169610. [PMID: 37377481 PMCID: PMC10291537 DOI: 10.1177/20543581231169610] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 03/13/2023] [Indexed: 06/29/2023] Open
Abstract
Background Individuals with kidney disease are at a high risk of bleeding and as such tools that identify those at highest risk may aid mitigation strategies. Objective We set out to develop and validate a prediction equation (BLEED-HD) to identify patients on maintenance hemodialysis at high risk of bleeding. Design International prospective cohort study (development); retrospective cohort study (validation). Settings Development: 15 countries (Dialysis Outcomes and Practice Patterns Study [DOPPS] phase 2-6 from 2002 to 2018); Validation: Ontario, Canada. Patients Development: 53 147 patients; Validation: 19 318 patients. Measurements Hospitalization for a bleeding event. Methods Cox proportional hazards models. Results Among the DOPPS cohort (mean age, 63.7 years; female, 39.7%), a bleeding event occurred in 2773 patients (5.2%, event rate 32 per 1000 person-years), with a median follow-up of 1.6 (interquartile range [IQR], 0.9-2.1) years. BLEED-HD included 6 variables: age, sex, country, previous gastrointestinal bleeding, prosthetic heart valve, and vitamin K antagonist use. The observed 3-year probability of bleeding by deciles of risk ranged from 2.2% to 10.8%. Model discrimination was low to moderate (c-statistic = 0.65) with excellent calibration (Brier score range = 0.036-0.095). Discrimination and calibration of BLEED-HD were similar in an external validation of 19 318 patients from Ontario, Canada. Compared to existing bleeding scores, BLEED-HD demonstrated better discrimination and calibration (c-statistic: HEMORRHAGE = 0.59, HAS-BLED = 0.59, and ATRIA = 0.57, c-stat difference, net reclassification index [NRI], and integrated discrimination index [IDI] all P value <.0001). Limitations Dialysis procedure anticoagulation was not available; validation cohort was considerably older than the development cohort. Conclusion In patients on maintenance hemodialysis, BLEED-HD is a simple risk equation that may be more applicable than existing risk tools in predicting the risk of bleeding in this high-risk population.
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Affiliation(s)
- Mohit Madken
- Department of Medicine, The Ottawa Hospital, ON, Canada
| | | | - Emily Rhodes
- Ottawa Hospital Research Institute, The Ottawa Hospital, ON, Canada
| | | | | | - Gregory L. Hundemer
- Department of Medicine, The Ottawa Hospital, ON, Canada
- Ottawa Hospital Research Institute, The Ottawa Hospital, ON, Canada
| | - Dearbhla M. Kelly
- Department of Nephrology, St. James Hospital, Dublin, Ireland
- Global Brain Health Institute, Trinity College Institute of Neuroscience, Trinity College Dublin, Ireland
| | | | - Bruce Robinson
- Department of Internal Medicine, University of Michigan, Ann Arbor, USA
| | - Brian Bieber
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | - Amber O. Molnar
- ICES, Toronto, ON, Canada
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Sunil V. Badve
- Department of Renal Medicine, St. George Hospital, Sydney, NSW, Australia
- Renal and Metabolic Division, The George Institute for Global Health, Sydney, NSW, Australia
- UNSW Medicine and Health, Sydney, NSW, Australia
| | | | - Gregory Knoll
- Department of Medicine, The Ottawa Hospital, ON, Canada
- Ottawa Hospital Research Institute, The Ottawa Hospital, ON, Canada
- ICES, Toronto, ON, Canada
| | - Manish M. Sood
- Department of Medicine, The Ottawa Hospital, ON, Canada
- Ottawa Hospital Research Institute, The Ottawa Hospital, ON, Canada
- ICES, Toronto, ON, Canada
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8
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Farfan Ruiz AC, Malick R, Rhodes E, Clark E, Hundemer G, Karaboyas A, Robinson B, Pecoits R, Sood MM. Adverse Gastrointestinal Events With Sodium Polystyrene Sulfonate Use in Patients on Maintenance Hemodialysis: An International Cohort Study. Can J Kidney Health Dis 2023; 10:20543581231172405. [PMID: 37359984 PMCID: PMC10288443 DOI: 10.1177/20543581231172405] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 03/19/2023] [Indexed: 06/28/2023] Open
Abstract
Background There are concerns regarding the gastrointestinal (GI) safety of sodium polystyrene sulfonate (SPS), a medication commonly used in the management of hyperkalemia. Objective To compare the risk of GI adverse events among users versus non-users of SPS in patients on maintenance hemodialysis. Design International prospective cohort study. Setting Seventeen countries (Dialysis Outcomes and Practice Patterns Study [DOPPS] phase 2-6 from 2002 to 2018). Patients 50 147 adults on maintenance hemodialysis. Measurements An adverse GI event defined by a GI hospitalization or GI fatality with SPS prescription compared with no SPS prescription. Methods Overlap propensity score-weighted Cox models. Results Sodium polystyrene sulfonate prescription was present in 13.4% of patients and ranged from 0.42% (Turkey) to 20.6% (Sweden) with 12.5% use in Canada. A total of 935 (1.9%) adverse GI events (140 [2.1%] with SPS, 795 [1.9%] with no SPS; absolute risk difference 0.2%) occurred. The weighted hazard ratio (HR) of a GI event was not elevated with SPS use compared with non-use (HR = 0.93, 95% confidence interval = 0.83-1.6). The results were consistent when examining fatal GI events and/or GI hospitalization separately. Limitations Sodium polystyrene sulfonate dose and duration were unknown. Conclusions Sodium polystyrene sulfonate use in patients on hemodialysis was not associated with a higher risk of an adverse GI event. Our findings suggest that SPS use is safe in an international cohort of maintenance hemodialysis patients.
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Affiliation(s)
- Ana Cecilia Farfan Ruiz
- Division of Nephrology, Department of Medicine, Ottawa Hospital Research Institute, The Ottawa Hospital, University of Ottawa, ON, Canada
| | - Ranjeeta Malick
- Division of Nephrology, Department of Medicine, Ottawa Hospital Research Institute, The Ottawa Hospital, University of Ottawa, ON, Canada
| | - Emily Rhodes
- Division of Nephrology, Department of Medicine, Ottawa Hospital Research Institute, The Ottawa Hospital, University of Ottawa, ON, Canada
- Institute for Clinical Evaluative Sciences, Ottawa, ON, Canada
| | - Edward Clark
- Division of Nephrology, Department of Medicine, Ottawa Hospital Research Institute, The Ottawa Hospital, University of Ottawa, ON, Canada
| | - Greg Hundemer
- Division of Nephrology, Department of Medicine, Ottawa Hospital Research Institute, The Ottawa Hospital, University of Ottawa, ON, Canada
| | | | | | | | - Manish M. Sood
- Division of Nephrology, Department of Medicine, Ottawa Hospital Research Institute, The Ottawa Hospital, University of Ottawa, ON, Canada
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9
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Martin M, Goethals P, Newhart K, Rhodes E, Vogel J, Stevenson B. Optimization of sewage sampling for wastewater-based epidemiology through stochastic modeling. J. Eng. Appl. Sci. 2023; 70:11. [PMCID: PMC9930068 DOI: 10.1186/s44147-023-00180-1] [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] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
The proliferation of the SARS-CoV-2 global pandemic has brought to attention the need for epidemiological tools that can detect diseases in specific geographical areas through non-contact means. Such methods may protect those potentially infected by facilitating early quarantine policies to prevent the spread of the disease. Sampling of municipal wastewater has been studied as a plausible solution to detect pathogen spread, even from asymptomatic patients. However, many challenges exist in wastewater-based epidemiology such as identifying a representative sample for a population, determining the appropriate sample size, and establishing the right time and place for samples. In this work, a new approach to address these questions is assessed using stochastic modeling to represent wastewater sampling given a particular community of interest. Using estimates for various process parameters, inferences on the population infected are generated with Monte Carlo simulation output. A case study at the University of Oklahoma is examined to calibrate and evaluate the model output. Finally, extensions are provided for more efficient wastewater sampling campaigns in the future. This research provides greater insight into the effects of viral load, the percentage of the population infected, and sampling time on mean SARS-CoV-2 concentration through simulation. In doing so, an earlier warning of infection for a given population may be obtained and aid in reducing the spread of viruses.
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Affiliation(s)
- Max Martin
- grid.419884.80000 0001 2287 2270United States Corps of Cadets, United States Military Academy, West Point, New York, USA
| | - Paul Goethals
- grid.419884.80000 0001 2287 2270Department of Mathematical Sciences, United States Military Academy, West Point, New York, USA
| | - Kathryn Newhart
- grid.419884.80000 0001 2287 2270Department of Geography & Environmental Engineering, United States Military Academy, West Point, New York, USA
| | - Emily Rhodes
- grid.266900.b0000 0004 0447 0018School of Civil Engineering and Environmental Science, University of Oklahoma, Norman, Oklahoma, USA
| | - Jason Vogel
- grid.266900.b0000 0004 0447 0018School of Civil Engineering and Environmental Science, University of Oklahoma, Norman, Oklahoma, USA
| | - Bradley Stevenson
- grid.266900.b0000 0004 0447 0018Microbiology and Plant Biology, University of Oklahoma, Norman, Oklahoma, USA
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10
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Noel AJ, Eddeen AB, Manuel DG, Rhodes E, Tangri N, Hundemer GL, Tanuseputro P, Knoll GA, Mallick R, Sood MM. A Health Survey-Based Prediction Equation for Incident CKD. Clin J Am Soc Nephrol 2023; 18:28-35. [PMID: 36720027 PMCID: PMC10101574 DOI: 10.2215/cjn.0000000000000035] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 10/17/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND Prediction tools that incorporate self-reported health information could increase CKD awareness, identify modifiable lifestyle risk factors, and prevent disease. We developed and validated a survey-based prediction equation to identify individuals at risk for incident CKD (eGFR <60 ml/min per 1.73 m2), with and without a baseline eGFR. METHODS A cohort of adults with an eGFR ≥70 ml/min per 1.73 m2 from Ontario, Canada, who completed a comprehensive general population health survey between 2000 and 2015 were included (n=22,200). Prediction equations included demographics (age, sex), comorbidities, lifestyle factors, diet, and mood. Models with and without baseline eGFR were derived and externally validated in the UK Biobank (n=15,522). New-onset CKD (eGFR <60 ml/min per 1.73 m2) with ≤8 years of follow-up was the primary outcome. RESULTS Among Ontario individuals (mean age, 55 years; 58% women; baseline eGFR, 95 (SD 15) ml/min per 1.73 m2), new-onset CKD occurred in 1981 (9%) during a median follow-up time of 4.2 years. The final models included lifestyle factors (smoking, alcohol, physical activity) and comorbid illnesses (diabetes, hypertension, cancer). The model was discriminating in individuals with and without a baseline eGFR measure (5-year c-statistic with baseline eGFR: 83.5, 95% confidence interval [CI], 82.2 to 84.9; without: 81.0, 95% CI, 79.8 to 82.4) and well calibrated. In external validation, the 5-year c-statistic was 78.1 (95% CI, 74.2 to 82.0) and 66.0 (95% CI, 61.6 to 70.4), with and without baseline eGFR, respectively, and maintained calibration. CONCLUSIONS Self-reported lifestyle and health behavior information from health surveys may aid in predicting incident CKD. PODCAST This article contains a podcast at https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast.aspx?p=CJASN&e=2023_01_10_CJN05650522.mp3.
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Affiliation(s)
- Ariana J. Noel
- Department of Medicine, University of Ottawa, Ottawa, Canada
| | | | - Douglas G. Manuel
- Institute for Clinical Evaluative Sciences, Ontario, Canada
- The Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Canada
- Statistics Canada, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Emily Rhodes
- The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Navdeep Tangri
- Division of Nephrology, Seven Oaks Hospital, Winnipeg, Canada
| | - Gregory L. Hundemer
- Department of Medicine, University of Ottawa, Ottawa, Canada
- The Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- Division of Nephrology, the Ottawa Hospital, Ottawa, Canada
| | - Peter Tanuseputro
- Institute for Clinical Evaluative Sciences, Ontario, Canada
- The Ottawa Hospital Research Institute, Ottawa, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Gregory A. Knoll
- Department of Medicine, University of Ottawa, Ottawa, Canada
- Institute for Clinical Evaluative Sciences, Ontario, Canada
- The Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- Division of Nephrology, the Ottawa Hospital, Ottawa, Canada
| | | | - Manish M. Sood
- Department of Medicine, University of Ottawa, Ottawa, Canada
- The Ottawa Hospital Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- Division of Nephrology, the Ottawa Hospital, Ottawa, Canada
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11
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Sood MM, Rhodes E, Talarico R, Gérin-Lajoie C, Simon C, Spilg E, McFadden T, Kyeeremanteng K, T Myran D, Grubic N, Tanuseputro P. Suicide and Self-Harm Among Physicians in Ontario, Canada. Can J Psychiatry 2022; 67:778-786. [PMID: 35548955 PMCID: PMC9510996 DOI: 10.1177/07067437221099774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Studies of occupation-associated suicide suggest physicians may be at a higher risk of suicide compared to nonphysicians. We set out to assess the risk of suicide and self-harm among physicians and compare it to nonphysicians. METHODS We conducted a population-based, retrospective cohort study using registration data from the College of Physicians and Surgeons of Ontario from 1990 to 2016 with a follow-up to 2017, linked to Ontario health administrative databases. Using age- and sex-standardized rates and inverse probability-weighted, cause-specific hazards regression models, we compared rates of suicide, self-harm, and a composite of either event among all newly registered physicians to nonphysician controls. RESULTS Among 35,989 physicians and 6,585,197 nonphysicians, unadjusted suicide events (0.07% vs. 0.11%) and rates (9.44 vs. 11.55 per 100,000 person-years) were similar. Weighted analyses found a hazard ratio of 1.05 (95% confidence interval: 0.69 to 1.60). Self-harm requiring health care was lower among physicians (0.22% vs. 0.46%; hazard ratio: 0.65, 95% confidence interval: 0.52 to 0.82), as was the composite of suicide or self-harm (hazard ratio: 0.70, 95% confidence interval: 0.57 to 0.86). The composite of suicide or self-harm was associated with a history of a mood or anxiety disorder (odds ratio: 2.84, 95% confidence interval: 1.17 to 6.87), an outpatient mental health visit in the past year (odds ratio: 3.08, 95% confidence interval: 1.34 to 7.10) and psychiatry visit in the preceding year (odds ratio: 3.87, 95% confidence interval: 1.67 to 8.95). INTERPRETATION Physicians in Ontario are at a similar risk of suicide deaths and a lower risk of self-harm requiring health care relative to nonphysicians. Risk factors associated with suicide or self-harm may help inform prevention programs.
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Affiliation(s)
- Manish M Sood
- Department of Medicine, University of Ottawa, Ottawa, Canada.,Division of Nephrology, Department of Medicine, the Ottawa Hospital, Ottawa, Canada
| | - Emily Rhodes
- 10055The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Robert Talarico
- Institute for Clinical Evaluative Sciences, Ontario, Canada.,10055The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Caroline Gérin-Lajoie
- 27389Canadian Medical Association, Physician Wellness and Medical Culture Team, Ottawa, Canada
| | - Christopher Simon
- 27389Canadian Medical Association, Physician Wellness and Medical Culture Team, Ottawa, Canada
| | - Edward Spilg
- Department of Medicine, University of Ottawa, Ottawa, Canada.,10055The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Taylor McFadden
- 27389Canadian Medical Association, Physician Wellness and Medical Culture Team, Ottawa, Canada
| | - Kwadwo Kyeeremanteng
- Department of Medicine, University of Ottawa, Ottawa, Canada.,10055The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Daniel T Myran
- Institute for Clinical Evaluative Sciences, Ontario, Canada.,10055The Ottawa Hospital Research Institute, Ottawa, Canada.,Department of Family Medicine, University of Ottawa, Ottawa, Canada
| | - Nicholas Grubic
- Institute for Clinical Evaluative Sciences, Ontario, Canada.,10055The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Peter Tanuseputro
- Department of Medicine, University of Ottawa, Ottawa, Canada.,10055The Ottawa Hospital Research Institute, Ottawa, Canada
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12
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Rhodes E, Kendall C, Talarico R, Muggah E, Gerin-Lajoie C, Simon C, McFadden T, Myran D, Sood MM, Tanuseputro P. Primary Care Physician Use and Frequency of Visits Among Physicians in Ontario, Canada. JAMA Netw Open 2022; 5:e2227662. [PMID: 35984659 PMCID: PMC9391953 DOI: 10.1001/jamanetworkopen.2022.27662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
IMPORTANCE Maintaining a healthy physician workforce includes the routine use of primary care physician (PCP) services; however, physicians may face barriers to attaining formal care. OBJECTIVE To analyze access to and frequency of visits to PCPs among physicians compared with nonphysicians. DESIGN, SETTING, AND PARTICIPANTS This population-based, retrospective cohort study used registration data from the College of Physicians and Surgeons of Ontario, Canada, from January 1, 1990, to March 31, 2018. Data for all newly practicing physicians as of March 31, 2018, were linked to Ontario health administrative databases. Data were analyzed from August 25, 2020, to August 6, 2021. MAIN OUTCOMES AND MEASURES The main outcomes were enrollment in a PCP practice and visits with a PCP. Generalized estimating equations compared primary care visits between physicians and nonphysicians, matched 1:5 based on age, sex, neighborhood income quintile, and health region. RESULTS Among 19 581 physicians (mean [SD] age, 43.99 [8.94] years; 53.27% male) matched to 97 905 nonphysicians, physicians were less likely to be enrolled with a PCP than were nonphysicians (81.8% vs 86.4%; absolute difference, 4.6%; adjusted odds ratio [OR], 0.75; 95% CI, 0.72-0.79) and had fewer primary care visits during the preceding 2 years (median [IQR], 2 [0-4] vs 4 [1-7]; adjusted relative rate ratio [RRR], 0.59; 95% CI, 0.58-0.60). Physicians aged 40 years or older and male physicians were less likely to be rostered (ages 40-44 years: OR, 0.70 [95% CI, 0.64-0.77]; male: OR, 0.60 [95% CI, 0.57-0.63]) and more likely to have a lower frequency of PCP visits (ages 40-44 years: RRR, 0.53 [95% CI, 0.51-0.56]; male: RRR, 0.50 [95% CI, 0.50-0.51]) compared with nonphysicians. CONCLUSIONS AND RELEVANCE In this retrospective cohort study, enrollment with a PCP practice and frequency of visits were lower among physicians compared with a matched general population of nonphysicians. Individual, system, and medical cultural factors associated with these results need to be better understood so that physicians can take better care of themselves and their patients.
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Affiliation(s)
- Emily Rhodes
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Claire Kendall
- Bruyère Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, Institute du Savoir Montfort, Ottawa, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada
| | - Robert Talarico
- Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada
| | - Elizabeth Muggah
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Caroline Gerin-Lajoie
- Physician Wellness and Medical Culture Team, Canadian Medical Association, Ottawa, Ontario, Canada
- Department of Psychiatry, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Christopher Simon
- Physician Wellness and Medical Culture Team, Canadian Medical Association, Ottawa, Ontario, Canada
| | - Taylor McFadden
- Physician Wellness and Medical Culture Team, Canadian Medical Association, Ottawa, Ontario, Canada
| | - Daniel Myran
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, Institute du Savoir Montfort, Ottawa, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada
| | - Manish M. Sood
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Division of Nephrology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Peter Tanuseputro
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, Institute du Savoir Montfort, Ottawa, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada
- Department of Family Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
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13
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Seale E, Reaume M, Batista R, Eddeen AB, Roberts R, Rhodes E, McIsaac DI, Kendall CE, Sood MM, Prud'homme D, Tanuseputro P. Patient–physician language concordance and quality and safety outcomes among frail home care recipients admitted to hospital in Ontario, Canada. CMAJ 2022; 194:E899-E908. [PMID: 35817434 PMCID: PMC9328476 DOI: 10.1503/cmaj.212155] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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] [Accepted: 06/08/2022] [Indexed: 11/18/2022] Open
Abstract
Background: When patients and physicians speak the same language, it may improve the quality and safety of care delivered. We sought to determine whether patient–physician language concordance is associated with in-hospital and postdischarge outcomes among home care recipients who were admitted to hospital. Methods: We conducted a population-based study of a retrospective cohort of 189 690 home care recipients who were admitted to hospital in Ontario, Canada, between 2010 and 2018. We defined patient language (obtained from home care assessments) as English (Anglophone), French (Francophone) or other (allophone). We obtained physician language from the College of Physicians and Surgeons of Ontario. We defined hospital admissions as language concordant when patients received more than 50% of their care from physicians who spoke the patients’ primary language. We identified in-hospital (adverse events, length of stay, death) and post-discharge outcomes (emergency department visits, readmissions, death within 30 days of discharge). We used regression analyses to estimate the adjusted rate of mean and the adjusted odds ratio (OR) of each outcome, stratified by patient language, to assess the impact of language-concordant care within each linguistic group. Results: Allophone patients who received language-concordant care had lower risk of adverse events (adjusted OR 0.25, 95% confidence interval [CI] 0.15–0.43) and in-hospital death (adjusted OR 0.44, 95% CI 0.29–0.66), as well as shorter stays in hospital (adjusted rate of mean 0.74, 95% CI 0.66–0.83) than allophone patients who received language-discordant care. Results were similar for Francophone patients, although the magnitude of the effect was smaller than for allophone patients. Language concordance or discordance of the hospital admission was not associated with significant differences in postdischarge outcomes. Interpretation: Patients who received most of their care from physicians who spoke the patients’ primary language had better in-hospital outcomes, suggesting that disparities across linguistic groups could be mitigated by providing patients with language-concordant care.
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Affiliation(s)
- Emily Seale
- Faculty of Medicine (Seale, Reaume, McIsaac, Kendall, Sood, Tanuseputro), University of Ottawa; Institut du Savoir Montfort (Seale, Reaume, Prud'homme, Tanuseputro), Ottawa, Ont.; Department of Internal Medicine (Reaume), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Ottawa Hospital Research Institute (Batista, Roberts, Rhodes, McIsaac, Kendall, Sood, Tanuseputro); ICES uOttawa (Batista, Bader Eddeen, McIsaac, Kendall, Sood, Tanuseputro); Institut du Savoir Montfort (Batista); Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital; Bruyère Research Institute (Kendall, Tanuseputro), Ottawa, Ont.; Université de Moncton (Prud'homme), Moncton, NB
| | - Michael Reaume
- Faculty of Medicine (Seale, Reaume, McIsaac, Kendall, Sood, Tanuseputro), University of Ottawa; Institut du Savoir Montfort (Seale, Reaume, Prud'homme, Tanuseputro), Ottawa, Ont.; Department of Internal Medicine (Reaume), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Ottawa Hospital Research Institute (Batista, Roberts, Rhodes, McIsaac, Kendall, Sood, Tanuseputro); ICES uOttawa (Batista, Bader Eddeen, McIsaac, Kendall, Sood, Tanuseputro); Institut du Savoir Montfort (Batista); Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital; Bruyère Research Institute (Kendall, Tanuseputro), Ottawa, Ont.; Université de Moncton (Prud'homme), Moncton, NB
| | - Ricardo Batista
- Faculty of Medicine (Seale, Reaume, McIsaac, Kendall, Sood, Tanuseputro), University of Ottawa; Institut du Savoir Montfort (Seale, Reaume, Prud'homme, Tanuseputro), Ottawa, Ont.; Department of Internal Medicine (Reaume), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Ottawa Hospital Research Institute (Batista, Roberts, Rhodes, McIsaac, Kendall, Sood, Tanuseputro); ICES uOttawa (Batista, Bader Eddeen, McIsaac, Kendall, Sood, Tanuseputro); Institut du Savoir Montfort (Batista); Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital; Bruyère Research Institute (Kendall, Tanuseputro), Ottawa, Ont.; Université de Moncton (Prud'homme), Moncton, NB
| | - Anan Bader Eddeen
- Faculty of Medicine (Seale, Reaume, McIsaac, Kendall, Sood, Tanuseputro), University of Ottawa; Institut du Savoir Montfort (Seale, Reaume, Prud'homme, Tanuseputro), Ottawa, Ont.; Department of Internal Medicine (Reaume), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Ottawa Hospital Research Institute (Batista, Roberts, Rhodes, McIsaac, Kendall, Sood, Tanuseputro); ICES uOttawa (Batista, Bader Eddeen, McIsaac, Kendall, Sood, Tanuseputro); Institut du Savoir Montfort (Batista); Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital; Bruyère Research Institute (Kendall, Tanuseputro), Ottawa, Ont.; Université de Moncton (Prud'homme), Moncton, NB
| | - Rhiannon Roberts
- Faculty of Medicine (Seale, Reaume, McIsaac, Kendall, Sood, Tanuseputro), University of Ottawa; Institut du Savoir Montfort (Seale, Reaume, Prud'homme, Tanuseputro), Ottawa, Ont.; Department of Internal Medicine (Reaume), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Ottawa Hospital Research Institute (Batista, Roberts, Rhodes, McIsaac, Kendall, Sood, Tanuseputro); ICES uOttawa (Batista, Bader Eddeen, McIsaac, Kendall, Sood, Tanuseputro); Institut du Savoir Montfort (Batista); Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital; Bruyère Research Institute (Kendall, Tanuseputro), Ottawa, Ont.; Université de Moncton (Prud'homme), Moncton, NB
| | - Emily Rhodes
- Faculty of Medicine (Seale, Reaume, McIsaac, Kendall, Sood, Tanuseputro), University of Ottawa; Institut du Savoir Montfort (Seale, Reaume, Prud'homme, Tanuseputro), Ottawa, Ont.; Department of Internal Medicine (Reaume), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Ottawa Hospital Research Institute (Batista, Roberts, Rhodes, McIsaac, Kendall, Sood, Tanuseputro); ICES uOttawa (Batista, Bader Eddeen, McIsaac, Kendall, Sood, Tanuseputro); Institut du Savoir Montfort (Batista); Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital; Bruyère Research Institute (Kendall, Tanuseputro), Ottawa, Ont.; Université de Moncton (Prud'homme), Moncton, NB
| | - Daniel I McIsaac
- Faculty of Medicine (Seale, Reaume, McIsaac, Kendall, Sood, Tanuseputro), University of Ottawa; Institut du Savoir Montfort (Seale, Reaume, Prud'homme, Tanuseputro), Ottawa, Ont.; Department of Internal Medicine (Reaume), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Ottawa Hospital Research Institute (Batista, Roberts, Rhodes, McIsaac, Kendall, Sood, Tanuseputro); ICES uOttawa (Batista, Bader Eddeen, McIsaac, Kendall, Sood, Tanuseputro); Institut du Savoir Montfort (Batista); Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital; Bruyère Research Institute (Kendall, Tanuseputro), Ottawa, Ont.; Université de Moncton (Prud'homme), Moncton, NB
| | - Claire E Kendall
- Faculty of Medicine (Seale, Reaume, McIsaac, Kendall, Sood, Tanuseputro), University of Ottawa; Institut du Savoir Montfort (Seale, Reaume, Prud'homme, Tanuseputro), Ottawa, Ont.; Department of Internal Medicine (Reaume), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Ottawa Hospital Research Institute (Batista, Roberts, Rhodes, McIsaac, Kendall, Sood, Tanuseputro); ICES uOttawa (Batista, Bader Eddeen, McIsaac, Kendall, Sood, Tanuseputro); Institut du Savoir Montfort (Batista); Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital; Bruyère Research Institute (Kendall, Tanuseputro), Ottawa, Ont.; Université de Moncton (Prud'homme), Moncton, NB
| | - Manish M Sood
- Faculty of Medicine (Seale, Reaume, McIsaac, Kendall, Sood, Tanuseputro), University of Ottawa; Institut du Savoir Montfort (Seale, Reaume, Prud'homme, Tanuseputro), Ottawa, Ont.; Department of Internal Medicine (Reaume), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Ottawa Hospital Research Institute (Batista, Roberts, Rhodes, McIsaac, Kendall, Sood, Tanuseputro); ICES uOttawa (Batista, Bader Eddeen, McIsaac, Kendall, Sood, Tanuseputro); Institut du Savoir Montfort (Batista); Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital; Bruyère Research Institute (Kendall, Tanuseputro), Ottawa, Ont.; Université de Moncton (Prud'homme), Moncton, NB
| | - Denis Prud'homme
- Faculty of Medicine (Seale, Reaume, McIsaac, Kendall, Sood, Tanuseputro), University of Ottawa; Institut du Savoir Montfort (Seale, Reaume, Prud'homme, Tanuseputro), Ottawa, Ont.; Department of Internal Medicine (Reaume), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Ottawa Hospital Research Institute (Batista, Roberts, Rhodes, McIsaac, Kendall, Sood, Tanuseputro); ICES uOttawa (Batista, Bader Eddeen, McIsaac, Kendall, Sood, Tanuseputro); Institut du Savoir Montfort (Batista); Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital; Bruyère Research Institute (Kendall, Tanuseputro), Ottawa, Ont.; Université de Moncton (Prud'homme), Moncton, NB
| | - Peter Tanuseputro
- Faculty of Medicine (Seale, Reaume, McIsaac, Kendall, Sood, Tanuseputro), University of Ottawa; Institut du Savoir Montfort (Seale, Reaume, Prud'homme, Tanuseputro), Ottawa, Ont.; Department of Internal Medicine (Reaume), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.; Ottawa Hospital Research Institute (Batista, Roberts, Rhodes, McIsaac, Kendall, Sood, Tanuseputro); ICES uOttawa (Batista, Bader Eddeen, McIsaac, Kendall, Sood, Tanuseputro); Institut du Savoir Montfort (Batista); Department of Anesthesiology and Pain Medicine (McIsaac), The Ottawa Hospital; Bruyère Research Institute (Kendall, Tanuseputro), Ottawa, Ont.; Université de Moncton (Prud'homme), Moncton, NB
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14
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Myran DT, Pugliese M, Tanuseputro P, Cantor N, Rhodes E, Taljaard M. The association between recreational cannabis legalization, commercialization and cannabis-attributable emergency department visits in Ontario, Canada: an interrupted time-series analysis. Addiction 2022; 117:1952-1960. [PMID: 35170149 DOI: 10.1111/add.15834] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 01/19/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND AIMS Recreational cannabis was legalized in Canada in October 2018. Initially, the Government of Ontario (Canada's largest province) placed strict limits on the number of cannabis retail stores before later removing these limits. This study measured changes in cannabis-attributable emergency department (ED) visits over time, corresponding to different regulatory periods. DESIGN Interrupted time-series design using population-level data. Two policy periods were considered; recreational cannabis legalization with strict store restrictions (RCL, 17 months) and legalization with no store restrictions [recreational cannabis commercialization (RCC), 15 months] which coincided with the COVID-19 pandemic. Segmented Poisson regression models were used to examine immediate and gradual effects in each policy period. SETTING Ontario, Canada. PARTICIPANTS All individuals aged 15-105 years (n = 13.8 million) between January 2016 and May 2021. MEASUREMENTS Monthly counts of cannabis-attributable ED visits per capita and per all-cause ED visits in individuals aged 15+ (adults) and 15-24 (young adults) years. FINDINGS We observed a significant trend of increasing cannabis-attributable ED visits pre-legalization. RCL was associated with a significant immediate increase of 12% [incident rate ratio (IRR) = 1.12, 95% confidence interval (CI) = 1.02-1.23] in rates of cannabis-attributable ED visits followed by significant attenuation of the pre-legalization slope (monthly slope change IRR = 0.98, 95% CI = 0.97-0.99). RCC and COVID-19 were associated with immediate significant increases of 22% (IRR = 1.22, 95% CI = 1.09-1.37) and 17% (IRR = 1.17, 95% CI = 1.00-1.37) in rates of cannabis-attributable visits and the proportion of all-cause ED visits attributable to cannabis, respectively, with insignificant increases in monthly slopes. Similar patterns were observed in young adults. CONCLUSIONS In Ontario, Canada, cannabis-attributable emergency department visits stopped increasing over time following recreational cannabis legalization with strict retail controls but then increased during a period coinciding with cannabis commercialization and the COVID-19 pandemic.
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Affiliation(s)
- Daniel T Myran
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Institute for Clinical Evaluative Sciences (ICES), Ottawa, Ontario, Canada
| | - Michael Pugliese
- Institute for Clinical Evaluative Sciences (ICES), Ottawa, Ontario, Canada
| | - Peter Tanuseputro
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Institute for Clinical Evaluative Sciences (ICES), Ottawa, Ontario, Canada.,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Nathan Cantor
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Emily Rhodes
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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15
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Myran D, Hsu A, Kunkel E, Rhodes E, Imsirovic H, Tanuseputro P. Socioeconomic and Geographic Disparities in Emergency Department Visits due to Alcohol in Ontario: A Retrospective Population-level Study from 2003 to 2017. Can J Psychiatry 2022; 67:534-543. [PMID: 34254563 PMCID: PMC9234901 DOI: 10.1177/07067437211027321] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE While the overall health system burden of alcohol is large and increasing in Canada, little is known about how this burden differs by sociodemographic factors. The objectives of this study were to assess sociodemographic patterns and temporal trends in emergency department (ED) visits due to alcohol to identify emerging and at-risk subgroups. METHODS We conducted a retrospective population-level cohort study of all individuals aged 10 to 105 living in Ontario, Canada. We identified ED visits due to alcohol between 2003 and 2017 using defined International Classification of Diseases, 10th edition, codes from a pre-existing indicator. We calculated annual age- and sex-standardized, and age- and sex-specific rates of ED visits and compared overall patterns and changes over time between urban and rural settings and income quintiles. RESULTS There were 829,662 ED visits due to alcohol over 15 years. Rates of ED visits due to alcohol were greater for individual living in the lowest- compared to the highest-income quintile neighbourhoods, and disparities (rate ratio lowest to highest quintile) increased with age from 1.22 (95% CI, 1.19 to 1.25) in 15- to 18-year-olds to 4.17 (95% CI, 4.07 to 4.28) in 55- to 59-year-olds. Rates of ED visits due to alcohol were significantly greater in rural settings (56.0 per 10,000 individuals, 95% CI, 55.7 to 56.4) compared to urban settings (44.8 per 10,000 individuals, 95% CI, 44.7 to 44.9), particularly for young adults. Increases in rates of visits between 2003 and 2017 were greater in rural versus urban settings (82 vs. 68% increase in age- and sex-standardized rates) and varied across sociodemographic subgroups with the largest annual increases in rates of visits in young (15 to 29) low-income women (6.9%, 95%CI, 6.7 to 7.3) and the smallest increase in older (45 to 59) high-income men (2.7, 95%CI, 2.4 to 3.0). CONCLUSION Alcohol harms display unique patterns with the highest burden in rural and lower-income populations. Rural-urban and income-based disparities differ by age and sex and have increased over time, which offers an imperative and opportunity for further interventions by clinicians and policy makers.
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Affiliation(s)
- Daniel Myran
- 10055The Ottawa Hospital Research Institute, Ontario, Canada.,Department of Family Medicine, University of Ottawa, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | - Amy Hsu
- 10055The Ottawa Hospital Research Institute, Ontario, Canada.,Department of Family Medicine, University of Ottawa, Ontario, Canada.,ICES, Toronto, Ontario, Canada
| | | | - Emily Rhodes
- 10055The Ottawa Hospital Research Institute, Ontario, Canada
| | | | - Peter Tanuseputro
- Department of Family Medicine, University of Ottawa, Ontario, Canada.,Bruyère Research Institute, Ottawa, Ontario, Canada.,Department of Medicine, University of Ottawa, Ontario, Canada
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16
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Myran DT, Rhodes E, Imsirovic H, Fernando SM, Sood MM, Tanuseputro P. Assessment of Age and Sex Differences in Risk of 1-Year Mortality After Emergency Department Visits Caused by Alcohol Use. JAMA Netw Open 2022; 5:e225499. [PMID: 35377429 PMCID: PMC8980906 DOI: 10.1001/jamanetworkopen.2022.5499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
This cross-sectional study assesses age and sex differences in risk of 1-year mortality in patients with emergency department visits due to alcohol compared with the general population in Ontario, Canada.
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Affiliation(s)
- Daniel T. Myran
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Emily Rhodes
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Shannon M. Fernando
- Division of Critical Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Manish M. Sood
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Peter Tanuseputro
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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17
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Kuhn KG, Jarshaw J, Jeffries E, Adesigbin K, Maytubby P, Dundas N, Miller AC, Rhodes E, Stevenson B, Vogel J, Reeves H. Predicting COVID-19 cases in diverse population groups using SARS-CoV-2 wastewater monitoring across Oklahoma City. Sci Total Environ 2022; 812:151431. [PMID: 34748841 PMCID: PMC8570442 DOI: 10.1016/j.scitotenv.2021.151431] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 10/29/2021] [Accepted: 10/31/2021] [Indexed: 05/10/2023]
Abstract
SARS-CoV-2 was discovered among humans in late 2019 and rapidly spread across the world. Although the virus is transmitted by respiratory droplets, most infected persons also excrete viral particles in their feces. This fact prompted a range of studies assessing the usefulness of wastewater surveillance to determine levels of infection and transmission and produce early warnings of outbreaks in local communities, independently of human testing. In this study, we collected samples of wastewater from 13 locations across Oklahoma City, representing different population types, twice per week from November 2020 to end of March 2021. Wastewater samples were collected and analyzed for the presence and concentration of SARS-CoV-2 RNA using RT-qPCR. The concentration of SARS-CoV-2 in the wastewater showed notable peaks, preceding the number of reported COVID-19 cases by an average of one week (ranging between 4 and 10 days). The early warning lead-time for an outbreak or increase in cases was significantly higher in areas with larger Hispanic populations and lower in areas with a higher household income or higher proportion of persons aged 65 years or older. Using this relationship, we predicted the number of cases with an accuracy of 81-92% compared to reported cases. These results confirm the validity and timeliness of using wastewater surveillance for monitoring local disease transmission and highlight the importance of differences in population structures when interpreting surveillance outputs and planning preventive action.
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Affiliation(s)
- Katrin Gaardbo Kuhn
- Department of Biostatistics & Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
| | - Jane Jarshaw
- Department of Biostatistics & Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Erin Jeffries
- Department of Microbiology & Plant Biology, University of Oklahoma, Norman, OK, USA
| | - Kunle Adesigbin
- Oklahoma City County Health Department, Oklahoma City, OK, USA
| | - Phil Maytubby
- Oklahoma City County Health Department, Oklahoma City, OK, USA
| | - Nicole Dundas
- Massachusetts Institute of Technology, Cambridge, MA, USA
| | - A Caitlin Miller
- School of Civil Engineering and Environmental Science, University of Oklahoma, Norman, OK, USA
| | - Emily Rhodes
- School of Civil Engineering and Environmental Science, University of Oklahoma, Norman, OK, USA
| | - Bradley Stevenson
- Department of Microbiology & Plant Biology, University of Oklahoma, Norman, OK, USA
| | - Jason Vogel
- School of Civil Engineering and Environmental Science, University of Oklahoma, Norman, OK, USA
| | - Halley Reeves
- Department of Family Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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18
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Myran DT, Cantor N, Rhodes E, Pugliese M, Hensel J, Taljaard M, Talarico R, Garg AX, McArthur E, Liu CW, Jeyakumar N, Simon C, McFadden T, Gerin-Lajoie C, Sood MM, Tanuseputro P. Physician Health Care Visits for Mental Health and Substance Use During the COVID-19 Pandemic in Ontario, Canada. JAMA Netw Open 2022; 5:e2143160. [PMID: 35061041 PMCID: PMC8783265 DOI: 10.1001/jamanetworkopen.2021.43160] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Physicians self-report high levels of symptoms of anxiety and depression, and surveys suggest these symptoms have been exacerbated by the COVID-19 pandemic. However, it is not known whether pandemic-related stressors have led to increases in health care visits related to mental health or substance use among physicians. OBJECTIVE To evaluate the association between the COVID-19 pandemic and changes in outpatient health care visits by physicians related to mental health and substance use and explore differences across physician subgroups of interest. DESIGN, SETTING, AND PARTICIPANTS A population-based cohort study was conducted using health administrative data collected from the universal health system (Ontario Health Insurance Plan) of Ontario, Canada, from March 1, 2017, to March 10, 2021. Participants included 34 055 physicians, residents, and fellows who registered with the College of Physicians and Surgeons of Ontario between 1990 and 2018 and were eligible for the Ontario Health Insurance Plan during the study period. Autoregressive integrated moving average models and generalized estimating equations were used in analyses. EXPOSURES The period during the COVID-19 pandemic (March 11, 2020, to March 10, 2021) compared with the period before the pandemic. MAIN OUTCOMES AND MEASURES The primary outcome was in-person, telemedicine, and virtual care outpatient visits to a psychiatrist or family medicine and general practice clinicians related to mental health and substance use. RESULTS In the 34 055 practicing physicians (mean [SD] age, 41.7 [10.0] years, 17 918 [52.6%] male), the annual crude number of visits per 1000 physicians increased by 27%, from 816.8 before the COVID-19 pandemic to 1037.5 during the pandemic (adjusted incident rate ratio per physician, 1.13; 95% CI, 1.07-1.19). The absolute proportion of physicians with 1 or more mental health and substance use visits within a year increased from 12.3% before to 13.4% during the pandemic (adjusted odds ratio, 1.08; 95% CI, 1.03-1.14). The relative increase was significantly greater in physicians without a prior mental health and substance use history (adjusted incident rate ratio, 1.72; 95% CI, 1.60-1.85) than in physicians with a prior mental health and substance use history. CONCLUSIONS AND RELEVANCE In this study, the COVID-19 pandemic was associated with a substantial increase in mental health and substance use visits among physicians. Physician mental health may have worsened during the pandemic, highlighting a potential greater requirement for access to mental health services and system level change.
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Affiliation(s)
- Daniel T. Myran
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
- ICES, Ontario, Canada
| | - Nathan Cantor
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Emily Rhodes
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Jennifer Hensel
- Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Amit X. Garg
- ICES, Ontario, Canada
- Department of Medicine, Western University, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | | | - Cheng-Wei Liu
- Department of Medicine, Western University, London, Ontario, Canada
| | | | | | | | | | - Manish M. Sood
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- ICES, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Division of Nephrology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Peter Tanuseputro
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- ICES, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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19
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Lysecki DL, Gupta S, Rapoport A, Rhodes E, Spruin S, Vadeboncoeur C, Widger K, Tanuseputro P. Children's Health Care Utilization and Cost in the Last Year of Life: A Cohort Comparison with and without Regional Specialist Pediatric Palliative Care. J Palliat Med 2022; 25:1031-1040. [PMID: 34981956 DOI: 10.1089/jpm.2021.0175] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Research remains inconclusive regarding the impact of specialist pediatric palliative care (SPPC) on health care utilization and cost. Objective: To better understand and quantify the impact of regional SPPC services on children's health care utilization and cost near end of life. Design: A retrospective cohort study used administrative databases to compare outcomes for child decedents (age 31 days to 19 years) from two similar regions in Ontario, Canada between 2010 and 2014, wherein one region had SPPC services (SPPC+) and the other did not (SPPC-). Measurements: Administrative databases provided demographics, health care utilization (days), and costs Canadian dollars) across settings in the last year of life, and location of death. Multivariable analyses produced relative rates (RRs) of health care days (acute and home care), intensive care unit (ICU) days, and health care costs (inpatient, outpatient, home, and physician) as well as the odds ratio (OR) of in-hospital death. Counterfactual analysis quantified the differences in utilization and costs. Results: A total of 807 children were included. On multivariable analysis, residence in the SPPC+ region (n = 363) was associated with fewer mean health care days (RR = 0.73; 95% confidence interval [CI]: 0.59-0.90); fewer mean ICU days (RR = 0.64; 95% CI: 0.44-0.94); lower mean health care costs (RR = 0.71; 95% CI: 0.56-0.91); and lower likelihood of in-hospital death (OR = 0.67; 95% CI: 0.49-0.92). The counterfactual analysis estimated mean reductions of 16.2 days (95% CI: 14.4-18.0) and $24,940 (95% CI: $21,703-$28,177) per child in the SPPC+ region. Conclusions: Although not a causal study, these results support an association between regional SPPC services and decreased health care utilization, intensity, and cost for children near end of life.
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Affiliation(s)
- David L Lysecki
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.,Quality of Life and Advanced Care, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Sumit Gupta
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.,Division of Hematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada
| | - Adam Rapoport
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.,Paediatric Advanced Care Team, Hospital for Sick Children, Toronto, Ontario, Canada.,Emily's House, Toronto, Ontario, Canada
| | - Emily Rhodes
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Sarah Spruin
- Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Christina Vadeboncoeur
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada.,Department of Pediatrics, CHEO, Ottawa, Ontario, Canada.,Roger Neilson House, Ottawa, Ontario, Canada
| | - Kimberley Widger
- Paediatric Advanced Care Team, Hospital for Sick Children, Toronto, Ontario, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontatio, Canada
| | - Peter Tanuseputro
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Bruyère Research Institute, University of Ottawa, Ottawa, Ontario, Canada
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20
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Reaume M, Batista R, Talarico R, Guerin E, Rhodes E, Carson S, Prud'homme D, Tanuseputro P. In-Hospital Patient Harm Across Linguistic Groups: A Retrospective Cohort Study of Home Care Recipients. J Patient Saf 2022; 18:e196-e204. [PMID: 32433437 DOI: 10.1097/pts.0000000000000726] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Research examining the impact of language barriers on patient safety is limited. We conducted a population-based study to determine whether patients whose primary language is not English are more likely to experience harm when admitted to hospitals in Ontario, Canada. METHODS We used linked administrative health records to establish a retrospective cohort of home care recipients (from 2010 to 2015) who were subsequently admitted to hospital. Patient language (obtained from home care assessments) was coded as English, French, or other. Harmful events were identified using the Hospital Harm Indicator developed by the Canadian Institute for Health Information. RESULTS We included 190,724 patients (156,186 Anglophones, 5,110 Francophones, and 29,428 Allophones). There was no significant difference in the unadjusted risk of harm for Francophones compared with Anglophones (relative risk [RR], 0.94; 95% confidence interval [CI], 0.87-1.02). However, Allophones were more likely to experience harm when compared with Anglophones (RR, 1.14; 95% CI, 1.10-1.18). The risk of harm was even greater for Allophones with low English proficiency (RR, 1.18; 95% CI, 1.13-1.24). After adjusting for potential confounders, Anglophones and Allophones were equally likely to experience harm of any type, but Allophones more likely to experience harm from infections and procedures. CONCLUSIONS Patients whose primary language was not English or French were more likely to experience harm after admission to hospital, especially if they had low English proficiency. For these patients, the risk of harm from infections and procedures persisted in the adjusted analysis, but the overall risk of harm did not.
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Affiliation(s)
| | | | | | - Eva Guerin
- Institut du Savoir Montfort, Ottawa, Ontario
| | - Emily Rhodes
- Department of Medicine, Ottawa Hospital Research Institute, Ottawa, Ontario
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21
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Reaume M, Batista R, Rhodes E, Knight B, Imsirovic H, Seale E, Riad K, Prud'homme D, Tanuseputro P. The Impact of Language on Emergency Department Visits, Hospitalizations, and Length of Stay Among Home Care Recipients. Med Care 2021; 59:1006-1013. [PMID: 34432768 DOI: 10.1097/mlr.0000000000001638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Research considering the impact of language on health care utilization is limited. We conducted a population-based study to: (1) investigate the association between residents' preferred language and hospital-based health care utilization; and (2) determine whether this association is modified by dementia, a condition which can exacerbate communication barriers. METHODS We used administrative databases to establish a retrospective cohort study of home care recipients (2015-2017) in Ontario, Canada, where the predominant language is English. Residents' preferred language (obtained from in-person home care assessments) was coded as English (Anglophones), French (Francophones), or other (Allophones). Diagnoses of dementia were ascertained with a previously validated algorithm. We identified all emergency department (ED) visits and hospitalizations within 1 year. RESULTS Compared with Anglophones, Allophones had lower annual rates of ED visits (1.3 vs. 1.8; P<0.01) and hospitalizations (0.6 vs. 0.7; P<0.01), while Francophones had longer hospital stays (9.1 vs. 7.6 d per admission; P<0.01). After adjusting for potential confounders, Francophones and Allophones were less likely to visit the ED or be hospitalized than Anglophones. We found evidence of synergism between language and dementia; the average length of stay for Francophones with dementia was 25% (95% confidence interval: 1.10-1.39) longer when compared with Anglophones without dementia. CONCLUSIONS Residents whose preferred language was not English were less frequent users of hospital-based health care services, a finding that is likely attributable to cultural factors. Francophones with dementia experienced the longest stays in hospital. This may be related to the geographic distribution of Francophones (predominantly in rural areas) or to suboptimal patient-provider communication.
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Affiliation(s)
- Michael Reaume
- Faculty of Medicine, University of Ottawa
- Institut du Savoir Montfort
| | - Ricardo Batista
- Institut du Savoir Montfort
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa
- ICES
| | - Emily Rhodes
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa
| | - Braden Knight
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa
- ICES
| | - Haris Imsirovic
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa
- ICES
| | - Emily Seale
- Faculty of Medicine, University of Ottawa
- Institut du Savoir Montfort
| | - Karine Riad
- Faculty of Medicine, University of Ottawa
- Institut du Savoir Montfort
| | - Denis Prud'homme
- Institut du Savoir Montfort
- Faculty of Health Sciences, University of Ottawa
| | - Peter Tanuseputro
- Faculty of Medicine, University of Ottawa
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa
- ICES
- Bruyère Research Institute, Ottawa, Canada
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22
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Hill K, Sucha E, Rhodes E, Bota S, Hundemer GL, Clark EG, Canney M, Harel Z, Wang TF, Carrier M, Wijeysundera HC, Knoll G, Sood MM. Amiodarone, verapamil, or diltiazem use with direct oral anticoagulants and the risk of hemorrhage in older adults. CJC Open 2021; 4:315-323. [PMID: 35386137 PMCID: PMC8978070 DOI: 10.1016/j.cjco.2021.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/03/2021] [Indexed: 12/26/2022] Open
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23
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Schreglmann S, Wang D, Peach R, Li J, Zhang X, Latorre A, Rhodes E, Panella E, Boyden E, Barahona M, Santaniello S, Rothwell J, Bhatia K, Grossman N. FV 12. Non-invasive Suppression of Essential Tremor via Phase-Locked Disruption of its Temporal Coherence. Clin Neurophysiol 2021. [DOI: 10.1016/j.clinph.2021.02.388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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24
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Robinson A, Wilson MN, Hayden JA, Rhodes E, Campbell S, MacDougall P, Asbridge M. Health Care Provider Utilization of Prescription Monitoring Programs: A Systematic Review and Meta-Analysis. Pain Med 2021; 22:1570-1582. [PMID: 33484144 PMCID: PMC8311582 DOI: 10.1093/pm/pnaa412] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To synthesize the literature on the proportion of health care providers who access and use prescription monitoring program data in their practice, as well as associated barriers to the use of such data. DESIGN We performed a systematic review using a standard systematic review method with meta-analysis and qualitative meta-summary. We included full-published peer-reviewed reports of study data, as well as theses and dissertations. METHODS We identified relevant quantitative and qualitative studies. We synthesized outcomes related to prescription monitoring program data use (i.e., ever used, frequency of use). We pooled the proportion of health care providers who had ever used prescription monitoring program data by using random effects models, and we used meta-summary methodology to identify prescription monitoring program use barriers. RESULTS Fifty-three studies were included in our review, all from the United States. Of these, 46 reported on prescription monitoring program use and 32 reported on barriers. The pooled proportion of health care providers who had ever used prescription monitoring program data was 0.57 (95% confidence interval: 0.48-0.66). Common barriers to prescription monitoring program data use included time constraints and administrative burdens, low perceived value of prescription monitoring program data, and problems with prescription monitoring program system usability. CONCLUSIONS Our study found that health care providers underutilize prescription monitoring program data and that many barriers exist to prescription monitoring program data use.
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Affiliation(s)
- Alysia Robinson
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Maria N Wilson
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jill A Hayden
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Emily Rhodes
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Samuel Campbell
- Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Peter MacDougall
- Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Anesthesiology, Pain Management and Peri-Operative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mark Asbridge
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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25
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Hundemer GL, Talarico R, Tangri N, Leon SJ, Bota SE, Rhodes E, Knoll GA, Sood MM. Ambulatory Treatments for RAAS Inhibitor-Related Hyperkalemia and the 1-Year Risk of Recurrence. Clin J Am Soc Nephrol 2021; 16:365-373. [PMID: 33608262 PMCID: PMC8011018 DOI: 10.2215/cjn.12990820] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [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: 08/08/2020] [Accepted: 01/04/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND OBJECTIVE The optimal ambulatory management of renin-angiotensin-aldosterone system inhibitor (RAASi)-related hyperkalemia to reduce the risk of recurrence is unknown. We examined the risk of hyperkalemia recurrence on the basis of outpatient pharmacologic changes following an episode of RAASi-related hyperkalemia. DESIGN We performed a population-based, retrospective cohort study of older adults (n=49,571; mean age 79 years) who developed hyperkalemia (potassium ≥5.3 mEq/L) while on a RAASi and were grouped as follows: no intervention, RAASi discontinuation, RAASi dose decrease, new diuretic, diuretic dose increase, or sodium polystyrene sulfonate within 30 days. The primary outcome was hyperkalemia recurrence, with secondary outcomes of cardiovascular events and all-cause mortality within 1 year. RESULTS Among patients who received a pharmacologic intervention (23% of the cohort), RAASi discontinuation was the most commonly prescribed strategy (74%), followed by RAASi decrease (15%), diuretic increase (7%), new diuretic (3%), and sodium polystyrene sulfonate (1%). A total of 16,977 (34%) recurrent hyperkalemia events occurred within 1 year. Compared with no intervention (35%, referent), the cumulative incidence of recurrent hyperkalemia was lower with RAASi discontinuation (29%; hazard ratio, 0.82; 95% confidence interval, 0.78 to 0.85), whereas there was no difference with RAASi dose decrease (36%; hazard ratio, 0.94; 95% confidence interval, 0.86 to 1.02), new diuretic (32%; hazard ratio, 0.95; 95% confidence interval, 0.78 to 1.17), or diuretic increase (38%; hazard ratio, 0.99; 95% confidence interval, 0.87 to 1.12) and a higher incidence with sodium polystyrene sulfonate (55%; hazard ratio, 1.30; 95% confidence interval, 1.04 to 1.63). RAASi discontinuation was not associated with a higher risk of 1-year cardiovascular events (hazard ratio, 0.96; 95% confidence interval, 0.91 to 1.02) or all-cause mortality (hazard ratio, 1.05; 95% confidence interval, 0.96 to 1.15) compared with no intervention. CONCLUSIONS Among older adults with RAASi-related hyperkalemia, RAASi discontinuation is associated with the lowest risk of recurrent hyperkalemia, with no apparent increase in short-term risks for cardiovascular events or all-cause mortality.
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Affiliation(s)
- Gregory L. Hundemer
- Division of Nephrology, Department of Medicine and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Robert Talarico
- Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada
| | - Navdeep Tangri
- Department of Internal Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Silvia J. Leon
- Department of Internal Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sarah E. Bota
- Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada
| | - Emily Rhodes
- Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada
| | - Greg A. Knoll
- Division of Nephrology, Department of Medicine and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Manish M. Sood
- Division of Nephrology, Department of Medicine and the Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada,Institute for Clinical Evaluative Sciences, Ottawa, Ontario, Canada
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Hundemer GL, Knoll GA, Petrcich W, Hiremath S, Ruzicka M, Burns KD, Edwards C, Bugeja A, Rhodes E, Sood MM. Kidney, Cardiac, and Safety Outcomes Associated With α-Blockers in Patients With CKD: A Population-Based Cohort Study. Am J Kidney Dis 2021; 77:178-189.e1. [DOI: 10.1053/j.ajkd.2020.07.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 07/04/2020] [Indexed: 01/10/2023]
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Batista R, Prud'homme D, Rhodes E, Hsu A, Talarico R, Reaume M, Guérin E, Bouchard L, Desaulniers J, Manuel D, Tanuseputro P. Quality and Safety in Long-Term Care in Ontario: The Impact of Language Discordance. J Am Med Dir Assoc 2021; 22:2147-2153.e3. [PMID: 33434567 DOI: 10.1016/j.jamda.2020.12.007] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 12/03/2020] [Accepted: 12/06/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES This study compared quality indicators across linguistic groups and sought to determine whether disparities are influenced by resident-facility language discordance in long-term care. DESIGN Population-based retrospective cohort study using linked databases. SETTING AND PARTICIPANTS Retrospective cohort of newly admitted residents of long-term care facilities in Ontario, Canada, between 2010 and 2016 (N=47,727). Individual residents' information was obtained from the Resident Assessment Instrument Minimum Data Set (RAI-MDS) to determine resident's primary language, clinical characteristics, and health care indicators. MEASURES Main covariates of interest were primary language of the resident and predominant language of the long-term care facility, which was determined using the French designation status as defined in the French Language Services Act. Primary outcomes were a set of quality and safety indicators related to long-term care: worsening of depression, falls, moderate-severe pain, use of antipsychotic medication, and physical restraints. Multivariable logistic regression models were used to assess the impact of resident's primary language, facility language, and resident-facility language discordance on each quality indicator. RESULTS Overall, there were few differences between francophones and anglophones for quality and safety indicators. Francophones were more likely to report pain (10.9% vs 9.9%; P = .001) and be physically restrained (7.3% vs 5.2%; P < .001), whereas a greater proportion of anglophones experienced worsening of depressive symptoms (24.0% vs 22.9%; P = .001). However, quality indicators were generally worse for francophones in Non-Designated facilities, except for pain, which was more commonly reported by francophones in French-Designated facilities. Anglophones were more likely to be physically restrained in French-Designated facilities (6.7% vs 5.1%; P < .001). CONCLUSIONS AND IMPLICATIONS For francophones, quality indicators tended to be worse in the presence of resident-facility language discordance. However, these findings did not persist after adjusting for individual- and facility-level characteristics, suggesting that the disparities observed at the population level cannot be attributed to linguistic factors alone.
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Affiliation(s)
- Ricardo Batista
- Institut du Savoir Montfort, Ottawa, Ontario, Canada; ICES, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
| | - Denis Prud'homme
- Institut du Savoir Montfort, Ottawa, Ontario, Canada; Hôpital Montfort, Sport Medicine Clinic, Ottawa, Ontario, Canada; School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Emily Rhodes
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Amy Hsu
- ICES, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Elizabeth Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Robert Talarico
- ICES, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Michael Reaume
- Institut du Savoir Montfort, Ottawa, Ontario, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Eva Guérin
- Institut du Savoir Montfort, Ottawa, Ontario, Canada; Hôpital Montfort, Sport Medicine Clinic, Ottawa, Ontario, Canada
| | - Louise Bouchard
- Institut du Savoir Montfort, Ottawa, Ontario, Canada; School of Social and Anthropological Studies, University of Ottawa, Ottawa, Ontario, Canada
| | - Jacinthe Desaulniers
- Réseau des services de santé en français de l'Est de l'Ontario, Ottawa, Ontario, Canada
| | - Douglas Manuel
- ICES, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Peter Tanuseputro
- ICES, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Elizabeth Bruyère Research Institute, Ottawa, Ontario, Canada; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Baldwin DS, Dang M, Farquharson L, Fitzpatrick N, Lindsay N, Quirk A, Rhodes E, Shah P, Williams R, Crawford MJ. Quality of English inpatient mental health services for people with anxiety or depressive disorders: Findings and recommendations from the core audit of the National Clinical Audit of Anxiety and Depression. Compr Psychiatry 2021; 104:152212. [PMID: 33160123 DOI: 10.1016/j.comppsych.2020.152212] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 09/04/2020] [Accepted: 09/17/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Clinical audit is a sustained cyclical quality improvement process seeking to improve patient care and outcomes by evaluating services against explicit standards and implementing necessary changes. National audits aim to improve population-level clinical care by identifying unwarranted variations and making recommendations for clinicians, managers and service commissioners. The National Clinical Audit of Anxiety and Depression aimed to improve clinical care for people admitted to English hospitals for treatment of anxiety and depression, to provide comparative data on quality of care, and to support local quality improvement initiatives by identifying and sharing examples of best practice. PROCEDURES Thirteen standards were developed based on NICE guidelines, literature review and feedback from a steering committee and reference group of service users and carers. All providers of NHS inpatient mental health services in England were asked to submit details of between 20 and 100 eligible service users/patients admitted between April 2017 and September 2018. To ascertain data reliability, participating services re-audited 5 sets of case-notes with a second auditor, and the coordinating team checked 10 randomly-selected sets of case-notes from 3 services, also selected at random. The reference group and steering committee identified key findings and developed a series of recommendations, which were discussed in regional quality improvement workshops and on-line webinars. FINDINGS Data from 3795 case notes were analysed. A sizeable proportion of records indicated that at least one important aspect of initial assessment was not documented. Many service users/patients who could have benefited from an intervention targeted at optimising physical health did not receive it. Only a minority (39%) were referred for psychological therapy. Use of outcome measures varied considerably but no single outcome measure was being used routinely. Most individuals had a care plan recorded in the notes, but a review date was documented in only two-thirds, and almost half of individuals had not received a copy. CONCLUSIONS There was considerable variation between English mental health services across many variables, and much scope for improvement. Clinicians should ensure that care plans are developed collaboratively with service users/patients and identified carers should be provided with information about support services. Health services should investigate the reasons for low referral rates for psychological therapies. Clinicians should ensure all service users have jointly developed crisis plans in place at discharge. Service managers should agree outcome measures to evaluate the treatment provided and clinicians should use these measures at initial assessment and review appointments. The implementation of such changes provides an opportunity for collaborative research into mental health service delivery and quality.
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Affiliation(s)
- D S Baldwin
- NCAAD Clinical Lead, Royal College of Psychiatrists, United Kingdom; Psychiatry, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, United Kingdom; University Department of Psychiatry and Mental Health, University of Cape Town, Cate Town, South Africa.
| | - M Dang
- NCAAD Programme Manager, Royal College of Psychiatrists, United Kingdom
| | - L Farquharson
- Clinical Advisor to the Spotlight Audits, Royal College of Psychiatrists, United Kingdom; Clinical Psychology, University of East London, United Kingdom
| | - N Fitzpatrick
- NCAAD Project Officer, Royal College of Psychiatrists, United Kingdom
| | - N Lindsay
- NCAAD Project Officer, Royal College of Psychiatrists, United Kingdom
| | - A Quirk
- CCQI Head of Clinical Audit and Research, Royal College of Psychiatrists, United Kingdom
| | - E Rhodes
- NCAAD Deputy Programme Manager, Royal College of Psychiatrists, United Kingdom
| | - P Shah
- NCAAD Service User Advisor, Royal College of Psychiatrists, United Kingdom
| | - R Williams
- CCQI Clinical Fellow, Royal College of Psychiatrists, United Kingdom; Department of Brain Sciences, Imperial College London, United Kingdom
| | - M J Crawford
- College Centre for Quality Improvement, Royal College of Psychiatrists, United Kingdom; Mental Health Research, Faculty of Medicine, Imperial College London, United Kingdom
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Riad K, Webber C, Batista R, Reaume M, Rhodes E, Knight B, Prud'homme D, Tanuseputro P. The impact of dementia and language on hospitalizations: a retrospective cohort of long-term care residents. BMC Geriatr 2020; 20:397. [PMID: 33032528 PMCID: PMC7545542 DOI: 10.1186/s12877-020-01806-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 06/16/2020] [Accepted: 09/30/2020] [Indexed: 12/22/2022] Open
Abstract
Background Hospitalizations carry considerable risks for frail, elderly patients; this is especially true for patients with dementia, who are more likely to experience delirium, falls, functional decline, iatrogenic complications, and infections when compared to their peers without dementia. Since up to two thirds of patients in long-term care (LTC) facilities have dementia, there is interest in identifying factors associated with transitions from LTC facilities to hospitals. The purpose of this study was to investigate the association between dementia status and incidence of hospitalization among residents in LTC facilities in Ontario, Canada, and to determine whether this association is modified by linguistic factors. Methods We used linked administrative databases to establish a prevalent cohort of 81,188 residents in 628 LTC facilities from April 1st 2014 to March 31, 2017. Diagnoses of dementia were identified with a previously validated algorithm; all other patient characteristics were obtained from in-person assessments. Residents’ primary language was coded as English or French; facility language (English or French) was determined using language designation status according to the French Language Services Act. We identified all hospitalizations within 3 months of the first assessment performed after April 1st 2014. We performed multivariate logistic regression analyses to determine the impact of dementia and resident language on the incidence of hospitalization; we also considered interactions between dementia and both resident language and resident-facility language discordance. Results The odds of hospitalization were 39% lower for residents with dementia compared to residents without dementia (OR 0.61, 95% CI 0.57–0.65). Francophones had lower odds of hospitalization than Anglophones, but this difference was not statistically significant (OR 0.91, 95% CI 0.81–1.03). However, Francophones without dementia were significantly less likely to be hospitalized compared to Anglophones without dementia (OR 0.71, 95% CI 0.53–0.94). Resident-facility language discordance did not significantly affect hospitalizations. Conclusions Residents in LTC facilities were generally less likely to be hospitalized if they had dementia, or if their primary language was French and they did not have dementia. These findings could be explained by differences in end-of-life care goals; however, they could also be the result of poor patient-provider communication.
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Affiliation(s)
- Karine Riad
- Faculty of Medicine, University of Ottawa, Ottawa, Canada.,Institut du Savoir Montfort, Ottawa, Canada
| | | | - Ricardo Batista
- Institut du Savoir Montfort, Ottawa, Canada.,Department of Medicine, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, ON, K1Y 4E9, Canada.,ICES, Ottawa, Canada
| | - Michael Reaume
- Faculty of Medicine, University of Ottawa, Ottawa, Canada.,Institut du Savoir Montfort, Ottawa, Canada
| | - Emily Rhodes
- Department of Medicine, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, ON, K1Y 4E9, Canada
| | | | - Denis Prud'homme
- Institut du Savoir Montfort, Ottawa, Canada.,Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Peter Tanuseputro
- Bruyère Research Institute, Ottawa, Canada. .,Department of Medicine, Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1053 Carling Ave, Ottawa, ON, K1Y 4E9, Canada.
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Ashley J, McArthur E, Bota S, Harel Z, Battistella M, Molnar AO, Jun M, Badve SV, Garg AX, Manuel D, Tanuseputro P, Wells P, Mavrakanas T, Rhodes E, Sood MM. Risk of Cardiovascular Events and Mortality Among Elderly Patients With Reduced GFR Receiving Direct Oral Anticoagulants. Am J Kidney Dis 2020; 76:311-320. [DOI: 10.1053/j.ajkd.2020.02.446] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 02/11/2020] [Indexed: 02/01/2023]
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Hill K, Sucha E, Rhodes E, Carrier M, Garg AX, Harel Z, Hundemer GL, Clark EG, Knoll G, McArthur E, Sood MM. Risk of Hospitalization With Hemorrhage Among Older Adults Taking Clarithromycin vs Azithromycin and Direct Oral Anticoagulants. JAMA Intern Med 2020; 180:1052-1060. [PMID: 32511684 PMCID: PMC7281381 DOI: 10.1001/jamainternmed.2020.1835] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
IMPORTANCE Clarithromycin is a commonly prescribed antibiotic associated with higher levels of direct oral anticoagulants (DOACs) in the blood, with the potential to increase the risk of hemorrhage. OBJECTIVE To assess the 30-day risk of a hospital admission with hemorrhage after coprescription of clarithromycin compared with azithromycin among older adults taking a DOAC. DESIGN, SETTING, AND PARTICIPANTS This population-based, retrospective cohort study was conducted among adults of advanced age (mean [SD] age, 77.6 [7.2] years) who were newly coprescribed clarithromycin (n = 6592) vs azithromycin (n = 18 351) while taking a DOAC (dabigatran, apixaban, or rivaroxaban) in Ontario, Canada, from June 23, 2009, to December 31, 2016. Cox proportional hazards regression was used to examine the association between hemorrhage and antibiotic use (clarithromycin vs azithromycin). Statistical analysis was performed from December 23, 2019, to March 25, 2020. MAIN OUTCOMES AND MEASURES Hospital admission with major hemorrhage (upper or lower gastrointestinal tract or intracranial). Outcomes were assessed within 30 days of a coprescription. RESULTS Among the 24 943 patients (12 493 women; mean [SD] age, 77.6 [7.2] years) in the study, rivaroxaban was the most commonly prescribed DOAC (9972 patients [40.0%]), followed by apixaban (7953 [31.9%]) and dabigatran (7018 [28.1%]). Coprescribing clarithromycin vs azithromycin with a DOAC was associated with a higher risk of a hospital admission with major hemorrhage (51 of 6592 patients [0.77%] taking clarithromycin vs 79 of 18 351 patients [0.43%] taking azithromycin; adjusted hazard ratio, 1.71 [95% CI, 1.20-2.45]; absolute risk difference, 0.34%). Results were consistent in multiple additional analyses. CONCLUSIONS AND RELEVANCE This study suggests that, among adults of advanced age taking a DOAC, concurrent use of clarithromycin compared with azithromycin was associated with a small but statistically significantly greater 30-day risk of hospital admission with major hemorrhage.
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Affiliation(s)
- Kevin Hill
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Ewa Sucha
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Emily Rhodes
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Marc Carrier
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Amit X Garg
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Division of Nephrology, Department of Medicine, Health Sciences Centre, London, Ontario, Canada.,Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Ziv Harel
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Division of Nephrology, Department of Medicine, St Michael's Hospital, Toronto, Canada
| | - Gregory L Hundemer
- Division of Nephrology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Edward G Clark
- Division of Nephrology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Greg Knoll
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Division of Nephrology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Eric McArthur
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Manish M Sood
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Division of Nephrology, Department of Medicine, The Ottawa Hospital, Ottawa, Ontario, Canada.,Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
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Reaume M, Batista R, Talarico R, Rhodes E, Guerin E, Carson S, Prud'homme D, Tanuseputro P. The impact of hospital language on the rate of in-hospital harm. A retrospective cohort study of home care recipients in Ontario, Canada. BMC Health Serv Res 2020; 20:340. [PMID: 32316965 PMCID: PMC7175496 DOI: 10.1186/s12913-020-05213-6] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 04/13/2020] [Indexed: 02/03/2023] Open
Abstract
Background Patients who live in minority language situations are generally more likely to experience poor health outcomes, including harmful events. The delivery of healthcare services in a language-concordant environment has been shown to mitigate the risk of poor health outcomes related to chronic disease management in primary care. However, data assessing the impact of language-concordance on the risk of in-hospital harm are lacking. We conducted a population-based study to determine whether admission to a language-discordant hospital is a risk factor for in-hospital harm. Methods We used linked administrative health records to establish a retrospective cohort of home care recipients (from 2007 to 2015) who were admitted to a hospital in Eastern or North-Eastern Ontario, Canada. Patient language (obtained from home care assessments) was coded as English (Anglophone group), French (Francophone group), or other (Allophone group); hospital language (English or bilingual) was obtained using language designation status according to the French Language Services Act. We identified in-hospital harmful events using the Hospital Harm Indicator developed by the Canadian Institute for Health Information. Results The proportion of hospitalizations with at least 1 harmful event was greater for Allophones (7.63%) than for Anglophones (6.29%, p < 0.001) and Francophones (6.15%, p < 0.001). Overall, Allophones admitted to hospitals required by law to provide services in both French and English (bilingual hospitals) had the highest rate of harm (9.16%), while Francophones admitted to these same hospitals had the lowest rate of harm (5.93%). In the unadjusted analysis, Francophones were less likely to experience harm in bilingual hospitals than in hospitals that were not required by law to provide services in French (English-speaking hospitals) (RR = 0.88, p = 0.048); the opposite was true for Anglophones and Allophones, who were more likely to experience harm in bilingual hospitals (RR = 1.17, p < 0.001 and RR = 1.41, p < 0.001, respectively). The risk of harm was not significant in the adjusted analysis. Conclusions Home care recipients residing in Eastern and North-Eastern Ontario were more likely to experience harm in language-discordant hospitals, but the risk of harm did not persist after adjusting for confounding variables.
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Affiliation(s)
- Michael Reaume
- Faculty of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8L1, Canada. .,Institut du Savoir Montfort, Ottawa, Canada.
| | - Ricardo Batista
- Department of Medicine, Ottawa Hospital Research Institute, Ottawa, Canada.,ICES, Ottawa, Canada
| | | | - Emily Rhodes
- Department of Medicine, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Eva Guerin
- Institut du Savoir Montfort, Ottawa, Canada
| | - Sarah Carson
- Faculty of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8L1, Canada.,Institut du Savoir Montfort, Ottawa, Canada
| | - Denis Prud'homme
- Institut du Savoir Montfort, Ottawa, Canada.,Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Peter Tanuseputro
- Faculty of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8L1, Canada.,Department of Medicine, Ottawa Hospital Research Institute, Ottawa, Canada.,ICES, Ottawa, Canada.,Bruyère Research Institute, Ottawa, Canada
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Akbari A, Tangri N, Brown PA, Biyani M, Rhodes E, Kumar T, Shabana W, Sood MM. Prediction of Progression in Polycystic Kidney Disease Using the Kidney Failure Risk Equation and Ultrasound Parameters. Can J Kidney Health Dis 2020; 7:2054358120911274. [PMID: 32215214 PMCID: PMC7081470 DOI: 10.1177/2054358120911274] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 06/24/2019] [Accepted: 01/21/2020] [Indexed: 11/16/2022] Open
Abstract
Background The kidney failure risk equation (KFRE) is a validated risk algorithm for predicting the risk of kidney failure in chronic kidney disease (CKD) patients regardless of etiology. Patients with autosomal dominant polycystic kidney disease (AD-PCKD) experience long disease trajectories and as such identifying individuals at risk of kidney failure would aid in intervention. Objective To examine the utility of the KFRE in predicting adverse kidney outcomes compared with existing risk factors in a cohort of patients with AD-PCKD. Methods Retrospective cohort study of AD-PCKD patients referred to a tertiary care center with a baseline kidney ultrasound and a KFRE calculation. Cox proportional hazards were used to examine the association of the KFRE and composite of an eGFR decline of >30% or the need for dialysis/transplantation. Discrimination and calibration of a parsimonious fully adjusted model and a model containing only total kidney volume (TKV) with and without the addition of the KFRE was determined. Results Of 340 patients with AD-PCKD eligible, 221 (65%) met inclusion criteria. Older age, cardiac disease, cancer, higher systolic blood pressure, albuminuria, lower eGFR and a higher initial TKV were more common in patients with a higher KFRE. A total of 120 events occurred over a median patient follow-up time of 3.2 years. KFRE was independently associated with the composite kidney outcome. Addition of the KFRE significantly improved discrimination and calibration in a TKV only model and a fully adjusted model. Conclusions In a diverse, referral population with AD-PCKD, the KFRE was associated with adverse kidney outcomes and improved risk prediction.
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Affiliation(s)
- Ayub Akbari
- Department of Medicine, Division of Nephrology, Kidney Research Centre, University of Ottawa, ON, Canada.,The Ottawa Hospital Research Institute, ON, Canada
| | | | - Pierre A Brown
- Department of Medicine, Division of Nephrology, Kidney Research Centre, University of Ottawa, ON, Canada.,The Ottawa Hospital Research Institute, ON, Canada
| | - Mohan Biyani
- Department of Medicine, Division of Nephrology, Kidney Research Centre, University of Ottawa, ON, Canada.,The Ottawa Hospital Research Institute, ON, Canada
| | - Emily Rhodes
- Institute for Clinical Evaluative Sciences, Ottawa, ON, Canada
| | - Teerath Kumar
- Department of Medicine, Division of Nephrology, Kidney Research Centre, University of Ottawa, ON, Canada
| | - Wael Shabana
- Department of Radiology, University of Ottawa, ON, Canada
| | - Manish M Sood
- Department of Medicine, Division of Nephrology, Kidney Research Centre, University of Ottawa, ON, Canada.,The Ottawa Hospital Research Institute, ON, Canada
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Wilson MN, Hayden JA, Rhodes E, Robinson A, Asbridge M. Effectiveness of Prescription Monitoring Programs in Reducing Opioid Prescribing, Dispensing, and Use Outcomes: A Systematic Review. The Journal of Pain 2019; 20:1383-1393. [DOI: 10.1016/j.jpain.2019.04.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/15/2019] [Accepted: 04/21/2019] [Indexed: 12/20/2022]
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Rhodes E, Wilson M, Robinson A, Hayden JA, Asbridge M. The effectiveness of prescription drug monitoring programs at reducing opioid-related harms and consequences: a systematic review. BMC Health Serv Res 2019; 19:784. [PMID: 31675963 PMCID: PMC6825333 DOI: 10.1186/s12913-019-4642-8] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [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: 04/09/2019] [Accepted: 10/15/2019] [Indexed: 11/10/2022] Open
Abstract
Background In order to address the opioid crisis in North America, many regions have adopted preventative strategies, such as prescription drug monitoring programs (PDMPs). PDMPs aim to increase patient safety by certifying that opioids are prescribed in appropriate quantities. We aimed to synthesize the literature on changes in opioid-related harms and consequences, an important measure of PDMP effectiveness. Methods We completed a systematic review. We conducted a narrative synthesis of opioid-related harms and consequences from PDMP implementation. Outcomes were grouped into categories by theme: opioid dependence, opioid-related care outcomes, opioid-related adverse events, and opioid-related legal and crime outcomes. Results We included a total of 22 studies (49 PDMPs) in our review. Two studies reported on illicit and problematic use but found no significant associations with PDMP status. Eight studies examined the association between PDMP status and opioid-related care outcomes, of which two found that treatment admissions for prescriptions opioids were lower in states with PDMP programs (p < 0.05). Of the thirteen studies that reported on opioid-related adverse events, two found significant (p < 0.001 and p < 0.05) but conflicting results with one finding a decrease in opioid-related overdose deaths after PDMP implementation and the other an increase. Lastly, two studies found no statistically significant association between PDMP status and opioid-related legal and crime outcomes (crime rates, identification of potential dealers, and diversion). Conclusion Our study found limited evidence to support overall associations between PDMPs and reductions in opioid-related consequences. However, this should not detract from the value of PDMPs’ larger role of improving opioid prescribing.
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Affiliation(s)
- Emily Rhodes
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Maria Wilson
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Alysia Robinson
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Jill A Hayden
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Mark Asbridge
- Department of Community Health & Epidemiology, Dalhousie University, Halifax, NS, Canada. .,Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada.
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Moorman D, Mallick R, Rhodes E, Bieber B, Nesrallah G, Davis J, Suri R, Perl J, Tanuseputro P, Pisoni R, Robinson B, Sood MM. Facility Variation and Predictors of Do Not Resuscitate Orders of Hemodialysis Patients in Canada: DOPPS. Can J Kidney Health Dis 2019; 6:2054358119879777. [PMID: 31632682 PMCID: PMC6778991 DOI: 10.1177/2054358119879777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 07/22/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Life expectancy in patients with end-stage kidney disease treated with hemodialysis (HD) is limited, and as such, the presence of an advanced care directive (ACD) may improve the quality of death as experienced for patients and families. Strategies to discuss and implement ACDs are limited with little being known about the status of Do Not Resuscitate (DNR) orders in the Canadian HD population. OBJECTIVES Using data from the Dialysis Outcomes and Practice Patterns Study (DOPPS), we set out to (1) examine the variability in DNR orders across Canada and its largest province, Ontario and (2) identify clinical and functional status measures associated with a DNR order. DESIGN We conducted a retrospective cohort study using data from the DOPPS Canada Phase 4 to 6 from 2009 to 2017. SETTING DOPPS facilities in Canada. PATIENTS All adults (>18 years) who initiated chronic HD with a documented ACD were included. MEASUREMENTS ACD and DNR orders. METHODS Descriptive statistics were compared for baseline characteristics (demographics, comorbidities, medications, facility characteristics, and patient functional status) and DNR status. The crude proportion of patients per facility with a DNR order was calculated across Canada and Ontario. Functional status was determined by activities of daily living and components of the Kidney Disease Quality of Life (KDQOL)-validated questionnaire. We used generalized estimating equations (GEEs) to create sequential multivariable models (demographics, comorbidities, and functional status) of variables associated with DNR status. RESULTS A total of 1556 (96% of total) patients treated with HD had a documented ACD and were included. A total of 10% of patients had a DNR order. The crude variation of DNR status differed considerably across facilities within Canada, between Ontario and non-Ontario, and within Ontario (interprovince variation = 6.3%-17.1%, Ontario vs non-Ontario = 8.2% vs 11.7%, intraprovincial variation [Ontario] = 1%-26%). Patients with a DNR order were more commonly older, white, with cardiac comorbidities, with less or shorter predialysis care compared with those without a DNR order. Patients with a DNR order reported lower energy, more difficulty with transfers, meal preparation, household tasks, and financial management. In a multivariate model, age, cardiac disease, stroke, dialysis duration, and intradialytic weight gain were associated with DNR status. LIMITATIONS Relatively small number of events or measures in certain categories. CONCLUSIONS A large inter- and intraprovincial (Ontario) variation was observed regarding DNR orders across Canada highlighting areas for potential quality improvement. While functional status did not appear to have a bearing on the presence of a DNR order, the presence of various comorbidities was associated with the presence of a DNR order.
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Affiliation(s)
| | | | | | - Brian Bieber
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | | | | | | | | | | | - Ronald Pisoni
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | - Bruce Robinson
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
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Hiremath S, Ruzicka M, Petrcich W, McCallum MK, Hundemer GL, Tanuseputro P, Manuel D, Burns K, Edwards C, Bugeja A, Magner P, McCormick B, Garg AX, Rhodes E, Sood MM. Alpha-Blocker Use and the Risk of Hypotension and Hypotension-Related Clinical Events in Women of Advanced Age. Hypertension 2019; 74:645-651. [DOI: 10.1161/hypertensionaha.119.13289] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Alpha-blockers (ABs) are commonly prescribed as part of a multidrug regimen in the management of hypertension. We set out to assess the risk of hypotension and related adverse events with AB use compared with other blood pressure (BP) lowering drugs using a population-based, retrospective cohort study of women (≥66 years) between 1995 and 2015 in Ontario, Canada. Cox proportional hazards examined the association of AB use and hypotension and related events (syncope, fall, and fracture) compared with other BP lowering drugs matched via a high dimensional propensity score. The primary outcome was a composite of hospitalizations for hypotension and related events (syncope, fractures, and falls) within 1 year. From 734 907 eligible women, 14 106 were dispensed an AB (mean age, 75.7; standard deviation 6.9 years, median follow-up 1 year) and matched to 14 106 dispensed other BP lowering agents. The crude incidence rate of hypotension and related events was 95.7 (95% CI [confidence interval], 90.4–101.1, events 1214 [8.6%]) with AB and 79.8 (95% CI, 74.9–84.7 per 1000 person-years, events 1025 [7.3%]) with other BP lowering medications (incident rate ratio, 1.20; 95% CI, 1.10–1.30). The risk was higher for hypotension (hazard ratio, 1.71; 95% CI, 1.33–2.20) and syncope (hazard ratio, 1.44; 95% CI, 1.18–1.75) with no difference in falls, fractures, adverse cardiac events, or all-cause mortality. Treatment of hypertension in women with ABs is associated with a higher risk of hypotension and hypotension-related events compared with other BP lowering agents. Our findings suggest that ABs should be used with caution, even as add on therapy for hypertension.
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Affiliation(s)
- Swapnil Hiremath
- From the Division of Nephrology, The Ottawa Hospital (S.H., M.R., G.L.H., K.B., C.E., A.B., P.M., B.M., E.R., M.M.S.), University of Ottawa, Canada
| | - Marcel Ruzicka
- From the Division of Nephrology, The Ottawa Hospital (S.H., M.R., G.L.H., K.B., C.E., A.B., P.M., B.M., E.R., M.M.S.), University of Ottawa, Canada
| | - William Petrcich
- The Institute of Clinical Evaluative Sciences, ON, Canada (W.P., M.K.M., P.T., D.M., A.X.G., M.M.S.)
| | - Megan K. McCallum
- The Institute of Clinical Evaluative Sciences, ON, Canada (W.P., M.K.M., P.T., D.M., A.X.G., M.M.S.)
| | - Gregory L. Hundemer
- From the Division of Nephrology, The Ottawa Hospital (S.H., M.R., G.L.H., K.B., C.E., A.B., P.M., B.M., E.R., M.M.S.), University of Ottawa, Canada
| | - Peter Tanuseputro
- The Institute of Clinical Evaluative Sciences, ON, Canada (W.P., M.K.M., P.T., D.M., A.X.G., M.M.S.)
| | - Douglas Manuel
- Kidney Research Centre, Ottawa Hospital Research Institute (D.M., K.B.), University of Ottawa, Canada
- The Institute of Clinical Evaluative Sciences, ON, Canada (W.P., M.K.M., P.T., D.M., A.X.G., M.M.S.)
| | - Kevin Burns
- From the Division of Nephrology, The Ottawa Hospital (S.H., M.R., G.L.H., K.B., C.E., A.B., P.M., B.M., E.R., M.M.S.), University of Ottawa, Canada
- Kidney Research Centre, Ottawa Hospital Research Institute (D.M., K.B.), University of Ottawa, Canada
| | - Cedric Edwards
- From the Division of Nephrology, The Ottawa Hospital (S.H., M.R., G.L.H., K.B., C.E., A.B., P.M., B.M., E.R., M.M.S.), University of Ottawa, Canada
| | - Ann Bugeja
- From the Division of Nephrology, The Ottawa Hospital (S.H., M.R., G.L.H., K.B., C.E., A.B., P.M., B.M., E.R., M.M.S.), University of Ottawa, Canada
| | - Peter Magner
- From the Division of Nephrology, The Ottawa Hospital (S.H., M.R., G.L.H., K.B., C.E., A.B., P.M., B.M., E.R., M.M.S.), University of Ottawa, Canada
- Bruyere Research Institute, the Ottawa Hospital, Canada (P.T.)
| | - Brendan McCormick
- From the Division of Nephrology, The Ottawa Hospital (S.H., M.R., G.L.H., K.B., C.E., A.B., P.M., B.M., E.R., M.M.S.), University of Ottawa, Canada
| | - Amit X. Garg
- The Institute of Clinical Evaluative Sciences, ON, Canada (W.P., M.K.M., P.T., D.M., A.X.G., M.M.S.)
- Division of Nephrology, Western University, London, Canada (A.X.G.)
| | - Emily Rhodes
- From the Division of Nephrology, The Ottawa Hospital (S.H., M.R., G.L.H., K.B., C.E., A.B., P.M., B.M., E.R., M.M.S.), University of Ottawa, Canada
| | - Manish M. Sood
- From the Division of Nephrology, The Ottawa Hospital (S.H., M.R., G.L.H., K.B., C.E., A.B., P.M., B.M., E.R., M.M.S.), University of Ottawa, Canada
- The Institute of Clinical Evaluative Sciences, ON, Canada (W.P., M.K.M., P.T., D.M., A.X.G., M.M.S.)
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Batista R, Prud'homme D, Hsu AT, Guérin E, Bouchard L, Rhodes E, Talarico R, Desaulniers J, Manuel D, Tanuseputro P. The Health Impact of Living in a Nursing Home With a Predominantly Different Spoken Language. J Am Med Dir Assoc 2019; 20:1649-1651. [PMID: 31351860 DOI: 10.1016/j.jamda.2019.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 06/02/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Ricardo Batista
- Institut du Savoir Montfort, Ottawa, Ontario, Canada; ICES, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Denis Prud'homme
- Institut du Savoir Montfort, Ottawa, Ontario, Canada; Hôpital Montfort, Ottawa, Ontario, Canada; School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Amy T Hsu
- ICES, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Eva Guérin
- Institut du Savoir Montfort, Ottawa, Ontario, Canada
| | - Louise Bouchard
- Institut du Savoir Montfort, Ottawa, Ontario, Canada; School of Social and Anthropological Studies, University of Ottawa, Ottawa, Ontario, Canada
| | - Emily Rhodes
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Robert Talarico
- ICES, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Jacinthe Desaulniers
- Réseau des services de santé en français de l'Est de l'Ontario, Ottawa, Ontario, Canada
| | - Douglas Manuel
- ICES, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Peter Tanuseputro
- ICES, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
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Frigon A, Dambreville C, Thibaudier Y, Hurteau M, Kuczynski V, Rhodes E. Adaptive Plasticity in the Spinal Control of Left‐right Coordination During Locomotion. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.656.9] [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: 11/11/2022]
Affiliation(s)
- Alain Frigon
- Physiology and BiophysicsUniversite de SherbrookeSherbrookeQuebecCanada
| | | | - Yann Thibaudier
- Physiology and BiophysicsUniversite de SherbrookeSherbrookeQuebecCanada
| | | | | | - Emily Rhodes
- Physiology and BiophysicsUniversite de SherbrookeSherbrookeQuebecCanada
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Tamir M, Bigman YE, Rhodes E, Salerno J, Schreier J. An expectancy-value model of emotion regulation: Implications for motivation, emotional experience, and decision making. Emotion 2015; 15:90-103. [DOI: 10.1037/emo0000021] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Fallows R, McCoy K, Hertza J, Klosson E, Estes B, Stroescu I, Salinas C, Stringer A, Aronson S, MacAllister W, Spurgin A, Morriss M, Glasier P, Stavinoha P, Houshyarnejad A, Jacobus J, Norman M, Peery S, Mattingly M, Pennuto T, Anderson-Hanley C, Miele A, Dunnam M, Edwards M, O'Bryant S, Johnson L, Barber R, Inscore A, Kegel J, Kozlovsky A, Tarantino B, Goldberg A, Herrera-Pino J, Jubiz-Bassi N, Rashid K, Noniyeva Y, Vo K, Stephens V, Gomez R, Sanders C, Kovacs M, Walton B, Schmitter-Edgecombe M, Schmitter-Edgecombe M, Parsey C, Cook D, Woods S, Weinborn M, Velnoweth A, Rooney A, Bucks R, Adalio C, White S, Blair J, Barber B, Marcy S, Barber B, Marcy S, Boseck J, McCormick C, Davis A, Berry K, Koehn E, Tiberi N, Gelder B, Brooks B, Sherman E, Garcia M, Robillard R, Gunner J, Miele A, Lynch J, McCaffrey R, Hamilton J, Froming K, Nemeth D, Steger A, Lebby P, Harrison J, Mounoutoua A, Preiss J, Brimager A, Gates E, Chang J, Cisneros H, Long J, Petrauskas V, Casey J, Picard E, Long J, Petrauskas V, Casey J, Picard E, Miele A, Gunner J, Lynch J, McCaffrey R, Rodriguez M, Fonseca F, Golden C, Davis J, Wall J, DeRight J, Jorgensen R, Lewandowski L, Ortigue S, Etherton J, Axelrod B, Green C, Snead H, Semrud-Clikeman M, Kirk J, Connery A, Kirkwood M, Hanson ML, Fazio R, Denney R, Myers W, McGuire A, Tree H, Waldron-Perrine B, Goldenring Fine J, Spencer R, Pangilinan P, Bieliauskas L, Na S, Waldron-Perrine B, Tree H, Spencer R, Pangilinan P, Bieliauskas L, Peck C, Bledsoe J, Schroeder R, Boatwright B, Heinrichs R, Baade L, Rohling M, Hill B, Ploetz D, Womble M, Shenesey J, Schroeder R, Semrud-Clikeman M, Baade L, VonDran E, Webster B, Brockman C, Burgess A, Heinrichs R, Schroeder R, Baade L, VonDran E, Webster B, Goldenring Fine J, Brockman C, Heinrichs R, Schroeder R, Baade L, VonDran E, Webster B, Brockman C, Heinrichs R, Schroeder R, Baade L, Bledsoe J, VonDran E, Webster B, Brockman C, Heinrichs R, Schroeder R, Baade L, VonDran E, Webster B, Brockman C, Heinrichs R, Thaler N, Strauss G, White T, Gold J, Tree H, Waldron-Perrine B, Spencer R, McGuire A, Na S, Pangilinan P, Bieliauskas L, Allen D, Vincent A, Roebuck-Spencer T, Cooper D, Bowles A, Gilliland K, Watts A, Ahmed F, Miller L, Yon A, Gordon B, Bello D, Bennett T, Yon A, Gordon B, Bennett T, Wood N, Etcoff L, Thede L, Oraker J, Gibson F, Stanford L, Gray S, Vroman L, Semrud-Clikeman M, Taylor T, Seydel K, Bure-Reyes A, Stewart J, Tourgeman I, Demsky Y, Golden C, Burns W, Gray S, Burns K, Calderon C, Tourgeman I, Golden C, Neblina C, San Miguel Montes L, Allen D, Strutt A, Scott B, Strutt A, Scott B, Armstrong P, Booth C, Blackstone K, Moore D, Gouaux B, Ellis R, Atkinson J, Grant I, Brennan L, Schultheis M, Hurtig H, Weintraub D, Duda J, Moberg P, Chute D, Siderowf A, Brescian N, Gass C, Brewster R, King T, Morris R, Krawiecki N, Dinishak D, Richardson G, Estes B, Knight M, Hertza J, Fallows R, McCoy K, Garcia S, Strain G, Devlin M, Cohen R, Paul R, Crosby R, Mitchell J, Gunstad J, Hancock L, Bruce J, Roberg B, Lynch S, Hertza J, Klosson E, Varnadore E, Schiff W, Estes B, Hertza J, Varnadore E, Estes B, Kaufman R, Rinehardt E, Schoenberg M, Mattingly M, Rosado Y, Velamuri S, LeBlanc M, Pimental P, Lynch-Chee S, Broshek D, Lyons P, McKeever J, Morse C, Ang J, Leist T, Tracy J, Schultheis M, Morgan E, Woods S, Rooney A, Perry W, Grant I, Letendre S, Morse C, McKeever J, Schultheis M, Musso M, Jones G, Hill B, Proto D, Barker A, Gouvier W, Nersesova K, Drexler M, Cherkasova E, Sakamoto M, Marcotte T, Hilsabeck R, Perry W, Carlson M, Barakat F, Hassanein T, Shevchik K, McCaw W, Schrock B, Smith M, Moser D, Mills J, Epping E, Paulsen J, Somogie M, Bruce J, Bryan F, Buscher L, Tyrer J, Stabler A, Thelen J, Lovelace C, Spurgin A, Graves D, Greenberg B, Harder L, Szczebak M, Glisky M, Thelen J, Lynch S, Hancock L, Bruce J, Ukueberuwa D, Arnett P, Vahter L, Ennok M, Pall K, Gross-Paju K, Vargas G, Medaglia J, Chiaravalloti N, Zakrzewski C, Hillary F, Andrews A, Golden C, Belloni K, Nicewander J, Miller D, Johnson S, David Z, Weideman E, Lawson D, Currier E, Morton J, Robinson J, Musso M, Hill B, Barker A, Pella R, Jones G, Proto D, Gouvier W, Vertinski M, Allen D, Thaler N, Heisler D, Park B, Barney S, Kucukboyaci N, Girard H, Kemmotsu N, Cheng C, Kuperman J, McDonald C, Carroll C, Odland A, Miller L, Mittenberg W, Coalson D, Wahlstrom D, Raiford S, Holdnack J, Ennok M, Vahter L, Gardner E, Dasher N, Fowler B, Vik P, Grajewski M, Lamar M, Penney D, Davis R, Korthauer L, Libon D, Kumar A, Holdnack J, Iverson G, Chelune G, Hunter C, Zimmerman E, Klein R, Prathiba N, Hopewell A, Cooper D, Kennedy J, Long M, Moses J, Lutz J, Tiberi N, Dean R, Miller J, Axelrod B, Van Dyke S, Rapport L, Schutte C, Hanks R, Pella R, Fallows R, McCoy K, O'Rourke J, Hilsabeck R, Petrauskas V, Bowden S, Romero R, Hulkonen R, Boivin M, Bangirana P, John C, Shapiro E, Slonaker A, Pass L, Smigielski J, Biernacka J, Geske J, Hall-Flavin D, Loukianova L, Schneekloth T, Abulseoud O, Mrazek D, Karpyak V, Terranova J, Safko E, Heisler D, Thaler N, Allen D, Van Dyke S, Axelrod B, Zink D, Puente A, Ames H, LePage J, Carroll C, Knee K, Mittenberg W, Cummings T, Webbe F, Shepherd E, Marcinak J, Diaz-Santos M, Seichepine D, Sullivan K, Neargarder S, Cronin-Golomb A, Franchow E, Suchy Y, Kraybill M, Holland A, Newton S, Hinson D, Smith A, Coe M, Carmona J, Harrison D, Hyer L, Atkinson M, Dalibwala J, Yeager C, Hyer L, Scott C, Atkinson M, Yeager C, Jacobson K, Olson K, Pella R, Fallows R, McCoy K, O'Rourke J, Hilsabeck R, Rosado Y, Kaufman R, Velamuri S, Rinehardt E, Mattingly M, Sartori A, Clay O, Ovalle F, Rothman R, Crowe M, Schmid A, Horne L, Horn G, Johnson-Markve B, Gorman P, Stewart J, Bure-Reyes A, Golden C, Tam J, McAlister C, Schmitter-Edgecombe M, Wagner M, Brenner L, Walker A, Armstrong L, Inman E, Grimmett J, Gray S, Cornelius A, Hertza J, Klosson E, Varnadore E, Schiff W, Estes B, Johnson L, Willingham M, Restrepo L, Bolanos J, Patel F, Golden C, Rice J, Dougherty M, Golden C, Sharma V, Martin P, Golden C, Bradley E, Dinishak D, Lockwood C, Poole J, Brickell T, Lange R, French L, Chao L, Klein S, Dunnam M, Miele A, Warner G, Donnelly K, Donnelly J, Kittleson J, Bradshaw C, Alt M, England D, Denney R, Meyers J, Evans J, Lynch-Chee S, Kennedy C, Moore J, Fedor A, Spitznagel M, Gunstad J, Ferland M, Guerrero NK, Davidson P, Collins B, Marshall S, Herrera-Pino J, Samper G, Ibarra S, Parrott D, Steffen F, Backhaus S, Karver C, Wade S, Taylor H, Brown T, Kirkwood M, Stancin T, Krishnan K, Culver C, Arenivas A, Bosworth C, Shokri-Kojori E, Diaz-Arrastia R, Marquez de la PC, Lange R, Ivins B, Marshall K, Schwab K, Parkinson G, Iverson G, Bhagwat A, French L, Lichtenstein J, Adams-Deutsch Z, Fleischer J, Goldberg K, Lichtenstein J, Adams-Deutsch Z, Fleischer J, Goldberg K, Lichtenstein J, Fleischer J, Goldberg K, Lockwood C, Ehrler M, Hull A, Bradley E, Sullivan C, Poole J, Lockwood C, Sullivan C, Hull A, Bradley E, Ehrler M, Poole J, Marcinak J, Schuster D, Al-Khalil K, Webbe F, Myers A, Ireland S, Simco E, Carroll C, Mittenberg W, Palmer E, Poole J, Bradley E, Dinishak D, Piecora K, Marcinak J, Al-Khalil K, Mroczek N, Schuster D, Snyder A, Rabinowitz A, Arnett P, Schatz P, Cameron N, Stolberg P, Hart J, Jones W, Mayfield J, Allen D, Sullivan K, Edmed S, Vanderploeg R, Silva M, Vaughan C, McGuire E, Gerst E, Fricke S, VanMeter J, Newman J, Gioia G, Vaughan C, VanMeter J, McGuire E, Gioia G, Newman J, Gerst E, Fricke S, Wahlberg A, Zelonis S, Chatterjee A, Smith S, Whipple E, Mace L, Manning K, Ang J, Schultheis M, Wilk J, Herrell R, Hoge C, Zakzanis K, Yu S, Jeffay E, Zimmer A, Webbe F, Piecora K, Schuster D, Zimmer A, Piecora K, Schuster D, Webbe F, Adler M, Holster J, Golden C, Andrews A, Schleicher-Dilks S, Golden C, Arffa S, Thornton J, Arffa S, Thornton J, Arffa S, Thornton J, Arffa S, Thornton J, Canas A, Sevadjian C, Fournier A, Miller D, Maricle D, Donders J, Larsen T, Gidley Larson J, Sheehan J, Suchy Y, Higgins K, Rolin S, Dunham K, Akeson S, Horton A, Reynolds C, Horton A, Reynolds C, Jordan L, Gonzalez S, Heaton S, McAlister C, Tam J, Schmitter-Edgecombe M, Olivier T, West S, Golden C, Prinzi L, Martin P, Robbins J, Bruzinski B, Golden C, Riccio C, Blakely A, Yoon M, Reynolds C, Robbins J, Prinzi L, Martin P, Golden C, Schleicher-Dilks S, Andrews A, Adler M, Pearlson J, Golden C, Sevadjian C, Canas A, Fournier A, Miller D, Maricle D, Sheehan J, Gidley LJ, Suchy Y, Sherman E, Carlson H, Gaxiola-Valdez I, Wei X, Beaulieu C, Hader W, Brooks B, Kirton A, Barlow K, Hrabok M, Mohamed I, Wiebe S, Smith K, Ailion A, Ivanisevic M, King T, Smith K, King T, Thorgusen S, Bowman D, Suchy Y, Walsh K, Mitchell F, Jill G, Iris P, Ross K, Madan-Swain A, Gioia G, Isquith P, Webber D, DeFilippis N, Collins M, Hill F, Weber R, Johnson A, Wiley C, Zimmerman E, Burns T, DeFilippis N, Ritchie D, Odland A, Stevens A, Mittenberg W, Hartlage L, Williams B, Weidemann E, Demakis G, Avila J, Razani J, Burkhart S, Adams W, Edwards M, O'Bryant S, Hall J, Johnson L, Grammas P, Gong G, Hargrave K, Mattevada S, Barber R, Hall J, Vo H, Johnson L, Barber R, O'Bryant S, Hill B, Davis J, O'Connor K, Musso M, Rehm-Hamilton T, Ploetz D, Rohling M, Rodriguez M, Potter E, Loewenstein D, Duara R, Golden C, Velamuri S, Rinehardt E, Schoenberg M, Mattingly M, Kaufman R, Rosado Y, Boseck J, Tiberi N, McCormick C, Davis A, Hernandez Finch M, Gelder B, Cannon M, McGregor S, Reitman D, Rey J, Scarisbrick D, Holdnack J, Iverson G, Thaler N, Bello D, Whoolery H, Etcoff L, Vekaria P, Whittington L, Nemeth D, Gremillion A, Olivier T, Amirthavasagam S, Jeffay E, Zakzanis K, Barney S, Umuhoza D, Strauss G, Knatz-Bello D, Allen D, Bolanos J, Bell J, Restrepo L, Frisch D, Golden C, Hartlage L, Williams B, Iverson G, McIntosh D, Kjernisted K, Young A, Kiely T, Tai C, Gomez R, Schatzberg A, Keller J, Rhodes E, Ajilore O, Zhang A, Kumar A, Lamar M, Ringdahl E, Sutton G, Turner A, Snyder J, Allen D, Verbiest R, Thaler N, Strauss G, Allen D, Walkenhorst E, Crowe S, August-Fedio A, Sexton J, Cummings S, Brown K, Fedio P, Grigorovich A, Fish J, Gomez M, Leach L, Lloyd H, Nichols M, Goldberg M, Novakovic-Agopian T, Chen A, Abrams G, Rossi A, Binder D, Muir J, Carlin G, Murphy M, McKim R, Fitsimmons R, D'Esposito M, Shevchik K, McCaw W, Schrock B, Vernon A, Frank R, Ona PZ, Freitag E, Weber E, Woods S, Kellogg E, Grant I, Basso M, Dyer B, Daniel M, Michael P, Fontanetta R, Martin P, Golden C, Gass C, Stripling A, Odland A, Holster J, Corsun-Ascher C, Olivier T, Golden C, Legaretta M, Vik P, Van Ness E, Fowler B, Noll K, Denney D, Wiechman A, Stephanie T, Greenberg B, Lacritz L, Padua M, Sandhu K, Moses J, Sordahl J, Anderson J, Wheaton V, Anderson J, Berggren K, Cheung D, Luber H, Loftis J, Huckans M, Bennett T, Dawson C, Soper H, Bennett T, Soper H, Carter K, Hester A, Ringe W, Spence J, Posamentier M, Hart J, Haley R, Fallows R, Pella R, McCoy K, O'Rourke J, Hilsabeck R, Fallows R, Pella R, McCoy K, O'Rourke J, Hilsabeck R, Gass C, Curiel R, Gass C, Stripling A, Odland A, Goldberg M, Lloyd H, Gremillion A, Nemeth D, Whittington L, Hu E, Vik P, Dasher N, Fowler B, Jeffay E, Zakzanis K, Jordan S, DeFilippis N, Collins M, Goetsch V, Small S, Mansoor Y, Homer-Smith E, Lockwood C, Moses J, Martin P, Odland A, Fontanetta R, Sharma V, Golden C, Odland A, Martin P, Perle J, Gass C, Simco E, Mittenberg W, Patt V, Minassian A, Perry W, Polott S, Webbe F, Mulligan K, Shaneyfelt K, Wall J, Thompson J, Tai C, Kiely T, Compono V, Trettin L, Gomez R, Schatzberg A, Keller J, Tsou J, Pearlson J, Sharma V, Tourgeman I, Golden C, Waldron-Perrine B, Tree H, Spencer R, McGuire A, Na S, Pangilinan P, Bieliauskas L, You S, Moses J, An K, Jeffay E, Zakzanis K, Biddle C, Fazio R, Willett K, Rolin S, O'Grady M, Denney R, Bresnan K, Erlanger D, Seegmiller R, Kaushik T, Brooks B, Krol A, Carlson H, Sherman E, Davis J, McHugh T, Axelrod B, Hanks R. Grand Rounds. Arch Clin Neuropsychol 2011. [DOI: 10.1093/arclin/acr056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lohi A, Wynnyckyj JR, Rhodes E. Spectral measurement of the complex refractive index of fly ashes of canadian lignite and sub-bituminous coals. CAN J CHEM ENG 2009. [DOI: 10.1002/cjce.5450700419] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Murchie S, Arvidson R, Bedini P, Beisser K, Bibring JP, Bishop J, Boldt J, Cavender P, Choo T, Clancy RT, Darlington EH, Des Marais D, Espiritu R, Fort D, Green R, Guinness E, Hayes J, Hash C, Heffernan K, Hemmler J, Heyler G, Humm D, Hutcheson J, Izenberg N, Lee R, Lees J, Lohr D, Malaret E, Martin T, McGovern JA, McGuire P, Morris R, Mustard J, Pelkey S, Rhodes E, Robinson M, Roush T, Schaefer E, Seagrave G, Seelos F, Silverglate P, Slavney S, Smith M, Shyong WJ, Strohbehn K, Taylor H, Thompson P, Tossman B, Wirzburger M, Wolff M. Compact Reconnaissance Imaging Spectrometer for Mars (CRISM) on Mars Reconnaissance Orbiter (MRO). ACTA ACUST UNITED AC 2007. [DOI: 10.1029/2006je002682] [Citation(s) in RCA: 666] [Impact Index Per Article: 39.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Manning TJ, Rhodes E, Land M, Parkman R, Sumner B, Lam TT, Marshall AG, Phillips D. Impact of environmental conditions on the marine natural product bryostatin 1. Nat Prod Res 2006; 20:611-28. [PMID: 16835096 DOI: 10.1080/14786410500462645] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Marine Natural Products (MNPs), such as bryostatin 1, are exposed to a range of physical and chemical conditions through the life cycle of the host organism. These include exposure to sunlight, oxidizing and reducing agents, cation binding, and adsorption to reactive metal oxide surfaces. Using Fourier Transform-Ion Cyclotron Resonance (FT-ICR), Matrix Assisted Laser Desorption Ionization Mass Spectrometry (MALDI-MS), UV/Vis absorbance spectroscopy, and molecular modeling, we studied the impact of UV light, TiO2, I2, and reaction with FeCl3 on the structure of bryostatin 1. Our results demonstrate that natural conditions transform bryostatin to a number of structures, including one with a molar mass of 806 Da, which we have previously identified in the sediment collected from the Gulf of Mexico. To date, at least 20 different structures of bryostatin have been reported in the literature. This work suggests that these variations may be products of the chemical environment in which the bryozoa Bugula neritina resides and are not the result of genetic variations within Bugula.
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Affiliation(s)
- Thomas J Manning
- Chemistry Department, Valdosta State University, Valdosta, GA 31698, USA.
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Affiliation(s)
- E Rhodes
- The Department of Botany, University of Leeds
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Manning T, Rhodes E, Loftis R, Phillips D, Demaria D, Newman D, Rudloe J. ET743: Chemical analysis of the sea squirtEcteinascidia turbinataecosystem. Nat Prod Res 2006; 20:461-73. [PMID: 16644544 DOI: 10.1080/14786410500462462] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The sea squirt Ecteinascidia turbinata produces the powerful drug ET743. In this study Inductively Coupled Plasma-Atomic Emission Spectroscopy (ICP-AES) and Matrix Assisted Laser Desorption Ionization-Mass Spectrometry (MALDI-MS) are systematically used to measure elemental and molecular species in a Florida Keys mangrove ecosystem that contains the sea squirt. ICP-AES is used to measure the concentration of 27 elements down to the parts per billion level in 16 organisms and 3 sediment samples that reside in the mangrove ecosystem including turtle grass, blue crabs, fire sponge, and lettuce slugs. MALDI-MS is used to search for ET743 in these same organisms and sediment samples. A mass spectral feature corresponding to ET743 is identified in the extract of the sea squirt, red mangrove root (Rhizophera mangle), the schoolmaster snapper (Lutjanus griseus), and a sediment sample taken from the ecosystem. We use MALDI-MS to study the impact that various environmental conditions, such as UV light, I(2), cation binding (Fe(+3), Zn(+2), Pb(+2), Cu(+2)), metal oxide nanoparticles (FeO, CuO, TiO(2), ZnO, Al(2)O(3)), a common mineral (CaCO(3)), and extremes in acidity (0.1 M HCl, 0.1 M NaOH) have on the ET743 structure. The data provide potential structures (degradation products, metal-ligand complexes, etc.) that might be present in organism or sedimentary extracts that are similar to ET743. We are studying the marine geochemistry of this ecosystem so a broth can be developed and tested for producing this marine natural product.
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Affiliation(s)
- Thomas Manning
- Department of Chemistry, Valdosta State University, Valdosta, Georgia 31698, USA.
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Abstract
Turbulence data are presented which were measured by hot-film anemometry in the liquid phase of a two-phase co-current stratified flow of air and water in a rectangular channel. Mean velocity profiles, u', v', and u' v' intensity distributions were measured across the liquid phase, with special attention being given to the vicinity of the interface. Distributions of total shear stress, eddy viscosity and turbulent energy have been calculated.
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Affiliation(s)
- R. B. Jeffries
- Department of Chemical Engineering, University of Waterloo, Waterloo, Ontario, Canada
| | - D. S. Scott
- Department of Chemical Engineering, University of Waterloo, Waterloo, Ontario, Canada
| | - E. Rhodes
- Department of Chemical Engineering, University of Waterloo, Waterloo, Ontario, Canada
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Manning TJ, Land M, Rhodes E, Chamberlin L, Rudloe J, Phillips D, Lam TT, Purcell J, Cooper HJ, Emmett MR, Marshall AG. Identifying bryostatins and potential precursors from the bryozoan Bugula neritina. Nat Prod Res 2005; 19:467-91. [PMID: 15938194 DOI: 10.1080/14786410412331280041] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The bryozoan species Bugula neritina contains the anticancer agent bryostatin. Bryostatin has been extracted from these sessile marine invertebrates since the late 1960s from the Gulf of California, Gulf of Mexico, as well as various locations on the eastern and western rims of the Pacific Ocean. In this work we are focusing on animals harvested in the Gulf of Mexico near Alligator Point (Florida). Using Inductively Coupled Plasma-Mass Spectrometry (ICP-MS) we measure the concentration of 70 elements in B. neritina, a sea squirt, and the sediment from the point of harvesting. This data has helped us generate an extraction process for marine natural products. Combining UV/VIS absorbance measurements with Matrix Assisted Laser Desorption Ionization-Time of Flight-Mass Spectrometer (MALDI-TOF-MS), we demonstrated that the specific form of bryostatin extracted is a function of the solvent. A 9.4T Fourier Transform-Ion Cyclotron Resonance (FT-ICR) mass spectrometer, whose sensitivity, mass accuracy, and resolving power allowed the exact empirical formulas of potential precursors of bryostatin to be identified, was employed. Finally we examine extracts of 14 marine species of the Gulf of Mexico, from the sand trout (Cynoscion arenarius) to chicken liver sponge (Chrondrilla nucula), all recently collected, which had shown some medicinal activity thirty years ago in a National Cancer Institute study. By the MALDI-TOF-MS, we were able to identify mass spectral features that correspond to different variations of the basic bryostatin structure, which raises the question if the bryozoans are the original source of bryostatin.
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Affiliation(s)
- Thomas J Manning
- Department of Chemistry, Valdosta State University, Valdosta, Georgia 31698, USA.
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Volkmann E, Rhodes E, Work L. Physical Properties of Coal Tars - Influence of Tar-Insoluble and Solvent-Insoluble Constituents. ACTA ACUST UNITED AC 2002. [DOI: 10.1021/ie50318a026] [Citation(s) in RCA: 7] [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: 11/30/2022]
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Rhodes E. Origins of a tragedy: Joseph Stalin's cycle of abuse. J Psychohist 2001; 24:377-89. [PMID: 11618992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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